MULTIPLE CHOICE.

SELECT THE LETTER OF THE

CORRECT ANSWER. 3. A client with a history of epilepsy has
consecutive seizures lasting more than 5
1. A client is scheduled for an outpatient minutes and is in status epilepticus. Which
electroencephalogram (EEG). interventions should be included in this client's
A nurse instructs the client to prepare for the immediate treatment? SELECT ALL THAT APPLY.
test by: 1. Administer dexamethasone (Decadron®)
a. removing all hair pins. intravenously.
b. avoiding eating or drinking at least 6 hours 2. Administer oxygen and prepare for
prior to the test. endotracheal
c. being prepared to have some of the scalp Dorabation
shaved. 3. Prepare for immediate defibrillation
d. having blood drawn for a glucose level 2 4. Continue to protect the patient from injury.
hours before the test. 5. Administer lorazepam (Ativan®)
intravenously.
: In an EEG, electrodes are placed on the scalp 6. Transfer to a facility with expertise in treating
over multiple areas of the brain to detect and status epilepticus.
record patterns of electrical activity. a. 1, 2, 3, and 5
Preparation includes clean hair without any b. 2, 3, 5 and 6
objects in the hair to prevent inaccurate test c. 2, 4 and 5
results. The client should not be NPO (nothing d. 3. 4, and 5
per mouth) since a usual glucose level is
important for normal brain functioning. The :status epilepticus is a medical emergency. The
scalp will not be shaved; the electrodes are client is at risk for brain hypoxia and permanent
applied with paste. There is no indication to brain damage. The client needs additional
have a serum glucose drawn before the test. oxygen, and intubation will secure the airways.
Care is taken to protect the client from injury
2. A client is seen by a primary care provider during the seizure. Either Lorazepam or
because of difficulty walking. A neurological diazepam can be administered more rapidly
assessment is done. A nurse informs the client than phenytoin.
that which assessment procedure was done to
test the functioning of the cerebellum? 4. A nurse is performing hourly neurological
assessment. checks on a client who is admitted
a. Ask the client to shut the eyes and distinguish with changes in mental status. The nurse
whether the touch is with a sharp or dull object understands that frequent assessments are
(either end of a cotton-tipped applicator). used to determine if a client is developing
b. Ask the client to hold hands with palms up increased intracranial pressure (ICP). Which
perpendicular to the body with eyes closed. option correctly describes the outcome if IC is
c. Ask the client to grasp and squeeze 2 fingers untreated and progresses?
of each of the examiner's hands. a. Displacement of brain tissue
d. Ask the client to alternate placing hands up b. Increase in cerebral circulation and perfusion
and then hands down on thighs as fast as c. Increase in serum pH
possible. d. Improved brain tissue oxygenation

:an outcome of undetected and untreated ICP is

:repetitive, alternating motion tests the client’s displacement of brain tissue, also referred to as
coordination: and indicator of cerebella brain herniation. Unchecked ICP progresses to
function.
cause shifts in brain tissue, resulting in
irreversible brain damage and possibly death. :brain abscess denotes a collection of pus in the
brain that occurs from an infection. The client
5. Following an industrial accident in which a who has idiopathic epilepsy has the lowest risk
client sustained a severe craniocerebral trauma, of developing a brain abscess because epilepsy
the client develops the complication of diabetes from an unknown cause does not have the risk
insipidus (DI). A nurse suspects this factors of an active infectious process or an
complication is occurring when observing which impaired immune system.
symptom?
a. Hyperglycemia 8. A client who had a craniotomy 2 days earlier
b. Large amounts of urinary output is receiving mannitol (Osmitrol®) intravenously
c. Elevated urine specific gravity to decrease intracranial pressure. Which
d. Decrease in level of consciousness diagnostic laboratory value. should be
monitored while the client is receiving this
:DI occurs due to lack of antidiuretic hormone, a medication?
hormone secreted by the posterior pituitary a. Serum osmolarity
gland. With a head injury, there may be b. White blood cell (WBC) count
compression of the pituitary gland and loss of c. Serum cholesterol
ADH production. Improper water balance d. Erythrocyte sedimentation rate (ESR)
results and the client excretes large amounts of
pale, dilute urine, and becomes hypotensive. :mannitol, an osmotic diuretic, increases the
serum osmolarity and pus fluid from the tissues,
6. An anxious client is seen in a clinic because decreasing cerebral edema postoperatively.
the client suspects that he/she has a brain Serum osmolarity levels are assessed as a
tumor. The client questions a nurse about parameter to determine proper dosage.
treatment options if tests show the presence of
a tumor. The nurse answers the client based on 9. client with epilepsy is prescribed phenytoin
the knowledge that treatment of a brain tumor sodium (Dilantin®) 100 mg 3 times per day
depends on: SELECT ALL THAT APPLY. orally as anticonvulsant therapy. The most
1. rate of growth of the tumor. precise method for a nurse to determine if this
2. whether the tumor is malignant or benign. is the proper dose for the client is:
3. cell type from which the tumor originates. a. observation of the client for seizures.
4. location within the brain. b. observation of the client for adverse effects.
5. whether the tumor will reoccur. c. determining whether the client is able to
6 the client's age and type of insurance. participate in usual activities.
a. 1, 2, 4, and 6 d. monitoring serum phenytoin levels,
b. 2, 4, 5 and 6
c. 1, 2, 3, 4 and 5 :dosages of anticonvulsant medications are
d. 4. 5 and o individualized and monitored by measuring
medication levels in the blood of the client.
7. A nurse is caring for a group of clients on a
medical unit in a rural hospital. Which client 10. What should be part of the nurse's teaching
would the nurse be least likely to monitor for plan for a child with epilepsy being discharged
the potential complication of a brain abscess? on a regimen of diphenylhydantoin (Dilantin)?
a. Client with endocarditis a. Drinking plenty of fluids.
b. Client with idiopathic epilepsy b. Brushing teeth after each meal.
c. Gent who has had a liver transplant c. Having someone be with the child during
d. Client with meningitis waking hours.
d. Reporting signs of infection. 13. A child with a brain tumor is less responsive
to verbal commands than he was when the
: phenytoin (dilantin) can cause gingival nurse assessed the client the previous hour. The
hyperplasia. Children taking dilanting should nurse should next:
brush their teeth after every meal and at a. Raise the head of the bed
bedtime, and visit their dentist on a regular b. Notify the physician.
basis. C. Administer an analgesic.
d. Obtain an oximeter reading.
11. After teaching a group of school teachers
about seizures, the teachers role-play a scenario 14. After a child undergoes a craniotomy for an
involving a child experiencing a generalized infratentorial brain tumor, the nurse should
tonic-clonic seizure. Which of the following place the child in which of the following
actions, when performed first, indicates that positions to prevent undue strain
the nurse's teaching has been successful? on the sutures?
a. Asking the other children what happened a Prone.
before the seizure. b. Semi-Fowler's.
b. Moving the child to the nurse's office for c. Side-lying.
privacy. d. Trendelenburg.
c. Removing any nearby objects that could harm
the child. 15. A child who was intubated after a
d. Placing a padded tongue blade between the craniotomy now shows signs of decreased level
child's of consciousness. The physician orders manual
teeth. hyper- ventilation to keep the Paco2 between
25 and 29 mm Hg and the Pao2 between 80 and
12. A nurse is developing a plan of care with the 100 mm Hg. The nurse interprets this order
parents of a 6-year-old girl diagnosed with a based on the understanding that this action will
seizure disorder. To promote growth and accomplish which of the following?
development, the nurse should instruct the a. Decrease intracranial pressure.
parents that: b. Ensure a patent airway.
a. The child will need activity limitation and will c. Lower the arousal level.
be unable to perform as well as her peers. d. Produce hypoxia.
b. There is potential for a learning disability and
the child may need tutoring to reach her grade 16. The most common type of goiter, once
level. encountered chiefly in geographic regions
c. The child will likely have normal intelligence where the natural supply of lodine is deficient
and be able to attend regular school. a. Nodular goiter
d. There will be problems associated with social b. Endemic goiter
stigma and parents should consider home c. Hyperthyroidism
schooling. d. Cushing's Syndrome

:most children who develop seizures after 17. This hormone is responsible for your
infancy are intellectually normal. A child with a metabolism, mood, and body temperature
seizure disorder needs the same experiences a. Thyroxine
and opportunities to develop intellectual, b. Triiodothyronine
emotional, and social abilities as any other c. Synthroid
child. d. Adrenocorticotropic Hormone (ACTH)

18. Normal Serum T3 levels

a. 4.5 to 11.5 ug/dL -glucocorticoids must be administered to
b. 3.6 to 10.7 ug/dL reverse hypotension.
c. 70 to 220 ng/dL
d. 80 to 100 mmHg 22. A client with Addison's disease is admitted
to the medical unit. The nurse diagnoses the
19. Is positive when carpopedal spasm is client with Deficient fluid volume related to
induced by occluding the blood flow to the arm inadequate fluid intake and to fluid loss
for 3 minutes with a blood pressure cuff secondary to inadequate adrenal hormone
a. Homan's sign secretion.
b. Trousseau's sign As the client's oral intake increases, which of
c. Chvostek's sign the following fluids would be most appropriate?
d. Cullen's sign a. Milk and diet soda.
b. Water and eggnog.
20. The nurse is instructing a young adult with c. Bouillon and juice.
Addison's disease how to adjust the dose of d. Coffee and milkshakes.
glucocorticoids. The nurse should explain that
the client may need an increased dosage of :electrolyte imbalances associated with
glucocorticoids in which of the following addison’s disease include hypoglycemia,
situations? hyponatremia, and hyperkalemia. Salted
a. Completing the spring semester of school. bouillon and fruit juices provide glucose and
b. Gaining 4 pounds. sodium to replenish these deficits. Diet soda
c. Becoming engaged. does not contain sugar. Water could cause
d. Undergoing a root canal. further sodium dilution. Coffee’s diuretic effect
would aggravate the fluid deficit. Milk contains
:adrenal crisis can occur with physical stress potassium and sodium/
such as surgery, dental work, infection, flu,
trauma, and pregnancy. In these situations, 23. When teaching a client newly diagnosed
glucocorticoid and mineralocorticoid dosages with primary Addison's disease, the nurse
are increased. Weight loss, not gain, occurs with should explain that the disease results from:
adrenal insufficiency. Psychological stress has a. Insufficient secretion of growth hormone
less effect on corticosteroid need than physical (GH).
stress. b. Dysfunction of the hypothalamic pituitary.
c. Idiopathic atrophy of the adrenal gland
21. Which of the following is the priority for a d. Over secretion of the adrenal medulla.
client in Addisonian crisis?
a. Controlling hypertension. 24. The nurse should assess a client with
b. Preventing irreversible shock. Addison's disease for which of the following?
c. Preventing infection. a. Weight gain.
d. Relieving anxiety. b. Hunger.
c. Lethargy.
:addison’s disease is caused by a deficiency of d. Muscle spasms.
adrenal corticoisteroids and can result in severe
hypotension and shock because of uncontrolled : although many of the disease signs and
loss of sodium in the urine and impaired symptoms are vague and nonspecific, most
mineralocorticoid function. This results in loss clients experience lethargy and depression as
of extracellular fluid and dangerously low blood early symptoms. Other early signs and
volume. symptoms include mood changes, emotional
lability, irritability, weight loss, muscle
weakness, fatigue, nausea, and vomiting. Most b. Serum calcium
clients experience a loss of appetite. Muscles c. Urine glucose
become weak, not spastic , because of adrenal d. Urine white blood cells.
insufficiency.
:the client will have an elevated sodium level as
25. A nurse is assessing a client with Addison's a result of low circulating blood volume. The
disease. The nurse should review laboratory fluid is being lost through the urine.
reports for which condition?
a. Hypokalemia. 44. The nurse is discharging a client diagnosed
b. Hypernatremia. with diabetes insipidus. Which statement made
c. Hypoglycemia. by the client warrants further intervention?
d. Decreased blood urea nitrogen (BUN) level
a. *I will keep a list of my medications in my
wallet and wear a Medi bracelet."
b. "I should take my medication in the morning
and leave it refrigerated at home."
42. The client diagnosed with a pituitary tumor c. "I should weigh myself every morning and
has developed syndrome of inappropriate record any weight gain."
antidiuretic hormone (SIADH). Which d. "If I develop a tightness in my chest, I will call
interventions would the nurse my health-
implement? care provider.
a. Assess for dehydration and monitor blood
glucose levels. :medication for DI usually taken q8-12hrs
b. Assess for nausea and vomiting and weigh depending on the client. The client should keep
daily. the medication close at hand.
c. Monitor potassium levels and encourage fluid
intake. 45. The client is admitted to the medical unit
d. Administer vasopressin IV and conduct a fluid with a diagnosis of rule out diabetes
deprivation test. insipidus(DI). Which instructions should the
nurse teach regarding a fluid deprivation test?
:early signs and symptoms are nausea and
vomiting. The client has the syndrome of a. The client will be asked to drink 100 ml of
inappropriate secretion o antidiuretic hormone. fluid as rapidly as possible and then will not be
1. excess fluid is not dehydrated, and allowed fluid for 24
blood glucose levels are not affected. nours.
3 client experiences dilutional b. The client will be given an injection of
hyponateremia, and the body has antidiuretic hormone, and urine output will be
to much fluid already. measured for four (4) to six (6) hours.
4 Vasopressin is the name of the c. The client will be NPO, and vital signs and
antidiuretic hormone. Giving more weights will be done hourly until the end of the
increases the client’s problem. Also, test.
a water challenge test is performed d. An IV will be started with normal saline, and
not fluid deprivation test. the client will be asked to try and hold the urine
in the bladder until a sonogram can be done.
43. The client is diagnosed with diabetes
insipidus. Which laboratory value should be
monitored by the nurse? :
a. Serum sodium.
46. The nurse is planning the care of a client 50. The nurse is caring for clients on a medical
diagnosed with syndrome of inappropriate floor. Which client should be assessed first?
antidiuretic hormone
(SIADH). Which interventions should be a. The client diagnosed with syndrome of
implemented? inappropriate antidiuretic hormone (SIADH)
Select all that apply. who has a weight gain of 1.5 pounds since
1. Restrict fluids per health-care provider order. yesterday.
2. Assess level of consciousness every two (2) b. The client was diagnosed with a pituitary
hours. tumor who has developed diabetes insipidus
3. Provide an atmosphere of stimulation. (DI) and has an intake of 1,500 ml and an output
4. Monitor urine and serum osmolality. of 1,600 ml in the last 8 hours.
5. Weigh the client every three (3) days. c. The client diagnosed with syndrome of
a, 2, 3, 4 b. 1, 2, 4. inappropriate antidiuretic hormone (SIADH)
c. 1, 2,5 who is having muscle twitching.
d. 2, 4, 5 d. The client diagnosed with diabetes insipidus
(DI) who is complaining of feeling tired after
47. The nurse is caring for a patient with having to get up at night.
diabetes insipidus
(DI) who is receiving vasopressin (Pitressin).
What therapeutic effect does the nurse expect
from this drug?
a. Increase in thirst
b. Improved skin turgor
c. Decrease in urine output
d. Normal serum albumin level

48. A patient has developed DI after a head

injury. Which medication should the nurse
anticipate to be prescribed for the management
of DI?

a. Corticotrophin (Acthar) /
b. Octreotide (Sandostatin)
c. Somatropin (Genotropin)
d. Desmopressin (DDAVP)

49.A nurse is assessing a client who has had

cranial surgery and is at risk for development of
diabetes insipidus. The nurse would assess for
which signs or symptoms that could indicate
development of this complication?

a. Diarrhea
b. Infection
c. Polydipsia
d. Weight gain