Med Surg Exam 2 Practice Questions

Which statement by the nurse best describes Parkinson's disease?

"A chemical imbalance in the brain leads to movement and coordination problems."

A patient with new-onset status epilepticus is prescribed phenytoin (Dilantin). After teaching the patient about this treatment regimen, the nurse assesses the client's understanding. Which statement indicates that the patient understands the teaching?

"Even when my seizures stop, I will take this drug"

Which statement by a patient about preventing stroke indicates a need for further teaching by the nurse?

"I only smoke cigars, which is better than smoking cigarettes."

The home-care nurse is counseling the client who has multiple sclerosis. The client is experiencing weakness, ataxia, intermittent adductor spasms of the hips, and occasional incontinence from loss of bladder sensation. Which self-care measures should the nurse recommend? Select all that apply

"If a muscle is in spasm stretch and hold it then relax." ; "Rest first and then walk as able using a walker for support." ; "Set an alarm to remind you to void 30 minutes after fluid intake."

The nurse is talking to the family of a patient who has Parkinson's disease. Which statement indicates that the family has a good understanding of the changes in motor movement associated with this disease?

"She has trouble chewing so I will offer bite-sized portions."

A client with cirrhosis is scheduled for a liver biopsy. The client asks if there are any risks after the procedure. The nurse's best response is:

"The major risk is bleeding postprocedure."

The nurse is preparing to insert a small-bore nasogastric feeding tube. Which actions are appropriate for the nurse to take? Select all that apply

-Insert the tube into the nares with the client's head hyperextended; Check the pH of the stomach contents; Place the client in a Fowler's position during administration of the feeding

A nurse is caring for a client with acute renal failure. Which findings should the nurse anticipate when reviewing the laboratory report of the client's blood level of calcium, potassium, and creatinine? Select all that apply. 1. Calcium: 7.6 mg/dL 2. Calcium: 10.5 mg/dL 3. Potassium 6.0 mEq/L 4. Potassium 3.5 mEq/L 5. Creatinine: 3.2 mg/dL 6. Creatinine: 1.1 mg/dL

1, 3, 5

A patient should have a CT scan _________ after ED arrival

25 minutes

The nurse sees a patient walking in the hallway who begins to have a seizure. The nurse should do which of the following in priority order? 1. Maintain patent airway 2.record the seizure activity observed 3.ease the patient to the floor 4. Obtain vital signs

3,1,4,2

What is the recommended benchmark time between the arrival of the patient to the ED and the reading of the CT scan?

45 minutes

20. The nurse is caring for a patient MS who has cognitive impairment. Interventions to assist with orientation include: Select all that apply

A single-date calendar ; Assist the patient with list making ; Recorded message reminders ; Keep frequently used items in familiar places

A client with acute kidney injury is placed on a fluid restriction. To determine whether outcomes related to fluid balance are being met, the nurse assesses for which finding?

Absence of lung crackles this

The nurse should teach the client with liver disease to avoid which over the counter (OTC) medication after discharge?

Acetaminophen (Tylenol)

The patient newly diagnosed with Parkinson's disease (Parkinson Disease) is being discharged. Which instruction for the patient's spouse is best for the nurse to provide?

Administer medications promptly on schedule to maintain therapeutic drug levels.

A client is admitted to the hospital from the emergency department with a diagnosis of urolithiasis. The nurse reviews the client's clinical record and performs an admission assessment. What is the priority nursing action?

Administer the prescribed morphine.

The client is admitted to the hospital with acute pancreatitis. The nurse taking a history should question the client about which of these risks for developing pancreatitis?

Alcoholism

A nurse reviews the laboratory results of a client with acute pancreatitis. Which test is most significant in determining the client's response to treatment?

Amylase level

A client with acute kidney failure becomes confused and irritable. Which does the nurse determine is the most likely cause of this behavior?

An increased blood urea nitrogen level

Which of the following is NOT a cause of ischemic stroke?

Aneurysm rupture

A client is admitted to the hospital for acute pancreatitis. The nurse obtains the client's vital signs, performs a physical assessment, and reviews the client's health history. What is the priority intervention by the nurse?

Assess the client for alcohol withdrawal symptoms

A client with a decreased glomerular filtration rate (GFR) asks how to prevent further damage to the kidneys. Which is the nurse's best response?

Avoid taking non-steroidal anti-inflammatory drugs (NSAIDs).

When assessing the patient with Parkinson's disease, the nurse would look for what key features in the neurological exam?

B. Resting tremor, muscle rigidity, bradykinesia, postural instability.

Which of the following is NOT a complication of ischemic stroke?

Blood loss

The nurse understands that a transischemic attack (TIA) is characterized by

Blurred vision, unilateral weakness, and aphasia lasting less than 24 hours, usually 30-60 minutes

What imaging study is vital in patients who present with symptoms of an ischemic stroke?

CT scan of the brain

A client has end-stage kidney disease (ESKD). The nurse observes tall, peaked T waves on the client's cardiac monitor. Which action by the nurse is best?

Check the serum potassium level

A nurse concludes that the anemia that accompanies chronic kidney disease should be treated because it contributes to:

Chronic fatigue from reading

The nurse assessed the client newly diagnosed with myasthenia gravis. Which finding should the nurse recognize as being unrelated to the diagnosis?

Circumoral tingling

The nurse is providing a client with a peritoneal dialysis exchange. The nurse notes the presence of cloudy peritoneal effluent(output). Which action by the nurse is most appropriate?

Collect a sample to send to the laboratory.

A client with cirrhosis who is receiving lactulose (Cephulac) is currently having 6 diarrhea stools per day. Which of the following prescriptions does the nurse anticipate from the health care provider?

Decrease frequency of lactulose dose

A client with acute renal failure moves into the diuretic phase after one week of therapy. For which signs during this phase should the nurse assess the client? Select all that apply.

Dehydration; Hypovolemia

During the immediate post-ictal period of a seizure, an appropriate nursing action is to:

Determine the amount of time between the seizure and when the patient returns to his/her baseline neurological status.

The nurse is caring for a patient with a stroke resulting in right-sided paresis and aphasia. The patient attempts to use the left hand for feeding and other self-care activities. The spouse becomes frustrated and insists on doing everything for the patient. Based on this data, which nursing diagnosis should the nurse document for this patient?

Disabled family coping related to dissonant coping style of significant person.

After the first hemodialysis treatment, your patient develops a headache, hypertension, restlessness, mental confusion, nausea, and vomiting. Which condition is indicated?

Disequilibrium syndrome from reading & PPT

The nurse in the emergency department documents that a newly admitted patient is "postictal upon transfer." What did the nurse observe?

Drowsy or confused state following a seizure

A nurse is performing the physical assessment of a client admitted to the hospital with a diagnosis of cirrhosis. The nurse expects to observe what skin conditions? Select all that apply.

Ecchymoses ; Telangiectasis

Which teaching intervention is most appropriate for the patient with Parkinson's disease?

Fall precautions

On the admission assessment, the nurse finds that the patient with MS is having severe issues with balance and his gait is unsteady. The nurse will ensure that the care team is aware that this patient's highest priority risk related to this assessment finding is risk for:

Falls

When an intestinal obstruction is suspected, a client has a nasogastric tube inserted and attached to suction. For what response should the nurse critically assess this client?

Fluid deficit

The nurse is assessing a patient admitted with a CVA. The physician has ordered a swallow study. The nurse knows which of the following lobes of the cerebral hemisphere is involved in the control of voluntary muscle movement, including those necessary for the production of speech and swallowing?

Frontal

In the ED, the initial assessment of the patient should include

Gathering information to determine time of symptom onset

A patient with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action should the nurse implement?

Give an antihypertensive medication.

A patient has been diagnosed with end-stage renal disease. In addition to patient's complaints of fatigue, anorexia, dyspnea, and nocturia, the nurse's assessment findings include: +1 pedal edema, basilar crackles in both lungs, and clear, pale urine. VS are: T 98.8° F, P 86, R 28, and BP 178/92. Lab values: Hct (hematocrit) 30%; Hgb 9.5 g/dL K+ (Potassium) 6.0 meq/L, Phosphorus 7.0 mg/dL. Which of the lab values are outside of normal range for adults?

Hct/Hgb, K, and Phosphorus

A client with cirrhosis is admitted to the hospital. Which assessment finding is consistent with development of portal hypertension?

Hematemesis

The client with multiple sclerosis tells the nurse about extreme fatigue. Which assessment findings should the nurse identify as contributing to the client's fatigue? Select all that apply.

Hemoglobin 9.1 & hematocrit 31.8 ; Taking baclofen 15 mg 3 times per day ; Stopped taking amitriptyline 8 weeks earlier ; Presence of a cardiac murmur at the tricuspid valve ; Bilateral leg weakness noted when walking in the room

A client has end-stage kidney disease (ESKD). Which food selection by the client demonstrates understanding of a low-sodium, low-potassium diet?

Herbs and spices

Which response by a client indicates an understanding of measures to facilitate the flow of peritoneal dialysate fluid?

I will take my stool softeners every day

The nurse is planning discharge teaching for a patient with Parkinson's disease. To maintain safety, the nurse should make which of the following suggestions to the family?

Install a raised toilet seat

A client with cirrhosis of the liver and ascites is scheduled to have a paracentesis. What should the nurse do to prepare the client for the procedure?

Instruct the client to void.

A client has a nasogastric (NG) tube in place for gastric decompression and complains of increasing nausea. What action should the nurse take first?

Irrigate the tube with saline

A client asks the nurse, "What are the advantages of peritoneal dialysis over hemodialysis?" Which response by the nurse is accurate? (Select all that apply.)

It will give you greater freedom in your scheduling ; You do not need a machine to do it ; You will have fewer dietary restrictions

A client is admitted with the diagnosis of acute pancreatitis. For which clinical manifestations should a nurse assess the client? Select all that apply.

Jaundice ; Acute pain ; Increased amylase

A patient with a confirmed acute ischemic stroke is admitted to the medical unit after evaluation in the emergency department. What is the nurse's priority action on admission?

Keep the patient NPO until the swallowing assessment is complete.

The nurse is caring for a client who begins to experience seizure activity while in bed. Which actions should the nurse take? Select all that apply

Loosening restrictive clothing ; Removing the pillow and raising the padded side rails; Positioning the client to the side, if possible, with the head flexed forward

The nurse is caring for a patient with Parkinson's disease. Which intervention does the nurse implement to prevent respiratory complications in the patient?

Maintain the head of the bed at 30 degrees or greater.

The nurse is teaching the patient newly diagnosed with multiple sclerosis (MS). Which statement by the patient indicates a correct understanding of the pathophysiology of the disease?

Many parts of my nervous system have lesions

Tissue plasminogen activator can be administered for ischemic stroke if the symptoms are:

No more than 3 hours since onset, 4.5 hours in select patients

A client with acute kidney injury had normal assessments 1 hour ago. Now the nurse finds that the client's respiration rate is 44 breaths/min and the client is restless. Which assessment does the nurse perform?

Obtain an oxygen saturation level

A client has a serum creatinine level of 2.5 mg/dL, a serum potassium level of 6 mmol/L, an arterial pH of 7.32, and a urine output of 250 mL/day. Which phase of acute kidney failure is the client experiencing?

Oliguric

A nurse is monitoring a client with renal failure for signs of fluid excess. Which finding does the nurse identify as inconsistent with fluid excess?

Orthostatic hypotension

The nurse is instituting seizure precautions for a client who is being admitted from the emergency department. Which measures should the nurse include in planning for the client's safety? Select all that apply

Padding the side rails of the bed ; Placing an airway at the bedside ; Placing oxygen and suction equipment at the bedside ; Flushing the IV catheter to ensure that it is patent

A client is at high risk for developing ascites because of cirrhosis of the liver. How should the nurse assess for the presence of ascites?

Percuss the client's abdomen and listen for dull sounds

A client hospitalized for worsening kidney injury suddenly becomes restless and agitated. Assessment reveals tachycardia and crackles bilaterally at the bases of the lungs. Which is the nurse's first intervention?

Place the client in high Fowler's position.

The nurse is doing discharge teaching for a client who has cirrhosis and ascites. Which of the following foods used by the client as snacks should the nurse instruct the client to avoid?

Potato chips

The nurse plans morning care for the patient after a cerebral vascular accident (CVA) resulting in left-side paralysis and homonymous hemianopia. During morning care, the nurse should do which of the following?

Provide care from the patient's right side

A nurse noted that a patient with chronic kidney disease (CKD) had a glomerular filtration rate (GFR) of 25 ml/min (stage 4 CKD). Given the lab result, how might the plan of care be changed for this patient?

Reduced drug dosages or a longer interval between doses of some medications

The nurse is administering cephalic lactulose to a client with a history of cirrhosis of the liver. The client asks the nurse why this medication is needed because the client is not constipated. What is the best response the nurse could give?

Reduces the blood ammonia level

The nurse is caring for a client with chronic kidney disease who has developed uremia. Which assessment finding does the nurse correlate with this problem?

Respiratory rate of 40 breaths/min

A 83-year-old male has been admitted with a diagnosis of stroke and a history of dementia. Which of the following nursing diagnoses has the highest priority for this patient?

Risk for injury

nurse teaches a client with chronic renal failure that salt substitutes cannot be used in the diet because:

Salt substitutes contain potassium, which must be limited to prevent abnormal heartbeats.

The nurse reviews the client's laboratory tests and notices that the total serum bilirubin is 2.5mg/dL. Which clinical manifestation would the nurse identify as most likely to be present?

Scleral icterus

When providing care for a client receiving peritoneal dialysis, the nurse notices that the effluent is cloudy. Which intervention is most important for the nurse to carry out?

Send a specimen for culture and sensitivity

Physical examination of a comatose patient reveals decorticate posturing. Which statement is accurate regarding this patient's status based upon this finding?

Severe dysfunction of the cerebral cortex has occurred.

19. A patient with multiple sclerosis is being treated with fingolimod (Gilenya) presents to the emergency department with complaints of dizziness. The nurse places the patient on the cardiac monitor and interprets the following rhythm as: Rhythm Strip#14

Sinus Bradycardia

The client returns to the nursing unit postoperatively after a colostomy. Which of the following assessments would require immediate action by the nurse?

Stoma is bluish

The nurse caring for a patient with MS is administering oral medications to the patient for the first time. The nurse notices that the patient is coughing with small sips of water. The nurse's priority intervention is to:

Stop medication administration and notify the physician

A patient is receiving IV sodium heparin infusion after fibrinolytic therapy with rtPA (Retavase) and begins to have severe epistaxis. What is the nurse's first action?

Stop the infusion immediately

During the acute phase of a cerebral vascular accident (CVA), the nurse should maintain the patient in which of the following positions?

Supine with the head of bed elevate 30-45 degrees

A nurse is caring for a client with complications associated with peritoneal dialysis. For which signs and symptoms should the nurse monitor the client? Select all that apply.

Tachycardia-associated with infection ; Cloudy outflow-indicative of infection ; Abdominal pain-indicative of infection of the abdominal cavity

The RN has assigned a client with a newly placed arteriovenous (AV) fistula in the right arm to an LPN. Which information about the care of this client is most important for the RN to provide to the LPN?

Take blood pressure in the left arm

The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. Which client activity suggests that teaching is most effective?

Taking medications as scheduled

The nurse should use the _________________ to help assess the patient's condition and predict outcomes after treatment.

The NIH Stroke Scale

An older adult with Parkinson's disease is prescribed levodopa and carbidopa. What information should the nurse include when teaching the client and spouse?

The client has an increased risk of falls

A patient with a recent CVA is transferred to an acute rehabilitation facility. The patient has right-sided paralysis and dysphagia. The nurse observes that a family member is preparing to help the patient eat lunch. Which of the following situations would require intervention by the nurse?

The family member waters down the pudding to help the patient swallow

The nurse cares for a patient diagnosed with a right-hemisphere cerebrovascular accident (CVA) with dysphagia. Which of the following actions by the nurse reflects appropriate care for the patient? Select all that apply.

The nurse assesses the patient's ability to swallow ; The nurse offers the patient apple juice slowly ; The nurse offers the patient scrambled eggs ; The nurse turns off the television

Bradykinesia is a classic symptom in Parkinson's disease. How would the nurse describe this finding in the patient with Parkinson's disease?

The patient's movements are slow; occasionally, muscles may even randomly "freeze".

A nurse is caring for a client with acute kidney failure who is receiving a protein restricted diet. The client asks why this diet is necessary. What information should the nurse include in a response to the client's questions?

This supplies only essential amino acids, reducing the amount of metabolic waste products, thus decreasing stress on the kidneys.

The patient's BP is 224/132, why would the patient receive antihypertensive medications after the CT scan ruled out a hemorrhagic stroke, thus confirming suspicion of ischemic stroke?

To facilitate the patient meeting criteria for fibrinolytic therapy

The nurse is caring for a patient with a history of epilepsy who suddenly begins to experience a tonic-clonic seizure and loses consciousness. What is the nurse's priority action?

Turn the client's head to the side

The nurse is caring for a client who is receiving peritoneal dialysis (PD). Which nursing intervention has the greatest priority when a dialysis exchange is performed?

Using sterile technique when hooking up dialysate bags to prevent infection

The nurse is assessing a 37-year-old patient diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find?

Vision changes-diplopia, nystagmus

Which assessment parameter does the nurse monitor in a client with chronic kidney disease to determine fluid and sodium retention status?

Weight and blood pressure

During the acute phase of stroke care nursing interventions include proper positioning of the patient

With the head of bed at 30 degrees to avoid aspiration and prevent elevation of intracranial pressure (ICP)

A client with acute kidney failure and on dialysis asks how much fluid will be permitted each day. Which is the nurse's best response?

You can drink an amount equal to your urine output, plus 700 mL

A client with chronic kidney disease states that he will be going to the dentist for a planned tooth extraction. Which is the nurse's best response?

You should receive prophylactic antibiotics before any dental procedure

The nurse is providing dietary teaching to a client who was just started on peritoneal dialysis (PD). Which instruction does the nurse provide to this client regarding protein intake?

You will need more protein now because some protein is lost by dialysis.

The nurse understands that decerebrate posturing is

abnormal posturing and rigidity characterized by extension of the arms and legs, pronation of the arms, plantar flexion, and body spasm in which the body is bowed forward.

The nurse understands that decorticate posturing is

abnormal posturing in which the patient's arms, wrists, and fingers are flexed with internal rotation and plantar flexion of the legs.

The nurse is teaching a female patient with multiple sclerosis. When teaching the patient how to reduce fatigue, the nurse should tell the patient to:

rest in an air-conditioned room