Chronic Exam Final

1) 72 y.o. Patient is having difficulty with solving problems in the home. Which question should the nurse ask the patient to assess their current mental status?

"What did you eat for lunch today?"

A client exhibiting an altered level of consciousness (LOC) due to a blunt force trauma to the head is admitted to the ED. The nurse should gauge the clients LOC on the results of what diagnosis tool?

- Glasgow coma scale

The nurse is caring for a 77 year old woman with MS. She states that she is very concerned about the progress of her disease and what the future holds. The nurse should know that elderly clients with MS are known to be particularly concerned about what variables? Select all that apply

- Possible nursing home placement - Increasing disability - Becoming a burden on the family

1) An elderly client has presented to the client with a new diagnosis of osteoarthritis. The client's daughter is accompanying him and the nurse has explained why the incidence of chronic diseases tends to increase with age. What rationale for this phenomenon should the nurse describe?

- with age, biological changes in the body

1) During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?

. Following proper hand-washing techniques

1) A neurologic nurse is reviewing seizures with a group of staff nurses. How should this nurse best describe the cause of seizure

. a dysrhythmia in the nerve cells in one section of the brain

1) The nurse is caring for a client with permanent neurologic impairments resulting from a traumatic head injury. When working with this client & family. What mutual goal should be prioritized?

Achieve as high a level of function as possible

1) A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?

An immune globulin injection

1) Teaching a 41 year old patient with early alcoholic cirrhosis. What do you want to tell them?

Avoid alcohol ingestion

The nurse is assessing a client diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find?

Bulging eyes

1) A patient is prescribed daily furosemide for CKD. Action to determine effectiveness of med?

Daily weight

A client diagnosed with MS has been admitted to the medical unit for treatment of an MS exacerbation. Included in the admission order is baclofen. What should the nurse identify as an expected outcome of this treatment?

Decreased muscle spasm in the lower extremities

A middle aged woman has sought care from her primary provider and undergone diagnostic testing that has resulted in a diagnosis of MS. what sign or symptom is most likely to have prompted the woman to seek care?

Difficulty in coordination

1) A clinic nurse is caring for a client diagnosed with RA. the client tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. How can the nurse best facilitate the client's adherence to her medication regimen?

Encourage her to have the pharmacy replace the tops with alternative that are easier to open

1) atient comes into the ER with a cervical spinal cord injury. What do you assess first?

Evaluate respiratory status

1) 70-year old patient→ Why screen for Hep C?

IV drug use 20 years ago

1) A nurse is performing the health history and physical assessment of a client who has a diagnosis of rheumatoid arthritis. What assessment finding is most consistent with the clinical presentation of RA?

Joint stiffness, especially in the morning

1) A client with a documented history of seizure disorder experiences a generalized seizure. What nursing action is most appropriate?

Loosen the client's restrictive clothing

The nurse is working with a client who is newly diagnosed with MS. What basic information should the nurse provide to the client?

MS is a progressive demyelinating disease of the nervous system

1) The nurse is caring for a boy who has muscular dystrophy. When planning assistance with the client's ADLs what goal should the nurse prioritize?

MaximiZing the client's level of function

1) A nurse is providing care for a client who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of what medication?

Methotrexate

The nurse is assessing a client with MS who is demonstrating involuntary, rhythmic eye movements. What term will the nurses use when documenting these eye movements?

Nystagmus

A hospital client has experienced a seizure. In the immediate recovery period, what action best protects the clients safety?

Place the client in a side-lying position

1) A client with a new diagnosis of amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the client best make known his wishes for care as his disease progresses?

Prepare an advance directive

The nurse is planning the care of a client with a diagnosis of vertigo. What nursing diagnosis risk should the nurse prioritize in this client's care?

Risk for falls

The nurse is caring for a client with corticosteroid therapy. What would be the priority information for the nurse to give the client regarding corticosteroid therapy?

The client is at an increased risk for developing infection

1) The nurse is providing care for a client who is withdrawing from heavy alcohol use. The nurse and other members of the care team are present at the bedside when the client has a seizure. In preparation for documenting this clinical event, the nurse should note which of the following

The client's activities immediately prior to the seizure

1) The nurse is caring for a client diagnosed with Parkinson disease. The client is having increasing problems with rising from the sitting to the standing position. What should the nurse suggest to the client to use that will aid in getting from the sitting to the standing position as well as air in improving bowel elimination

Use a raised toilet seat

1) A client with suspected Parkinson disease is initially being assessed by the nurse. When is the best time to assess for the presence of a tremor?

When the client is resting

1) The nurse is preparing to provide care for a client diagnosed with myasthenia gravis. The nurse should know that the signs and symptoms of the disease are the result of what?

a lower motor neuron lesion

1) A nurse knows that clients with "invisible" disabilities like chronic pain often feel that their chronic conditions are more challenging to deal with than more visible disabilities. Why would they feel this way?

despite appearances invisible disabilities can be as disabling as visible disabilities

1) The clinic nurse caring for a client with Parkinson disease disease notes that the client has been taking levodopa and carbidopa (Sinemet) for 7 years. For what common side effect should the nurse assess for the client?

dyskinesia

1) Caring for patients as a member of rehabilitation teams. What is your primary goal as the rehab nurse's role?

making sure that their team activities were coordinated and ensuring plan of care is implemented

1) After the change of shift report on the Alzheimer's unit. Which patient should the nurse assess first?

new cough after eating breakfast (could have aspirated)

1) Which hospitalized patient should the nurse assign closest from the nurse's station?

patient with new onset restlessness, confusion, and irritability after surgery

1) A home care nurse is making an initial visit to a 68-year-old man. The nurse finds the man tearful and emotionally withdrawn. Even though the man lives alone and has no family, he has been managing well at home until now. What would be the most appropriate action for the nurse to take?

reassess the client's psychosocial status and make the necessary referrals

A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan?

reduction in sodium intake

1) A client has just been diagnosed with Parkinson disease and the nurse is planning the client's subsequent care for the home setting. What nursing diagnosis should the nurse address when educating the clients family?

risk for injury

1) A client with Parkinson disease is undergoing a swallowing assessment because she has recently developed adventitious lung sounds. The client's nutritional needs should be met by what method?

semisolid food with thick liquids

A client has been diagnosed with glaucoma and the nurse is preparing health education regarding the client's medication regimen. The client states that she is eager to "beat this disease" and looks forward to the time that she will no longer require medications. How should the nurse best respond?

"In fact, glaucoma usually requires lifelong treatment with medications."

1) A client is undergoing diagnostic testing to determine the etiology of recent joint pain. The client asks the nurse about the difference between osteoarthritis and rheumatoid arthritis. What is the best response by the nurse?

"OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints"

1) An older adult has encouraged her husband to visit their primary provider. Stating that she is concerned that he may have Parkinson disease. Which of the wife's descriptions of her husband's health and function is most suggestive of Parkinson disease?

- "Lately he seems to move far more slowly than he ever has in the past."

1) New nurse states that the patient cannot sleep without the pain medication. What is the appropriate response as the preceptor of the new nurse?

- "being able to sleep doesn't mean the pain doesn't exist"

1) A client has a diagnosis of rheumatoid arthritis and the primary provider has now prescribed cyclophosphamide. The nurse's subsequent assessments should address what potential adverse effect?

- Bone marrow suppression

1) A client tells the nurse that her doctor just told her that her new diagnosis of rheumatoid arthritis is considered to be "chronic condition" she asks the nurse what "chronic condition" means what would be the nurses' best response

- Chronic conditions are defined as health problems that require management of several months or longer

A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessment?

- Daily weights and abdominal girth measurements

1) A nurse's plan of care for a client with rheumatoid arthritis includes several exercise based interventions. What goals should the nurse prioritize?

- Preserve or increase ROM while limiting joint stress

1) Patient had paracentesis an hour ago. Which is priority finding by the nurse?

- Urine output is 20mL/hr (normal: 30mL/hr- is the minimum)

1) Patient with dementia is sundowning in the late afternoon. What can you do to prevent sundowning earlier in the day?

- keep the blinds open during the day (as much natural light as possible because they sundown as soon as the sun goes down)

1) A client who undergoes hemodialysis three times weekly is on a fluid restriction of 1000ml/day. The nurse sees the client drinking a 355mL (12oz) soft drink after the client has already reached the max intake of fluid of the day. What action should the nurse take

- reinforce the importance of the fluid restriction and document the teaching and the intake of extra fluid

A nurse is planning care for a 28 year old woman hospitalized with diagnosis of myasthenia gravis. What approach would be most appropriate for the care and scheduling of diagnostic procedures for this client?

. In the morning, with frequent rest periods

The nurse is administering eye drops to a client with glaucoma. After instilling the clients first medication, how long should the nurse wait before instilling the clients second medication into the same eye?

5 minutes

A school nurse is called to the playground where a 6 year old girl has been found sitting unresponsive and "staring into space" according to the playground supervisor. How would the nurse document the girls activity in her chart at school?

Absence seizure

1) the nurse caring for a client in ICU diagnosed with Guillain-Barre syndrome should prioritize monitoring for what potential complication?

Autonomic Dysfunction

A client with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the client's prioritization for receiving a donor liver be determined?

By objectively determining the client's medical need

The nurse on the medical surgical unit is reviewing discharge instruction with a client who has a history of glaucoma. The nurse should anticipate the use of what meds?

Cholinergics

1) The nurse is caring for a client diagnosed with hypothyroidism secondary to Hashimoto's thyroiditis. When assessing the client, what sign or symptoms would the nurse expect to see?

Fatigue

A nurse has entered the room of a client with cirrhosis and found the client on the floor. The client states that she fell when transferring to the commode. The client's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action?

Have the client assessed by the primary provider due to the risk of internal bleeding

1) A 37 year old woman with multiple sclerosis is married and has three children. The nurse has worked extensively with the women and her family to plan appropriate care. What is the nurse's most important role with this client?

Help the client develop strategies to important treatment regimen

A nurse is caring for a client with liver failure and is performing an assessment in the knowledge of the clients increased r/o bleeding. The nurse recognizes that this risk is related to the client's inability to synthesize prothrombin in the liver. Which factor most likely contributes to this loss of function?

Inability of the liver to use vitamin K

1) The nurse's review of the client's most recent laboratory results indicates a bilirubin level of 3.0 mg/dL (51 mmol/L). The nurse should assess the client for

Jaundice

1) A client with Parkinson disease is experiencing episodes of constipation that are becoming increasingly frequent and severe. The client states that he has been achieving relief for the past few weeks by using over-the-counter laxatives. How should the nurse respond?

Let's explore other options, because laxatives can have side effects and create dependency."

A client with Guillain-barre syndrome has experienced a sharp decline in vital capacity. What is the nurse's most appropriate action?

Prepare to assist with intubation

1) A client has a glomerular filtration rate (GFR) of 43 mL/min/1.73m. Based on this GFR, the nurse interprets that the client's chronic kidney disease is at what stage?

Stage 3

The registered nurse taking shift report learns that an assigned client is blind. How should the nurse best communicate with this client?

State her name and role immediately after entering the client's room

1) A man and woman are in their early 80s and have provided constant care for their 44 year old son who has Down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have what concerns around what questions?

who will care for our son once we are unable?"

The nurse caring for a client diagnosed with Guillian_Barre syndrome is planning care with regard to clinical manifestations associated with this syndrome. The nurse's communication with the client should reflect the possibility of what sign of symptoms of the disease?

Vocal Paralysis

- characterized by inflamed, swollen joints" 1) A client with an exacerbation of systemic lupus erythematosus has been hospitalized in the medical unit. The nurse observes that the client expresses anger and irritation when her call bell isn't answered immediately. What would be the most appropriate response?

You seem like you're feeling angry. Is that something that we could talk about?"

1) As a case manager the nurse oversees the multidisciplinary care of several clients living with chronic conditions. Two of the nurses clients are living with spina bifida. The center of care for these two clients will typically exist where?

in the home

1) 5Priority assessment of a client with RA in the home?

the client's functional status