An urgent care nurse practitioner comes in to examine his patient, a 77-year-old woman who was brought in by her family for altered mental status. He notes that the patient appears restless and does not know where she is. Upon further assessment, he notes that her pupils are sluggish to react to light and are unequal in size. She is unable to sit up at the side of the bed and her blood pressure is 190/88 mm Hg. Which of the following does the NP suspect?
Ischemic stroke
Increased intracranial pressure
Myocardial infarction
Cerebral aneurysm
The Correct Answer is B
Choice A reason: Ischemic stroke may present with focal neurological deficits, but the combination of unequal pupils, inability to sit up, and high blood pressure suggests a more global intracranial process rather than a localized ischemic event.
Choice B reason: This choice is correct because the patient’s altered mental status, unequal and sluggish pupils, postural instability, and elevated blood pressure are classic signs of increased intracranial pressure. These findings suggest a critical neurological emergency.
Choice C reason: Myocardial infarction typically presents with chest pain, shortness of breath, and cardiovascular symptoms rather than altered mental status and pupil abnormalities.
Choice D reason: Cerebral aneurysm rupture can cause acute neurological decline, but unequal pupils and gradually increasing blood pressure are more consistent with generalized intracranial pressure rather than the sudden presentation of a subarachnoid hemorrhage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Decreased need for sleep can be present in both hypomania and mania; it does not differentiate the two.
Choice B reason: Irritability is also common in both hypomanic and manic episodes and is not specific for hypomania.
Choice C reason: Psychotic symptoms, such as delusions or hallucinations, are indicative of mania, not hypomania.
Choice D reason: Increased productivity, heightened energy, and elevated mood without significant functional impairment or psychotic features suggest a hypomanic episode rather than full mania.
Correct Answer is B
Explanation
Choice A reason: Hydrocodone is an opioid and is generally not first-line for chronic neuropathic pain, due to dependency risks and limited efficacy for burning neuropathic pain.
Choice B reason: This choice is correct because gabapentin is a first-line treatment for diabetic neuropathic pain. It targets nerve hyperexcitability and reduces burning, tingling, and neuropathic discomfort.
Choice C reason: Acetaminophen is useful for nociceptive pain but is not effective for neuropathic pain caused by diabetic peripheral neuropathy.
Choice D reason: Botulinum toxin is used for muscle spasticity or localized pain syndromes, not generalized diabetic neuropathy.
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