TEST BANK: PRIMARY CARE ART AND SCIENCE OF ADVANCED PRACTICE NURSING – AN INTERPROFESSIONAL APPROACH 6th EDITION DUNPHY Chapter 1: Primary Care in the Twenty-First Century: A Circle of Caring 1. A nurse has conducted a literature review in an effort to id

TEST BANK: PRIMARY CARE ART AND SCIENCE OF ADVANCED PRACTICE NURSING – AN INTERPROFESSIONAL APPROACH 6th EDITION DUNPHY Chapter 1: Primary Care in the Twenty-First Century: A Circle of Caring 1. A nurse has conducted a literature review in an effort to identify the effect of handwashing on the incidence of nosocomial (hospital-acquired) infections in acute care settings. An article presented findings at a level of significance of <0.01. This indicates that A. The control group and the experimental group were more than 99% similar. B. The findings of the study have less than 1% chance of being attributable to chance. C. The effects of the intervention were nearly zero. D. The clinical significance of the findings was less than 1:100. Answer: B Feedback: The level of significance is the level at which the researcher believes that the study results most likely represent a no chance event. A level of significance of <0.01 indicates that there is less than 1% probability that the result is due to chance. 2. A nurse has read a qualitative research study in order to understand the lived experience of parents who have a neonatal loss. Which of the following questions should the nurse prioritize when appraising the results of this study? A. How well did the authors capture the personal experiences of these parents? B. How well did the authors control for confounding variables that may have affected the findings? C. Did the authors use statistical measures that were appropriate to the phenomenon in question? D. Were the instruments that the researchers used statistically valid and reliable? Answer: A Feedback: Qualitative studies are judged on the basis of how well they capture and convey the subjective experiences of individuals. Statistical measures and variables are not dimensions of a qualitative methodology. 3. A nurse has expressed skepticism to a colleague about the value of nursing research, claiming that nursing research has little relevance to practice. How can the nurses colleague best defend the importance of nursing research? MedConnoisseur © 2022 A) The existence of nursing research means that nurses are now able to access federal grant money, something that didnt use to be the case. B) Nursing research has allowed the development of masters and doctoral programs and has greatly increased the credibility of the profession. C) The growth of nursing research has caused nursing to be viewed as a true profession, rather than simply as a trade or a skill. D) The application of nursing research has the potential to improve nursing practice and patient outcomes. Answer: D Feedback: The greatest value of nursing research lies in the potential to improve practice and, ultimately, to improve patient outcomes. This supersedes the contributions of nursing research to education programs, grant funding, or the public view of the profession. 4. Tracy is a nurse with a baccalaureate degree who works in the labor and delivery unit of a busy urban hospital. She has noticed that many new mothers abandon breast-feeding their babies when they experience early challenges and wonders what could be done to encourage more women to continue breast-feeding. What role is Tracy most likely to play in a research project that tests an intervention aimed at promoting breast-feeding? A) Applying for grant funding for the research project B) Posing the clinical problem to one or more nursing researchers C) Planning the methodology of the research project D) Carrying out the intervention and submitting the results for publication Answer: B Feedback: A major role for staff nurses is to identify questions or problems for research. Grant applications, methodological planning, and publication submission are normally carried out by nurses who have advanced degrees in nursing. 5. A patient signed the informed consent form for a drug trial that was explained to patient by a research assistant. Later, the patient admitted to his nurse that he did not understand the research assistants explanation or his own role in the study. How should this patients nurse respond to this revelation? A) Explain the research process to the patient in greater detail. B) Describe the details of a randomized controlled trial for the patient. C) Inform the research assistant that the patients consent is likely invalid. D) Explain to the patient that his written consent is now legally binding. Answer: C MedConnoisseur © 2022 Feedback: Just as the staff nurse is not responsible for medical consent, the staff nurse is not responsible for research consent. If patients who have agreed to participate exhibit ambivalence or uncertainty about participating, do not try to convince them to participate. Ask the person from the research team who is managing consents to speak with concerned patients about the study, even after a patient has signed the consent forms. 6. A nurse leader is attempting to increase the awareness of evidence-based practice (EBP) among the nurses on a unit. A nurse who is implementing EBP integrates which of the following? (Select all that apply.) A) Interdisciplinary consensus B) Nursing tradition C) Research studies D) Patient preferences and values E) Clinical expertise Answer: C, D, E Feedback: Fineout-Overholt, Melnyk, Stillwell, and Williamson define EBP as a problemsolving approach to the delivery of healthcare that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. 7. Mrs. Mayes is a 73-year-old woman who has a diabetic foot ulcer that has been extremely slow to heal and which now poses a threat of osteomyelitis. The wound care nurse who has been working with Mrs. Mayes applies evidence-based practice (EBP) whenever possible and has proposed the use of maggot therapy to debride necrotic tissue. Mrs. Mayes, however, finds the suggestion repugnant and adamantly opposes this treatment despite the sizable body of evidence supporting it. How should the nurse reconcile Mrs. Mayes views with the principles of EBP? A) The nurse should explain that reliable and valid research evidence overrides the patients opinion. B) The nurse should explain the evidence to the patient in greater detail. C) The nurse should integrate the patients preferences into the plan of care. D) The nurse should involve the patients family members in the decision-making process. Answer: C Feedback: Patient preferences should be integrated into EBP and considered alongside research evidence and the nurses clinical expertise; evidence does not trump the patients preferences. The family should be involved, but this is not an explicit dimension of EBP. Similarly, explaining the evidence in more detail is not a demonstration of EBP. 8. The administrators of a long-term care facility are considered the use of specialized, pressure- reducing mattresses in order to reduce the incidence of pressure ulcers among residents. They have sought input from the nurses on the unit, all of whom are aware of the need to implement the principles of evidence-based practice (EBP) in this decision. Which of the following evidence sources should the nurses prioritize? A) A qualitative study that explores the experience of living with a pressure ulcer B) A case study that describes the measures that nurses on a geriatric unit took to reduce pressure ulcers among patients C) Testimonials from experienced clinicians about the effectiveness of the mattress in question D) A randomized controlled trial that compared the pressure-reducing mattress with standard mattresses Ans: D Feedback: The most reliable evidence is considered RCTs. Qualitative studies, case studies, and expert opinion are low on the hierarchy of evidence. 9. Hospital administrators are applying the principles of evidence-based practice (EBP) in their attempt to ascertain the most efficient and effective way to communicate between nurses who are on different units, a project that will consider many types of evidence. Which of the following information sources should the administrators prioritize? A. A)A systematic review about communication in nursing contexts B. B)Nurses ideas about communication methods C. C)The results of a chart review D. D)The hospitals accreditation status Ans: A Feedback: Systematic reviews are assigned a high value in EBP. Reviews would be prioritized over nurses ideas or a chart review, though both are potential considerations. The hospitals accreditation status is not a relevant consideration. 10. A nurse has resolved to apply the evidence-based practice (EBP) process to the way that admission assessments are conducted and documented on a unit. How should the nurse begin the process of establishing EBP? A) Gather evidence showing the shortcomings of current practices B) Formulate a clear and concise question to be addressed C) Elicit support from the nurses who are most often responsible for admissions D) Search the literature for evidence that is potentially relevant to the practice need Ans: B MedConnoisseur © 2022 Feedback: The first step in applying EBP is to ask a clear, focused question. This should precede a search of the literature or the recruitment of participants. An assessment of the shortcomings of the current system is not an explicit component of the EBP process. 11. Which of the following questions best exemplifies the PICOT format for asking evidence-based questions? A)What affect does parents alcohol use have on the alcohol use of their teenage children? B)Among postsurgical patients, what role does meditation rather than benzodiazepines have on anxiety levels during the 48 hours following surgery? C)Among high school students, what is the effectiveness of a sexual health campaign undertaken during the first 4 weeks of the fall semester as measured by incidence of new sexually transmitted infections? D)In children aged 68, is the effectiveness of a descriptive pain scale superior to a numeric rating scale in the emergency room context? Feedback: The correct answer includes a population (postsurgical patients), intervention (meditation), comparison (benzodiazepines), outcome (anxiety levels), and a time frame (48 hours). No other option contains each of the five elements of a PICOT question. 12. A nurse has made plans to implement the University of North Carolina (UNC) model of 5 As during the process of applying evidence-based practice (EBP) to a practice problem. What is the final step that the nurse will take in applying this model? A) Analyze the results of the EBP process B) Advocate for others to embrace the identified change C) Adopt the changes identified in the review process D) Assess the outcomes of the new practice Ans: D Feedback: The final step in the UNC rubric is to Assess the change using the quality improvement process in place in the institution. 13. A nurse has been asked to make a presentation to a group of high school students on the subject of sexual health. However, the nurse does not have a background in this practice area and requires rapid access to evidence-based guidelines. Which of the following strategies is most likely to provide the nurse with valid and reliable evidence in a time-efficient manner? A) Search the Cochrane Library of Systematic Reviews B) Google search terms such as sexual health teens and sexual education C) Search Medline using PubMed and order relevant articles MedConnoisseur © 2022 D) Scan the most recent issues of nursing journals that address this area of practice Feedback: For some problems, a systematic review may be available from a source such as the Cochrane Library. Often this review is done by an expert panel providing excellent information on which to base decisions. This approach is more likely to produce valid and reliable results than a Google search and is more efficient than searching journal manually or ordering articles through PubMed. 14. The nurses at a university hospital have been informed that a computerized record system will be implemented over the next 12 months. The nurses should be aware that such as system presents particular challenges in the area of A) vulnerability to errors in charting and the inability to make changes. B) patient privacy and confidentiality of records. C) enforcing compliance with the system on the part of nurses. D) ensuring compatibility with different computer operating systems. Ans: B Feedback: Concerns about privacy become magnified when information is available to many people in many sites far removed from where the patient is located, a situation that exists when computerized records are used. This is usually considered a more important concern than issues of compliance, compatibility, or vulnerability to errors. MedConnoisseur © 2022 15. A nurse is nervous about the impeding introduction of computerized nursing care records at the hospital because he does not consider himself to be technologically adept. How should this nurse best respond to this situation? A) Take courses in advanced practice nursing to build his knowledge. B) Explore employment opportunities in settings that use written documentation systems. C) Advocate for a delay in the introduction of the proposed system. D) Seek out opportunities to learn the relevant knowledge and practice the necessary skills. Ans: D Feedback: A nurse who lacks technological knowledge or skills should seek out opportunities to expand these. This is preferable to finding a job elsewhere, studying advanced practice nursing, or attempting to delay the change. MedConnoisseur © 2022 Chapter 2. Caring and the Advanced Practice Nurse Multiple Choice 1. A goal of community nursing is to provide primary prevention from disease. Which of the following nursing actions reflect this goal? A) A nurse creates a pamphlet discussing heart-healthy foods and distributes it in the neighborhood community center. B) A nurse starts an intravenous line on a dehydrated baby who has been brought to the emergency department. C) A nurse performs range-of-motion exercises for a patient in traction. D) A nurse repositions an elderly patient confined to a wheelchair to avoid the formation of pressure ulcers. Ans: A MedConnoisseur © 2022 Feedback: Primary prevention involves the efforts to prevent disease from ever occurring. Primary prevention can be aimed at stopping the cause of disease. Generalized efforts to educate people regarding healthy diets are aimed at this type of primary prevention. Tertiary prevention focuses on preventing long-term disability and restoring functional capacity, as exemplified by repositioning an immobile patient, rehydrating a patient, or assisting with exercises. 2. A nurse decides to pursue a career in community-based nursing. Which of the following statements represents the environment in which the nurse will be working? A) Community-based nursing is limited to work in public clinics, schools, and industry. B) The key to community-based settings is that the nurse is in charge. C) The nurse serves as an educator, guide, and resource person and determines the action taken by the client. D) Care in the community is cost-effective. Ans: D Feedback: Care in the community is cost-effective and often more acceptable to the client because it causes less disruption in life. It takes place in a wide variety of settings and involves the nurse entering into a collaborative relationship with clients. 3. The movement of a client from acute care to a long-term nursing care facility involves planning to provide continuity of care. What is the term for this type of planning? A) Discharge planning MedConnoisseur © 2022 B) Comprehensive planning C) Ongoing planning D) Transition planning Ans: D Feedback: Transitions are the movement of the patient from one care environment to another. Transition planning refers to the planning process that takes place to assure that the patients wellbeing is maintained throughout the time of transition. Organizing this transition from one care setting to another is not termed discharge planning, comprehensive planning, or ongoing planning. 4. A nurse is called into work to perform triage in the aftermath of an earthquake. Which of the following are the expected responsibilities of this nurse? A) Set up and monitor IV lines. B) Prepare the emergency room for multiple victims. C) Screen victims to prioritize treatment. D) Check available blood products and assist with transfusions. Ans: C MedConnoisseur © 2022 Feedback: Triage involves the initial screening of victims for the purpose of prioritizing treatment and making the most effective and efficient use of both human and material resources. The other noted tasks are within the scope of disaster nursing but are not triage activities. 5. A client asks a nurse for help in obtaining an alternative healthcare provider. Which of the following is an accurate fact regarding alternative care that the nurse should share with this client? A) Most alternative healthcare practitioners do not have education-based credentials to practice their medicine. B) Alternative providers are not usually included in the federal HIPAA legislation that mandates confidentiality in conventional healthcare settings. C) The cost of alternative therapy is never covered by insurance carriers or healthcare plans. D) It is easy to find accurate safety and efficacy data for alternative medicine on the Internet. Ans: B Feedback: Alternative providers are not normally included in the federal Health Insurance Portability and Accountability Act of 1996 legislation that mandates confidentiality in conventional healthcare settings. Alternative practitioners do not necessarily lack credentials. Accurate online information can be difficult to find and costs for treatment may be covered by some insurance plans. 6. There is an increasing trend for nursing care to move from the hospital setting into the community. Nurses who are to provide excellent care in a community setting should prioritize which of the following? MedConnoisseur © 2022 A) Integrating culture and family into the planning and delivery of care B) Becoming more assertive in client education and the planning of client care C) Encouraging clients to limit their interactions with physicians D) Teaching clients to replace biomedical interventions with complementary therapies Ans: A Feedback: The move to community care heightens the importance of family-centered, culturallycompetent nursing. Community nursing does not necessarily require that a nurse become more assertive with client. It would be simplistic, and in most cases inappropriate, to guide clients to replace biomedical interventions or avoid doctors. 7. In spite of the important role that hospitals play in American healthcare, there is growing importance of community-based healthcare and community-based nursing. Which of the following statements best conveys a central aspect of the philosophy of community care? A) The client is in charge of his or her health and healthcare in the community. B) Nurses maximize their scope of practice in noninstitutional settings. C) Community settings allow for the greatest number and variety of treatment options. D) The nurse becomes the key member of the healthcare team in a community setting. Ans: A MedConnoisseur © 2022 Feedback: A central premise of community healthcare is the fact that patients/clients are in charge. The move toward community care is not motivated by an increased role for nurses. There are a greater number of treatment options in hospitals than in the community, but this fact does not negate the importance of community care. 8. Mr. Hammond is a 70-year-old man with a diagnosis of type 1 diabetes who developed a diabetic foot ulcer earlier this year. He has recently been discharged from the hospital and now requires regular wound care. Karen is a community health nurse who provides wound care for Mr. Hammond twice weekly. Which of Karens actions is most likely to empower Mr. Hammond? A) Encourage Mr. Hammond to acknowledge his contribution to the development of his wound. B) Provide information to Mr. Hammond that matches his expressed needs. C) Encourage Mr. Hammond to involve members of his family in his care. D) Delegate wound care to Mr. Hammond and reduce the frequency of her visits. Ans: B Feedback: Client empowerment is often fostered by assessing and meeting a clients need for information. Encouraging an acknowledgement of the clients contribution to his or her current health state is beneficial in many circumstances, but it less likely to make the client feel empowered. Similarly, family involvement can be beneficial but does not directly foster empowerment. Empowerment does not necessarily mean that the nurse does less and the client performs his or her own care; delegation may not be appropriate. 9. An elderly female client who resides in the community tends to defer decisions regarding her care to her eldest son. How should the community health nurse respond to the clients reluctance to make independent decisions? MedConnoisseur © 2022 A) Discuss this observation with the client and her son in an open manner and explore alternatives. B) Organize care so that it takes place at times when the son is not present in the home. C) Accommodate this aspect of the clients family dynamics when planning and carrying out care. D) Teach the client assertiveness skills that she can apply in her interactions with her son. Ans: C Feedback: The nurse should respect the clients desire to organize her care in the way that she prefers. It is not the responsibility of the nurse to reorganize or overcome this familys dynamics. 10. A client with a long-standing diagnosis of chronic obstructive pulmonary disease (COPD) has been enrolled in a disease management program. Which of the following activities will be prioritized in this program? A) Providing comprehensive and evidence-based care of the clients COPD B) Creating collaborative relationships between the client and the care team C) Ensuring that the client qualifies for Medicare and Medicaid D) Liaising between the client and his health maintenance organization (HMO) Ans: A MedConnoisseur © 2022 Feedback: Disease management focuses on providing the best evidence-based care for an individual with a specific chronic illness. This does not necessitate enrollment in an HMO, Medicare, or Medicaid. Collaborative relationships facilitate effective disease management but this is a means to the end of positive health outcomes rather than an end in itself. 11. One of the expressed goals of Healthy People 2020 is to achieve health equity and eliminate disparities. What health indicator can most accurately gauge whether this goal is being achieved? A) Environmental quality B) Injury and violence C) Mental health D) Access to healthcare services Ans: D Feedback: Health equity is achieved when all Americans have equitable access to health services and there a fewer disparities in health access and health outcomes. Environmental quality, mental health and injury, and violence are important health indicators but these are less directly indicative of health equity and the elimination of disparities. 12. Nurses have the potential to positively impact the health of communities. Which of the following actions is most likely to improve the health of a community? A) Publicizing the consequences of unhealthy lifestyles MedConnoisseur © 2022 B) Advocating politically for laws and policies that foster community health C) Ensuring that nurses are practicing to the full extent of their scope of practice D) Providing nursing care to individuals who are not patients or clients Ans: B Feedback: One important role of nurses in the promotion of healthy communities is as a supporter and advocate for political measures that would improve the health of the community. Publicizing negative health outcomes is appropriate in some contexts but this is likely less effective than promoting broad change politically. It is not normally appropriate to provide nursing care for individuals who are not patients or clients. Practicing to the full extent of ones scope of practice is not likely to impact community health in a direct way. 13. A nurse who provides care in an acute medical unit is aware of the importance of thorough discharge planning. The discharge planning process should begin A) once the patient has stabilized and is assured of positive outcomes. B) as soon as possible after the patient is admitted. C) once the patient has received a discharge order from his or her primary care provider. D) 48 to 72 hours before the projected date of discharge. MedConnoisseur © 2022 Ans: B Feedback: If possible, discharge planning should begin immediately upon admission. 14. A hospital patient has discussed with the nurse her use of visualization, biofeedback, and relaxation exercises in managing the chronic pain that results from her fibromyalgia. The nurse should recognize this patients use of what category of complementary/alternative medicine (CAM)? A) Biologically-based practices B) Manipulative practices C) Traditional indigenous medicine D) Mind-body medicine Ans: D Feedback: Examples of mind-body medicine include relaxation exercises, hypnosis, meditation, dance, prayer, visualization, and biofeedback. Biologically-based practices focus on food and dietary supplements while indigenous medicine applies the collective health knowledge of a particular culture. Manipulative practices involve the systematic application of touch. 15. A hospital patient who suffered a spinal cord injury has expressed an interest in exploring complementary/alternative therapies. The nurse should encourage the patient to begin this process by doing which of the following activities? A) Asking practitioners of different therapies to provide lists of satisfied clients B) Asking the patients primary care provider for permission to explore nonbiomedical treatments MedConnoisseur © 2022 C) Finding reliable evidence regarding the safety and effectiveness of therapies D) Determining whether the patients health insurance would cover the cost of alternative/complementary therapies Ans: C Feedback: The first step for an individual interested in complementary/alternative therapies is to assess the safety and effectiveness of the therapy in relationship to his or her own condition. This must precede the identification of specific practitioners or making financial arrangements. Communication with the care team is important, but the patient does not need to seek permission before exploring treatment alternatives. Chapter 3. Health Promotion Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which of the following is a primary prevention measure for a 76-year-old man newly diagnosed with a testosterone deficiency? a. Calcium supplementation b. Testicular self-examination c. Bone density test d. Digital rectal examination MedConnoisseur © 2022 2. Which of the following is an example of secondary prevention in a 50-year-old woman? a. Yearly mammogram b. Low animal fat diet c. Use of seat belt d. Daily application of sunscreen 3. Which of the following is an example of tertiary prevention in a patient with chronic renal failure? a. Fluid restriction b. Hemodialysis 4 days a week c. High-protein diet d. Maintenance of blood pressure at 120/80 4. Immunizations are an example of which type of prevention? a. Primary b. Secondary c. Tertiary True/False Indicate whether the statement is true or false. MedConnoisseur © 2022 1. Prevalence is the number of new cases of a particular disease. 2. The number of cases of a particular disease for the past 5 years is an example of the incidence rate. 3. ―There are 1,185,000 cases of HIV/AIDS in the United States‖ is an example of the morbidity rate. 4. Endemic is the term used when the presence of an event is constant. 5. The ―bird‖ flu of 2005 to 2006 is considered a sporadic outbreak. 6. A pandemic affects many communities in a short period of time. Chapter 3. Health Promotion Answer Section MULTIPLE CHOICE 1. ANS: A PTS: 1 2. ANS: A PTS: 1 3. ANS: B PTS: 1 4. ANS: TRUE/FALSE A PTS: 1 MedConnoisseur © 2022 1. ANS: F PTS: 1 2. ANS: F PTS: 1 3. ANS: T PTS: 1 4. ANS: T PTS: 1 5. ANS: F PTS: 1 6. ANS: T PTS: 1 Chapter 4. The Art of Diagnosis and Treatment MULTIPLE CHOICE 1. An 85-year-old man has come in for a physical examination, and the nurse notices that he uses a cane. When documenting general appearance, the nurse should document this information under the section that covers: a. Posture. b. Mobility. c. Mood and affect. d. Physical deformity. ANS: B Use of assistive devices would be documented under the mobility section. The other responses are all other categories of the general appearance section of the health history. MedConnoisseur © 2022 2. The nurse is performing a vision examination. Which of these charts is most widely used for vision examinations? a. Snellen b. Shetllen c. Smoollen d. Schwellon ANS: A The Snellen eye chart is most widely used for vision examinations. The other options are not tests for vision examinations. 3. After the health history has been obtained and before beginning the physical examination, the nurse should first ask the patient to: a. Empty the bladder. b. Completely disrobe. c. Lie on the examination table. d. Walk around the room. ANS: A MedConnoisseur © 2022 Before beginning the examination, the nurse should ask the person to empty the bladder (save the specimen if needed), disrobe except for underpants, put on a gown, and sit with the legs dangling off side of the bed or table. 4. During a complete health assessment, how would the nurse test the patients hearing? a. Observing how the patient participates in normal conversation b. Using the whispered voice test c. Using the Weber and Rinne tests d. Testing with an audiometer ANS: B During the complete health assessment, the nurse should test hearing with the whispered voice test. The other options are not correct. 5. A patient states, Whenever I open my mouth real wide, I feel this popping sensation in front of my ears. To further examine this, the nurse would: a. Place the stethoscope over the temporomandibular joint, and listen for bruits. b. Place the hands over his ears, and ask him to open his mouth really wide. c. Place one hand on his forehead and the other on his jaw, and ask him to try to open his mouth. d. Place a finger on his temporomandibular joint, and ask him to open and close his mouth. ANS: D MedConnoisseur © 2022 The nurse should palpate the temporomandibular joint by placing his or her fingers over the joint as the person opens and closes the mouth. 6. The nurse has just completed an examination of a patients extraocular muscles. When documenting the findings, the nurse should document the assessment of which cranial nerves? a. II, III, and VI b. II, IV, and V c. III, IV, and V d. III, IV, and VI ANS: D Extraocular muscles are innervated by cranial nerves III, IV, and VI. 7. A patients uvula raises midline when she says ahh, and she has a positive gag reflex. The nurse has just tested which cranial nerves? a. IX and X b. IX and XII c. X and XII d. XI and XII ANS: A Cranial nerves IX and X are being tested by having the patient say ahh, noting the mobility of the uvula, and when assessing the patients gag reflex. 8. During an examination, the nurse notices that a patient is unable to stick out his tongue. Which cranial nerve is involved with the successful performance of this action? MedConnoisseur © 2022 a.I b.V c.XI d.XII ANS: D Cranial nerve XII enables the person to stick out his or her tongue. 9. A patient is unable to shrug her shoulders against the nurses resistant hands. What cranial nerve is involved with successful shoulder shrugging? a.VII b.IX c.XI d.XII ANS: C Cranial nerve XI enables the patient to shrug her shoulders against resistance. 10. During an examination, a patient has just successfully completed the finger-to-nose and the rapid-alternating-movements tests and is able to run each heel down the opposite shin. The nurse will conclude that the patients function is intact. MedConnoisseur © 2022 a. Occipital b. Cerebral c. Temporal d. Cerebellar ANS: D The nurse should test cerebellar function of the upper extremities by using the finger-to-nose test or rapid-alternating-movements test. The nurse should test cerebellar function of the lower extremities by asking the person to run each heel down the opposite shin. 11. When the nurse performs the confrontation test, the nurse has assessed: a. Extraocular eye muscles (EOMs). b. Pupils (pupils equal, round, reactive to light, and accommodation [PERRLA]). c. Near vision. d. Visual fields. ANS: D The confrontation test assesses visual fields. The other options are not tested with the confrontation test. 12. Which statement is true regarding the complete physical assessment? MedConnoisseur © 2022 a. The male genitalia should be examined in the supine position. b. The patient should be in the sitting position for examination of the head and neck. c. The vital signs, height, and weight should be obtained at the end of the examination. d. To promote consistency between patients, the examiner should not vary the order of the assessment. ANS: B The head and neck should be examined in the sitting position to best palpate the thyroid and lymph nodes. The male patient should stand during an examination of the genitalia. Vital signs are measured early in the assessment. The sequence of the assessment may need to vary according to different patient situations. 13. Which of these is included in an assessment of general appearance? a. Height b. Weight c. Skin color d. Vital signs ANS: C General appearance includes items such as level of consciousness, skin color, nutritional status, posture, mobility, facial expression, mood and affect, speech, hearing, and personal hygiene. Height, weight, and vital signs are considered measurements. 14. The nurse should wear gloves for which of these examinations? a. Measuring vital signs MedConnoisseur © 2022 b. Palpation of the sinuses c. Palpation of the mouth and tongue d. Inspection of the eye with an ophthalmoscope ANS: C Gloves should be worn when the examiner is exposed to the patients body fluids. 15. The nurse should use which location for eliciting deep tendon reflexes? a. Achilles b. Femoral c. Scapular d. Abdominal ANS: A Deep tendon reflexes are elicited in the biceps, triceps, brachioradialis, patella, and Achilles heel. 16. During an inspection of a patients face, the nurse notices that the facial features are symmetric. This finding indicates which cranial nerve is intact? a.VII b.IX c.XI d.XII MedConnoisseur © 2022 ANS: A Cranial nerve VII is responsible for facial symmetry. 17. During inspection of the posterior chest, the nurse should assess for: a. Symmetric expansion. b. Symmetry of shoulders and muscles. c. Tactile fremitus. d. Diaphragmatic excursion. ANS: B During an inspection of the posterior chest, the nurse should inspect for symmetry of shoulders and muscles, configuration of the thoracic cage, and skin characteristics. Symmetric expansion and tactile fremitus are assessed with palpation; diaphragmatic excursion is assessed with percussion. 18. During an examination, the patient tells the nurse that she sometimes feels as if objects are spinning around her. The nurse would document that she occasionally experiences: a. Vertigo. b. Tinnitus. c. Syncope. d. Dizziness. ANS: A MedConnoisseur © 2022 Vertigo is the sensation of a person moving around in space (subjective) or of the person sensing objects moving around him or her (objective) and is a result of a disturbance of equilibratory apparatus 19. A patient tells the nurse, Sometimes I wake up at night and I have real trouble breathing. I have to sit up in bed to get a good breath. When documenting this information, the nurse would note: a. Orthopnea. b. Acute emphysema. c. Paroxysmal nocturnal dyspnea. d. Acute shortness of breath episode. ANS: C Paroxysmal nocturnal dyspnea occurs when the patient awakens from sleep with shortness of breath and needs to be upright to achieve comfort 20. During the examination of a patient, the nurse notices that the patient has several small, flat macules on the posterior portion of her thorax. These macules are less than 1 cm wide. Another name for these macules is: a. Warts. b. Bullae. c. Freckles. d. Papules. MedConnoisseur © 2022 ANS: C A macule is solely a lesion with color change, flat and circumscribed, less than 1 cm. Macules are also known as freckles 21. During an examination, the nurse notices that a patients legs turn white when they are raised above the patients head. The nurse should suspect: a. Lymphedema. b. Raynaud disease. c. Chronic arterial insufficiency. d. Chronic venous insufficiency. ANS: C Elevational pallor (striking) indicates arterial insufficiency 22. The nurse documents that a patient has coarse, thickened skin and brown discoloration over the lower legs. Pulses are present. This finding is probably the result of: a. Lymphedema. b. Raynaud disease. c. Chronic arterial insufficiency. d. Chronic venous insufficiency. MedConnoisseur © 2022 ANS: D Chronic venous insufficiency would exhibit firm brawny edema, coarse thickened skin, normal pulses, and brown discoloration 23. The nurse notices that a patient has ulcerations on the tips of the toes and on the lateral aspect of the ankles. This finding indicates: a. Lymphedema. b. Raynaud disease. c. Arterial insufficiency. d. Venous insufficiency. ANS: C Ulcerations on the tips of the toes and lateral aspect of the ankles are indicative of arterial insufficiency 24. The nurse has just recorded a positive iliopsoas test on a patient who has abdominal pain. This test is used to confirm a(n): a. Inflamed liver. b. Perforated spleen. c. Perforated appendix. d. Enlarged gallbladder. MedConnoisseur © 2022 ANS: C An inflamed or perforated appendix irritates the iliopsoas muscle, producing pain in the RLQ. 25. The nurse will measure a patients near vision with which tool? a. Snellen eye chart with letters b. Snellen E chart c. Jaeger card d. Ophthalmoscope ANS: C The Jaeger card is used to measure near vision 26. If the nurse records the results to the Hirschberg test, the nurse has: a. Tested the patellar reflex. b. Assessed for appendicitis. c. Tested the corneal light reflex. d. Assessed for thrombophlebitis. ANS: C The Hirschberg test assesses the corneal light reflex 27. During the examination of a patients mouth, the nurse observes a nodular bony ridge down the middle of the hard palate. The nurse would chart this finding as: a. Cheilosis. MedConnoisseur © 2022 b. Leukoplakia. c. Ankyloglossia. d. Torus palatinus. ANS: D A normal variation of the hard palate is a nodular bony ridge down the middle of the hard palate; this variation is termed torus palatinus 28. During examination, the nurse finds that a patient is unable to distinguish objects placed in his hand. The nurse would document: a. Stereognosis. b. Astereognosis. c. Graphesthesia. d. Agraphesthesia. ANS: B 29. After the examination of an infant, the nurse documents opisthotonos. The nurse recognizes that this finding often occurs with: a. Cerebral palsy. b. Meningeal irritation. c. Lower motor neuron lesion. d. Upper motor neuron lesion. MedConnoisseur © 2022 ANS: B Opisthotonos is a form of spasm in which the head is arched back, and a stiffness of the neck and an extension of the arms and legs are observed. Opisthotonus occurs with meningeal or brainstem irritation 30. After assessing a female patient, the nurse notices flesh-colored, soft, pointed, moist, papules in a cauliflower-like patch around her introitus. This finding is most likely: a. Urethral caruncle. b. Syphilitic chancre. c. Herpes simplex virus. d. Human papillomavirus. ANS: D Human papillomavirus appears in a flesh-colored, soft, moist, cauliflower-like patch of papules 31. While recording in a patients medical record, the nurse notices that a patients Hematest results are positive. This finding means that there is(are): a. Crystals in his urine. b. Parasites in his stool. c. Occult blood in his stool. d. Bacteria in his sputum. MedConnoisseur © 2022 ANS: C 32. While examining a 48-year-old patients eyes, the nurse notices that he had to move the handheld vision screener farther away from his face. The nurse would suspect: a. Myopia. b. Omniopia. c. Hyperopia. d. Presbyopia. ANS: D Presbyopia, the decrease in power of accommodation with aging, is suggested when the handheld vision screener card is moved farther away. Chapter 5. Evidence-Based Care Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which of the following are parts of evidence-based practice? MedConnoisseur © 2022 a. Clinician b. Patient c. Evidence d. All of the above 2. Which is the most important question to ask in nursing research? a. What findings constitute evidence? b. How will the findings be used? c. Is this a randomized controlled trial? d. What theory is being utilized? 3. Nursing research should be utilized by: a. Nurses at the bedside b. Advanced practice nurses c. Nurse researchers d. Nurses at all levels of practice 4. Applying evidence at the point of care requires: a. Readily available evidence-based resources b. Ability to review research literature c. Single articles in journals d. Current textbooks 5. Practice guidelines are designed to: a. Be inflexible b. Be utilized in every circumstance MedConnoisseur © 2022 c. Provide a reference point for decision making d. Be created by a professional organization to guide the practice of a profession 6. Which of the following is a crucial element of developing a guideline? a. Creating a physician expert panel b. Reviewing the literature with ratings of available evidence c. Conducting an external review of a guideline d. Developing evidence-based tables 7. Which of the following would be considered the research design for Level I evidence? a. Single, well-designed randomized clinical trial b. Systematic review of randomized clinical trial studies c. Well-designed controlled trials without randomization d. Systematic reviews of descriptive or qualitative studies 8. Which of the following would be considered the research design for Level II evidence? a. Single descriptive or qualitative study b. Well-designed case control or cohort studies c. Single, well-designed, randomized clinical trial d. Systematic review of randomized clinical trial studies MedConnoisseur © 2022 9. Which of the following would be considered the research design for Level III evidence? a. Well-designed controlled trials without randomization b. Systematic reviews of descriptive or qualitative studies c. Systematic review of randomized clinical trial studies d. Opinion of authorities and expert committees 10. Which of the following would be considered the research design for Level IV evidence? a. Single descriptive or qualitative study b. Opinion of authorities and expert committees c. Systematic review of randomized clinical trial studies d. Well-designed controlled trials without randomization 11. Which of the following would be considered the research design for Level V evidence? a. Systematic review of randomized clinical trial studies b. Well-designed controlled trials without randomization c. Systematic reviews of descriptive or qualitative studies d. Single descriptive or qualitative study 12. Which of the following would be considered the research design for Level VI evidence? a. Systematic reviews of descriptive or qualitative studies b. Opinion of authorities and expert committees c. Well-designed case control or cohort studies d. Single descriptive or qualitative study MedConnoisseur © 2022 13. Which of the following would be considered the research design for Level VII evidence? a. Well-designed controlled trials without randomization b. Opinion of authorities and expert committees c. Well-designed case control or cohort studies d. Single descriptive or qualitative study Chapter 5. Evidence-Based Care Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: B PTS: 1 3. ANS: D PTS: 1 4. ANS: A PTS: 1 5. ANS: C PTS: 1 6. ANS: B PTS: 1 7. ANS: B PTS: 1 MedConnoisseur © 2022 8. ANS: C PTS: 1 9. ANS: A PTS: 1 10. ANS: D PTS: 1 11. ANS: C PTS: 1 12. ANS: C PTS: 1 13. ANS: B PTS: 1 Chapter 6. Common Neurological Complaints Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Which statement about confusion is true? a. Confusion is a disease process. b. Confusion is always temporary. c. Age is a reliable predictor of confusion. d. Polypharmacy is a major contributor to confusion in older adults. MedConnoisseur © 2022 2. Sondra‘s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear? a. Meclizine b. Diphenhydramine c. Diamox d. Promethazine 3. The hallmark of an absence seizure is: a. No activity at all b. A blank stare c. Urine is usually voided involuntarily d. The attack usually lasts several minutes 4. How often should drug levels be monitored when a seizure medication has controlled the seizures, and the drug level is adequate? a. Every 3 months b. Every 6 months c. Annually d. Whenever there is a problem 5. Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)? a. A teenage male b. A 65-year-old male c. A 25-year-old female d. A 60-year-old female MedConnoisseur © 2022 6. Which of the following is a specific test to MS? a. Magnetic resonance imaging (MRI) b. Computed tomography (CT) scan c. A lumbar puncture d. There is no specific test. 7. Which drug for Alzheimer‘s disease should be administered beginning at the time of diagnosis? a. Cholinesterase inhibitors b. Anxiolytics c. Antidepressants d. Atypical antipsychotics 8. Which hematoma occurs along the temporal cranial wall and results from tears in the middle meningeal artery? a. Epidural hematoma b. Subdural hematoma c. Subarachnoid hematoma d. Intraparenchymal hemorrhage 9. Which cranial nerve is affected in a patient with a cerebrovascular accident who has difficulty chewing? a. CN V MedConnoisseur © 2022 b. CN VII c. CN IX d. CN X 10. Which statement best describes a carotid bruit? a. It is felt with the middle three fingers over the carotid artery. b. A bruit becomes audible when the lumen is narrowed to 1 mm or less. c. A low-pitched bruit is a medical emergency. d. The higher the pitch of the bruit, the higher the degree of stenosis. 11. Which patient is more likely to have a cluster headache? a. A female in her reproductive years b. A 40-year-old African American male c. A 55-year-old female who drinks 10 cups of coffee daily d. A 45-year-old male awakened at night 12. Inattention and a sleep-wake cycle disturbance are the hallmark symptoms of? a. Dementia b. Alzheimer‘s disease c. Parkinson‘s disease d. Delirium MedConnoisseur © 2022 13. Which type of meningitis is more benign, self-limiting, and caused primarily by a virus? a. Purulent meningitis b. Chronic meningitis c. Aseptic meningitis d. Herpes meningitis 14. Which is the most sensitive neuroimaging test to evaluate patients with encephalitis? a. MRI b. CT c. Electroencephalogram (EEG) d. An initial lumbar puncture 15. What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster? a. A stabbing pain on one small area of the body b. A vesicular skin lesion on one side of the body c. A pain that is worse upon awakening d. A lesion on the exterior ear canal 16. Gabby, aged 22, has Bell‘s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her? a. ―Most patients have complete recovery in 3 to 6 months.‖ b. ―Unfortunately, you‘ll probably have a small amount of residual damage.‖ c. ―Don‘t worry, I‘ll take care of everything.‖ MedConnoisseur © 2022 d. ―You may have a few more episodes over the course of your lifetime but no permanent damage.‖ 17. Sam, aged 65, is started on L-dopa for his Parkinson‘s disease (PD). He asks why this is necessary. You tell him: a. ―L-dopa is neuroprotective.‖ b. ―The primary goal of therapy is to replace depleted stores of dopamine.‖ c. ―This is the only drug that can provide symptomatic benefit.‖ d. ―This is the initial monotherapy drug.‖ 18. Which of the following signs is seen in a patient with more advanced PD? a. Resting tremor b. Bradykinesia c. Rigidity d. Postural instability 19. Which of the following is the most commonly experienced symptom of migraine? a. Light sensitivity b. Pulsatile pain c. Sound sensitivity MedConnoisseur © 2022 d. Experiencing an aura 20. Which of the following characteristics differentiates peripheral vertigo from central vertigo? a. The duration of central vertigo is shorter than that of peripheral vertigo. b. There is an auditory-associated symptom with peripheral vertigo and a visual- associated symptom with central vertigo. c. Central vertigo is positional, and peripheral vertigo is not. d. The onset of central vertigo is more sudden than that of peripheral vertigo. 21. Carotid endarterectomy should be considered only for symptomatic patients with greater than what percentage of stenosis? a. Greater than 25% b. Greater than 50% c. Greater than 75% d. Only for 100% occlusion 22. What antiplatelet agent is most widely used for secondary prevention of stroke? a. Aspirin b. Ticlopidine c. Clopidogrel d. Aspirin and clopidogrel 23. Which adjunctive diagnostic test should be used in the work-up of a patient with suspected Creutzfeldt-Jakob disease or transient epileptic amnesia? a. MRI b. CT MedConnoisseur © 2022 c. Cerebrospinal fluid analysis d. EEG 24. Which herbal preparation may cause delirium and should be avoided in an elderly patient? a. Sam-e b. Saint John‘s Wort c. Melatonin d. Saw Palmetto 25. Which of the following activities is part of the functional activities questionnaire? a. Asking the patient to unravel a Rubik‘s cube b. Determining if the patient can drive on the highway c. Asking the patient about a news event from the current week d. Seeing if the patient can keep his or her home clean 26. About 90% of all headaches are? a. Tension b. Migraine c. Cluster d. Without pathological cause MedConnoisseur © 2022 27. Which statement is true regarding driving and patients with a seizure disorder? a. Once diagnosed with a seizure disorder, patients must never drive again. b. After being seizure free for 6 months, patients may drive. c. Each state has different laws governing driving for individuals with a seizure disorder. d. These persons may drive but never alone. 28. Julie has relapsing-remitting muscular sclerosis. She has not had a good response to interferon. Which medication might help given intravenously once a month? a. Glatiramer acetate b. Natalizumab c. Fingolimod d. Glucocorticoids 29. The ‗freezing phenomenon‘ is a cardinal feature of? a. Parkinson‘s disease b. Alzheimer‘s disease c. A CVA d. Bell‘s palsy 30. A ratchet-like rhythmic contraction, especially in the hand, during passive stretching is known as? a. Spinothalamic dysfunction b. Ratcheting c. Cogwheeling d. Hand tremors MedConnoisseur © 2022 31. Clinical features of insidious onset, slow progression, and a lack of other findings to explain the symptoms are fairly diagnostic of which condition? a. Guillain-Barré syndrome b. Parkinson‘s disease c. Alzheimer‘s disease d. Huntington‘s disease 32. Which condition is characterized by the impaired ability to learn new information along with either a cognitive disturbance in language, function, or perception? a. Guillain-Barré syndrome b. Parkinson‘s disease c. Alzheimer‘s disease d. Delirium 33. A score of 20 to 25 on this test indicates early-stage Alzheimer‘s disease: a. SLUMS b. MoCA c. FAST d. MMSE 34. Intravenous thrombolytic therapy following an ischemic CVA should be given within how many hours of symptom onset? a. 1 hour b. 3 hours MedConnoisseur © 2022 c. 6 hours d. 12 hours 35. When administered at the beginning of an attack, oxygen therapy may help this kind of headache? a. Tension b. Migraine c. Cluster d. Stress Chapter 6. Common Neurological Complaints Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 2. ANS: C PTS: 1 3. ANS: B PTS: 1 4. ANS: B PTS: 1 5. ANS: C PTS: 1 6. ANS: D PTS: 1 7. ANS: A PTS: 1 8. ANS: A PTS: 1 9. ANS: A PTS: 1 10. ANS: D PTS: 1 11. ANS: D PTS: 1 MedConnoisseur © 2022 12. ANS: D PTS: 1 13. ANS: C PTS: 1 14. ANS: A PTS: 1 15. ANS: B PTS: 1 16. ANS: A PTS: 1 17. ANS: B PTS: 1 18. ANS: D PTS: 1 19. ANS: B PTS: 1 20. ANS: B PTS: 1 21. ANS: B PTS: 1 22. ANS: A PTS: 1 23. ANS: D PTS: 1 24. ANS: B PTS: 1 25. ANS: C PTS: 1 26. ANS: D PTS: 1 27. ANS: C PTS: 1 28. ANS: B PTS: 1 29. ANS: A PTS: 1 30. ANS: C PTS: 1 31. ANS: B PTS: 1 32. ANS: C PTS: 1 33. ANS: D PTS: 1 34. ANS: B PTS: 1 MedConnoisseur © 2022 35. ANS: C PTS: 1 Chapter 7. Seizure Disorders 1. A client asks the nurse to explain symptoms that would indicate the presence of a brain tumor. Which of the following should the nurse respond to this client? (Select all that apply.) 1. There are no symptoms specific to a brain tumor. 2. Dizziness is a common symptom. 3. Ringing or buzzing in the ears can occur. 4. Seizures may occur. 5. A headache that gets worse in the afternoon is specific to a brain tumor.. 6. A headache is usually experienced by 50% of all people diagnosed with a brain tumor. ANS: 2, 3, 4, 6 Symptoms of a brain tumor include dizziness, ringing or buzzing in the ears, seizures, and a headache. The headache of a brain tumor is usually worse in the morning and not the afternoon. There are symptoms associated with a brain tumor. 2. The nurse is instructing a client diagnosed with a brain tumor on symptoms to immediately report to her physician. Which of the following should be included in these instructions? (Select all that apply.) 1. New onset of seizures 2. One-sided weakness 3. Loss of balance MedConnoisseur © 2022 4. Problems with vision 5. Inability to talk 6. Loss of appetite ANS: 1, 2, 3, 4, 5 Brain tumor symptoms that require immediate attention include new onset of seizures, slow progressing hemiparesis, gait or balance disturbances, visual problems, hearing loss, and aphasia. Loss of appetite is not a brain tumor symptom. 3.A client is diagnosed with seizures occurring because of hepatic encephalopathy. The nurse realizes that the cause for this clients seizures would be: 1. physiological. 2. iatrogenic. 3. idiopathic. 4. psychokinetic. ANS: 1 The three major causes for seizures are physiological, iatrogenic, and idiopathic. Physiological seizures include those that occur with an acquired metabolic disorder such as hepatic encephalopathy. Iatrogenic causes include new medications or drug or alcohol use. Idiopathic causes include fevers, fatigue, or strong emotions. Psychokinetic is not a cause for seizures. MedConnoisseur © 2022 4.A client tells the nurse that he sees flashing lights that occur prior to the onset of a seizure. Which of the following phases of a seizure is this client describing to the nurse? 1. Prodromal phase 2. Aural phase 3. Ictal phase 4. Postictal phase ANS: 2 In the aural phase a sensation or warning occurs, which the patient often remembers. This warning can be visual, auditory, gustatory, or visceral in nature. The prodromal phase of a seizure includes the signs or activity before the seizure such as a headache or feeling depressed. The ictal phase of a seizure is the actual seizure. The postictal phase is the period immediately following the seizure. 5.A client is experiencing a grand mal seizure. Which of the following should the nurse do during this seizure? 1. Protect the clients head. 2. Leave the client alone. 3. Give water to the client to avoid dehydration. MedConnoisseur © 2022 4. Place a finger in the clients mouth to avoid swallowing the tongue. ANS: 1 One of the most important interventions for a nurse to perform during a seizure is to protect the clients head from injury. Never give a client a drink during a seizure. Placing a finger in the clients mouth could be very dangerous to the client and the nurse. Do not leave the client unattended during a seizure 6.A client is prescribed phenytoin (Dilantin) for a seizure disorder. Which of the following would indicate that the client is adhering to the medication schedule? 1. The client is sleepy. 2. The client is not experiencing seizures. 3. The client no longer has headaches. 4. The client is eating more food. ANS: 2 Phenytoin (Dilantin) is a medication to control seizures. The absence of seizures indicates that the client is adhering to the medication schedule. Sleepiness, lack of headaches, or improved appetite are not indications that the medication is being used as prescribed. 7. The nurse is unable to insert an intravenous access line into a client who is currently experiencing a seizure. Which of the following routes can the nurse use to provide medication to the client at this time? 1. Oral 2. Intranasal MedConnoisseur © 2022 3. Rectal 4. Intramuscular ANS: 2 For a client experiencing a seizure, oral medications and sharp objects can be dangerous and should not be used. Intranasally administered drugs are rapid and effective in treating a client experiencing an acute seizure. Intranasal delivery is more effective than rectal. 8. One of the most important things a nurse can teach a client about seizure control is to: 1. take the medication every day as prescribed by the doctor. 2. eat a balanced diet. 3. get lots of exercise. 4. take naps during the day. ANS: 1 Medication is effective only if it is taken as prescribed, and suddenly stopping the medication can trigger an increase in seizure activity. Diet and exercise are important to a healthy lifestyle but do little to control seizure activity. 9.A client is diagnosed with tonic-clonic seizures. Which are the characteristics of these types of seizures? (Select all that apply.) 1. Progressing through all of the seizure phases MedConnoisseur © 2022 2. Beginning before age 5 3. Lasting 2 to 3 minutes 4. Causing injury to the client 5. Occurring at any time, day or night 6. Being highly variable ANS: 1, 3, 4, 5, 6 Tonic-clonic seizures are the most common type of generalized seizure. The seizure will progress through all of the seizure phases and last 2 to 3 minutes. Because these seizures begin suddenly, there is an increased incidence of injury associated with them. These seizures can occur any time of the day or night, whether the client is awake or not. Seizure frequency is highly variable. Chapter 8. Degenerative Disorders MULTIPLE CHOICE 1.A client is diagnosed with a headache from a secondary cause. The nurse realizes this type of headache can be caused by: 1.a tumor. on. 3.a migraine. er ANS: 1 MedConnoisseur © 2022 Primary headaches are identified when no organic cause can be found. A tumor headache is caused by a tumor and is classified as a secondary headache. 2.The nurse should instruct a client diagnosed with migraine headaches to be careful not to overdose on acetaminophen (Tylenol). Which drug should the nurse tell the patient to avoid? 1.Aleve 2.Aspirin 3.Ibuprofen 4.Vicodin ANS: 4 Vicodin, although a narcotic analgesic, also contains acetaminophen (Tylenol). It is very easy to overdose on the acetaminophen (Tylenol) component, which can lead to kidney damage. Aleve does not contain acetaminophen (Tylenol). Aspirin and ibuprofen do not contain acetaminophen (Tylenol). 3.A client is diagnosed with seizures occurring because of hepatic encephalopathy. The nurse realizes that the cause for this clients seizures would be: 1. physiological. 2. iatrogenic. 3. idiopathic. okinetic. ANS: 1 The three major causes for seizures are physiological, iatrogenic, and idiopathic. Physiological seizures include those that occur with an acquired metabolic disorder such as hepatic encephalopathy. Iatrogenic causes include new medications or drug or alcohol use. Idiopathic causes include fevers, fatigue, or strong emotions. Psychokinetic is not a cause for seizures. 4.A client tells the nurse that he sees flashing lights that occur prior to the onset of a seizure. Which of the following phases of a seizure is this client describing to the nurse? 1.Prodromal phase 2.Aural phase 3.Ictal phase 4.Postictal phase ANS: 2 In the aural phase a sensation or warning occurs, which the patient often remembers. This warning can be visual, auditory, gustatory, or visceral in nature. The prodromal phase of a seizure includes the signs or activity before the seizure such as a headache or feeling depressed. The ictal phase of a seizure is the actual seizure. The postictal phase is the period immediately following the seizure. 5.A client is experiencing a grand mal seizure. Which of the following should the nurse do during this seizure? 1.Protect the clients head. 2.Leave the client alone. 3. Give water to the client to avoid dehydration. MedConnoisseur © 2022 4. Place a finger in the clients mouth to avoid swallowing the tongue. ANS: 1 One of the most important interventions for a nurse to perform during a seizure is to protect the clients head from injury. Never give a client a drink during a seizure. Placing a finger in the clients mouth could be very dangerous to the client and the nurse. Do not leave the client unattended during a seizure 6.A client is prescribed phenytoin (Dilantin) for a seizure disorder. Which of the following would indicate that the client is adhering to the medication schedule? 1. The client is sleepy. 2. The client is not experiencing seizures. 3.The client no longer has headaches. 4.The client is eating more food. ANS: 2 Phenytoin (Dilantin) is a medication to control seizures. The absence of seizures indicates that the client is adhering to the medication schedule. Sleepiness, lack of headaches, or improved appetite are not indications that the medication is being used as prescribed. 7.The nurse is unable to insert an intravenous access line into a client who is currently experiencing a seizure. Which of the following routes can the nurse use to provide medication to the client at this time? 1.Oral 2.Intranasal 3.Rectal 4.Intramuscular ANS: 2 For a client experiencing a seizure, oral medications and sharp objects can be dangerous and should not be used. Intranasally administered drugs are rapid and effective in treating a client experiencing an acute seizure. Intranasal delivery is more effective than rectal. 8.One of the most important things a nurse can teach a client about seizure control is to: the medication every day as prescribed by the doctor. 2. eat a balanced diet. 3. get lots of exercise. 4. take naps during the day. ANS: 1 Medication is effective only if it is taken as prescribed, and suddenly stopping the medication can trigger an increase in seizure activity. Diet and exercise are important to a healthy lifestyle but do little to control seizure activity. MedConnoisseur © 2022 9.The nurse is instructing a client newly diagnosed with multiple sclerosis (MS). To determine the effectiveness of his teaching, the nurse would expect the client to state: 1. It is best for me to be in a cold environment. 2. I should avoid taking a hot bath. 3. I should eat foods low in salt. 4. I should be better in a week. ANS: 2 The clinical manifestations of MS can be exacerbated by being in a hot, humid environment or by taking a hot bath. A cold environment and low-salt foods do not impact the symptoms of multiple sclerosis. If the client states that they will improve in a week, instruction has not been effective. 10.An adult female in her 30s complains of numbness and tingling in the hands, fatigue, loss of coordination, incontinence, nystagmus, and ataxia. Which of the following health problems do these symptoms suggest to the nurse? 1.Brain tumor 2.