Nokea
The nurse instructs the mother of a 5-year-old who sustained a mild brain injury that although all neurologic evaluations are normal, her child may exhibit postconcussive syndrome. What are common characteristics of this syndrome?
- A. Convulsions and high fever
- B. Irritability and memory deficits
- C. Muscular twitching and muscle pain
- D. Paresis of limbs and fatigue
Correct Answer: B
Rationale: Mild brain injury is characterized by brief or no loss of consciousness. This type constitutes the majority of head injuries. Neurologic examinations are often normal. Postconcussive syndrome can persist for months, years, or indefinitely. Signs and symptoms include fatigue, headache, vertigo, lethargy, irritability, personality changes, cognitive deficits, decreased information processing speed and memory, understanding, learning, and perceptual difficulties.
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What is the primary difference between the rehabilitation of children and the rehabilitation of adults?
- A. Level of disability
- B. Body part involved
- C. Degree of disability
- D. Developmental potential
Correct Answer: D
Rationale: The primary difference between rehabilitation of children and rehabilitation of adults is the developmental potential of the child.
What should the nurse do to reduce the incidence of postural hypotension in a patient with a spinal cord injury?
- A. Monitor diastolic blood pressure closely.
- B. Encourage the patient to remain in the bed.
- C. Raise the head of the bed for 15 to 20 minutes before transfer to a wheelchair.
- D. Encourage adequate intake of fluids to expand fluid volume.
Correct Answer: C
Rationale: Raising the head of the bed before transfer allows for gradual vessel accommodation from the supine position to the upright position. It is important to check the patient's blood pressure, but it will not reduce the incidence of postural hypotension. It is important to encourage the patient to get out of bed. Postural hypotension is related to a pooling of blood in the lower extremities and is not related to a fluid volume deficit.
The nurse explains that the Americans with Disabilities Act of 1990 defines a person as disabled if which criteria are met?
- A. The person has a physical or mental impairment.
- B. The person is limited in at least one major life activity.
- C. The person has a medical record of the impairment.
- D. The person is unemployed.
- E. The person needs assistance in completion of ADLs.
Correct Answer: A,B,C
Rationale: The definition is that a disabled person may have a physical or mental impairment that limits the person in one or more major life activities and has a medical record of that disability.
When the nurse observes a patient experiencing a severe episode of autonomic dysreflexia, what should be the initial intervention?
- A. Locate the cause of irritation.
- B. Assess the blood pressure.
- C. Cover the patient with several blankets.
- D. Raise the head of the bed to a high Fowler's position.
Correct Answer: D
Rationale: The head of the bed should be raised immediately. Raising the head of the bed will reduce the blood pressure. Finding the cause of the episode is secondary to preventing the possibility of a stroke from the hypertension.
The rehabilitation nurse stresses to the family of a patient with a brain injury that difficult and painful rehabilitation will probably be required for what length of time?
- A. 1 to 2 years
- B. 2 to 4 years
- C. 5 to 10 years
- D. 6 to 12 years
Correct Answer: C
Rationale: Most brain-related disabilities, including physical, cognitive, and psychosocial difficulties, call for at least 5 to 10 years of difficult and painful rehabilitation; many require lifelong treatment and attention.