West Kentucky Community And Technical College

1.The family nurse practitioner is performing the physical examination of a client with a suspected neurologic disorder. In addition to assessing other parts of the body, the nurse should assess for neck rigidity. Which method should help the nurse assess for neck rigidity correctly? A) Moving the head toward both sides B) Lightly tapping the lower portion of the neck to detect sensation C) Moving the head and chin toward the chest D) Gently pressing the bones on the neck Ans: C Feedbac...

1.The nurse is caring for a client with trigeminal neuralgia (tic douloureux). The care plan for this client reflects the client's problem eating due to jaw pain. To assist the client in meeting the adequate nutritional needs, what should the nurse suggest? A) Take small meals of nutrient and calorie-dense food. B) Increase the intake of calcium and proteins. C) Include additional servings of fruits and raw vegetables. D) Include fish, liver, and chicken in diet. Ans: A Feedback: To he...

1.Which action would be most appropriate when evaluating a client's neck for thyroid enlargement? A) Inspect changes in pigmentation in the neck. B) Perform repeated palpation of the thyroid gland. C) Palpate the thyroid gland gently. D) Examine the skin of the neck for excessive oiliness. Ans: C Feedback: The nurse should inspect the neck for thyroid enlargement and gently palpate the thyroid gland. Repeated palpation of the thyroid in case of thyroid hyperactivity can result in a su...

1.The nurse is caring for a client with a head injury after a fall from a hayloft. Which of the following indicates the presence of/or leaking of cerebral spinal fluid? A) Change in the level of consciousness (LOC) B) Signs of increased intracranial pressure (IICP) C) Halo sign D) Swelling Ans: C Feedback: To detect any CSF drainage, the nurse looks for a halo sign. If drainage is present, the nurse allows it to flow freely onto porous gauze and avoids tightly plugging the orifice. Cha...

1.A client with a neurologic deficit has been admitted to your unit. The nurse caring for the client is assessing the client and observes significant changes in the client's status. Which of the following action should the nurse perform immediately? A) Use the Glasgow Coma Scale. B) Use the Mini-Mental Status Examination. C) Report the change to the physician. D) Monitor the blood pressure. Ans: C Feedback: When significant changes occur, the nurse should immediately report them to the...

1.A client presents to the walk-in clinic complaining of a migraine. The client is prescribed a neuronal stabilizer. What should the nurse suggest to the client? A) Avoid crowds. B) Take drugs only after meals at night. C) Avoid caffeine and alcohol. D) Use caution while driving or performing hazardous activities. Ans: D Feedback: A client who is prescribed a neuronal stabilizer needs to exercise caution while driving and avoid performing hazardous activities. A client taking nonsteroid...

1.A client with major depression is having a disturbed sleep pattern. Which of the following nursing interventions will help the client to get maximum sleep during the night? A) Acknowledge the client's feeling of despair. B) Encourage active exercise before bedtime. C) Encourage the client to go to bed early. D) Keep the client busy during the day. Ans: D Feedback: The nurse should keep the client busy during the day and discourage the client from going to bed early. Left alone, depre...

1.Which of the following interventions should a nurse recommend for fostering effective coping skills and a sense of hardiness? A) Balanced diet B) Periodic checkup C) Nonprescribed sedative drug D) Daily exercise Ans: D Feedback: A nurse should recommend a daily exercise program to reduce stimulating neurotransmitters and release endorphins and enkephalins. Diet and periodic checkups are not essential to foster effective coping skills and a sense of hardiness. It is essential for the...

1.Building trust is especially critical to developing a therapeutic relationship with an anxious client. Which of the following interventions contributes to this trust? A) Leave the client alone during a new experience. B) Give support in nonverbal ways. C) Be available and attentive to the client's requirements. D) Give detailed explanations and do not repeat them frequently. Ans: C Feedback: Building trust is especially critical to developing a therapeutic relationship with an anxiou...

1.You are teaching the daughter how to instill ear drops of her father to remove impacted cerumen. What is important to teach this woman? A) Insert the irrigating syringe deeply. B) Direct the flow of the ear drops toward the eardrum. C) Refrigerate before instillation. D) Place the container in warm water before instillation. Ans: D Feedback: If irrigation or instillation of liquids is ordered, the nurse should warm the liquid to body temperature by placing the container in warm water....