Nokea
You are pulled from the ED to the neurologic floor. Which action should you delegate to the nursing assistant when providing nursing care for a patient with SCI?
- A. Assess patient's respiratory status every 4 hours.
- B. Take patient's vital signs and record every 4 hours.
- C. Monitor nutritional status including calorie counts.
- D. Have patient turn, cough, and deep breathe every 2 hours.
Correct Answer: B
Rationale: Taking and recording vital signs is a routine task suitable for delegation to a nursing assistant.
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The following signs occur in ipsilateral interruption of the cervical sympathetic trunk:
- A. enophthalmos
- B. ptosis
- C. vasodilatation in the skin of the face
- D. All above
Correct Answer: D
Rationale: Interruption of the cervical sympathetic trunk leads to Horner's syndrome, characterized by ipsilateral ptosis (drooping eyelid), miosis (pupil constriction), and anhidrosis (lack of sweating). Enophthalmos (sunken eye) and vasodilatation in the facial skin may also occur due to loss of sympathetic tone.
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.
What is a normal response when testing cranial nerve IX (Glossopharyngeal nerve) and X (Vagus nerve)?
- A. The uvula should remain midline when the patient says "ah."
- B. The patient should be able to smell different scents.
- C. The patient should have normal hearing.
- D. The patient should exhibit symmetrical facial expressions.
Correct Answer: A
Rationale: Cranial nerves IX and X are tested by observing the uvula's position when the patient says "ah." A midline uvula indicates normal function. Smell, hearing, and facial expressions are assessed by other cranial nerves.
Which of the following is NOT part of the endocrine system?
- A. pons
- B. pancreas
- C. parathyroid
- D. pineal gland
Correct Answer: A
Rationale: The pons is part of the brainstem and is involved in regulating sleep, respiration, and communication between different parts of the brain. It is not part of the endocrine system, which consists of glands that secrete hormones, such as the pancreas, parathyroid, and pineal gland. The pons plays a role in motor control and sensory processing, but it does not produce hormones.
What type of diet is recommended for people with seizures or epilepsy?
- A. high carbohydrate diet
- B. fruit-only diet
- C. ketogenic diet
- D. low-fat diet
Correct Answer: C
Rationale: The ketogenic diet is a high-fat, low-carbohydrate diet that has been shown to reduce seizure frequency in some individuals with epilepsy, particularly those who do not respond well to medication. It works by altering the body's metabolism to produce ketones, which may have anticonvulsant effects.