Exam 4 - Practice Questions

You are reviewing the pt hx of a pt who has cataracts. Which manifestation of cataracts do you expect to note? Eye pain floating spots blurred vision diplopia

Blurred vision

A patient is being taught about taking timilol (Timoptic). Which of the follow side effects should the patient report to the health care provider? A. Darkening of the iris B. Stinging in the eyes C. Bitter taste in the mouth D. Difficulty breathing

Difficulty breathing

By which routes are osmotic agents administered to reduce Intraocular pressure? (Select all that apply) A. Intravenously B. Orally C. Topically D. Intramuscularly E. Subcutaneously

Intravenously

A client with newly diagnosed glaucoma is receiving eye drops for the first time. After instilling the drops you gently squeezing the bridge of his nose for 1 minute. He asks you why you are pinching his nose. The best response should be: A. If I pinch the nose, you won't move around as much B. It keeps more of the medication in your eye C. Pinching the nose increases the blood supply to your eyes D. I'm sorry. I shouldn't have pinched your nose for such a long time

It keeps more medication in your eye

The patient with which disorder has the lowest risk for developing complications related to ophthalmic adrenergic agents? A. Mild hypertension B. Type I diabetes C. Renal failure D. Hyperthyroidism

Mild hypertension

The nurse is caring for an older patient who has a severe hearing impairment. What would be an appropriate nursing intervention? A. Encourage the patient to learn sign language B. Write out questions and responses C. Reduce environment noise before speaking with the patient D. Raise the voice to a higher pitch

Reduce environment noise before speaking with the patient

Pt shows signs of macular degeneration. What is the highest priority for this finding?

Refer the client to Ophthalmologist

What should the nurse educator include in a presentation regarding the causes of metabolic​ acidosis? Salicylate intoxication Uncontrolled diabetes mellitus Rapid infusion of sodium bicarbonate Chronic obstructive pulmonary disease​ (COPD

Salicylate Intoxication Uncontrolled Diabetes Mellitus

Which preventable factor can cause metabolic acidosis in the older​ adult? Vomiting and diarrhea Cardiac arrest Type 1 diabetes mellitus Salicylate poisoning

Salicylate poisoning

What is the name of this test? Snellen Weber Rinne SOLAR

Snellen

A patient in the outpatient clinic has possible acute otitis media. Which of the following manifestations should the nurse report immediately to the health care provider? A. Hearing loss in the affected ear B. Tenderness behind the ear C. Vertigo D. Tinnitus

Tenderness behind the ear

True or False One of the greatest challenges in the care of chronic eye disorders such as glaucoma is convincing the patient of the need for long-term treatment and adherence to the therapeutic regimen

True

True or False Postoperative positioning of the patient after eye surgery usually requires having the patient lie on his or her back on the nonoperative side

True

Pt reports feeling nauseated and just​ "sick." Which type of organism should the nurse suspect is causing the illness? Bacteria Virus Parasite Influenza

Virus

You're examing the eye of a 50 yo pt with a Hx of exudative macular degeneration. What mannifestations do you expect? Green-yellow drainage from the eye bleeding in the eye increased intraoptical pressure floaters and spots

bleeding in the eye

The nurse is teaching a patient the correct method for administering ear drops. Place the steps in order that the patient should do them. 1. Tilt the head toward the unaffected side 2. Instill the ordered number of drops 3. Pull the pinna (auricle) upward and backward 4. Place a loose cotton ball in the ear canal for 15-20 minutes 5. Partially fill the ear dropper with medication 6. Warm the drops by holding the bottle

6,1,5,3,2,4

What noise dB and above can be dangerous for your hearing? 50 20 85 100

85

1. The nurse is asking a client in the psychiatric crisis unit specific questions about recent substance use. Which assessment finding could indicate to the nurse that the client is experiencing mild to moderate delirium? 1. Time and place disorientation 2. Impaired abstract thinking 3. Persistent memory disturbance 4. Changes in personality

1. 1. Clients with delirium experience disorientation to time, then place, and then person. Impaired abstract thinking and noted changes in personality are characteristics of dementia. Persistent memory disturbance is associated with an amnestic disorder.

The family of a client with increasing dementia asks the nurse how to convince one sibling who refuses to acknowledge their elderly mother's personality change. Which information would the nurse address in teaching the family about personality change in dementia? Select all that apply. 1. Loss of interest in surroundings 2. Lack of consideration for others 3. Difficulty learning new things 4. Disregard for the concept of time 5. Inability to do things in sequence 6. Decreased performance of daily activities

1 and 2. Clients with dementia often manifest a loss of interest in their surroundings, a lack of consideration for others, and a tendency to be self-absorbed as manifestations of a personality change. Having difficulty learning new things and the loss or disregard for the concept of time are cognitive changes that occur in dementia. The inability to do things in an orderly sequence and the decreased performance of daily activities indicate the functional changes seen in clients with dementia.

Most important nursing intervention for client with confusion and mental status changes related to metabolic acidosis? Keep a calendar in the room. Reorient the client frequently. Turn on the bed alarm. Have familiar objects close.

Turn on the bed alarm

2. The nurse is explaining the symptoms of dementia to a military family member who has not seen his mother in 15 months. Which characteristics of dementia of the Alzheimer's type would the nurse address in her teaching session? Select all that apply. 1. Experiences an impending sense of doom 2. Forgets that food is cooking on the stove 3. Becomes lost walking on her own street 4. Unable to write and to sign her name 5. Begins to fear using public transportation 6. Unable to understand new information

2. 2, 3, 4, and 6. Common symptoms of dementia of the Alzheimer's type include forgetting things such as cooking food and where specific items were placed, becoming lost in one's own neighborhood, being unable to write or even sign one's name to a document, and being unable to understand new information. A client experiencing an impending sense of doom and fearing public transportation is most likely dealing with a panic attack with agoraphobia.

3. During an interaction with the spouse of a client with Alzheimer's disease, the nurse is asked the following question: "What exactly is Alzheimer's disease?" Which is the correct explanation for the nurse to tell the spouse? 1. " Often, Alzheimer's disease is a combination of several common autoimmune diseases that attack and shrink brain tissue." 2. " It is a brain disease that results from the development of abnormal structures called neurofibrillary tangles found in the person's brain." 3. " The disease is a genetic disease that changes a person's brain tissue, causing it to deteriorate due to an accumulation of excessive fluid." 4. " A biological and psychosocial component of undiagnosed moderate depression is causing a steady decline in daily performance."

3. 2. People with Alzheimer's disease have a disease of the brain where abnormal structures composed of twisted protein fibers (neurofibrillary tangles) are found within the nerve cells. These neurofibrillary tangles attack the inside of the neurons. The possible link of autoimmune diseases to Alzheimer's disease as well as the genetic errors identified on chromosomes 14, 19, and 21 along with biological and neurochemical problems are currently being investigated.

The nurse notices that a client with dementia about to eat his dinner picks up his spoon, looks at it, puts it down, and then picks up his fork, looks at it, and puts it back on the table. He sits staring at the utensils and his dinner. How does the nurse interpret this behavior? 1. A risk for altered nutrition 2. A disruption in metabolic functioning 3. A disturbance in executive functioning 4. A potential sensory-motor deficit

3. The client's inability to initiate activities or perform routine tasks are examples of the loss of the ability to think and reason abstractly; hence, a disturbance or interference in the client's executive functioning has occurred. This behavior does not indicate a problem with nutrition or with metabolic or sensory-motor functioning.

8. Which intervention should help a client diagnosed with Alzheimer's disease perform activities of daily living? 1. Have the client perform all basic care without help. 2. Tell the client morning care must be done by 9 a.m. 3. Give the client a written list of activities he's expected to do. 4. Encourage the client and give ample time to complete basic tasks.

4. Clients with Alzheimer's disease respond to the effect of those around them. A gentle, calm approach is comforting and nonthreatening, and a tense, hurried approach may agitate the client. The client has problems performing independently. The inherent expectations of deadlines and activity lists may lead to frustration.

4. The home health nurse notices that the elderly, diabetic client she sees every week is starting to demonstrate some difficulty answering questions about her chronic disease strategies and self-management activities. Which action would the nurse take to validate her suspicion of the client having cognitive changes and possibly the beginning stages of dementia? 1. Speak to the doctor about ordering cardiac diagnostic studies. 2. Petition the insurance company for a weekly home health aide. 3. Request that another nurse visit and perform a mental status exam. 4. Arrange to speak to a family caregiver as soon as possible.

5. 1. The nurse's highest priority when caring for a client with delirium is to ensure client safety. Offering recreational activities, providing a structured environment, and promoting sleep are all appropriate interventions after safety measures are in place.

The nurse has taught a family about the medication donepezil (Aricept). The nurse determines that teaching was successful when the family makes which statement? 1. " We will need to figure out a schedule to get dad's weekly blood work done." 2. " When dad's Alzheimer's disease worsens, he will need to stop taking this drug." 3. " This drug may slow down dad's pulse, since he has preexisting heart disease." 4. " Aricept acts like a diuretic medication, so dad should take it in the morning."

9. 3. Donepezil has the potential to cause bradycardia in clients with cardiac disease. Weekly blood work is not necessary for clients on donepezil. Donepezil can be used for mild, moderate, or severe Alzheimer's disease. Donepezil does not act like a diuretic; it can cause urinary retention, and the client may have difficulty passing his urine.

A patient arrives in the emergency department with possible detached retina. What intervention should the muse implement first? A. Place the patient in dependent position B. Discuss follow-up treatment with an ophthalmologist C. Provide care in a calm manner D. Notify the physician immediately

A. Place the patient in dependent position

Eleveated eosinophil count indicates a possible dxs of Salmonella Rubella Lyme disease Allergies

Allergies

(Absense of red reflex in right eye) Pt: "My doctor says I have cataracts. When should I have them removed?" It appears that the right eye is due for surgery. Are you having difficulty reading or doing activities you enjoy? Are you starting to experience frequent headache or pain in your right eye? Cataracts can be removed any time that it is convenient to you.

Are you having difficulty reading or doing activities you enjoy?

Which statement does the nurse include when teaching a patient about health promotion after eye surgery? (Select all that apply) A. Avoid bending at the waist B. Avoid any straining with stool C. Report any pain not relieved by prescribed medications D. Use aseptic technique when instilling eye medications E. Cough at least 10 times every hour

Avoid bending at the waist Avoid straining with stool Use aseptic technique when instilling eye medication

When teaching the patient about Ménière disease, which of the following diet changes should the nurse emphasize? A. Avoid foods high in sodium B. Increase the amount of green leafy vegetables C. Reduce the intake of milk and milk products D. Increase fluid intake before meals

Avoid foods in high sodium

You're caring for pt who is deficient in T cells. You should anticipate the cause of​ T-cell deficiency is related to decrease in leukocytes Impaired cellular immunity Decrease in granulocytes Hypersensitivity reaction

Decreased in leukocytes Impaired cellular immunity

You're assessing a pt for metabolic acidosis. Which manifestation will you likely to​ observe? (Select all that​ apply.) Bradycardia Hypokalemia Skeletal problems Warm, flushed skin, Nausea/ Vomiting

Bradycardia Skeletal Problems Warm, flushed skin, Nausea/Vomiting

The nurse is preparing a presentation on infections. Which factor regarding chronic infections should be​ included? Chronic infections only affect susceptible hosts. Chronic infections can persist for long periods. Chronic infections generally appear suddenly. Chronic infections do not affect young children.

Chronic infections can persist for long periods.

Which modifiable risk factor can affect the development of autoimmune diseases and require teaching? (SATA) Race/ Gender Chronic stress Introduction of solid foods too early Smoking

Chronic stress Introduction of solid foods too early Smoking

Immediately after cataract surgery, it is important for the nurse to place the patient in what position? A. Flat in bed B. Turned in affected side C. High Fowler's position D. Semi-Fowler's position

D. Semi-Fowler's position

During the nurses initial assessment of an older woman with open-angle glaucoma, what symptoms might the history reveal? A. Light flashes in both eyes B. Difficulty focusing on near objects C. Acute severe eye pain D. Watery drainage from both eyes

Difficulty focusing on near objects

When educating a patient about acute angle-closure glaucoma, what point should the nurse emphasize to the patients about this condition? A. Immediately report symptoms to the physician B. Do not use medications that cause pupil constriction C. Wear sunglasses when outdoors D. Lie down for 30 minutes until symptoms disappear

Immediately report symptoms to the physician

The nurse is preparing a discharge instruction sheet for a client who had an ear surgery two days ago. Which of the following must be included in this plan? A. Take antiemetics t.i.d B. Change the inner dressing daily C. Keep the mouth open when sneezing or coughing D. Do not bathe until released by the doctor

Keep the mouth open when sneezing and coughing

A patient voices an understanding of instructions about furosemide (Lasix) when he states A. "I will report any blurred vision." B. "I expect that this will cause me to have increased sensitivity to saltiness." C. "If I notice ringing in my ears, I will call the doctor." D. "I know that I need to monitor my feet for possible skin changes."

One of the side effects of furosemide is ringing in the ears (tinnitus). Furosemide does not cause changes in vision, in taste regarding saltiness, or in sensation of the skin.

In reviewing pt's health hx which factor should you consider a risk for developing immune system disorders? Physical Stressors African American Race Psychological stressors Genetic predisposition

Physical Stressors African American Race Psychological stressors Genetic predisposition

Administered sodium bicarbonate to pt with metabolic acidosis. As pH normalizes which labs are MOST important to watch? Creatinine Potassium Sodium Bicarbonate

Potassium

When teaching pt with Type I diabetes what should you teach to prevent metabolic acidosis? Take insulin as prescribed Monitor glucose levels weekly Notify healthcare provider when sick Drink eight 8 ounce glasses of water per day

Take insulin as prescribed Notify healthcare provider when sick Drink 8 ounces glasses of water per day

You're teaching pt's adult child about eye drop medications. You should include which piece of info related to aging.

Tremors and cognitive decline can impact remembering to use eye drops

True or False The cornea, the eyes white portion, is contiguous with iris and is no transparent

True

True or False The lens is a transparent, gelatinous mass of fibers encased in an elastic capsule situated behind the iris

True

Vertigo can be caused by orthostatic pressures. True False

True

Provider orders IV sodium​ bicarbonate for pt with metabolic acidosis. What adverse affects should you monitor for? Hypercapnia Generalized hives Diarrhea Vomiting

Vomiting