Nclex-Rn Practice Questions-Care Of The Adult - Neurosensory Disorders Part 4
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Question 1 |
Cataract surgery results in aphakia. Which statement best describes this term?
A | Absence of the crystalline lens |
B | A “keyhole” pupil |
C | Loss of accommodation |
D | Retinal detachment |
Question 2 |
Which statement indicates that a client needs additional teaching after cataract surgery?
A | “I’ll avoid eating until the nausea subsides.” |
B | “I can’t wait to get back to the gym. |
C | “I’ll avoid bending over to tie my shoelaces.” |
D | “I’ll avoid touching the dropper to my eye when using my eyedrops.” |
Question 3 |
A client underwent an enucleation of the right eye for a malignancy. Which intervention will the nurse perform?
A | Instilling miotics as ordered to the affected eye |
B | Teaching the client to clean the prosthesis in soap and water |
C | Assessing reactivity of the pupils to light and accommodation |
D | Teaching the client to prevent straining at stool leading to increased intraocular pressure |
Question 4 |
After a nurse instills atropine drops into both eyes for a client undergoing an ophthalmic examination, which instruction should be given to the client?
A | “Be careful because the blink reflex is paralyzed.” |
B | “Avoid wearing your regular glasses when driving.” |
C | “Be aware that the pupils may be unusually small.” |
D | “Wear dark glasses in bright light because the pupils are dilated.” |
Question 5 |
A nurse would use which of the following instruments in recording intraocular pressure?
A | Goniometer |
B | Ophthalmoscope |
C | Slit lamp |
D | Tonometer |
Question 6 |
A nurse should question an order to irrigate the ear canal in which circumstance?
A | Ear pain |
B | Hearing loss |
C | Otitis externa |
D | Perforated tympanic membrane |
Question 7 |
A client with a spinal cord injury has a neurogenic bladder. When planning for discharge, the nurse anticipates the client will need which procedure or program?
A | Intermittent catheterization program |
B | Kock pouch |
C | Transurethral prostatectomy |
D | Ureterostomy |
Question 8 |
Which method should be used to assess pupil accommodation?
A | Assessing for peripheral vision |
B | Touching the cornea lightly with a wisp of cotton |
C | Having the client follow an object upward, downward, obliquely, and horizontally |
D | Observing for pupil constriction and convergence while focusing on an object coming toward the client |
Question 9 |
A client with a right stroke has a flaccid left side. Which intervention would best prevent shoulder subluxation?
A | Splint the wrist. |
B | Use an air splint. |
C | Put the affected arm in a sling. |
D | Perform range-of-motion exercises on the affected side. |
Question 10 |
Which symptom would occur in a client with a detached retina?
A | Flashing lights and floaters |
B | Homonymous hemianopia |
C | Loss of central vision |
D | Ptosis |
Question 11 |
When caring for a client with quadriplegia, which nursing intervention takes priority?
A | Forcing fluids to prevent renal calculi |
B | Maintaining skin integrity |
C | Obtaining adaptive devices for more independence |
D | Preventing atelectasis |
Question 12 |
Client teaching for a client with Gardner-Wells tongs should include which reason for their use?
A | To reduce intracranial pressure (ICP) |
B | To reduce dislocations and pain |
C | To prevent deep vein thrombosis (DVT) |
D | To prevent the need for surgery |
Question 13 |
A client recovering from a spinal cord injury has a great deal of spasticity. Which medication may be used to control spasticity?
A | Hydralazine |
B | Baclofen (Lioresal) |
C | Lidocaine (Xylocaine) |
D | Methylprednisolone (Medrol) |
Question 14 |
A client is experiencing an episode of autonomic dysreflexia and becomes hypertensive. The most important intervention by the nurse would be?
A | Elevate the client’s legs. |
B | Put the client flat in bed. |
C | Put the bed in Trendelenburg’s position. |
D | Put the client in high Fowler’s position. |
Question 15 |
A nurse assesses a client who has episodes of autonomic dysreflexia. Which condition can cause autonomic dysreflexia?
A | Headache |
B | Lumbar spinal cord injury |
C | Neurogenic shock |
D | Noxious stimuli |
Question 16 |
Which client on the rehabilitation unit is most likely to develop autonomic dysreflexia?
A | A client with brain injury |
B | A client with herniated nucleus pulposus |
C | A client with a high cervical spine injury |
D | A client with a stroke |
Question 17 |
For a client having an episode of acute angle-closure glaucoma, the nurse expects to give which medication?
A | Acetazolamide (Diamox) |
B | Atropine |
C | Furosemide (Lasix) |
D | Urokinase |
Question 18 |
A client with a T1 spinal cord injury arrives at the emergency department with a blood pressure of 82/40 mm Hg, pulse of 34 beats/minute, dry skin, and flaccid paralysis of the lower extremities. Which condition should be suspected?
A | Autonomic dysreflexia |
B | Hypervolemia |
C | Neurogenic shock |
D | Sepsis |
Question 19 |
When discharging a client from the hospital after a laminectomy, the nurse recognizes that the client needs further teaching when he makes which statement?
A | “I’ll sleep on a firm mattress.” |
B | “I won’t drive for 2 to 4 weeks.” |
C | “When I pick things up, I’ll bend my knees.” |
D | “I can’t wait to pick up my 1-year-old granddaughter.” |
Question 20 |
When assessing a client with herniated nucleus pulposus of L4–L5, the nurse should expect to find which sign or symptom of spinal cord compression?
A | Lower back pain |
B | Pain radiating across the buttocks |
C | Positive Kernig’s sign |
D | Urinary incontinence |
Question 21 |
A client has a cervical spine injury at the level of C5. Which condition should the nurse anticipate during the acute phase?
A | Absent corneal reflex |
B | Decerebrate posturing |
C | Movement of only the right or left half of the body |
D | The need for mechanical ventilation |
Question 22 |
A client at the eye clinic reports difficulty seeing at night. This may result from which nutritional deficiency?
A | Vitamin A |
B | Vitamin B6 |
C | Vitamin C |
D | Vitamin K |
Question 23 |
A client with C7 quadriplegia is flushed and anxious and complains of a pounding headache. Which symptom(s) should also be anticipated?
A | Decreased urine output or oliguria |
B | Hypertension and bradycardia |
C | Respiratory depression |
D | Symptoms of shock |
Question 24 |
Which condition indicates that spinal shock is resolving in a client with C7 quadriplegia?
A | Absence of pain sensation in the chest |
B | Return of reflexes below the injury |
C | Spontaneous respirations |
D | Urinary continence |
Question 25 |
When using a Snellen alphabet chart, a nurse records a client’s vision as 20/40. Which statement best describes 20/40 vision?
A | The client has alterations in near vision and is legally blind. |
B | The client can see at 20 feet what the person with normal vision sees at 40 feet. |
C | The client can see at 40 feet what the person with normal vision sees at 20 feet. |
D | The client has a 20% decrease in acuity in one eye, and 40% decrease in the other eye. |
Question 26 |
When developing a teaching session on glaucoma for the community, which statement should the nurse stress?
A | Glaucoma is easily corrected with eyeglasses. |
B | White and Asian individuals are at the highest risk for glaucoma. |
C | Yearly screening for people ages 20 to 40 years is recommended. |
D | Glaucoma can be painless and vision may be lost before the person is aware of a problem. |
Question 27 |
Which procedure or assessment must a nurse perform when preparing a client for eye surgery?
A | Clipping the client’s eyelashes |
B | Verifying the affected eye has been patched for 24 hours before surgery |
C | Verifying the client has had nothing by mouth since midnight or at least 8 hours before surgery |
D | Obtaining informed consent |
Question 28 |
The nurse is teaching a client who has a diagnosis of a stroke versus a transient ischemic attack (TIA). Which statement by the nurse describing to the client the difference between stroke and TIA would be the most accurate?
A | TIAs resolve in less than 24 hours. |
B | TIAs may be hemorrhagic in origin. |
C | TIAs may cause a permanent motor deficit. |
D | TIAs may predispose the client to a myocardial infarction (MI). |
Question 29 |
A 40-year-old paraplegic client must perform intermittent catheterization of the bladder. Which instruction should be given?
A | “Clean the meatus from back to front.” |
B | “Measure the quantity of urine.” |
C | “Gently rotate the catheter during removal.” |
D | “Clean the meatus with soap and water.” |
Question 30 |
An 86-year-old client with a stroke in evolution and a history of coronary artery disease is brought to the medical-surgical floor. His medications include isosorbide (Isordil). Which condition is a concern?
A | Dehydration |
B | Hypocarbia |
C | Hypotension |
D | Tube feeding |
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