1. A client admitted to the hospital with a subarachnoid hemorrhage has complaints of severe headache, nuchal rigidity, and projectile vomiting. The nurse knows lumbar puncture (LP) would be contraindicated in this client in which of the following circumstances?
a. Vomiting continues
b. Intracranial pressure (ICP) is increased
c. The client needs mechanical ventilation
d. Blood is anticipated in the cerebralspinal fluid (CSF)
2. A client with a subdural hematoma becomes restless and confused, with dilation of the ipsilateral pupil. The physician orders mannitol for which of the following reasons?
a. To reduce intraocular pressure
b. To prevent acute tubular necrosis
c. To promote osmotic diuresis to decrease ICP
d. To draw water into the vascular system to increase blood pressure
3. A client with subdural hematoma was given mannitol to decrease intracranial pressure (ICP). Which of the following results would best show the mannitol was effective?
a. Urine output increases
b. Pupils are 8 mm and nonreactive
c. Systolic blood pressure remains at 150 mm Hg
d. BUN and creatinine levels return to normal
4. Which of the following values is considered normal for ICP?
a. 0 to 15 mm Hg
b. 25 mm Hg
c. 35 to 45 mm Hg
d. 120/80 mm Hg
5. Which of the following symptoms may occur with a phenytoin level of 32 mg/dl?
a. Ataxia and confusion
b. Sodium depletion
c. Tonic-clonic seizure
d. Urinary incontinence
6. Which of the following signs and symptoms of increased ICP after head trauma would appear first?
b. Large amounts of very dilute urine
c. Restlessness and confusion
d. Widened pulse pressure
7. Problems with memory and learning would relate to which of the following lobes?
8. While cooking, your client couldn’t feel the temperature of a hot oven. Which lobe could be dysfunctional?
9. The nurse is assessing the motor function of an unconscious client. The nurse would plan to use which of the following to test the client’s peripheral response to pain?
a. Sternal rub
b. Pressure on the orbital rim
c. Squeezing the sternocleidomastoid muscle
d. Nail bed pressure
10. The client is having a lumbar puncture performed. The nurse would plan to place the client in which position for the procedure?
a. Side-lying, with legs pulled up and head bent down onto the chest
b. Side-lying, with a pillow under the hip
c. Prone, in a slight Trendelenburg’s position
d. Prone, with a pillow under the abdomen.
11. A nurse is assisting with caloric testing of the oculovestibular reflex of an unconscious client. Cold water is injected into the left auditory canal. The client exhibits eye conjugate movements toward the left followed by a rapid nystagmus toward the right. The nurse understands that this indicates the client has:
a. A cerebral lesion
b. A temporal lesion
c. An intact brainstem
d. Brain death
12. The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the following trends in vital signs if the ICP is rising?
a. Increasing temperature, increasing pulse, increasing respirations, decreasing blood pressure.
b. Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure.
c. Decreasing temperature, decreasing pulse, increasing respirations, decreasing blood pressure.
d. Decreasing temperature, increasing pulse, decreasing respirations, increasing blood pressure.
13. The nurse is evaluating the status of a client who had a craniotomy 3 days ago. The nurse would suspect the client is developing meningitis as a complication of surgery if the client exhibits:
a. A positive Brudzinski’s sign
b. A negative Kernig’s sign
c. Absence of nuchal rigidity
d. A Glascow Coma Scale score of 15
14. A client is arousing from a coma and keeps saying, “Just stop the pain.” The nurse responds based on the knowledge that the human body typically and automatically responds to pain first with attempts to:
a. Tolerate the pain
b. Decrease the perception of pain
c. Escape the source of pain
d. Divert attention from the source of pain.
15. During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which of the following would be most appropriate to institute?
a. Limiting conversation with the child
b. Keeping extraneous noise to a minimum
c. Allowing the child to play in the bathtub
d. Performing treatments quickly
16. Which of the following would lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation?
a. Hemorrhagic skin rash
d. Dyspnea on exertion
17. When interviewing the parents of a 2-year-old child, a history of which of the following illnesses would lead the nurse to suspect pneumococcal meningitis?
a. Bladder infection
b. Middle ear infection
c. Fractured clavicle
d. Septic arthritis
18. The nurse is assessing a child diagnosed with a brain tumor. Which of the following signs and symptoms would the nurse expect the child to demonstrate? Select all that apply.
a. Head tilt
e. Increased appetite
f. Increased pulse
19. A lumbar puncture is performed on a child suspected of having bacterial meningitis. CSF is obtained for analysis. A nurse reviews the results of the CSF analysis and determines that which of the following results would verify the diagnosis?
a. Cloudy CSF, decreased protein, and decreased glucose
b. Cloudy CSF, elevated protein, and decreased glucose
c. Clear CSF, elevated protein, and decreased glucose
d. Clear CSF, decreased pressure, and elevated protein
20. A nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which of the following would be included in the plan of care?
a. No precautions are required as long as antibiotics have been started
b. Maintain enteric precautions
c. Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics
d. Maintain neutropenic precautions