ANSWERS 2023/2024 UPDATED GRADED A+
1. A nurse in an emergency department is assessing a client for suspected
cocaine intoxication. Which of the following findings should the nurseexpect?
A. Nystagmus
B. Dilated pupils
C. Hypersomnia
D. Depression
Ans: B. Dilated pupils
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2. A nurse is caring for a client who hasmajor depressive disorder and is
scheduled for electroconvulsive therapy (ECT).The client's spouse asks the
nurse about the possible side effects of the ECT. Which of the following
responses should the nurse make?
A. "The main side effects are temporary, and may include mild confusion, a
headache, and short-term memory loss."
B. "Most clients have no adverse effects to this treatment, but muscle cramping
may result from the induced seizure."
C. "Some clients have been known to have a myocardial infarction, but we will
monitor your spouse closely to be certain this does not happen."
D. "The most common side effects are directly related to the use of anesthesia."
Ans: A. "The main side effects are temporary, and may include mild confusion, a
headache, and short-term memory loss."
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3. A nurse is caringfor a client who has a history of alcohol use disorder and has
been hospitalized fordetoxification. The nurse enters the room and finds the client
,shouting in a terrified voice, "Get these bugs off of me!" Which of the following
responses by the nurseis appropriate?
A. "I'm sure that the bugs you see will not harm you."
B. "Tell me more about the bugs that you see in your room."
C. "I don't see any bugs, but you seem very frightened."
D. "I do not see anything. This is part of the withdrawal process."
Ans: C. "I don't see any bugs, but you seem very frightened."
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4. A nurse is teaching a community education course about the physical complications
related to substance use disorder. Which of the following findings should the nurse
include in the discussion as a health risk of heroin use?
A. Acute pancreatitis
B. Slowed breathing
C. Nasal septum perforation
D. Permanent short-term memory loss
ANS: B. Slowed breathing
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5. A nurse is collecting a health history on a client who has a diagnosis of
Wernicke-Korsakoff syndrome. Which ofthe following is an expected finding?
A. Family history of Alzheimer's disease.
B. Personal history of alcohol use disorder.
C. Undergoing current treatment for HIV.
D. Current rehabilitation for opiate addiction
ANS: B. Personal history of alcohol use disorder.
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6. A nurse is caring for a client who is withdrawing from opioids.Which of the
following medications should the nurse prepare to administer?
,A. Methadone
B. Disulfiram
C. Risperidone
D. Lithium carbonate
Ans: A. Methadone
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7. A nurse is assessing a client who is experiencing acute cocainetoxicity.
Which of the following findings should the nurse expect?
A. Tremors
B. Hypothermia
C. Hypotension
D. Respiratory depression
Ans: Tremors
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8. A nurse on a long-termcare unit is creating a plan of care for a client who has
Alzheimer's disease. Whichof the following interventions should the nurse include
in the plan?
A. Rotate assignment of daily caregivers.
B. Provide an activity schedule that changes from day to day.
C. Limit time for the client to perform activities.
D. Talk the client through tasks one step at a time.
ANS: Talk the client through tasks one step at a time
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9. A community health nurse is providing teaching to the family of a client who
has primary dementia. Which of the following manifestations should the nurse
tell the familyto expect?
A. Decreased auditory and visual acuity
B. Decreased display of emotions
, C. Personality traits that are opposite of original traits
D. Forgetfulness gradually progressing to disorientation
Ans: D. Forgetfulness gradually progressing to disorientation
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10. A nurse is performing a mental status examination (MSE) on a client who has a
new diagnosis of dementia. Which of the following components shouldthe nurse
include? (Select all that apply.)
A. Grooming
B. Long-term memory
C. Support systems
D. Affect
E. Presence of pain
Ans: A. Grooming
B. Long-term memory
D. Affect
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10. A nurse is caring for a client who has severe manifestationsof schizophrenia
and is medicated PRN for agitation with haloperidol. The nurse should assess
the client for which of the following adverse effects?
A. Dysrhythmias
B. Cataracts
C. Pancreatitis
D. Bleeding
ANS: A. Dysrhythmias
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11. A nurse is caringfor a client who was admitted with acute psychosis and is
being treated with haloperidol. The nurse should suspect that the client may be
experiencing tardivedyskinesia when the client exhibits which of the following?
(Select all that apply.)
A. Urinary retention and constipation