Neuro

A nurse assesses a client who is suspected of being in myasthenic crisis. Which assessment finding is most definitive in support of this conclusion? 1.Difficulty breathing 2.Decline in physical mobility 3.Disturbed sensory perception 4.Decreased tolerance to activity

1.Difficulty breathing

A nurse is providing instructions for a client who is receiving phenytoin (Dilantin) but has limited access to health care. What side effect is the basis for the nurse's emphasis on meticulous oral hygiene? 1.Hyperplasia of the gums 2.Alkalinity of the oral secretions 3.Irritation of the gingiva and destruction of tooth enamel 4.Promotion of plaque and bacterial growth at the gum lines

1.Hyperplasia of the gums

A client who had a right total hip replacement is progressing from the use of a walker to the use of a cane. In which hand should the nurse teach the client to hold the cane? 1.Left hand 2.Right hand 3.Stronger hand 4.Dominant hand

1.Left hand

A nurse is providing postoperative teaching to a client who is scheduled to have an above-the-knee amputation. The client will use crutches during the postoperative period. Which activity will prepare the client for crutch walking? 1.Lifting weights 2.Changing bed positions 3.Caring for the residual limb 4.Performing phantom limb exercises

1.Lifting weights

A client who is recuperating from a spinal cord injury at the T4 level wants to use a wheelchair. What should the nurse teach the client to do in preparation for this activity? 1.Push-ups to strengthen arm muscles 2.Leg lifts to prevent hip contractures 3.Balancing exercises to promote equilibrium 4.Quadriceps-setting exercises to maintain muscle tone

1.Push-ups to strengthen arm muscles

An older client experiences a cerebral vascular accident (CVA) and has right-sided hemiplegia and expressive aphasia. The client's children ask the nurse which functions will be impaired. The nurse explains that the abilities that will be affected include: 1.Stating wishes verbally 2.Recognizing familiar objects 3.Comprehending written words 4.Understanding verbal communication

1.Stating wishes verbally

A client has a history of progressive carotid and cerebral atherosclerosis and experiences transient ischemic attacks (TIAs). The nurse explains to the client that TIAs are: 1.Temporary episodes of neurological dysfunction 2.Intermittent attacks caused by multiple small clots 3.Ischemic attacks that result in progressive neurological deterioration 4.Exacerbations of neurological dysfunction alternating with remissions

1.Temporary episodes of neurological dysfunction

A nursing assistant assigned to provide hygiene to a client who has a history of transient ischemic attacks (TIAs) asks the nurse what a TIA is. What explanation should the nurse provide? 1.Temporary episodes of neurological dysfunction. 2.Transient attacks caused by multiple small emboli. 3.Periods of alternating exacerbations and remissions. 4.Ischemic attacks that result in progressive neurological deterioration

1.Temporary episodes of neurological dysfunction.

An older client with macular degeneration comes to the eye clinic. Which response reported by the client does the nurse identify as consistent with the diagnosis? 1.Sees best in dim light. 2.Sees halos around lights. 3.Cannot see objects in the periphery. 4.Cannot see an object in the center of the visual field

4.Cannot see an object in the center of the visual field

Some clients self-prescribe over-the-counter glucosamine to help relieve joint pain and stiffness. Which condition should the nurse identify as a reason for a client to reconsider taking this medication? 1.Osteoarthritis 2.Heart disease 3.Hyperthyroidism 4.Diabetes mellitus

4.Diabetes mellitus

A client is admitted to the hospital with the diagnosis of a right-sided brain attack (CVA). The client is right-handed. Which task will be most difficult for this client? 1.Eating meals 2.Writing letters 3.Combing the hair 4.Dressing every morning

4.Dressing every morning

On the second day after surgery, a client reports pain in the right calf. What should the nurse do first? 1.Apply a warm soak. 2.Document the symptom. 3.Elevate the leg above the heart. 4.Notify the health care provider

4.Notify the health care provider

A client is experiencing diplopia, ptosis, and mild dysphagia. Myasthenia gravis is diagnosed and an anticholinergic medication is prescribed. The nurse is planning care with the client and spouse. What instruction is the priority? 1.Eat foods that are pureed 2.Perform range-of-motion exercises 3.Recommend taking a stool softener daily 4.Take the medication according to a specific schedule

4.Take the medication according to a specific schedule

The nurse is caring for a client who has sustained blunt trauma to the forearm. The nurse assesses the client for which early sign of compartment syndrome? 1.Warm skin at site of injury 2.Escalating pain in the fingers 3.Rapid capillary refill in affected hand 4.Bounding radial pulse in the injured arm

2.Escalating pain in the fingers

A client is fitted for and receives a prosthesis after an above-the-knee amputation. A week later the client states, "I feel so much better." What is the reason why most clients report an improved self-image after using a prosthesis? 1.Their improved functional abilities 2.Their belief that they look more whole 3.The acceptance they receive from others 4.The fact that something is being done to help

1.Their improved functional abilities

The nurse is caring for a client four hours after the client's hip replacement surgery. When assisting the client out of bed, the nurse should: 1.Tell the client that both legs must have equal weight bearing 2.Advise the client that the legs must continually be kept wide apart 3.Sit the client in a straight-back chair so that the hips are kept flexed 4.Transfer the client using a mechanical lift because weight bearing on the leg is not allowed

2.Advise the client that the legs must continually be kept wide apart

A client had spinal anesthesia for surgery. On the second day after surgery the client complains of a headache. The nurse should: 1.Begin an early ambulation program 2.Encourage the client to drink at least 2 L of fluids in 24 hours 3.Remove antiembolic stockings being worn 4.Assist the client to sit at the bedside with the feet dangling

2.Encourage the client to drink at least 2 L of fluids in 24 hours

A client is taking phenytoin (Dilantin) to treat clonic-tonic seizures. The client's phenytoin level is 16 mg/L. Which action should the nurse take? 1.Hold the medication and notify the health care provider. 2.Administer the next dose of the medication as prescribed. 3.Hold the next dose and then resume administration as prescribed. 4.Call the health care provider to obtain a prescription with an increased dose

2.Administer the next dose of the medication as prescribed.

A client suffered an injury to the leg as a result of a fall. X-ray films indicate an intertrochanteric fracture of the femur. The client will be placed in Buck's traction until surgery is performed. When considering the client's plan of care, the nurse recalls that the primary purpose of Buck's traction is to: 1.Reduce the fracture 2.Immobilize the fracture 3.Maintain abduction of the leg 4.Eliminate rotation of the femur

2.Immobilize the fracture

After three months of rehabilitation following a craniotomy, a client still is having some motor speech difficulty. What should the nurse do to promote the client's use of speech? 1.Correct the client's mistakes immediately. 2.Respond to the client's efforts of speaking. 3.Use simple sentences when interacting with the client. 4.Explain again why the client is having difficulty communicating

2.Respond to the client's efforts of speaking.

A nurse explains to a client that stimulation of calcium deposition in the bone after a distal femoral fracture is achieved best by: 1.Resting the extremity 2.Weight-bearing activity 3.Normal aging processes 4.Ingesting foods high in calcium

2.Weight-bearing activity

A client is newly diagnosed with multiple sclerosis. The client is obviously upset with the diagnosis and asks, "Am I going to die?" The nurse's best response is: 1."Most individuals with your disease live a normal life span." 2."Is your family here? I would like to explain your disease to all of you." 3."The prognosis is variable; most individuals experience remissions and exacerbations." 4."Why don't you speak with your health care provider? You probably can get more details about your disease."

3."The prognosis is variable; most individuals experience remissions and exacerbations."

What should the nurse consider as the goal of therapy when administering allopurinol (Zyloprim) to a client with gout? 1.Increase bone density 2.Decrease synovial swelling 3.Decrease uric acid production 4.Prevent crystallization of uric acid

3.Decrease uric acid production

A client is admitted with a brain attack (CVA) with left-sided paralysis. The client leans to the left when placed in a sitting position and fails to respond to stimuli in the left visual field. The client's plan of care should include: 1.Keeping the client's head turned to the right 2.Approaching the client from the left side 3.Teaching the client to use head movements to scan the left field of vision 4.Arranging the furniture in the client's room so that the door is in the right visual field

3.Teaching the client to use head movements to scan the left field of vision

A client who has been diagnosed with a bipolar disorder has been admitted to the psychiatric unit. The nurse recognizes that providing adequate nutrition during the manic phase may be a challenge. Why would adequate nutritional intake be a challenge? 1.The client is too depressed to eat. 2.The client lacks the energy to eat. 3.The client is too busy keeping active to eat. 4.The client is on a restricted diet limiting cheese and other favorite foods

3.The client is too busy keeping active to eat.

A client has primary open-angle glaucoma. The nurse expects that the client will receive a prescription for which eye drops? 1.Tetracaine (Pontocaine) 2.Cyclopentolate (Cyclogyl) 3.Timolol maleate (Timoptic) 4.Atropine sulfate (Atropisol Ophthalmic)

3.Timolol maleate (Timoptic)

After surgery for a fractured hip, a client states, "I don't remember when I have ever been so uncomfortable." The nurse should: 1.Notify the health care provider 2.Use distraction techniques 3.Medicate the client as prescribed 4.Perform a complete pain assessment

4.Perform a complete pain assessment

After an amputation, a client's residual limb is bandaged snugly throughout the postoperative period. The nurse teaches the client that the primary purpose of the rigid bandaging of the residual limb is to: 1.Prevent suture line infection 2.Promote drainage of secretions 3.Prevent injury to the residual limb 4.Promote shrinkage of the distal end of the residual limb

4.Promote shrinkage of the distal end of the residual limb

Which alternative therapy may be beneficial for the nurse to discuss with a client who has terminal bone cancer 1.Biofeedback 2.Radiotherapy 3.Bariatric therapy 4.Radioactive implants

1.Biofeedback

A client just has been diagnosed with multiple sclerosis. The client is upset and asks the nurse, "Am I going to die?" What is the nurse's best response? 1."Most individuals with your disorder have a normal life span." 2."I would like to explain your disorder to both you and your family." 3."There is a variable prognosis, with most individuals experiencing remissions and exacerbations." 4."I think you should speak with your health care provider, who can give you more details about your prognosis."

3."There is a variable prognosis, with most individuals experiencing remissions and exacerbations."

A client is suspected of having myasthenia gravis. What are the most significant initial nursing assessments that should be performed? 1.Ability to chew and speak distinctly 2.Capacity to smile and close the eyelids 3.Effectiveness of respiratory exchange and ability to swallow 4.Degree of anxiety and concern about the suspected diagnosis

3.Effectiveness of respiratory exchange and ability to swallow

A client is admitted for the repair and revision of a residual limb after a traumatic amputation of the hand. A week after surgery the client complains of constant throbbing in the affected limb. Which is the most appropriate nursing intervention? 1.Apply cool compresses to the limb 2.Secure a prescription for pain medication 3.Elevate the extremity on two pillows 4.Loosen the bandage around the limb

3.Elevate the extremity on two pillows

A client has an open reduction and internal fixation for a fractured hip. Postoperatively the nurse should place the client's affected extremity in what position? 1.External rotation 2.Slight hip flexion 3.Moderate abduction 4.Anatomical body alignment

3.Moderate abduction