260 New Content (DM, Neuro + Sensory)
The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes mellitus?
A 48-year-old woman with a hemoglobin A1C of 8.4% (greater than 6.5)
Which client would the nurse identify as being at highest risk for a cerebrovascular accident (CVA)?
A 79 year old patient who has poorly controlled hypertension + smokes half a pack of cigarettes daily
2. The nurse plans the care for the hospice client with end-stage Parkinson's disease. Which of the following symptoms should the nurse expect to incorporate into the nursing care plan? A) Bradykinesia B) Hemiparesis C) Hemiplegia D) Visual impairment
A) Bradykinesia (slow movement)
The nurse prepares the patient for a test to determine the cause of the cerebrovascular accident (CVA). For which test should the nurse teach the client and family? A) Carotid Doppler studies B) Visual acuity testing C) Arterial blood flow to weakened extremity D) Speech therapy evaluation
A) Carotid Doppler study
A nurse is evaluating an elderly client's lifestyle to determine the level of risk for neurovascular problems. Which of the following should the nurse identify to the client as the most significant lifestyle risk factor for neurovascular problems such as Parkinson's disease and stroke? A) Cigarette smoking B) Failure to use seat belts C) Sexually transmitted disease D) Alcohol and drug abuse
A) Cigarette smoking
4. The nurse monitors a group of older adults exercising at the wellness center. For which of the following new assessment findings should the nurse immediately call first responders? A) Inability to speak and imbalance B) Muscle spasms and pain C) Nausea and lethargy D) Tremor in the hands
A) Inability to speak and imbalance (may be a stroke)
A 77-year-old woman has recently been diagnosed with type 2 diabetes. The gerontological nurse who is working with the woman has emphasized the need for the woman to make smart lifestyle choices in the management of her chronic condition. The woman has retorted, "Choices! I didn't choose to get diabetes and there's not much that I can do about it!" Which of the following statements best underlies the response that the nurse will provide? A) Many of the factors that contribute to increased quality of life are within the woman's direct control. B) The woman has the ability to adopt or reject behaviors that have the potential to cure her disease. C) The woman can identify treatment options in consultation with the physician who is providing her care. D) Lifestyle choices exist only in older adults with strong support networks and sufficient resources.
A) Many of the factors that contribute to increased quality of life are within the woman's direct control.
Which of the following patients on a subacute geriatric medicine unit is likely at the highest risk for experiencing a cerebrovascular accident (CVA)? A) Mr. L, age 79, who has poorly controlled hypertension and smokes half a pack of cigarettes daily. B) Mrs. H, a 90-year-old woman, who has a diagnosis of vascular dementia. C) Mr. J, a 77-year-old man, who has experienced an upper GI bleed and required a transfusion of packed red blood cells. D) Mrs. N, age 83, who has had a recent fall resulting in a broken left wrist and hip.
A) Mr. L, age 79, who has poorly controlled hypertension and smokes half a pack of cigarettes daily.
The nurse advises the 80-year-old patient not to sleep slumped in the recliner. The nurse explains that proper positioning of the head and neck can help prevent transient ischemic attacks (TIAs) in which of the following ways? A) Preventing impairment of cerebral blood flow B) Increasing neck muscle strength C) Maintaining blood pressure in a normal range D) Decreasing muscle tension
A) Preventing impairment of cerebral blood flow
The nurse is providing discharge instructions to a client with glaucoma. Which activities does the nurse instruct the client to avoid?
A. Bending over to tie shoes D. Blowing the nose frequently E. Lifting objects weighing more than 10 pounds
During a health promotion class, a group of older adults asks the nurse to teach them measures that they can take to foster neurologic health. What should the nurse tell the group? A) "Neurological illnesses are generally the result of factors beyond your control." B) "Quitting smoking and maintaining a healthy body weight can cut your risk of neurological diseases." C) "The best protective measure for your neurological health is to avoid environmental toxins and eat a healthy diet." D) "The more mentally active you stay by continually reading and learning, the less your chance of developing neurological disease."
B) "Quitting smoking and maintaining a healthy body weight can cut your risk of neurological diseases."
The son and daughter of an 80-year-old woman have expressed concern to the nurse that their mother has become impatient and irritable since her stroke earlier in the year. How should the nurse best respond to the children's concerns? A) "There is a new generation of medications that can help control outbursts with very few side effects." B) "This could be a sign that your mother is still experiencing transient ischemic attacks, so I will make sure to let her physician know." C) "This is not an uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality." D) "This is likely a temporarily response to the difficult changes that a stroke causes, and these behaviors will likely diminish with time."
C) "This is not an uncommon consequence of a stroke that must be difficult for you to see, since it is uncharacteristic of her personality."
During a neurologic evaluation, the nurse practitioner has asked an 83-year-old client to draw the face of the clock and then tell the nurse what time the clock reads. Which of the following assessment findings would be most indicative of expressive aphasia? A) The client appears unable to understand and follow the instruction. B) The client draws a person's face rather than the face of a clock. C) The client draws a clock but is unable to state the time. D) The client draws a clock with four hands rather than two.
C) The client draws a clock but is unable to state the time.
The nurse initiates teaching for the patient and family with newly diagnosed Parkinson's disease. In communicating with the patient and his family, which of the following should the nurse emphasize? A) Speech problems may affect the patient's expressive abilities. B) Emotional stability is maintained as the disease progresses. C) The disease progresses slowly, and therapy can minimize disability. D) Intellectual functioning is eventually impaired by this disease.
C) The disease progresses slowly, and therapy can minimize disability.
A nurse who provides care in a long-term facility is working with a 78-year-old resident who has a diagnosis of Parkinson's disease. Which of the following aspects of the care the nurse provides should be reconsidered or modified? A) The nurse encourages the resident to continue to participate in the regular exercise programs at the facility. B) The nurse provides assistance with activities of daily living when necessary but encourages the resident to do what can be done independently. C) The nurse phrases questions and directions in a simple and understandable manner applicable to the client's decreased cognition. D) The nurse facilitates active and passive range of motion exercises on a regular basis.
C) The nurse phrases questions and directions in a simple and understandable manner applicable to the client's decreased cognition **dont assume one has a cognitive impairment**
A 79-year-old male patient has a number of health problems, including Parkinson's disease. Which of the following signs and symptoms would the nurse attribute to the client's diagnosis of Parkinson's disease? (Select all that apply.) A) The patient's vision is gradually deteriorating. B) The patient experiences frequent, severe headaches. C) The patient moves slowly and has poor balance. D) The client shuffles when walking. E) The patient's face is less expressive than when healthy. F) The patient is emotionally unstable.
C) The patient moves slowly and has poor balance. D) The client shuffles when walking. E) The patient's face is less expressive than when healthy. F) The patient is emotionally unstable.
Which question should the RN ask during the assessment related to risk factors for vision loss in the older adult?
Do you have high blood pressure or diabetes?
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take?
Eat 15 g of simple carbohydrates.
An older client asks the nurse why she is most likely experiencing a gradual hearing loss. RN response?
Presbycusis is an age-related high frequency sensorineural hearing loss.
Nurses in change-of-shift report are discussing the care of a patient with a stroke who has progressively increasing weakness and decreasing level of consciousness (LOC). Which nursing diagnosis do they determine has the highest priority for the patient?
Risk for aspiration related to inability to protect airway
Which of the following nursing diagnoses is the priority diagnosis for a patient with Ménière's disease?
Risk for injury
A client who has been newly diagnosed with diabetes mellitus has been stabilized with daily insulin injections. Which teaching information should the nurse reinforce upon discharge?
Rotate the insulin injections sites systematically
Priority teaching in diabetic education plan?
Safe medication use
To reduce the risk of stroke, what action should the nurse encourage?
rigorous control of client's blood pressure and serum lipid levels
Which sensation-related RN diagnosis is most associated w/aging client and deficits in their sensory system?
risk for injury
Older client has significant vision changes. What should RN do when providing written teaching material for them?
select materials with large print
Which is a modifiable risk factor for transient ischemic attacks and ischemic strokes?
smoking
RN assessing the eyes of a 77-year-old client. Which finding would lead the nurse to suspect that the client is developing cataracts?
the client states "my vision is becoming more and more blurry"
A 56-year-old patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously, and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for
tissue plasminogen activator (tPA) infusion.
The nurse prepares to teach an older client on the use of a new hearing aid. What should this teaching include?
turn the device off when it is not being worn
RN cares for older client recovering from a stroke. Which intervention should the nurse use to enhance client's memory?
use familiar objects
Older adult client states, "I often have dry eyes; it is bothersome and irritating." What intervention should RN suggest
use of over-the-counter artificial tears
Client with diabetes and taking insulin has lost 12 pounds over the last month. What diagnosis would guide the RN's care
altered nutrition
A female patient who had a stroke 24 hours ago has expressive aphasia. The nurse identifies the nursing diagnosis of impaired verbal communication. An appropriate nursing intervention to help the patient communicate is to
ask questions that the patient can answer with "yes" or "no."
A 70-year-old female patient with left-sided hemiparesis arrives by ambulance to the emergency department. Which action should the nurse take first?
assess vitals (resp rate!)
During home health visit, RN notices patient with diabetes slurring speech. Priority assessment?
blood glucose levels
Which finding should RN prioritize and address first?
blood glucose of 338 mg/dL in an 88-year-old adult
otosclerosis
bones of the middle ear fuse/stiffen resulting in a conductive hearing loss due to inability to amplify sound.
macular degeneration
breakdown or thinning of the tissues in the macula, resulting in partial or complete LOSS OF CENTRAL VISION.
Which age related changes may result in hearing loss?
degeneration of the inner ear
Priority nursing diagnosis for the patient with peripheral neuropathy related to diabetes type II?
disturbed sensory perception
Priority nursing diagnosis for diabetic patient experiencing urinary frequency as a result of their diabetes?
disturbed sleep pattern
What guidelines apply to "sick days" and insulin use?
do not eliminate insulin when nauseated and vomiting
Pt w/Parkinson's disease. On which neurotransmitter should RN focus when teaching the client about this health problem?
dopamine
Older client has accumulated cerumen in both ear canals. What should RN anticipate being prescribed for this client?
ear irrigation
How does aging affect the endocrine system and hormones?
endocrine system's ability to regulate body activities decreases
Older adult w/diabetes has stopped exercise routine since "feeling funny" after the activity. RN appropriate response?
exercise affects metabolism of insulin
Priority nursing action for patient with HHS (hyperosmolar hyperglycemic disorder)?
fluid and electrolyte replacement
Polydipsia and polyuria related to diabetes mellitus are primarily due to:
fluid shifts resulting from the osmotic effect of hyperglycemia
Older client reports not leaving house much because of not being able to hear well. What should RN encourage?
have a hearing test done
Which laboratory findings suggests that the patient is controlling their diabetic diagnosis?
hemoglobin A1c 5.8%
Which finding suggests the diabetic patient could benefit from additional teaching?
hemoglobin A1c 9.1%
Hypoglycemia symptoms
hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin
Aphasia
impairment of language (cant put words/syllables together to form understandable sentences)
Glaucoma
inc IOP damages optic nerve
The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which symptom reported by the patient is considered one of the classic clinical manifestations of diabetes?
inc thirst
Which diagnosis is associated with the aging adult who has chronic diabetes?
ineffective tissue perfusion
RN developing teaching program for older adult with diabetes. Which would be most appropriate for RN to use?
printed handouts on white paper with font size 16
Which precaution is most important for the nurse to teach a 62-year-old client newly diagnosed with early-stage dry age-related macular degeneration?
quit smoking
A diabetic patient has a serum glucose level of 824 mg/dL and is unresponsive. Following assessment of the patient, the nurse suspects diabetic ketoacidosis rather than hyperosmolar hyperglycemic syndrome based on the finding of?
rapid, deep respirations
A patient in the emergency department with sudden-onset right-sided weakness is diagnosed with an intracerebral hemorrhage. Which information about the patient is most important to communicate to the health care provider?
The patient has atrial fibrillation and takes warfarin (Coumadin).
The nurse is working with an older adult patient with diagnoses of hyponatremia and anemia who is complaining of pain. Which of the following pieces of data should the nurse prioritize as a guide for choosing interventions?
The patient is complaining of intense pain that he rates at 8 out of 10.
A 68-year-old patient is being admitted with a possible stroke. Which information from the assessment indicates that the nurse should consult with the health care provider before giving the prescribed aspirin?
The patient reports that symptoms began with a severe headache *Hemorrhagic*
Which information about the patient who has had a subarachnoid hemorrhage is most important to communicate to the health care provider?
The patient's blood pressure (BP) is 90/50 mm Hg. **need it to be higher to provide O2 + nutrients**
Which stroke risk factor for a 48-year-old male patient in the clinic is most important for the nurse to address?
The patient's usual blood pressure (BP) is 170/94 mm Hg. **HTN**
What finding should signal RN to possible dysphagia in client who experienced stroke 3 weeks ago?
When providing oral care, nurse finds food pocketed in the client's cheeks
RN is teaching a group of hearing-impaired nursing home residents about hearing aids. Which point should RN emphasize?
While inserting the hearing aid, make sure the volume is off.
The client who had cataract surgery with a lens implant 1 week ago remarks to the home care nurse that after his daughter left to go to her home in another state yesterday, he combined all of his prescribed eyedrops together in one container so he had fewer drops to administer. What is the nurse's best response?
"Call your surgeon immediately and get new prescriptions to use one at a time because these drugs cannot be mixed together."
Which statement by the patient with type 2 diabetes is accurate.
"I am supposed to have a meal or snack if I drink alcohol" (want to dec hypoglycemia rx)
The nurse is teaching a 60-year-old woman with type 2 diabetes mellitus how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful?
"I can help control my blood pressure by avoiding foods high in salt."
The nurse is teaching a client about open-angle glaucoma management. Which statement by the client indicates a need for further instruction?
"I must press on the inside of my eye to prevent washout."
The nurse teaches a 38-year-old man who was recently diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient requires an intervention by the nurse?
"I will discard any insulin bottle that is cloudy in appearance."
RN suspects that older client experiencing presbycusis. What did client say to cause RN to make this determination?
"Why did the aide comment about the "un line" when looking out the window?"
A 54-year-old patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse?
"With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased."
What client statement would serve to support a medical diagnosis of presbycusis?
"at times I only hear jumbled words instead of sentences"
From the following list of signs and symptoms, identify those which are associated with angle closure (also called narrow-angle or closed-angle) glaucoma. (Select all that apply.) - painless - gradual loss of visual field - nausea + vomiting - normal visual acuity - seeing halos around lights
- nausea + vomiting - seeing halos around lights
What is the most important key concept to include in an education plan for an older client with a loss of central vision? 1. A loss of central vision accompanies macular degeneration. 2. A loss of central vision accompanies detached retina. 3. A loss of central vision accompanies corneal ulcer. 4. A loss of central vision accompanies open angle glaucoma.
1. A loss of central vision accompanies macular degeneration.
A 63-year-old patient who began experiencing right arm and leg weakness is admitted to the emergency department. In which order will the nurse implement these actions included in the stroke protocol?
1. Administer oxygen to keep O2 saturation >95%. 2. Use National Institute of Health Stroke Scale to assess patient. 3. Obtain computed tomography (CT) scan without contrast. 4. Infuse tissue plasminogen activator (tPA).
What are the effects of aging on vision?
1. Dec ability to focus **presbyopia** 2. Dec pupil size 3. Visual acuity declines 4. Difficulty w/ vision at night 5. Inc sensitivity to glare 6. Distortion of depth perception **FALL HAZARD** 7. Dec peripheral vision
Effects of aging on hearing
1. Impacted cerumen 2. Sensorineural hearing loss (presbycusis)
What are two important considerations for promoting vision
1. Routine examinations by ophthalmologist 2. Early detection and treatment of problems
Considerations for hearing aid care
1. Turn the aid off or remove the battery when not using 2. Store in a safe, padded container. 3. Clean weekly 4. Protect from exposure to extreme heat, cold weather or moisture 5. When changing the battery, turn off the aid first 6. Take for routine checks 7. Turn off before putting in ear
The nurse is caring for a patient who has a hearing deficit. Which of the following techniques should be implemented by the nurse to improve communication?
1. Use a low voice pitch with normal loudness 2. Use short sentences.
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital?
1. insulin administration 2. use of portable blood glucose monitor 3. hypoglycemia prevention, symptoms, and treatment
A nurse knows teaching to an older adult about vision care has been effective when the client states: 1. "Taking high doses of antioxidants increases my risk for macular degeneration." 2. "The development of cataracts has been associated with malnutrition, cigarette smoking, and diabetes." 3. "Having Alzheimer's disease increases one's risk of developing macular degeneration." 4. "If I take ototoxic medications, this will increase my risk for developing cataracts."
2. "The development of cataracts has been associated with malnutrition, cigarette smoking, and diabetes."
Thrombolytic therapy in treatment of ischemic stroke should be initiated in how many hours after onset of stroke?
3 hours
In order for tissue plasminogen activator (tPA) to be most effective in the treatment of stroke, it must be administered?
3 hours after the onset of stroke symptoms **only for ischemic**
An otologist has recommended the use of a hearing aid for a 74-year-old client who has experienced a progressive loss of hearing acuity in recent years. When teaching the client about this, which information would the nurse most likely include? 1. "With the right hearing aid, you can expect your hearing to be back to normal." 2. "You can save money by purchasing hearing aids online or by mail order after you get the prescription." 3. "Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise." 4. "Many people find that hearing aids only help with certain types of hearing loss that are caused by previous noise exposure."
3. "Even though hearing aids will help you, they also bring challenges like distorted speech and amplified background noise."
A 77-year-old client is diagnosed with glaucoma and is receiving treatment. When teaching the client about self-care measures to prevent complications, which information would the nurse most likely include? 1. Avoid watching television in low-light conditions or for long periods of time. 2. Remain in a lying position as much as possible throughout the day. 3. Avoid stress, coughing, sneezing, or the Valsalva maneuver. 4. Use antihypertensive medications and diuretics with great caution.
3. Avoid stress, coughing, sneezing, or the Valsalva maneuver. (will inc IOP)
A homecare nurse has begun providing care for an older adult male in the community who has recently been diagnosed with type 2 diabetes. The nurse is responsible for creating a care plan for the client and has consequently identified a number of goals for his care. Which of the following goals of care is most in need of reexamination or modification? 1. "The client will gain the knowledge and skills necessary to manage his diabetes independently and effectively within 3 months." 2. "The client will remain free of common complications of diabetes." 3. "The client will maintain a high quality of life despite his diabetes." 4. "The client will no longer require blood sugar monitoring or oral antihyperglycemic medications within 12 months."
4. "The client will no longer require blood sugar monitoring or oral antihyperglycemic medications within 12 months."
The nurse is making a home visit to an older adult with a severe hearing loss. The client also does not use a hearing aid. Several family members are present and voice difficulty in caring for client. Which suggestion would be most appropriate for the nurse to make? 1. Speak as loudly as possible and face the person. 2. Use simple, one-syllable words, talking directly into the affected ear. 3. Buy the person the best hearing aid available immediately. 4. Speak in a low-frequency voice, and use sign language.
4. Speak in a low-frequency voice, and use sign language.
The nurse is assisting with preparing a teaching plan for a client with diabetes mellitus regarding proper foot care. Which instruction should be included in the plan of care?
Apply moisturizing lotion to dry feet, but not between the toes
How should the gerontological RN initially promote optimal health and wellness in client who suffered a stroke?
Assess mobility limitations.
The nurse identifies the nursing diagnosis of imbalanced nutrition: less than body requirements related to impaired self-feeding ability for a left-handed patient with left-sided hemiplegia. Which intervention should be included in the plan of care?
Assist the patient to eat with the right hand.
During a health promotion seminar, a nurse is teaching a group of older adults at a senior center about some of the normal changes that accompany the aging process. Which of the following statements about the effects of aging on the nervous system is most accurate? A) "It's actually a myth that intellectual performance and verbal skills deteriorate in older adults." B) "Your brain actually becomes smaller as you age and this affects how quickly older adults react." C) "The brain's ability to assimilate new information decreases greatly after age 65." D) "While blood flow through the brain remains consistent across the life span, the electrical activity of the brain declines somewhat later in life."
B) "Your brain actually becomes smaller as you age and this affects how quickly older adults react."
Which of the following older adults with chronic conditions is most likely to have the greatest care needs? A) An 80-year-old woman with varicose veins who has just been diagnosed with osteoarthritis. B) A 74-year-old man with macular degeneration and type 1 diabetes. C) A 77-year-old man who has long-standing hypertension and is displaying early signs of chronic renal failure. D) An 84-year-old woman who lives with severe hearing loss and recurrent hemorrhoids.
B) A 74-year-old man with macular degeneration and type 1 diabetes.
Relatives brought an elderly relative to the health center because they noticed a new behavior in the elderly person. The nurse practitioner explained that the behavior they noticed was characteristic of Parkinson's disease. Which of the following symptoms was most likely noticed in their relative? A) Forced eyelid closure B) Faint tremor in the hands or feet C) Depression D) Difficulty in swallowing
B) Faint tremor in the hands or feet
Nurses should promote activities that reduce patients' risk of cerebrovascular accident (CVA). Which of the following is the most helpful activity to promote for reducing that risk? A) Maintaining physical activity B) Managing hypertension C) Maintaining adequate hydration D) Getting sufficient nutrition
B) Managing hypertension
The nurse assesses the members of a senior center. For which of the following new findings should the nurse require immediate follow-up by the primary care provider? A) Blood pressure of 96/62 mm Hg B) Numbness of hands C) Urinary incontinence D) Opaque sclera
B) Numbness of hands
A 77-year-old patient has been brought to the emergency department by the daughter due to recent visual disturbances and unilateral weakness. The diagnostic workup has led the diagnosis of transient ischemic attacks (TIAs). Which of the following patient history most likely contributed to the patient's current health problem? A) The patient was treated for anemia 3 months ago. B) The woman is a smoker and takes antihypertensive medications. C) The woman has a history of recurrent deep vein thromboses. D) The woman was diagnosed with Parkinson's disease early this year.
B) The woman is a smoker and takes antihypertensive medications.
An autopsy shows that Lewy bodies were present in a patient's brain. Which of the following characteristics did the living patient probably exhibit? A) Hemiparesis B) Tremor C) Diplopia D) Aphasia
B) Tremor *seen in pts w/ Parkinson's*
The nurse is performing preoperative teaching for an older adult client who will be having a cataract removed. Which instructions does the nurse include? (Select all that apply.)
B. "Several different types of eyedrops are requested after surgery, and they have to be taken several times a day for up to 4 weeks." C. "You will receive a medication to help you relax. Then you will receive some different eyedrops to dilate your pupils and paralyze the lens." D. "Bring sunglasses with you on the day of your procedure."
Which patients are NOT a candidate for tissue plasminogen activator (tPA) for the treatment of stroke? A. A patient with a CT scan that is negative. B. A patient whose blood pressure is 200/110. C. A patient who is showing signs and symptoms of ischemic stroke. D. A patient who received Heparin 24 hours ago.
B. A patient whose blood pressure is 200/110. D. A patient who received Heparin 24 hours ago.
A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?
CT Scan
A client presents with diaphoresis, palpitations, jitters, and tachycardia approximately 4 hours after taking the prescribed usual morning insulin. What is the nurses priority action?
Check the blood glucose level, and administer carbohydrates
Cataracts
Clouding of the lens and loss of transparency
6. The nurse presents at a seminar on neurologic health issues in older adults. Which of the following data should the nurse include in the presentation? A) Neurological health is in the hands of God. B) Older adults are not at risk for sexually transmitted infections (STIs) that impact the neurologic system. C) Head and neck injuries can be avoided with the use of protective gear like seat belts. D) A low body mass index reduces the risk of neurovascular disease.
D) A low body mass index reduces the risk of neurovascular disease.
A patient recovering from a stroke at home seems to have a pleasant environment. Family members come in to talk with him, and he has his own familiar clothing and books in his room. A calendar shows the current date. A television and a radio are near his bed. No one disturbs him with the details of his condition. However, he seems depressed and anxious. A visiting nurse would most likely recommend which of the following? A) Encouraging reminiscence. B) Giving him antidepressant drugs. C) Redecorating his room. D) Giving him more information.
D) Giving him more information. (state of health + treatments performed)
Promoting independence in an older patient with neurologic problems may take many forms. What advice to a patient's family would most help the patient achieve maximum levels of independence? A) Attend lectures on self-improvement. B) Prepare for personality changes in the patient. C) Complete tasks for the patient. D) Install self-help devices in the home
D) Install self-help devices in the home
Good nursing care of a patient who has had a cerebrovascular accident (CVA) can improve the patient's chance of survival and minimize the limitations that impair a full recovery. In the acute phase, nursing efforts should prioritize which of the following aims? A) Teach compensatory techniques for impaired communication. B) Talk to the patient during routine activities. C) Initiation of rehabilitation. D) Maintain a patent airway.
D) Maintain a patent airway.
3. The home care nurse plans the environment of the client with Parkinson's disease. Which of the following should the environment include? A) Brightly colored throw rugs B) Electric adjustable bed with side rails C) Weight training bench and weights D) Shower with nonslip surface and rails
D) Shower with nonslip surface and rails
A nurse is communicating with a family that includes an elder who has neurologic problems. What should the nurse suggest the family include in the home to lessen the likelihood of injury to the elder? A) Scatter rugs rather than wall-to-wall carpeting B) Soft, restful lighting in all areas C) Kitchen chairs with wheels for easy movement D) Smoke alarms with batteries that are replaced often
D) Smoke alarms with batteries that are replaced often
A nurse is providing care for an 80-year-old patient who experienced an ischemic cerebrovascular accident (CVA) 3 weeks prior. Which of the following nursing actions is most likely to appropriately address the cognitive changes that have accompanied the patient's stroke? A) Discuss distant past events while avoiding discussions of recent events. B) Emphasize written rather than spoken communication on the part of both the patient and the nurse. C) Increase the volume of spoken communication as much as possible. D) Talk to the patient and give explanations while performing routine care tasks.
D) Talk to the patient and give explanations while performing routine care tasks.
1. The nurse assesses a client with Parkinson's disease. Which of the following symptoms are unexpected, requiring immediate follow-up? A) Drooling B) Hallucinations C) Hypoglycemia D) Tremors
D) Tremors
The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations ofPD would explain these assessment data?
Difficulty swallowing and immobility.
A 72-year-old patient who has a history of a transient ischemic attack (TIA) has an order for aspirin 160 mg daily. When the nurse is administering medications, the patient says, "I don't need the aspirin today. I don't have a fever." Which action should the nurse take?
Explain that the aspirin is ordered to decrease stroke risk.
A client with glaucoma is being assessed for new symptoms. Which symptom indicates a high priority need for reassessment of intraocular pressure?
Gradual vision changes
Laboratory results have been obtained for a 50-year-old patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes?
Increased triglyceride levels *FATT!!*
A patient is admitted with uncontrolled atrial fibrillation. The patient's medication history includes vitamin D supplements and calcium. What type of stroke is this patient at MOST risk for?
Ischemic embolism (A.Fib inc risk for clot formation)
A patient, who is admitted with diabetes mellitus, has a glucose level of 380 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find?
Kussmaul respirations
The nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data support this diagnosis?
Masklike facies and a shuffling gait.
The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. What information is appropriate for the nurse to include?
Microangiopathy is specific to diabetes and most commonly affects the capillary membranes of the eyes, kidneys, and skin.
When caring for a patient with a new right-sided homonymous hemianopsia resulting from a stroke, which intervention should the nurse include in the plan of care?
Place objects needed on the patient's left side.
An older client who is hospitalized complains of heart palpitations and reports eating rhubarb daily. Which lab results should the nurse immediately assess?
Potassium
A client has recently had cataract surgery. About which symptom does the nurse instruct the client to notify the health care provider?
Reduction in vision
A patient screened for diabetes at a clinic has a fasting plasma glucose of 120 mg/dL (6.7 mmol/L). The nurse explains to the patient that this value:
Reflects impaired glucose tolerance, which is an early stage of diabetes.
During discharge teaching for a patient who experienced a mild stroke, you are providing details on how to eliminate risk factors for experiencing another stroke. Which risk factors are modifiable?
Smoking Obesity Sedentary lifestyle
RN assessing eyes of 77-yr-old client. Which finding would lead RN to suspect that the client is developing cataracts?
The client states, "My vision is becoming more and more blurry."
homonymous hemianopsia
The loss of the right or left half of the field of vision in both eyes.
True or False? Arteriosclerosis, hypertension, diabetes, and nutritional deficiencies can threaten an older adult's vision.
True
After receiving change-of-shift report on the following four patients, which patient should the nurse see first? a. A 60-year-old patient with right-sided weakness who has an infusion of tPA prescribed b. A 50-year-old patient who has atrial fibrillation and a new order for warfarin (Coumadin) c. A 40-year-old patient who experienced a transient ischemic attack yesterday who has a dose of aspirin due d. A 30-year-old patient with a subarachnoid hemorrhage 2 days ago who has nimodipine (Nimotop) scheduled
a. A 60-year-old patient with right-sided weakness who has an infusion of tPA prescribed
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability?
check blood glucose
Which action should RN suggest to maximize the client's independence in the home environment after having a stroke?
install grab bars in the bathroom
What intervention should RN include to help reduce the client's intraocular pressure in patient diagnosed with glaucoma?
instruct to avoid straining with defecation
A 73-year-old patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find?
left brain stroke (hard to comprehend)
Which health problem would cause the RN to question the health care provider regarding diabetic medication admin?
liver disease
Hyperglycemia symptoms
lots of eating, peeing, drinking. blurred vision, fatigue, weight loss
Risk factor for development of diabetes in the older adult population?
metabolic syndrome
An older patient with type 2 diabetes mellitus is complaining of burning feet. The nurse determines that the patient is most likely experiencing which type of pain?
neuropathic pain
After assessment, patient scheduled for diagnostic testing to determine presence of diabetes. Which was assessed by RN?
neuropathy
RN notes patient with diabetes has handwriting that is becoming increasingly more difficult to read. RN suspects which?
neuropathy
Best way to assess the older adult's ability to prepare and self-administer insulin?
observe them drawing up and administering the insulin
After a patient experienced a brief episode of tinnitus, diplopia, and dysarthria with no residual effects, the nurse anticipates teaching the patient about
oral low-dose aspirin therapy (s/s of TIA - want drugs that inhibit platelet formation)
RN concerned that patient may not be able to self inject prescribed insulin injection. What health problem does RN asses
osteoarthritis
