Final - evens cont.

A dietary modification for a patient with Ménière's disease would be: 1- A decrease in sodium intake to 2,000 mg daily. 2- Fluid restriction to 2 L/day. 3- An increase in calcium to 1 g/day. 4- An increase in vitamin C to 1.5 g/day.

1

The parent of a young client with severe hearing loss is quite concerned about the child's future independence because of impaired hearing. Which type of hearing loss is usually irreversible? 1- sensorineural 2- conductive 3- tinnitus 4- noise exposure

1

Which nursing intervention is the priority for a client in myasthenic crisis? 1- Assessing respiratory effort 2- Administering intravenous immunoglobin (IVIG) per orders 3- Preparing for plasmapheresis 4- Ensuring adequate nutritional support

1

Which nursing intervention should be included during the assessment of a client with an eye disorder? 1- Check the extraocular muscles by instructing the client to keep his or her head still when following an object. 2- Examine the retina with a direct ophthalmoscope. 3- Use a tonometer to indent or flatten the surface of the eye. 4- Instruct the client to stare at the central fixation spot on an Amsler grid and report if he or she sees any distortion of the squares.

1

Which test uses a tuning fork shifted between two positions to assess hearing? 1- Whisper 2- Watch tick 3- Rinne 4- Weber

3

A 66-year-old woman has sought care from her primary care provider because of increasingly frequent bouts of vertigo that have culminated in a fall. The nurse at the clinic should recognize that a diagnostic assessment of this woman may benefit from which of the following tests? A) Auditory brainstem response B) Audiometry C) Platform posturography D) The Rinne test

C

A group of disaster survivors is being defused by the critical incident stress management (CISM) team. What explanation describes the purpose of defusing? A) To assess how the patient is coping emotionally after the disaster B) To educate the patient on future coping strategies in future disasters C) To provide individuals with education about recognizing stress reactions D) To assess the need for referral to mental health

C

An acoustic neuroma is a benign tumor of which cranial nerve? 1- Eighth 2- Fifth 3- Seventh 4- Ninth

1

High doses of which medication can produce bilateral tinnitus? 1- Meclizine 2- Aspirin 3- Promethazine 4- Dimenhydrinate

2

What inner ear structure is affected when a patient is diagnosed with otosclerosis? 1- Malleus 2- Stapes 3- Incus 4- Tympanic membrane

2

A middle-aged male patient has sought care from his nurse practitioner claiming, "This ringing in my ears is enough to drive me crazy the last few weeks." The nurse recognizes the presence of tinnitus and should assess for which of the following factors that can contribute to the problem? Select all that apply. A) Use of ototoxic medications B) Otologic disorders C) Stress and anxiety D) Neurological disorders E) Family history

A,B,C,D

Carbamazepine (Tegretol)

Anticonvulsant

Diazepam (Valium)

Benzodiazepine

An elderly female patient with severe dehydration has been admitted to the critical care unit and is being treated for hypovolemic shock through aggressive fluid resuscitation. How should the nurse on the unit ideally position this patient? A) In the Trendelenburg position B) In the high Fowler's position C) Supine with her feet slightly elevated D) With the head of the bed between 30 and 45 degree

C

The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his tumor came from. What would be the nurse's best response? A) "Your tumor originated from somewhere outside the central nervous system." B) "Your tumor is pituitary in origin." C) "Your tumor originated from cells and structures within the brain." D) "Your tumor is from nerve tissue somewhere in your body."

C

Categories of shock

Hypovolemic Cardiogenic Distributive Obstructive

s/s of compensatory shock

LOR: anxious, restless, disoriented. HR: rapid RR: Rapid and shallow SCTM: pale/cool/clammy (may be pink with vasogenic shock. Dizzy or s/s of shock with any position change. Pt stands from a flat position and after 1 min. HR increases 30 beats/minute and/or signs and symptoms of shock develop.

perimetry test

Patients' head is held at a fixation point on the screen, a small dot of light is flashed on various parts of the screen and the patient presses a button to record when the dot is seen

S/S of obstructive shock

TachycardiaHypotensionTachypneaOliguriaDecreased COIncreased PAP/PAWPLow SVO2anasarcadecreased pulse pressure

irreversible shock

When the body has lost the battle to maintain perfusion to vital organs. Even if adequate vital signs return, the patient may die days later due to organ failure.

nonfunctioning pituitary tumors

do not produce any significant amounts of these hormones

Audiometry

measurement of hearing

Intradural-extramedullary tumors

within or under the spinal dura but not on the actual spinal cord

The nurse is caring for a client with an inoperable brain tumor. What is a major threat to this client? 1- Increased intracranial pressure 2- Decreased intracranial pressure 3- Hypervolemia 4- Hypovolemia

1

Tetrabenazine (Xenazine)

Huntington's; Orphan drug; Lots of side effects and interactions;

auditory brain stem response

measures the detectable electrical potential from cranial nerve VIII

Snellen chart

used to measure visual acuity

Jaeger chart

visual assessment tool with small print

color vision testing

visual testing of the cornea, lens, fluids, and membranes of the interior of the eye using a narrow beam of light

s/s of hypovolemic shock

- one of the first signs of shock is hypovolemia - Decreased LOC; Restlessness; Anxiety;l Weaknessl Rapid, weak, thready pulses; Arrhythmias; Hypotension; Narrowed pulse pressure; cool clammy skin; tachypnea, dyspnea, shallow irregular respirations; decreased 02 saturation; extreme thirst ; chills; feeling of impending doom; pallor; cyanosisobvious hemorrhage; temperature dysregulation

A nurse is providing care for a patient with human immunodeficiency virus (HIV) who has been admitted to the hospital because of a recent decrease in his CD4+ count. The nurse is aware of the patient's high risk of developing secondary illnesses, including Kaposi's sarcoma (KS). When assessing the patient for signs and symptoms of KS, the nurse would examine the patient for: 1- Newly acquired lesions that are reddish or bluish in color 2- Skin tears on the patient's trunk that are slow to heal 3- Changes in the shape, character, or color of a mole 4- Patches of scaly, dry, pruritic skin on the patient's torso

1

A patient is being evaluated for nodular cystic acne. What systemic pharmacologic agent may be prescribed for the treatment of this disorder? 1- Isotretinoin (Accutane) 2- Benzoyl peroxide 3- Retin-A 4- Salicylic acid

1

A patient has come to the office for her first eye examination and is diagnosed as having a visual acuity of 20/40. The patient asks the nurse what these numbers mean. What is a correct response by the nurse? 1- "A person whose vision is 20/40 can see an object from 40 feet away that a person with 20/20 vision can see from 20 feet away." 2- "A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away." 3- "A person whose vision is 20/40 can see an object from 40 inches away that a person with 20/20 vision can see from 20 inches away." 4- "A person whose vision is 20/40 can see an object from 20 inches away that a person with 20/20 vision can see from 40 inches away."

2

A patient is scheduled to have an electronystagmography as part of a diagnostic workup for Ménière's disease. What question is it most important for the nurse to ask the patient in preparation for this test? 1- "Have you ever experienced claustrophobia or feelings of anxiety while in enclosed spaces?" 2- "Do you currently take sedatives, tranquilizers, or antihistamines on a regular basis?" 3- "Do you have a history of falls or problems with loss of balance?" 4- "Do you have a history of either high or low blood pressure?"

2

Which is the primary medical management of arthropod-borne virus (arboviral) encephalitis? 1- Preventing renal insufficiency 2- Controlling seizures and increased intracranial pressure 3- Maintaining hemodynamic stability and adequate cardiac output 4- Preventing muscular atrophy

2

Which sedative medication is effective for treating pruritus? 1- Benzoyl peroxide 2- Hydroxyzine 3- Fexofenadine 4- Tetracycline

2

A 66-year-old woman with a recent history of headaches and agitation has been found to have a meningioma. The neurological nurse should understand that the symptoms of this woman's tumor are attributable to what pathophysiological process? 1- Invasion of brain tissue by the tumor 2- Intracerebral hemorrhage 3- Compression of brain tissue 4- Impaired cerebrospinal fluid (CSF) synthesis

3

The nurse is working with community groups. At which of the following locations would the nurse anticipate a possible scabies outbreak? 1- Shopping mall 2- Swimming pool 3- College dormitory 4- Gymnasium

3

The nurse notes that the client's lower extremities are covered with very dry skin and that the horny layer of the skin has become thickened. The nurse notes the finding as 1- dermatitis. 2- acantholysis. 3- lichenification. 4- pyodermas.

3

A nurse assesses a patient who has been diagnosed with having a pituitary adenoma that is pressing on the third ventricle. The nurse looks for the associated sign/symptom. What is that sign/symptom? 1- Disruption in sleep patterns 2- Unusual sensitivity to heat and cold 3- Visual disturbances 4- Increased intracranial pressure

4

The nurse is caring for a patient in liver failure who is exhibiting signs and symptoms of hypovolemic shock. The nurse should anticipate that the health care provider will order the administration of what crystalloid for the management of this patient? A) Lactated Ringer's B) Albumin C) Dextran D) 3% NaCl

4

Nurses are performing hourly neurological assessments of a patient who is postoperative day 1 following spinal surgery that was performed to treat spinal cord compression (SCC). The nurse's most recent assessment shows a marked reduction in motor and sensory function. How should the nurse best follow-up this assessment finding? A) Inform the care provider promptly about this sudden change. B) Reassess the patient in 15 minutes. C) Contact the anesthesiologist to discuss possible residual effects of anesthesia. D) Document these findings and have a colleague confirm the assessment.

A

The nurse is developing a plan of care for a patient who has stabilized after the emergency treatment of Guillain-Barré syndrome (GBS). What nursing intervention would receive priority for this patient? A) Using the incentive spirometer as prescribed B) Maintaining the patient on bed rest C) Reorienting the patient to person, time, and place D) Limiting free water to 1 L per day

A

A nurse in the intensive care unit (ICU) receives report from the nurse in the emergency department (ED) about a new patient being admitted with a spinal cord injury received while diving into a lake. The ED nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that the patient is probably experiencing? A) Anaphylactic shock B) Neurogenic shock C) Septic shock D) Hypovolemic shock

B

he nurse is conducting a scheduled assessment of a female patient who has been admitted to the unit following surgical repair of her fractured humerus. Which of the following assessment findings should prompt the nurse to contact the patient's care provider? A) The patient's capillary refill in her fingers is 1 to 2 seconds. B) The patient is able to wiggle each of her fingers and her thumb. C) There is a moderate amount of edema in the patient's hand and fingers. D) The patient

d

functional hearing loss

hearing loss where the organic etiology is unknown

The pharmacology class is learning about herpes zoster and medications that are used to treat this disease process. When planning care for a patient with herpes zoster what medications, if administered within the first 24 hours of the initial eruption, can arrest herpes zoster? 1- Deltasone (Prednisone) 2- Azathioprine (Imuran) 3- Triamcinolone (Kenalog) 4- Acyclovir (Zovirax)

4

A middle-aged woman has just received word that her recent diagnostic testing has resulted in a diagnosis of myasthenia gravis. The nurse who is contributing to this woman's care should be aware that she is experiencing signs and symptoms that are the result of what pathophysiological process? A) Inadequate action of acetylcholine B) Nerve demyelination C) Decreased levels of dopamine D) Loss of upper and lower motor neurons

A

A 56-year-old patient has come to the clinic for his routine eye examination and is told he needs bifocals. The patient asks the nurse what in his eye has changed so that he needs bifocals. What should the nurse respond? 1- "You know, you are getting older now, and we change as we get older." 2- "The parts of our eyes age, just like the rest of us." 3- "There is a gradual thickening of the lens of the eye, and it can limit accommodation of the eye." 4- "The eye gets shorter, back to front, as we age, and it changes how we see things."

3

A child goes to the school nurse and complains of not being able to hear her teacher. What test could the school nurse perform to make a general estimate of hearing loss? 1- Chiming clock test 2- Rinne test 3- Whisper test 4- Weber test

3

A client arrives at the emergency department complaining of extreme muscle weakness after minimal effort. The physician suspects myasthenia gravis. Which drug will be used to test for this disease? 1- Ambenonium (Mytelase) 2- Pyridostigmine (Mestinon) 3- Edrophonium (Tensilon) 4- Carbachol (Carboptic)

3

A nurse is aware of the significant potential benefits of cochlear implants for certain individuals. Which one of the following individuals is the most appropriate candidate for a cochlear implant? 1- An individual who has not yet experienced hearing loss but who possesses multiple risk factors 2- An individual who has been diagnosed with presbycusis 3- An individual who has longstanding and severe conductive hearing loss 4- An individual who has profound, bilateral, sensorineural hearing loss

4

A nursing instructor is preparing a class on air and bone conduction of sound. When describing the transmission of sounds by air conduction, which of the following would the instructor include? 1- Vibrations bypass the tympanic membrane to reach the inner ear. 2- Sounds travel through the external and middle ears. 3- It is a less efficient pathway for sound. 4- Vibration of the tympanic membrane diverts sound away from the ossicles.

2

Refractory shock

- Pooling of blood in the capillary beds- Inadequate perfusion of vital organs- Multisystem Organ Failure

The nurse is caring for a client experiencing hearing loss. The nurse uses the otoscope to assess the ear canal and tympanic membrane and notes a significant accumulation of cerumen. Which documentation of hearing loss type would be most accurate? 1- Conductive 2- Mixed 3- Central 4- Sensorineural

1

The nurse is evaluating the client while taking the color vision test. Which response would the nurse anticipate when caring for a client with normal color vision? 1- The nurse would anticipate the client identifying numbers and shapes. 2- The nurse would anticipate a cross-eyed appearance. 3- The nurse would anticipate responding to the color names in the pictures. 4- The nurse would anticipate no differentiation in between colors.

1

Which of the following is a clinical characteristic of neurogenic shock? 1- Bradycardia 2- Tachycardia 3- Cool skin 4- Moist skin

1

During an assessment using the positions test, what does an asymmetrical movement indicate? Select all that apply. 1- Weakness in the extraocular muscles 2- Dysfunction of the cranial nerve 3- Cataract 4- Glaucoma

1,2

The nurse is assisting the client in planning care during exacerbations of Ménière's disease. Which diet would the nurse identify as appropriate at this time? 1- A high-protein diet 2- A low-sodium diet 3- A low-fat diet 4- A calorie-controlled diet

2

There are several types of hearing loss. Which type of hearing loss benefits most from the use of a hearing aid? 1- Sensorineural 2- Conductive 3- Genetic 4- Acquired

2

When caring for a client with severe impetigo, the nurse should include which intervention in the care plan? 1- Placing mitts on the client's hands 2- Administering systemic antibiotics as ordered 3- Applying topical antibiotics as ordered 4- Continuing to administer antibiotics for 21 days as ordered

2

A client with spinal cord compression from a tumor must undergo diagnostic testing. Which of the following is the most likely procedure for this client? 1- Core needle biopsy 2- Ultrasonography 3- Computed tomography 4- Magnetic resonance imaging

4

A patient has been diagnosed with a loss of hearing related to damage of the end organ for hearing. What term is used to describe this condition? A) Exostoses B) Otalgia C) Sensorineural hearing loss D) Presbycusis

C

fluctuating hearing loss

Hearing loss that varies from day to day; some days a student may hear better or worse depending on a variety of factors (e.g., colds and allergies)

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing which effect? 1- Facial nerve paralysis 2- Nystagmus 3- Motor impairment 4- Diplopia

1

Which medication classification should be avoided in the treatment of brain tumors? 1- Anticoagulants 2- Osmotic diuretics 3- Corticosteroids 4- Anticonvulsants

1

Which of the following provides the best outcome for most tumor types? 1- Surgery 2- Radiation 3- Chemotherapy 4- Palliation

1

Which statement is accurate regarding isotretinoin? 1- It is teratogenic in humans. 2- Contraceptives are not needed during treatment. 3- To achieve the full effect of the medication, the client should take vitamin A supplements. 4- The side effects are irreversible.`

1

A female patient with a profound visual deficit is unable to read the largest E on the Snellen chart. How should the nurse proceed with assessment of the patient's visual acuity? 1- Document the fact that the patient does not have functional vision. 2- Hold up a random number of fingers in front of the patient's eyes and ask her to count them. 3- Give the patient a hand-held version of the Snellen chart and have her hold it at the furthest distance at which she can read it. 4- Ask the patient to identify the contents of a picture in a book or magazine.

2

A nures is performing an otoscopic examination on a client. Which finding would the nurse document as abnormal? 1- Umbo in the center of the tympanic membrane 2- External auditory canal erythema 3- Tympanic membrane pearly gray 4- Manubrium superior to the umbo

2

A client has undergone surgery for a spinal cord tumor that was located in the cervical area. The nurse would be especially alert for which of the following? 1- Hemorrhage 2- Bowel incontinence 3- Respiratory dysfunction 4- Skin breakdown

3

Health teaching for a patient who suffers from motion sickness would include recommending the use of which one of the following over-the-counter drugs? 1- Scopolamine 2- Phenergan 3- Dramamine 4- Ephedrine

3

What kind of otitis media is a pathogen-free fluid behind the tympanic membrane, resulting from irritation associated with respiratory allergies and enlarged adenoids? 1- Purulent otitis media 2- Infectious otitis media 3- Serous otitis media 4- Sterile otitis media

3

Which is a late sign of increased intracranial pressure (ICP)? 1- Irritability 2- Slow speech 3- Altered respiratory patterns 4- Headache

3

A patient is being treated for chronic venous stasis ulcers of the lower extremities. What medication does the nurse understand will increase peripheral blood flow by decreasing the viscosity of blood and assist with the healing of the ulcers? 1- Heparin 2- Warfarin (Coumadin) 3- Aspirin 4- Pentoxifylline (Trental)

4

A patient is having an eye examination. The ophthalmologist is looking inside the patient's eye with a hand-held instrument. What instrument is being used to perform this procedure? 1- Slit-lamp examination 2- An indirect ophthalmoscope 3- An Ishihara plate 4- A direct ophthalmoscope

4

The nurse is working in the emergency department when a physician asks for help as the client is performing a Romberg test. In which position would the nurse stand to be most helpful? 1- The nurse would stand directly in front of the client. 2- The nurse would stand between the client and physician. 3- The nurse would stand across the room but in direct alignment from the client. 4- The nurse would stand laterally to the client, opposite side to where the physician is standing.

4

Phenobarbital

Anticonvulsant

In accordance with a directive from the Joint Commission, the nurse who oversees the care at a small long-term care facility has been directed to create a disaster plan. This plan should address which of the following considerations? A) A policy for rapid reappraisal of residents' code status during a disaster B) A protocol for defining staff roles and responsibilities in a disaster C) A strategy for acquiring antidotes to biological weapons D) A plan for including residents' family members in care during a disaster

B

The intensive care nurse is caring for a middle-aged, male patient who has been diagnosed with septic shock. The patient's wife, children, and parents have been waiting anxiously in the designated waiting area of the intensive care unit. Knowing that the patient's condition has rapidly deteriorated over the past hour, the nurse should: A) Teach the family about the potential benefits of organ donation. B) Facilitate an opportunity for the family to be at the patient's bedside. C) Reassure the family that the patient is being treated with dignity. D) Ensure that the fami

B

gliomas

Brain tumors that develop from glial cells

A patient has been admitted to the intensive care unit (ICU) for the treatment of bacterial meningitis. The ICU nurse is aware of the need for aggressive treatment and vigilant nursing care because meningitis has the potential to cause what sequela? A) Hydrocephalus B) Glioma C) Increased intracranial pressure (ICP) D) Cerebrovascular accident (CVA)

C

A patient is experiencing respiratory insufficiency and cannot maintain spontaneous respirations. The nurse suspects that the health care provider will implement which of the following interventions? A) Administration of bronchodilators B) Jaw thrust maneuver C) Endotracheal intubation D) Cricothyroidotomy

C

The nursing instructor is talking with a group of senior nursing students about shock. When caring for a patient at risk for shock what assessment finding would the nurse consider a potential sign of shock? A) Elevated systolic blood pressure B) Elevated mean arterial pressure C) Shallow, rapid respirations D) Bradycardia

C

The nurse is providing care for a patient who is showing signs and symptoms of shock. The nurse is choosing and prioritizing nursing interventions that are framed in the knowledge that the restoration of adequate tissue perfusion is essential to the patient's safe recovery. Tissue perfusion results from the interplay of which of the following essential factors? Select all that apply. A) Hemostasis B) Balanced fluid intake and output C) Systemic vascular resistance D) Cardiac output E) Level of consciousness

C,D

A child has fallen off a swing on a playground and sustained a greenstick (partial) fracture of his radius. Because the child is otherwise healthy, healing has begun promptly after his injury. Which of the following is the first stage of bone healing? A) Angiogenesis and cartilage formation B) Remodeling C) Cartilage calcification and removal D) Inflammation and hematoma formation E) Bone formation

D

A patient has been admitted to the emergency department with a massive gastrointestinal bleed and the team recognizes that hypovolemic shock is an imminent possibility. What assessment finding would suggest that the patient is deteriorating from a preshock state into shock? A) The patient is confused and agitated. B) The patient's respiratory rate is 24 breaths per minute. C) The patient's blood pressure is 127/71. D) The patient has crackles on chest auscultation.

D

In the oncology nursing portion of their medical-surgical class, the nursing students are learning about Kaposi's sarcoma. Because of the student's knowledge of pathophysiology, the student nurse would be correct in identifying this type of skin malignancy as affecting which portion(s) of the body? A) Chest and back only B) Invaded breast tissue C) Infiltrated lymph nodes only D) Multiple body organs

D

The nurse is providing morning care for a male patient who is recovering from a head injury. The patient's right hand has begun twitching, and he is speaking unintelligibly. This patient has most likely experienced what type of seizure? A) Tonic-clonic seizure B) Complex partial C) Absence seizure D) Simple partial

D

When caring for a patient in shock, one of the major nursing goals is to reduce the risk that the patient will develop complications from shock. What does this require the nurse to do? A) Provide the family with realistic expectations around the patient's prognosis. B) Keep the health care provider updated with the most accurate information because during treatment of shock, the nurse is often powerless to help. C) Monitor for significant changes and evaluate patient outcomes on a scheduled basis, focusing on blood pressure and skin temperature. D) Understand the underlying mechanisms of shock, recognize the subtle and more obvious signs, and then provide rapid assessment and response.D

D

weber test

Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard.

Which patient would the nurse prioritize as needing emergency treatment, assuming no other injuries are present except the ones outlined below? A) A patient with blunt chest trauma with some difficulty breathing B) A patient with a sore neck that was immobilized in the field on a backboard with a cervical collar C) A patient with a possible fractured tibia with adequate pedal pulses D) A patient with acute confusion due to a drug reaction

a

acoustic neuroma

benign tumor on the auditory nerve (8th cranial nerve) that causes vertigo, tinnitus, and hearing loss

An older adult man has been diagnosed with a femoral head fracture after falling outside his home, and his health care provider has chosen open reduction with internal fixation (ORIF). How should the nurse best explain this procedure to the patient? A) "The surgeon will give you an anesthetic and then apply a cast." B) "The surgeon will place plates or rods outside your hip and keep you in traction until your bones heal." C) "The surgeon will use pins and rods to keep your bones in place until they heal." D) "The surgeon will use a scope inserted through punctures in your skin to remove any bone fragments."

c

types of obstructive shock

cardiac tamponade, tension pneumothorax, pulmonary embolism, constrictive pericarditis, aortic stenosis

rinne test

hearing acuity test performed with a vibrating tuning fork that is first placed on the mastoid process and then in front of the external auditory canal to test bone and air conduction

Extradural tumors

located outside the dura and often involve the vertebral bodies.

3 types of distributive shock

neurogenic, anaphylactic, septic

consensual pupillary response

refers to constriction of both pupils in response to light entering left or right pupil only

Ménière's disease

results in a degeneration of inner ear structures that can lead to hearing loss, tinnitus, vertigo, and an increase in pressure within the inner ear

Ishihara test

tests for color vision

A client with a history of depression is brought to the ED after overdosing on Valium. This client is at risk for developing which type of distributive shock? 1- neurogenic shock 2- septic shock 3- anaphylactic shock 4- hypovolemic shock

1

When caring for a client in a prenatal clinic who has history of acne vulgaris, which client medication would the nurse advise against? 1- Tretinoin 2- Benzoyl peroxide 3- Tazarotene 4- Isotretinoin

4

A client has been diagnosed with shingles. Which of the following medication classifications will reduce the severity and prevent development of new lesions? 1- Antiviral 2- Corticosteroids 3- Analgesics 4- Antipyretics

1

A nurse who provides care in an ophthalmologist's office has received training on the technique for assessing patients' intraocular pressure (IOP). This nurse will possess the skills necessary to perform what type of diagnostic testing? 1- Tonometry 2- Direct ophthalmoscopy 3- Perimetry testing 4- Slit-lamp examination

1

The nurse is caring for a client in the hospital emergency department who reports recent muscle weakness, sensory loss, aphasia, and visual changes accompanied by a suddent onset of complex partial seizures. The nurse anticipates which diagnostic test will be prescribed to rule out or confirm with high certainty the presence of a brain tumor? 1- Magnetic resonance imaging (MRI) 2- Computed tomography (CT) 3- Positron emission tomography (PET) 4- Cranial x-ray

1

The nursing is assessing a client who has been diagnosed with a pituitary adenoma, but has not yet started treatment. The client reports having increased heart rate, hand tremors, difficulty sleeping, weight loss and hyperthermia. The nurse anticipates the client will require blood work to assess for overproduction of which hormone? 1- Thyroid-stimulating hormone 2- Adrenocorticotropic hormone 3- Prolactin 4- Growth hormone

1

Which of the following is a late symptom of spinal cord compression? 1- Paralysis 2- Urinary incontinence 3- Fecal incontinence 4- Urinary retention

1

Which of the following tests uses a tuning fork between two positions to assess hearing? 1- Rinne 2- Whisper 3- Watch tick 4- Weber

1

The nurse is teaching a client about the correct use of topical concentrated corticosteroids. The nurse includes which statement(s)? Select all that apply. 1- Avoid applying to the face. 2- Avoid prolonged use. 3- Apply to intertriginous areas. 4- Hypertrichosis is normal.

1,2

The nurse is reviewing the audiology consultation on a woman who has been experiencing progressive hearing loss. To accurately interpret these diagnostic findings, the nurse should be aware of what important characteristics of sound? Select all that apply. 1- Frequency 2- Pitch 3- Intensity 4- Character 5- Familiarity

1,2,3

The nurse is assessing a client's hearing using the Rinne test. When providing instruction to elicit client feedback, which instruction is essential? 1- Raise your hand when you hear the vibration. 2- Raise your hand when you no longer hear sound. 3- Raise your hand when the vibration exceeds the sound. 4- Raise your hand when the sound exceeds the vibration.

2

The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning? 1- Decreased pulse rate, respirations of 20 breaths/minute 2- Increased pulse rate, adventitious breath sounds 3- Increased pulse rate, respirations of 16 breaths/minute 4- Decreased pulse rate, abdominal breathing

2

A client has been referred to an ophthalmologist for suspected macular degeneration. The nurse knows to prepare what test for the physician to give the client? 1- Ishihara polychromatic plates 2- Visual field 3- Amsler grid 4- Slit lamp

3

The nurse is caring for a client with increased intracranial pressure (ICP) after surgical resection of a brain tumor. The nurse recognizes the client is demonstrating late signs of ICP when which sign is observed? 1- Hypotension 2- Low pulse pressure 3- Tachycardia 4- Irregular respirations

4

The nurse is doing discharge teaching with a client newly diagnosed with Ménière's disease. Why would the nurse advise a low-sodium diet to this client? 1- To minimize the adverse effects of drug therapy 2- To reduce the magnitude of the hearing deficit 3- To minimize the risk of a tumor that involves the vestibulocochlear nerve 4- To reduce the production of fluid in the inner ear

4

Which drug should be available to counteract the effect of edrophonium chloride? 1- Prednisone 2- Atropine 3- Azathioprine 4- Pyridostigmine bromide

2

An 82-year-old woman was diagnosed with osteoporosis several years and has lost more than 5 inches in height over the past several years as a result of structural changes in her vertebrae. The nurse should recognize that this woman is experiencing the effects of: A) A Colles' fracture B) A compression fracture C) A stress fracture D) An impacted fracture

d

A patient is exhibiting bradykinesia, rigidity, and tremors related to Parkinson's disease. The nurse understands that these symptoms are directly related to what decreased neurotransmitter level? 1- Acetylcholine 2- Dopamine 3- Serotonin 4- PhenylalanineImpaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? 1- Glutamate 2- Acetylcholine 3- Dopamine 4- Serotonin

32

A 30-year-old female patient has been referred to a specialist by her primary care provider because she has recently developed fat pads at the base of her neck, an increasingly round face, and striae at various locations. The patient's signs of illness have been attributed to a brain tumor. What type of brain tumor is most likely to result in these changes to the woman's physical appearance? 1- Glioma 2- Acoustic neuroma 3- Meningioma 4- Pituitary adenoma

4

The nurse at the eye clinic is caring for a patient with suspected glaucoma. What complaint would be significant for a diagnosis of glaucoma? 1- A significant loss of central vision 2- Diminished acuity 3- Pain associated with a purulent discharge 4- The presence of halos around lights

4

A 55-year-old male patient has been admitted to the hospital with a gastrointestinal bleed, and the patient has just experienced a generalized seizure that may be attributable to alcohol withdrawal. When providing immediate care during the patient's seizure, what nursing diagnosis should be prioritized? A) Impaired gas exchange B) Acute pain C) Acute confusion D) Risk for impaired skin integrity

A

A community health nurse is performing a home visit to a patient with amyotrophic lateral sclerosis (ALS). The nurse should prioritize assessments related to which of the following? A) Respiratory function B) Potential skin breakdown C) Cardiac function D) Cognition

A

A medical-surgical nurse is aware that pulmonary embolism (PE) and tension pneumothorax are medical diagnoses that have the potential to result in shock. What commonality between these two health problems creates the potential for shock? A) Both health problems involve an obstruction of normal blood flow. B) Both problems precipitate massive vasodilation and fluid displacement into the interstitial space. C) Both health problems involve a profound disruption in the normal process of hemostasis. D) Both health problems result in hypovolemia.

A

A young male patient has been brought to the emergency department with a knife wound to the abdomen. When the patient's hands are removed from the area of the wound to facilitate assessment, the patient's intestine protrudes from the wound. How should the nurse respond to this development? A) Cover the protruding viscera with saline-soaked, sterile gauze. B) Don sterile gloves and attempt to push the organ back inside the wound. C) Irrigate the protruding intestine with sterile water or normal saline. D) Apply a pressure dressing to the wound.

A

s/s of anaphylactic shock

-Low BP-Rapid pulse-Problems c ventilation-Coughing-Itching-Dyspnea-Decreased consciousness-Nausea and vomiting

A client diagnosed with a malignant brain tumor is scheduled to receive chemotherapy intrathecally. When explaining this technique to the client, the nurse would describe the medication as being injected into which area? 1- Subarachnoid space 2- Central vein 3- Implanted port 4- Epidural space

1

A client is having a routine eye examination. The procedure being performed is done by using an instrument to indent or flatten the surface of the eye. This is known as ________ and it is routinely done to test for ________. 1- tonometry; intraocular pressure 2- retinoscopy; detached retina 3- tonometry; macular degeneration 4- retinoscopy; cataracts

1

A client is suspected of having amyotrophic lateral sclerosis (ALS). To help confirm this disorder, the nurse prepares the client for various diagnostic tests. The nurse expects the physician to order: 1- electromyography (EMG). 2- Doppler scanning. 3- Doppler ultrasonography. 4- quantitative spectral phonoangiography.

1

A nurse is performing an eye examination. Which question would not be included in the examination? 1- "Are you able to raise both eyebrows?" 2- Have you experienced blurred, double, or distorted vision?" 3- "Do any family members have any eye conditions?" 4- "What medications are you taking?"

1

A nurse is providing care to a client recently diagnosed with a brain tumor. When planning this client's care, the nurse anticipates which therapy as providing the best outcome for the client? 1- Surgery 2- Radiation therapy 3- Chemotherapy 4- Immunotherapy

1

A nurse is providing care to a client who has been diagnosed with metastatic brain cancer. When developing the client's plan of care, which outcome would the nurse most likely identify? 1- Improved quality of life 2- Elimination of distressing signs and symptoms 3- Removal of all or part of the tumor 4- Reduced incidence of recurrence

1

A nursing instructor is teaching pre-nursing students in a pathophysiology class. What would the instructor teach the students about Ménière's disease? 1- It is referred to as endolymphatic hydrops. 2- It originates in the middle ear. 3- It is referred to as lymphatic hydrops. 4- It originates in the outer ear.

1

A patient diagnosed with a tumor in the cerebellar region would expect to have changes in which of the following? 1- Balance and coordination 2- Vision 3- Hearing 4- Cognition

1

A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate? 1- Assess for facial weakness. 2- Initiate seizure precautions. 3- Assess visual acuity. 4- Ensure that client takes nothing by mouth.

2

A hospital patient's most recent blood work reveals a serum calcium level of 6.9 mg/dL (normal 8.5 to 0.5 mg/dL). In response to this low level of calcium, what physiological response is most likely to occur? A) Decreased metabolic rate B) Secretion of parathormone C) Decreased hematopoiesis D) Synthesis and secretion of somatotropic hormone

B

While reviewing the health history of a 72-year-old patient experiencing hearing loss, the nurse notes the patient has had no trauma or loss of balance. What factor is likely to be linked to the patient's hearing deficit? A) Recent completion of radiation therapy for treatment of thyroid cancer B) Routine use of quinine for management of leg cramps C) Allergy to hair coloring and hair spray D) Recent psychological stressors

B

A nurse is providing care for a female patient who remains unconscious following an ischemic stroke that she suffered 4 days ago. When providing eye care to remove mucus and debris from the eye, the nurse should use which of the following techniques? A) Use a cotton swab to gently clean from the outer (lateral) canthus to the inner (medial) canthus of each eye. B) Use a gentle up-and-down motion to cleanse each eye with a cotton ball, using a different cotton ball for each eye. C) Use a cotton ball or small gauze to wipe from the outer canthus to the inner canthus of each eye. D) Using one cotton ball for each eye, wipe from the inner to outer canthus of each eye.

D

A terrorist group has announced that they are responsible for the release of a nerve agent in a busy commuter rail station and victims are now being brought to the nearest hospital. Nurses at this hospital should be aware that these victims: A) Will have extensive skin lesions and hemorrhage from their mucous membranes B) Will likely have massive pulmonary and peripheral edema C) Will be experiencing physical erosion of their pulmonary mucosa D) Will likely have signs and symptoms similar to those of a cholinergic crisis

D

Four hours after his fractured radius was fit with a cast, a 20-year-old man has returned to the cast clinic stating that his arm "hurts even more than when I broke it." The nurse's gentle manipulation of the patient's fingers causes his excruciating pain. What action should the nurse take? A) Administer 5 mg oxycodone PO. B) Apply warm compresses the patient's hand and reassess in 15 minutes. C) Document the patient's complaint and implement distraction techniques. D) Report the patient's symptoms to the primary care provider.

D

s/s of neurogenic shock

Hypotension with wide PPNormal heart rate or bradyHypothermia (core)warm dry extremities

Catacholamines

epinephrine and norepinephrine - release during compensation stage of shock

positive inotropic effect

an increase in the force of contraction of the heart muscle (myocardium)

A middle-aged woman sustained an elbow fracture in a bicycle crash and has required reduction and fixation to aid healing. The nurse is aware of the need for vigilant neurovascular assessment. How should the nurse assess the function of the patient's ulnar nerve? A) Ask the patient to clench and unclench her fist several times. B) Ask the patient to rotate her hand at the wrist. C) Touch the back of the patient's hand with a pen and ask if the patient is able to feel the sensation. D) Ask the patient to spread her fingers as widely as possible.

d

audiometry

measurement of hearing

meningiomas

tumors that grow between the meninges

Sinusoidal harmonic acceleration

used to assess the vestibular-ocular system

Platform Posturography

used to investigate postural control capabilities, such as vertigo

slit-lamp examination

visual testing of the cornea, lens, fluids, and membranes of the interior of the eye using a narrow beam of light

Rosenbaum chart

Chart used for near vision testing

tympanogram

record of middle ear function (presented in graph form)

electronystagmography (ENG)

recording of eye movements in response to electrical impulses to diagnose balance problems

tonometry

the measurement of intraocular pressure

sensorineural hearing loss

hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness

A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: 1- a positive edrophonium (Tensilon) test. 2- Kernig's sign. 3- a positive sweat chloride test. 4- Brudzinski's sign.

1

A client with multiple sclerosis is being seen by a neuroophthalmologist for a routine eye exam. The nurse explains to the client that during the examination, the client will be asked to maintain a fixed gaze on a stationary point while an object is moved from a point on the side, where it can't be seen, toward the center. The client will indicate when the object becomes visible The nurse further explains that the test being performed is called a: 1- perimetry test 2- color vision test 3- slit-lamp examination 4- retinal angiography

1

A patient is diagnosed with pemphigus, a skin disease caused by an autoimmune response involving immunoglobulin G. Medical management includes administering high doses of corticosteroids. Which of the following is a drug that the health care provider may likely prescribe? 1- Temovate 2- Aristocort 3- Decaderm 4- Topicort

1

A patient with epilepsy is having a seizure. Which of the following should the nurse do after the seizure? 1- Keep the patient to one side. 2- Place a cooling blanket beneath the patient. 3- Help the patient sit up. 4- Pry the patient's mouth open to allow a patent airway.

1

A patient's recent diagnostic workup has resulted in a diagnosis of a glioma, and a treatment plan is being promptly created by the multidisciplinary care team. The patient's oncologist has recommended chemotherapy, which is to be administered by the intrathecal route. The nurse should understand that the rationale for choosing this administration route involves which of the following considerations? 1- The drug will bypass the blood-brain barrier. 2- The patient will not require IV access. 3- The drug can be administered on an outpatient basis. 4- The patient will require weekly, rather than daily, drug administration.

1

An 88-year-old client has a history of hearing loss and is returning for his annual hearing examination. During your client education session, you explain to the client that hearing involves which areas of the ear? 1- All sections of the ear are involved in perceiving sound. 2- The outer section of the ear is involved in perceiving sound. 3- The middle section of the ear is involved in perceiving sound. 4- The inner section of the ear is involved in perceiving sound.

1

Older adults with impaired cardiac function are more likely to develop which type of shock? 1- Cardiogenic shock 2- Neurogenic shock 3- Septic shock 4- Anaphylactic shock

1

The nurse should assess all possible causes of pruritus for a patient complaining of generalized pruritus. What does the nurse understand can be other causes for this condition? 1- End-stage kidney disease 2- Hypothyroidism 3- Pneumonia 4- Myasthenia gravis

1

The nursing instructor is discussing the difference between sensorineural and conductive hearing loss with his class. The discussion turns to evaluation for determining what kind of hearing loss a patient has. What Weber test result would indicate the presence of a sensorineural loss? 1- The sound is heard better in the ear in which he has better hearing. 2- The sound is heard equally in both ears. 3- The sound is heard better in the ear in which he has poorer hearing. 4- The sound is heard longer in the ear in which he has better hearing.

1

Which of the following medications is used to reduce turnover time of the psoriatic epidermis? 1- Methotrexate 2- Triamcinolone acetamide (Kenalog) 3- Tazarotene (Tazorac) 4- Acyclovir (Zovirax)

1

Which of the following reflect the pathophysiology of cutaneous signs of HIV disease? 1- Immune function deterioration 2- High CD4 count 3- Genetic predisposition 4- Decrease in normal skin flora

1

Which of the following tests confirms the diagnosis of myasthenia gravis (MG)? 1- Tensilon test 2- Computed tomography (CT) scan 3- Electromyogram (EMG) 4- Serum studies

1

Which positions is used to help reduce intracranial pressure (ICP)? 1- Avoiding flexion of the neck with use of a cervical collar 2- Keeping the head flat, avoiding the use of a pillow 3- Rotating the neck to the far right with neck support 4- Extreme hip flexion, with the hip supported by pillows

1

While in a skilled nursing facility, a client contracts scabies, which is diagnosed the day after discharge. The client is living at her daughter's home with six other people. During her visit to the clinic, the client asks a staff nurse, "What should my family do?" The most accurate response from the nurse is: 1- "All family members need to be treated." 2- "If someone develops symptoms, tell him to see a physician right away." 3- "Just be careful not to share linens and towels with family members." 4- "After you're treated, family members won't be at risk for contracting scabies."

1

The nurse is conducting a neurological assessment with a client who has increased intracranial pressure secondary to growth of brain tumor mass. What assessment tools can the nurse use to determine the client's neurological status? Select all that apply. 1- Glascow coma scale (GCS) 2- Mini mental status examination (MMSE) 3- Urinalysis 4- Chest ascultation 5- Beck Depression Inventory (BDI)

1,2

A client presents with silvery scales on the elbows and knees. The physician has made a diagnosis of plaque psoriasis. What is the probable cause(s) of psoriasis? 1- genetic predisposition 2- a triggering mechanism, such as systemic infection, injury to the skin, vaccination, or injection 3- injury, such as squeezing a lesion 4- diabetes mellitus; elevated blood glucose level promotes microbial growth

1,2,

A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position the patient in what position? 1- In the lithotomy position 2- In a flat side-lying position 3- In the Trendelenburg position 4- In the reverse Trendelenburg position

2

Photochemotherapy has been used as a treatment for which of the following skin disorders? 1- Shingles 2- Psoriasis 3- Allergic dermatitis 4- Rosacea

2

The nures is assessing a client using an Amsler Grid. The nurse is assessing for which of the following? 1- Visual acuity 2- Macular problems 3- Intraocular pressure 4- Visual field

2

The nurse is providing care for a young woman who has sought care because of signs and symptoms that are characteristic of psoriasis. When planning this woman's care, the nurse should be mindful of the fact that the etiology of the problem involves which of the following? 1- Chronic infection 2- Immune dysfunction 3- Persistent physical irritation 4- Benign neoplastic processes

2

The nurse is reviewing the results of a client's audiometric testing. The nurse determines that the client has a mild hearing loss based on the result signifying which loss of decibels? 1- 20 2- 30 3- 45 4- 80

2

The nurse recommends which type of therapeutic bath for its antipruritic action? 1- Sodium bicarbonate (baking soda) 2- Colloidal (oatmeal) 3- Water 4- Saline

2

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? 1- Parkinson disease 2- Amyotrophic lateral sclerosis 3- Alzheimer disease 4- Huntington disease

2

Which drug is an oral retinoid used to treat acne? 1- Estrogen 2- Isotretinoin 3- Tetracycline 4- Benzoyl peroxide

2

Which is a correct rationale for encouraging a client with otitis externa to eat soft foods? 1- Chewy foods, such as red meat, may react with prescribed analgesics and antibiotics. 2- Chewing may cause discomfort. 3- Chewing may lead to further complications, such as otitis media. 4- Chewing may cause excessive drainage

2

A 48-year-old woman has been diagnosed with Ménière's disease after several serious bouts of vertigo. The nurse is reviewing nutritional guidelines relevant to the management of the disease and should recommend which of the following? 1- A low-carbohydrate, high-protein diet 2- Eating several small meals each day rather than three larger meals 3- Limiting the amount of salt and sugar in the diet 4- A gluten-free diet emphasizing leafy green vegetables

3

A client comes to the eye clinic for a routine check-up. The client tells the nurse he thinks he is color blind. What screening test does the nurse know will be performed on this client to assess for color blindness? 1- Rosenbaum 2- Jaeger 3- Ishihara 4- Snellen

3

A client is diagnosed with otitis externa. Which instruction is most appropriate for the nurse to give? 1- Keep the ear covered with a scarf. 2- Avoid using cold water when shampooing hair. 3- Avoid swimming for 7 to 10 days. 4- Keep a dry cotton ball in the ear canal.

3

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond? 1- "You should ask your physician about that." 2- "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." 3- "You may experience progressive deterioration in all voluntary muscles." 4- "This form of muscular dystrophy is a relatively benign disease that progresses slowly."

3

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? 1- Related to visual field deficits 2- Related to difficulty swallowing 3- Related to impaired balance 4- Related to psychomotor seizures

3

A client with a traumatic brain injury is showing early signs of increasing intracranial pressure (ICP). While planning care for this client, what would be the priority expected outcome? 1- Attains desired fluid balance 2- Displays no signs or symptoms of infection 3- Maintains a patent airway 4- Demonstrates optimal cerebral tissue perfusion

3

A client with newly diagnosed seizures asks about stigma associated with epilepsy. The nurse will respond with which of the following statements? 1- "In most people, epilepsy is usually synonymous with intellectual disability." 2- "For many people with epilepsy, the disorder is synonymous with mental illnes." 3- "Many people with developmental disabilities resulting from neurologic damage also have epilepsy." 4- "Cases of epilepsy are often associated intellectual level."

3

A nurse is caring for a client with a brain tumor and increased intracranial pressure (ICP). Which intervention should the nurse include in the care plan to reduce ICP? 1- Encourage coughing and deep breathing. 2- Position the client with the head turned toward the side of the brain tumor. 3- Administer stool softeners. 4- Provide sensory stimulation.

3

A nurse is preparing to perform the whisper test to assess a client's gross auditory acuity. Which of the following would be most appropriate for the nurse to do? 1- Stand at a position diagonal to the client. 2- Have the client use a finger to occlude the ear to be tested. 3- Stand about 1 to 2 feet away from the ear to be tested. 4- Speak a phrase in a low normal tone of voice.

3

A nurse is reviewing a client's medical record and finds that the client has a spinal cord tumor that invovles the vertebral bodies. The nurse identifies this as which type of spinal tumor? 1- Intramedullary 2- Intradural-extramedullary 3- Extradural 4- Metastatic

3

A nurse practitioner checks pupillary response with a penlight. The nurse is aware that the normal pupil size in room lighting is: 1- 1 to 2 mm. 2- 2 to 3 mm. 3- 3 to 5 mm. 4- 4 to 7 mm.

3

A patient has been diagnosed with a loss of hearing related to damage of the end organ for hearing. What term is used to describe this condition? 1- Exostoses 2- Otalgia 3- Sensorineural hearing loss 4- Presbycusis

3

Magnetic resonance imaging has confirmed a diagnosis of glioblastoma multiforme (GBM) in a 56-year-old male patient. The nurse who is planning this patient's care should prioritize which of the following nursing actions? 1- Liaising with community agencies to organize long-term rehabilitation 2- Teaching the patient about the importance of healthy lifestyle in recovery from GBM 3- Choosing psychosocial interventions that are relevant to the patient's poor prognosis 4- Teaching the patient about the pharmacological interventions relevant to his treatment

3

Myasthenia gravis occurs when antibodies attack which receptor sites? 1- Serotonin 2- Dopamine 3- Acetylcholine 4- GABA

3

The nurse educator knows which statement about pituitary adenomas is true?1- They are most prevalent in the pediatric population.2- Most of these types of tumors are malignant.3- Cushing disease can result from a functioning tumor.4- Men are more likely to be diagnosed with this type of tumor.

3

Which of the following is a dermatophyte infection of the fingernails or toes? 1- Pediculosis 2- Tinea pedis 3- Onychomycosis 4- Onychocryptosis

3

A nurse is asked to assess a patient's need for a hearing aid. The nurse knows that a general guideline to determine need would be a hearing loss of: 1- 10 dB in the range of 200 to 1,000 Hz. 2- 20 dB in the range of 300 to 1,000 Hz. 3- 30 dB in the range of 400 to 1,500 Hz. 4- 40 dB in the range of 500 to 2,000 Hz.

4

A patient has been brought to the emergency department with multiple trauma after a motor vehicle accident. After immediate threats to life have been corrected, the nurse and trauma team should: A) Perform a rapid physical assessment. B) Splint the patient's fractures. C) Perform a detailed physical examination. D) Establish the patient's previous medical history.

A

The nurse is caring for a patient with Ménière's disease. The patient is scheduled to go home tomorrow, so the nurse is preparing the patient's discharge teaching. Dietary guidelines will be included. What foods should the patient be instructed to limit or avoid? A) Sweet pickles B) Frozen yogurt C) Citrus fruit D) Red meat

A

An 82 year-old woman who lives on her own has been brought to the emergency department after being found down in her apartment for two days. The woman is showing early signs of hypovolemic shock with tachycardia, lethargy, and hypotension. At what level would this patient most likely be triaged? A) Level 1: Resuscitation B) Level 2: Emergent C) Level 3: Urgent D) Level 4: Nonurgent

B

The clinic nurse caring for a patient with Parkinson's disease notes that the patient has been taking levodopa and carbidopa (Sinemet) for 7 years. What common side effects of Sinemet would the nurse assesses this patient for? A) Pruritus B) Dyskinesia C) Lactose intolerance D) Diarrhea

B

While participating in a disaster response exercise, a nurse has been reminded by the coordinators that triage in a mass casualty incident (MCI) event differs from triage in nondisaster circumstances. What principle will care providers use to guide the allocation of scarce health care resources in an MCI? A) Ensure that every victim receives an equitable amount of care. B) Do the greatest amount of good for the largest number of victims. C) Prioritize the care of the most critically ill victims. D) Focus efforts on victims with the highest risk of death.

B

compensatory shock

Body tries to keep bp up by increasing pulse, rests, pallorfight or flight

A nurse who provides care on a reconstructive orthopedic unit has walked past the room of a patient who is receiving balanced suspension traction for the treatment of a femoral head fracture. The nurse observes a nursing assistant lifting the suspended weights to facilitate positioning a bedpan under the patient. How should the nurse best follow-up this observation? A) Ensure the nursing assistant knows that such transfers must be performed quickly and efficiently. B) Assess the patient for the ability to transfer to a commode rather than using a bedpan. C) Teach the nursing assistant that weights should not be removed from traction, except in an emergency. D) Teach the nursing assistant to apply temporary weights to compensate for positional changes.

C

A trauma patient in the emergency department (ED) is showing signs of acute renal failure that the care team suspects are due to myoglobinuria. The ED nurse should recognize that these problems are most closely associated with what type of injury? A) Hemorrhage B) Severe lacerations C) Crush injury D) Blunt force trauma

C

An infusion of phenytoin (Dilantin) has been ordered for a patient whose brain tumor has just caused a seizure. The patient has been receiving D5W at 100 mL/hour to this point and has only one IV access site at this point. How should the nurse prepare to administer this drug to the patient? A) Saline lock the patient's IV and wait 15 minutes before administering phenytoin. B) Administer the drug orally due to the risk of precipitation. C) Thoroughly flush the patient's IV with normal saline. D) Mix the phenytoin in a 50 mL minibag of D5W.

C

Stages of Shock

CompensatoryProgressiveIrreversible

pathophysiology of shock

Decreased Blood VolumeDecreased Venous ReturnDecreased Stroke VolumeDecreased Cardiac OutputDecreased Tissue Perfusion

A client's spouse relates how the client reported a severe headache, and shortly after was unable to talk or move their right arm and leg. The spouse indicates the client has hypertension. What should be the focus of management during this phase? 1- preventing further neurologic damage 2- reporting changes to the physician 3- destabilizing client's condition 4- assessing vital signs frequently

1

A day care worker comes to the clinic for mild itching and rash of both hands. The nurse suspects contact dermatitis. The diagnosis is confirmed if the rash appears: 1- erythematous with raised papules. 2- dry and scaly with flaking skin. 3- inflamed with weeping and crusting lesions. 4- excoriated with multiple fissures.

1

A nurse is caring for a client admitted to the unit with a seizure disorder. The client seems upset and asks the nurse, "What will they do to me? I'm scared of the tests and of what they'll find out." The nurse should focus her teaching plans on which diagnostic tests? Transesophageal echocardiogram (TEE), troponin levels, and a complete blood count 1- EEG, blood cultures, and neuroimaging studies 2- X-ray of the brain, bone marrow aspiration, and EEG 3- Electrocardiography, TEE, prothrombin time (PT), and International 4- Normalized Ratio (INR)

1

The most important principle of psoriasis treatment is which of the following? 1- Gentle removal of scales 2- Application of emollient creams 3- Establishment of regular skin care routine 4- Dressing changes

1

An understanding of the pathophysiologic rationale behind shock is necessary for sound nursing practice. Which of the following statements best describes the pathophysiology of shock? 1- Blood is shunted from vital organs to peripheral areas of the body. 2- Cells lack an adequate blood supply and are deprived of oxygen and nutrients. 3- Circulating blood volume is decreased. 4- Hemorrhage occurs as a result of trauma.

2

During a Tensilon test to determine if a patient has myasthenia gravis, the patient complains of cramping and becomes diaphoretic. Vital signs are BP 130/78, HR 42, and respiration 18. What intervention should the nurse prepare to do? 1- Place the patient in the supine position. 2- Administer diphenhydramine (Benadryl) for the allergic reaction. 3- Administer atropine to control the side effects of edrophonium. 4- Call the rapid response team because the patient is preparing to arrest.

3

The nurse is admitting a patient with a diagnosis of a gastrointestinal bleed who is in the compensatory stage of shock. Which of the following is an early sign that accompanies compensatory shock? A) Increased urine output B) Decreased heart rate C) Hyperactive bowel sounds D) Cool, clammy skin

3

The nurse is caring for a client ordered for multiple eye screening. Following which procedure will the nurse instruct the client on a yellow coloring to the skin and urine as being normal? 1- Ultrasonography 2- Retinal Imaging 3- Retinal Angiography 4- Retinoscopy

3

Which condition is an autoimmune disease involving immunoglobulin G? 1- Toxic epidural necrolysis (TEN) 2- Stevens-Johnson syndrome (SJS) 3- Pemphigus 4- Bullous pemphigoid

3

A nurse helps a patient recently diagnosed with a pituitary adenoma understand that: 1- The cause is directly related to prior exposure to radiation. 2- Most tumors are malignant (>90%). 3- Transcranial surgery is usually necessary to remove the tumor. 4- Most tumors produce too much of one or more hormones.

4

A patient is diagnosed with a spinal cord tumor and has had a course of radiation and chemotherapy. Two months after the completion of the radiation, the patient complains of severe pain in the back. What is pain an indicator of in a patient with a spinal cord tumor? 1- Lumbar sacral strain 2- The development of a skin ulcer from the radiation 3- Hematoma formation 4- Spinal metastasis

4

The nurse is working in the triage section of a walk-in clinic. Which triad of common symptoms, when placed together, indicate Ménière's disease? 1- Blurred vision, vertigo, nausea 2- Syncope, vertigo, ear pain 3- Disorientation, vertigo, nausea 4- Hearing loss, vertigo, tinnitus

4

distributive shock

A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.

A critical care nurse has provided care for several patients over the preceding months who were admitted to the unit with septic shock. The nurse has become aware that the incidence of septic shock is increasing. Which of the following actions has the greatest potential to reduce the incidence of septic shock? A) Minimization of lengths of stay in hospitals and other institutional settings B) Evidence-based use of prophylactic antibiotics in hospitals and other care settings C) Vigilant application of infection control procedures D) Minimization of patient-staff contact during hospital treatment

C

The nursing educator on a neurological unit is conducting a brief in-service on glial cell tumors. The educator tells the nurses that the most common type of glioma is an astrocytoma and that astrocytomas are graded from I to IV, indicating the degree of malignancy. What is the tumor's grading based on? A) Cellular density, number of cells, and appearance B) Size of cells, number of cells, and appearance C) Cellular density, cell mitosis, and appearance D) Cell mitosis, size of cells, and appearance

C

A nurse is caring for a client with a history of severe migraines. The client has a medical history that includes asthma, gastroesophageal reflux disease, and three pregnancies. Which medication does the nurse anticipate the physician will order for the client's migraines? 1- Verapamil (Calan) 2- Metoprolol (Lopressor) 3- Amiodarone (Cordarone) 4- Captopril (Coreg)

1

A nurse practitioner explains to a patient recently diagnosed with noise-induced hearing loss that the basic altered physiology in the ear is the result of: 1- Damage to the hair cells inside the cochlea. 2- Stenosis of the semicircular canals. 3- Hardening of the tympanic membrane. 4- Malfunctioning of the incus and the staples.

1

A patient is to have an angiography done using fluorescein as a contrast agent to determine if the patient has macular edema. What laboratory work should the nurse monitor prior to the angiography? 1- BUN and creatinine 2- AST and ALT 3- Hemoglobin and hematocrit 4- Platelet count

1

Normal intraocular pressure

10-21 mm Hg

The nurse is teaching a class on diseases of the ear. What would the nurse teach the class is the most characteristic symptom of otosclerosis? 1- The client being distressed in the mornings 2- A progressive, bilateral loss of hearing 3- A red and swollen ear drum 4- The client describing a recent upper respiratory infection

2

Which of the following drugs may be used after a seizure to maintain a seizure-free state? 1- Valium 2- Phenobarbital 3- Ativan 4- Cerebyx

2

The nurse is conducting a physical assessment of a male patient who has been admitted to the hospital unit. The nursing documentation on the unit specifies an assessment of the patient's direct and consensual pupillary response. How should the nurse assess the patient's consensual pupillary response? 1- Ask the patient to follow the movement of pen from several feet away to near the tip of the patient's nose 2- Ask the patient to look straight ahead while bringing a penlight in from the periphery of the patient's vision 3- Shine a penlight in one of the patient's eyes while observing the response of the opposite eye 4- Shine a penlight in the patient's eye while asking him to identify a common object with the other eye

3

The nurse is providing end-of-life care to a client who was diagnosed with glioblastoma multiforme (GBM) 8 months ago. Despite a calm interaction with the client 1 hour ago, the client is now angry and yells, "Get out of my room and don't touch me anymore. I don't need your help!" How should the nurse respond? 1- "I am your nurse and caring for you is my obligation. If you no longer want my care, you have to make a request to my supervisor." 2- "You are not permitted to speak to me this way. I am a professional and I deserve for you to treat me with respect." 3- "I can see you no longer want me as your nurse today. I will ask one of my colleagues to come in to complete the rest of my assessment." 4- "I can tell now is not the right time for me to come in and check on you. Please let me know when it is a better time for me to come back."

4

A patient with Huntington's disease is prescribed medication to reduce the chorea. What medication will the nurse administer that is the only drug approved for the treatment of this symptom? 1- Tetrabenazine (Xenazine) 2- Carbamazepine (Tegretol) 3- phenobarbital 4- Diazepam (Valium)

1

Nurses are performing hourly neurological assessments of a patient who is postoperative day 1 following spinal surgery that was performed to treat spinal cord compression (SCC). The nurse's most recent assessment shows a marked reduction in motor and sensory function. How should the nurse best follow-up this assessment finding? 1- Inform the care provider promptly about this sudden change. 2- Reassess the patient in 15 minutes. 3- Contact the anesthesiologist to discuss possible residual effects of anesthesia. 4- Document these findings and have a colleague confirm the assessment.

1

Uncompensated shock

1. Decreased systolic and diastolic BP 2. Confusion, unconsciousness 3. Delayed capillary refill, cold extremities, cyanosis 4. Moderate tachycardia

Corticosteroids are used in the management of brain tumors to 1- prevent extension of the tumor. 2- facilitate regeneration of neurons. 3- reduce cerebral edema. 4- identify precise location of the tumor.

3

The nurse is admitting a patient with a diagnosis of a gastrointestinal bleed who is in the compensatory stage of shock. Which of the following is an early sign that accompanies compensatory shock? 1- Increased urine output 2- Decreased heart rate 3- Hyperactive bowel sounds 4- Cool, clammy skin

4

The nurse is caring for a client with a skin lesion that is oozing. The surrounding skin is acutely inflamed. What type of dressing should the nurse apply? 1- Occlusive 2- Protective 3- Passive 4- Interactive

4

An extended care facility has been the site of a breakout of scabies in recent days. The staff at the facility recognize the need for an expedited, coordinated response to this outbreak. This response should include which of the following measures? Select all that apply. A) Providing warm, soapy baths to affected residents B) Providing prophylactic antibiotics to unaffected residents C) Applying a topical scabicide to the skin of affected residents D) Providing a course of oral antiviral medication to all residents E) Vaccinating all staff and residents against scabies as soon as possible

A,C

A patient has been prescribed a topical corticosteroid and the nurse is providing relevant patient teaching about the correct technique for applying this medication. What guideline should the nurse provide to this patient? A) Apply the medication to the affected area and to unaffected skin within 2 to 3 inches of the affected skin. B) Apply a thin coating of the medication, but ensure that all affected areas are covered with the medication. C) Avoid covering affected areas with clothing or bandages after applying the medication. D) Apply a coating of the medication to the affected area and then gently rub it off after 5 to 10 minutes.

B

A patient who has been diagnosed with a brain tumor is being cared for in the neurological intensive care unit (ICU) because of a sudden exacerbation of the signs and symptoms of his neoplasm. Which of the following would be indicative of increased intracranial pressure (ICP)? A) Epistaxis B) Severe headache C) Increased jugular venous pressure (JVP) D) Electrocardiographic (ECG) changes

B

A patient who is being treated for hypovolemic shock is in an acutely ill state and unable to take food or fluids by mouth. The nurse knows that the patient's nutritional needs should not be neglected, however, and should advocate for which of the following? A) The initiation of total parenteral nutrition when the patient's condition stabilizes B) The initiation of parenteral or enteral nutritional support as soon as possible C) Administration of colloids in order to meet the patient's short-term nutritional needs D) Addition of multivitamins to the patient's intravenous solution

B

Patients who are in shock have special needs, including nutritional needs. What physiological phenomenon underlies these unique nutritional needs? A) The necessity of albumin as a food source because of the need for increased caloric intake B) The loss of fluids and decreased levels of stomach acids due to increased parasympathetic activity C) The release of catecholamines that creates an increase in metabolic rate and caloric requirements D) The increase in gastrointestinal function during shock and the resulting diarrhea

C

the nurse is planning the care of a 28-year-old female hospitalized with a diagnosis of myasthenia gravis. What schedule would be most appropriate for the organization of diagnostic procedures for this patient? A) All at one time, to provide a longer rest period B) Before meals, to stimulate her appetite C) In the morning, with frequent rest periods D) Before bedtime, to promote rest

C

The critical care nurse is caring for a client with bacterial meningitis. The client has developed cerebral vasculitis and increased ICP. What neurologic sequelae might this client develop? 1- Damage to the optic nerve 2- Damage to the vagal nerve 3- Damage to the olfactory nerve 4- Damage to the facial nerve

1

The critical care nurse is caring for a client with bacterial meningitis. The client has developed cerebral vasculitis and increased ICP. What neurologic sequelae might this client develop? Damage to the optic nerve Damage to the vagal nerve Damage to the olfactory nerve Damage to the facial nerve

1

The nurse educator is providing orientation to a new group of staff nurses on an oncology unit. Part of the orientation is to help nurses understand the differences between various types of brain tumors. The nurse educator correctly identifies that glioma tumors are classified based on the fact that they originate where in the brain? 1- Within the brain tissue 2- From the coverings of the brain 3- In the cranial nerves 4- From metastasis of a primary tumor

1

The nurse explains to the client with projectile vomiting and severe headache that a medication is being prescribed to reduced edema surrounding the brain and lessen these symptoms. What medication is the nurse preparing to administer? 1- Mannitol 2- Temozolomide 3- Bevacizumab 4- Everolimus

1

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe? 1- Diplopia and ptosis 2- Numbness 3- Patchy blindness 4- Loss of proprioception

1

The nurse is seeing the mother of a client who states, "I'm so relieved because my son's doctor told me his brain tumor is benign." The nurse knows what is true about benign brain tumors? 1- They can affect vital functioning. 2- They do not require surgical removal. 3- The prognosis is very poor. 4- They are all metastatic.

1

The physician suggests that a client use meclizine as treatment for his motion sickness. The nurse explains the rationale for this drug based on an understanding of which of the following as the drug's action? 1- Blocks conduction of the vestibular pathways 2- Antagonizes the response of histamine 3- Depresses the central nervous system 4- Lowers endolymphatic system pressure

1

A patient with generalized seizure disorder has just had a seizure. The nurse would assess for what characteristic associated with the postictal state? 1- Epileptic cry 2- Confusion 3- Urinary incontinence 4- Body rigidity

2

After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer? 1- Esophageal carcinoma 2- Pituitary carcinoma 3- Laryngeal carcinoma 4- Colorectal carcinoma

2

A 37-year-old mother of three has just been diagnosed with a grade I meningioma. As part of patient education, the nurse tells the patient that: 1- The tumor is malignant and aggressive. 2- The tumor will cause pressure on the eighth cranial nerve. 3- Growth is slow and symptoms are caused by compression rather than tissue invasion. 4- Surgery, which can result in complete removal of the possible tumor, should be done as soon as possible.

3

A patient has been admitted to the intensive care unit (ICU) for the treatment of bacterial meningitis. The ICU nurse is aware of the need for aggressive treatment and vigilant nursing care because meningitis has the potential to cause what sequela? 1- Hydrocephalus 2- Glioma 3- Increased intracranial pressure (ICP) 4- Cerebrovascular accident (CVA)

3

A young adult visits a health clinic for treatment of a severe case of eczema on his left leg. Which of the following is the preferred method for delivering medication in this scenario? 1- Therapeutic bath 2- Cream 3- Ointment 4- Topical anesthetic

3

An infusion of phenytoin (Dilantin) has been ordered for a patient whose brain tumor has just caused a seizure. The patient has been receiving D5W at 100 mL/hour to this point and has only one IV access site at this point. How should the nurse prepare to administer this drug to the patient? 1- Saline lock the patient's IV and wait 15 minutes before administering phenytoin. 2- Administer the drug orally due to the risk of precipitation. 3- Thoroughly flush the patient's IV with normal saline. 4- Mix the phenytoin in a 50 mL minibag of D5W.

3

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? 1- How to exercise 2- How to perform household tasks 3- How to take a bath 4- How to facilitate tasks such as using both hands to hold a drinking glass

4

The nurse is actively managing the intravenous fluid administration for a patient who has developed cardiogenic shock after a myocardial infarction. When performing this aspect of nursing care, what principle should guide the nurse's decision making? A) Adequate fluid resuscitation must be balanced against the risk of fluid overload. B) Intravenous fluid should be infused as quickly as possible in emergency treatment. C) In order to prevent increased afterload, the patient should not receive more than 125 mL of total intravenous fluid in 60 minutes. D) Temporary fluid restriction reduces cardiac workload and improves cardiac output.

A

The nursing instructor is discussing the difference between sensorineural and conductive hearing loss with his class. The discussion turns to evaluation for determining what kind of hearing loss a patient has. What Weber test result would indicate the presence of a sensorineural loss? A) The sound is heard better in the ear in which he has better hearing. B) The sound is heard equally in both ears. C) The sound is heard better in the ear in which he has poorer hearing. D) The sound is heard longer in the ear in which he has better hearing.

A

renin-angiotensin-aldosterone

A vital control and compensatory mechanism that is activated when renal blood flow is decreased, often in hypotensive states. When blood flow is decreased to the kidneys, renin is released from the kidneys, which in turn activates angiotensin I to become converted to angiotensin II (a vasoconstrictor) and stimulates aldosterone secretion. In hypotensive states, this mechanism raises blood pressure and maintains vital organs. In chronic disease states such as hypertension, it is inappropriately activated because of vasoconstriction to the kidneys, further contributing to the hypertension.

A female patient is sufficiently stable to be transferred from the PACU to the postsurgical unit following her total hip replacement surgery early this morning. When preparing to admit this patient, the nurse on the postsurgical unit should anticipate that the patient will require what positioning? A) Supine with her knees slightly elevated B) With her legs slightly abducted C) In a high Fowler's position with knees elevated D) With a low head-of-bed and with her knees touching each other

B

A female patient with a profound visual deficit is unable to read the largest E on the Snellen chart. How should the nurse proceed with assessment of the patient's visual acuity? A) Document the fact that the patient does not have functional vision. B) Hold up a random number of fingers in front of the patient's eyes and ask her to count them. C) Give the patient a hand-held version of the Snellen chart and have her hold it at the furthest distance at which she can read it. D) Ask the patient to identify the contents of a picture in a book or magazine.

B

A patient diagnosed with multiple sclerosis (MS) has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission orders is baclofen (Lioresal). What would be the expected outcome of this medication? A) Reduction in the appearance of new lesions on magnetic resonance imaging (MRI) B) Decreased muscle spasms in the lower extremities C) Increased muscle strength in the upper extremities D) Promotion of urinary continence

B

A patient with a history of human immunodeficiency virus (HIV) has just been diagnosed with toxic epidermal necrolysis (TEN) and admitted to the regional burn unit for treatment. The nurses who will be providing direct care for this patient should prioritize which of the following practices? A) Provision of enteral nutritional supplements B) Vigilant application of standard infection control precautions C) Intermittent urinary catheterization D) Continuous monitoring of blood glucose levels

B

patient's brain tumor has been manifested by seizures that have become more frequent and severe in recent days. The patient has been scheduled for neurosurgery but the nurse is nonetheless making changes to the patient's preoperative nursing care plan. The patient's seizures should cause the nurse to prioritize which of the following nursing diagnoses? A) Acute pain related to seizure activity B) Risk for injury related to seizures C) Impaired memory related to seizure activity D) Imbalanced nutrition: less than body requirements related to seizures

B

The nurse is giving a visual field examination to a 55-year-old male client. The client asks what this test is for. What would be the nurse's best answer? 1- "This test measures visual acuity." 2- "This test measures how well your eyes move." 3- "This test is to see how well your eyes are aging." 4- "This test measures peripheral vision and detects gaps in the visual field."

4

Which nursing diagnosis takes highest priority for a client admitted for evaluation for Ménière's disease? 1- Acute pain related to vertigo 2- Imbalanced nutrition: Less than body requirements related to nausea and vomiting 3- Risk for deficient fluid volume related to vomiting 4- Risk for injury related to vertigo

4

Which skin condition is caused by staphylococci, streptococci, or multiple bacteria? 1- Scabies 2- Pediculosis capitis 3- Poison ivy 4- Impetigo

4

The nurse is assisting with administering a Tensilon test to a patient with ptosis. If the test is positive for myasthenia gravis, what outcome does the nurse know will occur? 1- Thirty seconds after administration, the facial weakness and ptosis will be relieved for approximately 5 minutes. 2- After administration of the medication, there will be no change in the status of the ptosis or facial weakness. 3- The patient will have recovery of symptoms for at least 24 hours after the administration of the Tensilon. 4- Eight hours after administration, the acetylcholinesterase begins to regenerate the available acetylcholine and will relieve symptoms.

1

The nurse is caring for a client diagnosed with Guillain-Barre syndrome. His spouse asks about recovery rates. The nurse can correctly relate which of the following? 1- Approximately 60% to 75% of clients recover completely. 2- Only a very small percentage (5% to 8%) of clients recover completely. 3- Usually 100% of clients recover completely. 4- No one with Guillain-Barre syndrome recovers completely.

1

Which symptoms may a client with Ménière disease report before an attack? 1- Nystagmus 2- Low blood pressure 3- Photosensitivity 4- A full feeling in the ear

4

A patient has been admitted to the neurological ICU with a diagnosis of a brain tumor. The patient is scheduled to have a tumor resection/removal in the morning. What is a priority part of the nurse's preoperative assessment of this patient? A) The gag reflex B) Ability to chew C) Sensory perception D) Corneal reflex

A

A patient in shock has been started on a dobutamine infusion in the intensive care unit. The nurse knows that the infusion rate will be constantly adjusted to maximize therapeutic effect. Changes to the infusion rate of this vasoactive medication will be primarily based on what assessment finding? A) Mean arterial pressure (MAP) B) Arterial blood gasses (ABGs) C) Fluid balance D) Level of consciousness

A

The nurse is assessing a client with a confirmed spinal cord tumor. The client states, "I've been too embarrassed to tell anyone but, I have been awakened at night because I've wet the bed." It would be a priority for the nurse to further assess the client for which complication? 1- Spinal cord compression 2- Urinary tract infection 3- Knowledge deficit 4- Impaired skin integrity

1

The nurse is caring for a patient with Ménière's disease who is hospitalized with severe vertigo. What medication does the nurse anticipate administering to shorten the attack? 1- Meclizine (Antivert) 2- Furosemide (Lasix) 3- Cortisporin otic solution 4- Gentamicin (Garamycin) intravenously

1

The nurse is conducting an admission history and physical examination of a client with a history of contact dermatitis. The nurse assesses whether the client uses which medication classification? 1- Corticosteroids 2- Saline irrigations 3- Antifungals 4- Antivirals

1

The nurse is instructing a client's family members on the most incapacitating symptom of Ménière's disease. Which nursing instruction associated with the symptom is most helpful? 1- Assist the client when ambulating. 2- Keep a bucket beside the bed. 3- Ensure low lighting in the room. 4- Sit in front of the client when speaking.

1

The nurse is seeing a client who has just been diagnosed with a meningioma. The client states he is confused because the provider stated, "If you have to be diagnosed with a brain tumor, this is the least harmful." The client asks the nurse for clarification. How should the nurse respond? 1- "I am unable to interpret what your provider meant by making that statement; however, it is true that meningiomas are slow growing tumors that are not typically fatal." 2- "I am assuming your provider was trying to explain to you that meningomas have a high cure rate if treated with surgery, chemotherapy and radiation aggressively." 3- "It is likely that your provider was trying to be as supportive as possible with those positive words. You need a lot of support during this challenging time." 4- "It would have been important for you to clarify your provider's statement during your appointment. It is not within my scope to discuss the details of your diagnosis."

1

What advice should the nurse give a client with dermatitis until the etiology of the dermatitis is identified? 1- Use wool, synthetics, and other dense fibers. 2- Wear rubber gloves when in contact with soaps. 3- Rub the skin vigorously to dry. 4- Use hot water for bathing.

2

The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following? 1- "Have you experienced any viral infections in the last month?" 2- "Have you experienced any ptosis in the last few weeks?" 3- "Have you had difficulty with urination in the last 6 weeks?" 4- "Have you developed any new allergies in the last year?"

1

When performing a postoperative assessment on a client who has undergone surgery to manage increased intracranial pressure (ICP), a nurse notes an ICP reading of 0 mm Hg. Which action should the nurse perform first? 1- Check the equipment. 2- Contact the physician to review the care plan. 3- Continue the assessment because no actions are indicated at this time. 4- Document the reading because it reflects that the treatment has been effective.

1

Stress ulcers occur frequently in acutely ill patient. Which of the following medications would be used to prevent ulcer formation? Select all that apply. 1- Famotidine (Pepcid) 2- Ranitidine 3- Lansoprazole 4- Desmopressin

1,2,3

The causes of acquired seizures include what? (Mark all that apply.) 1- Cerebrovascular disease 2- Metabolic and toxic conditions 3- Hypernatremia 4- Brain tumor 5- Drug and alcohol withdrawal

1,2,4,5

experiencing nausea and vomiting and has little interest in eating. His family states, "We don't know how to help him." Which of the following would be appropriate for the nurse to suggest to help improve the client's nutritional intake? Select all that apply. 1- Ensure that the client is free of pain for meals. 2- Place the client near the sounds and smells of meals being prepared. 3- Plan meals for times when the client is rested. 4- Provide the client with foods that he likes. 5- Prepare the client for the insertion of a feeding tube.

1,3,4

A nurse is assessing a newly admitted client with meningitis. Which of the following findings in this client is most likely? 1- Negative Kernig's sign 2- Positive Brudzinski's sign 3- Increased intake 4- Hyper-alertness

2

A nurse is caring for a client experiencing an exacerbation of plaque psoriasis. The nurse assesses the area and documents a proliferation of which cell type? 1- Dermal 2- Epidermal 3- Endothelial 4- Epithelia

2

A client visits the physician's office for treatment of a skin disorder. As a primary treatment, the nurse expects the physician to order: 1- an IV corticosteroid. 2- an IV antibiotic. 3- an oral antibiotic. 4- a topical agent.

4

A patient's severe and widespread psoriasis has prompted her care provider to prescribe potent topical corticosteroids. When teaching this patient about her new medication regimen, the nurse should recognize that topical corticosteroids that are applied to large skin surfaces create a risk of: A) Adrenal suppression B) Disseminated intravascular coagulation (DIC) C) Hypothyroidism D) Kaposi's sarcoma

A

You are the clinic nurse in an ophthalmic clinic. When assessing clients, which client has an abnormal intraocular pressure (IOP)? 1- A client with an IOP of 8 mm Hg 2- A client with an IOP of 15 mm Hg 3- A client with an IOP of 19 mm Hg 4- A client with an IOP of 21 mm Hg

1

Cerebrospinal fluid (CSF) studies would indicate which of the following in a patient suspected of having meningitis? Select all that apply. 1- Decreased glucose 2- Increased protein 3- Increased white blood cells 4- Decreased protein 5- Increased glucose

1,2,3

The nurse educator is testing a group of nursing students about various types of brain tumors and their clinical manifestations. The students are correct when stating tumors located in the cerebellar region of the brain produce which symptoms? Select all that apply. 1- Staggering gait 2- Muscle incoordination 3- Abnormal eye movements 4- Visual hallucinations 5- Apathetic mental attitude

1,2,3

A client diagnosed with a brain tumor is exhibiting focal symptoms. Which assessment findings are the nurse likely to note? Select all that apply. 1- Muscle weakness 2- Sensory loss 3- Aphasia 4- Visual changes 5- Vomiting

1,2,3,4

The nurse is performing an assessment of the visual fields for a patient with glaucoma. When assessing the visual fields in acute glaucoma, what would the nurse expect to find? 1- Clear cornea 2- Constricted pupil 3- Marked blurring of vision 4- Watery ocular discharge

3

The nurse is reviewing diagnostic lab work of a client developing shock. Which laboratory result does the nurse note as a key in determining the type of shock? 1- Hemoglobin: 14.2 g/dL 2- Potassium: 4.8 mEq/L 3- WBC: 42,000/mm3 4- ESR: 19 mm/hour

3

The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse? 1- "Don't worry; your child will be fine." 2- "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." 3- "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." 4- "It's too early to give a prognosis."

3

When undergoing testing of visual acuity with a Snellen chart, the client can read the line labeled 20/50 but misses three letters on the line. The nurse documents this finding as which of the following? 1- 20/20 + 30 2- 20/20/50 3- 20/50-3 4- 20/50

3

A patient is in the progressive stage of shock with lung decompensation. What treatment does the nurse anticipate assisting with? 1- Pericardiocentesis 2- Thoracotomy with chest tube insertion 3- Administration of oxygen via venture mask 4- Intubation and mechanical ventilation

4

Amsler Grid Test

a central field of vision test that is a subjective monocular grid test designed to evaluate the function of the retina in the macular area of each eye, which is where 20/20 vision occurs

beta-2 adrenergic receptors

cause bronchodilation

The nurse is providing education to a client who is being discharged with an outpatient treatment plan that includes taking a chemotherapeutic agent. What instructions should the nurse include? Select all that apply. 1- The client should ensure no one else handles the medication. 2- If a dose is missed, the client should take double the amount at the regular time the following day. 3- The client should seek emergency help if nausea or vomiting occur. 4- The client should seek emergency care if he or she develops a fever. 5- Hair loss should be expected when taking the medication.

1,4,5

A 13-year-old patient is admitted to the pediatric unit with a suspected brain tumor. The nurse should understand that which diagnostic test is the most helpful in the diagnosis of brain tumors? 1- Computed tomography (CT) scan 2- Magnetic resonance imaging (MRI) 3- Brain biopsy 4- Blood work with adrenocorticotropic hormone (ACTH) levels

2

A client admitted with a massive myocardial infarction rapidly develops cardiogenic shock. Ideally, the physician would use the intra-aortic balloon pump (IABP) to support the injured myocardium. However, this client has a history of unstable angina pectoris, aortic insufficiency, hypertension, and diabetes mellitus. Which condition is a contraindication for IABP use? 1- Unstable angina pectoris 2- Aortic insufficiency 3- Hypertension 4- Diabetes mellitus

2

Audiometry confirms a client's chronic progressive hearing loss. Further investigation reveals ankylosis of the stapes in the oval window, a condition that prevents sound transmission. This type of hearing loss is called: 1- functional hearing loss. 2- fluctuating hearing loss. 3- sensorineural hearing loss. 4- conductive hearing loss.

4

A client comes to the walk-in clinic complaining of an earache. The cause is found to be impacted cerumen. The client asks the nurse what he can do at home to soften hardened cerumen. What should the nurse recommend to a client to soften hardened cerumen? 1- Avoid harsh sunlight. 2- Increase intake of red meat. 3- Increase intake of beta-carotene. 4- Take nonprescription preparations.

4

A client comes to the clinic for evaluation because of complaints of dizzinesss and difficulty walking. Further assessment reveals a staggering gait, marked muscle incoordination, and nystagmus. A brain tumor is suspected. Based on the client's assessment findings, the nurse would suspect that the tumor is located in which area of the brain? 1- Frontal lobe 2- Cerebellum 3- Motor cortex 4- Occipital lobe

2

A client is receiving long-term intravenous therapy with gentamicin for a chronic wound infection. Which of the following would be most important for the nurse to ensure? 1- Obtain specimens for wound cultures daily. 2- Arrange for audiograms twice a week. 3- Monitor complete blood counts every other day. 4- Assess intravenous access site daily.

2

The spouse of a client with terminal brain cancer asks the nurse about hospice. Which statement by the nurse best describes hospice care? 1- "Hospice care uses a team approach and provides complete care." 2- "Clients and families are the focus of hospice care." 3- "The physician coordinates all the care delivered." 4- "All hospice clients die at home."

2

Which client goal, established by the nurse, is most important as the nurse plans care for a seizure client in the home setting? 1- The client will take the seizure medication at the same time daily. 2- The client will remain free of injury if a seizure does occur. 3- The client will verbalize an understanding of feelings that preempt seizure activity. 4- The client will post emergency numbers on the refrigerator for ease of obtaining.

2

Which condition is a rare, transmissible, progressive fatal disease of the central nervous system characterized by spongiform degeneration of the gray matter of the brain? 1- Multiple sclerosis 2- Creutzfeldt-Jakob disease 3- Parkinson disease 4- Huntington disease

2

The nurse has been educating a client newly diagnosed with MS. Which statement by the client indicates an understanding of the education? 1- "I will take hot tub baths to decrease spasms." 2- "I should participate in non-weight-bearing exercises." 3- "I will stretch daily as directed by the physical therapist." 4- "The exercises should be completed quickly to reduce fatigue."

3

The nurse is caring for a client with an inoperable brain tumor. What teaching is important for the nurse to do with these clients? 1- Optimizing nutrition 2- Managing muscle weakness 3- Explaining hospice care and services 4- Offering family support groups

3

The nurse is educating a patient with a seizure disorder. What nutritional approach for seizure management would be beneficial for this patient? 1- Low in fat 2- Restricts protein to 10% of daily caloric intake 3- High in protein and low in carbohydrate 4- At least 50% carbohydrate

3

A client with fungal encephalitis receiving amphotericin B reports fever, chills, and body aches. The nurse knows that these symptoms 1- indicate renal toxicity and a worsening condition. 2- are primarily associated with infection with Coccidioides immitis and Aspergillus. 3- indicate the need for immediate blood and cerebral spinal fluid (CSF) cultures. 4- may be controlled by the administration of diphenhydramine and acetaminophen approximately 30 minutes before administration of the amphotericin.

4

A client presents to the community health office experiencing rapidly increasing symptoms of anaphylactic shock. Which nursing action would be completed first? 1- Obtain the name and information of the allergic substance. 2- Administer an epinephrine injection as ordered by the health care provider. 3- Obtain a health history. 4- Call 911.

2

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? 1- Edema associated with the tumor 2- Irritation of the meduallary vagal centers 3- Compression of surrounding structures 4- Distortion of pain-sensitive structures

2

A patient with amyotrophic lateral sclerosis (ALS) asks if the nurse has heard of a drug that will prolong the patient's life. The nurse knows that there is a medication that may prolong the life by 3 to 6 months. To which medication is the patient referring? 1- Baclofen 2- Riluzole 3- Dantrolene sodium 4- Diazepam

2

A 24-year-old man has suffered extensive head and neck injuries in a motorcycle accident and has been admitted to the intensive care unit (ICU) in apparent neurogenic shock. Which of the following are characteristics of this patient's diagnosis? A) The patient has adequate blood volume but is profoundly vasodilated. B) The patient is experiencing an exaggerated and pathological immune response. C) The patient is at risk of cerebral hemorrhage due to sympathetic stimulation. D) The patient is in hypertensive crisis as a result of baroreceptor dysfunction.

A

After thorough diagnosis and screening, a 9-year-old boy has been scheduled for a cochlear implant. The nurse who will be contributing to this child's care should recognize that: 1- The boy's hearing deficit will be considered normal within 24 to 48 hours after surgery. 2- A lengthy period of learning may be required before he can accurately interpret sounds. 3- The boy will achieve hearing through bone conduction. 4- The cochlear implant will provide a beneficial, but temporary, solution to the boy's hearing loss.

2

The client is having a Weber test. During a Weber test, where should the tuning fork be placed? 1- On the mastoid process behind the ear 2- In the midline of the client's skull or in the center of the forehead 3- Near the external meatus of each ear 4- Under the bridge of the nose

2

The diagnosis of multiple sclerosis is based on which test? 1- CSF electrophoresis 2- Magnetic resonance imaging 3- Evoked potential studies 4- Neuropsychological testing

2

The nurse and a nursing student are admitting a client with a malignant glioma brain tumor preoperatively for resection of the tumor. The nursing student asks the nurse, " I was told these types of tumors have a very poor prognosis. Why is the tumor being resected?" Which rationale for this intervention is true? 1- "Every life-saving treatment is administered when treating brain tumors." 2- "Surgical resection of the tumor will decrease intracranial pressure." 3- "Using this procedure will eliminate the need for chemotherapy." 4- "Removing bulk from the tumor will reverse the paralysis."

2

The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient? 1- Paclitaxel 2- Coumadin 3- Decadron 4- Dilantin

2

An older adult man has been diagnosed with Parkinson's disease and has begun treatment with levodopa and carbidopa. When providing health education about his new medication regimen, what should the nurse teach the man? 1- "If you're consistent with taking your medication, you might not experience symptoms for several more years." 2- "This medication can cure Parkinson's disease, but this is not necessarily the case for everyone." 3- "The beneficial effects of this medication usually increase over time, so you may not get maximum relief for a few years." 4- "This medication helps significantly but the benefits tend to decrease over time."

4

The nurse is caring for a client who was diagnosed with a glioma 5 months ago. Today, the client was brought to the emergency department by his caregiver because he collapsed at home. The nurse suspects late signs of rising intracranial pressure (ICP) when which blood pressure and pulse readings are noted? 1- BP = 90/50 mm Hg; HR = 75 bpm 2- BP =130/80 mm Hg; HR = 55 bpm 3- BP = 150/90 mm Hg; HR = 90 bpm 4- BP = 175/45 mm Hg; HR = 42 bpm

4

A client is being treated for acne vulgaris. What contributes to follicular irritation? 1- overproduction of sebum 2- chocolate 3- stress 4- potato chips

1

The central venous pressure (CVP) reading in hypovolemic shock is typically which of the following? 1- Low 2- High 3- Normal 4- Unable to measure

1

The nurse caring for a client with Ménière's disease makes which primary assessments? 1- Ability to function 2- Social support 3- Gross hearing 4- Level of disability

3

When discussing diseases of the middle ear, the nursing instructor distinguishes the different types of otitis media. What generally causes purulent otitis media? 1- Irritation associated with respiratory allergies and enlarged adenoids 2- Bronchial tree 3- Outer ear 4- Upper respiratory infections

4

A 15-year-old boy has been brought to the emergency department by his friends after severing his brachial artery while trying to scale a fence. In order to stop this patient's bleeding, the nurse should: A) Apply a tourniquet proximal to the site of the wound. B) Apply direct pressure to the wound. C) Administer platelets. D) Apply a tourniquet distal to the wound.

B

A middle-aged man has come to the emergency department because his foot slipped under his lawnmower, causing trauma to all his toes and to the metatarsal region of his foot. When providing wound care in the emergency room setting, what intervention should the nurse perform? A) Immediately apply a sterile wound dressing. B) Irrigate the wound with normal saline. C) Apply lidocaine to the skin surfaces adjacent to the wound. D) Apply an ice pack to the patient's wound.

B

A nurse is caring for patients exposed to a terrorist attack involving chemicals. The nurse has been advised that personal protective equipment must be worn in order to give the highest level of respiratory protection with a lesser level of skin and eye protection. What level of protection is this considered? A) Level A B) Level B C) Level C D) Level D

B

A 22-year-old college basketball player is undergoing diagnostic testing following a knee injury, and his primary care provider has ordered arthrography. What teaching should the nurse provide in preparation for this procedure? A) "A computer will create a three-dimensional image of your knee based on magnetic readings." B) "You'll be given some anesthetic and then several tissue samples will be taken from your knee joint." C) "You'll be given a small dose of radioactive solution, and the doctor will observe its distribution in your knee." D) "The doctor will inject some contrast solution into your joint and take a series of X-rays."

D

A 30-year-old female patient has been referred to a specialist by her primary care provider because she has recently developed fat pads at the base of her neck, an increasingly round face, and striae at various locations. The patient's signs of illness have been attributed to a brain tumor. What type of brain tumor is most likely to result in these changes to the woman's physical appearance? A) Glioma B) Acoustic neuroma C) Meningioma D) Pituitary adenoma

D

A nurse is aware of the significant potential benefits of cochlear implants for certain individuals. Which one of the following individuals is the most appropriate candidate for a cochlear implant? A) An individual who has not yet experienced hearing loss but who possesses multiple risk factors B) An individual who has been diagnosed with presbycusis C) An individual who has longstanding and severe conductive hearing loss D) An individual who has profound, bilateral, sensorineural hearing loss

D

A patient, diagnosed with cancer of the lung, has just been told that she has metastases to the brain. The family should be aware that the neurologic signs and symptoms of metastatic brain disease are most often what? A) Bradycardia B) Temperature greater than 100.5°F C) Increase in diastolic blood pressure D) Personality changes

D

A workplace explosion has injured many workers and has left a 40-year-old male client with full-thickness burns over 65% of his body and massive internal injuries. To what category would this person be triaged? A) Green B) Yellow C) Red D) Black

D

An infusion of nitroglycerine has been ordered by the critical care health care provider in the treatment of a patient who has been admitted to the intensive care unit in a state of shock. The nurse should anticipate that this patient is likely experiencing what type of shock? A) Neurogenic shock B) Septic shock C) Anaphylactic shock D) Cardiogenic shock

D

S/S of septic shock

Feverwarm skin (vasodilation) initially > progressing to cool, clammyTachycardiaHypotensionDICARDS

mafenide acetate

Topical agent that penetrates eschar, but may lead to metabolic acidosis.

Intramedullary tumors

Tumor originating within neural tissue

electronystagmography

method of assessing and recording eye movements by measuring the electrical activity of the extraocular muscles

Causes of septic shock

• Any type of bacteria; gram negative, gram positive that releases toxins• Fungi• Virus (rare)• Dilation of vascular beds; coagulation cascade (DIC)

A client with Guillain-Barre syndrome cannot swallow and has a paralytic ileus; the nurse is administering parenteral nutrition intraveneously. The nurse is careful to assess which of the following related to intake of nutrients? 1- Gag reflex and bowel sounds 2- Condition of skin 3- Respiratory status 4- Urinary output and capillary refill

1

A client has a history of hearing loss and is returning for an annual hearing examination. During client education, the nurse explains that hearing involves which areas of the ear? 1- all sections 2- outer section 3- middle section 4- inner section

1

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition? 1- Hemorrhagic stroke 2- Thyroid disorders 3- Hearing loss 4- Visual loss

1

What is the only known risk factor for brain tumors? 1- Ionizing radiation 2- Head trauma 3- Use of hair dyes 4- Cellular telephones

1

Which diagnostic test distinguishes between conductive and sensorineural hearing loss? 1- Whisper test 2- Rinne test 3- Audiometry 4- Weber test

2

The nurse is planning the care of a patient who has been admitted to the hospital for surgical treatment of prostate cancer that has metastasized to his spine. When planning nursing care that is specific to this patient's spinal metastasis, what outcome should the nurse identify? A) The patient will explain the importance of exercise in his recovery. B) The patient will maintain full range of motion. C) The patient will perform activities of daily living comparable to his prediagnosis abilities. D) The patient will state that pain control is adequate.

D

The nurse is providing discharge teaching to a client with a spinal cord tumor and instructs the client to avoid hot water bottles and heating blankets for what reason? 1- Impaired sensory perception 2- Motor weakness 3- Medication side effects 4- Cognitive impairment

1

To avoid the side effects of corticosteroids, which medication classification is used as an alternative in treating inflammatory conditions of the eyes? 1- Miotics 2- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3- Mydriatics 4- Cycloplegics

2

While reviewing the nursing documentation on a patient on the neurological unit, the nurse notes that the patient complained of a headache several times over the previous shift. How can the nurse differentiate between a headache that is caused by a brain tumor and a headache that is caused by meningitis or encephalitis? A) Assess the patient's carotid pulses bilaterally. B) Assess the patient's orientation to person, place, and time. C) Assess the active and passive range of motion of the patient's neck. D) Assess for the presence of a fever.

D

S/S of cardiogenic shock

Sys BP <90TachycardiaDelayed cap refillCool, mottled skin↑JVDDyspnea, cracklesOliguriaConcentrated urineAMS↓CO/CI <2.2 L/mm/m^2 ↓SV↑PAWP, CVP/RAP, SVRIMetabolic acidosisHypoxemia↑serum lactate >4↓mixed venous O2 Sattryponins CXREKG, Echo>18mmHg

A patient is receiving dopamine, a vasoactive drug used for shock, to increase stroke volume. What should the nurse be aware of when monitoring a vasoactive drug? A) The drug should be discontinued immediately after blood pressure increases. B) The drug dose should be weaned down prior to discontinuing. C) The drug may cause respiratory alkalosis. D) The drug reduces oxygen demands of the heart.

b

The nurse is writing a care plan for a patient with brain metastases. Following a thorough assessment, the nurse decides that an appropriate nursing diagnosis is "Anxiety related to lack of control over the health care needs and situation." In establishing this plan of care for the patient, the nurse will identify what measure as appropriate for the care of this patient? A) The patient will receive antianxiety medications every 4 hours. B) The patient's family will be instructed on measures to implement when providing care for the patient. C) The patient will be encouraged to verbalize concerns related to the disease and its treatment. D) The patient will begin a busy schedule of therapy, so that he will forget about the anxiety.

c