RN Targeted Medical Surgical Neurosensory and Musculoskeletal 2019
A nurse is reviewing postoperative instructions with a client following cataract surgery. Which of the client statements indicates an understanding of the instructions? A. "I should call my doctor if my vision gets worse." B. "I will take aspirin for eye discomfort." C. "I can blow my nose to clear out any drainage." "I can lift objects up to 20 pounds."
"I should call my doctor if my vision gets worse."
A nurse is teaching a client who has Parkinson's disease and is prescribed carbidopa-levodopa. Which of the following client statements indicates an understanding of the teaching? A. "I should expect an increase in my blood pressure while taking this medication." B. "I should take this medication 2 hours after meals to increase absorption." C. "I should expect that this medication can cause me to be drowsy." D. "I should expect this medication to be effective within 48 hours.
"I should expect this medication can cause me to be drowsy."
A nurse is teaching a client who has multiple sclerosis and has a new prescription for glatiramer acetate. Which of the following statements indicates that the client understands the teaching? A. "I will ask my partner to give the injection in the same spot each time." B. "I will avoid going to the store when it is crowded." C. "I will see relief of my symptoms in about 1 week." D. "I will exercise rigorously while taking this medication."
"I will avoid going to the store when it is crowded."
A nurse is developing a teaching plan for a client who has Meniere's disease. Which of the following instructions should the nurse include? A. "Move your head slowly to decrease vertigo." B. "Apply warm packs to the affected ear during acute attacks." C. "Increase your intake of foods and fluids high in salt." D. "Take corticosteroids during acute attacks."
"Move your head slowly to decrease vertigo."
A nurse is teaching a client who has osteoporosis and has a new prescription for alendronate. Which of the following information hold the nurse include in the teaching? A. "Take this medication with 8 ounces of milk." B. "Remain upright for 30 minutes after taking this medication." C. "Wait 1 hour after taking other medications to take alendronate." D. "Take vitamin C to promote absorption of this medication."
"Remain upright for 30 minutes after taking this medication."
A nurse is teaching a client and her family about the diagnosis and the treatment of Alzheimer's disease. Which of the following statements should the nurse identify as an indication that the family understands the teaching? A. "There is a test for Alzheimer's disease that can establish a reliable diagnosis." B. "The goal of medication therapy is to reverse the degenerative changes that can occur in brain tissue." C. "Early manifestations of Alzheimer's disease include mild tremors and muscular rigidity." D. "The medications that treat Alzheimer's disease can help delay cognitive changes."
"The medications that treat Alzheimer's disease can help delay cognitive changes
A nurse is caring for a client who has viral meningitis. Which of the the following actions should the nurse take? A. Assess the client's neurologic status every 8 hr. B. Initiate droplet precautions. C. Check capillary refill at least every 4 hr. D. Place the client in a well-lit environment.
Check capillary refill at least every 4 hr.
A nurse is caring for a client who is in balanced suspension skeletal traction and reports intermittent muscle spasms. Which of the following actions should the nurse take first? A. Reposition the client. B. Check the position of the weights and ropes. C. Administer a muscle relaxant. D. Provide distraction.
Check the position of the weights and ropes.
A nurse is caring for a client who has a basilar skull fracture following a fall from a ladder. Which of the following assessment findings should the nurse report to the provider? A. Glasgow Coma Scale score of 15 B. Intracranial pressure reading of 15 mm Hg C. Ecchymosis at base of skull D. Clear drainage from nose
Clear discharge from nose
A nurse is performing a pain assessment for a client who is postoperative. Which of the following findings should the nurse use to determine the severity of the client's pain? A. Client's vital sign changes B. Client's report of the type of pain C. Client's nonverbal communication D. Client's report of pain on a pain scale
Client's report of pain on a pain scale.
A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply.) A. Crepitus with joint movement B. Decreased range of motion of the affected joint C. Low-grade fever D. Spongy tissue over the joints E. Joint pain that resolves with rest
Crepitus with joint movement Decreased range of motion of the affected joint Joint pain that resolves with rest
A nurse is caring for a client who has a history of a status epilepticus and requires seizure precautions. Which of the the following actions should the nurse take? A. Assess hourly for a spike in blood pressure. B. Keep the client on bed rest. C. Keep a padded tongue blade at the bedside. D. Establish IV access.
Establish IV access.
A nurse is caring for a client who has a retinal detachment. Which of the following findings should the nurse expect? A. Photophobia B. Complete vision loss C. Flashes of bright light D. Cloudiness of the lens
Flashes of bright light
A nurse is assessing a client who had a right hemispheric stroke. Which of the following neurologic deficits should the nurse expect? A. Aphasia B. Right-sided neglect C. Impulsive behavior D. Inability to read
Impulsive behavior
A nurse is assessing a client who is quadriplegic following a cervical fracture at the vertebral level C5. The client reports a throbbing headache and nausea. The nurse notes facial flushing and a blood pressure of 220/110 mm Hg. Which of the following actions should the nurse take first? A. Administer hydralazine via IV bolus. B. Loosen the client's clothing. C. Empty the client's bladder. D. Elevate the head of the client's bed.
Elevate the head of the clients bed.
A nurse is planning care for a client following a lumbar puncture. Which of the following actions should the nurse plan to take? A. Apply a pressure dressing to the site for 8 hr. B. Restrict the client's fluid intake for 24 hr. C. Ensure that the client lies flat for up to 12 hr. D. Inform the client that neck stiffness is an expected outcome off the procedure.
Ensure the client lies flat for up to 12 hr.
A nurse is caring for a client who has multiple scerolsis. Which of the following findings should the nurse expect? A. Hypoactive deep-tendon reflexes B. Ascending paralysis C. Intention tremors D. Increased lacrimation
Intention tremors
A nurse is planning care for a client who has a closed traumatic brain injury form a fall and is receiving mechanical ventilation. Which of the following interventions is the nurse's priority? A. Maintain a PaCO2 of approximately 35 mm Hg. B. Provide small doses of fentanyl via IV bolus for pain management C. Measure body temperature every 1-2 hr. D. Reposition the client every 2 hr.
Maintain a PaCO2 of approximately 35 mm Hg.
A nurse is caring for a client who has advancing amyotrophic lateral sclerosis. Which of the following interventions is the nurses priority? A. Provide frequent rest periods throughout the day. B. Administer pain medication on a regular schedule C. Monitor pulse oximetry findings. D. Administer baclofen for spasticity.
Monster pulse oximetry findings
A nurse in an emergency department is assessing a client who reports sudden, severe eye pain w/ blurry vision. The provider determines that the client has primary angle-closure glaucoma. Which of the following medications should the nurse expect to administer? A. Osmotic diuretics via IV bolus B. Mydriatic ophthalmic drops C. Corticosteroid ophthalmic drops D. Epinephrine via IV bolus
Osmotic diuretics via IV bolus
A nurse is teaching an assistive personnel (AP) about providing care to a client following a total hip arthroplasty. Which of the following instructions should the nurse include? A. Avoid applying anti embolism stockings to the affected leg. B. Have the client lean forward when moving from a sitting to a standing position C. Discourage the client from sitting in a wheelchair with the back reclined. D. Place an abductor pillow between the client's legs when turning the client.
Place the abductor pillow between the client's legs when turning the client.
A nurse is caring for a client who is recovering from a stroke and has right-sided homonymous hemianopsia. To help the client adapt to the hemianopsia, the nurse should take which of the following actions? A. Check the client's cheek on the affected side after meals to be sure no food remains there. B. Encourage the client to sit upright with their head tilted slightly forward during meals. C. Provide the client with eating utensils that have large handles. D. Remind the client to look consciously at both sides of their meal tray.
Remind the client to look consciously at both sides of their meal tray.A nu
A nurse is caring for a client who is 72 hr postoperative following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? A. Remind the client that the surgery removed the limb. B. Change the dressing on the client's residual limb. C. Request a prescription for gabapentin for the client. D. Elevate the client's residual limb above heart level.
Request a prescription for gabapentin for the client.
A nurse is assessing a client who has a head injury following a motor vehicle crash. The nurse should identify which of the following indicated increasing intracranial pressure? A. Restlessness B. Dizziness C. Hypotension D. Fever
Restlessness
A nurse is caring for a client who has a spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition? A. Encourage the client to use the Valsalva maneuver. B. Stroke the client's inner thigh. C. Perform the Credé maneuver. D. Administer a diuretic
Stroke the client's inner thigh.
A nurse is planning to teach a client who has epilepsy and a new prescription for phenytoin. Which of the following instructions should the nurse plan to include? A. Rinse with antiseptic mouthwash instead of using dental floss. B. Use an over-the-counter antihistamine if a rash develops. C. Slowly taper the medication after 6 consecutive months without seizure activity. D. Take medications at a consistent time each day to maintain therapeutic blood levels.
Take the medications at a consistent time each day to maintain therapeutic blood levels.
A nurse in an emergency department is caring for a client who suddenly lost consciousness and fell at home. The provider determines that the client had an embolic stroke. Which of the following medications should the nurse expect to administer? A. Tissue plasminogen activator B. Recombinant factor VIII C. Nitroglycerin D. Lidocaine
Tissue plasminogen activator
A nurse is assessing a client who has rheumatoid arthritis. Which of the following findings should the nurse expect? A. Unilateral joint involvement B. Ulnar deviation C. Fractures of the spine D. Decreased sedimentation rate
Ulnar deviation