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LORMA COLLEGES COLLEGE OF NURSING San Fernando City, La Union NCM 104: Nursing Care of Clients with problems in Inflammatory and Immunologic Response, Perception and Coordination Second Semester, 2011-2012 MIDTERM EXAMINATION Instructions: Each question below contains four suggested answers. Select the best answer and write them in capital letters on your test booklet. Leave a space after five numbers. ERASURES are STRICTLY NOT ALLOWED. 1. Our human body is gifted with its own defense against invading microorganisms. Nurse Ria is correct if she mentions that both the eye and the respiratory tract are protected against infections by A. the mucous membranes that cover their surface. B. the secretion of complement proteins. C. the release of slightly acidic secretions. D. the secretion of lysozyme onto their surface. 2. Complement system refers to a group of dissolved plasma proteins. Which statement about the complement system is true? A) These proteins are involved in innate immunity and not acquired immunity. B) These proteins are secreted by cytotoxic T cells and other CD8 cells. C) This group of proteins includes interferons and interleukins. D) These proteins are one group of antimicrobial proteins acting together in cascade fashion. 3. A group of students are discussing regarding the topic on immunity. They are correct if they state that antigens are A) proteins embedded in B cell membranes B) proteins released during an inflammatory response C) foreign molecules that trigger the generation of antibodies D) proteins that consist of two light and two heavy polypeptide chains 4. If a newborn were accidentally given a drug that destroyed the thymus, what would most likely happen? A) His cells would lack class I MHC molecules on their surface. B) His humoral immunity would be missing. C) Genetic rearrangement of antigen receptors would not occur. D) His T cells would not mature and differentiate appropriately. 5. Which of the following differentiates T cells and B cells? A) T cells but not B cells are stimulated to increase the rate of their cell cycles. B) Only B cells are produced from stem cells of the bone marrow. C) T cells but not B cells can directly attack and destroy invading pathogens. D) T cells but not B cells have surface markers. 6. Which of the following is a pathway that would lead to the activation of cytotoxic T cells? A) B cell contact antigen helper T cell is activated clonal selection occurs

B) body cell becomes infected with a virus new viral proteins appear class I MHC molecule-antigen complex displayed on cell surface C) self-tolerance of immune cells B cells contact antigen cytokines released D) complement is secreted B cell contacts antigen helper T cell activated cytokines released. 7. Which of the following is the last line of defense against an extracellular pathogen? A) lysozyme production B) phagocytosis by neutrophils C) antibody production by plasma cells D) histamine release by basophils E) lysis by natural killer cells 8. Ana a 3rd year student, is reviewing her anatomy and physiology of the immune system. She is correct if she mentions the following as functions of the spleen except A. Initiates an immune response when antigens are detected in the blood B. stores erythrocytes and platelets and hemolyzes old, defective ones C. phagocytizes bacteria and foreign debris from the blood D. storage site of lymphocytes. 9. The client with RA has nontender movable nodules in subcutaneous tissue over the elbows and shoulders. Which statement is the best explanation for the nodules? A. The nodules indicate a rapidly progressive destruction of the affected tissue. B. The nodules are small amounts of synovial fluid that have become crystallized. C. The nodules are lymph nodes that have proliferated to try to fight the disease D. The nodules present a favourable prognosis and mean the client is better. 10. Which client problem is priority for a client diagnosed with RA? A. Activity intolerance B. Fluid and electrolyte imbalance C. Alteration in comfort D. Excessive nutritional intake 11. The nurse is planning to care for a client diagnosed with RA. Which interventions should be implemented? A. Plan a strenuous exercise program C. Maintain a keep-open IV B. Order a mechanical soft diet. D. Obtain an order for a sedative 12. The nurse is assisting in planning care for a client with diagnosis of immunodeficiency. The nurse would incorporate which of the following as a priority in the plan of care? A. Providing emotional support to decrease fear B. Protectingthe client from infection C. Encouraging discussion about lifestyle changes D. Identifying factors that decreased the immune function 13. The nurse is assisting in administering immunizations at a health care clinic. The nurse understands that an immunization will provide A. Natural immunity from disease B. Acquired immunity from disease C. Innate immunity from disease D. Protection from all diseases 14. The nurse is assigned to care for a client with systemic lupus erythematosus (SLE). The nurse plans care knowing that this disorder is

A. A local rash that occurs as a result of allergy B. An inflammatory disease of collagen contained in connective tissue C. A disease caused by overexposure to sunlight D. A disease caused by the continuous release of histamine in the body 15. The client diagnosed with SLE is being discharged from the medical unit. Which discharge instructions would be important for the nurse to include except? A. Use a sunscreen of SPF 30 or greater when in the sunlight. B. Notify the health care provider immediately when developing a low-grade fever. C. Some dyspnea is expected and does not need immediate attention D. The hands and feet may change colour if exposed to cold or heat 16. The nurse is assigned to care for a client admitted to the hospital with a diagnosis of systemic lupus erythematosus. The nurse reviews the physicians orders, expecting to note that which of the following medications is prescribed? A. Antibiotic C. antidiarrheal B. Narcotic analgesic D. Corticosteroid 17. The home care nurse is assigned to visit a client who returned to home from the emergency room following treatment for a sprained ankle. The nurse notes that the client was sent home with the crutches that have axillary pads and needs instructions on crutch walking. On admission assessment, the nurse discovers that the client has an allergy to latex. Before providing instructions on crutch walking the nurse most appriately A. Contacts the physician B. Covers the crutch pad with cloth C. Tells the client that the crutches must be remove from the house immediately D. Call the local medical supply store and ask for a cane to be delivered. 18. The client comes to the emergency department complaining of dyspnea and wheezing after eating at a seafood restaurant. The client cannot speak and has a bluish color around the mouth. Which intervention should the nurse implement first? A. Initiate an IV with normal saline. C. Administer oxygen at 100% B. Prepare to intubate the client D. Ask the client about iodine allergy. 19. A A. B. C. D. laboratory test result that supports the diagnosis of SLE is Leukocytosis, elevated BUN and CREA Pancytopenia, elevated antinuclear antibody (ANA) titer Thrombocytosis, elevated ESR None of these

20. In the human disease known as lupus, there is an immune reaction against a patient's own DNA from broken or dying cells. This kind of response typifies which kind of irregularity? A) allergy B) immunodeficiency C) autoimmune disease D) antigenic variation

Situation: A newborn admitted to the pediatric unit with upper lumbar myelomeningocele.

1. You are examining the back of neonate and notice that she has spina bifida. Which of the following matches the description of spina bifida? A. External saclike protusion along spinal column B. Dimple with tuft of hair along spine C. No trunk incurvation D. Extra vertebrae 2. Which assessment would the nurse anticipate finding? A. Minimal movement of the lower extremities B. Upper extremity paralysis. C. Urinary bladder prolapsed. D. Respiratory problems. 3. The mother asks if her baby is likely to have any other defects. The nurse responds based on the understanding that myelomeningocele is frequently associated with a. excessive cerebrospinal fluid (CSF) within the cranial cavity. b. abnormally small head. c. congenital absence of the cranial vault. d. overriding of the cranial sutures. 4. The client is scheduled for surgery the next day. Which nursing action has the greatest priority? A. Preventing rupture of the neningocele sac B. Preventing infection by supine position C. Encouraging the parents to hold, cuddle, and feed the infant D. Promoting range of motion exercises. 5. Which of the following statements by the mother with a repaired upper lumbar myelomeningocele indicates that she understands the nurses teaching at the time of discharge? A. I can apply a heating pad to his lower back. B. Ill be sure to keep him away from other infants. C. I will call the doctor if his urine has a funny smell. D. I will prop him with pillows to prevent him from rolling over. 6. The client with a repaired spina bifida demonstrates urinary incontinence and some flaccidity of the lower extremities. The teaching plan for the parents should include the fact that: a. an ileal bladder will be necessary once the child is of school age. b. a foley catheter offers the best hope for bladder management. c. the child will probably need an intermittent straight catheterization program. d. the child will probably wear diapers for a lifetime, since bladder training is impossible.

Seizures: Situation: Ms. Amy age 36 is a homemaker admitted in medical surgical ward because of seizures. 7. Which of the following will the nurse observe in the client in the ictal phase of a generalized grand mal (tonic clonic) seizure? A. Jerking in one extremity that spreads gradually to adjacent areas B. Vacant staring and an abrupt cessation of all activity C. Facial grimaces, patting motions, and lip smacking D. Loss of consciousness body stiffening, and violent muscle contraction

8. Which nursing assessment should be documented at the beginning of the ictal phase of a seizure? A. Heart rate, respiratory rate, pulse oximeter, and blood pressure B. Last dose of anticonvulsant and circumstances at the time C. Type of visual, auditory, and olfactory aura the client experience D. Movement of the head and eyes and muscle rigidity 9. Thecommunity nurse should inform the Amy;s sister that if the she experiences a seizure at home, the most important action to take during the seizure would be to A) move any chairs or desks at least 3 feet away from the patient B) note the sequence of movements with the time lapse of the event C) provide privacy as much as possible to minimize frightening the other children family member D) place the hands or a folded blanket under patients head. 10. Ms. Amy frequently forgets to take her Carbamazepine (Tegretol). As a result, she has been experiencing seizures. How can the nurse best help the patient remember to take her medications? A. Tell her to take her medication at bedtime B. Instruct her to take her medication after one of her favorite television shows C. Explain that she should take her medications with breakfast D. Tell her to buy an alarm watch to remind her Myesthenia Gravis: Situation: Ms. Cheena, a nursing student assigned to care for a patient with a diagnosis of myasthenia gravis questions the team leader about this illness. 11. The nurse (team leader) understands that the basic pathophysiological process involved in this disorder is: a. failure in the transmission of nerve impulses at the neuromuscular junction. b. a deficiency of Vit. E which damages the cell membrane. c. hardened patches scatter at random throughout the brain and spinal cord. d. inflammation and degenerative changes in both the posterior and anterior nerve roots. 12. The student asks the teamleader if what he can do to prevent exacerbations of myasthenia gravis. What is the most appropriate response? A. There is nothing you can do to prevent exacerbation except take your medication on schedule. B. Avoid exposure to excessive heat, crowds, and emotional extremes. C. Take your medication, get plenty of rest, and participate in frequent hard, physical exercise. D. Exposure to sunlight has beneficial effects and will cause your medication dosage to be decreased. 13. Tensilon 2 mg every 2 minutes until an adequate response is seen is given for: a. Myasthenia gravis c. Cholinergic crisis b. Guillain-Barre d. Autonomic dysreflexia

Situation: Recently, Ms. Jenny hospitalized with the diagnosis of multiple sclerosis is concerned about her fluctuating physical condition and general weakness.

14. Which of the following special procedures in neurological health assessment should be performed by the nurse to support the diagnosis? A. Romberg test B. Testing the corneal reflex C. Testing the stereognosis D. Assessing for orientation to person, time and place 15. The priority nursing intervention for this client would be to: a. have one of her parents stay with her. b. space her activities throughout the day. c. restrict her activities and encourage bed rest. d. teach her the limitations imposed by her disease. 16. The nurse should expect a client with an exacerbation of multiple sclerosis to experience a. double vision. c. flaccid paralysis. b. resting tremors d. mental retardation. Guillain Barre Situation: Ms. Lorie, age 37, was admitted to the medical surgical ward with complaints of numbness and tingling in the legs that has recently progressed to the arms. Guillian Barre(GB) is suspected. 17. Which of the following questions is important to include when assessing her? A. Has anyone in your family had Guillian-Barre syndrome? B. Did you have an upper respiratory tract infection recently? C. Did you bruise easily? D. Have you been out of the country during the past 4 months? 18. When assessing Ms. Lorie, which characteristic symptoms would the nurse expect to observe? A. Deteriorating level of consciousness B. Dilated pupils, facial numbness, and dysphagia C. Disorientation with inappropriate behavior and muscle weakness D. Ascending flaccid motor paralysis 19. You should prepare Ms. Lorie to: a. go home in a few days. b. be a paraplegia for the rest of his life. c. possibly intubated in the next few days until his illness resolves. d. be sent to a nursing home after the acute stage of his illness. CVA Situation: Mrs. Torres was admitted to the hospital with the diagnosis of CVA. Her daughter Marie is very concern regarding her mothers situation. 20. Marie approached the nurse and asks regarding the risk factor of CVA. The nurse counsels that the patient at the greatest risk for a CVA is a: a. 20-year- old obese Latin woman on birth control pills. b. 40-year-old athletic white man with a family history of CVA. c. 60-year-old Asian woman who smokes occasionally. d. 65-year-old African- American man with hypertension. 21. The student nurse was correct upon being asked by her instructor that immediately after a CVA, a major nursing prior is ensuring:

a. b. c. d.

Preservation of motor function Airway maintenance. Adequate hydration. Control of elimination.

22. The clinical instructor has conducted an oral recitation to his students. The student was able to recall her lecture when she states that the acute phase of a CVA has ended when: a. 48 hours has passes from onset. b. The patient begins to respond verbally. c. The blood pressure drops. d. Vital signs and neurologic signs stabilize. 23. Several days after a CVA, the patients family asks the nurse if tissue plasmiogen activator (tPA) is a drug therapy option now. The nurses response is based on the knowledge that this drug must be used within : a. 3 hours of onset of symptoms. b. 5 hours of onset of symptoms. c. 10 hours of onset of symptoms. d. 24 hours of onset of symptoms. 24. The patient who experienced a TIA was placed on warfarin (Coumadin) and has laboratory reports reflecting a therapeutic range for that drug, which are: a. b. c. d. prothrombin time (PT), 35 seconds; control (normal), 20 seconds; INR, 2. partial thromboplastin time (PTT), 30 seconds; control (normal), 30 seconds. prothrombin time (PT), 45 seconds; control (normal), 20 seconds; INR, 4. partial thromboplastin time (PTT), 52 seconds; control (normal), 30 seconds.

25. The etiology of an ischemic stroke would include: a. Cardiogenic embolus b. Cerebral aneurysm c. Arteriovenous malformation d. Intracerebral hemorrhage 26. A classic diagnostic symptom of hemmorhagic strokes are primarily caused by: a. b. c. d. Numbness of an arm or leg Double vision Severe headache Dizziness and tinnitis

Hypertension 27. A 38-year-old black obese diabetic patient is being evaluated for the use of propranolol (Inderal) in controlling his hypertension. The nurse points out that a contraindication for that drugs use in this patient would be his: a. Race b. Age c. Diabetes d. Weight

28. A patient being evaluated for the cause of hypertension has a lipid value of HDL, 68 mg/dL, and LDL, 82 mg/dL. The nurse assesses this finding as: a. b. c. d. Dyslipidemia Lipidemia Probable atherosclerosis Noncontributory

29. When a patient reports drowsiness from his antihypertensive medications, the nurse would include a nursing intervention instructing the patient to: a. Take the medication only when sleep is needed. b. Reduce the dose of the medication until the desired effect occurs. c. Avoid activities that require alertness. d. Talk to a counselor because this should not occur. 30. A patient who has been taking methyldopa (Aldomet) for his hypertension presents to the emergency department with a severe headache, blurred vision, and a blood pressure of 200/94 mm Hg. The nurse would suspect: a. b. c. d. Hpergycemia. Ineffective coping with sedation. Abrupt cessation of mediation. Sexual dysfunction.

31. The patient with hypertension comes to the ER and is experiencing nausea and vomiting and is restless and confused. His vital signs are BP 220/130, P 120, R 24. Based on these assessments, the nurse would conclude that the patient is experiencing: a. b. c. d. Hypertension crisis from cessation of drug. Stroke from increased blood pressure. Adverse drug reaction. Onset of diabetes.

32. A patient has hypertension and reports no symptoms. To encourage medication compliance, the nurse cautions the patient that uncontrolled hypertension can lead to sudden alterations in health, such as: a. Stroke b. Blindness c. Renal failure d. Epistaxis Falls Situation: A 79 year old patient was hospitalized due to fall that she experienced. The health care team talked to the patients relatives and told them the need of restrain for the patient. But the relatives refuse it, so to convince the relatives, the nurse is correct in explaining that the

Omnibus Reconciliation Act (OBRA) was enacted to protect patients from unnecessary restraint in long-term care facilities. 33. According to OBRA regulations, one reason to retrain a patient would be: a. If staffing is inadequate and nurse are unable to check on the patient at regular intervals. b. If the patient verbally abusive to the nursing staff. c. If the patient is at extremely high risk for a fall that is life- threatening. d. To allow medical procedures to be performed when the ppatient is not being cooperative. 34. During discharge instructions for a patient with a history of falling, the patient begins to cry and says, It sounds like you dont trust me to be alone anymore and you want me to redo my whole house. The nurses best response would be: a. Your family doesnt think you should live b yourself since you fall so much. b. You wont have to redo your house if someone can come and live with you. c. You may need to go to a long-term care facility d. Can you tell me more about how you are feeling. 35. After a patient has fallen, the most appropriate nursing intervention is to: a. Apply a vest retraint. b. Have the patient begin ambulation as soon as possible. c. Administer Haldol(haloperidol) as ordered, PRN. d. Apply wrist restrais. 36. In reviewing a patients medication administration record, the nurse is aware that some medications are considered to be chemical restrains. Of the following medications, the nurse recognizes the chemical restraint to be: a. Coumadin (warfarin) b. Mellaril (thioridazine) c. Isordil (isosorbide) d. Motrin ()ibuprofen Immobility 1. In assessing a patients risk for complications of immobility, the nurse should be

aware that there are several reasons for a person becoming immobile. A therapeutic reason may be:
a. b. c. d. To reduce the workload of the heart. Lack motivation. Bereavement resulting from the loss of a loved one. To decrease flexibility and strength.

2. The nurse is providing discharge instructions to the family of an older adult patient who

is unable to get out of bed. The nurse should instruct the family that the most effective way to prevent urinary incontinence associated with immobility is to:

a. b. c. d.

Use absorbent underpands Set up toileting program Restrict fluid intake to 500ml/ 24 hours. Restrict fluids after dinner and throughout the night.

3. A nurse caring for a patient who has been on bed rest for a week notices a reddened area on the patients left hip. The skin is intact but, when the nurse presses on the area, the redness does not fade. The nurse recognizes this pressure ulcer as a: a. b. c. d. Stage I ulcer Stage II ulcer Stage III ulcer. Stage 4 ulcer

4. A patient in traction because of a fractured hip from falling is diagnosed with a stage I pressure ulcer. She asks the nurse how she got a pressure ulcer when she had been confined to bed for only 2 days. The nurses response is based on her knowledge that: a. Erythema can occur in an hour or two, even in a person with healthy skin and adequate circulation. b. It takes several days for a pressure ulcer to form. c. The pressure ulcer probably occurred when she fell. d. The cause of pressure ulcers isnt really known. 5. The patient is complaining to the nurse that he feels the need to have a bowel movement but has not been able to defecate. He states that he has had cramping and even a small amount of brown watery stool. The nurse recognizes these symptoms as: a. b. c. d. Diarrhea Fecal incontinence Fecal impaction flatulence

6. The care plan of an older adult patient states that the patient should be monitored while in the bathroom because of a history of vasovagal reflex. The nurse knows that she should assess for: a. Extremely elevated blood pressure after ambulation b. Nausea and vomiting after a meal. c. Lightheadedness and fainting during defecation d. Inability to urinate 7. The patient who recently suffered a fractured femur and is currently in traction is at high risk for developing constipation. The most appropriate nursing intervention would be to: a. b. c. d. Get the patient up to the bedroom at least twice a day. Administer enemas each day until the patient has a bowel movement. Administer pain medication to prevent pain during defecation. Encourage a high fiber diet and increased amounts of fluids.

Multiple Sclerosis

Situation: Toni, a 32-year-old mother of two, has had multiple sclerosis for 5 years. She is currently enrolled in a school of nursing. Her husband is supportive and helps with the care of their preschool sons. Toni has been admitted to the clinical area for diagnostic studies related to symptoms of visual disturbances. 1. The nurse is aware that multiple sclerosis is a progressive disease of the central nervous system characterized by: a. Axon degeneration. b. Demyelination of the brain and the spinal cord. c. Sclerosed patches of neural tissue. d. All of the above. 2. During the physical assessment, the nurse recalls that the areas most frequently affected by multiple sclerosis are: a. b. c. d. The lateral, third, and fourth ventricles. The optical nerve chaism. The pons, medulla and cerebral penduncles All of the above

3. During the nursing interview, Toni minimizes her visual problem, talks about remaining in school to attempt advanced degrees, requests information about full-time jobs in nursing, and mentions her desire to have several more children . The nurse recognizes Tonis emotional responses as being: a. b. c. d. An example of inappropriate euphoria characteristics of the disease process. A reflection of coping mechanism used to deal with the exacerbation of her illness. Indicative of the remission phase of her chronic illness. Realistic for her current level of physical functioning.

4. Tonis disease process involves the sacral plexus. Assessment should include: a. Bladder problems or urinary tract infection b. Bowel management c. Sexual activity d. All of the above Parkinsons disease Situation: Charles is a 76-year- old retired golfer. He recently been diagnosed as having Parkinsons disease. 1. The nurse knows that the disease is characterized by: a. Bradykinesia b. Muscle rigidity c. Tremor d. All of the above 2. The nurse assess for the characteristics movements of Parkinsons disease, which is: a. An exaggerated muscle flaccidity that leads to frequent falls b. A hyperextension of the back and neck that alters normal movements c. A pronation

d. Combination of all 3. Charles is started on chemotherapy which is aimed at restoring dopaminergic activities. An example of which is: a. b. c. d. Artane Benadryl Elavil Dopar

4. Nutritional considerations as part of the NCP would include all of the following except: a. b. c. d. The diet should be semisolid to facilitate the passage of food. Calcium should be avoided The patient should be sitting in an upright position during feeding Thick fluids should be encouraged to provide additional calories.

Rheumatoc disorder 1. Joint disorder in rheumatic disease may be due to: a. Bony over growth b. Fluid accumulation c. Hypertrophied synovium d. All of the above 2. The most common symptom of rheumatoid disease that causes a patient to seek medical attention is: a. Joint swelling b. Limited movement c. Fatigue d. Pain 3. The nurse knows that a patient who is present with the symptom of blanching of his fingers on exposure to cold would be assessed for the rheumatic disease known as: a. Ankylosing spondylitis b. Raynauds phenomenon c. Reiters syndrome d. Sjogrens syndrome 4. Synovial fluid from an inflamed joint is characterized as: a. Clear and pale b. Milky, cloudy and dark yellow c. Scanty in volume d. Straw-colored 5. A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? a. Bone scan b. Computed tomography c. MRI d. Muscle biopsy

6. All of the following blood studies are consistent with a positive diagnosis of rheumatoid arthritis except: a. b. c. d. A positive C- reactive protein A positive antinuclear antibody An RBC count <4.0 x 10^6/ uL. A serum complement level >130 mg/ dL

7. A serum study that is positive for the rheumatoid factor is: a. A diagnostic for Sjogrens syndrome b. Diagnostic for SLE c. Specific rheumatoid arthritis d. Suggestive of rheumatoid arthritis 8. A popular and effective COX-2 inhibitor that increases the patients risk of smoke is: a. Bextra b. Celebrex c. Feldene d. Tolecti 9. The rheumatoid arthritis reaction produces enzymes that break down: a. Collagen b. Elastin c. Hematopoietic tissue d. Strong supporting tissue 10. In rheumatoid arthritis, the autoimmune reaction primarily occurs in the a. Joint tendons b. Cartilage c. Synovial tissue d. Interstitial space 11. In rheumatoid arthritis, the cartilage is replaced with fibrous connective tissue during the stage of synovial destruction known as: a. Cartilage erosion b. Increase phagocytic production c. Lymphocyte infiltration d. Pannus formation Neuroogic dysfunction 12. Nursing care activities for a patient with increase ICP would not include: a. Glycerin b. Isosorbide c. Mannitol d. Urea 13. The earliest sign of serious impairment of brain circulation related to increase ICP is: a. A bounding pulse b. Bradycardia

c. Hypertension d. Lethargy and stupor 14. As ICP rises, the nurse knows that she may be asked to give a commonly used osmotic diuretic: a. Glycerin b. Isosorbide c. Mannitol d. Urea 15. Long term use of anti- seizure medication in women leads to an increased incidence of: a. Anemia b. Osteoarthritis c. Osteoporosis d. Obesity 16. The most severe neurologic impairments are evidenced by the abnormal body posturing defines as: a. b. c. d. Decerebrate Decorticate Flaccid Ragid

17. Postcraniotomy cerebral edema is at a maximum how long after brain surgery? a. 6 hours b. 12-20 hours c. 24-72 hours d. 3-5 days 18. Neurologic and neurosurgical approaches to pain relief would include: a. Stimulation procedures b. Administration of intraspinal opiates c. Interruption of nerve tract that conduct pain d. All of the above mechanisms 19. A nurse assesses the patients level of consciousness using GCS. Which score indicates severe impairment of neurologic function? a. b. c. d. 3 6 9 12

20. Initial compensatory vital sign changes with increased ICP include all of the following except: a. A slow, bounding pulse b. An increased systemic BP c. A decreased temperature

d. Respiratory rate irregularities 21. A nurse knows that a patient experiencing Cushings triad would not exhibit: a. b. c. d. Bradycardia Bradypnea Hypertension Tachycardia

22. The spinal cord tapers off to to a fibrous band of tissue at the level of the: a. Coccygeal nerve b. First lumbar vertebra c. Lateral ventricle d. Medulla oblongata 23. To reduce leakage of CSF after myelography with an oil-based medium, the patient must lie for 12 to 24 hours in what position? a. High fowlers position b. With the head of the bed elevated c. Prone d. Recumbent 24. Patient preparation for electroencephalography includes omitting, for 24 before the test, all of the following except: a. Coffee and tea b. Solid foods c. Stimulants d. tranquilizers 25. the Babinski response is used to assess: a. muscle strength b. coordination c. biceps reflex d. muscle tone 26. the preganglionic fibers of the sympathetic neurons are located in those segmentsof the spinal cord identified as: a. b. c. d. C1 to T1 C3 to L1 C8 to L3 T1 to S5

27. A most widely used drug for the treatment of a migraine headache is: a. b. c. d. Amerge Imitrex Maxalt Zomig

28. A seizure characterized by loss of consciousness and tonic spasm s of the trink and extremities, rapidly followed by repetitive generalized clonic jerking, is classified as a: a. Focal seizure b. Generalized seizure c. Jacksonian seizure d. Partial seizure 29. A nutritional approach for seizure management include a diet that is : a. Low in fat b. Restricts protein to 10 % of daily calories intake c. High in protein and low in carbohydrate d. At least 50% carbohydrates