Nokea
An 83-year-old patient has had a stroke. The patient is right handed and has a history of hypertension and 'little' strokes. The patient presents with right hemiplegia. To afford the patient the best visual field, the nurse will approach the patient in which manner?
- A. from the right side.
- B. from the left side.
- C. from the center.
- D. from either side.
Correct Answer: B
Rationale: Another perceptual problem is hemianopia, which is characterized by defective vision or blindness in half of the visual field. If the patient has hemianopia, which is common, the patient should be approached from the nonparalyzed side for care.
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In which way will a nurse record the behavior when a patient with Alzheimer's disease attempts to eat using a napkin rather than a fork?
- A. Apraxia
- B. Agnosia
- C. Aphasia
- D. Dysphagia
Correct Answer: B
Rationale: Agnosia is a total or partial loss of the ability to recognize familiar objects or people through sensory stimuli as a result of organic brain damage.
Which aspect is the nurse assessing when asking the patient, 'Who is the president of the United States?' during a level of consciousness data collection?
- A. Orientation
- B. Memory
- C. Calculation
- D. Knowledge
Correct Answer: D
Rationale: Knowledge is tested by questions such as 'Who is the president?' or asking about current events.
Which factor is the nurse aware of when assessing a person with a craniocerebral injury?
- A. Most injuries of this type are irreversible.
- B. Open injuries are always more serious than closed injuries.
- C. Signs and symptoms may not occur until several days after the trauma.
- D. Trauma to the frontal lobe is more significant than to any other area.
Correct Answer: C
Rationale: If a patient who has been conscious for several days after head injury loses consciousness or develops neurologic signs and symptoms, a subdural hematoma should be suspected.
Following a myelogram the nurse will include in the postprocedure care observing for which possible complication?
- A. elevation of blood pressure.
- B. urine retention.
- C. Loss of sensation in lower extremities.
- D. slurred speech.
Correct Answer: C
Rationale: Postmyelogram care includes the data collection to ensure there is no leakage of CSF, sensation and strength of the lower extremities, or headache. To avoid a headache, the patient should be flat for a few hours.
Which food should the person who experiences migraine headaches avoid?
- A. Yogurt
- B. Caffeine
- C. Beef
- D. Pears
- E. Marinated foods
- F. Milk
Correct Answer: A,B,E
Rationale: Some foods may cause or worsen headaches. Foods that may provoke headaches include vinegar, chocolate, yogurt, alcohol, fermented or marinated foods, ripened cheese, cured sandwich meat, caffeine, and pork.