Concept Test 1: Harding

A patient who is having an acute exacerbation of multiple sclerosis has a prescription for methylprednisolone (Solu-Medrol) 150 mg IV. The label on the vial reads: methylprednisolone 125 mg in 2 mL. How many mL should the nurse administer?

2.4

A hospitalized patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first? A. Start the prescribed PRN O2 at 6 L/min. B. Put a moist hot pack on the patient's neck. C. Give the ordered PRN acetaminophen (Tylenol). D. Notify the patient's health care provider immediately.

A

A patient has been taking phenytoin (Dilantin) for 2 years. Which action should the nurse take when evaluating possible adverse effects of the medication? A. Inspect the oral mucosa. B. Listen to the lung sounds. C. Auscultate the bowel sounds. D. Check pupil reaction to light.

A

A patient hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the patient is experiencing delirium rather than dementia? A. The patient was oriented and alert when admitted. B. The patient's speech is fragmented and incoherent. C. The patient is oriented to person but disoriented to place and time. D. The patient has a history of increasing confusion over several years.

A

A patient reports feeling numbness and tingling of the left arm before experiencing a seizure. The nurse should know that this history is consistent with what type of seizure? A. Focal-onset B. Atonic C. Absence D. Myoclonic

A

A patient tells the nurse about using acetaminophen (Tylenol) several times every day for recurrent bilateral headaches that are present on wakening. Which action should the nurse plan to take first? A. Discuss the need to stop taking the acetaminophen. B. Suggest the use of biofeedback for headache control. C. Describe the use of botulism toxin (Botox) for headaches. D. Teach the patient about magnetic resonance imaging (MRI).

A

A patient with a family history of cystic fibrosis (CF) asks for information about genetic testing. Which response by the nurse is most appropriate? A. Refer the patient to a qualified genetic counselor. B. Ask the patient why genetic testing seems necessary. C. Remind the patient that genetic testing has many social implications. D. Tell the patient that cystic fibrosis is an autosomal recessive disorder.

A

After change-of-shift report, which patient should the nurse assess first? A. Patient with myasthenia gravis who is reporting increased muscle weakness. B. Patient with a bilateral headache described as "like a band around my head." C. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin). D. Patient with Parkinson's disease who has developed cogwheel rigidity of the arms.

A

After reviewing the health record shown in the accompanying figure for a patient who has multiple risk factors for Alzheimer's disease (AD), which topic will be most important for the nurse to discuss with the patient? A. Tobacco use B. Family history C. Cholesterol level D. Head injury history

A

The day shift nurse at the long-term care facility learns that a patient with dementia experienced sundowning late in the afternoon on the previous two days. Which action should the nurse take? A. Keep window blinds open during the day. B. Have the patient take a mid-morning nap. C. Provide hourly orientation to time and place. D. Move the patient to a quiet room in the afternoon.

A

The nurse in the outpatient clinic has obtained health histories for these new patients. Which patient may need referral for genetic testing? A. A 30-yr-old patient who has a sibling with polycystic kidney disease B. A 30-yr-old patient with dyspnea who has a history of cigarette smoking C. A 20-yr-old patient whose maternal grandparent died after a stroke at age 80 D. A 20-yr-old patient with a positive pregnancy test whose first child has cerebral palsy

A

The nurse observes a patient ambulating in the hospital hall. The patient's arms and legs suddenly jerk and the patient falls to the floor. What action should the nurse take first? A. Assess the patient for a possible injury. B. Give the scheduled divalproex (Depakote). C. Document the timing and description of the seizure. D. Notify the patient's health care provider about the seizure.

A

When caring for a young adult patient who has abnormalities in the cytochrome P450 (CYP 450) gene, which action will the nurse include in the patient's plan of care? A. Teach that some medications may not work effectively. B. Teach about genetic risk for cystic fibrosis in any children. C. Encourage scheduling screening mammograms starting at age 30. D. Encourage the patient to watch for early symptoms of heart disease.

A

When counseling a couple in which the man has an autosomal recessive disorder and the woman has no gene for the disorder, the nurse uses Punnett squares to show the couple the probability of their having a child with the disorder. Which statement by the nurse is accurate? A. "Each child would be a carrier of the disorder." B. "Each child would have 50% chance of having the disorder." C. "Your male children would display characteristics of the disorder." D. "Your female children would display characteristics of the disorder."

A

A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which interventions should the nurse include in the plan of care? (Select all that apply.) A. Provide an elevated toilet seat. B. Cut patient's food into small pieces. C. Serve high-protein foods at each meal. D. Place an armchair at the patient's bedside. E. Observe for sudden exacerbation of symptoms.

A, B, D

A patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room? (Select all that apply.) A.Side rail pads B. Tongue blade C. Oxygen mask D. Suction tubing E. Urinary catheter F. Nasogastric tube

A, C, D

A hospitalized patient reports a bilateral headache (4/10 on the pain scale) that radiates from the base of the skull. Which prescribed PRN medication should the nurse administer initially? A. lorazepam (Ativan) B. acetaminophen (Tylenol) C. morphine sulfate (MS Contin) D. butalbital and aspirin (Fiorinal)

B

A 74-yr-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rolling-type tremor. What should the nurse anticipate explaining to the patient? A. Oral corticosteroids B. Antiparkinsonian drugs C. Magnetic resonance imaging (MRI) D. Electroencephalogram (EEG) testing

B

A high school teacher who has been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, "I cannot teach any more. It will be too upsetting if I have a seizure at work." How should the nurse respond to specifically address the patient's concern? A. "You might benefit from some psychologic counseling." B. "Epilepsy usually can be well controlled with medications." C. "You will want to contact the Epilepsy Foundation for assistance." D. "The Department of Vocational Rehabilitation can help with work retraining."

B

A patient seen in the outpatient clinic is newly diagnosed with mild cognitive impairment (MCI). Which action will the nurse include in the plan of care? A. Suggest a move into an assisted living facility. B. Schedule the patient for more frequent appointments. C. Ask family members to supervise the patient's daily activities. D. Discuss the preventive use of acetylcholinesterase medications.

B

A patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which action should the nurse include in the plan of care? A. Observe for agitation and paranoia. B. Assist with active range of motion (ROM). C. Give muscle relaxants as needed to reduce spasms. D. Use simple words and phrases to explain procedures.

B

A patient who has severe Alzheimer's disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care? A. Encourage the patient to discuss events from the past. B. Maintain a consistent daily routine for the patient's care. C. Reorient the patient to the date and time every 2 to 3 hours. D. Provide the patient with current newspapers and magazines.

B

A patient with Parkinson's disease has bradykinesia. Which action should the nurse include in the plan of care? A. Instruct the patient in activities that can be done while lying or sitting. B. Suggest that the patient rock from side to side to initiate leg movement. C. Have the patient take small steps in a straight line directly in front of the feet. D. Teach the patient to keep the feet in contact with the floor and slide them forward.

B

After a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient reports nausea and severe abdominal cramps. Which action should the nurse take first? A. Auscultate the patient's bowel sounds. B. Notify the patient's health care provider. C. Administer the prescribed PRN antiemetic drug. D. Give the scheduled dose of prednisone (Deltasone)

B

The health care provider is considering the use of sumatriptan (Imitrex) for a 54-yr-old male patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider? A. The patient drinks 1 to 2 cups of coffee daily. B. The patient had a recent acute myocardial infarction. C. The patient has had migraine headaches for 30 years. D. The patient has taken topiramate (Topamax) for 2 months.

B

The home health registered nurse (RN) is planning care for a patient with seizure disorder related to a recent head injury. Which action can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? A. Make referrals to appropriate community agencies. B. Place medications in the home medication organizer. C. Teach the patient and family how to manage seizures. D. Assess for use of medications that may precipitate seizures.

B

The nurse is administering a mental status examination to a patient who has hypertension. The nurse suspects depression when the patient responds to the nurse's questions with A. "Is that right?" B. "I don't know." C. "Wait, let me think about that." D. "Who are those people over there?"

B

What action should the nurse include in completing a health history and physical assessment for a 36-yr-old female patient with possible multiple sclerosis (MS)? A. Assess for the presence of chest pain. B. Inquire about urinary tract problems. C. Inspect the skin for rashes or discoloration. D. Ask the patient about any increase in libido.

B

What should the nurse advise a patient with myasthenia gravis (MG) to do? A. Anticipate the need for weekly plasmapheresis treatments. B. Complete physically demanding activities early in the day. C. Protect the extremities from injury due to poor sensory perception. D. Perform frequent weight-bearing exercise to prevent muscle atrophy.

B

Which action should the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? A. Encourage decreased evening intake of fluid. B. Teach the patient how to use the Credé method. C. Suggest the use of adult incontinence briefs for nighttime only. D. Assist the patient to the commode every 2 hours during the day.

B

Which finding should the nurse expect when assessing a patient who is experiencing a cluster headache? A. Nuchal rigidity B. Unilateral ptosis C. Projectile vomiting D. Bilateral facial pain

B

Which information about a patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? A. The patient reports pain with neck flexion. B. The patient has increased serum creatinine. C. The patient walks a mile each day for exercise. D. The patient has the relapsing-remitting form of MS.

B

Which intervention should the nurse include in the plan of care for a patient who has primary restless legs syndrome (RLS) and is having difficulty sleeping? A. Teach about the use of antihistamines to improve sleep. B. Suggest that the patient exercise regularly during the day. C. Make a referral to a massage therapist for deep massage of the legs. D. Assure the patient that the problem is transient and likely to resolve.

B

Which intervention will the nurse include in the plan of care for a patient with moderate dementia who is admitted for other health problems? A. Provide complete personal hygiene care for the patient. B. Remind the patient frequently about being in the hospital. C. Reposition the patient frequently to avoid skin breakdown. D. Place suction at the bedside to decrease the risk for aspiration.

B

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia? A. Setting the medications up monthly in a medication box B. Having the patient's family member administer the medication C. Posting reminders to take the medications in the patient's house D. Calling the patient weekly with a reminder to take the medication

B

Which patient problem should the nurse identify as of highest priority for a patient who has Parkinson's disease and is unable to move the facial muscles? A. Activity intolerance B. Inadequate nutrition C. Disturbed body image D. Impaired physical mobility

B

Which actions could the nurse delegate to a licensed practical/vocational nurse (LPN/VN) who is part of the team caring for a patient with Alzheimer's disease? (Select all that apply.) A. Develop a plan to minimize difficult behavior. B. Administer the prescribed memantine (Namenda). C. Remove potential safety hazards from the patient's environment. D. Refer the patient and caregivers to appropriate community resources. E. Help the patient and caregivers choose memory enhancement methods. F. Evaluate the effectiveness of enteral nutrition on the patient's nutrition status.

B, C,

The spouse of a 67-yr-old male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am exhausted from worrying all the time. I don't know what to do." Which actions are best for the nurse to take at this time? (Select all that apply.) A. Suggest that a long-term care facility be considered. B. Offer ideas for ways to distract or redirect the patient. C. Teach the spouse about adult day care as a possible respite. D. Suggest that the spouse consult with the physician for antianxiety drugs. E. Ask the spouse what she knows and has considered about dementia care options.

B, C, E

The nurse should determine that teaching about migraine headaches has been effective when the patient says which of the following? A. "I can take the (Topamax) as soon as a headache starts." B. "A glass of wine might help me relax and prevent a headache." C. "I will lie down someplace dark and quiet when the headaches begin." D. "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."

C

A 22-yr-old patient seen at the health clinic with a severe migraine headache tells the nurse about having similar headaches recently. Which initial action should the nurse take? A. Teach about the use of triptan drugs. B. Refer the patient for stress counseling. C. Ask the patient to keep a headache diary. D. Suggest the use of muscle-relaxation techniques.

C

A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information should the nurse include in patient teaching? A. Recommendation to drink at least 4 L of fluid daily B. Need to avoid driving or operating heavy machinery C. How to draw up and administer injections of the medication? D. Use of contraceptive methods other than oral contraceptives

C

A 72-yr-old patient is brought to the clinic by the patient's spouse, who reports that the patient is unable to solve common problems around the house. To obtain information about the patient's current mental status, which question should the nurse ask the patient? A. "Are you sad right now?" B. "How is your self-image?" C. "What did you eat for lunch?" D. "Where were you were born?"

C

A patient is diagnosed with moderate dementia after multiple strokes. What would the nurse expect to find during assessment of the patient? A. Excessive nighttime sleepiness. B. Difficulty eating and swallowing. C. Loss of recent and long-term memory. D. Fluctuating ability to perform simple tasks.

C

A patient tells the nurse, "I would like to use a home genetic test to see if I will develop breast cancer." Which is the nurse's best initial response? A. "Home genetic testing can be very expensive." B. "Are you prepared to cope with a positive result?" C. "Are you concerned about developing breast cancer?" D. "Genetic testing only determines if you are at higher risk for breast cancer."

C

A patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility has had several episodes of wandering away from home. Which action will the nurse include in the plan of care? A. Reorient the patient several times daily. B. Have the family bring in familiar items. C. Place the patient in a room close to the nurses' station. D. Remind the patient not to wander from the nursing unit.

C

A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. How should the nurse respond? A. "MS symptoms will be worse after the pregnancy." B. "Women with MS frequently have premature labor." C. "Symptoms of MS are likely to improve during pregnancy." D. "MS is associated with an increased risk for congenital defects."

C

The sister of a patient diagnosed with BRCA gene-related breast cancer asks the nurse, "Do you think I should be tested for the gene?" Which response by the nurse is most appropriate? A. "In most cases, breast cancer is not caused by having the BRCA gene." B. "It depends on how you will feel if the test is positive for the BRCA gene." C. "There are many things to consider before deciding to have genetic testing." D. "First you should decide whether you are willing to have a bilateral mastectomy."

C

What action should the nurse incorporate when administering a mental status examination to a patient with delirium? Wait until the patient is well-rested. Administer an anxiolytic medication. Choose a place without distracting stimuli. Reorient the patient during the examination.

C

What should be the nurse's initial action for a patient with moderate dementia who develops increased restlessness and agitation? A. Reorient the patient to time, place, and person. B. Administer a PRN dose of lorazepam (Ativan). C. Assess for factors that might be causing discomfort. D. Assign unlicensed assistive personnel (UAP) to stay in the patient's room.

C

When administering the Mini-Cog exam to a patient with possible Alzheimer's disease, which action will the nurse take? A. Check the patient's orientation to time and date. B. Obtain a list of the patient's prescribed medications. C. Ask the patient to indicate a specific time on a clock drawing. D. Determine the patient's ability to recognize a common object.

C

Which action will help the nurse determine whether a new patient's confusion is caused by dementia or delirium? A. Ask about a family history of dementia. B. Administer the Mini-Mental Status Exam. C. Use the Confusion Assessment Method tool. D. Obtain a list of the patient's usual medications.

C

Which assessment should the nurse identify as most important regarding a patient with myasthenia gravis? A. Pupil size B. Grip strength C. Respiratory effort D. Level of consciousness

C

Which hospitalized patient will the nurse assign to the room closest to the nurses' station? A. Patient with Alzheimer's disease who has long-term memory deficit B. Patient with vascular dementia who takes medications for depression C. Patient with new-onset confusion, restlessness, and irritability after surgery D. Patient with dementia who has an abnormal Mini-Mental State Examination

C

Which prescribed intervention should the emergency department nurse implement first for a patient who is experiencing continuous tonic-clonic seizures? A. Give phenytoin (Dilantin) 100 mg IV. B. Monitor level of consciousness (LOC). C. Administer lorazepam (Ativan) 4 mg IV. D. Obtain computed tomography (CT) scan.

C

While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take? A. Insert an oral airway during the seizure to maintain a patent airway. B. Restrain the patient's arms and legs to prevent injury during the seizure. C. Time and observe and record the details of the seizure and postictal state. D. Avoid touching the patient to prevent further nervous system stimulation.

C

A 40-yr-old patient is diagnosed with early Huntington's disease (HD). What information should the nurse provide when teaching the patient, spouse, and adult children about this disorder? A. Improved nutrition and exercise can delay disease progression. B. Levodopa-carbidopa (Sinemet) will help reduce HD symptoms. C. Prophylactic antibiotics decrease the risk for aspiration pneumonia. D. Genetic testing is an option for the children to determine their HD risk.

D

A male patient with hemophilia asks the nurse if his future children will have hemophilia. Which response by the nurse is accurate? A. "All of your children will be at risk for hemophilia." B. "Hemophilia is a multifactorial inherited condition." C. "Only your male children are at risk for hemophilia." D. "Your female children will be carriers for hemophilia."

D

A patient is being evaluated for Alzheimer's disease (AD). What should the nurse explain to the patient's adult children? A. Brain atrophy detected by an MRI would confirm the diagnosis of AD. B. New drugs can reverse AD deterioration dramatically in some patients. C. The most important risk factor for AD is a family history of the disorder. D. A diagnosis of AD is made only after other causes of dementia are ruled out.

D

A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which assessment finding should indicate to the nurse that a change in the medication or dosage may be needed? A. Shuffling gait B. Tremor at rest C. Cogwheel rigidity of limbs D. Uncontrolled head movement

D

After change-of-shift report on the Alzheimer's disease/dementia unit, which patient will the nurse assess first? A. Patient who has not had a bowel movement for 5 days. B. Patient who has a stage II pressure ulcer on the coccyx. C. Patient who is refusing to take the prescribed medications. D. Patient who developed a new cough after eating breakfast.

D

The nurse is concerned about a postoperative patient's risk for injury during an episode of delirium. What is the nurse's most appropriate action? A. Secure the patient in bed using a soft chest restraint. B. Ask the health care provider to prescribe an antipsychotic drug. C. Instruct family members to remain at the patient's bedside and prevent injury. D. Assign unlicensed assistive personnel (UAP) to stay with and reorient the patient.

D

Which information about a patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication? A. Patient has tonic-clonic seizures. B. Patient experiences an aura before seizures. C. Patient's most recent blood pressure is 156/92 mm Hg. D. Patient has slight elevations in liver function test results.

D

Which medication taken by a patient with restless legs syndrome should the nurse discuss with the patient? A. Ibuprofen B. Multivitamin C. Acetaminophen D. Diphenhydramine

D