NURSE 208 Exam 1/2 NCLEX Qs || Already Graded A+.
The nurse performs an initial assessment on an older client. Which assessment findings would
the nurse expect to be the result of normal physiologic aging? (Select all that apply.)
a. Confusion
b. Hearing loss
c. Decerebrate positioning
d. Slurred speech
e. Constipation
f. Urinary incontinence correct answers ANS: B, E
Confusion, slurred speech, and incontinence are not normal changes of aging, although these
findings are common in the older adult population. Changes in the bones of the ear and intestinal
motility cause varying degrees of hearing loss and constipation.
Cognition Level: Analyzing
Integrated Process: Nursing Process
During a client's neurologic assessment, the nurse finds that the client continues to be drowsy but
easily awakened. How does the nurse document this client's level of consciousness?
a. Stuporous
b. Lethargic
c. Comatose
d. Alert correct answers ANS: B
A lethargic patient can be easily awakened; a stuporous patient requires painful or noxious
stimulation to awaken. The comatose patient cannot be awakened despite stimulation.
Cognitive Level: Understanding
Integrated Process: Communication and Documentation
, The nurse is assessing a client who opens both eyes when spoken to, obeys commands, and
seems confused during conversation. What Glasgow Coma Score (GCS) will the nurse
document?
a. 15
b. 14
c. 11
d. 9 correct answers ANS: B
To assess this client, the GCS score would be as follows:
Eye Opening 4
Motor Response 6
Verbal Response 4 (confused conversation)
Total 14
Cognitive Level: Applying
Integrated Process: Communication and Documentation
The nurse is teaching a client about what to expect during a cerebral angiographic exam. Which
statement by the client indicates a need for further teaching?
a. "I can't have this test because I am allergic to shellfish."
b. "My head will be strapped in place so that I don't move."
c. "I'll have to keep my leg very still after the procedure."
d. "I'll have a temporary dressing on my groin." correct answers ANS: A
Being allergic to seafood is no longer a contraindication to receiving iodine contrast materials.
Steroids, such as prednisone, will be prescribed for the client in anticipation of the allergy. The
other statements are true regarding the care and procedure for this diagnostic test.
Cognitive Level: Analyzing
Integrated Process: Teaching and Learning
The nurse assesses an older adult with a diagnosis of severe, late-stage Alzheimer's disease.
Which assessment findings would the nurse expect for this client? (Select all that apply.)
The nurse performs an initial assessment on an older client. Which assessment findings would
the nurse expect to be the result of normal physiologic aging? (Select all that apply.)
a. Confusion
b. Hearing loss
c. Decerebrate positioning
d. Slurred speech
e. Constipation
f. Urinary incontinence correct answers ANS: B, E
Confusion, slurred speech, and incontinence are not normal changes of aging, although these
findings are common in the older adult population. Changes in the bones of the ear and intestinal
motility cause varying degrees of hearing loss and constipation.
Cognition Level: Analyzing
Integrated Process: Nursing Process
During a client's neurologic assessment, the nurse finds that the client continues to be drowsy but
easily awakened. How does the nurse document this client's level of consciousness?
a. Stuporous
b. Lethargic
c. Comatose
d. Alert correct answers ANS: B
A lethargic patient can be easily awakened; a stuporous patient requires painful or noxious
stimulation to awaken. The comatose patient cannot be awakened despite stimulation.
Cognitive Level: Understanding
Integrated Process: Communication and Documentation
, The nurse is assessing a client who opens both eyes when spoken to, obeys commands, and
seems confused during conversation. What Glasgow Coma Score (GCS) will the nurse
document?
a. 15
b. 14
c. 11
d. 9 correct answers ANS: B
To assess this client, the GCS score would be as follows:
Eye Opening 4
Motor Response 6
Verbal Response 4 (confused conversation)
Total 14
Cognitive Level: Applying
Integrated Process: Communication and Documentation
The nurse is teaching a client about what to expect during a cerebral angiographic exam. Which
statement by the client indicates a need for further teaching?
a. "I can't have this test because I am allergic to shellfish."
b. "My head will be strapped in place so that I don't move."
c. "I'll have to keep my leg very still after the procedure."
d. "I'll have a temporary dressing on my groin." correct answers ANS: A
Being allergic to seafood is no longer a contraindication to receiving iodine contrast materials.
Steroids, such as prednisone, will be prescribed for the client in anticipation of the allergy. The
other statements are true regarding the care and procedure for this diagnostic test.
Cognitive Level: Analyzing
Integrated Process: Teaching and Learning
The nurse assesses an older adult with a diagnosis of severe, late-stage Alzheimer's disease.
Which assessment findings would the nurse expect for this client? (Select all that apply.)
