Med Surg 42
After teaching the wife of a client who has Parkinson disease, the nurse assesses the wife's understanding. Which statement by the client's wife indicates she correctly understands changes associated with this disease?
He may have trouble chewing, so I will offer bite-sized portions."
A nurse assesses a client who is recovering from the implantation of a vagal nerve stimulation device. For which clinical manifestations should the nurse assess as common complications of this procedure? (Select all that apply.)
Hoarseness Dysphagia
A nurse prepares to discharge a client with Alzheimer's disease. Which statement should the nurse include in the discharge teaching for this client's caregiver?
Install deadbolt locks on all outside doors."
A nurse delegates care for a client with Parkinson disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care?
Allow the client to be as independent as possible with activities."
A nurse witnesses a client with late-stage Alzheimer's disease eat breakfast. Afterward the client states, "I am hungry and want breakfast." How should the nurse respond?
"I see you are still hungry. I will get you some toast."
After teaching a client newly diagnosed with epilepsy, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?
"If I am nauseated, I will not take my epilepsy medication."
A nurse is teaching a client who has chronic headaches. Which statements about headache triggers should the nurse include in this client's plan of care? (Select all that apply.)
"Incorporate physical exercise into your daily routine." "Participate in a smoking cessation program." "Increase your intake of fruits and vegetables."
A nurse is teaching a client with chronic migraine headaches. Which statement related to complementary therapy should the nurse include in this client's teaching?
"Lie down in a darkened room when you experience a headache."
A nurse cares for a client who has been diagnosed with the Huntington gene but has no symptoms. The client asks for options related to family planning. What is the nurse's best response?
"Tell me more specifically what information you need about family planning so that I can direct you to the right information or health care provider."
A nurse assesses clients on a medical-surgical unit. Which clients should the nurse identify as at risk for secondary seizures? (Select all that apply.)
A 26-year-old woman with a left temporal brain tumor A 38-year-old male client in an alcohol withdrawal program A 42-year-old football player with a traumatic brain injury
A nurse evaluates the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which fluid results alerts the nurse to possible viral meningitis? (Select all that apply.)
Clear Increased protein level Normal glucose level
A nurse assesses a client who has encephalitis. Which manifestations should the nurse recognize as signs of increased intracranial pressure (ICP), a complication of encephalitis? (Select all that apply.)
Dilated pupils Widened pulse pressure Bradycardia
A nurse obtains a focused health history for a client who is suspected of having bacterial meningitis. Which question should the nurse ask?
Do you live in a crowded residence?"
A nurse cares for a client with advanced Alzheimer's disease. The client's caregiver states, "She is always wandering off. What can I do to manage this restless behavior?" How should the nurse respond?
Engage the client in scheduled activities throughout the day."
A nurse assesses a client with Alzheimer's disease who is recently admitted to the hospital. Which psychosocial assessment should the nurse complete?
Evaluate the client's reaction to a change of environment.
After teaching a client who is diagnosed with new-onset status epilepticus and prescribed phenytoin (Dilantin), the nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching?
Even when my seizures stop, I will continue to take this drug."
A nurse plans care for a client with epilepsy who is admitted to the hospital. Which interventions should the nurse include in this client's plan of care? (Select all that apply.)
Have suction equipment at the bedside. Keep bed rails up at all times. Ensure that the client has IV access.
A nurse assesses a client who is experiencing a cluster headache. Which clinical manifestations should the nurse expect to find? (Select all that apply.)
Ipsilateral tearing of the eye Miosis Nasal congestion
A nurse is teaching the daughter of a client who has Alzheimer's disease. The daughter asks, "Will the medication my mother is taking improve her dementia?" How should the nurse respond?
It will not improve her dementia but can help control emotional responses."
A nurse assesses a client with Huntington disease. Which motor changes should the nurse monitor for in this client?
Jerky hand movements
A nurse plans care for a client with Parkinson disease. Which intervention should the nurse include in this client's plan of care?
Keep the head of the bed at 30 degrees or greater.
A nurse assesses a client after administering prescribed levetiracetam (Keppra). Which laboratory tests should the nurse monitor for potential adverse effects of this medication?
Kidney function tests
A nurse assesses a client who is experiencing an absence seizure. For which clinical manifestations should the nurse assess? (Select all that apply.)
Lip smacking Picking at clothing Patting of the hand on the leg
A nurse cares for a client who is experiencing status epilepticus. Which prescribed medication should the nurse prepare to administer?
Lorazepam (Ativan)
A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex) for migraine headaches. Which condition should alert the nurse to hold the medication and contact the health care provider?
Prinzmetal's angina
A nurse delegates care for a client with early-stage Alzheimer's disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care?
Reorient the client to the day, time, and environment with each contact."
A nurse is caring for a client with meningitis. Which laboratory values should the nurse monitor to identify potential complications of this disorder? (Select all that apply.)
Sodium level Clotting factors
A nurse prepares to provide perineal care to a client with meningococcal meningitis. Which personal protective equipment should the nurse wear? (Select all that apply.)
Surgical mask Gloves
A nurse is teaching a client who experiences migraine headaches and is prescribed a beta blocker. Which statement should the nurse include in this client's teaching?
Take this drug as ordered, even when feeling well, to prevent vascular changes associated with migraine headaches."
A nurse assesses a client with a history of epilepsy who experiences stiffening of the muscles of the arms and legs, followed by an immediate loss of consciousness and jerking of all extremities. How should the nurse document this activity?
Tonic-clonic seizure
A nurse witnesses a client begin to experience a tonic-clonic seizure and loss of consciousness. Which action should the nurse take?
Turn the client's head to the side.
A nurse assesses a client who has a history of migraines. Which clinical manifestation should the nurse identify as an early sign of a migraine with aura?
Visual disturbances