RN Targeted Medical Surgical Neurosensory and Musculoskeletal Online Practice 2019

A nurse is reviewing postoperative instructions with a client following cataract surgery. Which of the following client statements indicates an understanding of the instructions? I should call my doctor if my vision gets worse." "I will take aspirin for eye discomfort." "I can blow my nose to clear out any drainage." "I can lift objects up to 20 pounds."

"I should call my doctor if my vision gets worse."

A nurse is teaching a client who has Parkinson's disease and is prescribed carbidopa-levodopa. Which of the following client statements indicates an understanding of the teaching? "I should expect an increase in my blood pressure while taking this medication." "I should take this medication 2 hours after meals to increase absorption." "I should expect that this medication can cause me to be drowsy." "I should expect this medication to be effective within 48 hours."

"I should expect that this medication can cause me to be drowsy."

A nurse is developing a teaching plan for a client who has Ménière's disease. Which of the following instructions should the nurse include? Move your head slowly to decrease vertigo." "Apply warm packs to the affected ear during acute attacks." "Increase your intake of foods and fluids high in salt." "Take corticosteroids during acute attacks."

"Move your head slowly to decrease vertigo."

A nurse is teaching a client who has osteoporosis and has a new prescription for alendronate. Which of the following information should the nurse include in the teaching? "Take this medication with 8 ounces of milk." "Remain upright for 30 minutes after taking this medication." "Wait 1 hour after taking other medications to take alendronate." "Take vitamin C to promote absorption of this medication."

"Remain upright for 30 minutes after taking this medication." To prevent esophagitis or esophageal ulcers, which can result from alendronate therapy, the client should sit upright for 30 min after taking this medication.

A nurse is teaching a client and her family about the diagnosis and treatment of Alzheimer's disease. Which of the following statements should the nurse identify as an indication that the family understands the teaching? "There is a test for Alzheimer's disease that can establish a reliable diagnosis." "The goal of medication therapy is to reverse the degenerative changes that can occur in brain tissue." "Early manifestations of Alzheimer's disease include mild tremors and muscular rigidity." "The medications that treat Alzheimer's disease can help delay cognitive changes."

"The medications that treat Alzheimer's disease can help delay cognitive changes." -Early manifestations include short-term memory loss, forgetfulness, and a shortened attention span. Mild tremors and muscular rigidity are manifestations of PARKINSON's DISEASE.

A nurse is assessing a client who has rheumatoid arthritis. Which of the following findings should the nurse expect? Unilateral joint involvement Ulnar deviation Fractures of the spine Decreased sedimentation rate

A client who has rheumatoid arthritis can experience inflammation in the hand joints that can make them susceptible to deformity from daily use. Ulnar deviation, or lateral deviation of the fingers, can occur from opening jars and other similar motions. -Rheumatoid arthritis usually occurs bilaterally and symmetrically. Osteoarthritis usually occurs unilaterally. -Compression fractures of the spine are more common in clients who have osteoporosis. A client who has rheumatoid arthritis will have an increased sedimentation rate due to the body's response to the inflammatory connective tissue disorder.

A nurse is caring for a client who has a basilar skull fracture following a fall from a ladder. Which of the following assessment findings should the nurse report to the provider? Glasgow Coma Scale score of 15 Intracranial pressure reading of 15 mm Hg Ecchymosis at base of skull Clear drainage from nose

Clear drainage from the nose indicates that cerebrospinal fluid is leaking from the skull fracture. This places the client at risk for meningeal infection because micro-organisms have access to the cranium through the nose and the tear in the dura. The nurse should report this finding to the provider.

a nurse is teaching a client who has multiple sclerosis and has a new prescription for glatiramer acetate. Which of the following statements indicates that the client understands the teaching? "I will ask my partner to give the injection in the same spot each time." "I will avoid going to the store when it is crowded." "I will see relief of my symptoms in about 1 week." "I will exercise rigorously while taking this medication."

Clients who are prescribed this medication are instructed to avoid crowds and individuals who have infection.

A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? Crepitus with joint movement Decreased range of motion of the affected joint Low-grade fever Spongy tissue over the joints Joint pain that resolves with rest

Osteoarthritis is a degenerative joint disease. Crepitus, a grating sound, is an expected finding with clients who have osteoarthritis as loosened bone and cartilage move around in the fluid inside the joint. Decreased range of motion is an expected finding with clients who have osteoarthritis because the client's pain limits movement. Joint pain that resolves with rest is an expected finding with clients who have osteoarthritis. A client who has osteoarthritis experiences increased pain with activity and decreased pain with rest.

A nurse is teaching an assistive personnel (AP) about providing care to a client following a total hip arthroplasty. Which of the following instructions should the nurse include?

Place an abductor pillow between the client's legs when turning the client

A nurse is planning to teaching a client who has epilepsy and a new prescription for phenytoin. Which of the following instructions should the nurse plan to include?

Take medication at a consistent time each day to maintain therapeutic blood levels -The nurse should teach the client that phenytoin can cause gingival hyperplasia, an overgrowth of gum tissue. To minimize gum injury and discomfort, the client should brush and floss after each meal, massage their gums, and schedule dental examinations regularly. -The nurse should teach the client to stop taking phenytoin if a rash develops and to report the development of a rash to the provider immediately. An adverse effect of phenytoin therapy is the development of a measles-like rash. If left untreated, the rash could progress to Stevens-Johnson syndrome or toxic epidermal necrolysis. -The nurse should teach the client to continue taking antiepileptic medications even in the absence of seizures. Stopping the medication can lead to the return of seizures or the complication of status epilepticus.

A nurse in an emergency department is caring for a client who suddenly lost consciousness and fell while at home. The provider determines that the client had an embolic stroke. Which of the following medications should the nurse expect to adminster? Tissue plasminogen activator Recombinant factor VIII Nitroglycerin Lidocaine

Tissue plasminogen activator is a thrombolytic agent that should dissolve the blood clot that caused the stroke. -Recombinant factor VIII helps manage the manifestations of hemophilia. -Nitroglycerin is a coronary and venous vasodilator that treats angina. -Lidocaine is an antidysrhythmic agent that treats ventricular dysrhythmias.

A nurse is caring for a client who has viral meningitis. Which of the following actions should the nurse take? The nurse should perform a complete vascular assessment at least every 4 hr to monitor for vascular compromise. Assess the client's neurologic status every 8 hr. Initiate droplet precautions. Place the client in a well-lit environment.

check capillary refill at least every 4 hr The nurse should perform a complete vascular assessment at least every 4 hr to monitor for vascular compromise. -The nurse should implement DROPLET PRECAUTION for clients who have BACTERIAL meningitis. Standard precautions are sufficient for clients who have viral meningitis.

A nurse is performing a pain assessment for a client who is postoperative. Which of the following findings should the nurse use to determine the severity of the client's pain? Client's vital sign changes Client's report of the type of pain Client's nonverbal communication Client's report of pain on a pain scale

client's report of pain on a pain scale

A nurse is caring for a client who has a history of status epilepticus and requires seizure precautions. Which of the following actions should the nurse take? Assess hourly for a spike in blood pressure. Keep the client on bed rest. Keep a padded tongue blade at the bedside. Establish IV access.

establish IV access

A nurse in an emergency department is caring for a client who has sustained a fracture of the femur following a motor-vehicle crash. Which of the following images should the nurse recognize as a comminuted fracture?

several pieces

A nurse is caring for a client who has advancing amyotrophic lateral sclerosis. Which of the following interventions is the nurse's priority? Provide frequent rest periods throughout the day. Administer pain medication on a regular schedule. Monitor pulse oximetry findings. Administer baclofen for spasticity.

The greatest risk to the client is respiratory compromise due to progressive paralysis of respiratory muscles. Therefore, the priority intervention is to monitor the client's oxygen saturation to identify respiratory compromise as soon as possible.

A nurse is assessing a client who has a head injury following a motor-vehicle crash. The nurse should identify that which of the following findings indicates increasing intracranial pressure?

Behavioral changes, such as restlessness and irritability, are early manifestations of increased intracranial pressure.

A nurse is caring for a client who is in balanced suspension skeletal traction and reports intermittent muscle spasms. Which of the following actions should the nurse take first? Reposition the client. Check the position of the weights and ropes. Administer a muscle relaxant. Provide distraction.

The first action the nurse should take when using the nursing process is to assess the client. The nurse should first check the position of the weights and ropes to investigate the cause of the muscle spasms. The weights might be too heavy, or the nurse might need to realign the client. -The nurse should reposition the client to realign him and try to relieve his muscle spasms. However, there is another action the nurse should take first. -The nurse should administer a muscle relaxant to minimize the client's muscle spasms. However, there is another action the nurse should take first. The nurse should provide sensory stimulation to help the client keep his focus away from the pain of the spasms. However, there is another action the nurse should take first.

A nurse is planning care for a client following a lumbar puncture. Which of the following actions should the nurse plan to take? Apply a pressure dressing to the site for 8 hr. Restrict the client's fluid intake for 24 hr. Ensure that the client lies flat for up to 12 hr. Inform the client that neck stiffness is an expected outcome of the procedure.

The client should lie flat for up to 12 hr to prevent cerebrospinal fluid leakage from the puncture site, which can cause a headache. -The nurse should apply pressure to the site and then apply an adhesive bandage, not a pressure dressing. -The client should increase fluid intake to replace the cerebrospinal fluid the provider removed during the procedure. -The nurse should instruct the client to report complications of a lumber puncture such as voiding difficulties, fever, stiffness of the back or neck, nausea, and vomiting.

A nurse in an emergency department is assessing a client who reports sudden, severe eye pain with blurry vision. The provider determines that the client has primary angle-closure glaucoma. Which of the following medications should the nurse expect to administer? Osmotic diuretics via IV bolus Mydriatic ophthalmic drops Corticosteroid ophthalmic drops Epinephrine via IV bolus

The nurse should expect to administer prescribed osmotic diuretics, such as mannitol, to reduce intraocular pressure and prevent damage to the eye.

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? Hypoactive deep-tendon reflexes Ascending paralysis Intention tremors Increased lacrimation

Clients who have multiple sclerosis are at risk for motor dysfunction, with intention tremors, poor coordination, and loss of balance.

A nurse is planning care for a client who has. closed traumatic brain injury from a fall and is receiving mechanical ventilation. Which of the following interventions is the nurses priority? Maintain a PaCO2 of approximately 35 mm Hg. Provide small doses of fentanyl via IV bolus for pain management. Measure body temperature every 1 to 2 hr. Reposition the client every 2 hr.

The greatest risk to this client is injury from increased intracranial pressure. Therefore, the nurse's priority intervention is to maintain the PaCO2 at 35 to 38 mm Hg to prevent hypercarbia and subsequent vasodilation that can lead to an increase in intracranial pressure. -The nurse should administer opiate pain medications to reduce agitation and restlessness during mechanical ventilation and to manage pain. Fentanyl does not affect vital signs as much as morphine does, so it is a safer choice for this client. However, this is not the nurse's priority intervention. -The nurse should monitor the client's body temperature because clients who have head injuries commonly develop a fever due to the body's response to the trauma or hypothalamic damage. However, this is not the nurse's priority intervention. - The nurse should reposition the client at least every 2 hr to help prevent skin breakdown. However, this is not the nurse's priority intervention.

A nurse is caring for a client who has a retinal detachment. Which of the following findings should the nurse expect? Photophobia Complete vision loss Flashes of bright light Cloudiness of the lens

The nurse should expect a client who has a retinal detachment to see flashes of bright light or floating dark spots in the affected eye as the retinal layers separate. -The nurse should expect photophobia in a client who has a migraine headache. -The nurse should expect a client who has a retinal detachment to have some visual field loss in the area of the detachment, but complete vision loss is not an expected finding. The nurse should expect a client who has cataracts to experience cloudiness of the lens.

A nurse is assessing a client who had a right hemispheric stroke. Which of the following neurologic deficits should the nurse expect? Aphasia Right-sided neglect Impulsive behavior Inability to read

The nurse should expect clients who had a right hemispheric stroke to demonstrate impulsive behavior, poor judgment, and lack of awareness of neurologic deficits. -Clients who had a left hemispheric stroke are likely to have aphasia. -Clients who had a right hemispheric stroke are likely to have neurologic deficits on the left side of the body, not the right side. The nurse should expect the client to be unaware of and unable to move the left side of the body. -Clients who had a left hemispheric stroke are likely to have difficulty reading due to the inability to discriminate different letters and words.

A nurse is teaching a client who is postoperative following a right hip arthroplasty. Which of the following images indicates the position the nurse should teach the client to take when sitting in a chair?

The nurse should instruct the client to sit with the hips at a 90° angle with the knees slightly lower than the hips to avoid hip dislocation. feet flat on the floor

A nurse a caring for a client who is 72 hr postoperative following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? Remind the client that the surgery removed the limb. Change the dressing on the client's residual limb. Request a prescription for gabapentin for the client. Elevate the client's residual limb above heart level.

The nurse should request a prescription for a nonopioid medication to help minimize phantom limb pain. Gabapentin is an oral antiepileptic medication that is effective for treating sharp, burning, phantom limb pain.

a nurse is caring for a client who has a spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition? Encourage the client to use the Valsalva maneuver. Stroke the client's inner thigh. Perform the Credé maneuver. Administer a diuretic.

The nurse should stimulate micturition by stroking the client's inner thigh. Other techniques include pinching the skin above the groin and providing digital anal stimulation. -The nurse should apply direct pressure over the client's bladder, also known as the Credé maneuver, to express urine from a flaccid bladder. It is not effective for clients who have a spastic bladder due to the spasticity of the external sphincter. -The nurse should encourage the client to hold their breath and bear down, also known as the Valsalva maneuver, to express urine from a flaccid bladder. It is not effective for clients who have a spastic bladder due to the spasticity of the external sphincter. -Antispasmodics such as oxybutynin, rather than diuretics, can be effective for treating mild spastic bladder problems.

A nurse is assessing a client who is quadriplegic following a cervical fracture at vertebral level C5. The client reports a throbbing headache and nausea. The nurse notes facial flushing and a blood pressure of 220/110 mmHg. Which of the following actions should the nurse take first? Administer hydralazine via IV bolus. Loosen the client's clothing. Empty the client's bladder. Elevate the head of the client's bed.

These assessment findings indicate that the client is experiencing autonomic dysreflexia and is at greatest risk for possible rupture of a cerebral vessel or increased intracranial pressure. The first action the nurse should take is to move the client from a supine to an upright position, which will result in rapid postural hypotension. -The nurse should administer hydralazine, a potent vasodilator, to lower the client's blood pressure. However, there is another action the nurse should take first. -The nurse should loosen the client's clothing because body temperature and tactile stimulation are triggers of autonomic dysreflexia. However, there is another action the nurse should take first. -The nurse should empty the client's bladder because a full bladder or a fecal impaction is a trigger of autonomic dysreflexia. However, there is another action the nurse should take first.

A nurse is caring for a client who is recovering from a stroke and has right-sided homonymous hemianopsia. To help the client adapt to the hemianopsia, the nurse should take which of the following actions? Check the client's cheek on the affected side after meals to be sure no food remains there. Encourage the client to sit upright with their head tilted slightly forward during meals. Provide the client with eating utensils that have large handles. Remind the client to look consciously at both sides of their meal tray.

remind the client to look consciously at both sides of their meal tray -Homonymous hemianopsia does not cause the client to pocket food. However, food can accumulate on the affected side of the mouth, so the nurse should place food on the unaffected side of the client's mouth when assisting with eating. -Homonymous hemianopsia does not cause dysphagia. However, as stroke can cause dysphagia, positioning the client upright and having them tilt their head forward to swallow can help prevent aspiration. -Homonymous hemianopsia does not impair the client's fine motor skills. However, as stroke can impair fine motor skills, eating utensils that have a wide grip surface can help compensate for a weak hand grasp.