PN 2 EXAM 3 Questions And Answers (Latest Solutions)

Exam #3 PN 2 Ch. 64, 46-48, 41-44 Know what the left temporal lobe of brain affects as far as the senses 1. 1. A nurse prepares to teach a client who has experienced damage to the left temporal lobe of the brain. Whic ...

Exam #3 PN 2 Ch. 64, 46-48, 41-44 Know what the left temporal lobe of brain affects as far as the senses 1. 1. A nurse prepares to teach a client who has experienced damage to the left temporal lobe of the brain. Which action should the nurse take when providing education about newly prescribed medications to this client? a. Help the client identify each medication by its color. b. Provide written materials with large print size. c. Sit on the clients right side and speak into the right ear. d. Allow the client to use a white board to ask questions. ANS: C The temporal lobe contains the auditory center for sound interpretation. The clients hearing will be impaired in the left ear. The nurse should sit on the clients right side and speak into the right ear. The other interventions do not address the clients left temporal lobe damage. Know what hypoactive deep tendon reflexes affect 2. A nurse plans care for a client who has a hypoactive response to a test of deep tendon reflexes. Which intervention should the nurse include in this clients plan of care? a. Check bath water temperature with a thermometer. b. Provide the client with assistance when ambulating. c. Place elastic support hose on the clients legs. d. Assess the clients feet for wounds each shift. ANS: B Hypoactive deep tendon reflexes and loss of vibration sense can impair balance and coordination, predisposing the client to falls. The nurse should plan to provide the client with ambulation assistance to prevent injury. The other interventions do not address the clients problem. Know what things can interfere with MRI scans 10. A nurse obtains a focused health history for a client who is scheduled for magnetic resonance imaging (MRI). Which condition should alert the nurse to contact the provider and cancel the procedure? a. Creatine phosphokinase (CPK) of 100 IU/L b. Atrioventricular graft c. Blood urea nitrogen (BUN) of 50 mg/dL d. Internal insulin pump ANS: D Metal devices such as internal pumps, pacemakers, and prostheses interfere with the accuracy of the image and can become displaced by the magnetic force generated by an MRI procedure. An atrioventricular graft does not contain any metal. CPK and BUN levels have no impact on an MRI procedure. 14. After teaching a client who is scheduled for magnetic resonance imaging (MRI), the nurse assesses the clients understanding. Which client statement indicates a correct understanding of the teaching? a. I must increase my fluids because of the dye used for the MRI. b. My urine will be radioactive so I should not share a bathroom. c. I can return to my usual activities immediately after the MRI. d. My gag reflex will be tested before I can eat or drink anything. ANS: C No postprocedure restrictions are imposed after MRI. The client can return to normal activities after the test is complete. There are no dyes or radioactive materials used for the MRI; therefore, increased fluids are not needed and the clients urine would not be radioactive. The procedure does not impact the clients gag reflex. Know what a single-photon emission computed tomography (SPECT) scan is and if there is any care required afterwards 20. A nurse cares for a client who is recovering from a single-photon emission computed tomography (SPECT) with a radiopharmaceutical agent. Which statement should the nurse include when discussing the plan of care with this client? a. You may return to your previous activity level immediately. b. You are radioactive and must use a private bathroom. c. Frequent assessments of the injection site will be completed. d. We will be monitoring your renal functions closely. ANS: A The client may return to his or her previous activity level immediately. Radioisotopes will be eliminated in the urine after SPECT, but no monitoring or special precautions are required. The injection site will not need to be assessed after the procedure is complete. Know what imitrex is and any side effects associated with it 3. 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? a. Bronchial asthma b. Prinzmetals angina c. Diabetes mellitus d. Chronic kidney disease ANS: B Sumatriptan succinate effectively reduces pain and other associated symptoms of migraine headache by binding to serotonin receptors and triggering cranial vasoconstriction. Vasoconstrictive effects are not confined to the cranium and can cause coronary vasospasm in clients with Prinzmetals angina. The other conditions would not affect the clients treatment. What is bacterial meningitis and how is it contracted? 9. A nurse obtains a focused health history for a client who is suspected of having bacterial meningitis. Which question should the nurse ask? a. Do you live in a crowded residence? b. When was your last tetanus vaccination? c. Have you had any viral infections recently? d. Have you traveled out of the country in the last month? ANS: A Meningococcal meningitis tends to occur in multiple outbreaks. It is most likely to occur in areas of high-density population, such as college dormitories, prisons, and military barracks. A tetanus vaccination would not place the client at increased risk for meningitis or protect the client from meningitis. A viral infection would not lead to bacterial meningitis but could lead to viral meningitis. Simply knowing if the client traveled out of the country does not provide enough information. The nurse should ask about travel to specific countries in which the disease is common, for example, sub-Saharan Africa. What are clinical manifestations of Parkinson’s? 10. After teaching the wife of a client who has Parkinson disease, the nurse assesses the wifes understanding. Which statement by the clients wife indicates she correctly understands changes associated with this disease? a. His masklike face makes it difficult to communicate, so I will use a white board. b. He should not socialize outside of the house due to uncontrollable drooling. c. This disease is associated with anxiety causing increased perspiration. d. He may have trouble chewing, so I will offer bite-sized portions. ANS: D Because chewing and swallowing can be problematic, small frequent meals and a supplement are better for meeting the clients nutritional needs. A masklike face and drooling are common in clients with Parkinson disease. The client should be encouraged to continue to socialize and communicate as normally as possible. The wife should understand that the clients masklike face can be misinterpreted and additional time may be needed for the client to communicate with her or others. Excessive perspiration is also common in clients with Parkinson disease and is associated with the autonomic nervous systems response. 11. A nurse plans care for a client with Parkinson disease. Which intervention should the nurse include in this clients plan of care? a. Ambulate the client in the hallway twice a day. b. Ensure a fluid intake of at least 3 liters per day. c. Teach the client pursed-lip breathing techniques. d. Keep the head of the bed at 30 degrees or greater. ANS: D Elevation of the head of the bed will help prevent aspiration. The other options will not prevent aspiration, which is the greatest respiratory complication of Parkinson disease, nor do these interventions address any of the complications of Parkinson disease. Ambulation in the hallway is usually implemented to prevent venous thrombosis. Increased fluid intake flushes out toxins from the clients blood. Pursed-lip breathing increases exhalation of carbon dioxide. Know patient/family teaching for Alzheimer’s and what the medications do 12. A nurse is teaching the daughter of a client who has Alzheimers disease. The daughter asks, Will the medication my mother is taking improve her dementia? How should the nurse respond? a. It will allow your mother to live independently for several more years. b. It is used to halt the advancement of Alzheimers disease but will not cure it. c. It will not improve her dementia but can help control emotional responses. d. It is used to improve short-term memory but will not improve problem solving. ANS: C Drug therapy is not effective for treating dementia or halting the advancement of Alzheimers disease. However, certain drugs may help suppress emotional disturbances and psychiatric manifestations. Medication therapy may not allow the client to safely live independently. 13. A nurse assesses a client with Alzheimers disease who is recently admitted to the hospital. Which psychosocial assessment should the nurse complete? a. Assess religious and spiritual needs while in the hospital. b. Identify the clients ability to perform self-care activities. c. Evaluate the clients reaction to a change of environment. d. Ask the client about relationships with family members. ANS: C As Alzheimers disease progresses, the client experiences changes in emotional and behavioral affect. The nurse should be alert to the clients reaction to a change in environment, such as being hospitalized, because the client may exhibit an exaggerated response, such as aggression, to the event. The other assessments should be completed but are not as important as assessing the clients reaction to environmental change. 14. A nurse witnesses a client with late-stage Alzheimers disease eat breakfast. Afterward the client states, I am hungry and want breakfast. How should the nurse respond? a. I see you are still hungry. I will get you some toast. b. You ate your breakfast 30 minutes ago. c. It appears you are confused this morning. d. Your family will be here soon. Lets get you dressed. ANS: A Use of validation therapy with clients who have Alzheimers disease involves acknowledgment of the clients feelings and concerns. This technique has proved more effective in later stages of the disease, when using reality orientation only increases agitation. Telling the client that he or she already ate breakfast may agitate the client. The other statements do not validate the clients concerns. 16. A nurse cares for a client with advanced Alzheimers disease. The clients caregiver states, She is always wandering off. What can I do to manage this restless behavior? How should the nurse respond? a. This is a sign of fatigue. The client would benefit from a daily nap. b. Engage the client in scheduled activities throughout the day. c. It sounds like this is difficult for you. I will consult the social worker. d. The provider can prescribe a mild sedative for restlessness. ANS: B Several strategies may be used to cope with restlessness and wandering. One strategy is to engage the client in structured activities. Another is to take the client for frequent walks. Daily naps and a mild sedative will not be as effective in the management of restless behavior. Consulting the social worker does not address the caregivers concern. 17. A nurse prepares to discharge a client with Alzheimers disease. Which statement should the nurse include in the discharge teaching for this clients caregiver? a. Allow the client to rest most of the day. b. Place a padded throw rug at the bedside. c. Install deadbolt locks on all outside doors. d. Provide a high-calorie and high-protein diet. ANS: C How do you treat lower back pain? 1. A nurse promotes the prevention of lower back pain by teaching clients at a community center. Which instruction should the nurse include in this education? a. Participate in an exercise program to strengthen muscles. b. Purchase a mattress that allows you to adjust the firmness. c. Wear flat instead of high-heeled shoes to work each day. d. Keep your weight within 20% of your ideal body weight. ANS: A Exercise can strengthen back muscles, reducing the incidence of low back pain. The other options will not prevent low back pain. 2. A nurse plans care for a client with lower back pain from a work-related injury. Which intervention should the nurse include in this clients plan of care? a. Encourage the client to stretch the back by reaching toward the toes. b. Massage the affected area with ice twice a day. c. Apply a heating pad for 20 minutes at least four times daily. d. Advise the client to avoid warm baths or showers. ANS: C Heat increases blood flow to the affected area and promotes healing of injured nerves. Stretching and ice will not promote healing, and there is no need to avoid warm baths or showers. 4. A nurse assesses clients at a community center. Which client is at greatest risk for lower back pain? a. A 24-year-old female who is 25 weeks pregnant b. A 36-year-old male who uses ergonomic techniques c. A 45-year-old male with osteoarthritis d. A 53-year-old female who uses a walker ANS: C Osteoarthritis causes changes to support structures, increasing the clients risk for low back pain. The other clients are not at high risk. What happens with spinal cord injuries at level T5? Clinical manifestations? 7. A nurse assesses a client with a spinal cord injury at level T5. The clients blood pressure is 184/95 mm Hg, and the client presents with a flushed face and blurred vision. Which action should the nurse take first? a. Initiate oxygen via a nasal cannula. b. Place the client in a supine position. c. Palpate the bladder for distention. d. Administer a prescribed beta blocker. ANS: C The client is manifesting symptoms of autonomic dysreflexia. Common causes include bladder distention, tight clothing, increased room temperature, and fecal impaction. If persistent, the client could experience neurologic injury. Precipitating conditions should be eliminated and the physician notified. The other actions would not be appropriate. 7. A nurse assesses a client who experienced a spinal cord injury at the T5 level 12 hours ago. Which manifestations should the nurse correlate with neurogenic shock? (Select all that apply.) a. Heart rate of 34 beats/min b. Blood pressure of 185/65 mm Hg c. Urine output less than 30 mL/hr d. Decreased level of consciousness e. Increased oxygen saturation ANS: A, C, D Neurogenic shock with acute spinal cord injury manifests with decreased oxygen saturation, symptomatic bradycardia, decreased level of consciousness, decreased urine output, and hypotension. What happens in cervical spine injuries? Clinical manifestations? 8. An emergency room nurse initiates care for a client with a cervical spinal cord injury who arrives via emergency medical services. Which action should the nurse take first? a. Assess level of consciousness. b. Obtain vital signs. c. Administer oxygen therapy. d. Evaluate respiratory status. ANS: D The first priority for a client with a spinal cord injury is assessment of respiratory status and airway patency. Clients with cervical spine injuries are particularly prone to respiratory compromise and may even require intubation. The other assessments should be performed after airway and breathing are assessed What is the purpose of rehabilitation for patients with paraplegia? 11. A nurse is caring for a client with paraplegia who is scheduled to participate in a rehabilitation program. The client states, I do not understand the need for rehabilitation; the paralysis will not go away and it will not get better. How should the nurse respond? a. If you dont want to participate in the rehabilitation program, Ill let the provider know. b. Rehabilitation programs have helped many clients with your injury. You should give it a chance. c. The rehabilitation program will teach you how to maintain the functional ability you have and prevent further disability. d. When new discoveries are made regarding paraplegia, people in rehabilitation programs will benefit first. ANS: C Participation in rehabilitation programs has many purposes, including prevention of disability, maintenance of functional ability, and restoration of function. The other responses do not meet this clients needs. 6. A nurse assesses a client with paraplegia from a spinal cord injury and notes reddened areas over the clients hips and sacrum. Which actions should the nurse take? (Select all that apply.) a. Apply a barrier cream to protect the skin from excoriation. b. Perform range-of-motion (ROM) exercises for the hip joint. c. Re-position the client off of the reddened areas. d. Get the client out of bed and into a chair once a day. e. Obtain a low-air-loss mattress to minimize pressure. ANS: C, E What are the clinical manifestations of early multiple sclerosis (MS)? 13. A nurse assesses a client with early-onset multiple sclerosis (MS). Which clinical manifestation should the nurse expect to find? a. Hyperresponsive reflexes b. Excessive somnolence c. Nystagmus d. Heat intolerance ANS: C Early signs and symptoms of MS include changes in motor skills, vision, and sensation. Hyperresponsive reflexes, excessive somnolence, and heat intolerance are later manifestations of MS. Know what Gilenya medication is used for and any side effects that can be caused 15. A nurse assesses a client with multiple sclerosis after administering prescribed fingolimod (Gilenya). For which adverse effect should the nurse monitor? a. Peripheral edema b. Black tarry stools c. Bradycardia d. Nausea and vomiting ANS: C Fingolimod (Gilenya) is an antineoplastic agent that can cause bradycardia, especially within the first 6 hours after administration. Peripheral edema, black and tarry stools, and nausea and vomiting are not adverse effects of fingolimod. Know the late clinical manifestation of ALS 17. A nurse assesses a client with a neurologic disorder. Which assessment finding should the nurse identify as a late manifestation of amyotrophic lateral sclerosis (ALS)? a. Dysarthria b. Dysphagia c. Muscle weakness d. Impairment of respiratory muscles ANS: D In ALS, progressive muscle atrophy occurs until a flaccid quadriplegia develops. Eventually, the respiratory muscles are involved, which leads to respiratory compromise. Dysarthria, dysphagia, and muscle weakness are early clinical manifestations of ALS. What is Guillain-Barre? What are the clinical manifestations? How is it treated? 1. A client is admitted with Guillain-Barr syndrome (GBS). What assessment takes priority? a. Bladder control b. Cognitive perception c. Respiratory system d. Sensory functions ANS: C Clients with GBS have muscle weakness, possibly to the point of paralysis. If respiratory muscles are paralyzed, the client may need mechanical ventilation, so the respiratory system is the priority. The nurse will complete urinary, cognitive, and sensory assessments as part of a thorough evaluation. 2. The nurse learns that the pathophysiology of Guillain-Barr syndrome includes segmental demyelination. The nurse should understand that this causes what? a. Delayed afferent nerve impulses b. Paralysis of affected muscles c. Paresthesia in upper extremities d. Slowed nerve impulse transmission ANS: D Demyelination leads to slowed nerve impulse transmission. The other options are not correct. 3. A client with Guillain-Barr syndrome is admitted to the hospital. The nurse plans caregiving priority to interventions that address which priority client problem? a. Anxiety b. Low fluid volume c. Inadequate airway d. Potential for skin breakdown ANS: C Airway takes priority. Anxiety is probably present, but a physical diagnosis takes priority over a psychosocial one. The client has no reason to have low fluid volume unless he or she has been unable to drink for some time. If present, airway problems take priority over a circulation problem. An actual problem takes precedence over a risk for a problem. 12. An older client is hospitalized with Guillain-Barr syndrome. A family member tells the nurse the client is restless and seems confused. What action by the nurse is best? a. Assess the clients oxygen saturation. b. Check the medication list for interactions. c. Place the client on a bed alarm. d. Put the client on safety precautions. ANS: A In the older adult, an early sign of hypoxia is often confusion and restlessness. The nurse should first assess the clients oxygen saturation. The other actions are appropriate, but only after this assessment occurs. 4. An older adult client is hospitalized with Guillain-Barr syndrome. The client is given amitriptyline (Elavil). After receiving the hand-off report, what actions by the nurse are most important? (Select all that apply.) a. Administering the medication as ordered b. Advising the client to have help getting up c. Consulting the provider about the drug d. Cutting the dose of the drug in half e. Placing the client on safety precautions ANS: B, C, E 5. The nurse caring for a client with Guillain-Barr syndrome has identified the priority client problem of decreased mobility for the client. What actions by the nurse are best? (Select all that apply.) a. Ask occupational therapy to help the client with activities of daily living. b. Consult with the provider about a physical therapy consult. c. Provide the client with information on support groups. d. Refer the client to a medical social worker or chaplain. e. Work with speech therapy to design a high-protein diet. ANS: A, B, E How do patients protect their eyes? What teaching can we provide? 1. The nurse has given a community group a presentation on eye health. Which statement by a participant indicates a need for more instruction? a. I always lose my sunglasses, so I dont wear them. b. I have diabetes and get an annual eye exam. c. I will not share my contact solution with others. d. I will wear safety glasses when I mow the lawn. ANS: A Know the normal range for the IOP 5. A clients intraocular pressure (IOP) is 28 mm Hg. What action by the nurse is best? a. Educate the client on corneal transplantation. b. Facilitate scheduling the eye surgery. c. Plan to teach about drugs for glaucoma. d. Refer the client to local Braille classes. ANS: C This increased IOP indicates glaucoma. The nurses main responsibility is teaching the client about drug therapy. Corneal transplantation is not used in glaucoma. Eye surgery is not indicated at this time. Braille classes are also not indicated at this time. What should we teach patients about eye drops? How do they instill eye drops? 2. A client is seen in the ophthalmology clinic with bacterial conjunctivitis. Which statements by the client indicate a good understanding of home management of this condition? (Select all that apply.) a. As long as I dont wipe my eyes, I can share my towel. b. Eye irrigations should be done with warm saline or water. c. I will throw away all my eye makeup when I get home. d. I wont touch the tip of the eyedrop bottle to my eye. e. When the infection is gone, I can use my contacts again. ANS: C, D How do you treat external otitis? 5. A client has external otitis. On what comfort measure does the nurse instruct the client? a. Applying ice four times a day b. Instilling vinegar-and-water drops c. Use of a heating pad to the ear d. Using a home humidifier ANS: C A heating pad on low or a warm moist pack can provide comfort to the client with otitis externa. The other options are not warranted. What are the steps for instilling ear drops? 10. A nursing student is instructed to remove a clients ear packing and instill eardrops. What action by the student requires intervention by the registered nurse? a. Assessing the eardrum with an otoscope b. Inserting a cotton ball in the ear after the drops c. Warming the eardrops in water for 5 minutes d. Washing the hands and removing the packing ANS: D The student should wash his or her hands, don gloves, and then remove the packing. The other actions are correct. What should you teach patients concerning how to prevent hearing loss? 13. A nurse is teaching a community group about preventing hearing loss. What instruction is best? a. Always wear a bicycle helmet. b. Avoid swimming in ponds or lakes. c. Dont go to fireworks displays. d. Use a soft cotton swab to clean ears. ANS: A Avoiding head trauma is a practical way to help prevent hearing loss. Swimming can lead to hearing loss if the client has repeated infections. Fireworks displays are loud, but usually brief and only occasional. Nothing smaller than the clients fingertip should be placed in the ear canal. What is mastoiditis and what complications can occur from it? -No answer for this one.. Mastoiditis is an infection of the mastoid air cells caused by progressive otitis media. Antibx therapy is used to treat the middle ear infection before it progresses to mastoiditis. If mastoiditis is not managed appropriately, it can lead to brain abscess, meningitis and death. Know what labs to check with diabetes and polyuria -keytones and specific gravity, A1C 1.A nurse is teaching a client with diabetes mellitus who asks, Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL? How should the nurse respond? a. Glucose is the only fuel used by the body to produce the energy that it needs. b. Your brain needs a constant supply of glucose because it cannot store it. c. Without a minimum level of glucose, your body does not make red blood cells. d. Glucose in the blood prevents the formation of lactic acid and prevents acidosis. ANS: B 2.A nurse reviews laboratory results for a client with diabetes mellitus who presents with polyuria, lethargy, and a blood glucose of 560 mg/dL. Which laboratory result should the nurse correlate with the clients polyuria? a. Serum sodium: 163 mEq/L b. Serum creatinine: 1.6 mg/dL c. Presence of urine ketone bodies d. Serum osmolarity: 375 mOsm/kg ANS: D Hyperglycemia causes hyperosmolarity of extracellular fluid. This leads to polyuria from an osmotic diuresis. The clients serum osmolarity is high. The clients sodium would be expected to be high owing to dehydration. Serum creatinine and urine ketone bodies are not related to the polyuria. Know what to teach patients about controlling their diabetes and why they should control it 6.A nurse teaches a client who is diagnosed with diabetes mellitus. Which statement should the nurse include in this clients plan of care to delay the onset of microvascular and macrovascular complications? a. Maintain tight glycemic control and prevent hyperglycemia. b. Restrict your fluid intake to no more than 2 liters a day. c. Prevent hypoglycemia by eating a bedtime snack. d. Limit your intake of protein to prevent ketoacidosis. ANS: A 36.After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I need to have an annual appointment even if my glucose levels are in good control. b. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick. c. I can still develop complications even though I do not have to take insulin at this time. d. If I have surgery or get very ill, I may have to receive insulin injections for a short time. ANS: B Clients with diabetes need to be seen at least annually to monitor for long-term complications, including visual changes, microalbuminuria, and lipid analysis. The client may develop complications and may need insulin in the future. 36.After teaching a client with type 2 diabetes mellitus, the nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I need to have an annual appointment even if my glucose levels are in good control. b. Since my diabetes is controlled with diet and exercise, I must be seen only if I am sick. c. I can still develop complications even though I do not have to take insulin at this time. d. If I have surgery or get very ill, I may have to receive insulin injections for a short time. ANS: B How is insulin stored? 15.A nurse cares for a client with diabetes mellitus who is visually impaired. The client asks, Can I ask my niece to prefill my syringes and then store them for later use when I need them? How should the nurse respond? a. Yes. Prefilled syringes can be stored for 3 weeks in the refrigerator in a vertical position with the needle pointing up. b. Yes. Syringes can be filled with insulin and stored for a month in a location that is protected from light. c. Insulin reacts with plastic, so prefilled syringes are okay, but you will need to use glass syringes. d. No. Insulin syringes cannot be prefilled and stored for any length of time outside of the container. ANS: A Insulin is relatively stable when stored in a cool, dry place away from light. When refrigerated, prefilled plastic syringes are stable for up to 3 weeks. They should be stored in the refrigerator in the vertical position with the needle pointing up to prevent suspended insulin particles from clogging the needle. What causes Kussmaul respirations and what is it? 20.A nurse cares for a client experiencing diabetic ketoacidosis who presents with Kussmaul respirations. Which action should the nurse take? a. Administration of oxygen via face mask b. Intravenous administration of 10% glucose c. Implementation of seizure precautions d. Administration of intravenous insulin ANS: D The rapid, deep respiratory efforts of Kussmaul respirations are the bodys attempt to reduce the acids produced by using fat rather than glucose for fuel. 2.A nurse assesses a client who is experiencing diabetic ketoacidosis (DKA). For which manifestations should the nurse monitor the client? (Select all that apply.) a. Deep and fast respirations b. Decreased urine output c. Tachycardia d. Dependent pulmonary crackles e. Orthostatic hypotension ANS: A, C, E DKA leads to dehydration, which is manifested by tachycardia and orthostatic hypotension. Usually clients have Kussmaul respirations, which are fast and deep. Increased urinary output (polyuria) is severe. Because of diuresis and dehydration, peripheral edema and crackles do not occur. Know how to detect decreased kidney function and know the normal value for urine specific gravity 29.A nurse assesses a client with diabetes mellitus. Which clinical manifestation should alert the nurse to decreased kidney function in this client? a. Urine specific gravity of 1.033 b. Presence of protein in the urine c. Elevated capillary blood glucose level d. Presence of ketone bodies in the urine ANS: B Renal dysfunction often occurs in the client with diabetes. Proteinuria is a result of renal dysfunction. Know which electrolytes are affected by insulin and why 32.A nurse reviews the laboratory results of a client who is receiving intravenous insulin. Which should alert the nurse to intervene immediately? a. Serum chloride level of 98 mmol/L b. Serum calcium level of 8.8 mg/dL c. Serum sodium level of 132 mmol/L d. Serum potassium level of 2.5 mmol/L ANS: D Insulin activates the sodium-potassium ATPase pump, increasing the movement of potassium from the extracellular fluid into the intracellular fluid, resulting in hypokalemia. In hyperglycemia, hypokalemia can also result from excessive urine loss of potassium. The chloride level is normal. The calcium and sodium levels are slightly low, but this would not be related to hyperglycemia and insulin administration. Know which medications are safe or not safe to give after IV contrast has been given (Actos, Amaryl, Glucotrol, Glucophage) 39.A nurse reviews the medication list of a client recovering from a computed tomography (CT) scan with IV contrast to rule out small bowel obstruction. Which medication should alert the nurse to contact the provider and withhold the prescribed dose? a. Pioglitazone (Actos) b. Glimepiride (Amaryl) c. Glipizide (Glucotrol) d. Metformin (Glucophage) ANS: D Glucophage should not be administered when the kidneys are attempting to excrete IV contrast from the body. This combination would place the client at high risk for kidney failure. The nurse should hold the metformin dose and contact the provider. The other medications are safe to administer after receiving IV contrast. Know the normal ranges for : Fasting blood glucose, postprandial blood glucose, hemoglobin A1C 41.A nurse reviews laboratory results for a client with diabetes mellitus who is prescribed an intensified insulin regimen: Fasting blood glucose: 75 mg/dL Postprandial blood glucose: 200 mg/dL Hemoglobin A1c level: 5.5% How should the nurse interpret these laboratory findings? a. Increased risk for developing ketoacidosis b. Good control of blood glucose c. Increased risk for developing hyperglycemia d. Signs of insulin resistance ANS: B The client is maintaining blood glucose levels within the defined ranges for goals in an intensified regimen. Because the clients glycemic control is good, he or she is not at higher risk for ketoacidosis or hyperglycemia and is not showing signs of insulin resistance. Know complications that occur after an implantation of a vagal nerve-stimulation device 8. 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.) a. Bleeding b. Infection c. Hoarseness d. Dysphagia e. Seizures ANS: C, D Know what meningitis is and what lab values can be affected 9. 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.) a. Sodium level b. Liver enzymes c. Clotting factors d. Cardiac enzymes e. Creatinine level ANS: A, C Know the care of a patient wearing a halo fixator 8. A nurse plans care for a client with a halo fixator. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Tape a halo wrench to the clients vest. b. Assess the pin sites for signs of infection. c. Loosen the pins when sleeping. d. Decrease the clients oral fluid intake. e. Assess the chest and back for skin breakdown. ANS: A, B, E Know what Meniere’s disease is and the clinical manifestations No answer for this one Meniere’s disease usually first occurs in people between the age of 20 and 50y/o. Its has 3 features tinnitus, one -sided sensor neural auditory sensory perception loss and vertigo, occurring in attacks that can last for several days. Meniere disease is an excess of endolymphatic fluid that distorts the entire inner ear canal system. This distortion decreases hearing by dilating the cochlear duct, causes vertigo b/c of the damage to the vestibular system and stimulates tinnitus. S/S headache, increasing tinnitus, and fullness of the affected ear can precede the attack of vertigo. Tinnitus as a continous, low pitched roar or a humming sound, which worsens just before and during an attack. 1. A client presents to the ED reporting foreign body in eye. What diagnostic testing would nurse prepare? A. corneal staining 2. Nurse admonsters eyedrops to client with infection in r eye. Drops go in both eyes, 2 diff bottles used. Nurse accidentally uses the l bottle for the r eye. What action is best? B. obtain a new bottle 3. Pt doesn’t understand why vision loss due to glaucoma is irreversible. What explanation best? A bc eye pressure was too high, tissue died 4. Pt IOP is 28 mmhg. (12-22 norm) What action is best? C. plan to teach about drugs for glaucoma 5. Pt had a retinal detachment and undergone surgical correction. Discharge info most important? A. avoid reading, writing or close work as sewing 6. Pt is taking timolol (timoptic) eyedrops. Nurse assess pt pulse at 48 bpm. What action is priority? D. hold drops and notify provider 7. Nurse is teaching pt about ear hygiene and health. What pt statement indicates need further teaching? A. soft cotton swab is alright to clean my ears with 8. Nurse is teaching pt w diabetes who asks why is it necessary to maintain blood glucose levels no lower than 60. How would nurse respond? B. Your brain needs constant supply of glucose bc it cannot store it 9. Nurse cares for a pt who has a family history of diabetes. Pt states my father has type 1, will I develop. How would nurse respond? A. your risk of diabetes is higher than the general pop but it may not occur 10. Nurse assess pts who are at risk for diabetes. Which pt is at greatest risk? D. 48 yo American Indian 11. Nurse teaches a pt with type 2 diabetes who is prescribed glipizide (Glucotrol) which statement would the nurse include in pt teaching? B. avoid taking nonsteroidal anti inflame (NSAID) 12. After teaching a pt with type 2 diabetes who is prescribed nateglinide (starlix) nurse assess the pt’s understanding. Which statement made by pt indicates correct understanding of therapy? D. I will take this med immediately before I eat 13. Nurse assess a pt with diabetes and notes that the pt on responds to sternal rub by moaning, cap blood glucose of 33, IV line that is infiltrated with 0.45% NS. What action? A. Administer 1mg of intramuscular glucagon 14. Nurse cares for pt experiencing DKA who presents w kussmual respirations. What action would you take? D. administration of IV insulin 15. Nurse teaches a pt with type 1 diabetes. Which statement would the nurse include in the pt’s teaching to decrease the pt’s insulin needs? D. walk at a moderate pace for 1 mile a day 16. Nurse assess a pt with diabetes 3 hours after a surgical procedure & notes that the pt breath has a fruity odor. What action should you take? C. Consult the provider to test for ketoacidosis 17. Nurse teaches a pt w diabetes who is expericing numbness and reduced senation. Which statement nurse include in teaching to prevent injury? D. use a bath thermometer to test warm temp 18. Nurse reviews the med list of a pt with 20 year history of diabetes. Pt holds up the bottle of persscribed duloxetine (Cymbalta) & states my cousin has depression & is taking this drug. Do you think im depressed? How would nurse respond? B. its for peripheral neuropathy. Do you have burning pain in feet/hands? 19. Nurse asses pt who has diabetes and notes the pt is awake/alert. Shaky, diaphoretic, weak. 5 mins adter administering half cup of OJ the pt manifestations haven’t changed. Action? Administer another half- cup (120ml) of orange juice 20. Nurse reviews labs result of pt who is receiving IV insulin. Which would alert nurse immediately? D. potassium 2.5 21. When teaching a pt recently diagnosed w type 1, I will never be able to stick self w needle. 22. Nurse prepares to admin insulin at 1800. Pt record: insulin 12 units daily 1800, reg insulin 6 units QID 6, 1800, 2400. A. draw inject glargine first, then draw and inject reg 23. Nurse prepares to admin prescribed reg insulin &NPH insulin. Place the nurses actions in correct order to admin. . 3. Wash hands 1. Inspect expiration dates. 2. Gently roll bottles. 4. Inject air in reg 5. Withdraw nph 6. Withdraw reg 7. Inject air in NPH 8. Clean rubber stopper (31287465) 24. Nurse reviews chart and new prescription with pt with DKA. B. increase IV rate and consult w provider about potassium prescription (potassium chloride 40 meq, increase fluids to 100ml) 25. Nursing student learns that age related changes affects eyes and visions. Which changes does this include? A. decrease eye muscle tone D. Decrease general color perception e. increase in point of near vision B. development of arcus senilis 26. Nurse is teaching older adults at a senior center about changes to the ears that occur with aging. Which instruction should the nurse include? D. normal for pinna to become elongated due to changes in ear structure B. hair in canal may become coarser/longer C. hearing function may be reduced cerium is drier and impacts 27. Nurse provides diabetic education at a public health fair. Which disorders would the nurse include as complications of diabetes? A. stroke B. kidney failure C blindness A patient in the family practice clinic has restless leg syndrome. Routine laboratory work reveals white blood cells 8000mm3 (8x10^9 L); magnesium 0.8mEq/L (0.4mmol/L), and sodium 138 mEq/L (138mmol/L). What action by the nurse is best? Instruct the patient on a magnesium supplement A patient is taking long-term corticosteroids for myasthenia gravis. What teaching is most important? “Avoid large crowds and people who are ill.” The nurse is preparing a patient for a Tensilon (edrophonium chloride) test. What action by the nurse is most important? “Obtaining atropine sulfate” A nurse cares for a patient with amyotrophic lateral sclerosis (ALS). The patient states “I do not want to be placed on a mechanical ventilator.” How would the nurse respond? “What would you like to be done if you begin to have difficulty breathing?” A nurse teaches a patient with a lower motor neuron lesion who wants to achieve bladder control. Which statement would the nurse include in this patient’s teaching? “Tighten your abdominal muscles to stimulate urine flow” A nurse assesses a patient who is recovering from anterior cervical discectomy and fusion. Which complication would alert the nurse to urgently communicate with the healthcare provider? “Auscultated stridor” A nurse delegates care for a client with early stage Alzheimer’s disease to an unlicensed assistive personnel (UAP). Which statement would the nurse include when delegating this client’s care? ‘Reorient the client to the day, time, and environment with each contact.” A nurse delegates care for a client with Parkinson disease to an unlicensed assistive personnel (UAP). Which statement would the nurse include when delegating this client’s care? ‘Allow the client to be as independent as possible with activities.” A nurse is teaching care to the unlicensed assistive personel (UAP). Which statement would the nurse include when delegating care for a patient with cranial nerve II impairment? “tell the patient where food items are on the breakfast tray” A nurse is teaching a patient with cerebellar function impairment. Which statement would the nurse include in this patient’s discharge teaching? “Ask a friend to drive you to your follow-up appointments.” A nurse performs an assessment of pain discrimination on an older adult patient. The patient correctly identifies, with eyes closed, a sharp sensation on the right hand when touched with a pin. Which action would the nurse take next? Touch the pin on the same area of the left hand A nurse plans care for an 83-year old patient who is experiencing age-related sensory perception changes. Which intervention would the nurse include in this patient’s plan of care? Ensure that the path to the bathroom is free from clutter. A nurse obtains a focused health history for a patient who is scheduled for magnetic resonance angiography. Which priority question would the nurse ask before the test? “Do you have allergies to iodine or shellfish?” A nurse asks a patient to take deep breaths during an electroencephalography. The patient asks, “Why are you asking me to do this?” how would the nurse respond? “Hyperventilation causes cerebral vasoconstriction and increases the likelihood of seizure activity” A nurse assesses a patient who demonstrates a positive Romberg’s sign with eyes closed but not with eyes open. Which condition does the nurse associate with this finding? Difficulty with proprioception