Lifespan-2

The nurse performs a focused assessment on a client diagnosed with multiple sclerosis​ (MS). Which assessment should the nurse perform as a part of the physical​ examination specific to MS? (Select all that​ apply.) The​ client's visual acuity The​ client's balance The​ client's breathing sounds he​ client's affect The​ client's speech

The client's visual acuity, the client's balance, the client's affect, the client's speech

The nurse is assessing an older adult client in a long-term care facility after a fall. Which finding requires priority action? Redness and severe swelling are found at the hip joint. The client is repeatedly flexing the injured leg at the hip. Pain is relieved by moving the affected extremity. The injured leg is shortened and externally rotated.

The injured leg is shortened and externally rotated

The nurse is providing teaching about home care for a client with osteoarthritis of the knees. Which information should the nurse​ include? (Select all that​ apply.) Using assistive devices to minimize stress placed on affected joint Taking pain medications as ordered Encouraging heavy lifting to maintain muscle strength Installing handrails in the bathroom Continuing activity with repetitive movement

Using assistive devices to minimize stress placed on affected joint, taking pain medications as ordered, installing handrails in the bathroom

The nurse is teaching older adults with osteoarthritis​ (OA) actions to effectively manage chronic pain. Which recommendation should the nurse​ include? (Select all that ​apply.) Using firm support in chairs and mattresses to properly align the body Teaching proper posture and good body mechanics for activities of mobility Encouraging resting painful joints Limiting isometric exercises to reduce strain on the joints Applying cool compresses to painful joints to reduce inflammation

Using firm support in chairs and mattresses to properly align the body, teaching proper posture and good body mechanics for activities of mobility, encouraging resting painful joints, applying cool compresses to painful joints to reduce inflammation

A Pt with Parkinson's is reporting that his gait is more unsteady; there is an increased risk for falls. Which suggestion could the nurse offer to diminish this risk? Walk standing erect with a walker with wheels Walk by stepping over imaginary lines on the floor Walk leaning forward using a cane with a base Use a wheelchair

Walk by stepping over imaginary lines on the floor

A client has been diagnosed with​ relapsing-remitting multiple sclerosis​ (MS). Which statement by the nurse most accurately explains to the client the onset of symptoms with this type of​ MS? "Symptoms will develop​ slowly, but continuously with no periods of​ remission." ​"Symptoms will become progressively worse with periods of​ flare-ups." ​"Symptoms will not develop for at least several years after​ diagnosis." "Symptoms will flare up at​ times, with periods of partial or complete​ remission."

"Symptoms will flare up at times, with periods of partial or complete remission"

Lab results are back for a client who has limiting joint pain. Synovial fluid analysis shows no uric acid crystals or bacteria. The client asks what the test results mean. How should the nurse respond? "These test results mean that your joint pain is likely not related to any form of arthritis." "These test results mean that your joint pain is likely caused by either cancer of the joint or gout." "These test results mean that your joint pain is likely caused by either rheumatoid arthritis or septic arthritis." "These test results mean that your joint pain is likely not caused by gout or septic arthritis."

"These test results mean that your joint pain is likely not caused by gout or septic arthritis."

The nurse is caring for an​ 8-year-old child who sustained a hip fracture from a motor vehicle crash. The parents ask if the child will be scheduled for a hip replacement. How should the nurse​ respond? ​"Hip replacements are not done in children because they need to be revised with​ growth." ​"We will place the child in traction for a few​ days, then do the hip​ replacement." ​"A hip replacement will be performed once the child is medically​ stable." "Treatment for hip fractures in children often involves casting for 4 to 6​ weeks."

"Treatment for hip fractures in children often involves casting for 4 to 6​ weeks."

What is the normal range for CO2 in an ABG greater than 90 16-22 35-45 less than 80

35-45

A nurse conducted a class on fall prevention for a group of older adult clients in the community. Which observation during a client home visit indicates that teaching on fall prevention was effective? All meat is placed in the freezer. A shower seat was placed in the shower. Throw rugs are placed in the kitchen. The locks were changed on the doors.

A shower seat is placed in the shower

The nurse assesses a child suspected of having autism spectrum disorder​ (ASD). Which behavior noted in the assessment supports the​ diagnosis? An aversion to being touched Eye contact when talking Lethargy with excessive sleeping Large facial features

An aversion to being touched

The first day after surgery to repair a fractured hip sustained from a fall, an older adult client refuses to ambulate but states, "I will consider it tomorrow." In this situation, which is the priority action by the nurse? Coordinate personnel to assist with ambulation Document the client's refusal Assess why the client is refusing to ambulate Notify the healthcare provider

Assess why the client is refusing to ambulate

The quick and easiest way to help correct respiratory alkalosis in a hyperventilating patient is Use IV interventions Assist them to slow their breathing Have them drink an acidic drink like fruit juice Have the the patient do some exercise

Assist them to slow their breathing

The nurse assesses an older adult woman and determines the client is at high risk for osteoporosis and hip fractures. Based on these​ findings, which test should the nurse request from the healthcare​ provider? Magnetic resonance imaging​ (MRI) scan Hormone levels Bone density testing Computerized tomography​ (CT) scan

Bone density testing

Why do clients with Parkinson disease (PD) nearly always take carbidopa in combination with levodopa? Carbidopa prevents levodopa's conversion to dopamine in the brain, thus intensifying levodopa's effectiveness. Carbidopa enhances levodopa's conversion to dopamine throughout the body, thus intensifying levodopa's effectiveness. Carbidopa minimizes the conversion of levodopa to dopamine within the brain, thus minimizing levodopa's unwanted side effects. Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects.

Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects.

The nurse is caring for a client admitted with an exacerbation of multiple sclerosis (MS). The client is demonstrating frustration with eating because he is experiencing hand and arm spasms that prevent the proper use of utensils. Which intervention should the nurse implement to best assist this client? Consult with the occupational therapist regarding assistive devices for meals. Plan time and staff to feed the client. Consult with the physical therapist regarding hand and arm exercises. Counsel the client to select finger foods for meals.

Consult with the occupational therapist regarding assistive devices for meals.

Which intervention is most appropriate for the nurse to include in the plan of care for a child with autism spectrum disorder​ (ASD)? Encouraging the​ client's family to bring in familiar objects from home Rearranging the hospital room until a comfortable arrangement is found Scheduling procedures for different times each day Putting the television on loud to provide stimulation for the client

Encouraging the​ client's family to bring in familiar objects from home

________ is a process whereby fluid and solutes move together across a membrane from an area of higher pressure to one of lower pressure. Diffusion Osmosis Filtration Active transport

Filtration

The nurse is teaching the parents of a very young client newly diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) about the newly prescribed medication methylphenidate​ (Ritalin). Which instruction should the nurse​ include? Give the medication prior to going to bed at night. Restrict the amount of calories that the client eats each day. Observe the child for excessive sleepiness. Give the medication first thing in the morning.

Give the medication first thing in the morning.

An woman planning to get pregnant inquires how best to reduce the risk of her child having CP. What advice is most accurate? Have prenatal care and take folic acid Have prenatal care from a qualified obstetrician Have prenatal care and avoid having any vaccinations

Have prenatal care and take precautions to avoid preterm labor

During an​ assessment, the nurse suspects that an​ 18-month-old client is demonstrating manifestations of cerebral palsy​ (CP). Which assessment finding should the nurse use to validate this​ conclusion? (Select all that​ apply.) Thumb sucking Good trunk control Head lag Arched back Asymmetric crawling

Head lag, arched back, asymmetric crawling

The nurse is teaching the parents of a child recently diagnosed with autism spectrum disorder​ (ASD). Which etiologies should the nurse​ include? (Select all that​ apply.) ​Mercury-containing vaccinations Immunologic factors Genetics Environmental factors Breast feeding

Immunologic factors Genetics Environmental factors

A client with chronic hip pain is diagnosed with osteoarthritis. Which instruction regarding home safety is most appropriate for the nurse to provide to this client? Install grab bars in the bathroom near the commode and in the shower. Rest in a recliner. Place scatter rugs in high-traffic areas. Walk up and down the steps at home as much as possible.

Install grab bars in bathroom near the commode and in the shower

The nurse notes a high level of stress between the parents of a child with cerebral palsy​ (CP). Which action should the nurse take to support the​ parents? Make a referral for marriage counseling Listen to concerns and encourage expression of feelings Refer all medical questions to the healthcare provider Explain that most children with CP are eventually placed in​ long-term care facilities

Listen to concerns and encourage expression of feelings

When considering acid-base balance, health promotion should focus on beginning an exercise regimen. maintaining fluid balance. conducting yearly health screenings. obtaining immunizations.

Maintaining fluid balance

The nurse is preparing discharge instructions for an older adult client recovering from respiratory acidosis caused by restrictive lung disease and pneumonia. Which topics should the nurse include in the discharge teaching for this client? Select all that apply. Obtain annual influenza immunization. Engage in frequent hand washing. Avoid crowds. Restrict fluids. Cover the nose and mouth when coughing.

Obtain annual influenza immunization. Engage in frequent hand washing. Avoid crowds. Cover the nose and mouth when coughing.

The nurse is planning care for a client with osteoarthritis​ (OA). Which nursing diagnosis is a priority for the nurse to​ address? Skin​ Integrity, Impaired Lifestyle, Sedentary Family​ Processes, Interrupted Pain, Chronic

Pain, Chronic

Using the provided ABG values, what is the acid base balance shown? pH= 7.26 HCO3= 12mEq/L PCO2= 28mmHg

Partially compensated respiratory acidosis

The nurse is caring for a client who has cerebral palsy​ (CP). Which intervention should the nurse use to promote flexibility and prevent​ contractures? Administer mood stabilizers Perform​ range-of-motion (ROM) exercises Offer the use of assistive devices Provide muscle relaxants

Perform range-of-motion (ROM) exercises

The parents of a young client newly diagnosed with​ attention-deficit/hyperactivity disorder​ (ADHD) are concerned about the school environment and the​ child's grades. Which suggestion should the nurse encourage the parents to discuss with the​ child's teacher?​ (Select all that​ apply.) Place the child in the front of the classroom close to the teacher. Provide a quiet area for examinations and extra time if necessary. Place the child in the back of the classroom. Don't allow the child to do special tasks or run errands without supervision. Allow the child to have snacks in class.

Place the child in the front of the classroom close to the teacher, provide a quiet area for examinations and extra time if necessary, don't allow the child to do special tasks or run errands without supervision

The nurse caring for a child recently diagnosed with cerebral palsy (CP) is discussing the plan of care with the parents. Which should the nurse identify as a major goal of therapy for this child? Promoting optimal global development Curing the underlying defect Reversing the degenerative processes that have occurred Increasing the child's IQ level

Promoting optimal global development

The nurse is caring for a child diagnosed with autism spectrum disorder (ASD) who is being admitted to the hospital with dehydration. Which action by the nurse is appropriate when the child arrives to the care area? Take the child on a tour of the pediatric unit. Take the child to the playroom for arts and crafts. Orient the child to a four-bed patient room Quietly orient the child to a single-bed hospital room.

Quietly orient the child to a single-bed hospital room.

A client with a history of relapsing-remitting multiple sclerosis (MS) is expecting her first child. Which of the following nursing interventions would be indicated for this client? Discuss the client's options for pain control during labor, as her contractions will be especially severe. Tell the client to expect a period of remission after delivery. Instruct the client to expect an exacerbation of symptoms while pregnant. Suggest the client seek reproductive counseling

Suggest the client seek reproductive counseling

The school nurse is helping to create an individualized education plan​ (IEP) for a young client with​ attention-deficit/hyperactivity disorder​ (ADHD). Which behavioral goal should the nurse include in the plan of​ care? The client will achieve school performance to minimum competency. The client will respect the boundaries of others. The client will accurately manage medication administration. The client will demonstrate a decrease in attentiveness.

The client will respect the boundaries of others.

An adult client seeks care for attention-deficit/hyperactivity disorder​ (ADHD). Which items in the collected history would support this diagnosis. high level of contentment, positive work relations, and mild temperment forgetfulness, anxiety, and trouble multitasking passive attitude, low energy, and strong relationships excessive planning, poor sleep, and high stress

forgetfulness, anxiety, and trouble multitasking

Serum potassium of 3.25 mEq/L indicates hypocalcemia hypernatremia hypokalemia hyperkalemia

hypokalemia

A mother of a toddler questions what can be done to assist her child's development. All of the following are ways to help except. provide age appropriate toys such as blocks Speak with child using single step directions limit introduction of solid foods read simple short stories with the child

limit introduction of solid foods

A client is admitted to the hospital with sudden, severe abdominal pain. The client is diagnosed with respiratory alkalosis. Which arterial blood gas value does the nurse document to support this diagnosis? pH is 7.33 and PaCO2 is 36. pH is 7.35 and PaO2 is 88. pH is 7.51 and HCO3 is 30. pH is 7.47 and PaCO2 is 25.

pH is 7.47 and PaCO2 is 25

The nurse is assessing a client suspected of having multiple sclerosis. Which manifestation should the nurse place as the top priority? stress incontinence sexual dysfunction tingling sensations vertigo

vertigo

The nurse is caring for a client with third spacing. Which information should the nurse use to explain this health problem to the​ client's family? "Fluid moves into an area where it is not available to support normal physiological functioning" "Fluid in the blood vessels is unavailable for the body to​ use." "Fluid moves into the fatty tissue under the​ skin." ​"Fluid leaves the body through increased​ urination."

"Fluid moves into an area where it is not available to support normal physiological functioning"

A middle-aged female client states to the nurse, "I have noticed a slight tremor in my left hand when it's at rest. I think I might have Parkinson disease because my mother had it." Which response by the nurse is the most appropriate? "You probably don't have Parkinson disease. Your mother was probably exposed to a toxin that caused her illness." "You shouldn't worry too much, because Parkinson disease has a higher prevalence in males." "It is unlikely that you have the same illness as your mother." "Having a close relative with Parkinson disease can increase your chance of developing it as well."

"Having a close relative with Parkinson disease can increase your chance of developing it as well."

The nurse working at an eye center is providing teaching to a community group. Which statement should the nurse​ include? ​"Most eye injuries are​ preventable." ​"Older adult men are at the greatest risk for eye​ injuries." "Most individuals that incur an eye injury are wearing​ goggles." ​"Children incur more eye injuries than​ adults."

"Most eye injuries are preventable"

While assessing a client with eye​ pain, the nurse finds​ red, cloudy conjunctiva and swollen eyelids. The nurse should suspect which eye​ injury? Penetrating trauma injury to the eye Chemical burn of the eye Corneal abrasion Detached retina

Chemical burn of the eye

The nurse is assessing a​ 3-year-old child with autism spectrum disorder​ (ASD). In which area should the nurse expect to find​ impairments? (Select all that​ apply.) Communication Knowing their own name Social adaptability Ability to engage in complex thought process Ability to organize responses to situations

Communication, Social adaptability, ability to organize responses to situations

The wife of a client with Parkinson disease (PD) expresses frustration about trying to communicate with her husband. What can the nurse do to facilitate communication between the client and spouse? Consult with speech therapy for exercises to aid the client with speech and language. Suggest the client and spouse communicating by writing. Recommend that the client and spouse learn sign language. Suggest that the spouse obtain a hearing aid.

Consult with speech therapy for exercises to aid the client with speech and language.

After performing a physical assessment, the nurse suspects that a client is experiencing manifestations of osteoarthritis (OA). Which finding supports the nurse's suspicion? (select all that apply) Leg tremors Crepitation Reduced joint flexibility Joint stiffness Joint tenderness

Crepitation, reduced joint flexibility, joint stiffness, joint tenderness

A client with Parkinson disease​ (PD) is prescribed an anticholinergic agent to treat tremors and rigidity. The nurse should teach the client about which adverse effect they may experience from this​ medication? (Select all that​ apply.) Tremors Drooling Dry mouth Loss of perspiration Rigidity

Dry mouth Loss of perspiration

In clients with Parkinson disease, increasing doses of and long-term exposure to levodopa can cause which of the following conditions? Compulsive behavior Dyskinesia Insomnia Hypertension

Dyskinesia

The nurse is assessing an older adult client. Which finding should cause the nurse to suspect the client has Parkinson disease​ (PD)? (Select all that​ apply.) The client has hand tremors at rest. The​ client's blood pressure increases when the client stands up. The client does not remember what he ate for breakfast. The​ client's facial expression shows no emotion. The client has slurred speech.

The client has hand tremors at rest. The client does not remember what he ate for breakfast. The​ client's facial expression shows no emotion. The client has slurred speech.

A client with CHF has an order for furosemide (Lasix) IVP. What will the nurse assess first to evaluate the effectiveness of the medication? Leg circumference Lung sounds Urine output Serum electrolytes

Urine output

What is an example of an objective family burden? limited access to specialized care amount of unsecured financial debt criticism by extended family member as to care management options child requiring monitoring for self-harm

amount of unsecured financial debt

The most common disorder that increases a client's risk for respiratory alkalosis is: a cardiovascular disorder. a chronic respiratory infection disorder a congenital disorder. an anxiety disorder.

an anxiety disorder