**Complex Concept I Final Exam: Sensory and Mobility Modules

The nurse is admitting a client diagnosed with multiple sclerosis. Which clinical manifestation should the nurse assess?Select all that apply. 1. Muscle flaccidity. 2. Lethargy. 3. Dysmetria. 4. Fatigue. 5. Dysphagia.

1, 3, 4, 5

The client diagnosed with an acute exacerbation of multiple sclerosis is placed on high-dose intravenous injections of corticosteroid medication. Which nursing intervention should be implemented? 1. Discuss discontinuing the proton pump inhibitor with the HCP. 2. Hold the medication until after all cultures have been obtained. 3. Monitor the client's serum blood glucose levels frequently. 4. Provide supplemental dietary sodium with the client's meals.

3.

The 30-year-old female client is admitted with complaints of numbness, tingling, a crawling sensation affecting the extremities, and double vision which has occurred two(2) times in the month. Which question is most important for the nurse to ask the client? 1. "Have you experienced any difficulty with your menstrual cycle?" 2. "Have you noticed a rash across the bridge of your nose?" 3. "Do you get tired easily and sometimes have problems swallowing?" 4. "Are you taking birth control pills to prevent conception?"

3. These are clinical manifestation of MS and can go un diagnosed for years be-cause of the remitting-relapsing nature of the disease. Fatigue and difficulty swallowing are other symptoms of MS.

A nurse is providing teaching for a client who has a new diagnosis of dry macular degeneration. Which of the following instructions should the nurse include in the teaching? A. Increase intake of deep yellow and orange vegetables. B. Administer eye drops twice daily. C. Avoid bending at the waist. D. Wear an eye patch at night.

A

An older patient with osteoarthritis is preparing for discharge. Which of the following information is correct. A. Increased physical activity and daily exercise will help decrease discomfort associated with the condition. B. Joint pain will diminish after a full night of rest. C. Nonsteroidal anti-inflammatory medications should be taken on an empty stomach. D. Acetaminophen (Tylenol) is a more effective anti-inflammatory than ibuprofen (Motrin).

A

The client with glaucoma asks the nurse if complete vision will return. The most appropriate response is: A. "Although some vision has been lost and cannot be restored, a further loss may be prevented by adhering to the treatment plan." B. "Your vision will return as soon as the medications begin to work." C. "Your vision will never return to normal." D. "Your vision loss is temporary and will return in about 3-4 weeks."

A

The client with glaucoma is prescribed a miotic cholinergic medication. Which data support the teaching for this med has been effective? A. The client reports taking the med on vacations B. The client reports taking a stool softener every day. C. The client places the med in the inner canthus D. The client wears gloves when instilling the med.

A

The nurse cares for a client who is visually impaired. The nurse knows which disease is the leading cause of legal blindness in adults over the age of 60? A. age-related macular degeneration (AMD) B. cortical cataracts C. normal tension glaucoma D. diabetic retinopathy

A

Which of the following statements would indicate that a client with peripheral neuropathy understands teaching about foot care at home? a "I will check my feet for cuts and bruises every night." b "I will always buy my shoes over the Internet." c "If I get a blister, I treat it with alcohol and a Band-Aid." d "I will walk barefoot as long as I am in the house."

A

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect? A. Drowsiness B. Dry mouth C. Coughing D. Dark sweat or saliva

A

A patient with Parkinson Disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option below is the best for this patient? A. Scrambled eggs with a side of cottage cheese B. Grilled cheese with apple slices C. Baked chicken with bacon slices D. Tacos with refried beans

A The patient should have a diet of soft foods that are easy to swallow and chew.

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? Select all that apply. A. Heberden's nodes B. Swelling of all joints C. Small body frame D. Enlarged joint size E. Limp when walking

A, D, E

A nurse is teaching a client who has a history of low-back injury. Which of the following instructions should the nurse provide the client to prevent future problems with low back pain? Select all that apply. A. Engage in regular exercise including walking B. Sit for up to 10hr each day to rest the back C. Maintain weight within 25% of ideal body weight D. Create a smoking cessation plan E. Wear low-heeled shoes

A, D, E

A nurse is teaching a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include? Select all that apply. A. Apply heat to joints to alleviate pain B. Ice inflamed joints for 30 minutes after activity C. Reduce the amount of exercise done on days with increased pain D. Elevate the knees with a pillow while in bed E. Wear foot insoles in shoes

A,C, E

A nurse is caring for a client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this as a manifestation of which of the following diseases? A. Cataracts B. Open-angle glaucoma C. Macular degeneration D. Angle-closure glaucoma

B

A nurse is caring for a client who injured their lower back due to a fall and reports sharp pain in their back and down their left leg. In which of the following positions should the nurse plan to place the client to attempt to decrease the pain? A. Prone without the use of pillows B. Semi-Fowler's with a pillow under the knees C. High-Fowler's with the knees flat on the bed D. Supine with the head flat

B

A nurse is preparing to collect data for a client who has multiple sclerosis (MS). Which of the following findings should the nurse expect? A. Elevated BP B. Client report of fatigue C. Client report of rhinitis D. Muscle rigidity

B

Heberden's nodes are a common sign of osteoarthritis. Which of the following statements is correct about this deformity? A. It appears only in men. B. It appears on the distal interphalangeal joint. C. It appears on the proximal interphalangeal joint. D. It appears on the dorsolateral aspect of the interphalangeal joint.

B

A nurse is providing information about capsaicin cream to a client who reports continuous knee pain from osteoarthritis. Which of the following information should the nurse include? A. Continuous pain relief is provided B. Put on gloves before applying the cream to other parts of the body C. Remove cream is burning sensation occurs D. Apply the medication every 2hr during the day

B When taking actions, the nurse should instruct the client to put on gloves before applying cream to parts of the body other than the hands

The 65 year old client is diagnosed with macular degeneration. Which statement indicates the client understands the discharge teaching concerning this diagnosis? A. I should use artificial tears 3 times a day. B. I will look at my Amsler grid at least twice a week C. I am going to use low-watt lightbulbs in my house D. I will wear dark sunglasses when I go outside.

B provides earliest sign of worsening condition.

You're providing diet education to a patient with Parkinson's Disease. Which statement below demonstrates the patient understood your teaching? Select all that apply:* A. "I will limit foods high in fiber like fruits and vegetables in my diet." B. "I will be sure to drink 2 Liter of fluid per day." C. "It is very common for me to experience diarrhea with this disease." D. "I will avoid taking Carbidopa/Levodopa with a protein rich meal."

B&D Constipation (not diarrhea) is a common symptom with Parkinson's Disease. Therefore, the patient should be vigilant about preventing constipation by EATING foods high in fiber like fruits/vegetable and drinking 2 L of fluid per day (unless contraindicated). In addition, diet teaching should be included with the medication Carbidopa/Levodopa. The patient should NOT take this medication with a protein rich meal because levodopa competes with protein in the small intestine (hence decreasing it absorption).

A nurse is caring for a client who has stage IV Parkinson's disease and has lost 20 lbs since their last checkup one month ago. The client presents with akinesia and rigidity. A nurse is developing a plan of care for the nutritional needs. Which of the following actions should the nurse include? Select all that apply. A. Provide three large balanced meals daily. B. Record diet and fluid intake daily. C. Document weight every other week. D. Offer cold fluids such as milk shakes. E. Offer nutritional supplements between meals.

B, D, E

A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? Select all that apply. A. "This medication will help you with your tremors." B. "This medication will help you with your bladder function." C. "This medication can cause your skin to bruise easily." D. "This medication can cause you to experience dizziness." E. "Nasal congestion and drainage occur."

B, D, E Baclofen is an antispasmodic medication that is given to clients who have MS to treat muscle spasms. An adverse effect of this medication is drowsiness, dizziness, weakness, and nausea. Instruct the client to monitor for these findings, as they can lead to impaired safety. The client should be instructed not to discontinue baclofen abruptly.

A 68-year-old client comes to the outpatient clinic and complains to the attending nurse about his increased difficulty with "close-work" such as knitting. He indicates he does not have difficulty seeing objects on either side but does state that straight lines appear distorted or wavy. The nurse suspects which of the following disorders is consistent with the client's reported symptoms? A. Glaucoma B. Cataracts C. Macular degeneration D. Subconjunctival hemorrhage

C

A client who has glaucoma is to have miotic eye drops instilled in both eyes. The nurse knows that the purpose of the medication is to: A. Anesthetize the cornea B. Dilate the pupils C. Constrict the pupils D. Paralyze the muscles of accommodation

C

A nurse is caring for a client who is taking benztropine and is reporting tremors and rigidity in the left hand and arm. Which of the following findings should the nurse identify as an adverse effect of benztropine? ​​​​​​​ A. Aspiration B. Diarrhea C. Dry mouth D. Dark urine

C

A patient has muscle spasms and acute low back pain. An appropriate nursing intervention for this problem is to teach the patient to a. avoid the use of cold because it will exacerbate the muscle spasms. b. keep both feet flat on the floor when prolonged standing is required. c. keep the head elevated slightly and flex the knees when resting in bed d. twist gently from side to side to maintain range of motion in the spine.

C

A patient is prescribed to take Carbidopa/Levodopa (Sinemet). As the nurse you know that which statement is incorrect about this medication: A. It can take up to 3 weeks for the patient to notice a decrease in signs and symptoms when beginning treatment with this medication. B. Body fluids can turn a dark color and stain clothes. C. This medication is most commonly prescribed with a vitamin B6 supplement. D. Carbidopa helps to prevent Levodopa from being broken down in the blood before it enters the brain. Hence, levodopa is able to enter the brain.

C

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of?* A. Physical exercise to improve fatigue B. Low fat diet C. Hand hygiene and avoiding infection D. Reporting ideation of suicide

C

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the physician's orders, expecting which type of eye drops to be instilled? A. An osmotic diuretic B. A miotic agent C. A mydriatic medication D. A thiazide diuretic

C

Preparing to administer eye drops to a client with glaucoma. When instilling the med, which action should the RN take? A. Instruct client to blink several times after instilling the med. B. Ask the client to look straight ahead during instillation C. Apply pressure to the puncta after instilling the med D> Place each drop of the med directly onto the client's cornea.

C

You're patient with Parkinson's Disease has been taking Carbidopa/Levodopa for several years. The patient reports that his signs and symptoms actually become worse before the next dose of medication is due. As the nurse, you know what medication can be prescribed with this medication to help decrease this for happening? A. Anticholinergic (Benztropine) B. Dopamine agonists (Ropinirole) C. COMT Inhibitor (Entacapone) D: Beta blockers (Metoprolol)

C

Which medications below can help treat muscle spasms in a patient with multiple sclerosis? Select all that apply: A. Propranolol B. Isoniazid C. Baclofen D. Diazepam E. Modafinil

C, D

Which information will the nurse include when teaching a patient with acute low back pain (select all that apply)? a. Sleep in a prone position with the legs extended. b. Keep the knees straight when leaning forward to pick something up. c. Avoid activities that require twisting of the back or prolonged sitting. d. Symptoms of acute low back pain frequently improve in a few weeks. e. Ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) can be used to relieve pain.

C, D, E

A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching? A. "You can resume playing golf in 2 days." B. "You need to tilt your head back when washing your hair." C. "You can get water in your eyes in 1 day." D. "You need to limit your housekeeping activities."

D

A patient with glaucoma asks the nurse what he can do to improve his vision. The nurse knows that: A. Vision loss from glaucoma will heal itself over time. B. Vision loss from glaucoma can be corrected with glasses. C. Vision loss from glaucoma can be helped with daily medication. D. Vision loss from glaucoma is irreparable once present.

D

The nurse is caring for a client experiencing severe macular degeneration who will be taught to ambulate with a cane. Before cane-assisted ambulation instructions begin, what would the nurse check for as the priority to assure client safety? A. A high level of stamina & energy B. Self-consciousness about using a cane. C. Full range of motion in lower extremities D. Balance, muscle strength & confidence.

D

The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions would the nurse include in the plan of care? A. Decrease fluid intake to control the intraocular pressure. B. Avoid overuse of the eyes. C. Decrease the amount of salt in the diet. D. Eye medications will need to be administered lifelong.

D

The nurse is teaching a client with diabetes about measures the client can take in the home to prevent injury related to peripheral neuropathy. The nurse makes which of the following suggestions? a Use only scatter rugs in the house. b Use cold water for baths and showers. c Switch bright lights on at night when walking about the house. d Use a night light in the bedroom and bath.

D

Teaching for peripheral neuropathy:

No direct heat or cold Focus on treating the underlying cause and promoting safety /comfort Teach the client and their families preventive & comfort measures. Clients with GBS may require frequent teaching if anxiety interferes with the ability to understand. Include the family in decision making Foot care Exercise Smoking cessation Avoidance of toxic chemicals Nutrition, stressing the importance of identifying sources of B12 Avoidance of repetitive motion and / or prolonged pressure Massage to improve circulation, stimulate nerves, and reduce pain Referrals as appropriate

Medications for low back pain

Nonsteroidal anti-inflammatory drugs: Over-the-counter or prescription NSAIDs can be helpful. Mild opioids- Tramadol can be used if NSAIDs are ineffective. Topical creams sprays and gels- Can temporarily dull pain by using heat or cold sensations Ziconotide- Used for severe chronic back pain

Clinical manifestations for peripheral neuropathy :

Tingling ("pins and needles") Numbness Loss of sensation in the arms and legs A burning sensation in the feet or hands (electric-like pain) Muscle twitching, cramps and/or spasms Falling, loss of coordination Muscle weakness Inability to move a part of the body (paralysis)

Caring for a client with multiple sclerosis and receiving interferon beta-1a. The nurse identifies which statement as a potential adverse effect of the med? My body aches all over I have abdominal cramping My hair seems to be thinning It hurts when I urinate.

body aches

Assessing a client with osteoarthritis and client has Heberden's nodes. Which finding should the nurse expect? Inflamed, fluid filled sacs over the joints Clubbing of the fingernails Flexion contracture of the fingers Hard lumps over the joints of the fingers.

hard lumps

The client is diagnosed with cataracts. Which symptom would the nurse expect the client to report? Halos around lights Floating spots in the eye Everything has a yellow haze Painless, blurry vision

painless blurry vision

A client reports that her osteoarthritis pain in her knees is increasing each day. The nurse wants to discuss non-pharmalogical approaches to help relieve her pain. Which intervention should the nurse suggest? Apply warm compresses to the joints Decrease daily intake of protein Keep joints in extension during rest periods Limit sleep to 6-7 hours/night

warm compresses