NUR421

The daughter of a patient with Huntington's disease asks the nurse what the risk is of her inheriting the disease. What is the best response by the nurse? "The disease is not hereditary and therefore there is no risk to you." "If one parent has the disorder, there is an 75% chance that you will inherit the disease." "If one parent has the disorder, there is a 50% chance that you will inherit the disease." "The disease is inherited and all offspring of a parent will develop the disease."

Correct response: "If one parent has the disorder, there is a 50% chance that you will inherit the disease." Explanation: Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. The disease affects approximately 1 in 10,000 men or women of all races at midlife. It is transmitted as an autosomal dominant genetic disorder; therefore, each child of a parent with Huntington disease has a 50% risk of inheriting the disorder (Ha & Fung, 2012). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Huntington Disease, p. 2108. Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders - Page 2108

A client with newly diagnosed seizures asks about stigma associated with epilepsy. The nurse will respond with which of the following statements? "In most people, epilepsy is usually synonymous with intellectual disability." "For many people with epilepsy, the disorder is synonymous with mental illness." "Many people with developmental disabilities resulting from neurologic damage also have epilepsy." "Cases of epilepsy are often associated with intellectual level."

Correct response: "Many people with developmental disabilities resulting from neurologic damage also have epilepsy." Explanation: Many people who have developmental disabilities because of serious neurologic damage also have epilepsy. Epilepsy is not associated with intellectual level. It is not synonymous with intellectual disability or mental illness. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, The Epilepsies, p. 1998. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 1998

The parents of a client intubated due to the progression of Guillain-Barré syndrome ask whether their child will die. What is the best response by the nurse? "Don't worry; your child will be fine." "Once Guillain-Barré syndrome progresses to the diaphragm, survival decreases significantly." "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." "It's too early to give a prognosis."

Correct response: "There are no guarantees, but a large portion of people with Guillain-Barré syndrome survive." Explanation: The survival rate of Guillain-Barré syndrome is approximately 90%. The client may make a full recovery or suffer from some residual deficits. Telling the parents not to worry dismisses their feelings and does not address their concerns. Progression of Guillain-Barré syndrome to the diaphragm does not significantly decrease the survival rate, but it does increase the chance of residual deficits. The family should be given information about Guillain-Barré syndrome and the generally favorable prognosis. With no prognosis offered, the parents are not having their concerns addressed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, p. 2082. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2082

A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is most appropriate? Encourage the client to close his eyes. Alternatively patch one eye every 2 hours. Turn out the lights in the room. Instill artificial tears.

Correct response: Alternatively patch one eye every 2 hours. Explanation: Patching one eye at a time relieves diplopia (double vision). Closing the eyes and making the room dark aren't the most appropriate options because they deprive the client of sensory input. Artificial tears relieve eye dryness but don't treat diplopia. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, Improving Cognitive Function, p. 2077. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2077

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture? Assess capillary refill in the toes. Assess for paresthesia in the toes. Assess the radial pulse. Assess mobility of the shoulder.

Correct response: Assess the radial pulse. Explanation: Volkmann's contracture is a type of acute compartment syndrome that occurs with a supracondylar fracture of the humerus. The nurse assesses neurovascular function of the hand and forearm. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Elbow, p. 1199. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1199

The nurse is caring for a client admitted with a diagnosis of septic meningitis. The nurse is aware that this infection is caused by which of the following? Bacteria Virus Lymphoma Leukemia

Correct response: Bacteria Explanation: Septic meningitis is caused by bacteria. In aseptic meningitis, the cause is viral or secondary to lymphoma, leukemia, or human immunodeficiency virus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, Meningitis, p. 2065. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2065

Which is the earliest sign of increasing intracranial pressure? Vomiting Change in level of consciousness Headache Posturing

Correct response: Change in level of consciousness Explanation: The earliest sign of increasing intracranial pressure (ICP) is a change in level of consciousness. Other manifestations of increasing ICP are vomiting, headache, and posturing. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, Quality and Safety Nursing Alert, p. 1980. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 1980

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? Compound Depressed Impacted Comminuted

Correct response: Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Figure 42-2, p. 1189-1190. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1189-1190

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Compound Greenstick Oblique Spiral

Correct response: Compound Explanation: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Types of Fractures, p. 1189. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1189

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? Ability to stretch arm over the head Difficulty lying on affected side Pain worse in the morning Minimal pain with movement

Correct response: Difficulty lying on affected side Explanation: Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Rotator Cuff Tear, p. 1187. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1187

A nurse is inspecting the area of contusion and notes numerous areas of bruising. How would the nurse document this finding? Whiplash injury Callus Ecchymosis Palsy

Correct response: Ecchymosis Explanation: Bruises due to the rupture of many small blood vessels leads to ecchymoses. Whiplash injury refers to a sprain of the cervical spine. Callus refers to the healing mass that occurs in the bone after a fracture. Palsy refers to decreased sensation and movement. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Contusions, Strains, and Sprains, p. 1185. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1185

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for? Bone graft Joint replacement Fasciotomy Amputation

Correct response: Fasciotomy Explanation: Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Medical Management, p. 1194. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1194

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: Complex regional pain syndrome Delayed union Compartment syndrome Fat embolism syndrome

Correct response: Fat embolism syndrome Explanation: The clinical manifestations described in the scenario are characteristic of fat embolism syndrome. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Clinical Manifestations, p. 1193. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1193

The nurse is assessing a client who was brought to the emergency department due to a severe headache with sudden onset, lowered level of consciousness and slurred, non-sensical speech. The client completed chemotherapy and radiation treatment for a glioma-type brain tumor 6 months ago. The client has been taking low molecular weight heparin since completing treatment. The nurse should be prepared to provide care for which possible problem? Intracerebral hemorrhage Deep vein thrombosis Pulmonary embolism Spinal metastasis

Correct response: Intracerebral hemorrhage Explanation: Clients receiving anticoagulant agents, such as low molecular weight heparin, must be closely monitored because of the risk of central nervous system hemorrhage, also known as an intercerebral hemorrhage. Both deep vein thrombosis and pulmonary embolism would be prevented or mitigated by the use of anticoagulant medications such as low molecular weight heparin. The nurse should always consider the risk of these latter problems, however, because the client is clearly at risk for impaired coagulation. Spinal metastasis can result in spinal cord compression, which is considered a medical emergency requiring immediate treatment. In this case, the nurse would observe reports of back pain, extremity weakness, ataxia and/or paralysis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Pharmacologic Therapy, p. 2096. Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders - Page 2096

The nurse is providing postoperative care for a client who just underwent surgery to remove a metastatic intramedullary tumor. On postoperative day 3, the client states, "I am really looking forward to going running again, it had become too difficult because of the loss of feeling in my feet." Which should the nurse address in the client's care plan? Body image disturbance Anxiety Impaired cognition Knowledge deficit

Correct response: Knowledge deficit Explanation: Clients with extensive neurologic deficits before surgery usually do not make significant functional recovery, even after successful tumor removal. In this case, the client had already developed bilateral sensory loss in the lower extremities indicating the fairly progressed impact of the tumor on the client's functional ability. The client's statement reflects a knowledge deficit and it is a priority to provide information regarding the possibility that lower extremity sensation may not return. Although body image disturbance and anxiety may be identified and addressed. This would occur after the client demonstrates an accurate understanding of loss of functional capabilities as a result of the progressed tumor. Ensuring the client understands the extent of functional loss due to the impact of the tumor is a priority. The client does not demonstrate impaired cognition. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Medical Management, p. 2100. Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders - Page 2100

A nurse is preparing to administer an antiseizure medication to a client. Which of the following is an appropriate antiseizure medication? Lamictal Lamisil Labetalol Lomotil

Correct response: Lamictal Explanation: Lamictal is an antiseizure medication. Its packaging was recently changed in an attempt to reduce medication errors, because this medication has been confused with Lamisil (an antifungal), labetalol (an antihypertensive), and Lomotil (an antidiarrheal). Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, Table 66-4, p. 2000. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 2000

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurologic symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period? Discourage the client from doing any range-of-motion (ROM) exercises. Have the client sit up in a chair as much as possible. Logroll the client from side to side. Elevate the head of the bed to 90 degrees.

Correct response: Logroll the client from side to side. Explanation: Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. The nurse should encourage ROM exercises to maintain muscle strength. Because of pressure on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Providing Preoperative Care, p. 2118. Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders - Page 2118

A patient 3 days postoperative from a craniotomy informs the nurse, "I feel something trickling down the back of my throat and I taste something salty." What priority intervention does the nurse initiate? Give the patient some mouthwash to gargle with. Request an antihistamine for the postnasal drip. Ask the patient to cough to observe the sputum color and consistency. Notify the physician of a possible cerebrospinal fluid leak.

Correct response: Notify the physician of a possible cerebrospinal fluid leak. Explanation: Any sudden discharge of fluid from a cranial incision is reported at once, because a large leak requires surgical repair. Attention should be paid to the patient who complains of a salty taste or "postnasal drip," because this can be caused by cerebrospinal fluid trickling down the throat. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, Quality and Safety Nursing Alert, p. 1914. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 1914

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? The fracture line extends through the entire bone substance. The fracture results from an underlying bone disorder. Bone fragments are separated at the fracture line. One side of the bone is broken and the other side is bent.

Correct response: One side of the bone is broken and the other side is bent. Explanation: In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Figure 42-2, p. 1190. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190

The most common cause of cholinergic crisis includes which of the following? Overmedication Infection Undermedication Compliance with medication

Correct response: Overmedication Explanation: A cholinergic crisis, which is essentially a problem of overmedication, results in severe generalized muscle weakness, respiratory impairment, and excessive pulmonary secretion that may result in respiratory failure. Myasthenic crisis is a sudden, temporary exacerbation of MG symptoms. A common precipitating event for myasthenic crisis is infection. It can result from undermedication. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, Complications, p. 2081. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2081

A patient is admitted to the hospital for management of an extrapyramidal disorder. Included in the physician's admitting orders are the medications levodopa, benztropine, and selegiline. The nurse knows that most likely, the client has a diagnosis of: Parkinson's disease. Huntington's disease. seizure disorder. multiple sclerosis.

Correct response: Parkinson's disease. Explanation: Although antiparkinson drugs are used in some clients with Huntington's disease, these drugs are most commonly used in the medical management of Parkinson's disease. The listed medications are not used to treat a seizure disorder. The listed medications are not used to treat MS. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, p. 2103. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 2103

Elderly clients who fall are most at risk for which injuries? Wrist fractures Humerus fractures Pelvic fractures Cervical spine fractures

Correct response: Pelvic fractures Explanation: Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Gerontologic Considerations, p. 1203. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1203

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? Related to visual field deficits Related to difficulty swallowing Related to impaired balance Related to psychomotor seizures

Correct response: Related to impaired balance Explanation: A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Localized Symptoms, p. 2094.

A client with herpes simplex virus (HSV) encephalitis is receiving acyclovir. To ensure early intervention, the nurse monitors laboratory values and urine output for which type of adverse reactions? Musculoskeletal Integumentary Hepatic Renal

Correct response: Renal Explanation: Monitoring of blood chemistry test results and urinary output will alert the nurse to the presence of renal complications related to acyclovir therapy. Complications with the integumentary system will can be observed by the nurse; it is not necessary to review laboratory results or urine output for integumentary reactions. Urine output is not monitored for musculoskeletal or hepatic adverse reactions. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, p. 2070. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2070

A client has undergone surgery for a spinal cord tumor that was located in the cervical area. The nurse would be especially alert for which of the following? Hemorrhage Bowel incontinence Respiratory dysfunction Skin breakdown

Correct response: Respiratory dysfunction Explanation: When a spinal tumor is located in the cervical area, respiratory compromise may occur from postoperative edema. Hemorrhage would be a concern with any surgery. Bowel incontinence and skin breakdown are possible but not specific to cervical spinal tumors. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, Monitoring and Managing Potential Complications, p. 2101. Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders - Page 2101

A client with neurologic infection develops cerebral edema from syndrome of inappropriate antidiuretic hormone (SIADH). Which is an important nursing action for this client? Maintaining adequate hydration Administering prescribed antipyretics Restricting fluid intake and hydration Hyperoxygenation before and after tracheal suctioning

Correct response: Restricting fluid intake and hydration Explanation: Fluid restriction may be necessary if the client develops cerebral edema and hypervolemia from SIADH. Antipyretics are administered to clients who develop hyperthermia. In addition, it is important to maintain adequate hydration in such clients. A client with neurologic infection should be given tracheal suctioning and hyperoxygenation only when the respiratory distress develops. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, p. 1983. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 1983

Nursing assessment findings reveal joint swelling and tenderness and a butterfly rash on the face. The nurse suspects which of the following? Ankylosing spondylitis Scleroderma Fibromyalgia Systemic lupus erythematous

Correct response: Systemic lupus erythematous Explanation: The butterfly rash is a unique skin manifestation of systemic lupus erythematous. Other clinical manifestations include joint swelling and tenderness, pain on movement, and morning stiffness. The disease can affect all body systems. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018.

The nurse is caring for a client with trigeminal neuralgia (tic douloureux). The care plan for this client reflects the client's problem eating due to jaw pain. To assist the client in meeting the adequate nutritional needs, what should the nurse suggest? Take small meals of soft consistency Increase the intake of calcium and proteins. Include additional servings of fruits and raw vegetables Include fish, liver, and chicken in diet

Correct response: Take small meals of soft consistency Explanation: To help a client with trigeminal neuralgia, who suffers pain in the jaws meet his or her nutritional needs, the nurse should offer small meals of soft consistency. Foods may be pureed to minimize jaw movements when eating. There is no need for the client to increase the intake of fruits and raw vegetables, calcium, or proteins during trigeminal neuralgia. The nurse should avoid offering meat and fish in the diet because they require excessive chewing by the client. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, Providing Postoperative Care, p. 2088. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2088

Which client should the nurse assess for degenerative neurologic symptoms? The client with Huntington disease. The client with Paget disease. The client with osteomyelitis. The client with glioma.

Correct response: The client with Huntington disease. Explanation: Huntington disease is a chronic, progressive, degenerative neurologic hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia. Paget disease is a musculoskeletal disorder, characterized by localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae. Osteomyelitis is an infection of the bone. Malignant glioma is the most common type of brain tumor. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders, p. 2108. Chapter 70: Management of Patients With Oncologic or Degenerative Neurologic Disorders - Page 2108

Which of the following teaching points is a priority in the management of symptoms for a client with Bell's palsy? Avoid stimuli that trigger pain. Use ophthalmic lubricant and protect the eye. Encourage semiannual dental exams. Complete the course of antibiotics as prescribed.

Correct response: Use ophthalmic lubricant and protect the eye. Explanation: The VII cranial nerve supplies muscles to the face. In Bell's palsy, the eye can be affected which results in incomplete closure and risk for injury. The eye can become dry and irritated unless eye moisturizing drops and ophthalmic ointment is applied. Avoiding stimuli that can trigger pain is specific to tic douloureux(cranial nerve V disorder). Encouraging dental exams is a part of care but not the priority. Antibiotics are not used in the treatment of Bell's palsy because it is thought to be caused by a virus. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, Nursing Management, p. 2089. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 2089

A patient has been diagnosed with meningococcal meningitis at a community living home. When should prophylactic therapy begin for those who have had close contact with the patient? Within 24 hours after exposure Within 48 hours after exposure Within 72 hours after exposure Therapy is not necessary prophylactically and should only be used if the person develops symptoms.

Correct response: Within 24 hours after exposure Explanation: People in close contact with patients with meningococcal meningitis should be treated with antimicrobial chemoprophylaxis using rifampin (Rifadin), ciprofloxacin hydrochloride (Cipro), or ceftriaxone sodium (Rocephin). Therapy should be started within 24 hours after exposure because a delay in the initiation of therapy limits the effectiveness of the prophylaxis. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, Prevention, p. 2067. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2067

A client is sitting in a chair and begins having a tonic-clonic seizure. The most appropriate nursing response is to: hold the client's arm still to keep him from hitting anything. carefully move the client to a flat surface and turn him on his side. allow the client to remain in the chair but move all objects out of his way. place an oral airway in the client's mouth to maintain an open airway.

Correct response: carefully move the client to a flat surface and turn him on his side. Explanation: When caring for a client experiencing a tonic-clonic seizure, the nurse should help the client to a flat non-elevated surface and then position him on his side to ensure that he doesn't aspirate and to protect him from injury. These steps help reduce the risk of injury from falling or hitting surrounding objects and help establish an open airway. The client shouldn't be restrained during the seizure. Also, nothing should be placed in his mouth; anything in the mouth could impair ventilation and damage the inside of the mouth. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, Chart 66-4, p. 1998. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 1998

A neurologic deficit is best defined as a deficit of the: central and peripheral nervous systems with decreased, impaired, or absent functioning. central nervous system that affects one body system. central nervous system with absent functioning. peripheral nervous system with decreased or impaired functioning.

Correct response: central and peripheral nervous systems with decreased, impaired, or absent functioning. Explanation: A client with a neurologic deficit may have decreased, impaired, or absent functioning of the central and peripheral systems. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, p. 2011. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2011

An osmotic diuretic such as mannitol is given to the client with increased intracranial pressure (ICP) to control fever. control shivering. dehydrate the brain and reduce cerebral edema. reduce cellular metabolic demand.

Correct response: dehydrate the brain and reduce cerebral edema. Explanation: Osmotic diuretics draw water across intact membranes, thereby reducing the volume of brain and extracellular fluid. Antipyretics and a cooling blanket are used to control fever in the client with increased ICP. Chlorpromazine may be prescribed to control shivering in the client with increased ICP. Medications such as barbiturates are given to the client with increased ICP to reduce cellular metabolic demands. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, p. 1982. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 1982

A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma? immobilization surgical repair external rotation enhancing complications

Correct response: immobilization Explanation: Treatment of musculoskeletal trauma involves immobilization of the injured area until it has healed. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, p. 1186. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform? joint manipulation and immobilization analgesia and immobilization heat and immobilization ice and immobilization

Correct response: joint manipulation and immobilization Explanation: The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, p. 1186. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186

The primary arthropod vector in North America that transmits encephalitis is the tick. horse. mosquito. flea.

Correct response: mosquito. Explanation: Arthropod-borne viruses, or arboviruses, are maintained in nature through biologic transmission between susceptible vertebrate hosts by blood feeding arthropods (mosquitoes, psychodidae, ceratopogonids, and ticks). Arthropod vectors transmit several types of viruses that cause encephalitis. The primary vector in North America is the mosquito. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies, p. 2070. Chapter 69: Management of Patients With Neurologic Infections, Autoimmune Disorders, and Neuropathies - Page 2070

A fracture is considered pathologic when it results in a fragment of bone being pulled away by a ligament or tendon and its attachment. occurs through an area of diseased bone. involves damage to the skin or mucous membranes. presents as one side of the bone being broken and the other side being bent.

Correct response: occurs through an area of diseased bone. Explanation: Pathologic fractures can occur without the trauma of a fall. An avulsion fracture results in a fragment of bone being pulled away by a ligament or tendon and its attachment. A greenstick fracture presents as one side of the bone being broken and the other side being bent. A compound fracture involves damage to the skin or mucous membranes. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 42: Management of Patients With Musculoskeletal Trauma, Figure 42-2, p. 1190. Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to prevent extension of the tumor. facilitate regeneration of neurons. reduce cerebral edema. identify the precise location of the tumor.

Correct response: reduce cerebral edema. Explanation: Corticosteroids may be used before and after treatment to reduce cerebral edema and to promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2017, Chapter 70: pg 2096

The nurse is caring for a client immediately after supratentorial intracranial surgery. The nurse performs the appropriate action by placing the patient in the dorsal recumbent position. supine position with the head slightly elevated. prone position with the head turned to the unaffected side. Trendelenburg position.

Correct response: supine position with the head slightly elevated. Explanation: After surgery, the nurse should place the client in either a supine position with the head slightly elevated or a side-lying position on the unaffected side. The dorsal recumbent, Trendelenburg, and prone positions can increase intracranial pressure. Reference: Hinkle, J.L., & Cheever, K.H., Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 14th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 66: Management of Patients With Neurologic Dysfunction, p. 1988. Chapter 66: Management of Patients With Neurologic Dysfunction - Page 1988