Neuro Nclex Questions
A client is being monitored for transient ischemic attacks. This client is oriented, can open the eyes spontaneously, and follow commands. What is the Glasgow coma scale score?
15
The nurse should assess an older adult with macular degeneration for: a. Loss of central vision b. Loss of peripheral vision c. Total blindness d. Blurring of vision
A. Loss of central vision
Which of the following nursing measures is not appropriate when providing oral hygiene for a client who has had a stroke? a. Placing the client on the back with a small pillow under the head b. Keeping portable suctioning equipment at the bedside c. Opening the client's mouth with a padded tongue blade. d. Cleaning the client's mouth and teeth with a toothbrush.
A. Placing the client on the back with a small pillow under the head
In planning care for the client who has had a stroke, the nurse should obtain a history of the client's functional status before the stroke because a. The rehabilitation plan will be guided by it b. Functional status before the stroke will help predict outcomes c. It will help the client recognize physical limitations d. The client can be expected to regain most functional status
A. The rehabilitation plan will be guided by it
Which of the following goals is collaboratively established by the client with Parkinson's disease, nurse, and physical therapist? a. To maintain joint flexibility b. To build muscle strength c. To improve muscle endurance d. To reduce ataxia
A. To maintain joint flexibility
The nurse is teaching a client about taking prophylactic warfarin sodium (Coumadin). Which statement indicates that the client understands how to take this drug? Select all that apply. a. "The drug's action peaks in two hours." b. "Maximum dosage is not achieved until 3 to 4 days after starting medications." c. Effects of the drug continue for 4 to 5 days after discontinuing medication." d. "Protamine sulfate is the antidote for warfarin." e. " I should have my blood levels tested periodically."
B. "Maximum dosage is not achieved until 3 to 4 days after starting medications." C. "Effects of the drug continue for 4 to 5 days after discontinuing medication." E. "I should have my blood vessels tested periodically."
A client is experiencing mood swings after a stroke and often has episodes of tearfulness that are distressing to the family. Which is the best technique for the nurse to instruct family members to try when the client experiences a crying episode? a. Sit quietly with the client until the episode is over b. Ignore the behavior c. Attempt to divert the client's attention d. Tell the client that this behavior is unacceptable
C. Attempt to divert the client's attention
A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. The nurse should first: a. Ask what medications the client is taking b. Complete a history and health assessment c. Identify the time of onset of the stroke d. Determine if the client is scheduled for any surgical procedures
C. Identify the time and onset of the stroke
Tonometry is performed on a suspected diagnosis of glaucoma. The nurse looks at the test results documented in the client's chart, knowing that which is the range for normal intraocular pressure? a. 2 to 7 mm Hg b. 10 to 21 mm Hg c. 22 to 30 mm Hg d. 31 to 35 mm Hg
b. 10 to 21 mm hg
A client is prescribed an eyedrop and an eye ointment for the right eye. How should the nurse best administer the medications? a. Administer the eyedrop first, followed by the eye ointment b. Administer the eye ointment first, followed by the eyedrop c. Administer the eyedrop, wait 15 minutes, and administer the eye ointment d. Administer the eye ointment, wait 15 minutes, and administer the eyedrop
a. Administer the eyedrops first, followed by the ointment
During the early postoperative period, a client who has undergone a cataract extraction complains of nausea and severe eye pain over the operative site. What should be the initial nursing action? a. Call the health care provider b. Reassure the client that this is normal c. Turn the client onto his or her operative side d. Administer the prescribed pain medication and antiemetic
a. Call the health care provider
Which of the following should the nurse include in the discharge plan for a client with MS who has an impaired peripheral sensation? Select all that apply a. Carefully test the temperature of bath water b. Avoid kitchen activities because of the risk of injury c. Avoid hot water bottles and heating pads d. inspect the skin daily for injury or pressure points e. Wear warm clothing when outside in cold temperatures
a. Carefully test the temperature of bath water c. Avoid hot water bottles and heating pads d. inspect the skin daily for injury or pressure points e. Wear warm clothing when outside in cold temperatures
Which of the following is an expected outcome for a client with Parkinson's disease who has a pallidotomy improved? a. Functional ability b. Emotional stress c. Alertness d. Appetite
a. Functional ability
A client is having a cataract removed and will use eyeglasses after the surgery. The nurse should develop a teaching plan that includes which of the following? Select all that apply a. Images will appear to be one-third larger b. Look through the center of the glasses c. The changes will be immediate d. Use handrails when climbing stairs e. Stay out of the sun for 2 weeks
a. Images will appear to be one-third larger b. Look through the center of the glasses d. Use handrails when climbing stairs
The nurse is teaching the family of a client with dysphagia about decreasing the risk of aspiration while eating. Which of the following strategies should the nurse include in the teaching plan. Select all that apply a. Maintaining an upright position while eating b. Restricting the diet to liquids until swallowing improves c. Introducing foods on the unaffected side of the mouth d. Keeping distractions to a minimum. e. Cutting food into large pieces of finger food
a. Maintaining an upright position while eating c. Introducing foods on the unaffected side of the mouth d. Keeping distractions to a minimum
The nurse is planning the care of a hemiplegic client to prevent joint deformities of the arm and hand. Which of the following positions are appropriate? Select all that apply. a. Placing a pillow in a axilla so the arm is away from the body b. Inserting a pillow under the slightly flexed arm so the hand is higher than the elbow c. Immobilizing the extremity in a sling d. Positioning a hand cone in the hand so the fingers are barely flexed e. Keeping the arm at the side using a pillow
a. Placing a pillow in the axilla so the arm is away from the body. b. Inserting a pillow under the slightly flexed arm so the hand is higher than the elbow d. Positioning a hand cone in the hand so the fingers are barely flexed
When communicating with a client who has aphasia, which of the following are helpful? Select all that apply a. Present one thought at a time b. Avoid writing messages c. Speak with normal volume d. Make use of gestures e. Encourage pointing to the needed object
a. Present one thought at a time c. Speak with normal volume d. make use of gestures e. encourage pointing to the needed object
After returning home, a client who has had cataract surgery will need to continue to instill eyedrops in the affected eye. The client is instructed to apply slight pressure against the nose at the inner canthus of the eye after instilling the eyedrops. The expected outcome of applying pressure is that the pressure: a. Prevents the medication from entering the tear duct b. Prevents the drug from running down the client's face c. Allows the sensitive cornea to adjust to the mediation d. Facilitates distribution of the medication over the eye surface
a. Prevent the medication from entering the tear duct
The nurse is instructing the client about postoperative care following cataract removal. What position should the nurse teach the client to use? a. Remain in a semi-fowler's position b. Position the feet higher than the body c. Lie on the operative side d. Place the head in dependent position
a. Remain in a semi-fowlers position
Which of the following is not a realistic outcome to establish with a client who has MS? The client will develop: a. Joint mobility b. Muscle strength c. Cognition d. Mood elevation
c. Cognition
The nurse is assigned to care for a client with complete right-sided hemiparesis. Which characteristics are associated with this condition? Select all that apply a. The client is aphasic b. The client has weakness in the face and tongue c. To The client has weakness on the right side of the body d. The client has complete bilateral paralysis of the arms and legs e. The client has lost the ability to move the right arm but is able to walk independently f. The client has lost the ability to ambulate independently but is able to feed and bathe himself on herself without assistance
a. The client is aphasic b. The client has weakness in the face and tongue c. The client has weakness on the right side of the body
The nurse is performing a neurological assessment of a client who has sustained damage to the frontal cortex. Which of the following deficits will the nurse look for during assessment? a. The inability to tell how a mouse and cat are alike b. The inability to maintain steady balance for the Romberg test c. Absence of movements below the waist d. Intentional tumors
a. The inability to tell how a mouse and a cat are alike
The clinic nurse is preparing to test the visual acuity of a client, using a Snellen chart. Which identifies the accurate procedure for this visual acuity test? a. The right eye is tested, followed by the left eye, and then both eyes are tested b. Both eyes are assessed together, followed by an assessment of the right eye and then the left eye c. The client is asked to stand at a distance of 40 feet from the chart and is asked to read the largest line on the chart d. The client is asked to stand at a distance of 40 feet from the chart and to read the line that can be read 200 feet away by an individual with unimpaired vision
a. The right eye is tested, followed by the left eye, and then both eyes.
Which of the following is a potential complication following cataract surgery? Select all that apply a. Acute bacterial endophthalmitis b. Retrobulbar hemorrhage c. Rupture of the posterior capsule d. Suprachoroidal hemorrhage e. Vision loss
a. acute bacterial endopthalmitis e. vision loss
The nurse is preparing a teaching plan for a client who is undergoing cataract extraction with intraocular implantation. Which home care measures should the nurse include in the plan? Select all that appl a. Avoid activities that require bending over b. Contact the surgeon if eye scratchiness occurs c. Place an eye shield on the surgical eye at bedtime d. Episodes of sudden severe pain in the eye are expected e. Contact the surgeon if a decrease in visual acuity occurs f. Take acetaminophen (Tylenol) for minor eye discomfort
a. avoid activities that require bending over c. place an eye shield on the surgical eye at bedtime e. contact the surgeon if a decrease in visual acuity occurs f. Take acetaminophen (Tylenol) for minor eye discomfort
The nurse is preparing a teaching plan for a client who had a cataract extraction with intraocular implantation. Which home care measures should the nurse include in the plan? Select all that apply. a. avoid activities that require bending over b. contact the surgeon if eye scratchiness occurs c. Take acetaminophen for minor eye discomfort d. Expect episodes of sudden severe pain in the eye e. place an eye shield on the surgical eye at bedtime f. contact the surgeon if a decrease in visual acuity occurs
a. avoid activities that require bending over c. take acetaminophen for minor eye discomfort e. place an eye shield on the surgical eye at bedtime f. contact the surgeon if a decrease in visual acuity occurs
The nurse is assessing the client's pupils following a sports injury. Which of the following assessment findings indicates a neurologic concern? Select all that apply. a. unequal pupils b. pupil reactions quick c. pinpoint pupils d. absence of pupillary response e. pupils react to light
a. unequal pupils c. pin point pupils d. absence of pupillary response
The nurse is preparing to administer eyedrops. Which interventions should the nurse take to administer the drops? Select all that apply a. Wash hands b. Put gloves on c. Place the drop in the conjunctival sac d. Pull the lower lid down against the cheek bone e. Instruct the client to squeeze the eyes shut after instilling the eyedrop f. Instruct the client to tilt the head forward, open the eyes, and look down
a. wash hands b. put gloves on c. Place the drop in the conjunctival sac d. Instruct the client to squeeze the eye shut after instilling the eye drop
The client with a cataract tells the nurse about being afraid of being awake during eye surgery. Which of the following responses by the nurse would be the most appropriate? a. "have you ever had any reactions to local anesthetics in the past?" b. "what is it that disturbs you about the idea of being awake?" c. "by using a local anesthetic, you won't have nausea and vomiting after the surgery." d. "there's really nothing to fear about being awake. You'll be given a medication that will help you relax"
b. "What is it that disturbs you about the idea of being awake?"
A client was just admitted to the hospital to rule out a GI bleed. The client has brought several bottles of medications prescribed by different specialist. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse identify as the cause of the client's complaint? a. Doxycycline (Vibramycin) b. Acetylsalicylic acid (asprin) c. Atropine sulfate (Isopto Atropine) d. Diltiazem hydrochloride (Cardizem)
b. Acetylsalicylic acid (Aspirin)
A client has a neurological deficit involving the limbic system. Which assessment finding is specific to this type of deficit? a. In disoriented to person, place, and time b. Affect is flat, with periods of emotional lability c. Cannot recall what was eaten for breakfast today d. Demonstrates inability to add and subtract; does not know who is the president of the United States
b. Affect is flat, with periods of emotional lability
A client is ordered to undergo CT of the brain with IV contrast. Before the test, the nurse should complete which action first? a. Obtain a blood sample to evaluate BUN and creatinine concentrations b. Assess the client for medication allergies c. Obtain two large-bore IV lines d. Maintain the client NPO for 6 hours before the test.
b. Assess the client for medication allergies
Which term refers to the inability to coordinate muscle movements, resulting in difficulty walking? a. agnosia b. ataxia c. spasticity d. rigidity
b. Ataxia
Which medication, if prescribed for the client with glaucoma, should the nurse question? a. Betaxolol (Betoptic) b. Atropine sulfate (Isopto Atropine) c. Pilocarpine hydrochloride (Isopto Carpine) d. Pilocarpine (Ocusert Pilo-20, Ocusert Pilo-40)
b. Atropine sulfate (Isoptro Atropine)
A client who has been treated for chronic open-angle glaucoma (COAG) for 5 years asks the nurse, "How does glaucoma damage my eyesight?" the nurse's reply should be based on the knowledge that COAG: a. Results from chronic eye inflammation b. Causes increased intraocular pressure c. Leads to detachment of the retina d. Is caused by decreased blood flow to the retina
b. Causes increased intraocular pressure
The nurse observes the client instill eyedrops. The client says, "I just try to hit the middle of my eyeball so the drops don't run out of my eye." The nurse explains to the client that this method may cause: a. Scleral staining b. Corneal injury c. Excessive lacrimation d. Systemic drug absorption
b. Corneal injury
To decrease intraocular pressure following cataract surgery, the nurse should instruct the client to avoid: a. Lying supine b. Coughing c. Deep breathing d. Ambulation
b. Coughing
A client with a suspected brain tumor is scheduled for a computed tomography (CT) scan. What should the nurse do when preparing the client for this test? a. Immobilize the neck before the client is moved onto a stretcher. b. Determine whether the client is allergic to iodine, contrast dyes, or shellfish. c. Place a cap over the client's head d. Administer a sedative as ordered.
b. Determine whether the client is allergic to iodine, contrast dyes, or shellfish.
In preparation for cataract surgery, the nurse is to administer cyclopentolate (Cyclogyl) eyedrops. The nurse understands that which characterizes the medication action? a. Produces miosis of the operative eye b. Dilates the pupil of the operative eye c. Constricts the pupil of the operative eye d. Provides lubrication to the operative eye
b. Dilates the pupil of the operative eye
The nurse is to instill drops of phenylephrine hydrochloride (Neo-Synephrine) into the client's eye prior to cataract surgery. Which of the following is the expected outcome? a. Dilation of the pupil and blood vessels b. Dilation of the pupil and constriction of blood vessels c. Constriction of the pupil and constriction of blood vessels d. Constriction of the pupil and dilation of blood vessels
b. Dilation of the pupil and constriction of the blood vessel
The nurse is teaching a client with bladder dysfunction from multiple sclerosis (MS) about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply a. Restrict fluids to 1,000 mL/24 hr b. Drink 400 to 500 mL with each meal c. Drink fluids midmorning, midafternoon, and late afternoon d. Attempt to void at least every 2 hr e. Use intermittent catheterization as needed
b. Drink 400 to 500 mL with each meal c. Drink fluids mid-morning, mid afternoon, and late afternoon
The nurse is assisting a client with a stroke who has homonymous hemianopia. The nurse should understand that the client will: a. Have a preference for foods high in salt b. Eat food on only half of the plate c. Forget the names of foods d. Not to be able to swallow liquids
b. Eat food only on half of the plate
A client with glaucoma is to receive 3 gtt of acetazolamide (Diamox) in the left eye. What should the nurse do? a. Ask the client to close the right eye while administering the drug in the left eye b. Have the client look up while the nurse administers the eyedrops c. Have the client lift the eyebrows while the nurse positions the hand with the dropper on the client's forehead d. Wipe the eyes with a tissue following administration of the drops
b. Have the client look up while the nurse administers eye drops
The nurse is assisting a client who has new-onset vision loss to transition to home from the hospital. The client can see shadow and light in the right eye only. When at home, the client is at greatest risk for which of the following? a. Loss of sensory perception b. Injury from falls c. Denial of changes in vision d. Isolation from social activities
b. Injury from falls
Which of the following should the nurse provide as part of the information to prepare the client for tonometry? a. Oral pain medication will be given before the procedure b. It is a painless procedure with no adverse effects c. Blurred or double vision may occur after the procedure d. Medication will be given to dilate the pupils before the procedure
b. It is a painless procedure with no adverse effects
The nurse is preparing a client with MS for discharge from the hospital to home. The nurse should tell the client: a. You will need to accept the necessity for a quiet and inactive lifestyle b. Keep active, use stress reduction strategies, and avoid fatigue c. Follow good health habits to change the course of the disease d. Practice using the mechanical aids that you will need when future disabilities arise
b. Keep active, use stress reduction techniques, and avoid fatigue
Betaxolol hydrochloride eyedrops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side/adverse effects of this medication? a. Monitoring temperature b. Monitoring blood pressure c. Assessing peripheral pulses d. Assessing blood glucose level
b. Monitoring blood pressure
A client with Parkinson's disease is prescribed levodopa therapy. Improvement in which of the following indicates effective therapy? a. Mood b. Muscle rigidity c. Appetite d. Alertness
b. Muscle rigidity
A client with Parkinson's disease needs a long time to complete morning care but becomes annoyed when the nurse offers assistance and refuses all help. Which action is the nurse's best initial response in this situation? a. Tell the client firmly that he or she needs assistance and help with the morning care b. Praise the client for the desire to be independent and give extra time and encouragement c. Tell the client that he or she is being unrealistic about the abilities and must accept the fact that he or she needs help d. Suggest to the client to at least modify the morning care routine if he or she insists on self-care
b. Praise the client for the desire to be independent and give extra time and encouragement
What is a priority nursing assessment in the first 24 hr after admission of the client with a thrombotic stroke? a. Cholesterol level b. Pupil size and pupillary response c. Bowel sounds d. Echocardiogram
b. Pupil size and pupillary constriction
1. A client with MS lives with her daughter and 3 year old granddaughter. The daughter asks the nurse what she can do at home to help her mother. Which of the following measures would be most beneficial? a. Psychotherapy b. Regular exercise c. Daycare for the granddaughter d. Weekly visits by another person with MS
b. Regular activities
Which of the following techniques is not appropriate when the nurse changes a client's position in bed if the client has hemiparalysis? a. Rolling the client onto the side b. Sliding the client to move up in bed c. Lifting the client when moving the client up in bed d. Having the client help lift off the bed using a trapeze
b. Sliding the client to move up in bed
Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)? a. Double vision b. Sudden bursts of energy c. Weakness in the extremities d. Muscle tremors
b. Sudden bursts of energy
A client who has sustained a head injury to the parietal love cannot identify a familiar touch. The nurse knows that this deficit is which of the following? a. Visual agnosia b. Tactile agnosia c. Ataxia d. Positive Romberg
b. Tactile agnosia
A client has had MS for 15 yr and has received various drug therapies. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used? a. The client exhibits intolerance to many drugs b. The client experiences spontaneous remissions from time to time c. The client requires multiple drugs simultaneously d. The client endures long periods of exacerbation before the illness responds to a particular drug.
b. The client experiences spontaneous remissions from time to time
The nurse observes that when a client with Parkinson's disease unbuttons the shirt, the upper arm tremors disappear. Which statement best guides the nurse's analysis of this observation about the client's tremors? a. The tremors are probably psychological and can be controlled at will b. The tremors sometimes disappear with purposeful and voluntary movements c. The tremors disappear when the client's attention is diverted by some activity d. There is no explanation for the observation; it is a chance occurrence
b. The tremors sometimes disappear with purposeful and voluntary movements
At what time of day should the nurse encourage a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? a. Early in the morning, when the client's energy level is high b. To coincide with the peak action of drug therapy c. Immediately after a rest period d. When family members will be available
b. To coincide with the peak action of drug therapy
Which of the following is an initial sign of Parkinson's disease? a. Rigidity b. Tremor c. Bradykinesia d. Akinesia
b. Tremor
For the client who is experiencing expressive aphasia, which nursing intervention is most helpful in promoting communication? a. Speaking loudly and slowly b. Using a "picture board" for the client to point to pictures c. Writing directions so client can read them d. Speaking in short sentences
b. Using a "picture board" for the client to point to pictures
The nurse should conduct a focused assessment with the client with multiple sclerosis for risk of which of the following? Select all that apply a. Dehydration b. Falls c. Seizures d. Skin breakdown e. Fatigue
b. falls c. seizures e. fatigue
A miotic medication has been prescribed for the client with glaucoma and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client? a. "the medication will help dilate the eye to prevent pressure from occurring." b. "the medication will relax the muscles of the eyes and prevent blurred vision." c. "the medication causes the pupil to constrict and will lower the pressure in the eye." d. "the medication will help block the responses that are sent to the muscles in the eye."
c. "the medication causes the pupil to constrict and will lower the pressure in the eye."
The nurse is observing a student nurse administer eyedrops. What should the nurse instruct the student to do? a. Move the dropper to the inner canthus b. Have the client raise the eyebrows c. Administer the drops in the center of the lower lid d. Have the client squeeze both eyes after administering the drops
c. Administer the eye drops in the center of the lower lid
During the first 24 hr after thrombolytic treatment for an ischemic stroke, the primary goal is to control the client's: a. Pulse b. Respirations c. Blood pressure d. Temperature
c. Blood pressure
A health care provider has prescribed carbidopa-levodopa (Sinetmet) four times per day for a client with Parkinson's disease. The client wants "to end it all now that the Parkinson's disease has progressed." What should the nurse do? Select all that apply a. Explain that the new prescription for Sinemet will treat the depression b. Encourage the client to discuss feelings as the Sinemet is being administered c. Contact the health care provider before administering the Sinemet d. Determine if the client is on antidepressants or monoamine oxidase (MAO) inhibitors e. Determine if the client is at risk for suicide
c. Contact the health care provider before administering Sinetmet d. Determine if the client is on antidepressants or MAOIs e. Determine if the client is at risk for suicide
What is the expected outcome of thrombolytic drug therapy for stroke? a. Increased vascular permeability b. Vasoconstriction c. Dissolved emboli d. Prevention of hemorrhage
c. Dissolved emboli
Which intervention should the nurse suggest too help a client with MS avoid episodes of urinary incontinence? a. Limit fluid intake to 1,000 mL/day b. Insert an indwelling urinary catheter c. Establish a regular voiding schedule d. Administer prophylactic antibiotics, as prescribed
c. Establish a regular voiding schedule
The nurse is admitting a client with glaucoma. The client brings prescribed eyedrops from home and insists on using them in the hospital. The nurse should: a. Allow the client to keep the eyedrops at the bedside and use as prescribed on the bottle b. Place the eyedrops in the hospital medication drawer and administer as labeled on the bottle c. Explain to the client that the physician will write a prescription for the eyedrops to be used at the hospital d. Ask the client's wife to assist the client in administering the eyedrops while the client is in the hospital
c. Explain to the client that the physician will write a prescription for the eyedrops to be used at the hospital
The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care? a. Avoid overuse of the eyes b. Decrease the amount of salt in the diet c. Eye medications will need to administer for life d. Decrease fluid intake to control the intraocular pressure
c. Eye medications will need to be administered for life
Which of the following is the most effective means of preventing plantar flexion in a client who has had a stroke with residual paralysis? a. Place the client's feet against a firm footboard. b. Reposition the client every 2 hr c. Have the client wear ankle-high tennis shoes at intervals throughout the day d. Massage the client's feet and ankles regularly
c. Have the client wear ankle high tennis shoes at intervals throughout the day.
A client has been diagnosed with an acute episode of angle-closure glaucoma. The nurse plans the client's nursing care with the understanding that acute angle-closure glaucoma: a. Frequently resolves without treatment b. Is typically treated with sustained bed rest c. Is a medical emergency that can rapidly lead to blindness d. Is most commonly treated with steroid therapy
c. Is a medical emergency that can rapidly lead to blindness
When the nurse enters the client's room, the nurse perceives that the client is staring straight ahead. Which of the following is the best course of action for the nurse to take next? a. Hold an interdisciplinary meeting on the client's behalf promptly b. Consult with psychiatry c. Listen to the client and observe the body language d. Address the client by first name upon entering the room
c. Listen to the client and observe the body language
The nurse develops a teaching plan for a client newly diagnosed with Parkinson's disease. Which of the following topics that the nurse plans to discuss is the most important? a. Maintaining a balanced nutritional diet b. Enhancing the immune system c. Maintaining a safe environment d. Engaging in diversional activity
c. Maintaining a safe environment
A client has a history of macular degeneration. While the hospital, the priority nursing goal will be to: a. Provide education regarding community services for clients with adult macular degeneration (AMD) b. Provide health care related to monitoring the eye condition c. Promote a safe, effective care environment d. Improve vision
c. Promote a safe, effective care environment
A client uses timolol maleate (Timoptic) eyedrops. The expected outcome of this drug is to control glaucoma by: a. Constricting the pupils b. Dilating the canals of Schlemm c. Reducing aqueous humor formation d. Improving the ability of the ciliary muscle to contract
c. Reducing aqueous humor formation
The nurse has given instructions to a client with Parkinson's disease about maintaining mobility. Which action demonstrates that the client understands the directions? a. Sits in soft, deep chairs to promote comfort b. Exercises in the evening to combat fatigue c. Rocks back and forth to start movement with bradykinesia d. Buys clothes with many buttons to maintain finger dexterity
c. Rocks back and forth to start movement with bradykinesia
The client has had a cataract removed. The nurse's discharge instructions should include which of the following? a. Keep the head aligned straight b. Utilize bright lights in the home c. Use an eye shield at night d. Change the eye patch as needed
c. Use an eye shield at night
One day after cataract surgery the client is having discomfort from bright light. The nurse should advise the client to a. Dim lights in the house and stay inside for one week b. Attach sun shields to existing eyeglasses when in direct sunlight c. Use sunglasses that wrap around the side of the face when in bright light d. Patch the affected eye when in bright light
c. Use sunglasses that wrap around the side of the face when in bright light
A client is being switched from levodopa to carbidopa-levodopa (Sinemet). The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment? a. Euphoria b. Jaundice c. Vital sign fluctuation d. Signs and symptoms of diabetes
c. Vital sign fluctuation
The nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care? a. avoid overuse of the eye b. decrease the amount of salt in the diet c. eye medications will need to be administered for life d. decrease fluid intake to control the intraocular pressure
c. eye medications will need to be administered for life
A client with multiple sclerosis (MS) is receiving baclofen (Lisoresal). The nurse determines that the drug is effective when it achieves which of the following? a. Induces sleep b. Stimulates the client's appetite c. Relieves muscular spasticity d. Reduces the urine bacterial count
c. relieves muscular spasticity
The nurse has instructed the family of a client with stroke (brain attack) who has homonymous hemianopsia about measures to help the client overcome the deficit. Which statement suggests that the family understands the measures to use when caring for the client? a. "We need to discourage him from wearing eyeglasses." b. "We need to place objects in his impaired field of vision." c. "We need to approach him from the impaired field of vision." d. "We need to remind him to turn his head to scan the lost visual field."
d. "We need to remind him to turn his head to scan the lost visual field."
When the nurse talks with a client with multiple sclerosis who has slurred speech, which nursing intervention is contraindicated? a. Encouraging the client to speak slowly b. Encouraging the client to speak distinctly c. Asking the client to repeat indistinguishable words d. Asking the client to speak louder when tired
d. Asking the client to speak louder when tired
A new medication regimen is prescribed for a client with Parkinson's disease. At which time should the nurse make certain that the medication is taken? a. At bedtime b. All at one time c. Two hours before mealtime d. At the time scheduled
d. At the time scheduled
The nurse is performing as assessment on a client with a suspected diagnosis of cataract. What is the chief clinical manifestation that the nurse expects to note in the early stages of cataract formation? a. Diplopia b. Eye pain c. Floating spots d. Blurred vision
d. Blurred vision
The nurse is assessing the adaptation of a client to changes in functional status after a stroke (brain attack). Which observation indicates to the nurse that the client is adapting most successfully? a. Gets angry with family if they interrupt a task b. Experiences bouts of depression and irritability c. Has difficulty with using modified feeding utensils d. Consistently uses adaptive equipment in dressing self
d. Consistently uses adaptive equipment in dressing self
During recovery from a stroke, a client is given nothing by mouth to help prevent aspiration. To determine when the client is ready for a liquid diet, the nurse assesses the client's swallowing ability once per shift. This assessment evaluates: a. Cranial nerves I and II b. Cranial nerves III and V c. Cranial Nerves VI and VIII d. Cranial nerves IX and X
d. Cranial nerves IX and X
The nurse should assess clients with chronic open-angle glaucoma (COAG) for: a. Eye pain b. Excessive lacrimation c. Colored light flashes d. Decreasing peripheral vision
d. Decreasing peripheral vision
Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease. The nurse monitors the client for side/adverse effects to the medication. Which finding indicates that the client is experiencing an adverse effect? a. Pruritus b. Tachycardia c. Hypertension d. Impaired voluntary movements
d. Impaired voluntary movements
After cataract removal surgery, the client is instructed to report sharp pain in the operative eye because this could indicate which of the following postoperative complications? a. Detached retina b. Prolapse of the iris c. Extracapsular erosion d. Intraocular hemorrhage
d. Intraocular hemorrhage
A client with multiple sclerosis is experiencing bowel incontinence and is starting a bowel retraining program. Which strategy is not appropriate? a. Eating a diet high in fiber b. Setting a regular time for elimination c. Using an elevated toilet seat d. Limiting fluid intake to 1,000 mL/day
d. Limiting fluid intake to 1,000 mL/day
A short time after cataract surgery, the client has nausea. The nurse should first a. Instruct the client to take a few deep breaths until the nausea subsides b. Explain that this is a common feeling that will pass quickly c. Tell the client to call the nurse promptly if vomiting occurs d. Medicate the client with an antiemetic, as prescribed
d. Medicate the client with an antiemetic, as prescribed
The nurse is providing instructions to a client who will be safe-administering eyedrops. To minimize systemic absorption of the eyedrops, the nurse should instruct the client to take which action? a. Eat before instilling the drops b. Swallow several times after instilling the drops c. Blink vigorously to encourage tearing after instilling the drops d. Occlude the nasolacrimal duct
d. Occlude the nasolacrimal duct
A client tells the nurse about the vision being blurred and hazy throughout the entire day. The nurse should recommend that the client do which of the following? a. Purchase a pair of magnifying glasses b. Wear glasses with tinted lenses c. Schedule an appointment with an optician d. Schedule an appointment with an ophthalmologist
d. Schedule an appointment with an ophthalmologist
The right hand of a client with multiple sclerosis trembles severely whenever she attempts a voluntary action. She spills her coffee twice at lunch and cannot get her dress fastened securely. Which is the best legal documentation in nurses' notes of the chart for this client assessment? a. Has an intention tremor of the right hand b. Right-hand tremor worsens with purposeful acts c. Needs assistance with dressing and eating due to severe trembling and clumsiness d. Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup
d. Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup
Which of the following clinical manifestations should the nurse assess when a client has acute angle-closure glaucoma? a. Gradual loss of central vision b. Acute light sensitivity c. Loss of color vision d. Sudden eye pain
d. Sudden eye pain
A client's vision is tested with a Snellen chart. The results of the tests are documented as 20/60. How should the nurse interpret this finding? a. The client is legally blind b. The client's vision is normal c. The client can read at a distance of 60 feet what a client what a client with normal vision can read at 20 feet d. The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet
d. The client can read only at a distance of 20 feet what a client with normal vision can read at 60 feet.
Which goal is the most realistic for a client diagnosed with Parkinson's disease? a. To cure the disease b. To stop progression of the disease c. To begin preparations for terminal care d. To maintain optimal body function
d. To maintain optimal body function
A nurse is teaching a client who had a stroke about ways to adapt to a visual disability. Which does the nurse identify as the primary safety precaution to use? a. Wear a patch over one eye b. Place personal items on the sighted side c. Lie in bed with the unaffected side toward the door d. Turn the head from side to side when walking
d. Turn the head from side to side when walking
Which measure should the nurse teach the client with adult macular degeneration (AMD) as a safety precaution? a. Wear a patch over one eye b. Place personal items on the sighted side c. Lie in bed with the unaffected side toward the door d. Turn the head from side to side when walking
d. Turn the head from side to side when walking
The nurse is performing an assessment on a client with a suspected diagnosis of cataract. Which clinical manifestation should the nurse expect to note in the early stages of cataract formation? a. diplopia b. eye pain c. floating spots d. blurred vision
d. blurred vision