MSNCB Neurological Nursing 5 — Questions and Answers
Question 1: A patient with amyotrophic lateral sclerosis (ALS) has a forced vital capacity (FVC) of 48%. The nurse should anticipate discussing:
- Increased physical therapy to maintain strength
- Non-invasive ventilatory support options (Correct answer)
- Immediate surgical tracheostomy
- Discontinuation of riluzole therapy
Correct answer: Non-invasive ventilatory support options
An FVC below 50% in ALS indicates significant respiratory compromise and is the threshold for discussing non-invasive ventilation (BiPAP).
Question 2: Which nursing assessment finding is most consistent with a epidural hematoma?
- Gradual onset of neurological deterioration over days
- Brief loss of consciousness, lucid interval, then rapid deterioration (Correct answer)
- Slow progressive headache over weeks with personality changes
- Bilateral arm weakness with preserved leg strength
Correct answer: Brief loss of consciousness, lucid interval, then rapid deterioration
Epidural hematoma classically presents with a lucid interval between initial loss of consciousness and rapid neurological deterioration due to arterial bleeding.
Question 3: A patient post-ischemic stroke develops unilateral neglect. Which nursing intervention best addresses this deficit?
- Place all objects on the unaffected side to ensure patient can see them
- Approach the patient only from the unaffected side
- Place objects on the affected side and teach the patient to scan toward it (Correct answer)
- Patch the eye on the affected side to encourage use of the other eye
Correct answer: Place objects on the affected side and teach the patient to scan toward it
Rehabilitation for unilateral neglect focuses on training the patient to consciously scan toward the affected side, placing items there to encourage awareness.
Question 4: A nurse caring for a patient on therapeutic hypothermia after cardiac arrest should monitor for which common complication?
- Hyperthermia rebound
- Coagulopathy and electrolyte imbalances (Correct answer)
- Hyperglycemia requiring insulin infusion
- Pulmonary hypertension
Correct answer: Coagulopathy and electrolyte imbalances
Therapeutic hypothermia commonly causes coagulopathy, hypokalemia, hypomagnesemia, and hypophosphatemia due to intracellular electrolyte shifts.
Question 5: Which finding in a patient with a cervical spinal cord injury indicates the development of neurogenic shock?
- Hypertension and tachycardia
- Hypotension and bradycardia (Correct answer)
- Hypertension and bradycardia
- Hypotension and tachycardia
Correct answer: Hypotension and bradycardia
Neurogenic shock results from disrupted sympathetic pathways, causing hypotension and paradoxical bradycardia without compensatory tachycardia.
Question 6: A patient with trigeminal neuralgia describes episodes of severe, lancinating facial pain triggered by chewing or touching the face. Which medication is the first-line treatment?
- Gabapentin
- Carbamazepine (Correct answer)
- Amitriptyline
- Oxycodone
Correct answer: Carbamazepine
Carbamazepine is the first-line pharmacological treatment for trigeminal neuralgia and has FDA approval specifically for this condition.
Question 7: A patient is being evaluated for brain death. Which finding is INCONSISTENT with a brain death determination?
- Absent corneal reflexes bilaterally
- Positive apnea test
- Intact oculovestibular (cold caloric) reflex (Correct answer)
- Fixed, dilated pupils bilaterally
Correct answer: Intact oculovestibular (cold caloric) reflex
An intact oculovestibular (cold caloric) reflex indicates brainstem activity, which is incompatible with a brain death determination.
MSNCB Neurological Nursing 5
A patient with amyotrophic lateral sclerosis (ALS) has a forced vital capacity (FVC) of 48%.
The nurse should anticipate discussing: