SUPPLEMENTAL REVIEW

1. The nurse has instructed the family of a client with Cerebrovascular Accident who has
homonymous hemianopsia about measures to help the client overcome the deficit. The nurse
determines that the family understands the measures to us if they stated to:

a. Place objects in the client’s impaired field of vision

b. Approach the client from the impaired field of vision
c. Remind the client to turn head to scan the lost visual field
d. Discourage the client from wearing eyeglasses

RATIONALE
 Neurologic deficit: CVA / STROKE (HOMONYMOUS HEMIANOPSIA = NOT ALARMING)
 ANISOCORIA: PYRAMIDAL TRACT (INVOLVES BRAIN AND SPINAL COLUMN = ALARMING)

2. A nurse instructs the mother of a three year old child who has PKU about acceptable foods to
include in the child’s diet. Which of the following foods, if selected by the mother indicates a
correct understanding of the teaching?

a. Chocolate milkshake
b. Scrambled eggs
c. Peanut butter sandwich
d. Animal shaped crackers

RATIONALE
 CAN DAMAGE THE CNS (PHENYLKETONURIA IS ALSO A GENETIC DISORDER)
 “I would subject my child for genetic counseling.”
 TEST: GUTHRIE CAPILLARY TEST ( > 8MG/DL = indicates positive for PKU)

3. Which of the following questions would be the most important for a nurse to ask when taking a
history from a patient who is suspected of having Multiple Sclerosis?

a. Are you easily distracted?

b. Is your vision blurred?
c. Has your appetite decreased?
d. Do you have ringing in your ears?

RATIONALE
 MULTIPLE SCLEROSIS: Demyelination can affect how the brain can process
 DEMYELINATION of the myelin sheath  sensory, integration and motor.
- Sensory has to be string enough to integrate and create a motor response.
- myelin sheath breaks down = low nerve impulse
 TRIAD SYMPTOMS (vision, speech, motor) : Nystagmus, Motor incoordination, Scanning
speech
 SPASTICITY = Dantrium or Baclofen
 PARESTHESIA = Carbamazepine or Tegetrol
 URINARY RETENTION = Bethanecol
 CEREBELLAR ATAXIA: sudden, uncoordinated muscle movement due to disease or injury to
the cerebellum (DRUG OF CHOICE: Propanolol)
 Ataxia (Cerebral ataxia): Motor incoordination problem
 Multiple Sclerosis Cause: VIRAL = virus attacks the CNS = motor coordination problem

4. Which of the following findings would a nurse expect to observe when assessing a patient who
has Myasthenia Gravis?

a. Tongue deviation
b. Intentional tremors (Parkinson’s disease)
 c. Plantar flexion
d. Drooping eyelids

RATIONALE
 TEST: TENSILON = confirms myasthenic crisis or myasthenia gravis (If nay improvement after
injection) (If it worsens, CHOLINERGIC effect: administer ANTICHOLINERGIC .. atropine sulfate)
 DRUG OF CHOICE: Mestinon or Neostigmine

5. When the nurse is assessing a 50 year old patient who has Cirrhosis of the liver, which of the
following findings would indicate that the patient’s condition is worsening?

a. Positive Babinski’s sign (Stroke) (flexion: good prognosis) (fanning of toes: not intact)
b. Visual fields loss
c. Flapping hand tremors (Asterixis)
d. Bibasilar lung crackles

RATIONALE:
 Fanning of the toes = there is an impairment or the neurologic system is not attached.
 ASTERIXIS: Flapping Hand tremors
 Complication of Liver Cirrhosis: Hypertension, Esophageal varices, Hepatic encephalopathy
 Post OR surgery involving the neck = bleed in the esophagus  frequent swallowing / use
penlight to lighten the oral cavity
o Sengstaken-Blakemore Tube: control the bleeding of the esophageal varices
o Hepatic Encepalopathy: Ammonia is delivered to the brain

 Ammonia
o LACTULOSE (laxative): a drug that binds the ammonia to promote excretion of ammonia
- CEREBROVASCULAR = pampahilis sa plema
- STROKE PATIENT / CVA - increase cranial pressure  can lead to brain
stem compression
o NEOMYCIN SULFATE

6. To which of the following interventions would a nurse give priority in the care of patient
admitted to the hospital with a suspected diagnosis of Guillain Barre Syndrome

a. Evaluate the level of consciousness every 15 minutes

b. Perform passive range of motion exercises every four hours
c. Assess breath sounds every two hours
d. Provide skin care every shift

RATIONALE
 Myasthenia Gravis: descending paralysis
 Present neurologic deficits because it is a degenerative disorder
 Guillan-Barre Syndrome: ascending paralysis; degenerative disorder (ABC)
 EQUIPMENT PREPARED AT BEDSIDE: Tracheostomy set

7. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the
following laboratory values would the nurse expect to find/ note in the client

a. Increase oxygen saturation with exercise

b. Hypocapnia
c. A hyperinflated chest on x-ray film
d. A widened diaphragm noted on chest x-ray film

RATIONALE
 COPD: respiratory acidosis (low oxygen = hypoxia  hypoxic drive) (administer low O2)
 Barrel Chest (hyperinflated)

8. A nurse is caring for a client with a diagnosis of gout. Which of the following laboratory values
would the nurse expect to find/ note in the client?

a. Uric acid level of 8mg/dl

b. Calcium level of 9mg/dl
c. Phosphorus level of 3mg/dl
d. Potassium level of 4mEq/l
RATIONALE
 Probenecid: promotes excretion of uric acid
 Colchicine : long term management for gout
 Allupyoric: decreases uric acid synthesis
 Maalox: neutralizes uric acid

 Ranitidine: blocks hydrochloric acid secretion
 Omeprazole: inhibits the secretions of hydrochloric acid (30 mins before or after meals)
 Above 7 uric acid pt is candidate for gout arthritis

9. A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing’s
Disease. Which statement by the student indicates an accurate understanding of this disorder?

a. Cushing’s disease is characterized by an over secretion of glucocorticoid hormones

b. Cushing’s disease is characterized by an under secretion of glucocorticoid hormones
c. Cushing’s disease is characerized by an over secretion of insulin
d. Cushing’s disease is characterized by an under secretion of corticotropic hormones
RATIONALE
 ANYTHING DOWN THE SOIL = Sodium : UP IN THE TREE = Potassium
 Phreochromocytome: tumor in adrenals (BMA TEST TO CONFIRM)
: CHARACTERISTIC = high blood pressure

10. A three month old infant is diagnosed of having a communicating hydrocephalus. In helping the
parents understand the physician’s explanation of the baby’s problem, the nurse should state:

a. Too much cerebrospinal fluid is produced within the ventricles of the brain (obstruction)
b. The cerebrospinal fluid is prevented from proper absorption by a blockage in the
ventricles of the brain (non-communicating)
c. The part of the brain surfaces that normally absorbs cerebrospinal fluid after its
production is not functioning adequately (absorption)
d. There is a flow of cerebrospinal fluid between the brain cells and the ventricles which do
not empty properly into the spinal cord

RATIONALE
 CSF is produced in the CHOROID PLEXUS  2 Lateral Ventricles  Foramen of Monroe (3rd
ventricle)  Aqueduct of Sylvius (4th ventricle)  Fourth ventricle  subArachnoid space 
Foramen of Lushka and Magendie (stored)
 CSF = hydrocephalus
 Absorption of CSF in subarachnoid space
 Communicating type of hydrocephalus
 Obstruction in the flow of CSF in ventricular system
 Non communicating type of hydrocephalus)
 PROBLEMS OF INCREASED INTRACRANIAL PRESSURE
 Lesion, Tumor, Infarct, Aneurysm, Atriovenous malformation affecting the CEREBRUM 
DECORTICATION (better prognosis compared to DECEREBRATION)
 DECEREBRATION = involvement of brainstem (brainstem compression) (STROKE: prevent
escalation of ICP: administer lactulose to decrease uric acid and prevent VALSAVA
MANEUVER)
 Pons and medulla oblongata = CARDIAC AND RESPIRATORY CENTER
 Macewen’s sign = crack pat, dilated scalp base, frontal bossing, sun setting eyes
(hydrocephalus)
 ILLUMINATING OF THE CHILD’S HEAD = trans-illumination (maklaro ang tubig sa ulo sa bata)
 increase Blood pressure and temp, Respiratory rate decrease, Acutely altered mental status ,
Irritability, Note for projectile vomiting, Seizures (BRAINS)
B = Blood pressure increase
R = Respiratory rate decrease
A = Acutely altered mental status
I = Irritability
N = Note for projectile vomiting
S = Seizures

11. In assessing a child with Croup, the nurse would expect to find
a. Bronchospasm, whooping cough
b. Expiratory stridor, crackles
c. Laryngospasm, barking cough
 d. Productive cough, respiratory stridor

RATIONALE
 CROUP: LARYNGOTRACHEOBRONCHITIS (Barking cough)

12. The nurse is positioning the client with increased intracranial pressure. Which of the following
positions would the nurse avoid?

a. Head turned to side (if there’s projectile vomiting: facilitate drainage)

b. Head midline
c. Neck in neutral position (safe answer)
d. Head of bed elevated 30-45 degrees

RATIONALE
 DO NOT FLEX OR HYPEREXTEND = CAN INCREASE THE ICP

13. The client is admitted to the hospital with a diagnosis of benigh prostatic hypertrophy, and a
transurethral resection of the prostate is performed. Four hours after surgery, the nurse take the
client’s vital signs and empties the urinary drainage bag, Which of the following assessment
findings would indicate the need to notify the physician?

a. Red bloody urine

b. Urinary output of 200 ml greater than intake
c. Blood pressure of 100/50 mmHg, pulse 130 beats per minute (hemorrhage / hypovolemic)
d. Pain related to bladder spasms

RATIONALE
 HYPOTENSION, TACHYCARDIA, TACHYPNEA = HYPOVOLEMIC SHOCK
 HYPERTENSION, BRADYCARDIA, BRADYPNEA = INCREASED INTRACRANIAL PRESSURE

14. A sweat chloride test is performed on a child with suspected diagnosis of cystic fibrosis. The
nurse review the test results and determines that which of the following is a positive result for
cystic fibrosis.

a. Chloride level of 20 mEq/L

b. Chloride level of 30 mEq/L
c. Chloride level of 40 mEq/L
d. Chloride level of 70 mEq/L

RATIONALE
 SWEAT CHLORIDE TEST: 70 mEq/L
 CHEST PHYSIOTHERAPHY: Before meals ( can stimulate vomiting if after meals )

15. The client is admitted with an exacerbation of Multiple Sclerosis. The nurse is assessing the
client for possible precipitating risk factors. Which of the following factors, if stated by the
client, would the nurse assess as being unrelated to the exacerbations?

a. A stressful week at work

b. Ingestion of more fruits and vegetables
c. A recent bout of a flu
d. Inability to sleep well

16. Which of the following is a manisfestation of congenital hip dislocation?

a. Affected hip is abducted away from the unaffected leg

b. Affected hip is hyperextended
c. Affected hip is in external rotation
d. Affected leg is longer than the unaffected leg

17. Which of the manifestations, if reported by a patient, should a nurse recognize as supporting a
diagnosis of meningitis?

a. Pain with neck flexion

b. Tingling of the lips (problem of calcium)
c. Drooling of the saliva
 d. Weakness of the legs

RATIONALE
 BRUDZINSKI SIGN = Pain upon neck flexion (meningitis)
 KERNIG’S SIGN = Pain upon flexion

18. A 32 year old patient in an ambulatory care center is suspected of having an acoustic neuroma.
Which of the following findings, if present in the patient, would support this diagnosis?

a. Diplopia
b. Dysphagia
c. Tinnitus
d. Ataxia

19. A client undergoes cerebral angiography for evaluation after an intracranial computed
tomography scan revealed a subarachnoid hemorrhage. Afterward, the nurse checks frequently
for signs and symptoms of associated with this procedure. Which findings indicate spasm or
occlusion of a cerebral artery by clot?

a. Nausea, vomiting, profuse sweating

b. Hemiplegia (body paralysis), seizures, decreasing level of consciousness
c. Difficulty breathing or swallowing
d. Tachycardia, tachypnea, hypotension (hypovolemic shock)

RATIONALE
 ISCHEMIC, EMBOLIC, HEMORRHAGIC TYPE OF STROKE = if ang clot maabots utok

20. A client is suspected of having amyotrophic lateral sclerosis. To confirm this disorder, the
nurse prepares the client for various diagnostic tests. The nurse expects the doctor to order

a. Electromyography
b. Doppler scanning
c. Doppler ultrasonography
d. Angiography