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The Client with Parkinsons Disease; Multiple Sclerosis; Unconscious Patient 1.

Which of the following is an initial sign of Parkinson's disease? 1. Rigidity. 2. Tremor. 3. Bradykinesia. 4. Akinesia. 2. The nurse develops a teaching plan for a client newly diagnosed with Parkinson's disease. Which of the following topics that the nurse plans to discuss is the most important? 1. Maintaining a balanced nutritional diet. 2. Enhancing the immune system. 3. Maintaining a safe environment. 4. Engaging in diversional activity. 3. The nurse observes that a client's upper arm tremors disappear as he unbuttons his shirt. Which statement best guides the nurse's analysis of these observations about the client's tremors? 1. The tremors are probably psychological and can be controlled at will. 2. The tremors sometimes disappear with purposeful and voluntary movements. 3. The tremors disappear when the client's attention is diverted by some activity. 4. There is no explanation for the observation; it is probably a chance occurrence. 4. When does the nurse encourage a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? 1. Early in the morning, when the client's energy level is high. 2. To coincide with the peak action of drug therapy. 3. Immediately after a rest period. 4. When family members will be available. 5. Which goal is the most realistic and appropriate for a client diagnosed with Parkinson's disease? 1. To cure the disease. 2. To stop progression of the disease. 3. To begin preparations for terminal care. 4. To maintain optimal body function. 6. What is the primary goal collaboratively established by the client with Parkinson's disease, nurse, and physical therapist? 1. To maintain joint flexibility. 2. To build muscle strength. 3. To improve muscle endurance. 4. To reduce ataxia. 7. A client with Parkinson's disease is prescribed levodopa (l-dopa) therapy. Improvement in which of the following indicates effective therapy? 1. Mood. 2. Muscle rigidity. 3. Appetite. 4. Alertness. 8. A client is being switched from levodopa to carbidopa-levodopa (Sinemet). The nurse should monitor for which of the following possible complications during medication changes and dosage adjustment? 1. Euphoria. 2. Jaundice. 3. Vital sign fluctuation. 4. Symptoms of diabetes.

Tell the client that she is being unrealistic about her abilities and must accept the fact that she needs help. endure long periods of exacerbation before the illness responds to a particular drug. 3. Reduces the urine bacterial count. 4. Encouraging the client to speak slowly. 2. but she becomes annoyed when the nurse offers assistance and refuses all help. The right hand of a client with MS trembles severely whenever she attempts a voluntary action. 2. Weakness in the extremities. Praise the client for her desire to be independent and give her extra time and encouragement. 14. Asking the client to repeat indistinguishable words." What is the nurse's best response? The main goal for the client after pallidotomy is improved 1. Which is the best legal documentation in nursing notes of the chart for this client assessment? . 3. Sudden bursts of energy. 15. Relieves muscular spasticity. 11. 3. At bedtime. 3. 4. Induces sleep. alertness. 4. 2. which nursing intervention is contraindicated? 1. 12. When the nurse talks with a client with MS who has slurred speech. At the time scheduled. 4. Tell the client firmly that she needs assistance and help her with her care. Encouraging the client to speak distinctly. The nurse determines that the drug is effective when it achieves which of the following? 1. Muscle tremors. Which statement is the nurse's best initial response in this situation? 1. Asking the client to speak louder when tired. A client with MS is receiving baclofen (Lioresal). 13. Suggest to the client that if she insists on self-care.9. appetite. She spills her coffee twice at lunch and cannot get her dress fastened securely. Two hours before mealtime. 3. Which of the following is not a typical clinical manifestation of multiple sclerosis (MS)? 1. require multiple drugs simultaneously. exhibit intolerance to many drugs. 2. A client with Parkinson's disease asks the nurse to explain to his nephew "what the doctor said the pallidotomy would do. Stimulates the client's appetite. 4. 2. What is the primary reason why the nurse has found it difficult to evaluate the effectiveness of the drugs that the client has used? Clients with MS 1. 16. All at one time. A client has had MS for 15 years and has received various drug therapies. 2. experience spontaneous remissions from time to time. At which time would the nurse make certain that the medication is taken? 1. 3. A client with Parkinson's disease needs a long time to complete her morning hygiene. Double vision. she should at least modify her routine. 4. functional ability. 3. emotional stress. A new medication regimen is ordered for a client with Parkinson's disease. 2. 10. 4.

2. 2. Limiting fluid intake to 1. 2.000 mL/day.000 mL/day. Weekly visits by another person with MS." 4. Using an elevated toilet seat. "Follow good health habits to change the course of the disease. 2. 4. Setting a regular time for elimination 3. Day care for the granddaughter. and a drug overdose is suspected. Activated charcoal powder. 3. Which of the following is an inappropriate outcome to establish with a client who has MS? 1. as ordered 22. The client will develop cognition. 18. Limit fluid intake to 1."Has an intention tremor of the right hand. Dextrose 50%. "Practice using the mechanical aids that you will need when future disabilities arise. Avoid kitchen activities because of the risk of injury. 2." 3. 4. 3. Which of the following is inappropriate for the nurse to include in the discharge plan for a client with MS who has an impaired peripheral sensation? 1. 4. Regular exercise. Avoid hot water bottles and heating pads. "You will need to accept the necessity for a quiet and inactive lifestyle. Psychotherapy." 4. Eating a diet high in fiber." 20. Insert an indwelling urinary catheter 3. The client will develop mood elevation. "Keep active. and avoid fatigue. "Slight shaking of right hand increases to severe tremor when client tries to button her clothes or drink from a cup." 17. 23. Sodium thiosulfate. . 4. Which of the following measures would be most beneficial? 1. use stress reduction strategies. The client will develop muscle strength. Carefully test the temperature of bath water." 2. . 3. A client with MS lives with her daughter and 3-year-old granddaughter. A client with MS is experiencing bowel incontinence and is starting a bowel retraining program." "Right-hand tremor worsens with purposeful acts. Administer prophylactic antibiotics. 3. Vitamin K. Which of the following medications should the nurse have available for further emergency treatment? 1. The daughter asks the nurse what she can do at home to help her mother. 4." "Needs assistance with dressing and eating due to severe trembling and clumsiness. 4. An empty bottle of aspirin was found in his car. Which strategy is inappropriate? 1. The nurse is preparing a client with MS for discharge from the hospital to home. 2. 3. Establish a regular voiding schedule. 1. A client is brought to the emergency department unconscious. 19. Inspect the skin daily for injury or pressure points. Which of the following instructions is appropriate? 1. The client will develop joint mobility. 2. Which intervention should the nurse suggest to help a client with MS avoid episodes of urinary incontinence? 1. 21.

Give the wife and sister a big hug and assure them that the client is in good hands. Occiput. Explain that because the client was found on hospital property. CNS depression. 27. 2. The nurse monitors which of the following anatomic areas as a pressure point? 1. An unconscious intubated client does not have increased intracranial pressure. Turning the client with a draw sheet and placing a pillow behind the back and one between the legs. Which clinical manifestations would the nurse expect to assess in a client diagnosed with an overdose of a cholinergic agent. 29. 4. Minimize pain. 3. Which findings would the nurse most commonly expect to assess? Select all that apply. he was probably asking for help and did not intentionally overdose. Positioning the client in the supine position with the head to the side and slightly elevated on two pillows 4. Urinary incontinence. 30. Encourage the wife and sister to express their feelings and concerns. Sensory neuropathy. 25. An unconscious client has been positioned on one side.1°C). 3. A number of clients have presented at the emergency department after a possible bioterrorist act of arsenic overexposure. 3. 3. Increase caloric intake. Severe diarrhea. and move the endotracheal tube to the opposite side daily. Allow the wife and sister to help care for the client by rubbing his back when he is turned. 2.3°C). Educate regarding drug abuse. Abdominal pain 4. 4. Seizures. Which of the following would be an appropriate initial nursing intervention with this family? 1. 2.24. 1. 4. The left arm is rested on the mattress with the elbow flexed . Cleaning the mouth carefully. keep the room temperature at 70°F (21. Sacrum. The client is placed in a right side-lying position. Heels. Violent vomiting. The head is placed on a small pillow. The wife and sister of a client who had attempted suicide with an overdose are distraught about his comatose condition and the possibility that he took an intentional drug overdose. 4. 26. 2. Select all that apply. 3. 2. Ankles. 2. 2. and place the client on a cooling blanket if the client's temperature is higher than 101°F (38. Dry mucous membranes. 28. 3. Monitoring the oral temperature. and listen carefully. Maintain intact skin. apply a thin coat of petroleum jelly. Which of the following is a priority during the first 24 hours of hospitalization for a comatose client with suspected drug overdose? 1. Which of the following positions is incorrect? 1. The right leg is extended without pillow support. Which nursing intervention would be essential? 1. 3. 1.

the nurse should 1. 3. Decreased respirations. The nurse observes that the client's right eye does not close totally. Dilated nonreactive pupils. Dispose of the residual and continue with the feeding 3. Cleaning the area around the urethral meatus. weigh the client before administering the feeding 36. Delay feeding the client for 1 hour and then recheck the residual. 35. Cyanosis. The left leg is supported on a pillow with the knee flexed 31. 2. 33. 4. 4. Irrigating the catheter with several ounces of normal saline solution. A client has been pronounced brain dead. When the nurse performs oral hygiene for an unconscious client. Readminister the residual to the client and continue with the feeding. 3. Clean the eyelid with a clean washcloth every shift 34. Clamping the catheter periodically to maintain muscle tone. 2. Hypotension. When the nurse checks for the client's gastric residual before administering the next scheduled feeding and obtains 40 mL of gastric residual. which should have the highest priority? 1. Place an eye patch over the completely closed right eye. what is the appropriate intervention? 1. 2. 4.4. Deep tendon reflexes. heat the formula in a microwave. 2. Keep a suction machine available. Place the client in a prone position. Changing the location where the catheter is taped to the client's leg. Prevention of bone demineralization. Use gauze wrapped around the fingers to clean the client's gums. 4. Increase in muscle tone. 3. 2. Based on this finding. Wear sterile gloves while brushing the client's teeth. . Withhold the tube feeding and notify the physician. 4. 2. Which findings would the nurse assess? Select all that apply. 2. 32. 4. Absent corneal reflex. 4. 1. which nursing intervention is the priority? 1. 3. Which symptom is an early indicator of hypoxia in the unconscious client? 1. 3. obtain a sterile gavage bag and tubing. Maintenance of joint mobility. 4. 3. Decerebrate posturing. 37. The client is to receive 200 mL of tube feeding every 4 hours. place the client in a semi-Fowler's position. When administering intermittent enteral feeding to an unconscious client. Of the following nursing interventions for catheter care. 38. 3. Preservation of muscle mass. which nursing intervention is most appropriate? 1. 2. Make sure the client wears eyeglasses at all times. Restlessness. What is the intended outcome for the nursing intervention of performing passive range-ofmotion exercises on an unconscious client? 1. Instill artificial tears once every shift.