Adult health EAQ #3 Neuro

A nurse finds a victim under the wreckage of a collapsed building. The individual is conscious, supine, breathing satisfactorily, and reports back pain and an inability to move the legs. Which action should the nurse take first? 1 Leave the individual lying on the back with instructions not to move, and leave to seek additional help. 2 Roll the individual onto the abdomen, place a pad under the head, and cover with any material available. 3 Gently raise the individual to a sitting position to determine whether the pain either diminishes or increases in intensity. 4 Gently lift the individual onto a flat piece of lumber and, using any available transportation, rush to the closest medical institution

1 Leave the individual lying on the back with instructions not to move, and leave to seek additional help.

a client is scheduled for head and neck surgery although the health care provider has explained the surgery the client still has moderate to severe anxiety. what action should the nurse take initially? 1. attempt to discover what the client is concerned about 2. elaborate on what the HCP has already said 3. teach the client to use the suction equipment preoperatively 4. plan for postoperative communication because a tracheostomy is likely

1. attempt to discover what the client is concerned about

a client is admitted to the hospital with a suspected brain tumor based on the history of loss of equilibrium and coordination the nurse suspects the tumor is located where ? 1. cerebellum 2. parietal lobe 3. basal ganglia 4. occipital lobe

1. cerebellum

a client is diagnosed as having expressive aphasia which type of impairment does the nurse expect the client to exhibit? 1. speaking or writing 2. following specific instructions 3. understanding speech or writing 4. recognizing words or familiar objects

1. speaking or writing

the nurse considers that a 70 year old female can best limit further progression of osteoporosis by doing what? 1. taking supplemental calcium and vitamin d 2. increasing the consumption of eggs and cheese 3. taking supplemental magnesium and vitamin E 4. increasing the consumption of milk and milk products

1. taking supplemental calcium and vitamin d

which synovial joint movement is described as turning the sole outward away from the midline of the body? 1. pronation 2. eversion 3. adduction 4. supination

2 idkkk

which joint helps in the gliding movement of the wrist? 1. pivot joint 2. hinge joint 3. biaxial joint 4. ball and socket joint

2 idkkkk

a client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint what reason should the nurse include in a response to this question? 1. lubricated the joint 2. reduces inflammation 3. provides physiotherapy 4. prevents ankylosis of the joint

2. reduces inflammation

a nurse is providing education to a community group of hospice. the nurse clarifies that the primary goal of hospice is help clients do what? 1. have the option of assisted suicide 2. remain comfy until the end of life 3. explore the newest treatments for their form of cancer 4. release family members from participating in care

2. remain comfy until the end of life

during a home visit a nurse discovers that a child in the household has a disability and has been experiencing seizures in addition the childs parents is unresponsive to the childs physical, emotional. or medical needs, and seems to provoke seizure episodes by harsh verbal exchanges with the child the seizure episodes by harsh verbal exchanges with the child the nurse believes that intervention by an appropriate community resource is indicated where should the nurse make a referral? 1. outpatient clinic 2. hospital pediatric unit 3. child protective services 4. bureau of the handicapped

3. child protective services

a nurse is caring for a client who just had an above the knee amputation what is the key factor in assessing how the client will cope with the body image change? 1. extent of the change 2. suddenness of the change 3. obviousness of the change 4. personal perception of the change

4. personal perception of the change

an xray film indicates that an older client has a fractured femur. the client asks the nurse "will i be able to walk again?" what is the best response by the nurse? 1. i have no idea bc only time will tell 2. you only broke a bone it could have been worse 3. youll walk again this is common issue in older ppl 4. tell me more about your concerns about being able to walk

4. tell me more about your concerns about being able to walk

the nurse is caring for an elderly client who has a right hip fracture. what intervention should be included in the plan of care? 1. nutrition supplements 2. cardiac monitoring 3. oxygen therapy 4. venous thromboembolism prevention (VTE)

4. venous thromboembolism prevention (VTE)

which clinical indicator does a nurse identify when assessing a client with hemiplegia? 1. paresis of both lower extremities 2. paralysis of one side of the body 3. paralysis of both lower extremities 4. paresis of upper and lower extremities

2. paralysis of one side of the body

the nurse is caring or a client with rheumatoid arthritis when should the nurse expect the client to experience increased pain and limited movement of the joints? 1. after assistive exercise 2. when the room is cool 3. in morning on awakening 4. when the latex fixation test is positive

3. in morning on awakening

a client who is receiving radiation therapy or bone cancer lives alone and works full time what should the nurse encourage this client to do? 1. perform regularly scheduled aerobic activity daily 2. take a leave of absence from work when receiving therapy 3. include rest periods during the day while receiving radiaiton 4. continue the activities usually performed before becoming ill

3. include rest periods during the day while receiving radiaiton

family members of a client who has a brain attack (CVA) ask why the client cries easily and without provocation the nurse explains what about the client? 1. the client is making an attempt to get attention 2. the client has selective memory from the past especially the sad events 3. the client has little control over this behavior 4. the client feels guilty about the demands being made on the family

3. the client has little control over this behavior

a nurse providing care in a hospital witnesses a client spouse shaking the client vigorously because the client has had an episode of incontinence because of the suspicion of physical abuse, legally with whom should the nurse discuss the concerns? 1. the client 2. the clients spouse 3. the clients primary HCP 4. adult protective services

4. adult protective services

building confidence in ones worth is important for a client who is scheduled for a below the knee amputation because of an amputation does what? 1. alters a persons sexuality 2. implies a lack of wholeness 3. increases dependency needs 4. affects an idealized self image

4. affects an idealized self image

when a disaster occurs the nurse may have to first treat mass hysteria that is indicated by what response? 1. panic 2. coma 3. euphoria 4. depression

1. panic

which muscle of the head and neck facilitates the ability to draw the lips together? 1. zygomticus 2. orbicularis oris 3. orbicularis oculi 4. sternocleidomastoid

2. orbicularis oris

a client with multiple sclerosis is informed that it is a chronic progressive neurologic condition the client asks the nurse "will i experience pain?" what is the nurses best response? 1. tell me about your fears regarding pain 2. analgesics will be prescribed to control the pain 3. pain is not a characteristic symptom of this condition 4. lets make a list of the things you need to ask your HCP

3. pain is not a characteristic symptom of this condition

a client has paraplegia as a result of motorcycle accident what is the reason the nursing care plan should include turning the client every one to two hours? 1. maintain comfort 2. prevent pressure ulcers 3. prevent flexion contractures of the extremities 4. improve venous circulation in the lower extremities

2. prevent pressure ulcers

acetylasalicylic acid is prescribed for a client with rheumatoid arthritis the nurse understands what is the major rationale for this treatment? 1. reduction of fever 2. preservation of bone integrity 3. reduction of joint inflammation 4. prevention of flexion contractures

3. reduction of joint inflammation

a client with a brain attack (cerebrovascular accident) is admitted to the hospital. what is the priority nursing intervention for this client? 1. changing position every 2 hours 2. keeping a serial record of the pulse 3. performing range of motion exercises 4. monitoring for increased intracranial pressure

4. monitoring for increased intracranial pressure

while walking in the hall a hospitalized client has a tonicclonic seizure what should the nurse do to protect the client during the seizure? 1. hold the clients extremities firmly 2. protect the clients head from injury 3. insert an airway between the clients teeth 4. have several staff members move the client to a soft surface

2. protect the clients head from injury they fall suddenly

a client exhibits the characteristic gait associated with parkinsons disease when recording on the clients record how does the nurse document this gait? 1. ataxic 2. shuffling 3. scissoring 4. aysmmetric

2. shuffling

a client with multiple sclerosis is in remission which diversional activity should the nurse encourage that best meets the clients needs while in remission? 1. hiking 2. swimming 3. sewing classes 4. watching tv

2. swimming

a client is scheduled for arthroscopic knee surgery and asks the nurse about the procedure which statement by the nurse best describes the procedure? 1. it is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it 2. it is a radiological procedure where dye is injected to help diagnose the extent of the knee injury 3. the procedure will determine the type of treatments to HCP will prescribe 4. you will be anesthetized so that you dont remember anything abou the procedure

1. it is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it

an older client with dementia of the alzeheimers type is residing in a nursing home when in bed the client consistently is found sleeping in the semi fowler position what are of the clients body does the nurse determine is at the greatest risk for developing a pressure ulcer? 1. sacrum 2. scapulae 3. ischial spine 4. greater trochanter

1. sacrum

a client asks for information about glaucoma what does the nurse explain about glaucoma? 1. there isn an increase in the pressure within the eyeball 2. there is an opacity of the crystalline lens or its capsule 3. there is a curvature of the cornea that becomes unequal 4. there is a separation of the neural retina from the pigmented retina

1. there isn an increase in the pressure within the eyeball

a client hospitalized with a severe myocardial infarction tells the nurse "my life is over i may as well just give up" what is the best response by the nurse? 1. you feel your life is over 2. have you nothing to live for 3. we are not going to let you die 4. everything will be fine dont worry

1. you feel your life is over

After a cervical neck injury, a client is placed in a halo fixation device with a body cast. A statement that indicates that the client's concern about body image has been resolved successfully is: 1 "I hate having everyone else do things for me." 2 "I've gotten used to the brace. I may even miss it when it's gone." 3 "I've been keeping my daily calories low in an attempt to lose weight." 4 "I can't get to sleep. However, I make up for it in the morning by sleeping later."

2 "I've gotten used to the brace. I may even miss it when it's gone."

in the postanesthesia care unit after a below the knee amputation a client begins crying after feeling for the affected lower leg how should the nurse respond? 1. administer medication to induce sleep 2. allow the client to ventilate feelings of loss 3. provide time for privacy by leaving the room 4. dont address the behavior until the client is more alter

2. allow the client to ventilate feelings of loss

a nurse uses a doll object to stroke the lateral side of the underside of a clients left foot and move upward to the great toe what reflex is the nurse testing? 1. moro 2. babinski 3. stepping 4. cremasteric

2. babinski

a client who just has been diagnoses with primary open angle glaucoma refuses therapy the nurse reinforces that it is important for the client to seek treatment because POAG is left untreated it may lead to what? 1. cataracts 2. blindness 3. retinal detachment 4. blurred distance vision

2. blindness

what therapeutic effect does the nurse expect to identify when mannitol is administered parenterally to a client with cerebral edema? 1. improved renal blood flow 2. decreased intracranial pressure 3. maintenance of circulatory volume 4. prevention of the development of thrombi

2. decreased intracranial pressure

a nurse is interviewing a client with a tentative diagnosis of parkinson disease what should the nurse expect the client to report about how the onset of symptoms occurred? 1. suddenly 2. gradually 3. overnight 4. irreg

2. gradually

a client experiences an acute episode of rheumatoid arthritis the nurse observes that the clients finger joints are swollen what does the nurse conclude that this swelling is most likely related to? 1. urate crystals in the synovial tissue 2. inflammation in the joints synovial lining 3. formation of bony spurs on the joint surfaces 4. escaped fluid from the capillaries that increases interstitial fluid

2. inflammation in the joints synovial lining

a client experiences a cerebral vascular accident (CVA) and is admitted to the hospital in a come what is the priority nursing care for this client? 1. monitor VS 2. maintain an open airway 3. monitor pupil response and equality 4. maintain fluid and electrolyte balance

2. maintain an open airway

when making rounds a nurse observes a client who is experiencing a seizure what should the nurse do? 1. hyperextend the clients neck 2. move obstacles away from the client 3. restrain the clients body movements 4. attempt to place an airway in the clients mouth

2. move obstacles away from the client

after a cerebrovascular accident (also known as brain attack) a client is unable to differentiate between heat or cold and sharp or dull sensory stimulation. what lobe of the brain should the nurse conclude is likely affected? 1. frontal 2. parietal 3. occipital 4. temporal

2. parietal

a client with dementia is admitted with a fractured hip following a fall at home the clients family member witnessed the fall four hours after admission the clients blood increases to a moderately severe hypertensive level the client pulls on the bedclothes continuously the clients family member asks for pain medication for the client what does the nurse conclude? 1. the client has the need to go to the bathroom 2. the client may be in pain and unable to respond app 3. the family member may be trying to keep the client overmedicated 4. the family member feels guilty about the fall and wants to keep the client pain free

2. the client may be in pain and unable to respond app

a client with rheumatoid arthritis has been given a prescription for acetylsalicylic acid the client asks the nurse "what kind of drug is acetylsalicylic acid?" the nurse recalls that the classification to which this drug belongs is what? 1. sedatives 2. hypnotics 3. analgesics 4. antibiotics

3. analgesics

a client who has a long leg cast for a fractured bone is to be discharged from the emergency department when discussing pain management the nurse should advise the client to take the prescribed as needed oxycodone and acetaminophen when? 1. just as a last resort 2. before going to sleep 3. as the pain becomes intense 4. when the discomfort begins

3. as the pain becomes intense

an 84 year old woman is admitted to the hospital with a diagnosis of dementia of the alzheimer type what does the nurse know about this disorder? 1. problem that first emerges in the 3rd decade of life 2. nonorganic disorder that occurs in the later years of life 3. cognitive problem that is a slow and relentless deterioration of the mind 4. disorder that is easily diagnosed through laboratory and psychological tests

3. cognitive problem that is a slow and relentless deterioration of the mind

a nurse reviews information for a client diagnosed with open angle glaucoma what should the nurse explain as being the chief aim of treatment? 1. rest the eye 2. dilate the pupil 3. control the intraocular pressure 4. prevent secondary infections

3. control the intraocular pressure

after cataract surgery the nurse teaches a client how to self administer eye drops the nurse reinforces the use of what technique? 1. placing the drops on the cornea of the eye 2. raising the upper eyelid w gently traction 3. holding the dropper tip above the conjunctival sac 4. squeezing the eye shut after instilling the medication

3. holding the dropper tip above the conjunctival sac

a client with a distal femoral fracture has a long leg cast applied. what important element of discharge program should the nurse focus on when teaching crutch walking? 1. establishing a schedule for pain medication 2. maintaining a fixed schedule of daily activites 3. modifying the home environment to prevent accidents 4. understanding that a more sedentary lifestyle is necessary

3. modifying the home environment to prevent accidents

a client admitted to the hospital with an acute episode of rheumatoid arthritis (RA) asks why physical therapy has not been prescribed what is the most appropriate nursing response? 1. your HCP must have forgotten to prescribe it 2. your condition is not severe enough to have physical therapy approved 3. your joints are still inflamed and physical therapy can be harmful 4. physical therapy is not helpful for persons who suffer from RA

3. your joints are still inflamed and physical therapy can be harmful

A client has expressive aphasia. The client's family members ask how they can help the client regain as much speech function as possible. The nurse instructs them to: 1 Speak louder than usual during visits while looking directly at the client 2 Tell the client to use the correct words when speaking 3 Give positive reinforcement for correct communication 4 Encourage the client to speak while being patient with each attempt

4 Encourage the client to speak while being patient with each attempt

a client is scheduled for arthroscopy of the knee in the morning and asks the nurse about the procedure which statement by the nurse best describes the procedure? 1. the procedure will determine the types of treatments that will be prescribed 2. it is a direct visualization of the joint to diagnose the extent of your knee injury 3. you will not remember anything about the procedure because you will be anesthetized 4. it is a radiological procedure that will aid in the diagnosis of the extent of your knee injury

4 idk

a client with expressive aphasia becomes agitated and upset when attempting to communicate with the nurse to help reduce the clients frustration what should the nurse do? 1. limit the clients contact with others to minimize communication attempts 2. anticipate needs so the client does not need to ask for help 3. face the client while speaking loudly 4. allow the client adequate time to speak

4. allow the client adequate time to speak

an 80 year old client with dementia of the alzheimers type is admitted to a nursing home a family member visits and remarks how thin and wrinkled the client has become which response by the nurse will help the family member most to understand the aging process? 1. most ppl at the age should be careful about weight gain 2. this is typical of older adults they really dont eat well 3. it looks as though the frequent tanning has taken its toll 4. as we age we lost the tissue that helps puff out the skin

4. as we age we lost the tissue that helps puff out the skin

the nurse is caring for a client who is suspected of having a brain tumor who is scheduled for a computed tomography (CT) scan the nurse expects that the pre-procedure plan of care will include what? 1. telling the client about what to expect during the examination 2. withholding routine medications 3. administering the prescribed sedative 4. explaining that radiation will not be involved

4. explaining that radiation will not be involved

initially after a stroke a clients pupils are equal and reactive to light later the nurse assesses that the right pupil is reacting more slowly than the left and that the systolic blood pressure is beginning to rise what complication should the nurse consider that the client is developing? 1. spinal shock 2. hypovolemic shock 3. transtentorial herniation 4. increasing intracranial pressure

4. increasing intracranial pressure

a clients sustains a fractured right femur in a fall on the ice and is admitted to the hospitals emergency department how should the nurse assess this client for signs of circulatory impairment? 1. turn the client to the side lying position 2. ask the client to cough and deep breathe 3. instruct the client to wiggle the toes of the right foot 4. take the clients pedal pulse in the affected extremity

4. take the clients pedal pulse in the affected extremity

the client is admitted to the emergency department after a fall from a roof after determining that the client sustained a head injury the nurse observes clear fluid coming from the clients left ear what will the nurse do next? 1. turn the client to the unaffected side 2. cleanse the clients ear with sterile gauze 3. place sterile cotton loosely in the external canal of the left ear 4. test the drainage from the clients ear with glucose reagent strip

4. test the drainage from the clients ear with glucose reagent strip

a client who is receiving chemotherapy for lung cancer has nausea and vomiting because of the therapy the client wants to know if it is true that smoking marijuana will help. what is the nurses best response? 1. smoking marijuana is not legal in any state 2. marijuana is effective for nausea and vomiting if it is injected 3. marijuana is not proven to be effective in preventing chemotherapy induced nausea and vomiting 4. tetrahydrocannabinol is an ingredient in marijuana that decreases nausea and vomiting in some people

4. tetrahydrocannabinol is an ingredient in marijuana that decreases nausea and vomiting in some people

which health problem does the nurse identify from an older clients history that increases the clients risk factors for a brain attack? 1. glaucoma 2. hypothyroidism 3. continuous nervousness 4. transient ischemic attacks (TIAs)

4. transient ischemic attacks (TIAs)