211 - Unit 3 - NCLEX Practice Questions

Which client would be most at risk for secondary Parkinson's disease caused by pharmacotherapy? 1. A 30-year-old client with schizophrenia taking chlorpromazine (Thorazine) 2. A 50-year-old client taking nitroglycerin tablets for angina 3. A 60-year-old client taking prednisone for chronic obstructive pulmonary disease 4. A 75-year-old client using naproxen for rheumatoid arthritis

1. Phenothiazines such as chlorpromazine deplete dopamine, which may lead to tremor rigidity (extrapyramidal effects). The other drugs don't place the client at a greater risk for developing Parkinson's disease.

41. Which symptom occurs initially in Parkinson's disease? 1. Akinesia 2. Aspiration of food 3. Dementia 4. Pill rolling movements of the hand

4. Early symptoms of Parkinson's disease include coarse resting tremors of the fingers and thumb. Akinesia and aspiration are late signs of Parkinson's disease. Dementia occurs in only 20% of clients with Parkinson's disease

A nurse is teaching a female adolescent with inflammatory bowel disease about treatment with corticosteroids. Which adverse effects are concerns for this client? Select all that apply. 1. Acne 2. Hirsutism 3. Mood swings 4. Osteoporosis 5. Growth spurts 6. Adrenal suppression

1, 2, 3, 4, and 6. Adverse effects of corticosteroids include acne, hirsutism, mood swings, osteoporosis, and adrenal suppression. Steroid use in children and adolescents may cause delayed growth, not growth spurts.

The nurse is caring for a 15-year-old female client whose mother and grandmother both have osteoporosis. The client asks the nurse if there are any foods that she could include in her diet to help prevent osteoporosis. The best response by the nurse is: Select all that apply. 1. American cheese. 2. 8 oz container of yogurt. 3. potatoes. 4. sardines. 5. eggs. 6. spinach.

1, 2, 4, and 6. American cheese, yogurt, sardines, and spinach are all good sources of calcium. Potatoes and eggs are considered poor sources of calcium.

A perimenopausal client is at high risk for osteoporosis because of family history, lactose intolerance, and small body frame. The client asks the nurse how to prevent osteoporosis. What is the most important information for the nurse to provide for this client? 1. Increase the amount of calcium and vitamin D in your diet. 2. Hormone replacement therapy (HRT) is recommended. 3. Have a bone density test yearly. 4. It is not necessary to stop smoking.

1. Adequate calcium and vitamin D intake are an important part of an overall prevention program. Bone density tests can evaluate the risk for osteoporosis but do not need to be done yearly. Smoking is a risk factor for developing osteoporosis. Studies show that estrogen in HRT may influence the development of breast and uterine cancers.

A client is experiencing early symptoms of multiple sclerosis (MS). What would the nurse expect to assess? 1. Diplopia 2. Grief 3. Paralysis 4. Dementia

1. Early symptoms of MS include slurred speech and diplopia. Grief isn't a clinical manifestation. Paralysis is a late symptom of MS. Although depression and a short attention span may occur, dementia is rarely associated with MS.

The nurse is caring for an 82-year-old male client with Parkinson's disease who is frequently incontinent of urine. What is the most appropriate intervention by the nurse? 1. Diaper the client. 2. Apply a condom catheter. 3. Insert an indwelling urinary catheter. 4. Provide skin care every 4 hours.

2. A condom catheter uses a condom-type device to drain urine away from the client. Diapering the client may keep urine away from the body but may also be demeaning if the client is alert or the family objects. Because the client with Parkinson's disease is already prone to urinary tract infections, an indwelling urinary catheter should be avoided because it may promote this. Skin care must be provided as soon as the client is incontinent to prevent skin maceration and breakdown.

Which antiparkinsonian drug can cause drug tolerance or toxicity if taken for too long at one time? 1. Amantadine (Symmetrel) 2. Levodopa-carbidopa (Sinemet) 3. Pergolide 4. Selegiline (Eldepryl)

2. Long-term therapy with levodopa-carbidopa can result in drug tolerance or toxicity shown by confusion, hallucinations, or decreased drug effectiveness. The other drugs don't require that the client take a drug holiday

A 42-year-old client recently had a total hysterectomy and bilateral oophorectomy. Which of the following responses by the client indicates that the nurse's teaching about osteoporosis has been effective? 1. "Osteoporosis affects only women over 65 years." 2. "My risk for osteoporosis is low because I still have my thyroid gland." 3. "I'm still producing hormones, so I don't have to worry about osteoporosis." 4. "I need to take precautions to protect myself from osteoporosis because I have had surgically induced menopause."

Menopause at any age puts women at risk for osteoporosis because of the associated hormonal imbalance. This client's thyroid gland won't protect her from osteoporosis. With her ovaries removed, she's no longer producing hormones.

A 62-year-old client is admitted to the hospital with pneumonia. He has a history of Parkinson's disease, which his family says is progressively worsening. Which symptom will the nurse most likely observe when assessing the client? 1. Impaired speech 2. Muscle flaccidity 3. Pleasant and smiling demeanor 4. Tremors in the fingers that increase with purposeful movement

1. In Parkinson's disease, dysarthria, or impaired speech, is due to a disturbance in muscle control. Muscle rigidity results in resistance to passive muscle stretching. The client may have a masklike appearance. Tremors should decrease with purposeful movement and sleep.

An elderly client with rheumatoid arthritis is being treated with prednisone (Deltasone). The nurse is aware that complications occurring with long-term therapy include which of the following? 1. Breast and uterine cancer 2. Osteoporosis and diabetes mellitus 3. Weight loss and lactose intolerance 4. Deep vein thrombosis (DVT), pulmonary embolus, and stroke

2. Long-term prednisone therapy can increase the loss of calcium from bones, slow down the formation of new bone tissue (resulting in osteoporosis), and alter glucose metabolism (resulting in diabetes mellitus). Breast and uterine cancer, DVT, pulmonary embolus, stroke, weight loss, and lactose intolerance are not common adverse effects of prednisone. CN: Physiological integrity; CNS: Pharmacological and parenteral therapies;

The nurse is assessing a child with sickle cell anemia. Which bone-related complication would the nurse be alert for during assessment? 1. Arthritis 2. Osteoporosis 3. Osteogenic sarcoma 4. Spontaneous fractures

2. Sickle cell anemia causes hyperplasia and congestion of the bone marrow, resulting in osteoporosis. Arthritis doesn't occur secondary to sickle 1491 cell anemia; however, a crisis can cause localized swelling over joints, resulting in arthralgia. Bones do become weakened, but spontaneous fractures don't occur as a result. Osteogenic sarcoma is bone cancer; sickle cell anemia isn't a contributing factor to bone cancer.

A client with suspected multiple sclerosis (MS) undergoes a lumbar puncture. The nurse understands that the results of the cerebrospinal fluid (CSF) may show: 1. blood or increased red blood cells. 2. elevated white blood cells (WBCs) or pus. 3. increased glucose concentrations. 4. increased protein levels.

4. Elevated gamma globulin fraction in CSF without an elevated level in the blood occurs in MS. WBCs or pus indicates infection. Blood may be found with trauma or subarachnoid hemorrhage. Increased glucose concentration is a nonspecific finding indicating infection or subarachnoid hemorrhage

To evaluate the effectiveness of levodopa-carbidopa (Sinemet), a nurse should assess the client for: 1. improved visual acuity. 2. decreased dyskinesia. 3. reduction in short-term memory. 4. lessened rigidity and tremor.

4. Levodopa-carbidopa increases the amount of dopamine in the central nervous system, allowing for more smooth, purposeful movements. The drug doesn't affect visual acuity and should improve dyskinesia and short-term memory.

Before feeding a client with Parkinson's disease, which nursing action is most important? 1. Sit the client upright. 2. Have suction available. 3. Order a clear liquid diet. 4. Have a speech therapist evaluate the client.

4. A speech therapist can evaluate the client's swallowing and make recommendations before the client is fed. Aspiration due to involuntary movement is common. Sitting the client upright and having suction available are helpful when feeding the client, but evaluation of the client's swallowing ability should come first. Clear liquids may be too difficult for the client; semisoft foods may be easier to swallow.

A bedridden client develops disuse osteoporosis. Which nursing intervention is most important for this client? 1. Turn, cough, and deep-breathe. 2. Increase fluids to 3,000 ml daily. 3. Promote venous return by elevating the legs. 4. Provide active and passive range-of-motion (ROM) exercises.

4. All the interventions listed are good for a bedridden client. However, active and passive ROM exercises provide the mechanical stresses of weight bearing that are absent and their absence can lead to disuse osteoporosis.

The nurse is teaching the client about the primary cause of osteoporosis. What is the most important information for the nurse to provide? 1. "Alcoholism is the primary cause of osteoporosis." 2. "Malnutrition is the primary cause of osteoporosis." 3. "Hormonal imbalance is the primary cause of osteoporosis." 4. "Osteogenesis imperfecta is the primary cause of osteoporosis."

Hormonal imbalance, faulty metabolism, and poor dietary intake of calcium cause primary osteoporosis. Alcoholism, malnutrition, osteogenesis imperfecta, rheumatoid arthritis, liver disease, scurvy, lactose intolerance, hyperthyroidism, and trauma cause secondary osteoporosis.

A 70-year-old female client complains of lower back pain and is diagnosed with osteoporosis. The nurse is aware that this client is most at risk for which condition? 1. Pain 2. Fracture 3. Hardening of the bones 4. Increased bone matrix and remineralization

2. The primary complication of osteoporosis is fractures. With osteoporosis, bones soften, and there's a decrease in bone matrix and remineralization. Pain may occur, but fractures can be life threatening.

A 76-year-old woman with a history of osteoporosis experienced a right hip fracture and is admitted to the hospital. The client had a total hip replacement. The most important nursing diagnosis for this client would be? 1. Acute pain 2. Self-care deficit 3. Risk for impaired skin integrity 4. Imbalanced nutrition: Less than body requirements

1. Relieving pain and making the client comfortable are the highest priorities. All of the other nursing diagnoses would be lower priorities.

The nurse is teaching a client about the risk factors of osteoporosis. It is most important for the nurse to include which factors? Select all that apply. 1. Inadequate dietary intake of calcium 2. Blood pressure medications 3. Family history 4. Smoking 5. Oral hypoglycemics

1, 3, and 4. Inadequate dietary intake of calcium, family history, and smoking are risk factors of osteoporosis. There is no evidence that blood pressure medications or oral hypoglycemics are risk factors.

A young female client has been recently diagnosed with multiple sclerosis (MS) and wants more information on the disease. In teaching the client, which statement by the nurse is most accurate? 1. MS is an autoimmune disease. 2. MS is more common in men than women. 3. MS is characterized by remyelination. 4. MS is an acute and curable disease.

1. MS is a chronic autoimmune disease that is more common in women than in men. It is characterized by multiple areas of demyelination and scarring (sclerosis) of the underlying nerve fibers. There are no known cures for MS, although treatment can help promote remissions and prevent exacerbations.

A client who was diagnosed with multiple sclerosis (MS) asks the nurse if there are any conditions or activities that may exacerbate MS. What is the best response by the nurse? 1. Pregnancy 2. Range-of-motion (ROM) exercises 3. Swimming 4. Urine retention

1. Pregnancy, stress, fatigue, and heat may exacerbate MS. Exercise to maintain ROM is encouraged; swimming is particularly effective due to weightlessness and the cooling of nerves. Urine retention is common due to neurogenic bladder but doesn't lead to the exacerbation of symptoms.

The nurse is teaching a class on primary prevention of osteoporosis. What is the most important information for the nurse to provide? 1. Maintain the optimal calcium intake. 2. Place items within reach of the client. 3. Install bars in the bathroom to prevent falls. 4. Use a professional alert system in the home in case a fall occurs when the client is alone.

1. Primary prevention of osteoporosis includes maintaining optimal calcium intake. Placing items within reach of the client, using a professional alert system in the home, and installing bars in bathrooms are all secondary and tertiary prevention methods to prevent falls.

A client with multiple sclerosis (MS) is started on 20 mg of glatiramer (Copaxone) subcutaneously daily. Immediately after the injection, the client experiences flushing and chest pain. What is the most appropriate nursing intervention? 1. Call a code. 2. Call the physician to inform him of the client's adverse reaction. 3. Administer oxygen. 4. Monitor the client to see if the symptoms quickly dissipate.

4. Glatiramer helps to decrease the number of relapses in the MS client. Flushing, chest pain, palpitations, anxiety, shortness of breath, and itching occur in some clients following administration of the medication. They typically are transient and self-limiting and don't need specific treatment.

A nurse is evaluating a client to determine the extent of Parkinson's disease. The nurse would observe for which symptom? 1. Bulging eyeballs 2. Diminished distal sensation 3. Increased dopamine levels 4. Muscle rigidity

4. Parkinson's disease is characterized by the slowing of voluntary muscle movement, muscular rigidity, and resting tremor. Bulging eyeballs (exophthalmos) occur in Graves' disease. Diminished distal sensation doesn't occur in Parkinson's disease. Dopamine is deficient in this disorder.

A nurse is teaching a client and his family about dietary practices related to Parkinson's disease. Which signs and symptoms would be most important for the nurse to address? 1. Fluid overload and drooling 2. Aspiration and anorexia 3. Choking and diarrhea 4. Dysphagia and constipation

4. The eating problems associated with Parkinson's disease include dysphagia, risk of choking, drooling, aspiration, and constipation. Fluid overload, anorexia, and diarrhea aren't problems specifically related to Parkinson's disease.

A postmenopausal client asks a nurse how to prevent osteoporosis. What is the best response by the nurse? 1. "Take a multivitamin daily." 2. "After menopause, there's no way to prevent osteoporosis." 3. "Drink two glasses of milk each day and swim three times a week." 4. "Do weight-bearing exercises regularly."

4. Weight-bearing exercises are recommended for the prevention of osteoporosis. Telling the client that there's no way to prevent osteoporosis would be an incorrect statement. A multivitamin doesn't provide adequate calcium for a postmenopausal woman, and calcium alone won't prevent osteoporosis. Two glasses of milk per day don't provide the daily requirements for adult women, and swimming isn't a weight-bearing exercise.

The nurse is teaching a client with multiple sclerosis (MS) about ways to avoid exacerbation of the disease. What is the best information for the nurse to include? 1. Patching the affected eye 2. Sleeping 8 hours each night 3. Taking hot baths for relaxation 4. Drinking 1½ to 2 qt (1.5 to 2 L) of fluid daily

2. MS is exacerbated by exposure to stress, fatigue, and heat. Clients should balance activity with rest. Patching the affected eye may result in improvement in vision and balance but won't prevent exacerbation of the disease. Adequate hydration will help prevent urinary tract infections secondary to a neurogenic bladder.

A client is admitted with Parkinson's disease. The client's face is expressionless, and the client's speech is monotone. Which of the following observations by the nurse is most accurate? 1. The client is most likely depressed and should be left alone. 2. These are common symptoms of Parkinson's disease that produce an undesired façade of an alert and responsive individual. 3. The client's antipsychotic medication may need to be adjusted. 4. The client probably has dementia.

2. The nurse should recognize that these are common symptoms of Parkinson's disease. The symptoms do not indicate depression or dementia, although these are common in Parkinson's disease. Antipsychotic medication will often mimic Parkinson's disease extrapyramidal symptoms and is not indicated. Parkinson's disease is caused by degeneration of the substantia nigra in the basal ganglia of the brain, where dopamine is produced and stored. This degeneration results in motor dysfunction, resulting in symptoms such as an expressionless face and monotone speech.

A nurse notes severe hypocalcemia in a client with anorexia nervosa. Which history finding supports a diagnosis of osteoporosis? 1. Eating a vegetarian diet 2. Drinking well water 3. Going scuba diving 4. Smoking cigarettes

4. Hypocalcemia and cigarette smoking increase the risk for osteoporosis. Eating a vegetarian diet, drinking well water, and going scuba diving don't predispose the client to osteoporosis.