-PRACTICE TEST-MEDICAL-SURGICAL NURSING:NEUROLOGIC DISTURBANCES

1. The client with suspected meningitis is admitted to the unit. The doctor is performing an assessment to determine meningeal irritation and spinal nerve root inflammation. A positive kernig’s sign is charted if the nurse notes:a. pain on flexion of the hip and knee c. pain when the head is turned to the left side b. nuchal rigidity on flexion of the neck d. dizziness when charging positions2. a client has been admitted for meningitis. In reviewing the laboratory analysis of cerebrospinal fluid (CSF), the nurse would expect to note?a. high protein c. elevated sedimentation rateb. clear color d. increased glucose3. what is the mode of transmission of meningitis?a. droplet b. airborne c. contact d. fecal-oral4. the nurse is caring for a client admitted with suspected myasthenia gravis. Which finding is usually associated with diagnosis of myasthenia gravis?a. visual disturbances including diplopia c. cogwheel rigidity and loss of coordinationb. ascending paralysis and loss of motor function d. progressive weakness that at the day’s end5. Diagnose of myasthenia gravis is frequently based on the client’s response to an intravenous injection of endrophonium (tensilon). If the client responds positively to this drug, the nurse should expect:a. relief of ptosis , but not of weakness, in other facial musclesb. a promt and dramatic increase in muscle strengthc. exacerbation of symptomatologyd. a slight increase in muscle strength that is countered by an increase of muscle fatigability6. the client is scheduled for a tensilon test to check for myasthenia gravis. Which medication should be kept available during the test?a. atropine sulphate b. furosemide c. prostigmin d. promethazine7. which nursing diagnosis is the highest priority when caring for a client with myasthenia gravis (MG)?a. pain c. ineffective copingb. risk of injury d. ineffective airway clearance8. a diagnosis of multiple sclerosis is often delayed because of varied symptoms experienced by those affected with the disease. Which symptom is most common in those with multiple sclerosisa. resting tremors c. flaccid paralysisb. double vision d. “pill-rolling” tremors9. a client with respiratory complications of multiple sclerosis (MS) is admitted to the medical-surgical unit. Which equipment is most important for the nurse to keep at the client’s bedside?a. sphygmomanometer c. nasal cannula and oxygenb. padded tongue blade d. suction machine with catheters 10 ms. Minchin presents to the health unit with complaints of fatigue, weakness and loss of balance. Assessment and diagnostic test result shows that Ms. Minchin has multiple sclerosis. She asks the nurse if there is a cure for her condition. The nurse is correct in saying that:a. no cure exists for her conditionb. surgical incision and aspiration has been found to be effective in treating multiple sclerosisc. large doses of antimicrobial therapy has been found to be effective in treating multiple sclerosisd. surgical removal of the thyroid gland has been found to be effective in treating multiple sclerosis11. Ms. Minchin complains of having vision disturbance. The health care provider further assesses Ms Minchin. A common vision problem that occurs in clients with multiple sclerosis resulting patchy blindness is known as:a. diplopia b. nystagmus c. hordeolum d. scotoma 12. which of the following signs and symptoms are considered principal symptoms of amyotrophic lateral sclerosis (AML)a. drooping of the mouth, incomplete eye closure, and inability to puff out his cheekb. muscle weakness, muscle atrophy of the feet and hands, and fasciculationc. alteration in mental function, asymmetrical weakness of limb and fasciculationd. progressive weakness in the muscles of the arms, legs, and trunk and increase breath sound upon auscultation

13. a client with a head injury has an intracranial pressure (ICP) monitor in place. Cerebral per fusion pressure calculations are ordered. If the client’s ICP is 22 and the mean pressure reading is 70 what is the client’s cerebral perfusion pressure?a. 92 b. 72 c. 58 d. 4814. when monitoring a client for early signs of increasing ICP the nurse should be particularly alert for which of the following?a. papillary changes c. decreasing bpb. difficulty arousing the client d. elevated temperature15. the nurse qis caring for a client with brain tumor and increase intracranial pressure. Which intervention would the nurse include in the plan of care to reduce ICP? a. encourage couching and deep breathing c. administer stool softenersb. posision with the head turned towards the side of the brain tumor d. provide sensory stimulation16. the nurse is monitoring a client for increasing intracranial pressure (ICP). Early signs of increased ICP include:a. pupillary changes c. decreasing blood pressureb. diminished responsiveness d. elevated pressure17. the client is admitted after a motor vehicle accident wuth pressure of 102℉ rectally . the most likely explainations for the elevated temperature ids that:a. there was damage to the hypothalamusb. he has an infection from the abrasions to the head and facec. he will require a cooling blanket to decrease the temperatured. there was damage to the frontal lobe of the brain18. for a client with head injury whose neck has been stabilized, the preferred bed position is a. trendelenburg c. flatb. 30-degree head of bed elevation d. side-lying19 a nurse assessing client with head injury. The client has a clear drainage from the nose and ears. How can the nurse determine if the damage if the drainage is cerebrospinal fluid (CSF)?a. Measure the pH of the fluid c. test for glucoseb. measure the specific gravity of the fluid d. test chloride20. a client who has been severally beaten is admitted to the emergency department. The nurse suspects basilar skull fracture after assessing:a. raccoon’s eyes and battle’s sign c. motor less in the legs that exceeds that in the armsb. nuchal rigidity and kernig’s sign d. pupillary changes21 a client is admitted to the hospital with seizures. The client has jerking of the right arm and switching of the face, but alert and aware of the seizures. This behavior is characteristics of which type of seizure?a. absence b. complex partial c. simple partial d tonic-clonic22. a client with seizure disorder is admitted for pneumonia. If the client has a generalized tonic-clonic seizure what is the appropriate action for the nurse to perform during seizure episode?a. ventilate the client with an “ambu bag” if apneic c. suction secretionsb. move hard objects away from the clients head d. open the mouth to insert oral airway23. one of the most important things for the nurse to do during the ictal phase is to:a. protect the patients headb. leave the patient alonec. give water to the patient to avoid dehydration.d. put your finger in the patients mouth to avoid swallowing the tongue24. the nurse caring for a client with cerebrovascular accident (CVA) who is complaining of being nauseated and is requesting an emesis basin. Which action would the nurse take first?a. administer an ordered antiemetic c. turn the client to one side b. obtain an ice bag and apply to the client’s throat d. notify the physician25. a 70 year old male who is recovering from a stroke exhibits signs of unilateral neglect. Which behaviour is suggestive of unilateral neglect?a. the clients is observed shaving only one side of his faceb. the client is unable to distinguish between two tactile stimuli presented simultaneouslyc. the client unable to complete a range of vision without turning his head side to side

d. the clients is unable to carry out connective and motor activity at the same time.26. a nurse is developing a plan of care for a client whose experiencing homonymous hemianopsia afte a cerebrovascular accident (CVA) the nurse documents interventions that will promote a safe environment knowing that in this disordera. the client is unable to carry out skilled act such as dressing in absence of paralysisb. the client has lost the ability to recognize familiar objects through the sensesc. the client has paralysis of the sympathetic nerves of the eye, causing sinking of the eyeballd. the client has a visual loss in the same half of the visual field of each eye27. the nurse caring for the client following a cerebral vascular accident. Which portion of the brain is responsible for taste, smell, and hearing?a. occipital b. frontal c. temporal d. parietal28. where would the nurse place the call light for a client with a right-sided brain attack and left homonymous hemianopsia?a. where the client’s prefers c. on the client’s left sideb. directly in front of the client d. on the client’s right side29. mrs. Palm cerebrovascular accident (CVA) resulted from the most common cause ischemic brain injury, which was known as:a. thrombosis c. subarachnoid haemorrhageb. cerebral hematoma d. cerebral hypertension30. Mary palm, age 76, was admitted to the medical-surgical floor with a cerebrovascular accident in the right hemisphere. Her daughter states that before this episode her mother was experiencing periods of left-sided weakness that would resolve in less than a day. This type of neurologic problem is called:a. completed CVA c. stroke-in-evolutionb. transient ischemic attack d. progressive bleeding aneurysm31. the nurse doing bowel and bladder retaining for the client with paraplegia. Which of the following is not a factor for the nurse to considera. diet pattern b.mobility c. fluid intake d. sexual function32. the nurse is caring for a client with an unstable spinal cord injury at the t7 level. Which intervention should take priority in planning care?a. increase fluid intake to prevent dehydrationb. place client on a pressure reducing support surfacec. use skin care products designed for use with incontinenced. increase caloric intake to aid healing33. a nurse is caring for a client with thoracic spinal injury. As part of the nursing care plan the nursing care plan, the nurse monitor for spinal shock. In the event that spinal shock occurs, the nurse anticipates the most likely intravenous (IV) fluid to prescribe would be:a. 5%dextrose in water c. 5% dextrose in 0.9% normal salineb. dextran d. 0.9% normal saline34. a client admitted to the nursing unit from the emergency department has a C-4 spinal cord injury. Which assessment should the perform first when admitting the client to the nursing unit?a. take the client’s temperature c. observe for dyskinesiasb. assess extremely muscle strength d. listen to breath sound35. a client with a c3 spinal cord injury experiences automatic hyperreflexa. After placing the client in high fowler’s position, the nurse’s next action should be to:a. notify the doctor c. administer an antihypertensiveb. make sure the catheter is patent d. provide supplemental oxygen36. the nurse is caring for a client hospitalize with a facial stroke. Which diet section would be suited to the client?a. roast beef sandwich, potato chips, pickle spear, iced teab. spit pea soup, mashed potatoes, pudding, milkc. tomato soup, cheese toast, jello, coffeed. hamburger, baked beans, fruit cup, iced tea

37. a 35 year old woman who just recently gave birth suffers from bell’s palsy. A nurse who is in charge of providing discharge teaching would include which the following instruction?a. chew on the unaffected side of the mouth and eat semisolid foodsb. to reduce pain, apply moist cold packs to the affected side of the facec. ware eye glasses when going outdoors to protect the eyesd. avoid massaging the face38. a client with bell’s palsy asks the nurse why artificial tears were ordered by a physician. Select the best reply by the nursea. “when your affected eye fails to make tears, the eye can become irritated and ulcerated”b. “because your eyes remains close foreign matter can be trapped beneath the lid”c. “artificial tears will remove the purulent drainage from your eye, which speed healing”d. ”because you cannot blink your affected eye, it can became dry and irritated39. The nurse is caring for a client with trigeminal neuralgia (tik douloureaux). To assist the client with nutrition needs, the nurse should?a. offer small meals of high calorie soft food c. provide additional servings of fruits and raw vegetablesb. assist the client to sit in a chair for meals d. encourage the client to eat fish, liver and chicken40. a client with trigeminal neuralgia has a dysfunction of:a. cranial nerve IV b. cranial nerve V c. cranial nerve VI d. cranial nerve VII41. The client with Alzheimer’s disease is being assisted with activities of daily living when the nurse notes that the client uses her toothbrush to her hair. The nurse is aware that the client is exhibiting:a. agnosia b. apraxia c. anomia d. aphasia42. the client with dementia is experiencing confusion late in the afternoon and before bedtime. The nurse is aware that the client’s experiencing with what is known as:a. chronic fatigue syndrome c. sundowningb. normal aging d. delusions43. a 78 year old Alzheimer’s client is being treated for malnutrition and dehydration. The nurse decides to place him closer to the nurses’ station because of his tendency to:a. forget to eat c. exhibit acquiescent behaviourb. not change his position often d. wander44. the nurse should instruct the patent with Parkinson’s disease to avoid which of the following?a. walking in an indoor shopping mall c. Walking to the car on a cold winter dayb. sitting on the deck on a cool summer evening. D. Sitting on the beach in the sun on a summer day.45. Which nursing diagnosis takes highest priority of a client with Parkinson’s?a. Imbalanced nutrition. Less than body requirements c. Impaired urinary eliminationb. Ineffective airway clearance d. Risk of injurySITUATION: Parkinson’s disease and Alzheimer’s disease are progressive neurologic disease that causes disability which usually happens later in a person’s life. Though very different disorders, they are often defined interchangeably. Nurse Marshal was assigned to care for these patients.46. During the evaluation of the quality of home are for a patient with Alzheimer’s disease, the priority for Nurse Marshal is to reinforce which statement by a family member?a. We have safety bars installed in the bathroom and have 24 hour alarms on the doors.b. At least 2 full meals a day are eaten.c. We go to a group discussion every week at our community center.d. The medication is not a problem to have it taken 3 times a day.47. A patient with Parkinson’s has been taking levodopa (Larodopa) for bradykinesia, shuffling gait, and rigidity. To evaluate the effectiveness of the medication, Nurse Marshal would document which change in the chart?Patient has:a. been more ambulatory. c. less resistance to a respiratory infections.b. an increase of 2 lbs. in weight. d. no tremors or shuffling gait.48. when evaluating the extent of Parkinson’s disease, a nurse observes for which of the following conditions?a. bulging eyeballs c. increased dopamine levelsb. diminished distal sensation d. muscle rigidity

49. which of the following symptoms occurs initially in Parkinson’s disease?a. pill rolling movements of the hand c. aspiration of foodb. akinesia d. dementia50. which assessment would assessment would indicate a patient with Alzheimer’s is disoriented? The patient:a. cannot provide the name of her physician c. does not know where she is or what day it isb. is unable to list her current medication d. asks repeatedly to be allowed to go home

Medical-surgical nursing-brain bullets neurological disturbances

1. the nervous system is the sensory control apparatus consisting of a network of nerve cells2. the nerve cells are called nervous which coordinate the actions of the transmit electrical and chemical transmission signals between different parts of its body 3. the nervous system has 2 parts: the “central” nervous system and the “peripheral” nervous system

The central nervous system is comprised of the brain, retina and spinal cord The “peripheral” nervous system is the nerve tissue that transmits sensation and motor information back and

forth from the body to the central nervous system.4. Neurons sends signals to other cells as electrochemical waves travelling along thin fibers called axons.5. Axons cause chemicals, called neorotransmitters, to be released at junctions which are called synapses6. The frontal lobe is responsible for emotions, reasoning, planning, movement, and parts of speech. It is also involved in purposeful acts such as creativity, judgment, problem solving, and planning7. the parental is responsible for the processing of nerve impulse related to sense, such as touch, pain, taste, pressure, and temperature. They also have language functions8. the occipital is responsible for the brain’s ability to recognize objects. It is responsible for our vision 9. the temporal is responsible for hearing, memory, meaning, and language. They also play a role in emotion and learning. The temporal lobes are concerned with interpreting and processing auditory stimuli.10. the cerebral cortex controls your thinking, voluntary movements, language, reasoning, and perception.11. the cerebellum controls your movement, balance, posture, and coordination. New research has also linked it to thinking, novelty, and emotions. ( the word cerebellum comes from the Latin word “little brain “)12. the hypothalamus controls your body temperature, emotions, hunger , thirst, appetite, digestion and sleep.13. the thalamus controls your sensory integration. And motor integration.14. the pituitary gland controls your sensory hormones and it helps to turn food to energy.15. the pineal gland controls your growing and maturing.

Answers & rationalesMedical-surgical nursingNeurologic disturbances

1. answer: a – kernig’s sign is a positive if pain occurs on flexion of the hip and knee. The brudzinski reflex is positive if pain occurs on flexion of the head and neck onto the chest so answer b is incorrect c and d- might be present but are not related to kernig’s sign2. answer : a- high protein a positive CSF for meningitis would include presence of protein, a positive blood culture, decreased glucose, cloudy color with an increase opening pressure, and elevated white blood cell count.3. answer: a – meningitis is transmitted through droplet thus patient should wear facial mask to promote reserve isolation.4. answer: d – the client with myasthenia develops progressive weakness that worsens during the day; A – refers to symptoms of multiple sclerosis b – refers to symptoms of guillain barre syndrome; c – refers to Parkinson’s disease5. answer: b – endometrium(tesilon) is a short acting the anticholinesterase compound. A positive tensilon test result( a prompt and dramatic increase in muscle strength) is consistent with the diagnostics of myasthenia gravis6. answer: a – a tropine sulfate is the antidote for tensilon and is given to treat cholinergic crises; b – furosemide is a diuretic; c – prostigmin is a treatment for myasthenia gravis; and d – promethazine is an antiernetic , antianxiety medication.7. answer: d – client with MG have respiratory muscle failure.8. answer: b – the most common symptoms reported by clients with multiple sclerosis is double vision; a, c, d – are not symptoms commonly reported by clients with multiple sclerosis, so they are wrong.9. answer: d – Ms weakness the respiratory muscles and impairs swallowing, putting the client at risk for aspiration. To ensure a patient oral airway, the nurse should keep a suction machine and suction catheters at the bedside, a sphygmomanometer is no more important for this client than for any other. A padded tongue blade is an appropriate seizure precaution but shouldn’t be used in this client because its large size could cause oral airway obstruction. A nasal cannula and oxygen would be ineffective to ensure adequate oxygen delivery; this client requires a mechanical ventilator.10. answer: a - there is no cure for MS. An individualized, organized and rational treatment program is indicated to relieve the clients with myasthenia gravis. 11 answer: d – there are usually visual disturbance due to the lessons in the optic nerve. Scotoma is known as patchy blindness 12. answer: b – signs and symptoms of ALS depends on the location of the affected neurons and the severity of the disease. Muscles weakness, atrophy, and fasciculation are the principal symptoms of the disorder. Unlike any degenerative disease, ALS doesn’t affect mental function. As the disease progress, the patient may report progressive weakness in muscles of arms, legs, and trunk. Neurological examination reveals brisk and overactive stretch reflexes. When the disease progress to the brain stem and cranial nerve, the patient has difficulty speaking. Chewing, swallowing, and ultimately breathing. In these patients auscultation may reveal decreased breath sounds a- is s/sx of bell palsy. 13 answer: d – the cerebral perfusion pressure is obtained by subtracting the ICP from the mean arterial pressure (MAP). A client must have a CCP of 70-100 to have a normal reading and adequate cerebral perfusion. A, b, and c – are all incorrect calculations.14 answer: b – the first sign of pressure on the reticular activating system in the brain stem is a decrease in responsiveness, evidenced by difficulty arousing the client.15 answer: c – stool softeners reduce of straining during bowel movement which can increase ICP by raising the intrathoracic pressure and interfering with a venous return; a – coughing increases ICP; b – keeping the head in midline and avoiding extreme neck flexion prevent obstruction of venous blood flow from the brain; d – sensory stimulation can increase ICP.16. answer: b – usually, diminished responsiveness is the first sign of ICP; a- pupillary changes occur later, c –increased ICP causes systolic blood pressure to rise; d – temperature changes vary and may not occur even with a serve decrease in responsiveness. 17. answer: a – damage to the hypothalamus can result in an elevated temperature because this is portion of the brain helps regulate body temperature; b, c, and d – are incorrect because there is no data to support the possibility of an

infection, a cooling blanket might not be required, and the frontal lobe is not responsible for regulation of the body temperature18. answer: b – with increased ICP, HOB, is elevated to promote venous outflow; a trendelenburg is contraindicated; c – flat or neutral position is indicated when elevating the head of bed would increase the risk of neck injury or airway obstruction; d – not therapeutic treatment for increase ICP19. answer; c – cerebrospinal fluid is positive for glucose20. answer: a – a basilar skull fracture commonly causes only periorbital ecchymosis( racoon’s eyes) and postmastoid ecchymosis (Battle’s sign); however, it sometimes also causes otorrhea, rhitorrhea, and loss of cranial nerve I (olfactory nerve) function. Nuchal rigidity and kernig’s sign are associated with meningitis. Motor loss in the legs that exceeds that in the arms suggest central cord syndrome. Pupillary changes are common in skull fractures with associated meningeal artery bleeding and truncal herniation.21. answer: c- a simple partial seizure, there is characterized by jerking of extremities, twitching of the face, and mental alertness; a, b, d – are not characterized with these clinical manifestation. Answer b is differentiated by the clients awareness of the seizure. 22 answer: b – with a tonic-clonic seizure, there is muscle rigidity, then muscle jerking. The nurse must provide for the safety of the client by clearing the environment. During seizure there should be nothing in the client’s mouth; doing so could cause injury to the client or nurse. Resistant can further cause injury.23. answer: a – one the most important interventions for a nurse to perform during seizure is to protect the patients head from injury. Never give a patient a drink during seizure. Putting you’re your finger your finger in the patients mouth could be very dangerous to the patient and the nurse.24. answer: c – turning the client to the side will allow any vomit to drain the from the mouth and decrease the risk for aspiration; a, b, and d – are all appropriate nursing interventions, but a patient airway the prevention of aspiration are priorities. 25. answer: a – the client with unilateral neglect will neglect one side of the body; b, c, and d are not associated with unilateral neglect. 26. answer: d – homonymous hemianopsia is a visual loss in the same half of the visual field of each eye, so the clients has only half of normal vision; a – describes apraxia; b – describes agnosia; c – describes homer syndrome 27. answer: c – the temporal lobe is responsible for taste, smell, and hearing. The occipital lobe is responsible for vision. The frontal lobe is responsible for judgment, foresight, and behavior. The parietal lobe is responsible for ideation, sensory functions, and language. 28. answer: d – the client with right sided brain attack has left visual field blindness. The client will see only from the right side.29. answer: a – ischemic brain injury most commonly results from thrombosis caused by plaque build-up in the cerebral arteries.30. answer: b – a TIA elicits symptoms of a stroke, but they usually disappear within 24 hours. 31. answer: d - when assisting the client with bowel and bladder training, the least helpful factor is the sexual function. Dietary history, mobility, and fluid intake are important factors, these must be taken into consideration because they relate to constipation, urinary function, and the ability to use the urinal or bedpan.32. Answer: B – This client is at greatest risk for skin breakdown because of immobility and decreased sensation. The first action should be to choose and then place the client on the best support surface to relieve pressure, shear and friction forces.33. Answer: D – Normal saline 0.9% is an isotonic solution that primarily remains in the intravascular space, increasing intravascular volume. This IV fluid would increase the client’s blood pressure. Dextran is rarely used in spinal shock because isotonic fluid administration is sufficient. Additionally, Dextran has potentially serious side effects. Dextrose 5% in water is a hypotonic solution that pulls fluid out of the intravascular space and is not indicated for shock. Dextrose 5% in normal saline 0.9% is hypertonic and indicated for shock resulting from hemorrhage or burns.34. Answer: D – Because compromise of respiration is a leading cause of death in cervical cord injury, respiratory assessment is the highest priority. Assessment of temperature and strength can be done after adequate oxygenation is assured. Dyskinesias occur in cerebellar disorders, so they are not as important in cord-injured clients, unless head injury is suspected.35. Answer: B – After raising the client’s head to lower the blood pressure, the nurse should make sure that the client is not lying on the catheter; A and C – are not the first or second actions the nurse should take; D- The client with autonomic hyperreflexia has an extreme elevation in blood pressure. The use of supplemental oxygen is not indicated.

36. Answer: B – The client with a facial stroke will have difficulty swallowing and chewing, and the foods in answer B provide the least amount of chewing. The foods in Answer A, C, and D would require more chewing and, thus, are incorrect.37. Answer: A – Patient teaching for clients with Bell’s palsy includes protecting the eyes with an eye patch, especially when outdoors. Tell the client to keep warm and avoid exposure to dust and wind. When exposure is unavoidable, instruct him to cover his face. To help client cope with difficulty in eating and drinking, instruct him to chew on the unaffected side of the mouth and to eat semisolid foods. To reduce pain, moist heat compress can be applied to the affected side. To help maintain muscle tone, massage the client’s face with a gentle upward motion two to three times daily for 5 to 10 minutes.38. Answer D – Bell’s palsy may cause paralysis of the eyelid and loss of the blink reflex on the affected side. The eye may not close completely. These problems render eye susceptible to drying the irritation from dust or other debris.39. Answer A – Offer small meals of high calorie soft food. If the client is losing weight because of poor appetite due to the pain, assist in selecting foods that are high in calories and nutrients, to provide more nourishment with less chewing. Suggest that frequent, small meals be eaten instead of three large ones. To minimize jaw movements when eating, suggest that foods be pureed.40. Answer B – A client with trigeminal neuralgia has a dysfunction of Cranial nerve V; A client with Bell’s palsy has a dysfunction of Cranial nerve VII41. Answer B – Apraxia is the inability to use objects appropriately. A, C and D – Agnosia is loss of sensory comprehension, anomia is the inability to find words, and aphasia is the inability to speak or understand42. Answer C – Increased confusion at right is known as “sundowning” syndrome. This increased confusion occurs when the sun begins to set and continues during the night. A – fatigue is not necessarily present. B – Increased confusion at night is not part of normal aging, D – A delusion is a firm, fixed belief.43. Answer: D – a client with Alzheimer’s disease is at risk for injury because of its tendency to wander. Placing him closer to the nurses’ station makes it easier to monitor him and better insures his safety if he begins to wander . placing the client to the nurses’ station won’t help the client remember to eat, change his position often, or modify his behavior44. answer: D the patient with parkinson’s disease may be hypertensive to heat, which increases the risk of hypethermia and he should be instructed to avoid sun exposure during hot weather .45. Answer: B – in parkinson’s crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such as crisis is at risk for aspiration and pneumonia. Also, excessive drooling increases the risk of airway obstruction. Because of these concerns, the nursing diagnosis of ineffective airway clearance takes highest priority. Although the other option also are appropriate. They aren’t immediately life-threating.46. Answer: B – we have safety bas installed in the bathroom and have 24 hour alarms on the doors. Ensuring safety of the patient with increasing memory loss is a priority of home care. Note all options are correct statements. However, safety is most important to reinforce.47. Answer: A – there is no cure for this symptoms, but levodopa (lerodopa) does reduce the rigidity and bradykinesis which facilities mobility for the patient. B, c – are incorrect; d – unrealistic48. answer: D – parkinson’s disease is characterized the slowing of voluntary muscle movement, muscular, rigidity, and resting tremor. Bulging eyeballs(exopthalamos) occur in graves disease. Diminished distal sensation doesn’t occur in parkinson’s disease. Dopamine is deficient in this disorder49. Answer: A - early symptoms of parkinson’s disease include coarse resting tremors of the fingers and thumb. Akinesia and aspiration are late signs of parkinson’s disease. Dementia occurs in only 20% of the patients with parkinson’s disease.50. Answer: C – the ability to identify person, place, and time correctly are the cardinal signs of orientation status; a and b – may be form memory and not disorientation; d – the patient may be very oriented and wants to go hme.

- PRCTICE SET – MEDICAL-SURGICAL NURSING:

NEURO-SENSORY DISTURBANCES1. an elderly client with glaucoma has been prescribed timoptic eyedrops. Timoptic should be used with caution in clients with a history of:a. diabetes b. gastric ulcers c. emphysema d. pancreatic2. a client who has glaucoma is to have miotic eyedrops installed in both eyes. The nurse knows that the pupose of the medication is to:a. anesthetize the cornea c. constrict the pupils b. dilate the pupils d. paralyze the muscles of accommodation3. an early client with glaucoma is scheduled for a cholecystectomy. Which medication order should the nurse question?a. meperidine b cimetadine c. atropine d. promethazine4. a client has recently been diagnose with open-angle glaucoma. The nurse should tell the client to avoid talking:a. aleve (naprosyn) c. Tylenol (acetaminophen)b. Benadryl( diphenhydramine) d. robitussin(guaifenesin)5. which of the following risk factors would the nurse assess for in the client with glaucomaa. family history. Increased intraocular pressure, and age of 45-65.b. history of diabetes and age greater than 50c. female gender, cigarette smoking, age greater than 65d. myopia, history of diabetes, and sudden serve physical exertion.6. an elderly client with glaucoma has been prescribe timoptic eyedrops. Timoptic should be used with caution in clients with a history of:a. diabetes b. gastric ulcer c. emphysema d. pancreatitis7. which symptom is not associated with glaucoma?a. veil-like loss of vision c. seeing halos around lightsb. foggy loss of vision d. complains eye pain8. the nurse is preparing to discharge a client following a trabeculoplasty for the treatment of glaucoma. The nurse should instruct the client to:a. wash her eyes with baby shampoo and water twice a dayb. take only tub baths for the first month following surgeryc. begin using her eye makeup again 1 week after surgery d. wear eye protection for several months after surgery9. a client has recently been diagnose with open-angle glaucoma. The nurse should tell the client to avoid talking?a. aleve (naprosyn) c. Tylenol (acetaminophen)b. Benadryl( diphenhydramine) d. robitussin(guaifenesin)10. a client who has glaucoma is to have miotic eyedrops installed in both eyes. The nurse knows that the purpose of the medication is to:a. anesthetize the cornea c. constrict the pupilsb. dilate the pupils d. paralyze the muscles of accommodation11. what is the normal range of intraocular pressure?a. 10 to 15 mmHg b5 to 10 mmHg c. 10 to 21 mmHg 15 to 31 mmHg12. a client had cataract surgery should be told to call his physician if he has which of the following conditions?a. blurred vision b. eye pain c. glare d. itching13. cataracts result in opacity of the crystalline lens. Which of the following best explains the functions of the lens?a. the lens controls stimulations of the retina. c. the lens focuses light rays on the retinab. the lens orchestrates eye movement d. the lens magnifies small objects14. the nurse is preparing a client for cataract surgery. The nurse is aware that the procedure will use:a. mydriatrics to facilitate removal c. a laser to smooth and reshape the lensb. miotic medications such as timoptic d. silicone oil injections into the eyeball15. the nurse is preparing a client for discharge following the removal of cataract. The nurse should tell the client to:a. take aspirin for discomfort c. remove the eye shield before going to sleepb. avoid bending over to put on his shoes ` d. continue showering as usual

16. mr. boohlagh is diagnose with retinal detachment. Which intervention is the most important for this patient?a. admitting him to the hospital on strict bed rest c. referring him to an ophthalmologistb. patching both of his eyes d. preparing him for a surgery17. signs and symptoms of retinal detachment include:a. painless decrease in vision, veil over the visual field, and flashing lightsb. veil over the visual field, increase intraocular pressure, and yellow-green halos around visual imagesc. photophobia, yellow-green halos around visual images, and blurred visiond. unilateral eye inflammation, cloudy cornea, and moderately dilated pupil18. Gretchen suffered a cerebrovascular accident that left his/her unable to comprehend speech and unable to speak. This type of aphasia is known as:a. receptive aphasia b. expressive aphasia c. global aphasia d. condition aphasia19. the nurse is explaining cryotherapy to a client who has a detached retina. The nurse should explain that the MAJOR purpose of cryotherapy in the treatment of detached retina is to:a. create a scar that promotes healing c. freeze small blood vesselsb. disintegrates debris in the eye d. halt secretions of the lacrimal duct20 a client is admitted with a detached retina of the left eye. The nurse patches about eyes what is the rationale for patching the eyes?a. To prevent eye infection c. to prevent photophobiab. to decrease eye movement d. to prevent nystagmus21. the nurse is caring for a client with Meniere’s disease. When teaching the client about the disease, the nurse should explain that the client should avoid foods high in?a. calcium b. fiber c. sodium c. carbohydrate22. a client with otosclerosis is scheduled for a stapedectomy. Which finding suggest a compilation involving the seventh cranial nerve?a. diminishing hearing c. inability to move the tongue side to sideb. sensation of fullness in the ear d. changes in facial sensation23. the nurse doing the assessment for the patient with bell’s palsy known that the CN affected is:a. CN 7 b.CN 8 c. CN 6 d.CN 524. which nursing diagnosis takes highest priority for a client admitted for evaluation for Meniere’s disease?a. pain related vertigob. imbalanced nutrition: less than the body requirements related to nausea and vomitingc. risk for deficient fluid volume related to vomitingd. risk for injury related to vertigoSITUATON: Meniere’s disease is a disorder of the inner ear. Meniere’s episode may occur in clusters and several attacks may occur within a short period of time25 a patient is diagnosed with Meniere’s disease. Which of the following nursing diagnoses would take priority for tis patient?a. ineffective tissue perfusion (cerebral) c. imbalanced nutrition: more than body requirementsb. risk of injury d. impared social interaction26. which of the following symptoms would the nurse expect to find when assessing a patients Meniere’s disease?a. epistaxis b. ptosis c. tinnitus d. facial pain27