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Reduction of Risk-Sensory-Perception-Mobility
1.
 
For a client with a neurological disorder, which nursing assessment will be most helpful in determining subtlechanges in the clients level of consciousness?a.
 
Client posturingb.
 
Glasgow Coma Scalec.
 
Client thinking patternd.
 
Occurrence of hallucinations
The Glasgow Coma Coma Scale score best evaluates changes in a clients level of consciousness by evaluating eyeopening, motor, and verbal responses. Option #1 indicates increased intracranial pressure. Options #3 and #4 aremore appropriate for the psychiatric client.
2.
 
The most important information for the nurse to obtain prior to a computerized axial tomography (CAT) scanconcerns:a.
 
problems being in closed spaces.b.
 
allergies to aspirin.c.
 
intact swallow and gag reflex.d.
 
full range of motion of all extremities.
If the client has claustrophobia, the scan may cause severe anxiety. Option #2 is incorrect because aspirin is not usedfor the scan. Options #3 and #4 are assessment data related to CVA but not necessary for CT scan.
3.
 
Which clients pain should be assessed initially?a.
 
A client experiencing pain 2 hours after a liver biopsy.b.
 
A client with a long leg cast who was medicated for pain 45 min. earlier.c.
 
A maternity client who experiences pain during breast feeding.d.
 
A 4-year-old child who complains of a sore throat after a tonsillectomy.
While it is important to evaluate any client's discomfort, this client could be developing compartmental syndrome andneeds immediate attention. It is important to further evaluate the pulse, sensation, movement, color, andtemperature. Options #1, #3, and #4 are not a priority to #2. A client will experience discomfort after a liver biopsy.There is a release of oxytocin during breast feeding which will cause some discomfort.
4.
 
Which nursing response indicates an understanding of a toddler that is drowsy after a grandmal seizure?a.
 
This is an expected finding after a seizure. Maintain bedrest and neurological assessments.b.
 
This indicates cortical damage. Assess for impaired motor and sensory function.c.
 
Another seizure will shortly occur. Precautions should be taken.d.
 
There is decreased sensory stimulation. Ambulate the child to initiate an increased response.
The postictal state sometimes leaves a client unresponsive, drowsy, and difficult to arouse. Options #2 and #3 are notcorrect. Option #4 is incorrect because an individual needs to rest after a seizure of this type.
5.
 
At the time of diagnosis, a client with Bell's Palsy is given a supply of eye patches. The client should be cautionedagainst:a.
 
allowing the cornea of the eye to become dry.b.
 
photosensitivity regarding light on the retina.c.
 
sudden movement of the head when bending over.d.
 
contamination from the affected eye to the other eye.
Paralysis of the eyelid allows the cornea to dry. Patches can be used to keep the eyelid closed to prevent damage.Drops and/or ointments are also used to reduce the chance of corneal damage. Option #2 is incorrect because theproblem, properly managed, should not result in a problem with light. Option #3 is for clients with increasedintraocular pressure. Option #4 is incorrect because Bells Palsy is not contagious.
6.
 
Which action should the nurse take if a CBC of a client receiving Cephalexin (Keflex) intravenously reflects asignificant decrease in red cells and platelets?a.
 
Withhold drug pending notification of physician regarding lab results.b.
 
Administer medication for next 2 scheduled doses and notify physician of CBC changes.c.
 
Discontinue drug until another CBC can be performed.d.
 
Proceed with administration of dose without delay.
Cephalexin is an antibiotic associated with the development of aplastic anemia. The physician should be notified assoon as the problem is identified. Options #2, #3, and #4 are not appropriate nursing decisions regarding thismedication.
 
 
7.
 
While the nurse is irrigating an ear to remove cerumen, the client comments that he is getting dizzy. The nursewould stop the procedure and:a.
 
notify the physician immediately.b.
 
monitor for changes in intracranial pressurec.
 
warm the irrigant and resume the procedure.d.
 
explore the canal with a cotton applicator.
Water that is too cool can elicit dizziness when it comes in contact with the tympanic membrane. Option #1 is notnecessary. Option #2 is incorrect because the client is not experiencing increased intraocular pressure. Option #4could compact the cerumen against the membrane and is never recommended.
8.
 
A client with a recent lumbar spinal cord injury must be repositioned. Nursing actions would include:a.
 
having client raise his leg and turn to opposite side.b.
 
removing the pillow between the clients legs.c.
 
turning the client smoothly, maintaining straight alignment.
d.
 
moving the client to the middle of the bed.
 Maintaining straight alignment is necessary to keep the spine straight. Option #1 will increase the twisting of thetrunk when the client turns. Option #2 will diminish support to the legs and possibly allow twisting of the hips. Option#4 will not allow the client to, he in the center of the bed after the turning.
9.
 
A client with a closed head injury begins to vomit. Which assessment is the most important for the nurse toreport when calling the physician?a.
 
Increasing lethargy.b.
 
Heart rate 80.c.
 
Sodium level of 145.d.
 
Presence of facial symmetry.
Changes in level of consciousness, increasing drowsiness or difficulty in arousing (e.g., increasing lethargy), are initialsigns of increased intracranial pressure. Options #2, #3, and #4 are normal findings.
10.
 
A client returns to the unit after having plastic surgery for left hand reconstruction. The nurse would implementwhich action to the left hand?a.
 
Apply heat.b.
 
Apply cold packs.c.
 
Alternate with heat and cold packs.d.
 
Apply paraffin.
Cold packs will cause vasoconstriction which will decrease the edema. Options #1 and #4 are incorrect. Option #3 isused for arthritis.
11.
 
The nurse is observing a client for complications following a craniotomy. The client begins complaining of thirstand fatigue. Which nursing observation is most important to report to the physician?a.
 
Specific gravity of urine is increased; urine is foul smelling.b.
 
Fluid intake over past 24 hours has been 3000 cc.c.
 
Urine output in excess of 4000 cc in 24 hours.d.
 
Presence of diarrhea and excoriation of anal area.
In diabetes insipidus, one of the first signs is a significant increase in urine output and pale colored urine. Option #1 isincorrect because the specific gravity is decreased, and foul smelling urine usually indicates infection. Option #2 isincorrect because intake is normal. Option #4 is associated with a client in chemotherapy, but not as often as Option#3.
12.
 
Before teaching a CVA client about self-care, which plan would be a priority?a.
 
Have the client identify perception of health status.b.
 
Identify the clients strengths and weaknesses.c.
 
Encourage client to discuss concerns with another CVA client.d.
 
Provide client with a written plan of therapy.
Before teaching or client learning can occur, the client must identify thoughts about his/her current status includingconcerns, fears, anxieties, etc. Option #2 is not a priority because the nurse is processing instead of the client. Option#3 is important, but is not a priority over #1. Option #4 will be done at a later time.
13.
 
The nurse enters the room and discovers the client has slurred speech, right-sided paralysis, and unequal pupils.The most appropriate next step for the nurse is to:a.
 
call the physician.b.
 
assess the respiratory status.c.
 
determine the level of consciousness.
 
 
d.
 
perform a complete neurological evaluation.
Assess the respiratory status and make sure the client has an open airway is the appropriate next step. Option #1 isincorrect because the physician will need to be notified after the nurse completes her assessment of vital signs.Option #3 will need to be determined, but is not the appropriate next step. Option #4 is not a priority over Option #2.Part of the neurological assessment has been given in the question.
14.
 
The client is admitted via the emergency room with a possible cervical spinal cord injury. The most importantinformation for the nurse to obtain is:a.
 
history of accident and type of trauma.b.
 
neurological functioning.c.
 
respiratory status and tissue perfusion.d.
 
allergies and pre-existing medical conditions.
Respirations are a priority, especially with cervical injuries. Options #1, #2, and #4 are all important but are allsecondary to respirations.
15.
 
The nurse would identify which ocular response as desirable for the client using Pilocarpine eye drops?a.
 
Pupillary constriction.b.
 
Pupillary dilation.c.
 
Corneal lubrication.
d.
 
Clearing of injected sclera.
 Pilocarpine is a miotic which constricts the pupils, allowing the aqueous humor to circulate more freely and reducingthe intraocular pressure. Options #2, #3, and #4 are not therapeutic responses to Pilocarpine.
16.
 
What would be the highest priority for a client 72 hours after having 2nd-degree burns to 20% of his body in thelower abdominal area, back, and both legs?a.
 
Airway.b.
 
Body image.c.
 
Fluid and electrolytes.d.
 
Pain.
Second-degree burns create a lot of pain for the client. Option #1 would be a priority within the first few hours forupper extremity burns. However, these are on the lower body. Option #2 is a concern, but not a priority to pain.Option #3 is a major concern initially after the burns.
17.
 
Which is the most important postoperative nursing action for the client following a sceleral buckling procedurefor detached retina?a.
 
Remove reading material to decrease eye strain.b.
 
Closely assess for presence of nausea and prevent vomiting.c.
 
Assess color of drainage from affected eye.d.
 
Maintain sterility for q3h saline eye irrigations.
It is important to prevent nausea and vomiting as this would increase the intraocular pressure and could causedamage to the area repaired. Option #1 would not be effective. Option #3 refers to an eye infection. This would beimportant after the initial operative day. Option #4 is incorrect because eye irrigations are not common following thisprocedure.
18.
 
Which nursing intervention is important in the immediate postoperative period of a client who had a cataractremoved from his left eye?a.
 
Position on right side with head slightly elevated.b.
 
Place client on his left side to protect the eye.c.
 
Perform sensory neuro checks every two hours.d.
 
Maintain complete bed rest for the first 48 hours.
The client should be positioned on his back or on his unaffected side to prevent trauma to the surgical eye. Option #2is positioning the client on his affected side. Options #3 and #4 are not necessary with the cataract client.
19.
 
A client is admitted with a diagnosis of trigeminal neuralgia (Tic Douloureux) involving the maxillary branch of the affected nerve. The nurse would plan nursing care to assist the client with which problem?a.
 
Intermittent blurred vision and tinnitus.b.
 
Intense facial pain on affected side.c.
 
Attacks of severe dizziness and vertigo.d.
 
Impaired speech function due to muscle spasm.
A characteristic of this condition is the intense facial pain experienced along the nerve tract. Nursing care should bedirected toward preventing stimuli to the area and decreasing pain. Option #1 does not occur with this condition.Option #3 describes Menieres disease. Option #4 may occur, but Option #2 is a priority.
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