Exam 3 Practice questions

A client with a recent history of sinusitis develops meningitis and demonstrates a positive Brudzinski sign. What is the priority nursing care? 1 Monitoring intracranial pressure 2 Adding pads to the side of the bed 3 Administering prescribed antibiotics 4 Hydrating the client with hypotonic saline

3

Which antiepileptic drug is used as the first-line treatment for absence seizures? 1 Phenytoin 2 Diazepam 3 Valproic acid 4 Acetazolamide

3

A nurse is caring for an infant with bacterial meningitis. The parents ask how their baby could have contracted the illness. What does the nurse consider as the most likely route of transmission to the central nervous system? 1 Genitourinary tract 2 Gastrointestinal tract 3 Skin or mucous membranes 4 Cranial apertures or sinuses

4

According to the Healthcare Personnel Vaccination Recommendations, what meningococcal conjugate vaccine dose should a nurse administer to a 12-year-old with an HIV infection? 1 Single initial dose and a booster dose 3 years later 2 Single initial dose and a booster dose 5 years later 3 Single initial dose and a booster dose 7 years later 4 Two initial doses and a booster dose at 16 years old

4

Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos

Elevate the head of the patient's bed to reduce periorbital fluid

A client with hyperthyroidism has been treated with radioactive iodine ( 131I) to destroy overactive thyroid gland cells. To reduce radiation exposure, the nurse's principles for providing care should be based on what?

Limiting distance and time spent with the client

Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm?

Propranolol (Inderal

Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland?

Thyroid-stimulating hormone (TSH) level low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH

The nurse will plan to teach a patient to minimize physical and emotional stress while the patient is undergoing

a 24-hour urine test for free cortisol.

An 82-yr-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed

diazepam (Valium). Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults

Which neurologic manifestation in a client is associated with hyperthyroidism?

exopthalmos

Phenytoin is used to treat

partial, secondary, and generalized tonic-clonic seizures.

Diazepam is used to treat

status epilepticus

A nurse is caring for an infant born with a myelomeningocele who is scheduled for surgery. What is the priority preoperative goal for this infant? 1 Keeping the infant sedated 2 Keeping the infant infection free 3 Ensuring maintenance of leg movement 4 Ensuring development of a strong sucking reflex

2

An infant with a myelomeningocele is admitted to the pediatric intensive care unit. While the infant is awaiting surgical correction of the defect, what is the most appropriate nursing intervention? 1 Using disposable diapers 2 Placing the infant in the prone position 3 Performing neurologic checks above the site of the lesion 4 Washing the area below the defect with a nontoxic antiseptic

2 The prone position is the best position for preventing pressure on the sac.

For how long should a nurse maintain isolation of a child with bacterial meningitis? 1 For 12 hours after admission 2 Until the cultures are negative 3 Until antibiotic therapy is completed 4 For 48 hours after antibiotic therapy begin

4

Which nursing assessment of a 70-yr-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?

Apical pulse rate

A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?

Assess the patient's respiratory effort. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany

The nurse has administered prescribed IV mannitol (Osmitrol) to an unconscious patient. Which parameter should the nurse monitor to determine the medication's effectiveness? a. Blood pressure c. Intracranial pressure b. Oxygen saturation d. Hemoglobin and hematocrit

C

A patient has been admitted with meningococcal meningitis. Which observation by the nurse requires action? a. The patient receives a regular diet tray. b. The bedrails on both sides of the bed are elevated. c. Staff have turned off the lights in the patient's room. d. Staff have entered the patient's room without a mask.

D

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)?

Increased thyroxine (T4) level

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency

Increasing serum sodium levels

A nurse is caring for a 2-year-old child with meningitis. For which clinical manifestations of increasing intracranial pressure should the nurse assess the child? Select all that apply.

Seizures Vomiting Decreased respiratory rate

Which assessment finding for a 33-yr-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse?

Temperature 103.8° F (40.4° C

A nurse is caring for a client with hyperthyroidism. Which laboratory test will be most beneficial in monitoring the effectiveness of drug therapy?

Thyroxine (T 4), total

The nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids

keep the specimen refrigerated or on ice.

A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient

that symptoms of hypothyroidism may occur as the RAI therapy takes effect.

Changes in the patient's voice indicate that

the goiter is compressing the laryngeal nerve and may lead to airway compression.

Phenytoin level

10-20

A child is admitted to the hospital with a tentative diagnosis of meningitis, and a lumbar puncture is performed to confirm the diagnosis. What finding from the spinal fluid report should lead the nurse to conclude that bacterial meningitis is present? 1 Increased protein 2 Increased glucose 3 Decreased specific gravity 4 Decreased white blood cell count

1 causes increased permeability of the blood-cerebrospinal fluid barrier, resulting in increased protein in cerebrospinal fluid

A client who is at risk for seizures as a result of severe preeclampsia is receiving an intravenous infusion of magnesium sulfate. What findings cause the nurse to determine that the client is showing signs of magnesium sulfate toxicity? Select all that apply. 1 Proteinuria 2 Epigastric pain 3 Respirations of 10 breaths/min 4 Loss of patellar reflexes 5 Urine output of 40 mL/hr

3 4

A child is admitted to the pediatric unit with a diagnosis of meningococcal meningitis. What does the nurse conclude about isolation? 1 It is unnecessary during the incubation period. 2 It is required for 7 to 10 days until the fever subsides. 3 It will be unnecessary after the diagnosis is confirmed. 4 It will be necessary for 24 to 72 hours after the initiation of antibiotic therapy

4

Which action will the public health nurse take to reduce the incidence of epidemic encephalitis in a community? a. Teach about prophylactic antibiotics after exposure to encephalitis. b. Encourage the use of effective insect repellent during mosquito season. c. Remind patients that most cases of viral encephalitis can be cared for at home. d. Arrange to screen school-age children for West Nile virus during the school year.

B

A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication? a. Inspect the oral mucosa. c. Auscultate the bowel sounds. b. Listen to the lung sounds. d. Check pupil reaction to light.

A

A patient who has bacterial meningitis is disoriented and anxious. Which nursing action will be included in the plan of care? a. Encourage family members to remain at the bedside. b. Apply soft restraints to protect the patient from injury. c. Keep the room well-lighted to improve patient orientation. d. Minimize contact with the patient to decrease sensory input.

A

A patient reports feeling numbness and tingling of the left arm before experiencing a seizure. The nurse determines that this history is consistent with what type of seizure? a. Focal c. Absence b. Atonic d. Myoclonic

A The initial symptoms of a focal seizure involve clinical manifestations that are localized to a particular part of the body or brain.

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next?

Administer IV calcium gluconate.

A 12-year-old girl is admitted to the pediatric unit with a diagnosis of meningococcal meningitis. Three days after admission the child is afebrile and asymptomatic but appears sad and cries frequently. How should the nurse help the child verbalize her thoughts and feelings?

Correct1 By telling the child that she seems sad and upset

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus?

Glucocorticoids accelerate the process of gluconeogenesis.

Which statement by a 50-yr-old female patient indicates to the nurse that further assessment of thyroid function may be necessary?

"I feel a lump in my throat when I swallow."

A 13-month-old child is admitted with a tentative diagnosis of bacterial meningitis, and the practitioner schedules a lumbar puncture. What is the most important action the nurse should take in preparation for the lumbar puncture? 1 Asking the parents what they were told about the test 2 Using a doll to demonstrate the procedure to the child 3 Obtaining a pacifier for the child to suck on during the procedure 4 Telling the parents that they may stay with their child during the test

1

A client is admitted to the emergency department in the midst of persistent tonic-clonic seizures (status epilepticus). Diazepam is to be administered immediately. In addition to decreasing central neuronal activity, what other effect does the nurse anticipate? 1 Relaxing peripheral muscles 2 Slowing cardiac contractions 3 Dilating tracheobronchial structures 4 Providing amnesia of the convulsive episode

1

A nurse is caring for an infant with meningitis. When the nurse extends the baby's leg, the hamstring muscles go into spasm and the infant begins to cry. What sign or reflex is the infant exhibiting? 1 Kernig sign 2 Babinski reflex 3 Chvostek sign 4 Cremasteric reflex

1

A nurse places a school-aged child with bacterial meningitis in isolation with droplet precautions. What is the purpose of these precautions? 1 They keep the child away from uninfected people. 2 The infectious process is interrupted as quickly as possible. 3 The child is protected from contracting a secondary infection. 4 They prevent the development of a hospital-acquired infection.

1

A nurse is caring for a child with a diagnosis of meningitis. What clinical findings indicate an increase in intracranial pressure? Select all that apply. 1 Irritability 2 Bradycardia 3 Hyperalertness 4 Decreased pulse pressure 5 Decreased systolic blood pressure

1 2

The nurse is caring for a client who underwent surgery for a brain tumor. On assessment, the nurse suspects meningitis in the client. Which finding would help confirm the nurse's suspicion? 1 Positive Kernig sign 2 Glasgow coma score: 10 3 Absence of nuchal rigidity 4 Negative Brudzinski sign

1 Meningitis may occur secondary to surgical procedures on the brain. It is highly probable when Kernig sign is positive

An infant who underwent revision of a ventriculoperitoneal shunt is found to have meningitis, the result of an infected shunt. What clinical manifestations support this conclusion? Select all that apply. 1 Fever 2 Lethargy 3 Stiff neck 4 Poor feeding 5 Depressed fontanels

1234

A 1-year-old infant has been admitted with a tentative diagnosis of bacterial meningitis. A lumbar puncture is performed to confirm the diagnosis. What laboratory report on the cerebrospinal fluid (CSF) supports this diagnosis? 1 Decreased cell count 2 Increased protein level 3 Increased glucose level 4 Low spinal fluid pressure

2

What is the priority nursing intervention for an infant with a myelomeningocele before surgical correction? 1 Minimizing infection 2 Preventing trauma to the sac 3 Monitoring for increasing paralysis 4 Assessing the degree of bowel and bladder control

2

A child is admitted to the pediatric intensive care unit with acute bacterial meningitis. What is the nurse's priority intervention?

2 Checking the child's level of consciousness hourly

A 2-year-old toddler is admitted to the pediatric unit with a diagnosis of bacterial meningitis. What is the most important safety measure for the nurse to institute immediately after the child has a seizure? 1 Monitoring the child's vital signs 2 Padding the side rails of the toddler's crib 3 Placing the child in the side-lying position 4 Bringing suction equipment to the bedside

3

A newborn with a myelomeningocele is being transferred immediately from the birthing room to the neonatal intensive care unit (NICU). What is the initial nursing intervention? 1 Start antibiotic prophylaxis 2 Provide routine newborn care 3 Apply a sterile saline dressing 4 Assess the infant for paralysis

3

A nurse is caring for a child with meningococcal meningitis. What clinical finding does the nurse expect to encounter during a physical assessment? 1 Severe glossitis 2 Low-grade fever 3 Purpuric skin rash 4 Tremors of the extremities

3

What does a nurse recognize as the most serious complication of meningitis in young children? 1 Epilepsy 2 Blindness 3 Peripheral circulatory collapse 4 Communicating hydrocephalus

3

A 2½-year-old toddler is admitted with a fever of 103° F (39.4° C), stiffness of the neck, and general malaise. The diagnosis is acute bacterial meningitis. What is the priority nursing intervention for this child? 1 Increasing fluids 2 Administering oxygen 3 Giving a tepid sponge bath 4 Instituting droplet precautions

4 Droplet precautions prevent the spread of infection to others; isolation is a priority and should be implemented immediately

Admission vital signs for a brain-injured patient are blood pressure of 128/68 mm Hg, pulse of 110 beats/min, and of respirations 26 breaths/min. Which set of vital signs, if taken 1 hour later, will be of most concern to the nurse? a. Blood pressure of 154/68 mm Hg, pulse of 56 beats/min, respirations of 12 breaths/min b. Blood pressure of 134/72 mm Hg, pulse of 90 beats/min, respirations of 32 breaths/min c. Blood pressure of 148/78 mm Hg, pulse of 112 beats/min, respirations of 28 breaths/min d. Blood pressure of 110/70 mm Hg, pulse of 120 beats/min, respirations of 30 breaths/min

A

The nurse observes a patient ambulating in the hospital hall when the patient's arms and legs suddenly jerk and the patient falls to the floor. The nurse will first a. assess the patient for a possible injury. b. give the scheduled divalproex (Depakote). c. document the timing and description of the seizure. d. notify the patient's health care provider about the seizure.

A The patient who has had a myoclonic seizure and fall is at risk for head injury and should first be evaluated and treated for this possible complication.

A patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room (select all that apply)? a. Side-rail pads d. Suction tubing b. Tongue blade e. Urinary catheter c. Oxygen mask f. Nasogastric tube

A, C, D The patient is at risk for further seizures, and O2 and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The bed's side rails should be padded to minimize the risk for patient injury during a seizure

Which prescribed intervention will the nurse implement first for a patient in the emergency department who is experiencing continuous tonic-clonic seizures?

Administer lorazepam (Ativan) 4 mg IV. should administer rapidly acting antiseizure medications such as the benzodiazepines.

Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease?

Antithyroid medications may take several months for full effect.

A client with the diagnosis of Cushing syndrome has the following laboratory results: Na (sodium) 149 mEq/L (149 mmol/L); K + (potassium) 3.2 mEq/L (3.2 mmol/L); Hb (hemoglobin) 17 g/dL (170 mmol/L); and glucose 90 mg/dL (5 mmol/L). What should the nurse teach the client? Select all that apply.

Avoid foods high in salt. Eat foods high in potassium.

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

B

Family members of a patient who has a traumatic brain injury ask the nurse about the purpose of the ventriculostomy system being used for intracranial pressure monitoring. Which response by the nurse is best for this situation? a. "This type of monitoring system is complex and it is managed by skilled staff." b. "The monitoring system helps show whether blood flow to the brain is adequate." c. "The ventriculostomy monitoring system helps check for alterations in cerebral perfusion pressure." d. "This monitoring system has multiple benefits including facilitation of cerebrospinal fluid drainage."

B

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

B

The public health nurse is planning a program to decrease the incidence of meningitis in teenagers and young adults. Which action is most likely to be effective? a. Emphasize the importance of hand washing. b. Immunize adolescents and college freshman. c. Support serving healthy nutritional options in the college cafeteria. d. Encourage adolescents and young adults to avoid crowds in the winter.

B

When a brain-injured patient responds to nail bed pressure with internal rotation, adduction, and flexion of the arms, the nurse reports the response as a. flexion withdrawal. c. decorticate posturing. b. localization of pain. d. decerebrate posturing.

C

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

C

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

C Many older patients (especially with compromised liver function) may not be able to metabolize phenytoin.

A patient being admitted with bacterial meningitis has a temperature of 102.5° F (39.2° C) and a severe headache. Which order should the nurse implement first? a. Administer ceftizoxime (Cefizox) 1 g IV. b. Give acetaminophen (Tylenol) 650 mg PO. c. Use a cooling blanket to lower temperature. d. Swab the nasopharyngeal mucosa for cultures.

D Antibiotic therapy should be instituted rapidly in bacterial meningitis, but cultures must be done before antibiotics are started.

When assessing a 53-yr-old patient with bacterial meningitis, the nurse obtains the following data. Which finding requires the most immediate intervention? a. The patient exhibits nuchal rigidity. b. The patient has a positive Kernig's sign. c. The patient's temperature is 101° F (38.3° C). d. The patient's blood pressure is 88/42 mm Hg.

D Shock is a serious complication of meningitis, and the patient's low blood pressure indicates the need for interventions such as fluids or vasopressors

A 13-month-old child is undergoing lumbar puncture for confirmation of a diagnosis of bacterial meningitis. During the procedure the nurse notes that the spinal fluid is cloudy. What does this finding indicate?

Increased white blood cell (WBC) count

A client with newly diagnosed hyperthyroidism is treated with propylthiouracil, an antithyroid drug, along with potassium iodide. What should the nurse take into consideration when caring for the client?

Monitoring for signs of infection or bleeding is necessary.

A 44-yr-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for the patient problem of disturbed body image related to changes in appearance?

Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

A patient with possible viral meningitis is admitted to the nursing unit after lumbar puncture was performed in the emergency department. Which action prescribed by the health care provider should the nurse question? a. Restrict oral fluids to 1000 mL/day. b. Elevate the head of the bed 20 degrees. c. Administer ceftriaxone (Rocephin) 1 g IV every 12 hours. d. Give ibuprofen (Motrin) 400 mg every 6 hours as needed for headache.

The patient with meningitis has increased fluid needs, so oral fluids should be encouraged. The other actions are appropriate.