Evolve Neuro Review Practice Test.
A nurse is caring for a client who sustained trauma to the head. What criteria should a nurse evaluate to determine the client's score on the Glasgow Coma Scale (GCS)? (Select all that apply.) - CORRECT ANSWER Quality of verbal response
Ability to follow commands
Stimulus needed to open the eyes
A nurse is caring for a client who is hospitalized because of injuries sustained in a major automobile collision. As the client is describing the accident to a friend, the client becomes very restless, and his pulse and respirations increase sharply. Which factor probably is related to the client's physical responses? - CORRECT ANSWER Delayed psychological response to trauma
A client diagnosed with Bell's palsy has many questions about the course of the disorder. The nurse explains that: - CORRECT ANSWER Most clients recover from the effects in several weeks
The nurse is caring for a client with increased intracranial pressure (ICP). What clinical manifestations are associated with increased ICP? (Select all that apply.) - CORRECT ANSWER Psychotic behaviors
Jacksonian seizures
Nausea and vomiting
A client with rheumatoid arthritis calls the outpatient clinic to report that pain with exercising has increased. To decrease pain, the nurse should suggest: - CORRECT ANSWER Decrease the number of repetitions of the exercises
A client is receiving phenytoin (Dilantin) for a seizure disorder and heparin for a deep vein thrombosis. Warfarin (Coumadin) is added in preparation for discontinuing the heparin. Why must the nurse observe
the client closely during the initial days of treatment with warfarin? - CORRECT ANSWER Warfarin affects
the metabolism of phenytoin
A nurse is planning to transfer a client who is experiencing pain from the bed to a chair. Place the following steps in the order in which they should be implemented. - CORRECT ANSWER 1.Verify the client's activity prescription. 2.Identify factors that may impact the ability to transfer.
3.Explain the steps of the transfer.
4.Ensure that the wheels on the bed are locked.
5.Position the client in functional body alignment before transferring
A client arrives on the nursing unit unconscious and exhibiting decerebrate posturing. When assessing the client, the nurse expects to observe: - CORRECT ANSWER Hyperextension of both the upper and lower extremities
The nurse teaches a premenopausal obese client about strategies to prevent osteoporosis. Which strategy identified by the client indicates that the teaching is effective? - CORRECT ANSWER Joins a tennis league and practices every day
The bed alarm is ringing because of an elderly client attempting to get out of bed. A nurse enters the room and finds the client agitated and confused. The family member is upset and states, "He has never been like this. I don't know what to do." After getting the client back into bed, which of these nursing actions are appropriate? - CORRECT ANSWER Request the nursing assistant to stay with the client, while the nurse calls the primary health care provider.
A client has a decreased serum sodium level. The nurse should assess the client for which signs of hyponatremia? (Select all that apply.) - CORRECT ANSWER Confusion
Muscle weakness
To what does the nurse attribute the increased risk of respiratory complications in clients with myasthenia gravis? - CORRECT ANSWER Ineffective coughing
What instructions should the nurse provide to a client after a long leg cast is removed? - CORRECT ANSWER Elevate the extremity when sitting
A client manifests right-sided hemianopsia as a result of a brain attack (CVA). The nurse develops a plan of care and includes: - CORRECT ANSWER Instruct the client to scan surroundings
A nurse is caring for a client who sustained trauma to the head. What criteria should a nurse evaluate to determine the client's score on the Glasgow Coma Scale (GCS)? (Select all that apply.) - CORRECT ANSWER Quality of verbal response
Ability to follow commands
Stimulus needed to open the eyes
A nurse is caring for a client who is hospitalized because of injuries sustained in a major automobile collision. As the client is describing the accident to a friend, the client becomes very restless, and his pulse and respirations increase sharply. Which factor probably is related to the client's physical responses? - CORRECT ANSWER Delayed psychological response to trauma
A client diagnosed with Bell's palsy has many questions about the course of the disorder. The nurse explains that: - CORRECT ANSWER Most clients recover from the effects in several weeks
The nurse is caring for a client with increased intracranial pressure (ICP). What clinical manifestations are associated with increased ICP? (Select all that apply.) - CORRECT ANSWER Psychotic behaviors
Jacksonian seizures
Nausea and vomiting
A client with rheumatoid arthritis calls the outpatient clinic to report that pain with exercising has increased. To decrease pain, the nurse should suggest: - CORRECT ANSWER Decrease the number of repetitions of the exercises
A client is receiving phenytoin (Dilantin) for a seizure disorder and heparin for a deep vein thrombosis. Warfarin (Coumadin) is added in preparation for discontinuing the heparin. Why must the nurse observe
the client closely during the initial days of treatment with warfarin? - CORRECT ANSWER Warfarin affects
the metabolism of phenytoin
A nurse is planning to transfer a client who is experiencing pain from the bed to a chair. Place the following steps in the order in which they should be implemented. - CORRECT ANSWER 1.Verify the client's activity prescription. 2.Identify factors that may impact the ability to transfer.
3.Explain the steps of the transfer.
4.Ensure that the wheels on the bed are locked.
5.Position the client in functional body alignment before transferring
A client arrives on the nursing unit unconscious and exhibiting decerebrate posturing. When assessing the client, the nurse expects to observe: - CORRECT ANSWER Hyperextension of both the upper and lower extremities
The nurse teaches a premenopausal obese client about strategies to prevent osteoporosis. Which strategy identified by the client indicates that the teaching is effective? - CORRECT ANSWER Joins a tennis league and practices every day
The bed alarm is ringing because of an elderly client attempting to get out of bed. A nurse enters the room and finds the client agitated and confused. The family member is upset and states, "He has never been like this. I don't know what to do." After getting the client back into bed, which of these nursing actions are appropriate? - CORRECT ANSWER Request the nursing assistant to stay with the client, while the nurse calls the primary health care provider.
A client has a decreased serum sodium level. The nurse should assess the client for which signs of hyponatremia? (Select all that apply.) - CORRECT ANSWER Confusion
Muscle weakness
To what does the nurse attribute the increased risk of respiratory complications in clients with myasthenia gravis? - CORRECT ANSWER Ineffective coughing
What instructions should the nurse provide to a client after a long leg cast is removed? - CORRECT ANSWER Elevate the extremity when sitting
A client manifests right-sided hemianopsia as a result of a brain attack (CVA). The nurse develops a plan of care and includes: - CORRECT ANSWER Instruct the client to scan surroundings
