Neuro practice q

A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what? Select one: A. "I will make sure to follow the weight loss plan designed by the dietitian." B. "I will take my oral antidiabetic agents when my morning blood sugar is high." C. "I read that a pancreas transplant will provide a cure for my diabetes." D. "I will make sure I call the diabetes educator when I have questions about my insulin."

A. "I will make sure to follow the weight loss plan designed by the dietitian." Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.

A diabetic educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? Select one: A. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." B. "I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea." C. "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." D. "I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine."

A. "I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours." The nurse must explanation the "sick day rules" again to the patient who plans to stop taking insulin when sick. The nurse should emphasize that the patient should take insulin agents as usual and test one's blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration.

A medical nurse is caring for a patient with type 1 diabetes. The patient's medication administration record includes the administration of regular insulin three times daily. Knowing that the patient's lunch tray will arrive at 11:45, when should the nurse administer the patient's insulin? Select one: A. 11:15 B. 11:45 C. 11:50 D. 10:45

A. 11:15 Regular insulin is usually administered 20-30 min before a meal. Earlier administration creates a risk for hypoglycemia; later administration creates a risk for hyperglycemia.

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? Select one: A. A biguanide B. An alpha glucosidase inhibitor C. A thiazolidinedione D. A sulfonylurea

A. A biguanide Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

Which of the following individuals is most likely to possess an increased risk of developing Alzheimer's disease in the future? Select one: A. A man with a family history of Down syndrome B. A man whose admission assessment reveals polypharmacy C. A woman with a diagnosis of autism D. A woman with poorly controlled type 1 diabetes'

A. A man with a family history of Down syndrome A family history of Down syndrome is a risk factor for Alzheimer's disease. Autism is not a noted risk factor and both polypharmacy and poorly controlled blood sugar could contribute to delirium, not dementia.

A patient with a cerebral aneurysm exhibits signs and symptoms of an increase in intracranial pressure (ICP). What nursing intervention would be most appropriate for this patient? Select one: A. Absolute bed rest in a quiet, nonstimulating environment B. Encouraging independence with ADLs to promote recovery C. Early initiation of physical therapy D. Range-of-motion exercises to prevent contractures

A. Absolute bed rest in a quiet, nonstimulating environment The patient is placed on immediate and absolute bed rest in a quiet, nonstressful environment because activity, pain, and anxiety elevate BP, which increases the risk for bleeding. Visitors are restricted. The nurse administers all personal care. The patient is fed and bathed to prevent any exertion that might raise BP.

A neurologic flow chart is often used to document the care of a patient with a traumatic brain injury. At what point in the patient's care should the nurse begin to use a neurologic flow chart? Select one: A. As soon as the initial assessment is made B. When the patient's condition begins to deteriorate C. At the beginning of each shift D. When there is a clinically significant change in the patient's condition

A. As soon as the initial assessment is made Neurologic parameters are assessed initially and as frequently as the patient's condition requires. As soon as the initial assessment is made, the use of a neurologic flowchart is started and maintained. A new chart is not begun at the start of every shift.

The ED nurse is caring for a patient who has been brought in by ambulance after sustaining a fall at home. What physical assessment finding is suggestive of a basilar skull fracture? Select one: A. Bruising over the mastoid B. Unilateral facial numbness C. Epistaxis D. Periorbital edema

A. Bruising over the mastoid An area of ecchymosis (bruising) may be seen over the mastoid (Battle's sign) in a basilar skull fracture. Numbness, edema, and epistaxis are not directly associated with a basilar skull fracture.

A patient diagnosed with a cerebral aneurysm reports a severe headache to the nurse. What action is a priority for the nurse? Select one: A. Call the physician immediately. B. Administer an analgesic. C. Inform the nurse-manager. D. Sit with the patient for a few minutes.

A. Call the physician immediately. A headache may be an indication that the aneurysm is leaking. The nurse should notify the physician immediately. The physician will decide whether administration of an analgesic is indicated. Informing the nurse-manager is not necessary. Sitting with the patient is appropriate, once the physician has been notified of the change in the patient's condition.

Relatives brought an elderly relative to the health center because they noticed a new behavior in the elderly person. The nurse practitioner explained that the behavior they noticed was characteristic of Parkinson's disease. Which of the following symptoms was most likely noticed in their relative? Select one: A. Faint tremor in the hands or feet B. Forced eyelid closure C. Difficulty in swallowing D. Depression

A. Faint tremor in the hands or feet A progressive, faint tremor is often an early sign of Parkinson's disease. Forced eyelid closure, dysphagia, and depression are likely later signs.

A patient has recently begun mobilizing during the recovery from an ischemic stroke. To protect the patient's safety during mobilization, the nurse should perform what action? Select one: A. Have a colleague follow the patient closely with a wheelchair. B. Ensure that the patient's family members do not participate in mobilization. C. Avoid mobilizing the patient in the early morning or late evening. D. Support the patient's full body weight with a waist belt during ambulation.

A. Have a colleague follow the patient closely with a wheelchair. During mobilization, a chair or wheelchair should be readily available in case the patient suddenly becomes fatigued or feels dizzy. The family should be encouraged to participate, as appropriate, and the nurse should not have to support the patient's full body weight. Morning and evening activity are not necessarily problematic.

An 82-year-old man is admitted for observation after a fall. Due to his age, the nurse knows that the patient is at increased risk for what complication of his injury? Select one: A. Hematoma B. Skull fracture C. Stroke D. Embolus

A. Hematoma Two major factors place older adults at increased risk for hematomas. First, the dura becomes more adherent to the skull with increasing age. Second, many older adults take aspirin and anticoagulants as part of routine management of chronic conditions. Because of these factors, the patient's risk of a hematoma is likely greater than that of stroke, embolism, or skull fracture.

A nurse is reviewing the trend of a patient's scores on the Glasgow Coma Scale (GCS). This allows the nurse to gauge what aspect of the patient's status? Select one: A. Level of consciousness B. Sensory involvement C. Cognitive ability D. Reflex activity

A. Level of consciousness The Glasgow Coma Scale (GCS) examines three responses related to LOC: eye opening, best verbal response, and best motor response.

A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur? Select one: A. Middle-aged or older people with either type 2 diabetes or no known history of diabetes B. Patients who are obese and who have no known history of diabetes C. Adolescents with type 2 diabetes and sporadic use of antihyperglycemics D. Patients with type 1 diabetes and poor dietary control

A. Middle-aged or older people with either type 2 diabetes or no known history of diabetes HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes.

Which of the following older adults is most likely to have his or her health problem characterized as delirium rather than dementia? Select one: A. Mr. L, whose wife has brought him to the emergency department because of the forgetfulness and confusion that he has exhibited over the last 48 hours. B. Mrs. O, whose children state that her personality has changed markedly and who has difficulty finding words lately. C. Mrs. Y, who was diagnosed with a brain tumor and who has experienced consequent changes in behavior and cognition. D. Mr. J, who has developed an unsteady and awkward gait coupled with uncoordinated motor skills in recent months.

A. Mr. L, whose wife has brought him to the emergency department because of the forgetfulness and confusion that he has exhibited over the last 48 hours. A rapid onset of cognitive changes is indicative of delirium. Personality and language changes, deterioration in motor skills, and changes attributable to an organic change such as a tumor are more closely associated with dementia.

A 76-year-old male patient with a diagnosis of schizophrenia has been admitted with suspected hyponatremia after consuming copious quantities of tap water. Given this diagnosis, what clinical manifestations and lab results should the nurse anticipate the patient will exhibit? Select one: A. Muscle weakness, lethargy, and headaches. B. Low blood pressure, dry mouth, and increased urine osmolality C. High urine specific gravity, tachycardia, and a weak, thready pulse D. Increased hematocrit and blood urea nitrogen and seizures

A. Muscle weakness, lethargy, and headaches. Weakness, lethargy, and nausea are noted manifestations of hyponatremia. High urine specific gravity, tachycardia, and a weak, thread pulse are associated with hypernatremia, while low blood pressure, fever, and increased urine osmolality are manifestations of fluid volume deficit. Increased hematocrit and blood urea nitrogen and seizures are also associated with hypernatremia.

Recognizing the prevalence and incidence of dehydration among older adults, a care aide at a long-term care facility is in the habit of encouraging residents to drink even though they may not feel thirsty at the time. Which of the following facts underlies the care aide's advice? Select one: A. Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high. B. The renin-angiotensin-aldosterone system (RAAS) is less able to facilitate sodium clearance in older adults. C. The metabolic needs for both fluid and sodium in older adults differ from those of younger individuals. D. Regulation and maintenance of effective circulating volume by the kidneys is less effective in the elderly.

A. Older adults often experience a decrease in the sensation of thirst, even when serum sodium levels are high. The elderly are prone to hypodipsia even when osmolality and serum sodium levels are elevated, a fact that is compounded by sensory and/or neurological deficits. Hypodipsia in the elderly is not related to differing metabolic needs, ineffective kidney function, or compromise of the RAAS.

The nurse is caring for a patient in the ICU who has a brain stem herniation and who is exhibiting an altered level of consciousness. Monitoring reveals that the patient's mean arterial pressure (MAP) is 60 mm Hg with an intracranial pressure (ICP) reading of 5 mm Hg. What is the nurse's most appropriate action? Select one: A. Participate in interventions to increase cerebral perfusion pressure. B. Administer osmotic diuretics as ordered. C. Prepare the patient for craniotomy. D. Position the patient in the high Fowler's position as tolerated.

A. Participate in interventions to increase cerebral perfusion pressure. The cerebral perfusion pressure (CPP) is 55 mm Hg, which is considered low. The normal CPP is 70 to 100 mm Hg. Patients with a CPP of less than 50 mm Hg experience irreversible neurologic damage. As a result, interventions are necessary. A craniotomy is not directly indicated. Diuretics and increased height of bed would exacerbate the patient's condition.

After a subarachnoid hemorrhage, the patient's laboratory results indicate a serum sodium level of less than 126 mEq/L. What is the nurse's most appropriate action? Select one: A. Prepare to administer 3% NaCl by IV as ordered. B. Facilitate testing for hypothalamic dysfunction. C. Administer a bolus of normal saline as ordered. D. Prepare the patient for thrombolytic therapy as ordered.

A. Prepare to administer 3% NaCl by IV as ordered. The patient may be experiencing syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt-wasting syndrome. The treatment most often is the use of IV hypertonic 3% saline. A normal saline bolus would exacerbate the problem and there is no indication for tests of hypothalamic function or thrombolytic therapy.

Nurse Y is providing care for a male patient who is in the late stages of vascular dementia. The nurse is in the habit of reminding the patient who he is, where he is, and what month and year it is when interacting with him. How is nurse Y's action best understood? Select one: A. Reorientation can be a useful intervention when used appropriately. B. Reorientation is ineffective with patients diagnosed with dementias. C. Reorientation does not slow the progression of cognitive losses and is thus unwarranted. D. Reorientation serves only to remind patients with dementia of their cognitive losses, so it is best avoided.

A. Reorientation can be a useful intervention when used appropriately. Reorientation, or reality therapy, can be a useful intervention in patients for whom it is appropriate in light of the severity of their cognitive deficits. Despite not slowing the progress of the disease itself, it can still be of benefit when living with the effects of dementia.

A nurse in the ICU is providing care for a patient who has been admitted with a hemorrhagic stroke. The nurse is performing frequent neurologic assessments and observes that the patient is becoming progressively more drowsy over the course of the day. What is the nurse's best response to this assessment finding? Select one: A. Report this to the physician as a possible sign of clinical deterioration. B. Report this finding to the physician as an indication of decreased metabolism. C. Provide more stimulation to the patient and monitor the patient closely. D. Recognize this as the expected clinical course of a hemorrhagic stroke.

A. Report this to the physician as a possible sign of clinical deterioration. Alteration in LOC often is the earliest sign of deterioration in a patient with a hemorrhagic stroke. Drowsiness and slight slurring of speech may be early signs that the LOC is deteriorating. This finding is unlikely to be the result of metabolic changes and it is not expected. Stimulating a patient with an acute stroke is usually contraindicated.

A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment? Select one: A. Stress has likely caused an increase in the patient's blood sugar levels. B. The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures. C. Alterations in bile metabolism and release have likely caused hyperglycemia. D. The patient's volatile fluid balance surrounding surgery has likely caused unstable blood sugars.

A. Stress has likely caused an increase in the patient's blood sugar levels. During periods of physiologic stress, such as surgery, blood glucose levels tend to increase, because levels of stress hormones (epinephrine, norepinephrine, glucagon, cortisol, and growth hormone) increase. The patient's need for insulin is unrelated to the action of bile, the patient's overestimation of previous blood sugar control, or fluid imbalance.

During a neurologic evaluation, the nurse practitioner has asked an 83-year-old client to draw the face of the clock and then tell the nurse what time the clock reads. Which of the following assessment findings would be most indicative of expressive aphasia? Select one: A. The client draws a clock but is unable to state the time. B. The client appears unable to understand and follow the instruction. C. The client draws a person's face rather than the face of a clock. D. The client draws a clock with four hands rather than two.

A. The client draws a clock but is unable to state the time. The patient with expressive aphasia will be able to understand commands but will not be able to put symbols together into an intelligent speech form. This phenomenon is best demonstrated by answer C.

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? Select one: A. The effects of hormonal changes during pregnancy B. Overconsumption of carbohydrates during the first two trimesters C. Increased caloric intake during the first trimester D. Changes in osmolality and fluid balance

A. The effects of hormonal changes during pregnancy Hyperglycemia and eventual gestational diabetes develops during pregnancy because of the secretion of placental hormones, which causes insulin resistance. The disease is not the result of food intake or changes in osmolality.

A female patient with a history of chronic renal failure has developed hypocalcemia. Which of the following assessment findings would provide potential confirmation of this diagnosis? Select one: A. The patient has muscle spasms and complains of numbness around her mouth. B. The patient is difficult to rouse and is disoriented to time and place. C. The patient's heart rate is 120 beats per minute and she is diaphoretic (sweaty).

A. The patient has muscle spasms and complains of numbness around her mouth. Spasms and numbness are characteristic of hypocalcemia. Respiratory effects, tachycardia, and diaphoresis are not associated with low calcium levels, whereas decreased level of consciousness can be indicative of hypercalcemia.

A patient diagnosed with transient ischemic attacks (TIAs) is scheduled for a carotid endarterectomy. The nurse explains that this procedure will be done for what purpose? Select one: A. To remove atherosclerotic plaques blocking cerebral flow B. To decrease cerebral edema C. To determine the cause of the TIA D. To prevent seizure activity that is common following a TIA

A. To remove atherosclerotic plaques blocking cerebral flow The main surgical procedure for select patients with TIAs is carotid endarterectomy, the removal of an atherosclerotic plaque or thrombus from the carotid artery to prevent stroke in patients with occlusive disease of the extracranial arteries. An endarterectomy does not decrease cerebral edema, prevent seizure activity, or determine the cause of a TIA.

The most reliable method for measuring body water or fluid volume increase is by assessing: Select one: A. body weight change. B. serum sodium levels. C. intake and output. D. tissue turgor.

A. body weight change. Daily weights are a reliable index of water volume gain (1 liter of water weighs 2.2 pounds). When an unbalanced distribution of body water exists in the tissues and organs, assessment of surface skin tissue turgor will be inaccurate. Measurement of renal output is unreliable because fluid retention may be a compensatory response, or the renal system may be dysfunctional. Serum sodium levels are affected by multiple variables other than body water volume.

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe? Select one: A. "The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin." B. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." C. "The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase." D. "Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it."

B. "Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down." Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. The body does not "make" glucose.

A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the body's need for insulin? Select one: A. Low stimulation B. Exercise C. Adequate sleep D. Low-fat diet

B. Exercise Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low fat intake and low levels of stimulation do not reduce a patient's need for insulin. Adequate sleep is beneficial in reducing stress, but does not have an effect that is pronounced as that of exercise.

A rehabilitation nurse caring for a patient who has had a stroke is approached by the patient's family and asked why the patient has to do so much for herself when she is obviously struggling. What would be the nurse's best answer? Select one: A. "Rehabilitation means helping patients do exactly what they did before their stroke." B. "The focus on care in a rehabilitation facility is to help the patient to resume as much self-care as possible." C. "We are trying to help her be as useful as she possibly can." D. "We aren't here to care for her the way the hospital staff did; we are here to help her get better so she can go home."

B. "The focus on care in a rehabilitation facility is to help the patient to resume as much self-care as possible." In both acute care and rehabilitation facilities, the focus is on teaching the patient to resume as much self-care as possible. The goal of rehabilitation is not to be "useful," nor is it to return patients to their prestroke level of functioning, which may be unrealistic.

A diabetic patient calls the clinic complaining of having a "flu bug." The nurse tells him to take his regular dose of insulin. What else should the nurse tell the patient? Select one: A. "For now, check your urine for ketones every 8 hours." B. "Try to eat small amounts of carbs, if possible." C. "Make sure to stick to your normal diet." D. "Ensure that you check your blood glucose every hour."

B. "Try to eat small amounts of carbs, if possible." For prevention of DKA related to illness, the patient should attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours.

Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control? Select one: A. A patient who skips breakfast when his glucose reading is greater than 220 mg/dL B. A patient who adheres closely to a meal plan and meal schedule C. A patient who never deviates from her prescribed dose of insulin D. A patient who eliminates carbohydrates from his daily intake

B. A patient who adheres closely to a meal plan and meal schedule The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.

Which of the following patients would likely be at highest risk of developing hyperkalemia? Select one: A. A patient who has experienced an ischemic stroke with multiple sensory and motor losses B. A patient who has been admitted for the treatment of acute renal failure following a drug overdose C. An elderly patient who is experiencing vomiting and diarrhea as a result of influenza D. A patient whose thyroidectomy resulted in the loss of his parathyroid gland

B. A patient who has been admitted for the treatment of acute renal failure following a drug overdose Renal failure is one of the most common causes of hyperkalemia. Stroke does not typically have a direct influence on potassium levels, whereas vomiting and diarrhea can precipitate hypokalemia. Loss of the parathyroid influences calcium, not potassium, levels.

The nurse is reviewing the medication administration record of a female patient who possesses numerous risk factors for stroke. Which of the woman's medications carries the greatest potential for reducing her risk of stroke? Select one: A. Lorazepam 1 mg SL b.i.d. PRN B. Aspirin 81 mg PO o.d. C. Naproxen 250 PO b.i.d. D. Calcium carbonate 1,000 mg PO b.i.d.

B. Aspirin 81 mg PO o.d. Research findings suggest that low-dose aspirin may lower the risk of stroke in women who are at risk. Naproxen, lorazepam, and calcium supplements do not have this effect.

A preceptor is discussing stroke with a new nurse on the unit. The preceptor would tell the new nurse which cardiac dysrhythmia is associated with cardiogenic embolic strokes? Select one: A. Ventricular tachycardia B. Atrial fibrillation C. Bundle branch block D. Supraventricular tachycardia

B. Atrial fibrillation Cardiogenic embolic strokes are associated with cardiac dysrhythmias, usually atrial fibrillation. The other listed dysrhythmias are less commonly associated with this type of stroke.

A patient is admitted to the neurologic ICU with a suspected diffuse axonal injury. What would be the primary neuroimaging diagnostic tool used on this patient to evaluate the brain structure? Select one: A. X-ray B. MRI C. Ultrasound D. PET scan

B. MRI CT and MRI scans, the primary neuroimaging diagnostic tools, are useful in evaluating the brain structure. Ultrasound would not show the brain nor would an x-ray. A PET scan shows brain function, not brain structure.

A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient? Select one: A. Avoid the use of moisturizing lotions. B. Avoid hot-water bottles and heating pads. C. Examine feet weekly for redness, blisters, and abrasions. D. Dry feet vigorously after each bath.

B. Avoid hot-water bottles and heating pads. High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.

A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following? Select one: A. Cleanse the injection site thoroughly with alcohol prior to injecting. B. Avoid using the same injection site more than once in 2 to 3 weeks. C. Inject at a 45º angle. D. Avoid mixing more than one type of insulin in a syringe.

B. Avoid using the same injection site more than once in 2 to 3 weeks. To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks. Mixing different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a 90º angle. Cleansing the injection site with alcohol is optional.

The husband of an elderly woman notices that she is posting reminder notes to herself throughout the house and making many lists. He thinks these behaviors might be early signs of Alzheimer's disease. What should he do? Select one: A. Ask his wife's physician to order blood work. B. Be alert for signs of depression. C. Ignore the signs he has noticed. D. Provide his wife with zinc and antioxidant supplements.

B. Be alert for signs of depression. Depression is a risk in the early stages of Alzheimer's disease. Although the husband may not want to mention the signs to his wife—she may merely be trying to be more organized—he should not ignore them himself, but be alert for further problems. Supplements may be too late if she already has Alzheimer's disease, and their worth has not been proved. At this stage, there is little use having blood work.

A patient with a new diagnosis of ischemic stroke is deemed to be a candidate for treatment with tissue plasminogen activator (t-PA) and has been admitted to the ICU. In addition to closely monitoring the patient's cardiac and neurologic status, the nurse monitors the patient for signs of what complication? Select one: A. Septicemia B. Bleeding C. Acute pain D. Seizures

B. Bleeding Bleeding is the most common side effect of t-PA administration, and the patient is closely monitored for any bleeding. Septicemia, pain, and seizures are much less likely to result from thrombolytic therapy.

The nurse plans the care for the hospice client with end-stage Parkinson's disease. Which of the following symptoms should the nurse expect to incorporate into the nursing care plan? Select one: A. Hemiparesis B. Bradykinesia C. Hemiplegia D. Visual impairment

B. Bradykinesia Bradykinesia (slow movement) must be incorporated in a plan of care for the client with end-stage Parkinson's disease. The others are not common findings with Parkinson's disease.

When caring for a patient who has had a stroke, a priority is reduction of ICP. What patient position is most consistent with this goal? Select one: A. Position changes every 15 minutes while awake B. Elevation of the head of the bed C. Extension of the neck D. Head turned slightly to the right side

B. Elevation of the head of the bed Elevation of the head of the bed promotes venous drainage and lowers ICP; the nurse should avoid flexing or extending the neck or turning the head side to side. The head should be in a neutral midline position. Excessively frequent position changes are unnecessary.

The husband of a 77-year-old woman is her sole care provider, a responsibility that has become onerous since she was diagnosed with Alzheimer's disease 3 months prior. When working with the husband, which of the following actions is most appropriate? Select one: A. Organizing outside help to minimize the amount of direct care that the husband provides. B. Encouraging the husband not to feel guilty for needing respite on occasion. C. Encouraging the husband to independently develop techniques for basic care that he feels work best for him and his wife. D. Emphasizing to the husband the importance of remaining optimistic and enthusiastic when interacting with his wife.

B. Encouraging the husband not to feel guilty for needing respite on occasion. The need for respite is a common need that the nurse should normalize for the husband. Techniques for basic care should be taught, and expecting the husband to exhibit a positive demeanor at all times is unrealistic and likely to foster guilt. While outside help may be required at times, the goal should not be to minimize or eliminate the care the husband himself provides.

Determine which of the following nursing considerations has the highest priority for an elderly adult with dementia. Select one: A. Promoting therapy and activity B. Ensuring patient safety C. Respecting the individual D. Providing physical care

B. Ensuring patient safety One of the foremost care considerations is the safety of patients with dementia. All of the other nursing considerations are important, but none as important as ensuring the safety of the elderly adult with dementia.

What should be included in the patient's care plan when establishing an exercise program for a patient affected by a stroke? Select one: A. Have the patient perform active range-of-motion (ROM) exercises once a day. B. Exercise the affected extremities passively four or five times a day. C. Keep activity limited, as the patient may be over stimulated. D. Schedule passive range of motion every other day.

B. Exercise the affected extremities passively four or five times a day. The affected extremities are exercised passively and put through a full ROM four or five times a day to maintain joint mobility, regain motor control, prevent development of a contracture in the paralyzed extremity, prevent further deterioration of the neuromuscular system, and enhance circulation. Active ROM exercises should ideally be performed more than once per day.

A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support checking blood levels for the diagnosis of diabetes? Select one: A. Random plasma glucose greater than 126 mg/dL B. Fasting plasma glucose greater than or equal to 126 mg/dL C. Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions D. Random plasma glucose greater than 150 mg/dL

B. Fasting plasma glucose greater than or equal to 126 mg/dL Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? Select one: A. Administering sodium bicarbonate intravenously B. Fluid and electrolyte replacement C. Reversing acidosis by administering insulin D. Administration of antihypertensive medications

B. Fluid and electrolyte replacement The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

When preparing to discharge a patient home, the nurse has met with the family and warned them that the patient may exhibit unexpected emotional responses. The nurse should teach the family that these responses are typically a result of what cause? Select one: A. Changes in brain activity during sleep and wakefulness B. Frustration around changes in function and communication C. Temporary changes in metabolism D. Unmet physiologic needs

B. Frustration around changes in function and communication Emotional problems associated with stroke are often related to the new challenges around ADLs and communication. These challenges are more likely than metabolic changes, unmet physiologic needs, or changes in brain activity, each of which should be ruled out.

A patient diagnosed with a hemorrhagic stroke has been admitted to the neurologic ICU. The nurse knows that teaching for the patient and family needs to begin as soon as the patient is settled on the unit and will continue until the patient is discharged. What will family education need to include? Select one: A. How to differentiate between hemorrhagic and ischemic stroke B. How to correctly modify the home environment C. Techniques for adjusting the patient's medication dosages at home D. Risk factors for ischemic stroke

B. How to correctly modify the home environment For a patient with a hemorrhagic stroke, teaching addresses the use of assistive devices or modification of the home environment to help the patient live with the disability. This is more important to the patient's needs than knowing about risk factors for ischemic stroke. It is not necessary for the family to differentiate between different types of strokes. Medication regimens should never be altered without consultation.

The nurse assesses a client with Parkinson's disease. Which of the following symptoms are unexpected, requiring immediate follow-up? Select one: A. Hallucinations B. Hypoglycemia C. Drooling D. Tremors

B. Hypoglycemia Hypoglycemia is not an expected symptom from either Parkinson's disease or its treatment, and it would require immediate attention. The other symptoms relate to either Parkinson's disease or its treatment and no immediate follow-up is necessary.

During a period of extreme excess fluid volume, a renal dialysis patient may be administered which type of IV solution to shrink the swollen cells by pulling water out of the cell? Select one: A. 0.9% sodium chloride B. IV albumin C. Lactated Ringer solution D. 5% dextrose and water

B. IV albumin When cells are placed in a hypotonic solution, which has a lower effective osmolality than the ICF, they swell as water moves into the cell, and when they are placed in a hypertonic solution, which has a greater effective osmolality than the ICF, they shrink as water is pulled out of the cell.

A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy constitutes a risk for what nursing diagnosis? Select one: A. Impaired urinary elimination B. Infection C. Acute pain D. Acute confusion

B. Infection Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in pain, confusion, or impairments in urinary function.

A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individual's risk for developing diabetes? Select one: A. Undergo eye examinations regularly. B. Lose weight, if obese. C. Stop using tobacco in any form. D. Have blood glucose levels checked annually.

B. Lose weight, if obese. Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.

A nurse is teaching basic "survival skills" to a patient newly diagnosed with type 1 diabetes. What topic should the nurse address? Select one: A. Management of diabetic ketoacidosis B. Recognition of hypoglycemia and hyperglycemia C. Signs and symptoms of diabetic nephropathy D. Effects of surgery and pregnancy on blood sugar levels

B. Recognition of hypoglycemia and hyperglycemia It is imperative that newly diagnosed patients know the signs and symptoms and management of hypo- and hyperglycemia. The other listed topics are valid points for education, but are not components of the patient's immediate "survival skills" following a new diagnosis.

A renal failure patient with severe hyperkalemia (K+ level 7.2 mEq/L) has just been admitted to the nursing unit. Given the severity of this situation, the nurse should be prepared to administer which intravenous infusion stat? Select one: A. Lactated Ringer solution at 150 mL/hour to maintain blood glucose levels B. Regular insulin infusion, rate dependent on lab values C. Infusion of Solu-Medrol to decrease irritation to the intravascular system D. Dilaudid via patient-controlled device (PCA) to control pain

B. Regular insulin infusion, rate dependent on lab values The administration of sodium bicarbonate, β-adrenergic agonists, or insulin distributes potassium into the ICF compartment and rapidly decreases the ECF concentration. Lactated Ringer solution, steroids, or narcotics will not help to lower potassium levels.

A 77-year-old female hospital patient has contracted Clostridium difficile during her stay and is experiencing severe diarrhea. Which of the following statements best conveys a risk that this woman faces? Select one: A. She is prone to isotonic fluid volume excess. B. She is susceptible to isotonic fluid volume deficit. C. She could develop third-spacing edema as a result of plasma protein losses. D. She is at risk of compensatory fluid volume overload secondary to gastrointestinal water and electrolyte losses.

B. She is susceptible to isotonic fluid volume deficit. This woman is at risk of isotonic fluid volume deficit and sodium imbalances as a result of her diarrhea. She is not likely to develop fluid volume excess or third spacing as consequences of diarrhea.

The home care nurse plans the environment of the client with Parkinson's disease. Which of the following should the environment include? Select one: A. Weight training bench and weights B. Shower with nonslip surface and rails C. Brightly colored throw rugs D. Electric adjustable bed with side rails

B. Shower with nonslip surface and rails Tub rails and nonslip tub surfaces are appropriate for clients with Parkinson's disease. While an adjustable bed may be useful, mobility equipment should be individually decided with input from the occupational and physical therapists.

A patient who suffered an ischemic stroke now has disturbed sensory perception. What principle should guide the nurse's care of this patient? Select one: A. Attention to the affected side should be minimized in order to decrease anxiety. B. The patient should be approached on the side where visual perception is intact. C. The patient should avoid turning in the direction of the defective visual field to minimize shoulder subluxation. D. The patient should be approached on the opposite side of where the visual perception is intact to promote recovery.

B. The patient should be approached on the side where visual perception is intact. Patients with decreased field of vision should first be approached on the side where visual perception is intact. All visual stimuli should be placed on this side. The patient can and should be taught to turn the head in the direction of the defective visual field to compensate for this loss. The nurse should constantly remind the patient of the other side of the body and should later stand at a position that encourages the patient to move or turn to visualize who and what is in the room.

One of the major causes of hyperkalemia is ____________, which alters potassium elimination. Select one: A. plasma albumin deficit B. renal dysfunction C. metabolic alkalosis D. aldosterone excess

B. renal dysfunction A major cause of hyperkalemia is impaired renal function, since the kidneys control potassium elimination. Aldosterone excess enhances potassium elimination and lowers the serum level. Metabolic acidosis causes potassium release by cells and renal retention—alkalosis does the opposite. Plasma albumin has a significant role in calcium balance and does not affect potassium distribution.

A community health nurse is giving an educational presentation about stroke and heart disease at the local senior citizens center. What nonmodifiable risk factor for stroke should the nurse cite? Select one: A. Smoking B. Asian American race C. Advanced age D. Female gender

C. Advanced age Advanced age, male gender, and race are well-known nonmodifiable risk factors for stroke. High-risk groups include people older than 55 years of age; the incidence of stroke more than doubles in each successive decade. Men have a higher rate of stroke than that of women. Another high-risk group is African Americans; the incidence of first stroke in African Americans is almost twice that as in Caucasian Americans; Asian American race is not a risk factor. Smoking is a modifiable risk.

A diabetic nurse is working for the summer at a camp for adolescents with diabetes. When providing information on the prevention and management of hypoglycemia, what action should the nurse promote? Select one: A. Eat a meal or snack every 8 hours. B. Check blood sugar at least every 24 hours. C. Always carry a form of fast-acting sugar. D. Perform exercise prior to eating whenever possible.

C. Always carry a form of fast-acting sugar. The following teaching points should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient? Select one: A. An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities. C. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. D. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.

C. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living. The nurse recognizes that providing information on the long-term complications—especially foot and eye problems—associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes.

The nurse is providing care for a patient who is unconscious. What nursing intervention takes highest priority? Select one: A. Providing appropriate pain control B. Maintaining accurate records of intake and output C. Maintaining a patent airway D. Inserting a nasogastric (NG) tube as ordered

C. Maintaining a patent airway Maintaining a patent airway always takes top priority, even though each of the other listed actions is necessary and appropriate.

A patient who just suffered a suspected ischemic stroke is brought to the ED by ambulance. On what should the nurse's primary assessment focus? Select one: A. Seizure activity B. Pain C. Cardiac and respiratory status D. Fluid and electrolyte balance

C. Cardiac and respiratory status Acute care begins with managing ABCs. Patients may have difficulty keeping an open and clear airway secondary to decreased LOC. Neurologic assessment with close monitoring for signs of increased neurologic deficit and seizure activity occurs next. Fluid and electrolyte balance must be controlled carefully with the goal of adequate hydration to promote perfusion and decrease further brain activity.

A nursing student is writing a care plan for a newly admitted patient who has been diagnosed with a stroke. What major nursing diagnosis should most likely be included in the patient's plan of care? Select one: A. Post-trauma syndrome B. Hyperthermia C. Disturbed sensory perception D. Adult failure to thrive

C. Disturbed sensory perception The patient who has experienced a stroke is at a high risk for disturbed sensory perception. Stroke is associated with multiple other nursing diagnoses, but hyperthermia, adult failure to thrive, and post-trauma syndrome are not among these.

A diabetes nurse educator is teaching a group of patients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic patient? Select one: A. Eat three substantial meals a day, if possible. B. Reduce food intake and insulin doses in times of illness. C. Do not eliminate insulin when nauseated and vomiting. D. Report elevated glucose levels greater than 150 mg/dL.

C. Do not eliminate insulin when nauseated and vomiting. The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.

A patient is brought by ambulance to the ED after suffering what the family thinks is a stroke. The nurse caring for this patient is aware that an absolute contraindication for thrombolytic therapy is what? Select one: A. Blood pressure of ≥ 180/110 mm Hg B. Evidence of stroke evolution C. Evidence of hemorrhagic stroke D. Previous thrombolytic therapy within the past 12 months

C. Evidence of hemorrhagic stroke Thrombolytic therapy would exacerbate a hemorrhagic stroke with potentially fatal consequences. Stroke evolution, high BP, or previous thrombolytic therapy does not contraindicate its safe and effective use.

The nurse is assessing a patient with a suspected stroke. What assessment finding is most suggestive of a stroke? Select one: A. Projectile vomiting B. Dysrhythmias C. Facial droop D. Periorbital edema

C. Facial droop Facial drooping or asymmetry is a classic abnormal finding on a physical assessment that may be associated with a stroke. Facial edema is not suggestive of a stroke and patients less commonly experience dysrhythmias or vomiting.

A patient has been brought to the emergency department by paramedics after being found unconscious. The patient's Medic Alert bracelet indicates that the patient has type 1 diabetes and the patient's blood glucose is 22 mg/dL (1.2 mmol/L). The nurse should anticipate what intervention? Select one: A. Subcutaneous administration of 10 units of Humalog B. IV bolus of 5% dextrose in 0.45% NaCl C. IV administration of 50% dextrose in water D. Subcutaneous administration of 12 to 15 units of regular insulin

C. IV administration of 50% dextrose in water In hospitals and emergency departments, for patients who are unconscious or cannot swallow, 25 to 50 mL of 50% dextrose in water (D50W) may be administered IV for the treatment of hypoglycemia. Five percent dextrose would be inadequate and insulin would exacerbate the patient's condition.

You are making initial shift assessments on your patients. While assessing one patient's peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy? Select one: A. Phlebitis B. Fluid overload C. Infiltration D. Air emboli

C. Infiltration Infiltration is the administration of nonvesicant solution or medication into the surrounding tissue. This can occur when the IV cannula dislodges or perforates the wall of the vein. Infiltration is characterized by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness in the area of infiltration, and a significant decrease in the flow rate. Air emboli, phlebitis, and fluid overload are not indications of infiltration.

A patient is admitted to the neurologic ICU with a spinal cord injury. In writing the patient's care plan, the nurse specifies that contractures can best be prevented by what action? Select one: A. Repositioning the patient every 2 hours B. Performing ROM exercises once a day C. Initiating (ROM) exercises as soon as possible after the injury D. Initiating range-of-motion exercises (ROM) as soon as the patient initiates

C. Initiating (ROM) exercises as soon as possible after the injury Passive ROM exercises should be implemented as soon as possible after injury. It would be inappropriate to wait for the patient to first initiate exercises. Toes, metatarsals, ankles, knees, and hips should be put through a full ROM at least four, and ideally five, times daily. Repositioning alone will not prevent contractures.

The nurse is caring for a patient who is postoperative following a craniotomy. When writing the plan of care, the nurse identifies a diagnosis of "deficient fluid volume related to fluid restriction and osmotic diuretic use." What would be an appropriate intervention for this diagnosis? Select one: A. Change the patient's position as indicated. B. Monitor arterial blood gas (ABG) values. C. Monitor serum electrolytes. D. Maintain NPO status.

C. Monitor serum electrolytes. The postoperative fluid regimen depends on the type of neurosurgical procedure and is determined on an individual basis. The volume and composition of fluids are adjusted based on daily serum electrolyte values, along with fluid intake and output. Fluids may have to be restricted in patients with cerebral edema. Changing the patient's position, maintaining an NPO status, and monitoring ABG values do not relate to the nursing diagnosis of deficient fluid volume.

A patient with a spinal cord injury has experienced several hypotensive episodes. How can the nurse best address the patient's risk for orthostatic hypotension? Select one: A. Administer an IV bolus of normal saline prior to repositioning. B. Maintain bed rest until normal BP regulation returns. C. Monitor the patient's BP before and during position changes. D. Allow the patient to initiate repositioning.

C. Monitor the patient's BP before and during position changes. To prevent hypotensive episodes, close monitoring of vital signs before and during position changes is essential. Prolonged bed rest carries numerous risks and it is not possible to provide a bolus before each position change. Following the patient's lead may or may not help regulate BP.

A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patient's ability to prepare and self-administer insulin? Select one: A. Provide a health education session reviewing the main points of insulin delivery. B. Review the patient's first hemoglobin A1C result after discharge. C. Observe the patient drawing up and administering the insulin. D. Ask the patient to describe the process in detail.

C. Observe the patient drawing up and administering the insulin. Nurses should assess the patient's ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.

A patient with a head injury has been increasingly agitated and the nurse has consequently identified a risk for injury. What is the nurse's best intervention for preventing injury? Select one: A. Restrain the patient as ordered. B. Arrange for friends and family members to sit with the patient. C. Pad the side rails of the patient's bed. D. Administer opioids PRN as ordered.

C. Pad the side rails of the patient's bed. To protect the patient from self-injury, the nurse uses padded side rails. The nurse should avoid restraints, because straining against them can increase ICP or cause other injury. Narcotics used to control restless patients should be avoided because these medications can depress respiration, constrict the pupils, and alter the patient's responsiveness. Visitors should be limited if the patient is agitated.

A 70-year-old male resident of a long-term care facility is in the advanced stages of Alzheimer's disease. Consequently, the resident frequently wanders throughout and, on more than one occasion, outside the facility. Due to his cognitive deficits, he is not responsive to patient teaching and redirection. What is the nurse manager's best response to the resident's behavior? Select one: A. Work with the resident's family to establish a supervision schedule. B. Begin placing the resident in a wheelchair with a tray when he shows signs of restlessness. C. Provide a controlled and safe place for the patient to wander. D. Administer the minimum effective dose of a sedative when the resident is most restless.

C. Provide a controlled and safe place for the patient to wander. While enlisting the help of family to ensure the resident's safety may be useful, establishing a safe and defined area for the resident to wander is ideal and is preferable to chemical or physical restraint.

The nurse initiates teaching for the patient and family with newly diagnosed Parkinson's disease. In communicating with the patient and his family, which of the following should the nurse emphasize? Select one: A. Intellectual functioning is eventually impaired by this disease. B. Emotional stability is maintained as the disease progresses. C. The disease progresses slowly, and therapy can minimize disability. D. Speech problems may affect the patient's expressive abilities.

C. The disease progresses slowly, and therapy can minimize disability. Patients with Parkinson's disease may appear to have intellectual problems because of difficulty with speech and emotion, but they do not lose their mental abilities.

The nurse is discussing macrovascular complications of diabetes with a patient. The nurse would address what topic during this dialogue? Select one: A. The need for frequent eye examinations for patients with diabetes B. The need to monitor urine for the presence of albumin C. The fact that patients with diabetes have an elevated risk of myocardial infarction D. The relationship between kidney function and blood glucose levels

C. The fact that patients with diabetes have an elevated risk of myocardial infarction Myocardial infarction and stroke are considered macrovascular complications of diabetes, while the effects on vision and renal function are considered to be microvascular.

A 78-year-old man has been diagnosed by his geriatrician as being in the third stage of Alzheimer's disease. Which of the following manifestations would be most congruent with the staging of the man's disease? Select one: A. The man displays an uncharacteristically flat affect and denies that he is experiencing any cognitive deficits. B. The man is commonly oriented to person but disoriented to time and place. C. The man's wife and children have recently noticed a change in his memory and judgment and he gets easily flustered in social situations. D. The man no longer remembers his wife's name and requires assistance with most of his activities of daily living.

C. The man's wife and children have recently noticed a change in his memory and judgment and he gets easily flustered in social situations. Cognitive changes noticeable by others and anxiety in social settings are indicators of stage 3 Alzheimer's. Choice A reflects stage 4, while choices C and D suggest stages 5 and 6, respectively.

An elderly woman found with a head injury on the floor of her home is subsequently admitted to the neurologic ICU. What is the best rationale for the following physician orders: elevate the HOB; keep the head in neutral alignment with no neck flexion or head rotation; avoid sharp hip flexion? Select one: A. To prevent flexion contractures B. To decrease cerebral arterial pressure C. To avoid impeding venous outflow D. To prevent aspiration of stomach contents

C. To avoid impeding venous outflow Any activity or position that impedes venous outflow from the head may contribute to increased volume inside the skull and possibly increase ICP. Cerebral arterial pressure will be affected by the balance between oxygen and carbon dioxide. Flexion contractures are not a priority at this time. Stomach contents could still be aspirated in this position.

A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia and is subsequently diagnosed with diabetes. Based on the fact that the child's pancreatic beta cells are being destroyed, the patient would be diagnosed with what type of diabetes? Select one: A. Type 2 diabetes B. Non-insulin-dependent diabetes C. Type 1 diabetes D. Prediabetes

C. Type 1 diabetes Beta cell destruction is the hallmark of type 1 diabetes. Non-insulin-dependent diabetes is synonymous with type 2 diabetes, which involves insulin resistance and impaired insulin secretion, but not beta cell destruction. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

A 71-year-old man is obese and has poorly controlled hypertension. The man states that while he has been a smoker since his teens, many of his peers have done likewise and still enjoy good health. Over the last 2 to 3 days, his wife has noted that he has become uncharacteristically forgetful and suspicious and he was found wandering outside his house last night. Which of the following health problems is his care team most likely to suspect? Select one: A. Wernicke encephalopathy B. Alzheimer's disease C. Vascular dementia D. Creutzfeldt-Jakob disease

C. Vascular dementia The patient's risk factors, course, and symptoms are more characteristic of vascular dementia than Creutzfeldt-Jakob disease, Alzheimer's disease, or Wernicke encephalopathy.

Which of the following is an anion? Select one: A. sodium B. potassium C. chloride D. hydrogen

C. chloride

Solutions in which the extracellular osmotic force is greater than the intracellular environment is known as: Select one: A. normotonic B. isotonic C. hypertonic D. hypotonic

C. hypertonic

Hyponatremia can be caused by ______and manifested by _______. Select one: A. third spacing; hypertonicity B. hypovolemia; dehydration C. water retention; hypotonicity D. aldosterone excess; low ADH

C. water retention; hypotonicity Hyponatremia can be caused by dilutional water retention (hypotonicity). Hypovolemia, third spacing (maldistribution of body fluid) and dehydration are associated with hypernatremia and/or hypertonicity. Hyponatremia can be caused by aldosterone deficit, which increases renal loss of sodium.

Nurse R is providing care for a 71-year-old woman who has been admitted to the surgical unit following her post-anesthetic recovery from a bilateral mastectomy. The patient has been physically stable but disoriented to place and time since admission, but the nurse knows that a history of dementia is noted in the patient's chart. The patient's daughter is distraught, however, because "mom was always just a bit forgetful, but nothing at all like this." What would be the most appropriate response by the nurse? Select one: A. "If your mother already has dementia, her confusion is to be expected." B. "Are you blaming us for your mother's confusion?" C. "It is nothing for you to worry about, most elderly persons are forgetful." D. "Delirium can also cause an alteration in mental status and can be caused from a new environment, altered level of consciousness, excess stimuli, adverse drug reactions, and physiologic disturbance, all which your mother has likely experienced as a result of her hospitalization and surgery."

D. "Delirium can also cause an alteration in mental status and can be caused from a new environment, altered level of consciousness, excess stimuli, adverse drug reactions, and physiologic disturbance, all which your mother has likely experienced as a result of her hospitalization and surgery." Answer C is the best response because it informs the patient's daughter about what may be occurring with her mother. The daughter has stated that the mother is usually a bit forgetful but not like she is now. This means that the daughter has noticed a difference, which may be attributable to delirium instead of the dementia that the patient already has. Not all elderly persons are forgetful and this does not address the patient's daughter's concern. Answer D is defensive and the patient's daughter has not made any accusations.

An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse interpret as suggestive of diabetes? Select one: A. "No matter how much sleep I get, it seems to take me hours to wake up." B. "When I went to the washroom the last few days, my urine smelled odd." C. "I've always been a fan of sweet foods, but lately I'm turned off by them." D. "Lately, I drink and drink and can't seem to quench my thirst."

D. "Lately, I drink and drink and can't seem to quench my thirst." Classic clinical manifestations of diabetes include the "three Ps": polyuria, polydipsia, and polyphagia. Lack of interest in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

Which one of the following statements about delirium and dementia is most accurate? Select one: A. Dementia and delirium are the same. B. Dementia occurs in all elderly persons. C. Delirium causes a progressive, irreversible decline in cognition. D. A person who has dementia can suffer from delirium.

D. A person who has dementia can suffer from delirium. Persons with dementia can develop delirium as a response to an acute condition but be undiagnosed because changes are not understood or identified. Both dementia and delirium cause cognitive impairment, but there are significant differences in the two disorders. Dementia causes a progressive, irreversible decline in cognition. Dementia occurs in approximately 5% of the elderly population.

The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response? Select one: A. "I will need to have your medications adjusted so you will need to be readmitted to the hospital for a complete workup." B. "If you build up too much urine in your bladder, it can cause you to get confused, especially when your body is under stress. " C. "It is normal to be a little confused following surgery, and it is safe not to urinate at night." D. "Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids."

D. "Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids." In elderly patients, the clinical manifestations of fluid and electrolyte disturbances may be subtle or atypical. For example, fluid deficit may cause confusion or cognitive impairment in the elderly person. There is no mention of medications in the stem of the question or any specific evidence given for the need for readmission to the hospital. Confusion is never normal, common, or expected in the elderly. Urinary retention does normally cause confusion.

A family member brings the patient to the clinic for a follow-up visit after a stroke. The family member asks the nurse what he can do to decrease his chance of having another stroke. What would be the nurse's best answer? Select one: A. "Have your heart checked regularly." B. "Eat a nutritious diet." C. "Get medication to bring down your sodium levels." D. "Stop smoking as soon as possible."

D. "Stop smoking as soon as possible." Smoking is a modifiable and highly significant risk factor for stroke. The significance of smoking, and the potential benefits of quitting, exceed the roles of sodium, diet, and regular medical assessments.

The husband of a 74-year-old female patient is distraught at her recent diagnosis of Alzheimer's disease. In an effort to identify a cure, the husband is conducting extensive online research as well as speaking with each member of the care team about possible treatments. How can the nurse best respond to the husband's inquiry? Select one: A. "Eliminating any exposure to aluminum or mercury has been shown to have a positive impact on people in the early stages of Alzheimer's." B. "There is presently no cure for Alzheimer's disease but highly promising treatments are expected." C. "Drugs that affect the neurotransmitters in the brain are now available that can cure many early cases of Alzheimer's." D. "There isn't any cure currently available for Alzheimer's but some drugs have been shown to slow the progression of the disease."

D. "There isn't any cure currently available for Alzheimer's but some drugs have been shown to slow the progression of the disease." Drugs affecting the action of acetylcholinesterase can slow the progression of Alzheimer's but they do not constitute a cure. Aluminum and mercury are implicated in the etiology of Alzheimer's but their removal does not cure the disease. Extensive research in the treatment of Alzheimer's is ongoing, but a cure is not noted to be imminent.

The son and daughter of an 80-year-old woman have expressed concern to the nurse that their mother has become impatient and irritable since her stroke earlier in the year. How should the nurse best respond to the children's concerns? Select one: A. "There is a new generation of medications that can help control outbursts with very few side effects." B. "This could be a sign that your mother is still experiencing transient ischemic attacks, so I will make sure to let her physician know." C. "This is likely a temporarily response to the difficult changes that a stroke causes, and these behaviors will likely diminish with time." D. "This is not an uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality."

D. "This is not an uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality." Neurologic illnesses are often accompanied by profound and uncharacteristic behavioral changes, requiring understanding and patience. It would be inappropriate to direct the family toward medications or to tell the family that the changes will resolve. Such changes are not necessarily indicative of transient ischemic attacks.

A nurse in a medical unit has noted that a client's potassium level is elevated at 6.1 mEq/L. The nurse has notified the physician, removed the banana from the client's lunch tray, and is performing a focused assessment. When questioned by the client for the rationale for these actions, which of the following explanations is most appropriate? Select one: A. "Your potassium levels in the blood are higher than they should be, which brings a risk of changes in the brain function." B. "I'll need to monitor you today for signs of high potassium; tell me if you feel as if your heart is beating quickly or irregularly." C. "The amount of potassium in your blood is too high, but this can be resolved by changing the intravenous fluid you are receiving." D. "Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness."

D. "Your potassium level is high, and so I need you let me know if you feel numbness, tingling, or weakness." Paresthesia and muscle weakness are manifestations of hyperkalemia. Tachycardia and dysrhythmias are more commonly associated with hypokalemia, and the greatest risks associated with potassium imbalances are cardiac rather than neurological. Hyperkalemia is not normally resolved by correction using IV fluid.

When caring for a patient who had a hemorrhagic stroke, close monitoring of vital signs and neurologic changes is imperative. What is the earliest sign of deterioration in a patient with a hemorrhagic stroke of which the nurse should be aware? Select one: A. Tonic-clonic seizures B. Generalized pain C. Shortness of breath D. Alteration in level of consciousness (LOC)

D. Alteration in level of consciousness (LOC) Alteration in LOC is the earliest sign of deterioration in a patient after a hemorrhagic stroke, such as mild drowsiness, slight slurring of speech, and sluggish papillary reaction. Sudden headache may occur, but generalized pain is less common. Seizures and shortness of breath are not identified as early signs of hemorrhagic stroke.

A patient with spinal cord injury has a nursing diagnosis of altered mobility and the nurse recognizes the increased the risk of deep vein thrombosis (DVT). Which of the following would be included as an appropriate nursing intervention to prevent a DVT from occurring? Select one: A. Assisting the patient with passive range of motion (PROM) exercises B. Administering an antifibrinolyic agent C. Placing the patient on a fluid restriction as ordered D. Applying thigh-high elastic stockings

D. Applying thigh-high elastic stockings It is important to promote venous return to the heart and prevent venous stasis in a patient with altered mobility. Applying elastic stockings will aid in the prevention of a DVT. The patient should not be placed on fluid restriction because a dehydrated state will increase the risk of clotting throughout the body. Antifibrinolytic agents cause the blood to clot, which is absolutely contraindicated in this situation. PROM exercises are not an effective protection against the development of DVT.

As per her routine, the daughter of an 82-year-old patient recovering from a prostate resection has come to the hospital in the morning to be with her father at the bedside. The daughter has approached her father's nurse and stated that he is uncharacteristically difficult to rouse this morning, with his only verbal response being occasional nonsensical muttering. What is the care team's most appropriate response? Select one: A. Screening for risk factors that would suggest Alzheimer's disease. B. Diagnostic imaging to determine the location of any organic brain changes. C. Assessment of the patient's mood and current stressors. D. Assessment to determine the cause of his delirium.

D. Assessment to determine the cause of his delirium. The patient's rapid onset and obtunded level of consciousness are most indicative of delirium rather than dementia or depression.

Which of the following assessments should be prioritized in the care of a patient who is being treated for hypokalemia? Select one: A. Detailed fluid balance monitoring B. Monitoring of hemoglobin levels and oxygen saturation C. Arterial blood gases D. Cardiac monitoring

D. Cardiac monitoring Imbalances of potassium levels have potentially fatal cardiac implications, a fact that necessitates frequent electrocardiography or cardiac telemetry. This supersedes the importance of fluid balance monitoring, arterial blood gases (ABGs), oxygen saturation, or hemoglobin levels.

The nurse prepares the patient for a test to determine the cause of the cerebrovascular accident (CVA). For which test should the nurse teach the client and family? Select one: A. Visual acuity testing B. Arterial blood flow to weakened extremity C. Speech therapy evaluation D. Carotid Doppler studies

D. Carotid Doppler studies Those with arteriosclerosis are at risk for thrombus formation causing most CVAs. Carotid Doppler studies examine the blood flow to the brain and arteriosclerosis. The other choices evaluate the impact of cerebrovascular attacks.

An elderly man is admitted to the hospital for surgery. A day later, he seems confused and disoriented. He imagines there is a trapdoor in the ceiling above his bed. His wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed "sharp as a tack." What should the nurse do first? Select one: A. Control environmental temperatures and noises. B. Have the patient evaluated for Alzheimer's disease. C. Tell the wife there is nothing to worry about. D. Check the patient's chart for medications that can cause delirium.

D. Check the patient's chart for medications that can cause delirium. The rapid onset and the delusion make it likely that this is delirium rather than dementia. The man's medication should be checked immediately, as painkillers used after surgery may have this effect. Controlling the environment may be helpful, but removing the cause of delirium is of the most importance. The wife is quite right to be concerned, but she should be told about the likelihood of delirium in this situation. Evaluation for Alzheimer's disease can take place later if that seems desirable.

The nurse provides for the care of the client after a cerebrovascular accident with expressive aphasia. Which of the following interventions should be the priority intervention? Select one: A. Remind the patient that no improvement is expected. B. Listen for the intent of the message and do not concentrate on the words. C. Encourage the client to speak when no one is around. D. Devise a picture chart for the patient to point for requests.

D. Devise a picture chart for the patient to point for requests. Although listening for intent is appropriate, the high priority is to devise a method of communication that allows the patient to express requests or needs. Recovery continues for years and improvement can occur, albeit slowly.

What should the nurse suspect when hourly assessment of urine output on a patient postcraniotomy exhibits a urine output from a catheter of 1,500 mL for two consecutive hours? Select one: A. Cushing syndrome B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Adrenal crisis D. Diabetes insipidus

D. Diabetes insipidus Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in patients after brain surgery. Cushing syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. SIADH is the result of increased secretion of ADH; the patient becomes volume-overloaded, urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patient's most recent laboratory reports, you note that the patient's magnesium levels are high. You should prioritize assessment for which of the following health problems? Select one: A. Cool, clammy skin B. Tachycardia C. Acute flank pain D. Diminished deep tendon reflexes

D. Diminished deep tendon reflexes To gauge a patient's magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with hypermagnesemia.

The nurse has created a plan of care for a patient who is at risk for increased ICP. The patient's care plan should specify monitoring for what early sign of increased ICP? Select one: A. Loss of corneal reflex B. Projectile vomiting C. Decreased pulse and respirations D. Disorientation and restlessness

D. Disorientation and restlessness Early indicators of ICP include disorientation and restlessness. Later signs include decreased pulse and respirations, projectile vomiting, and loss of brain stem reflexes, such as the corneal reflex.

A patient exhibiting an altered level of consciousness (LOC) due to blunt-force trauma to the head is admitted to the ED. The physician determines the patient's injury is causing increased intracranial pressure (ICP). The nurse should gauge the patient's LOC on the results of what diagnostic tool? Select one: A. Monro-Kellie hypothesis B. Mental status examination C. Cranial nerve function D. Glasgow Coma Scale

D. Glasgow Coma Scale LOC, a sensitive indicator of neurologic function, is assessed based on the criteria in the Glasgow Coma Scale: eye opening, verbal response, and motor response. The Monro-Kellie hypothesis states that because of the limited space for expansion within the skull, an increase in any one of the components (blood, brain tissue, cerebrospinal fluid) causes a change in the volume of the others. Cranial nerve function and the mental status examination would be part of the neurologic examination for this patient, but would not be the priority in evaluating LOC.

A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer? Select one: A. Half a sandwich with a protein-based filling B. A combination of protein and carbohydrates, such as a small cup of yogurt C. Two teaspoons of sugar dissolved in a cup of apple juice D. Half of a cup of juice, followed by cheese and crackers

D. Half of a cup of juice, followed by cheese and crackers Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may result in a sharp rise in blood sugar that will last for several hours.

The nurse is assessing the patient for the presence of a Chvostek's sign. What electrolyte imbalance would a positive Chvostek's sign indicate? Select one: A. Hyperkalemia B. Hypermagnesemia C. Hyponatremia D. Hypocalcemia

D. Hypocalcemia You can induce Chvostek's sign by tapping the patient's facial nerve adjacent to the ear. A brief contraction of the upper lip, nose, or side of the face indicates Chvostek's sign. Both hypomagnesemia and hypocalcemia may be tested using the Chvostek's sign.

During a home visit, the nurse discovers that the client is less verbal, less active, less responsive to directions, severely anxious, and more stuporous. The nurse interprets these findings to indicate that the client needs which intervention? Select one: A. An increase in medication B. a clinic appointment C. A sleeping aide D. Immediate evaluation

D. Immediate evaluation

A nurse is caring for a patient diagnosed with a hemorrhagic stroke. When creating this patient's plan of care, what goal should be prioritized? Select one: A. Prevent complications of immobility. B. Relieve anxiety and pain. C. Relieve sensory deprivation. D. Maintain and improve cerebral tissue perfusion.

D. Maintain and improve cerebral tissue perfusion. Each of the listed goals is appropriate in the care of a patient recovering from a stroke. However, promoting cerebral perfusion is a priority physiologic need, on which the patient's survival depends.

A patient with a history of type 1 diabetes has just been admitted to the critical care unit (CCU) for diabetic ketoacidosis. The CCU nurse should prioritize what assessment during the patient's initial phase of treatment? Select one: A. Assessing the patient for signs and symptoms of venous thromboembolism B. Monitoring the patient for dysrhythmias C. Assessing the patient's level of consciousness D. Maintaining and monitoring the patient's fluid balance

D. Maintaining and monitoring the patient's fluid balance In addition to treating hyperglycemia, management of DKA is aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin. The nurse should monitor the patient for dysrhythmias, decreased LOC and VTE, but restoration and maintenance of fluid balance is the highest priority.

Nurses should promote activities that reduce patients' risk of cerebrovascular accident (CVA). Which of the following is the most helpful activity to promote for reducing that risk? Select one: A. Maintaining adequate hydration B. Maintaining physical activity C. Getting sufficient nutrition D. Managing hypertension

D. Managing hypertension Managing hypertension is the most important strategy. The other three choices, though less important, do tend to improve cerebral perfusion levels and general health.

A patient is being admitted to the neurologic ICU following an acute head injury that has resulted in cerebral edema. When planning this patient's care, the nurse would expect to administer what priority medication? Select one: A. Furosemide (Lasix) B. Hydrochlorothiazide (HydroDIURIL) C. Spirolactone (Aldactone) D. Mannitol (Osmitrol)

D. Mannitol (Osmitrol) The osmotic diuretic mannitol is given to dehydrate the brain tissue and reduce cerebral edema. This drug acts by reducing the volume of brain and extracellular fluid. Spirolactone, furosemide, and hydrochlorothiazide are diuretics that are not typically used in the treatment of increased ICP resulting from cerebral edema.

Which of the following therapies may be most helpful in slowing the progression of symptoms in Alzheimer's disease? Select one: A. Avoiding exposure to zinc B. Prophylactic use of antibiotics C. Avoiding exposure to aluminum D. Medications that stop or slow the enzyme that breaks down acetylcholine

D. Medications that stop or slow the enzyme that breaks down acetylcholine Medications that stop or slow the enzyme that breaks down acetylcholine may be helpful in slowing the progression of symptoms in Alzheimer's disease. Avoiding exposure to aluminum has not been conclusively identified as having a role in the development of Alzheimer's disease. Low zinc levels are present in persons with Alzheimer's disease, although it is not known if this is a cause or a result of the disease. There is no evidence that prophylactic antibiotics can slow the progression of Alzheimer's disease, let alone prevent it.

A patient newly diagnosed with type 2 diabetes is attending a nutrition class. What general guideline would be important to teach the patients at this class? Select one: A. Low fat generally indicates low sugar. B. Animal fats should be eliminated from the diet. C. Protein should constitute 30% to 40% of caloric intake. D. Most calories should be derived from carbohydrates.

D. Most calories should be derived from carbohydrates. Currently, the ADA and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) recommend that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein.Low fat does not automatically mean low sugar. Dietary animal fat does not need to be eliminated from the diet.

A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? Select one: A. Active transport B. Diffusion C. Hydrostatic pressure D. Osmosis and osmolality

D. Osmosis and osmolality Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. Hydrostatic pressure refers to changes in water or volume related to water pressure. Diffusion is the movement of solutes from an area of greater concentration to lesser concentration; the solutes in an intact vascular system are unable to move so diffusion normally should not be taking place. Active transport is the movement of molecules against the concentration gradient and requires adenosine triphosphate (ATP) as an energy source; this process typically takes place at the cellular level and is not involved in vascular volume changes.

A female patient is diagnosed with a right-sided stroke. The patient is now experiencing hemianopsia. How might the nurse help the patient manage her potential sensory and perceptional difficulties? Select one: A. Keep the lighting in the patient's room low. B. Approach the patient on the side where vision is impaired. C. Place the patient's clock on the affected side. D. Place the patient's extremities where she can see them.

D. Place the patient's extremities where she can see them. The patient with homonymous hemianopsia (loss of half of the visual field) turns away from the affected side of the body and tends to neglect that side and the space on that side; this is called amorphosynthesis. In such instances, the patient cannot see food on half of the tray, and only half of the room is visible. It is important for the nurse to remind the patient constantly of the other side of the body, to maintain alignment of the extremities, and if possible, to place the extremities where the patient can see them. Patients with a decreased field of vision should be approached on the side where visual perception is intact. All visual stimuli (clock, calendar, and television) should be placed on this side. The patient can be taught to turn the head in the direction of the defective visual field to compensate for this loss. Increasing the natural or artificial lighting in the room and providing eyeglasses are important in increasing vision. There is no reason to keep the lights dim.

The patient has been diagnosed with aphasia after suffering a stroke. What can the nurse do to best make the patient's atmosphere more conducive to communication? Select one: A. Have the patient speak to loved ones on the phone daily. B. Help the patient complete his or her sentences. C. Speak in a loud and deliberate voice to the patient. D. Provide a board of commonly used needs and phrases.

D. Provide a board of commonly used needs and phrases. The inability to talk on the telephone or answer a question or exclusion from conversation causes anger, frustration, fear of the future, and hopelessness. A common pitfall is for the nurse or other health care team member to complete the thoughts or sentences of the patient. This should be avoided because it may cause the patient to feel more frustrated at not being allowed to speak and may deter efforts to practice putting thoughts together and completing a sentence. The patient may also benefit from a communication board, which has pictures of commonly requested needs and phrases. The board may be translated into several languages.

A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin (Glucophage). Following an ordered increase in the patient's daily dose of metformin, the nurse should prioritize which of the following assessments? Select one: A. Monitoring the patient's level of consciousness and behavior B. Monitoring the patient's neutrophil levels C. Assessing the patient for signs of impaired liver function D. Reviewing the patient's creatinine and BUN levels

D. Reviewing the patient's creatinine and BUN levels Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patient's renal function. This drug does not typically affect patients' neutrophils, liver function, or cognition.

The nurse is preparing health education for a patient who is being discharged after hospitalization for a hemorrhagic stroke. What content should the nurse include in this education? Select one: A. Mild, intermittent seizures can be expected. B. Drowsiness is normal for the first week after discharge. C. Take ibuprofen for complaints of a serious headache. D. Take antihypertensive medication as ordered.

D. Take antihypertensive medication as ordered. The patient and family are provided with information that will enable them to cooperate with the care and restrictions required during the acute phase of hemorrhagic stroke and to prepare the patient to return home. Patient and family teaching includes information about the causes of hemorrhagic stroke and its possible consequences. Symptoms of hydrocephalus include gradual onset of drowsiness and behavioral changes. Hypertension is the most serious risk factor, suggesting that appropriate antihypertensive treatment is essential for a patient being discharged. Seizure activity is not normal; complaints of a serious headache should be reported to the physician before any medication is taken. Drowsiness is not normal or expected.

A nurse is providing care for an 80-year-old patient who experienced an ischemic cerebrovascular accident (CVA) 3 weeks prior. Which of the following nursing actions is most likely to appropriately address the cognitive changes that have accompanied the patient's stroke? Select one: A. Emphasize written rather than spoken communication on the part of both the patient and the nurse. B. Discuss distant past events while avoiding discussions of recent events. C. Increase the volume of spoken communication as much as possible. D. Talk to the patient and give explanations while performing routine care tasks.

D. Talk to the patient and give explanations while performing routine care tasks. It is beneficial for post-CVA patients to be spoken to and have routine activities explained. While distant memory often remains more intact, it would not be appropriate for the nurse to avoid discussion of current or recent events. It would likely be inappropriate and/or unnecessary to forego spoken communication in favor of written communication. The nurse should speak clearly and distinctly but in not too high a volume.

The most recent blood work of a patient with a longstanding diagnosis of type 1 diabetes has shown the presence of microalbuminuria. What is the nurse's most appropriate action? Select one: A. Determine whether the patient has been using expired insulin. B. Ensure that the patient receives a comprehensive assessment of liver function. C. Administer a fluid challenge and have the test repeated. D. Teach the patient about actions to slow the progression of nephropathy.

D. Teach the patient about actions to slow the progression of nephropathy. Clinical nephropathy eventually develops in more than 85% of people with microalbuminuria. As such, educational interventions addressing this microvascular complication are warranted. Expired insulin does not cause nephropathy, and the patient's liver function is not likely affected. There is no indication for the use of a fluid challenge.

The nurse is caring for a patient recovering from an ischemic stroke. What intervention best addresses a potential complication after an ischemic stroke? Select one: A. Limiting intake of insoluble fiber B. Providing frequent small meals rather than three larger meals C. Keeping a urinary catheter in situ for the full duration of recovery D. Teaching the patient to perform deep breathing and coughing exercises

D. Teaching the patient to perform deep breathing and coughing exercises Because pneumonia is a potential complication of stroke, deep breathing and coughing exercises should be encouraged unless contraindicated. No particular need exists to provide frequent meals and normally fiber intake should not be restricted. Urinary catheters should be discontinued as soon as possible.

A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? Select one: A. The patient would benefit from a dose of metformin (Glucophage). B. The patient should promptly eat some protein and carbohydrates. C. The patient should withhold his next scheduled dose of insulin. D. The patient's insulin levels are inadequate.

D. The patient's insulin levels are inadequate. Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating. Withholding insulin or eating food would exacerbate the patient's ketonuria. Metformin will not cause short-term resolution of hyperglycemia.

A 77-year-old patient has been brought to the emergency department by the daughter due to recent visual disturbances and unilateral weakness. The diagnostic workup has led the diagnosis of transient ischemic attacks (TIAs). Which of the following patient history most likely contributed to the patient's current health problem? Select one: A. The woman was diagnosed with Parkinson's disease early this year. B. The patient was treated for anemia 3 months ago. C. The woman has a history of recurrent deep vein thromboses. D. The woman is a smoker and takes antihypertensive medications.

D. The woman is a smoker and takes antihypertensive medications. Smoking and the use of antihypertensives are associated with TIAs. The other cited health issues are less often contributors to TIAs.

A patient with a diagnosis of schizophrenia has been admitted to the emergency department after ingesting more than 2 gallons of water. Which of the following pathophysiologic processes may result from the sudden water gain? Select one: A. Syndrome of inappropriate secretion of ADH (SIADH) B. Isotonic fluid excess in the extracellular fluid compartment C. Hypernatremia D. Water movement from the extracellular to intracellular compartment

D. Water movement from the extracellular to intracellular compartment A disproportionate gain of water with no accompanying gain in sodium results in the movement of water from the extracellular to intracellular compartment. Hyponatremia accompanies this process. Because of the lack of sodium increase, accumulated fluid is hypotonic, not isotonic. SIADH is not a consequence of water intake.

The nurse is performing stroke risk screenings at a hospital open house. The nurse has identified four patients who might be at risk for a stroke. Which patient is likely at the highest risk for a hemorrhagic stroke? Select one: A. Black male, age 60, with history of diabetes B. White female, age 60, with history of excessive alcohol intake C. Black male, age 50, with history of smoking D. White male, age 60, with history of uncontrolled hypertension

D. White male, age 60, with history of uncontrolled hypertension Uncontrolled hypertension is the primary cause of a hemorrhagic stroke. Control of hypertension, especially in individuals over 55 years of age, clearly reduces the risk for hemorrhagic stroke. Additional risk factors are increased age, male gender, and excessive alcohol intake. Another high-risk group includes African Americans, where the incidence of first stroke is almost twice that as in Caucasians.

Which represented the greatest percentage of water in the extracellular compartment? Select one: A. plasma volume B. intracellular volume C. transcellular volume D. interstitial volume

D. interstitial volume