Med Surg II #1
A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? A. Keep the client in a side-lysing position B. Document the duration of the seizure C. Reorient the client to the environment D. Provide client hygiene
A
A nurse is reinforcing teaching with a client who has parkinson's disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include in the teaching? A. Rise slowly when standing B. Expect urine to become dark-colored C. Avoid foods containing tyramine D. Report any skin discoloration
A
A nurse is teaching a client who has a new diagnosis of rheumatoid arthritis. Which of the following statements should the nurse include in the teaching? A. You can experience morning stiffness when you get out bed B. You can experience abdominal pain C. You can experience weight gain D. You can experience low blood sugar
A
A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? (Select all that apply) A. Urinalysis B. Erythrocyte segmentation rate (ESR) C. BUN D. Antinuclear antibody (ANA) titer E. WBC count
B D E
A nurse is assessing a client who has a seizure disorder. The client reports he thinks he is about to have a seizure. Which of the following actions should the nurse implement? (select all that apply) A. Provide privacy B. Ease the client to the floor if standing C. Move furniture away from the client D. Loosen the client clothing E. Protect the client's head with padding F. Restrain the client
A B C D E
A nurse is caring for a client who has experienced a right-hemispheric stroke. Which of the following are expected finings? (Select all that apply) A. Impulse control difficulty B. Left hemiplegia C. Loss of depth perception D. Aphasia E. Lack of situational awareness
A B C E
A nurse is planning care for a client who has dysphagia and a new dietary prescription. which of the following should the nurse include in the plan of care? (Select all that apply) A. Have suction equipment available for use B. Feed the client thickened liquids C. Place food on the unaffected side of the client's mouth D. Assign an assistive personnel to feed the client slowly E. Teach the client to swallow with her neck flexed.
A B C E
A nurse is providing information to a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include in the information? (select all that apply) A. Apply heat to hints to alleviate pain B. Ice inflamed joints following activity C. Install an elevated toilet seat D. Take tub baths E. Complete high-energy activities in the morning
A B C E
A nurse is admitting a client to the orthopedic unit following a total knee arthroplasty. Which of the following actions by the nurse are appropriate? (Select all that apply) A. Check continuous passive motion device settings B. Palpate dorsal pedal pulses C. Place a pillow behind the knee D. Elevate heels off bed E. Apply heat therapy to incision
A B D
A nurse is beginning a physical assessment of a client who has a new diagnosis of multiple sclerosis which of the following findings should the nurse expect? (Select all that apply) A. Areas of paresthesia B. Involuntary eye movements C. Alopecia D. Increased salivation E. Ataxia
A B E
A nurse is caring for a client who has global aphasia (both receptive and expressive) which of the following should the nurse include in the client's plan of care? (Select all that apply) A. Speak to the client at a slower rate B. Assist the client to use flash cards with pictures C. Speak to the client in a loud voice D. Complete sentences that the client cannot finish E. Give instruction one step at a time
A B E
A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (Select all that apply) A. Recent influenza B. Decreased range of motion C. Hypersalivation D. Increased blood pressure E. Pain at rest
A B E
A nurse is planning discharge teaching for a client who had a total hip arthroplasty. Which of the following should the nurse include in the teaching? (Select all that apply) A. Clean the incision daily B. Turn the toes inward when sitting or lying C. Sit in a straight-backed armchair D. Bend at the waist when putting on socks E. Use a raised toilet seat
A C E
A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? (select all that apply) A. Heberden's nodes B. selling of all joints C. Small body frame D. Enlarged joint size E. Limp when walking
A D E
A nurse is completing a preoperative teaching plan for a client who is scheduled to have a total hip arthroplasty. Which of the following should the nurse include in the teaching plan? (Select all that apply) A. Encourage complete autologous blood donation B. Sit in a low reclining chair C. Instruct the client to roll onto the operative hip D. Use an abductor pillow when turning the client E. Perform isometric exercises.
A D E
A nurse is caring for a client who has left homonymous hemianopsia. Which the following is an appropriate nursing intervention? A. Teach the client to scan to the right to see objects not he right side of her body B. Place the bedside table on the right side of the bed C. Orient the client to the food on her plate using the clock method D. Place the wheelchair on the client's let side
B
A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eye lids
B
A nurse is providing information about capsaicin cream to a clint who reports continuous knee pain from osteoarthritis. Which of the following information should the nurse include in the discussion? A. Continous pain relief is provided B. Inspect for skin irritation and cuts prior to application C. Cover the area with tight bandages after application D. apply the medication ever 2 hr during the day
B
A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. Which of the following information should the nurse include in the review? (select all that apply) A. avoid overwhelming fatigue. B. remove caffeinated products from the diet C. Limit looking at flashing lights D. Perform aerobic exercise E. Limit episodes fo hypoventilation F. Use of aerosol hairspray is recommended
B C
A nurse is assessing a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? (Select all that apply) A. Skin reddened over the joint B. Pain when bearing weight C. Joint crepitus D. Swelling of the affected joint E. Limited joint motion
B C D E
A nurse is assessing a client for manifestations of parkinson's disease. Which of the following are expected findings? (Select all that apply) A. Decreased vision B. Pill-rolling tremor of the fingers C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression
B C D F
A nurse is developing a plan of care for the nutritional needs of a client who has stage IV parkinson's disease. Which actions should the nurse include in the pan of care? (select all that apply) A. Provide three large balanced meals daily B. Record diet and fluid intake daily C. Document weight every other week D. Place the client in Fowler's position to eat E. Offer nutritional supplements between meals
B E
A nurse is assessing a client who has experienced a left-hemispheric stroke. Which of the following is an expected finding? A. Impulse control difficulty B. Poor judgment C. Inability to recognize familiar objects D. Loss of depth perception
C
A nurse is caring for a client who displays signs of stage III Parkinson's disease. Which of the following actions should the nurse include in the plan of care? A. Recommend a community support group B. Integrate a daily exercise routine C. Provide a walker for ambulation D. Perform ADLs for the client
C
A nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. Which of the following statements should the nurse include in the teaching? A. It is safe to use microwaves that are 1,200 watts or less B. You should avoid the use of CT scans with contrast C. You should place a magnet over the implantable device when you feel an area occurring D. It is recommended that you use ultrasound diathermy for pain management.
C
A nurse is providing discharge instructions to a female client who has a prescription for phenytoin. Which of the following information should the nurse include? A. Consider taking oral contraceptives when on this medication B. Watch for receding gums when taking the medication C. take the medication at the same time every day D. Provide a urine sample to determine therapeutic levels of the medication
C
A nurse is caring for a client who has Parkinson's disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. Teach the client to walk more quickly when ambulating B. Complete passive range-of-motion exercises daily C. Place the client on a low-protein, low-calorie diet D. Give the client extra time to perform activities
D
A nurse is riving the health record of a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure? A. Age 78 years B. History of cancer C. previous joint replacement D. Bronchitis 2 weeks ago
D
A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? A. This medication will help you with your tremors B. This medication will help you with your bladder function C. This medication may cause your skin to bruise easily D. This medication may cause your skin to appear yellow in color
D