Health Assessment Neurological System NCLEX Questions

Health Assessment Neurological System NCLEX Questions Related

Review Health Assessment Neurological System NCLEX Questions related questions and content

A patient says, I feel detached and weird all the time, like I'm looking at life through a cloudy window. Everything seems unreal. These feelings really interfere with my work and study. Which term should the nurse use to document this complaint?

  • A. Depersonalization
  • B. Hypochondriasis
  • C. Dissociation
  • D. Malingering
Correct Answer: A

Rationale: Correct Answer: A. Depersonalization

Rationale:
1. Depersonalization involves feeling detached from oneself or reality, as described by the patient.
2. The patient's description of feeling like they are looking through a cloudy window aligns with depersonalization symptoms.
3. Interference with work and study suggests significant distress, a common feature of depersonalization disorder.

Summary of other choices:
B. Hypochondriasis: Involves excessive worry about having a serious illness, which is not indicated in the patient's complaint.
C. Dissociation: While depersonalization is a type of dissociative symptom, it specifically refers to feeling detached and unreal, not necessarily a broader dissociative disorder.
D. Malingering: Involves feigning or exaggerating symptoms for secondary gain, which is not evident in the patient's genuine distress and impairment.

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The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client:

  • A. You will need to accept the necessity for a quiet and inactive lifestyle.
  • B. Keep active, use stress reduction strategies, and avoid fatigue.
  • C. Follow good health habits to change the course of the disease.
  • D. Practice using the mechanical aids that you will need when future disabilities arise.
Correct Answer: B

Rationale: Encouraging activity, stress reduction, and fatigue management is essential for maintaining quality of life in MS. A completely inactive lifestyle is not recommended.

Which of the following is not a branch of the trigeminal nerve?

  • A. Supraorbital nerve
  • B. Great auricular nerve
  • C. Mental nerve
  • D. Lacrimal nerve
Correct Answer: B

Rationale: The great auricular nerve is a branch of the cervical plexus (C2-C3), not the trigeminal nerve. It supplies sensation to the skin over the parotid gland and ear.

A patient complains of pain in the foot of a leg that was recently amputated. What should the nurse recognize about this pain?

  • A. It is caused by swelling at the incision.
  • B. It should be treated with ordered analgesics.
  • C. It will become worse with the use of a prosthesis.
  • D. It can be managed with diversion because it is psychologic.
Correct Answer: B

Rationale: Phantom pain is treated with analgesics.

Following 2 weeks of IV antibiotic therapy, a patient with acute osteomyelitis of the tibia is prepared for discharge from the hospital. The nurse determines that additional instruction is needed when the patient makes which statement?

  • A. I will need to continue antibiotic therapy for 4 to 6 weeks.
  • B. I shouldn't bear weight on my affected leg until healing is complete.
  • C. I can use a heating pad on my lower leg for comfort and to promote healing.
  • D. I should notify the health care provider if the pain in my leg becomes worse.
Correct Answer: C

Rationale: Heating pads are contraindicated in osteomyelitis.

A person who is drunk may have difficulty walking in a straight line because the alcohol has impacted their:

  • A. thalamus
  • B. reticular formation
  • C. amygdala
  • D. cerebellum
Correct Answer: D

Rationale: The cerebellum is responsible for coordinating voluntary movements, balance, and posture. Alcohol impairs the cerebellum's function, leading to difficulties in walking, balance, and fine motor control. This is why individuals who are drunk often exhibit unsteady movements and have trouble walking in a straight line. The cerebellum's role in motor coordination makes it particularly sensitive to the effects of alcohol.

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