Bridge to NCLEX: neuro, musculoskeletal

For a 65 y/o woman who has lived with a T1 spinal cord injury for 20 years, which health teaching instructions should the nurse emphasize? A. a mammogram is needed every year B. Bladder function tends to improve with age C. Heart disease is not common in persons with spinal cord injury D. As a person ages, the need to change body position is less important.

A

Which condition is transmitted through wound contamination, causes painful tonic spasms or seizures, and can be prevented by immunization? A. tetanus B. botulism C. neurosyphilis D. systemic inflammatory response syndrome

A Tetanus

How is urinary function maintained during the acute phase of spinal cord injury? A. an indwelling catheter B. intermittent catheterization C. insertion of a suprapubic catheter D. use of incontinent pads to protect the skin

A during the acute phase of spinal cord injury, the bladder is hypotonic, causing urinary retention with the risk for reflux into the kidney or rupture of the bladder. An indwelling catheter is used to keep the bladder empty and to monitor urinary output.

Which syndrome of incomplete spinal cord lesion is described as cord damage common in the cervical region resulting in greater weakness in upper extremities than lower? A. central cord syndrome B. anterior cord syndrome C. Posterior cord syndrome D. Cauda equine and conus medullaris syndromes

A in central cord syndrome, motor weakness and sensory loss are present in both upper and lower extremities, with upper extremities affected more than lower extremities

A patient is admitted to the hospital with guillain-barre syndrome. She had weakness in her feet and ankles that has progressed to weakness with numbness and tingling in both legs. During the acute phase of the illness, what should the nurse know about guillain barre syndrome? A. the most important aspect of care is to monitor the patient's respiratory rate and depth and vital capacity. B. Early treatment with corticosteroids can suppress the immune response and prevent ascending nerve damage. C. the most serious complication of this condition is ascending demyelination of the peripheral nerves and the cranial nerves D. although voluntary motor neurons are damaged by the inflammatory response, the autonomic nervous system is unaffected by the disease.

A the most serious complication of GB syndrome is respiratory failure and it is essential that respiratory rate and depth and vital capacity are monitored to detect involvement of the autonomic nerves that affect respiration.

during the patient's process of grieving for the losses resulting from spinal cord injury, what should the nurse do? A. help the patient to understand that working through the grief will be a lifelong process. B. assist the patient to move through all stages of the mourning process to acceptance C. let the patient know that anger directed at the staff or the family is not a positive coping mechanism D. facilitate the grieving process so that is it completed by the time the patient is discharged from rehabilitation

A working through the grief process is a lifelong process that is triggered by new experiences, such as marriage, child rearing, employment, or illness, which the patient must adjust to throughout life within the context of her or her disability.

Surgical intervention is being considered for a patient with trigeminal neuralgia. The nurse recognizes that which procedure has the least residual effects with a positive outcome? A. Glycerol rhizotomy B. Gamma knife radiosurgery C. Microvascular decompression D. Percutaneous radiofrequency rhizotomy

A D and C provide the greatest relief of pain but glycerol rhizotomy causes less sensory loss and fewer sensory aberrations with comparable pain relief and less danger

Pre-test practice questions: Although he has been told that ginkgo biloba will probably have no effect, a 58-year-old man with early stage Alzheimer's disease insists on taking the herb because he believes it will slow the disease progression. Which statement, if made by the patient to the nurse, indicates understanding about the side effects of ginkgo? A) "Ginkgo may increase the risk of bruising." B) "Ginkgo may cause leg pain while walking." C) "It is not safe to suddenly stop taking ginkgo." D) "Ringing in the ears is a side effect of ginkgo."

A) "Ginkgo may increase the risk of bruising." Rationale: Ginkgo biloba may increase the risk for bruising and bleeding. There are no indications that sudden withdrawal of ginkgo biloba is unsafe. Ginkgo biloba is possibly effective for treating intermittent claudication (leg pain while walking). There is insufficient evidence to indicate that ginkgo biloba is effective in treatment of tinnitus (ringing in the ears).

NCLEX review questions: Which statement by the wife of a patient with Alzheimer's disease (AD) demonstrates an accurate understanding of her husband's medication regimen? A) "I'm really hoping his medications will slow down his mental losses." B) "We're both holding out hope that this medication will cure his disease." C) "I know that this won't cure him, but we learned that it might prevent a bodily decline while he declines mentally." D) "I learned that if we are vigilant about his medication schedule, he may not experience the physical effects of his disease."

A) "I'm really hoping his medications will slow down his mental losses." Rationale: There is presently no cure for Alzheimer's disease, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.

NCLEX review questions: For which patient should the nurse prioritize an assessment for depression? A) A patient in the early stages of Alzheimer's disease B) A patient who is in the final stages of Alzheimer's disease C) A patient experiencing delirium secondary to dehydration D) A patient who has become delirious following an atypical drug response

A) A patient in the early stages of Alzheimer's disease Rationale: Patients in the early stages of Alzheimer's disease are particularly susceptible to depression, since the patient is acutely aware of his or her cognitive changes and the expected disease trajectory. Delirium is typically a shorter-term health problem that does not typically pose a heightened risk of depression.

NCLEX review questions: The nurse who has administered a dose of risperidone (Risperdal) to a patient with delirium should assess for what intended effect of the medication? A) Lying quietly in bed B) Alleviation of depression C) Reduction in blood pressure D) Disappearance of confusion

A) Lying quietly in bed Rationale: Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution. Antidepressant medications treat depression, and antihypertensive medications treat hypertension. However, there are no medications that will cause confusion to disappear in a patient with delirium.

Pre-test practice questions: A 78-year-old woman is in the intensive care unit after emergency abdominal surgery. The nurse notes that the patient is disoriented and confused, has incoherent speech, and is restless and agitated. Which action by the nurse is most appropriate? A) Reorient the patient. B) Notify the physician. C) Document the findings. D) Administer lorazepam (Ativan).

A) Reorient the patient. Rationale: The patient is exhibiting clinical manifestations of delirium. Care of the patient with delirium is focused on eliminating precipitating factors and protecting the patient from harm. Give priority to creating a calm and safe environment. The nurse should stay at the bedside and provide reassurance and reorienting information as to place, time, and procedures. The nurse should reduce environmental stimuli, including noise and light levels. Avoid the use of chemical and physical restraints if possible.

NCLEX review questions: The patient is having some increased memory and language problems. What diagnostic tests will be done before this patient is diagnosed with Alzheimer's disease (select all that apply)? A) Urinalysis B) MRI of the head C) Liver function tests D) Neuropsychologic testing E) Blood urea nitrogen and serum creatinine

A) Urinalysis B) MRI of the head C) Liver function tests D) Neuropsychologic testing E) Blood urea nitrogen and serum creatinine Rationale: Because there is no definitive diagnostic test for Alzheimer's disease, and many conditions can cause manifestations of dementia, testing must be done to eliminate any other causes of cognitive impairment. These include urinalysis to eliminate a urinary tract infection, an MRI to eliminate brain tumors, liver function tests to eliminate encephalopathy, BUN and serum creatinine to rule out renal dysfunction, and neuropsychologic testing to assess cognitive function.

Which statements describe neurosyphilis (select all that apply)? A. occurs 10-20 years after bacterial infection B. infection can affect any part of the nervous syst4em C. descending paralysis with cranial nerve involvement D. degenerative changes in the spinal cord and brainstem E. Inhibits transmission of acetylcholine at myoneural junction F. initially manifests with GI symptoms with subsequent absorption of neurotoxin

A, B, D

During assessment of the patient with trigeminal neuralgia, the nurse should (select all that apply)? A. inspect all aspects of the mouth and teeth. B. assess the gag reflex and respiratory rate and depth C. lightly palpate the affected side of the face for edema D. test for temperature and sensation perception on the face E. ask the patient to describe factors that initiate an episode

A, D, E

A patient is diagnosed with Bell's Palsy. What information should the nurse teach the patient about Bell's Palsy (select all that apply)? A. Bell's Palsy affects the motor branches of the facial nerve. B. Antiseizure drugs are the drug of choice for treatment of Bell's Palsy. C. Nutrition and avoidance of hot foods or beverages are special needs of this patient. D. Herpes simplex 1 is strongly associated as a precipitating factor in the development of Bell's Palsy. E. Moist heat, gentle massage, electrical stimulation of the nerve, and exercises are prescribed to treat Bell's palsy. F. An inability to close the eyelid, with an upward movement of the eyeball when closure is attempted is evident.

A, D, E, F Bells palsy affects the motor branches of the facial nerve. it is treated with corticosteroids, usually prednisone.

The patient was in a traffic collision and is experiencing loss of function below C4. Which effect must the nurse be aware of to provide priority care for the patient? A. respiratory diaphragmatic breathing B. loss of all respiratory muscle function C. Decreased response of the sympathetic nervous system D. GI hypomotility with paralytic ileus and gastric distention

A. spinal injury below C4 will result in diaphragmatic breathing and usually hypoventilation from decreased vital capacity and tidal volume from intercostal muscle impairment. The nurse's priority actions will be to monitor rate, rhythm, depth, and effort of breathing to observe for changes from baseline and identify the need for ventilation assistance.

A patient is admitted to the ED with a possible cervical spinal cord injury following an automobile crash. During admission of the patient, what is the highest priority for the nurse? A. maintaining a patent airway B. maintaining immobilization of the cervical spine C. assessing the patient for head and other injuries D. assessing the patient's motor and sensory function

A. the need for a patent airway is the first priority for any injured patient and a high cervical injury may decrease the gag reflex and the ability to maintain an airway as well as the ability to breathe.

When planning care for the patient with trigeminal neuralgia, which patient outcome should the nurse set as the highest priority? A. Relief of pain B. Protection of the cornea C. Maintenance of nutrition D. Maintenance of positive body image

A. trigeminal pain is excruciating and may come in clusters. there is no other concern other than pain control

When assessing a patient with a traumatic brain injury, the nurse notes uncoordinated movement of the extremities. The nurse would document this as A. Ataxia. B. Apraxia. C. Anisocoria. D. Anosognosia.

A. Ataxia.

A patient is suspected of having a cranial tumor. The signs and symptoms include memory deficits, visual disturbances, weakness of right upper and lower extremities, and personality changes. The nurse recognizes that the tumor is most likely located in the a. frontal lobe b. parietal lobe c. occipital lobe d. temporal lobe

A. Frontal lobe

A patient who has a neurologic disease that affects the pyramidal tract is likely to manifest which of the following signs? A. Impaired muscle movement B. Decreased deep tendon reflexes C. Decreased level of consciousness D. Impaired sensation of touch, pain, and temperature

A. Impaired muscle movement

During admission of a patient with a severe head injury to the ED, the nurse places highest priority on assessment for a. patency of of airway b. presence of a neck injury c. neurologic status with Glascow Coma Scale d. CSF leakage from ears and nose

A. Patency of airway is the #1 priority with all head injuries

18. The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding a. relief of joint pain. b. increased urine output. c. elevated serum uric acid. d. increased white blood cells (WBC).

ANS: A Colchicine produces pain relief in 24 to 48 hours by decreasing inflammation. The recommended increase in fluid intake of 2 to 3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC count might decrease with decreased inflammation, but would not increase.

1. Which finding will the nurse expect when assessing a 58-year-old patient who has osteoarthritis (OA) of the knee? a. Discomfort with joint movement b. Heberden's and Bouchard's nodes c. Redness and swelling of the knee joint d. Stiffness that increases with movement

ANS: A Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA). Stiffness in OA is worse right after the patient rests and decreases with joint movement.

33. Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication? a. Blurred vision b. Joint tenderness c. Abdominal cramping d. Elevated blood pressure

ANS: A Plaquenil can cause retinopathy. The medication should be stopped. The other findings are not related to the medication although they will also be reported.

11. The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with a. a warm bath followed by a short rest. b. a short routine of isometric exercises. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness.

ANS: A Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day, when joint stiffness is decreased.

13. A 37-year-old patient with 2 school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that home life is very stressful. Which response by the nurse is most appropriate? a. "Tell me more about situations that are causing you stress." b. "You need to see a family therapist for some help with stress." c. "Your family should understand the impact of your rheumatoid arthritis." d. "Perhaps it would be helpful for your family to be involved in a support group."

ANS: A The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.

6. Which action will the nurse include in the plan of care for a 33-year-old patient with a new diagnosis of rheumatoid arthritis? a. Instruct the patient to purchase a soft mattress. b. Suggest that the patient take a nap in the afternoon. c. Teach the patient to use lukewarm water when bathing. d. Suggest exercise with light weights several times daily.

ANS: B Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid arthritis. Patients are taught to avoid stressing joints, to use warm baths to relieve stiffness, and to use a firm mattress. When stabilized, a therapeutic exercise program is usually developed by a physical therapist to include exercises that improve the flexibility and strength of the affected joints, and the patient's overall endurance.

8. Which information will the nurse include when preparing teaching materials for patients with exacerbations of rheumatoid arthritis? a. Affected joints should not be exercised when pain is present. b. Application of cold packs before exercise may decrease joint pain. c. Exercises should be performed passively by someone other than the patient. d. Walking may substitute for range-of-motion (ROM) exercises on some days.

ANS: B Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints and improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.

29. Which assessment information obtained by the nurse indicates that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone (Deltasone)? a. The patient has joint pain and stiffness. b. The patient's blood glucose is 165 mg/dL. c. The patient has experienced a recent 5-pound weight loss. d. The patient's erythrocyte sedimentation rate (ESR) has increased.

ANS: B Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this side effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication.

2. Which assessment finding about a patient who has been using naproxen (Naprosyn) for 6 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider? a. The patient has gained 3 pounds. b. The patient has dark-colored stools. c. The patient's pain has become more severe. d. The patient is using capsaicin cream (Zostrix).

ANS: B Dark-colored stools may indicate that the patient is experiencing gastrointestinal bleeding caused by the naproxen. The information about the patient's ongoing pain and weight gain also will be reported and may indicate a need for a different treatment and/or counseling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.

41. After the nurse has taught a 28-year-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management? a. "I am going to join a soccer team to get more exercise." b. "I will need to stop drinking so much coffee and soda." c. "I will call the doctor every time my symptoms get worse." d. "I should avoid using over-the-counter medications for pain."

ANS: B Dietitians frequently suggest that patients with fibromyalgia limit their intake of caffeine and sugar because these substances are muscle irritants. Mild exercise such as walking is recommended for patients with fibromyalgia, but vigorous exercise is likely to make symptoms worse. Because symptoms may fluctuate from day to day, the patient should be able to adapt the regimen independently, rather than calling the provider whenever symptoms get worse. Over-the-counter medications such as ibuprofen and acetaminophen are frequently used for symptom management.

19. A patient with gout has a new prescription for losartan (Cozaar) to control the condition. The nurse will plan to monitor a. blood glucose. b. blood pressure. c. erythrocyte count. d. lymphocyte count.

ANS: B Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell (RBC) count, or lymphocytes.

34. A 31-year-old woman is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider about the methotrexate? a. The patient had a history of infectious mononucleosis as a teenager. b. The patient is trying to get pregnant before her disease becomes more severe. c. The patient has a family history of age-related macular degeneration of the retina. d. The patient has been using large doses of vitamins and health foods to treat the RA.

ANS: B Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy.

3. After the nurse has finished teaching a 68-year-old patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching? a. "I can take glucosamine to help decrease my knee pain." b. "I will take 1 g of acetaminophen (Tylenol) every 4 hours." c. "I will take a shower in the morning to help relieve stiffness." d. "I can use a cane to decrease the pressure and pain in my hip."

ANS: B No more than 4 g of acetaminophen should be taken daily to avoid liver damage. The other patient statements are correct and indicate good understanding of OA management.

7. A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is most appropriate? a. Teach the patient about adverse effects of the RA medications. b. Suggest that the patient use over-the-counter (OTC) artificial tears. c. Reassure the patient that dry eyes are a common problem with RA. d. Ask the health care provider about discontinuing methotrexate (Rheumatrex) .

ANS: B The patient's dry eyes are consistent with Sjögren's syndrome, a common extraarticular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes are not a side effect of methotrexate. Although dry eyes are common in RA, it is more helpful to offer a suggestion to relieve these symptoms than to offer reassurance. The dry eyes are not caused by RA treatment, but by the disease itself.

42. Which information will the nurse include when teaching a patient with newly diagnosed chronic fatigue syndrome about self-management? a. Avoid use of over-the-counter antihistamines or decongestants. b. A low-residue, low-fiber diet will reduce any abdominal distention. c. A gradual increase in your daily exercise may help decrease fatigue. d. Chronic fatigue syndrome usually progresses as patients become older.

ANS: C A graduated exercise program is recommended to avoid fatigue while encouraging ongoing activity. Because many patients with chronic fatigue syndrome have allergies, antihistamines and decongestants are used to treat allergy symptoms. A high-fiber diet is recommended. Chronic fatigue syndrome usually does not progress.

12. Anakinra (Kineret) is prescribed for a 49-year-old patient who has rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about a. avoiding concurrently taking aspirin. b. symptoms of gastrointestinal (GI) bleeding. c. self-administration of subcutaneous injections. d. taking the medication with at least 8 oz of fluid.

ANS: C Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected, instructions to take it with 8 oz of fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or nonsteroidal antiinflammatory drugs (NSAIDs), and these should not be discontinued.

31. A patient with an acute attack of gout in the right great toe has a new prescription for probenecid (Benemid). Which information about the patient's home routine indicates a need for teaching regarding gout management? a. The patient sleeps about 8 to 10 hours every night. b. The patient usually eats beef once or twice a week. c. The patient takes one aspirin a day to prevent angina. d. The patient usually drinks about 3 quarts water daily.

ANS: C Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.

24. The nurse is planning care for a patient with hypertension and gout who has a red and painful right great toe. Which nursing action will be included in the plan of care? a. Gently palpate the toe to assess swelling. b. Use pillows to keep the right foot elevated. c. Use a footboard to hold bedding away from the toe. d. Teach patient to avoid use of acetaminophen (Tylenol).

ANS: C Because any touch on the area of inflammation may increase pain, bedding should be held away from the toe and touching the toe will be avoided. Elevation of the foot will not reduce the pain, which is caused by urate crystals. Acetaminophen can be used for pain relief.

35. Which laboratory data is important to communicate to the health care provider for a patient who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis? a. The blood glucose is 90 mg/dL. b. The rheumatoid factor is positive. c. The white blood cell (WBC) count is 1500/µL. d. The erythrocyte sedimentation rate is elevated.

ANS: C Bone marrow suppression is a possible side effect of methotrexate, and the patient's low WBC count places the patient at high risk for infection. The elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in rheumatoid arthritis. The blood glucose is normal.

9. Which laboratory result will the nurse monitor to determine whether prednisone (Deltasone) has been effective for a 30-year-old patient with an acute exacerbation of rheumatoid arthritis? a. Blood glucose test b. Liver function tests c. C-reactive protein level d. Serum electrolyte levels

ANS: C C-reactive protein is a marker for inflammation, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels will also be monitored to check for side effects of prednisone. Liver function is not routinely monitored in patients receiving corticosteroids.

4. The nurse will anticipate the need to teach a 57-year-old patient who has osteoarthritis (OA) about which medication? a. Adalimumab (Humira) b. Prednisone (Deltasone) c. Capsaicin cream (Zostrix) d. Sulfasalazine (Azulfidine)

ANS: C Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with RA.

28. When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate (Rheumatrex). The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is a. "You have the right to refuse to take the methotrexate." b. "Methotrexate is less expensive than some of the newer drugs." c. "It is important to start methotrexate early to decrease the extent of joint damage." d. "Methotrexate is effective and has fewer side effects than some of the other drugs."

ANS: C Disease-modifying antirheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.

39. Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)? a. A 38-year-old man who plays on a summer softball team b. A 56-year-old man who is a member of a construction crew c. A 56-year-old woman who works on an automotive assembly line d. A 49-year-old woman who is newly diagnosed with diabetes mellitus

ANS: C OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a construction crew would involve nonrepetitive work and thus would not be as risky.

5. A patient with rheumatoid arthritis being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? a. Draw blood for rheumatoid factor analysis. b. Teach the patient about injections for the nodules. c. Assess the nodules for skin breakdown or infection. d. Discuss the need for surgical removal of the nodules.

ANS: C Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor, and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence.

20. A 71-year-old patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of a. sertraline (Zoloft). b. famotidine (Pepcid). c. oxycodone (Roxicodone). d. hydrochlorothiazide (HydroDIURIL).

ANS: D Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer

43. After the nurse assesses a 78-year-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management, which information is most important to report to the health care provider? a. Knee crepitation is noted with normal knee range of motion. b. Patient reports embarrassment about having Heberden's nodes. c. Patient's knee pain while golfing has increased over the last year. d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

ANS: D Older patients are at increased risk for renal toxicity caused by nonsteroidal antiinflammatory drugs (NSAIDs) such as naproxen. The other information will also be reported to the health care provider but is consistent with the patient's diagnosis of osteoarthritis and will not require an immediate change in the patient's treatment plan.

10. The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests that they a. stand rather than sit when performing household and yard chores. b. strengthen small hand muscles by wringing sponges or washcloths. c. protect the knee joints by sleeping with a small pillow under the knees. d. avoid activities that require repetitive use of the same muscles and joints.

ANS: D Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase the joint stress. Patients are encouraged to position joints in the extended position, and sleeping with a pillow behind the knees would decrease

30. The home health nurse is doing a follow-up visit to a 41-year-old patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed? a. The patient takes a 2-hour nap each day. b. The patient has been taking 16 aspirins daily. c. The patient sits on a stool while preparing meals. d. The patient sleeps with two pillows under the head.

ANS: D The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective.

The most common early symptom of a spinal cord tumor is A. urinary incontinence. B. back pain that worsens with activity C. paralysis below the level of involvement D. impaired sensation of pain, temperature, and light touch

B

A 70 year old patient is admitted after falling from his roof. He has a spinal cord injury at the C7 level. What findings during the assessment identify the presence of spinal shock? A. paraplegia with a flaccid paralysis B. tetraplegia with total sensory loss C. total hemiplegia with sensory and motor loss D. spastic tetraplegia with loss of pressure sensation

B at the C7 level, spinal shock is manifested by tetraplegia and sensory loss. this may be temporary or permanent

The patient is diagnosed with Brown Sequard syndrome after a knife wound to the spine. Which description accurately describes this syndrome? A. damage to the most distal cord and nerve roots, resulting in flaccid paralysis of the lower limbs and are flexic bowel and bladder B. Spinal cord damage resulting in ipsilateral motor paralysis and contralateral loss of pain and sensation below the level of the lesion C. Rare cord damage resulting in loss of proprioception below the lesion level with retention of motor control and temperature and pain sensation D. often caused by flexion injury with acute compression of cord resulting in complete motor paralysis and loss of pain an temperature sensation below the level of injury.

B characterized by ipsilateral loss of motor function and position and vibratory sense and vasomotor paralysis with contralateral loss of pain and temperature sensation below the level of the injury.

A patient with paraplegia has developed an irritable bladder with reflex emptying. what will be most helpful for the nurse to teach the patient? A. hygiene care for an indweilling urinary catheter B. how to perform intermittent self cath C. to empty the bladder with manual pelvic pressure in coordination with reflex voiding patterns D. that a urinary diversion, such as an ileal conduit, is the easiest way to handle urinary elimination

B intermittent self cath 5-6 times a day is the recommended method of bladder management for the patient with a spinal cord injury and reflexic neurogenic bladder because it more closely mimics normal emptying and has less potential for infection. the patient and family should be taught the procedure using clean technique and if the patient has use of the arms, self cath should be performed.

A patient with a metastatic tumor of the spinal cord is scheduled for removal of the tumor by a laminectomy. In planning postoperative care for the patient, what should the nurse recognize? A. most cord tumors cause auto destruction of the cord as in traumatic injuries. B. metastatic tumors are commonly extradural lesions that are treated palliatively C. radiation therapy is routinely administered following surgery for all malignant spinal cord tumors. D. because complete removal of intradeullary tumors is not possible, the surgery is considered palliative

B most metastatic or secondary tumors are extradural lesions in which treatment, including surgery is palliative.

A patient is admitted to the emergency department with a spinal cord injury at the level of T2. Which finding is of most concern to the nurse? A. SpO2 of 92% B. Heart rate of 42 bpm C. Blood pressure of 88/60 mmHg D. loss of motor and sensory function in arms and legs

B neurogenic shock associated with cord injuries above the level of T6 greatly decreases the effect of the sympathetic nervous system and bradycardia and hypotension occur. A heart rate of 42 is not adequate to meet the oxygen needs of the body.

Two days following a spinal cord injury, a patient asks continually about the extent of impairment that will result from the injury. What is the best response by the nurse? A. "You will have more normal function when spinal shock resolves and the reflex arc returns" B. "the extent of your injury cannot be determined until the secondary injury to the cord is resolved." C. "when your condition is more stable, MRI will be done to reveal the extent of the cord damage." D. Because long term rehab can affect the return of function, it will be years before we can tell what the complete effect will be.

B until the edema and necrosis at the site of injury are resolved in 72 hours to 1 week after the injury, it is not possible to determine how much cord damage is present from the initial injury, how much secondary injury occurred, or how much the cord was damaged by edema that extended above the level of the original injury.

a week following a spinal cord injury at T2 , a patient experiences movement in his leg and tells the nurse that he is recovering some function. What is the nurse's best response to a the patient? A. "it is really still too soon to know if you will have a return of function." B. "That could be a really positive finding. Can you show me the movement?" C. "That's wonderful. We will start exercising your legs more frequently now." D. I'm sorry but the movement is only a reflex and does not indicate normal function."

B when spinal shock ends, reflex movement and spasms will occur, which may be3 mistaken for return of function, however, with the resolution of edema, some normal function may also occur. it is important when movement occurs to determine whether the movement is voluntary and can be consciously controlled, which would indicate some return

NCLEX review questions: A 59-year-old female patient, who has frontotemporal lobar degeneration, has difficulty with verbal expression. One day she walks out of the house and goes to the gas station to get a soda but does not understand that she needs to pay for it. What is the best thing the nurse can suggest to this patient's husband to keep the patient safe during the day while the husband is at work? A) Assisted living B) Adult day care C) Advance directives D) Monitor for behavioral changes

B) Adult day care Rationale: To keep this patient safe during the day while the husband is at work, an adult day care facility would be the best choice. This patient would not need assisted living. Advance directives are important but are not related to her safety. Monitoring for behavioral changes will not keep her safe during the day.

NCLEX review questions: When providing community health care teaching regarding the early warning signs of Alzheimer's disease, which signs should the nurse advise family members to report (select all that apply)? A) Misplacing car keys B) Losing sense of time C) Difficulty performing familiar tasks D) Problems with performing basic calculations E) Becoming lost in a usually familiar environment

B) Losing sense of time C) Difficulty performing familiar tasks D) Problems with performing basic calculations E) Becoming lost in a usually familiar environment Rationale: Difficulty performing familiar tasks, problems with performing basic calculations, losing sense of time, and becoming lost in a usually familiar environment are all part of the early warning signs of Alzheimer's disease. Misplacing car keys is a normal frustrating event for many people.

Pre-test practice questions: The nurse in the long-term care facility cares for a 70-year-old man with severe (late-stage) dementia who is undernourished and has problems chewing and swallowing. What should the nurse include in the plan of care for this patient? A) Turn on the television to provide a distraction during meals. B) Provide thickened fluids and moist foods in bite-size pieces. C) Limit fluid intake during scheduled meals to prevent aspiration. D) Allow the patient to select favorite foods from the menu choices.

B) Provide thickened fluids and moist foods in bite-size pieces. Rationale: If patients with dementia have problems chewing or swallowing, pureed foods, thickened liquids, and nutritional supplements should be provided. Foods that are easy to swallow are moist and should be in bite-size pieces. Distractions at mealtimes, including the television, should be avoided. Fluids should not be limited but offered frequently; fluids should be thickened. Patients with severe (late-stage) dementia have difficulty understanding words and would not have the cognitive ability to select menu choices.

NCLEX review questions: The patient has been diagnosed with the mild cognitive impairment stage of Alzheimer's disease. What nursing interventions should the nurse expect to use with this patient? A) Treat disruptive behavior with antipsychotic drugs. B) Use a calendar and family pictures as memory aids. C) Use a writing board to communicate with the patient. D) Use a wander guard mechanism to keep the patient in the area.

B) Use a calendar and family pictures as memory aids. Rationale: The patient with mild cognitive impairment will have problems with memory, language, or another essential cognitive function that is severe enough to be noticeable to others but does not interfere with activities of daily living. A calendar and family pictures for memory aids will help this patient. This patient should not yet have disruptive behavior or get lost easily. Using a writing board will not help this patient with communication.

Goals of rehabilitation for the patient with an injury at the C6 level include (select all that apply) A. stand erect with leg brace. B. feed self with had devices C. assist with transfer activities D. drive adapted van from wheelchair E. push a wheelchair on a flat surface.

B, C, D, E

Vasogenic cerebral edema increases ICP by a. shifting fluid in gray matter b. altering the endothelial lining of cerebral capillaries c. leaking molecules from the intracellular fluid to the capillaries d. altering the osmotic gradient flow inot the intravascular component

B. Altering the endothelial lining of cerebral capillaries

How should the nurse most accurately assess the position sense of a patient with a recent traumatic brain injury? A. Ask the patient to close his or her eyes and slowly bring the tips of the index fingers together. B. Ask the patient to maintain balance while standing with his or her feet together and eyes closed. C. Ask the patient to close his or her eyes and identify the presence of a common object on the forearm. D. Place the two points of a calibrated compass on the tips of the fingers and toes and ask the patient to discriminate the points.

B. Ask the patient to maintain balance while standing with his or her feet together and eyes closed.

When assessing the accessory nerve, the nurse would A. Assess the gag reflex by stroking the posterior pharynx. B. Ask the patient to shrug the shoulders against resistance. C. Ask the patient to push the tongue to either side against resistance. D. Have the patient say "ah" while visualizing elevation of soft palate.

B. Ask the patient to shrug the shoulders against resistance.

A nursing measure that is indicated to reduce the potential for seizures and increased ICP in the patient with bacterial meningitis is a. administering codeine for relief of head and neck pain b. controlling fever with prescribed drugs and cooling techniques c. keeping the room darkened and quiet to minimize environmental stimulation d. maintaining the patient on strict bed rest with the HOB slightly elevated

B. Controlling fever with prescribed drugs and cooling techniques

The nurse recognizes the presence of Cushing's triad in the patient with a. Increased pulse, irregular respiration, increased BP b. decreased pulse, irregular respiration, increased pulse pressure c. increased pulse, decreased respiration, increased pulse pressure d. decreased pulse, increased respiration, decreased systolic BP

B. Cushing's triad consists of three vital sign measures that reflect ICP and its effect on the medulla, the hypothalamus, the pons, and the thalamus. Because these structures are very deep, Cushing's triad is usually a late sign of ICP. The signs include an increasing systolic BP with a widening pulse pressure, a bradycardia with a full and bounding pulse, and irregular respirations.

The nurse plans care for a patient with increased ICP with the knowledge that the best way to position the patient is to a. keep the head of the bed flat b. elevate the head of the bed to 30 degrees c. maintain patient on the left side with the head supported on a pillow d. use a continuous rotation bed to continuously change patient position

B. elevate the head of the bed to 30 degrees

A patient with a C7 spinal cord injury undergoing rehabilitation tells the nurse he must have the flu because he has a bad headache and nausea. The nurse's first priority is to A. call the physician B. check the patient's temperature C. take the patient's blood pressure D. elevate the head of the bed to 90 degrees

C

A patient with guillain barre syndrome asks whether he is going to die as the paralysis spreads toward his chest. In responding to the patient, what should the nurse know to be able to answer this question? A. Patients who require ventilatory support almost always die B. death occurs when nerve damage affects the brain and meninges C. most patients with guillain barre syndrome make a complete recovery. D. if death can be prevented, residual paralysis and sensory impairment are usually permanent

C 85-95% of patient's recover with 30% of them having some residual weakness

During assessment of a patient with a spinal cord injury, the nurse determines that the patient has a poor cough with diaphragmatic breathing. Based on this finding, what should be the nurse's first action? A. institute frequent turning and repositioning B. use tracheal suctioning to remove secretions C. assess lung sounds and respiratory rate and depth D. prepare the patient for endotracheal intubation and mechanical ventilation

C because pneumonia and atelectasis are potential problems related to ineffective coughing and the loss of intercostal and abdominal muscle function, the nurse should assess the patient's breath sounds and respiratory function to determine whether secretions are being retained or whether there is progression of respiratory impairment.

The healthcare provider has ordered IV dopamine for a patient in the ED with a spinal cord injury. the nurse determines that the drug is having the desired effect when what is observed in the patient assessment? A. Heart rate of 68 B. respiratory rate of 24 C. blood pressure of 106/82 D. Temp of 96.8

C dopamine is a vasopressor that is used to maintain blood pressure during states of hypotension that occur during neurogenic shock associated with spinal cord injury.

What causes an initial incomplete spinal cord injury to result in complete cord damage? A. edematous compression of cord above the level of injury B. continued trauma to the cord resulting from damage to stabilizing ligaments C. infarction and necrosis of the cord caused by edema, hemorrhage, and metabolites D. Mechanical transection of the cord by sharp vertebral bone fragments after the initial injury

C primary injury rarely affects the entire cord but the pathophysiology of secondary injury may result in damage that is the same as mechanical severance of the cord. complete cord dissolution occurs through autodestruction of the cord by hemorrhage, edema and the presence of metabolites and norepi, resulting in anoxia and infarction of the cord.

A patient with a spinal cord injury has spinal shock. The nurse plans care for the patient based on what knowledge? A. rehabilitation measures cannot be initiated until spinal shock has resolved B. the patient will need continuous monitoring for hypotension, tachycardia, and hypoxemia C. resolution of spinal shock is manifested by spasticity, hyperreflexia, and reflex emptying of the bladder. D. the patient will have complete loss of motor and sensory functions below the level of the injury but autonomic functions are not affected.

C spinal shock occurs in about half of all people with acute spinal cord injury. in spinal shock, the entire cord below the level of the lesion fails to function, resulting in a flaccid paralysis and hypomotility of most processes without any reflex activity. return of reflex activity, although hyperreflexive and spastic, signals the end of spinal shock.

What should the nurse do when providing care for a patient with an acute attack of trigeminal neuralgia? A. carry out all hygiene and oral care for the patient. B. use conversation to distract the patient from pain C. maintain a quiet, comfortable, draft-free environment. D. Have the patient examine the mouth after each meal for residual food.

C stimulation of the face through talking, environment or drafts may precipitate an attack

The patient's spinal cord injury is at T4. what is the highest level goal of rehab that is realistic for this patient to have? A. indoor mobility in manual wheelchair B. ambulate with crutches and leg braces C. be independent in self care and wheelchair use D. completely independent ambulation with short leg braces and canes.

C with the injury at T4 the highest level realistic goal for this patient is to be able to be independent in self care and wheelchair use because arm function will not be affected.

NCLEX review questions: Benzodiazepines are indicated in the treatment of cases of delirium that have which cause? A) Polypharmacy B) Cerebral hypoxia C) Alcohol withdrawal D) Electrolyte imbalances

C) Alcohol withdrawal Rationale: Benzodiazepines can be used to treat delirium associated with sedative and alcohol withdrawal. However, these drugs may worsen delirium caused by other factors and must be used cautiously. Polypharmacy, cerebral hypoxia, and electrolyte imbalances are not treated with benzodiazepines.

NCLEX review questions: Which nursing intervention is most appropriate when caring for patients with dementia? Avoid direct eye contact. Lovingly call the patient "honey" or "sweetie." Give simple directions, focusing on one thing at a time. Treat the patient according to his or her age-related behavior.

C) Give simple directions, focusing on one thing at a time. Rationale: When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is childlike. The nurse should use gentle touch and direct eye contact. Calling the patient "honey" or "sweetie" can be condescending and does not demonstrate respect.

Pre-test practice questions: Unlicensed assistive personnel (UAP) working for a home care agency report a change in the alertness and language of an 82-year-old female patient. The home care nurse plans a visit to evaluate the patient's cognitive function. Which assessment would be most appropriate? A) Glasgow Coma Scale (GCS) B) Confusion Assessment Method (CAM) C) Mini-Mental State Examination (MMSE) D) National Institutes of Health Stroke Scale (NIHSS)

C) Mini-Mental State Examination (MMSE) Rationale: The MMSE is a commonly used tool to assess cognitive function. Cognitive testing is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. The CAM is used to assess for delirium. The GCS is used to assess the degree of impaired consciousness. The NIHSS is a neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.

Nursing management of a patient with a brain tumor includes (select all that apply) a. discussing with the patient methods to control appropriate behavior b. using diversion techniques to leep the patient stimulated and motivated c. assisting and supporting the family in understanding any changes in behavior d. limiting self care activities until the patient has regained maximal physical functioning e. plan for seizure precautions and teaching the patient and caregiver about antiseizure drugs.

C, E

Without surgical stabilization, what method of immobilization for the patient with a cervical spinal cord injury should the nurse expect to be used? A. kinetic beds B. hard cervical collar C. skeletal traction with skull tongs D. sternal occipital mandibular immobilizer brace

C. the development of better surgical stabilization has made surgery the more frequent treatment of cervical injuries. However, when surgery cannot be done, skeletal traction with the use of crutchfield, vinke, or other types of skull tongs is required to immobilize the cervical vertebrae, even if a fracture has not occurred.

A patient's sudden onset of hemiplegia has necessitated a computed tomography (CT) of her head. Which of the following assessments should the nurse complete prior to this diagnostic study? A. Assess the patient's immunization history. B. Screen the patient for any metal parts or a pacemaker. C. Assess the patient for allergies to shellfish, iodine, or dyes. D. Assess the patient's need for tranquilizers or antiseizure medications.

C. Assess the patient for allergies to shellfish, iodine, or dyes.

The nurse is alerted to possible acute subdural hematoma in the patient who a. has a linear skull fracture crossing a major artery b. has focal symptoms of brain damage with no recollection of a head injury c. develops decreased LOC and a headache within 48 hours of head injury d. has an immediate loss of consciousness with a brief lucid interval followed by decreasing LOC

C. develops decreased LOC and a headache within 48 hours of head injury

The nurse on the clinical unit is assigned to four patients. Which patient should she assess first? a. patient with a skull fracture whose nose is bleeding b. elderly patient with a stroke who is confused and whose daughter is present c. patient with meningitis who is suddenly agitated and reporting a HA of 10 on a 0 to 10 scale d. patient who had a craniotomy for a brain tumor who is now 3 days postoperative and has had continued emesis

C. patient with meningitis who is suddenly agitated and reporting a HA of 10 on a 0 to 10 scale

Data regarding mobility, strength, coordination, and activity tolerance are important for the nurse to obtain because A. Many neurological diseases affect one or more of these areas. B. Patients are less able to identify other neurological impairments. C. These are the first functions to be affected by neurological disease. D. Aspects of movement are the most important function of the nervous system.

Correct answer: A Rationale: Many neurologic disorders affect the patient's mobility, strength, and coordination. These problems can alter the patient's usual activity and exercise patterns.

A patient's eyes jerk while the patient looks to the left. You will record this finding as A. Nystagmus. B. CN VI palsy. C. Oculocephalia. D. Ophthalmic dyskinesia.

Correct answer: A Rationale: Nystagmus produces fine, rapid jerking movements of the eyes.

Lower motor neurons differ from upper motor neurons primarily in that lesions of the lower motor neurons A. Cause hyporeflexia and flaccidity. B. Affect motor control of the lower body. C. Arise in structures above the spinal cord. D. Interfere with reflex arcs in the spinal cord.

Correct answer: A Rationale: The cell bodies of lower motor neurons that send impulses to skeletal muscles in the arms, legs, and trunk are located in the anterior horn of the spinal cord, and lesions generally cause weakness or paralysis and decreased muscle tone. Upper motor neurons include the brainstem and cerebral cortex motor neurons that influence skeletal muscle movement, and lesions at this point cause weakness and paralysis with hyperreflexia and spasticity.

The nurse is caring for a patient with peripheral neuropathy who is going to have EMG studies tomorrow morning. The nurse should A. Ensure the patient has an empty bladder. B. Instruct the patient that there is no risk of electrical shock. C. Ensure the patient has no metallic jewelry or metal fragments. D. Instruct the patient that she or he may experience pain during the study.

Correct answer: B Rationale: Electromyography (EMG) assesses electrical activity associated with nerves and skeletal muscles. Activity is recorded by insertion of needle electrodes to detect muscle and peripheral nerve disease. The nurse should inform the patient that pain and discomfort are associated with insertion of needles. There is no risk of electric shock with this procedure.

A patient has a lesion involving the fasciculus gracilis/cuneatus of the spinal cord. The nurse would expect the patient to experience loss of A. Pain and temperature sensation. B. Touch, deep pressure, vibration, and position sense. C. Unconscious information about body position and muscle tension. D. Voluntary muscle control from the cerebral cortex to the peripheral nerves.

Correct answer: B Rationale: The fasciculus gracilis and fasciculus cuneatus tracts carry information and transmit impulses concerned with touch, deep pressure, vibration, position sense, and kinesthesia. Spinothalamic tracts carry pain and temperature sensations; the spinocerebellar tracts carry subconscious information about muscle tension and body position; and descending corticobulbar tracts carry impulses responsible for voluntary impulses from the cortex to the cranial nerves.

During neurological testing, the patient is able to perceive pain elicited by pinprick. Based on this finding, the nurse may omit testing for A. Position sense. B. Patellar reflexes. C. Temperature perception. D. Heel-to-shin movements.

Correct answer: C Rationale: If pain sensation is intact, assessment of temperature sensation may be omitted, because both sensations are carried by the same ascending pathways.

An obstruction of the anterior cerebral arteries will affect functions of A. Visual imaging. B. Balance and coordination. C. Judgment, insight, and reasoning. D. Visual and auditory integration fro language comprehension.

Correct answer: C Rationale: The anterior cerebral artery feeds the medial and anterior portions of the frontal lobes. The anterior portion of the frontal lobe controls higher-order processes such as judgment and reasoning.

Drugs or diseases that impair the function of the extrapyramidal system may cause loss of A. Sensations fo pain and temperature. B. Regulation of the autonomic nervous system. C. Integration of somatic and special sensory inputs. D. Automatic movements associated with skeletal muscle activity.

Correct answer: D Rationale: A group of descending motor tracts carries impulses from the extrapyramidal system, which includes all motor systems (except the pyramidal system) concerned with voluntary movement. It includes descending pathways originating in the brainstem, basal ganglia, and cerebellum. The motor output exits the spinal cord by way of the ventral roots of the spinal nerves.

Assessment of muscle strength of older adults cannot be compared with that of younger adults because A. Stroke is more common in older adults. B. Nutritional status is better in young adults. C. Most young people exercise more than older people. D. Aging leads to a decrease in muscle bulk and strength.

Correct answer: D Rationale: Changes associated with aging include decreases in muscle strength and agility related to decreased muscle bulk.

Paralysis of lateral gaze indicates a lesion of cranial nerve A. II. B. III. C. IV. D. VI.

Correct answer: D Rationale: Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) are responsible for eye movement. The lateral rectus eye muscle is innervated by cranial nerve VI, and it is the primary muscle that is responsible for lateral eye movement.

In a patient with a disease that affects the myelin sheath of nerves, such as multiple sclerosis, the glial cells affected are the A. Microglia. B. Astrocytes. C. Ependymal cells. D. Oligodendrocytes.

Correct answer: D Rationale: Glial cell types include oligodendrocytes, astrocytes, ependymal cells, and microglia, and each has specific functions. Oligodendrocytes are specialized cells that produce the myelin sheath of nerve fibers in the central nervous system (CNS), and they are primarily found in the white matter of the CNS.

A result of stimulation of the parasympathetic nervous system is (select all that apply) A. Constriction of the bronchi. B. Dilation of skin blood vessels. C. Increased secretion of insulin. D. Increased blood glucose levels. E. Relaxation of the urinary sphincters.

Correct answers: A,B,C,E Rationale: Parasympathetic nervous system stimulation results constriction of the bronchi, dilation of blood vessels to the skin, increased secretion of insulin, and relaxation of the urinary sphincter. Sympathetic nervous system stimulation results in increased blood glucose levels.

A patient is admitted to the hospital with a C4 spinal cord injury after a motorcycle collision. The patient's bP is 84/50 mm Hg, his pulse is 38 bpm, and he remains orally intubated. The nurse determines that this pathophysiologic responnse is caused by A. increased vasomotor tone after injury B. a temporary loss of sensation and flaccid paralysis below the level of injury C. loss of parasympathetic nervous system innervation resulting in vasoconstriction D. Loss of sympathetic nervous system innervation resulting in peripheral vasodilation

D

During routine assessment of a patient with Guillain-Barre syndrome, the nurse finds the patient is short of breath. The patient's respiratory distress is caused by A. elevated protein levels in the CSF. B. immobility resulting from ascending paralysis C. degeneration of motor neurons in the brainstem and spinal cord. D. paralysis ascending to the nerves that stimulate the thoracic area

D

The patient is admitted to the ICU with a spinal cord injury and diagnosed with Brown-Sequard syndrome. On physical examination, the nurse would most likely find A. upper extremity weakness only. B. complete motor and sensory loss below C7 C. Loss of position sense and vibration in both lower extremities D. ipsilateral motor loss and contralateral sensory loss below C7

D

What is one indication for early surgical therapy of the patient with a spinal cord injury? A. there is incomplete cord lesion involvement B. the ligaments that support the spine are torn. C. a high cervical injury causes loss of respiratory function D. evidence of continued compression of the cord is apparent.

D although surgical treatment of spinal cord injuries often depends on the preference of the surgeon, surgery is usually indicated when there is continued compression of the cord by extrinsic forces or when there is evidence of cord compression.

Following a T2 spinal cord injury, the patient develops paralytic ileus. while this condition is present, what should the nurse anticipate that the patient will need? A. IV fluids B. Tube feedings C. parenteral nutrition D. nasogastric suctioning

D during the first two to three days after a spinal cord injury, paralytic ileus may occur and NG suction must be used to remove secretions and gas from the GI tract until peristalsis resumes.

In counseling patients with spinal cord lesions regarding sexual functions, how should the nurse advise a male patient with a complete lower motor neuron lesion? A. he is most likely to have relexogenic erections and may experience orgasm if ejaculation occurs B. he may have uncontrolled reflex erections but orgasm and ejaculation are usually not possible C. he has a lesion with the greatest possibility of successful psychogenic erection with ejaculation and orgasm D. he will probably be unable to have either psychogenic or relexogenic erections and no ejaculation or orgasm

D most patients with complete lower motor neuron lesion are unable to have either psychogenic or reflexogenic erections and alternative methods of obtaining sexual satisfaction may be suggested.

Pre-test practice questions: The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer's disease? A) A 65-year-old male does not recognize his family members and close friends. B) A 59-year-old female misplaces her purse and jokes about having memory loss. C) A 79-year-old male is incontinent and not able to perform hygiene independently. D) A 72-year-old female is unable to locate the address where she has lived for 10 years.

D) A 72-year-old female is unable to locate the address where she has lived for 10 years. Rationale: An early warning sign of Alzheimer's disease is disorientation to time and place such as geographic disorientation. Occasionally misplacing items and joking about memory loss are examples of normal forgetfulness. Impaired ability to recognize family and close friends is a clinical manifestation of middle or moderate dementia (or Alzheimer's disease). Incontinence and inability to perform self-care activities are clinical manifestations of severe or late dementia (or Alzheimer's disease).

NCLEX review questions: Which patient may face the greatest risk of developing delirium? A) A patient with fibromyalgia whose chronic pain has recently worsened B) A patient with a fracture who has spent the night in the emergency department C) An older patient whose recent computed tomography (CT) shows brain atrophy D) An older patient who takes multiple medications to treat various health problems

D) An older patient who takes multiple medications to treat various health problems Rationale: Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.

In planning community education for prevention of spinal cord injuries, what group should the nurse target? A. Older men B. teenage girls C. elementary school age children D. adolescent and young adult men

D. spinal cord injuries are highest in adolescent and young adult men between the ages of 16 and 30 and those who are impulsive risk takers in their daily lives

Of the following patients, the nurse recognizes that the one with the highest risk for stroke is a(n): A. obese 45-year old Native American. B. 35-year-old Asian American woman who smokes. C. 32-year-old white woman taking oral contraceptives. D. 65-year-old African American man with hypertension.

D. 65-year-old African American man with hypertension. Nonmodifiable risk factors for stroke include age (older than 65 years), male gender, ethnicity or race (incidence is highest in African Americans; next highest in Hispanics, Native Americans/Alaska Natives, and Asian Americans; and next highest in white people), and family history of stroke or personal history of a transient ischemic attack or stroke. Modifiable risk factors for stroke include hypertension (most important), heart disease (especially atrial fibrillation), smoking, excessive alcohol consumption (causes hypertension), abdominal obesity, sleep apnea, metabolic syndrome, lack of physical exercise, poor diet (high in saturated fat and low in fruits and vegetables), and drug abuse (especially cocaine). Other risk factors for stroke include a diagnosis of diabetes mellitus, increased serum levels of cholesterol, birth control pills (high levels of progestin and estrogen), history of migraine headaches, inflammatory conditions, hyperhomocystinemia, and sickle cell disease.

A patient with ICP monitoring has pressure of 12 mm Hg. The nurse understand that this pressure reflects a. a severe decrease in cerebral perfusion pressure b. an alteration in the production of CSF c. the loss of autoregulatory control of ICP d. a normal balance between brain tissue, blood, and CSF

D. A normal balance between brain tissue, blood, and CSF- normal is 10- 15 mm Hg

When assessing motor function of a patient admitted with a stroke, the nurse notes mild weakness of the arm demonstrated by downward drifting of the arm. The nurse would most accurately document this finding as A. Athetosis. B. Hypotonia. C. Hemiparesis. D. Pronator drift.

D. Pronator drift.

A normal assessment finding of the musculoskeletal system is: a. no deformity or crepitation b. muscle and bone strength of 4 c. ulnar deviation and subluxation d. angulation of bone toward midline

a

A patient with a fracture of the pelvis should be monitored for: a. changes in urine output b. petechiae on the abdomen c. a palpable lump in the buttock d. sudden increase in blood pressure

a

A patient with tendonitis asks what the tendon does. The nurse's response is based on the knowledge that tendons: a. connect bone to muscle b. provide strength to the muscle c. lubricate joints with synovial fluid d. relieve friction between moving parts

a

Before discharge from the same-day surgery unit, instruct the patient who has had a surgical correction of bilateral hallux valgus to: a. rest frequently with the feet elevated b. soak the feet in warm water several times a day c. expect the feet to be numb for the next few days d. expect continued pain in the feet, since this is not uncommon.

a

During postoperative period, the nurse instructs the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes: a. hip flexion contractures b. skin irritation and breakdown c. clot formation at the incision site d. increased risk of wound dehiscence

a

The increased risk for falls in the older adult is most likely due to: a. changes in balance b. decrease in bone mass c. loss of ligament elasticity d. erosion of articular cartilage

a

The nurse explains to a patient with a fracture of the distal shaft of the humerus who is returning for a 4-week checkup that healing is indicated by: a. formation of callus b. complete bony union c. hematoma at fracture site d. presence of granulation tissue

a

A 50-year-old man complains of recurring headaches. He describes these as sharp, stabbing, and located around his left eye. He also reports that his left eye seems to swell and get teary when these headaches occur. Based on this history, you suspect that he has a. cluster headaches. b. tension headaches. c. migraine headaches. d. medication overuse headaches.

a Rationale: Cluster headaches involve repeated headaches that can occur for weeks to months, followed by periods of remission. The pain of cluster headache is sharp and stabbing; the intense pain lasts a few minutes to 3 hours. Cluster headaches can occur every other day and as often as eight times a day. The clusters occur with regularity, usually occurring at the same time each day and during the same seasons of the year. Typically, a cluster lasts 2 weeks to 3 months, and the patient then goes into remission for months to years. The pain usually is located around the eye and radiates to the temple, forehead, cheek, nose, or gums. Other manifestations may include swelling around the eye, lacrimation (tearing), facial flushing or pallor, nasal congestion, and constriction of the pupil. During the headache, the patient is often agitated and restless, unable to sit still or relax.

While performing passive range of motion for a patient, the nurse puts the ankle joint through the movements of (select all that apply): a. flexion and extension b. inversion and eversion c. pronation and supination d. flexion, extension, abduction, and adduction e. pronation, supination, rotation, and circumduction

a b

Which individuals would be at high risk for low back pain (select all that apply)? a. A 63yo man who is a long-distance truck driver b. A 36yo 6ft, 2 in construction worker who weighs 260 lb c. A 28yo female yoga instructor who is 5 ft, 6ft and weighs 130lb d. A 30yo male nurse who works on an orthopedic unit and smokes e. A 44yo female chef with prior compression fracture of the spine

a b d e

A patient with osteomyelitis is treated with surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse answers (select all that apply): a. "the beads are used to directly deliver antibiotics to the site of the infections" b. "there are no effective oral or IV antibiotics to treat most cases of bone infection." c. "This is the safest method of delivering long-term antibiotic therapy for a bone infusion" d. " The beads are an adjunct to debridement and oral and IV antibiotics for deep infections." e. "The ischemia and bone death that occur with osteomyelitis are impenetrable to IV antibiotics."

a d

Social effects of a chronic neurologic disease include (select all that apply) a. divorce. b. job loss. c. depression. d. role changes. e. loss of self-esteem.

a, b, c, d, e Rationale: Social problems related to chronic neurologic disease may include changes in roles and relationships (e.g., divorce, job loss, role changes); other psychologic problems (e.g., depression, loss of self-esteem) also may have social effects.

Common psychosocial reactions of the stroke patient to the stroke include (select all that apply) a. depression. b. disassociation. c. intellectualization. d. sleep disturbances. e. denial of severity of stroke.

a, d, e Rationale: The patient with a stroke may experience many losses, including sensory, intellectual, communicative, functional, role behavior, emotional, social, and vocational losses. Some patients experience long-term depression, manifesting symptoms such as anxiety, weight loss, fatigue, poor appetite, and sleep disturbances. The time and energy required to perform previously simple tasks can result in anger and frustration. Frustration and depression are common in the first year after a stroke. A stroke is usually a sudden, extremely stressful event for the patient, caregiver, family, and significant others. The family is often affected emotionally, socially, and financially as their roles and responsibilities change. Reactions vary considerably but may involve fear, apprehension, denial of the severity of stroke, depression, anger, and sorrow.

Bridge to NCLEX questions: A major goal of treatment for the patient with AD is to a. maintain patient safety. b. maintain or increase body weight. c. return to a higher level of self-care. d. enhance functional ability over time.

a. maintain patient safety. Rationale: The overall management goals are that the patient with AD will (1) maintain functional ability for as long as possible, (2) be maintained in a safe environment with a minimum of injuries, (3) have personal care needs met, and (4) have dignity maintained. The nurse should place emphasis on patient safety while planning and providing nursing care.

A patient has been diagnosed with osteosarcoma of the humerus. He shows an understanding of his treatment options when he states: a. "I accept that I have to lose my arm with surgery." b. "The chemotherapy before surgery will shrink the tumor." c. "This tumor is related to the melanoma I had 3 years ago." d. "I'm glad they can take out the cancer with such a small scar."

b

A patient is scheduled for an electromyogram (EMG). The nurse explains that this diagnostic test involves: a. incision or puncture of the joint capsule b. insertion of small needles into certain muscles c. administration of a radioisotope before the procedure d. placement of skin electrodes to record muscle activity.

b

In caring for a patient after a spinal fusion, the nurse would immediately report to the physician which patient symptom? a. the patient experiences a single episode of emesis b. the patient is unable to move the lower extremities c. the patient is nauseated and has not voided in 4 hrs d. the patient complains of pain at the bone graft donor site

b

You are teaching a patient with osteopenia. What is important to include in the teaching plan?: a. lose weight b. stop smoking c. eat a high-protein diet d. start swimming for exercise

b

For a patient who is suspected of having a stroke, one of the most important pieces of information that the nurse can obtain is a. time of the patient's last meal. b. time at which stroke symptoms first appeared. c. patient's hypertension history and management. d. family history of stroke and other cardiovascular diseases.

b Rationale: During initial evaluation, the most important point in the patient's history is the time since onset of stroke symptoms. If the stroke is ischemic, recombinant tissue plasminogen activator (tPA) must be administered within 3 to 4.5 hours of the onset of clinical signs of ischemic stroke; tPA reestablishes blood flow through a blocked artery and prevents brain cell death in patients with acute onset of ischemic stroke.

A patient with osteoarthritis is scheduled for a total hip arthroplasty. The nurse explains that the purpose of this procedure is to (select all that apply): a. fuse the joint b. replace the joint c. prevent further damage d. improve or maintain ROM e. decrease the amount of destruction in the joint

b d

Bridge to NCLEX questions: Which statement(s) accurately describe(s) mild cognitive impairment (select all that apply)? a. Always progresses to AD b. Caused by variety of factors and may progress to AD c. Should be aggressively treated with acetylcholinesterase drugs d. Caused by vascular infarcts that, if treated, will delay progression to AD e. Patient is usually not aware that there is a problem with his or her memory

b. Caused by variety of factors and may progress to AD Rationale: Although some individuals with mild cognitive impairment (MCI) revert to normal cognitive function or do not go on to develop Alzheimer's disease (AD), those with MCI are at high risk for AD. No drugs have been approved for the treatment of MCI. A person with MCI is often aware of a significant change in memory.

Bridge to NCLEX questions: Creutzfeldt-Jakob disease is characterized by a. remissions and exacerbations over many years. b. memory impairment, muscle jerks, and blindness. c. parkinsonian symptoms, including muscle rigidity and tremors at rest. d. increased intracranial pressure secondary to decreased CSF drainage.

b. memory impairment, muscle jerks, and blindness. Rationale: Creutzfeldt-Jakob disease (CJD) is a fatal brain disorder caused by a prion protein. The earliest symptom of the disease may be memory impairment and behavioral changes. The disease progresses rapidly, with mental deterioration, involuntary movements (i.e., muscle jerks), weakness in the limbs, blindness, and eventually coma

Bridge to NCLEX questions: The early stage of AD is characterized by a. no noticeable change in behavior. b. memory problems and mild confusion. c. increased time spent sleeping or in bed. d. incontinence, agitation, and wandering behavior.

b. memory problems and mild confusion. Rationale: An initial sign of AD is a subtle deterioration in memory.

An indication of a neurovascular problem noted during assessment of the patient with a fracture is: a. exaggeration of strength with movement b. increased redness and heat below the injury c. decreased sensation distal to the fracture site d. purulent drainage at the site of an open fracture

c

The bone cells that function in the resorption of bone tissue are called: a. osteoids b. osteocytes c. osteoclasts d. osteoblasts

c

While obtaining subjective assessment data related to the musculoskeletal system, it is particularly important to ask a patient about other medical problems such as: a. hypertension b. thyroid problems c. diabetes mellitus d. chronic bronchitis

c

The nurse explains to the patient with a stroke who is scheduled for angiography that this test is used to determine the a. presence of increased ICP. b. site and size of the infarction. c. patency of the cerebral blood vessels. d. presence of blood in the cerebrospinal fluid.

c Rationale: Angiography provides visualization of cerebral blood vessels and can help estimate perfusion and detect filling defects in the cerebral arteries.

A patient with right-sided hemiplegia and aphasia resulting from a stroke most likely has involvement of the a. brainstem. b. vertebral artery. c. left middle cerebral artery. d. right middle cerebral artery.

c Rationale: If the middle cerebral artery is involved in a stroke, the expected clinical manifestations include aphasia, motor and sensory deficit, and hemianopsia on the dominant side and include neglect, motor and sensory deficit, and hemianopsia on the nondominant side.

A patient experiencing TIAs is scheduled for a carotid endarterectomy. The nurse explains that this procedure is done to a. decrease cerebral edema. b. reduce the brain damage that occurs during a stroke in evolution. c. prevent a stroke by removing atherosclerotic plaques blocking cerebral blood flow. d. provide a circulatory bypass around thrombotic plaques obstructing cranial circulation.

c Rationale: In a carotid endarterectomy, the atheromatous lesion is removed from the carotid artery to improve blood flow.

Bladder training in a male patient who has urinary incontinence after a stroke includes a. limiting fluid intake. b. keeping a urinal in place at all times. c. assisting the patient to stand to void. d. catheterizing the patient every 4 hours.

c Rationale: In the acute stage of stroke, the primary urinary problem is poor bladder control and incontinence. Nurses should promote normal bladder function and avoid the use of indwelling catheters. A bladder retraining program consists of (1) adequate fluid intake, with most fluids administered between 7:00 am and 7:00 pm; (2) scheduled toileting every 2 hours with the use of a bedpan, commode, or bathroom; and (3) noting signs of restlessness, which may indicate the need for urination. Intermittent catheterization may be used for urinary retention (not urinary incontinence). During the rehabilitation phase after a stroke, nursing interventions focused on urinary continence include (1) assessment for bladder distention by palpation; (2) offering the bedpan, urinal, commode, or toilet every 2 hours during waking hours and every 3 to 4 hours at night; (3) using a direct command to help the patient focus on the need to urinate; (4) assistance with clothing and mobility; (5) scheduling most fluid intake between 7:00 am and 7:00 pm; and (6) encouraging the usual position for urinating (i.e., standing for men and sitting for women).

A 65-year-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is a. searching the Internet for educational videos. b. evaluating the home for environmental safety. c. promoting physical exercise and a well-balanced diet. d. designing an exercise program to strengthen and stretch specific muscles.

c Rationale: Promotion of physical exercise and a well-balanced diet are major concerns of nursing care for patients with Parkinson's disease.

The factor related to cerebral blood flow that most often determines the extent of cerebral damage from a stroke is the a. amount of cardiac output. b. oxygen content of the blood. c. degree of collateral circulation. d. level of carbon dioxide in the blood.

c Rationale: The extent of the stroke depends on the rapidity of onset, size of the lesion, and presence of collateral circulation.

Bridge to NCLEX questions: Vascular dementia is associated with a. transient ischemic attacks. b. bacterial or viral infection of neuronal tissue. c. cognitive changes secondary to cerebral ischemia. d. abrupt changes in cognitive function that are irreversible.

c. cognitive changes secondary to cerebral ischemia. Rationale: Vascular dementia is the loss of cognitive function that results from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions caused by cardiovascular disease. In this type of dementia, narrowing and blocking of arteries that supply the brain causes a decrease in blood supply.

1. The nurse suspects an ankle sprain when a patient at the urgent care center relates: a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track c. dropping a 10-lb weight on his lower leg at the health club d. twisting his ankle while running bases during a baseball game

d

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when: a. the patient is unable to tolerate prolonged immobilization: a. the patient is unable to tolerate prolonged immobilization b. the patient cannot tolerate the surgery of closed reduction c. a temporary cast would be too unstable to provide normal mobility d. adequate alignment cannot be obtained by other nonsurgical methods

d

A patient with a stable, closed fracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects compartment syndrome and notifies the physician when the patient experiences: a. increasing edema of the limb b. muscle spasms of the lower arm c. rebounding pulse at the fracture site d. pain when passively extending the fingers

d

In teaching a patient scheduled for a total ankle replacement, it is important to tell the patient that after surgery he should avoid: a. lifting heavy objects b. sleeping on the back c. abduction exercises of the affected ankle d. bearing weight on the affected leg for 6 weeks

d

The nurse's responsibility for a patient with a suspected disc herniation who is experiencing acute pain and muscle spasms is: a. encouraging total bed rest for several days b. teaching the principles of back strengthening exercises c. stressing the importance of straight-leg raises to decrease pain. d. promoting the use of cold and hot compresses and pain medication.

d

To prevent muscle atrophy, the nurse teaches the patient with a leg immobilized in traction to perform (select all that apply): a. flexion contractions b. tetanic contractions c. isotonic contractions d. isometric contractions e. extension contractions

d

When grading muscle strength, the nurse records a score of 3, which indicates: a. no detection of muscular contraction b. a barely detectable flicker of contraction c. active movement against full resistance without fatigue d. active movement against gravity but not against resistance

d

Information provided by the patient that would help differentiate a hemorrhagic stroke from a thrombotic stroke includes a. sensory disturbance. b. a history of hypertension. c. presence of motor weakness. d. sudden onset of severe headache.

d Rationale: A hemorrhagic stroke usually causes a sudden onset of symptoms, which include neurologic deficits, headache, nausea, vomiting, decreased level of consciousness, and hypertension. Ischemic stroke symptoms may progress in the first 72 hours as infarction and cerebral edema increase.

Of the following patients, the nurse recognizes that the one with the highest risk for a stroke is a(n) a. obese 45-year-old Native American. b. 35-year-old Asian American woman who smokes. c. 32-year-old white woman taking oral contraceptives. d. 65-year-old African American man with hypertension.

d Rationale: Nonmodifiable risk factors for stroke include age (older than 65 years), male gender, ethnicity or race (incidence is highest in African Americans; next highest in Hispanics, Native Americans/Alaska Natives, and Asian Americans; and next highest in white people), and family history of stroke or personal history of a transient ischemic attack or stroke. Modifiable risk factors for stroke include hypertension (most important), heart disease (especially atrial fibrillation), smoking, excessive alcohol consumption (causes hypertension), abdominal obesity, sleep apnea, metabolic syndrome, lack of physical exercise, poor diet (high in saturated fat and low in fruits and vegetables), and drug abuse (especially cocaine). Other risk factors for stroke include a diagnosis of diabetes mellitus, increased serum levels of cholesterol, birth control pills (high levels of progestin and estrogen), history of migraine headaches, inflammatory conditions, hyperhomocystinemia, and sickle cell disease.

The nurse is reinforcing teaching with a newly diagnosed patient with amyotrophic lateral sclerosis. Which statement would be appropriate to include in the teaching? a. "ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication." b. "Even though the symptoms you are experiencing are severe, most people recover with treatment." c. "You need to consider advance directives now, since you will lose cognitive function as the disease progresses." d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

d Rationale: The disease results in destruction of the motor neurons in the brainstem and spinal cord, causing gradual paralysis. Cognitive function is maintained. Because there is no cure for amyotrophic lateral sclerosis (ALS), collaborative care is palliative and based on symptom relief. Death usually occurs within 3-6 years after diagnosis.

The nurse finds that an 87-year-old woman with Alzheimer's disease is continually rubbing, flexing, and kicking out her legs throughout the day. The night shift reports that this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to a. ask the physician for a daytime sedative for the patient. b. request soft restraints to prevent her from falling out of her bed. c. ask the physician for a nighttime sleep medication for the patient. d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.

d Rationale: The severity of sensory symptoms of restless legs syndrome (RLS) ranges from infrequent, minor discomfort (paresthesias, including numbness, tingling, and "pins and needles" sensation) to severe pain. The discomfort occurs when the patient is sedentary and is most common in the evening or at night. The pain at night can disrupt sleep and is often relieved by physical activity, such as walking, stretching, rocking, or kicking. In the most severe cases, patients sleep only a few hours at night, which results in daytime fatigue and disruption of the daily routine. The motor abnormalities associated with RLS consist of voluntary restlessness and stereotyped, periodic, involuntary movements. The involuntary movements usually occur during sleep. Symptoms are aggravated by fatigue.

Bridge to NCLEX questions: Which patient is most at risk for developing delirium? a. A 50-year-old woman with cholecystitis b. A 19-year-old man with a fractured femur c. A 42-year-old woman having an elective hysterectomy d. A 78-year-old man admitted to the medical unit with complications related to heart failure

d. A 78-year-old man admitted to the medical unit with complications related to heart failure Rationale: Risk factors that can precipitate delirium include age of 65 years or older, male gender, and severe acute illness (e.g., heart failure). The 78-year-old man has the most risk factors for delirium

Bridge to NCLEX questions: The clinical diagnosis of dementia is based on a. CT or MRS. b. brain biopsy. c. electroencephalogram. d. patient history and cognitive assessment.

d. patient history and cognitive assessment. Rationale: The diagnosis of dementia depends on determining the cause. A thorough physical examination is performed to rule out other potential medical conditions. Cognitive testing (e.g., Mini-Mental State Examination) is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. Diagnosis of dementia related to vascular causes is based on the presence of cognitive loss, the presence of vascular brain lesions demonstrated by neuroimaging techniques, and the exclusion of other causes of dementia. Structural neuroimaging with computed tomography (CT) or magnetic resonance imaging (MRI) is used in the evaluation of patients with dementia. A psychologic evaluation is also indicated to determine the presence of depression.

Bridge to NCLEX questions: Dementia is defined as a a. syndrome that results only in memory loss. b. disease associated with abrupt changes in behavior. c. disease that is always due to reduced blood flow to the brain. d. syndrome characterized by cognitive dysfunction and loss of memory.

d. syndrome characterized by cognitive dysfunction and loss of memory. Rationale: Dementia is a syndrome characterized by dysfunction in or loss of memory, orientation, attention, language, judgment, and reasoning. Personality changes and behavioral problems such as agitation, delusions, and hallucinations may result.