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Vernon Russell Bundled Exams and Study Guides with complete solutions.

Neuro Check - CORRECT ANSWER-a. LOC b. Sensory perception d. Memory e. Cranial Nerves The nurse is evaluating a patient's neurological status. What should the nurse include when assessing a patient's level of awareness? - CORRECT ANSWER-When assessing level of awareness, the nurse should assess Time (e.g., what is today's date? what day of the week is it?; Place (e.g., Where are you now? What is the name of this city?); and Person (e.g., What is your name? How old are you?). If ...

A patient with dysphagia following a stroke expresses concern about having difficulty eating and drinking. What is the appropriate reply by the nurse? - CORRECT ANSWERMuscle weakness frequently occurs after a stroke; we need to make sure that food is not going into your lungs. Rationale: The appropriate reply by the nurse would be to explain that muscle weakness frequently occurs after a stroke. Making sure the GI tract is functioning would be an appropriate action to take after surgery. Te...

Mr. Russell asks the nurse, "What is the purpose of these passive rang of motion (ROM) exercises? I can move my own arms and legs." What is the correct response by the nurse? - CORRECT ANSWER-Passive range of motion exercises will help you to maintain mobility in your joints The nurse is completing passive range of motion on Mr.Russell. What movements would the nurse expect to complete at the elbow joint? - CORRECT ANSWER-Flexion, extenison, supination, pronation The nurse is assess...

The nurse has an order to complete neurochecks every four hours. Which assessments would the nurse include in the neurological examination? (Select all that apply.) - CORRECT ANSWER-Level of consciousness, Memory, Sensory perception, Cranial nerves Components of a neurological examination include memory, level of consciousness, sensory perception, cranial nerves, patterns of speech, and bilateral hand grips. Range of motion would be appropriate for a musculoskeletal assessment. When takin...

Vernon Russell has many comorbidities. When completing your admission history and assessment, you recognize that his Choose Answer.. and his Choose Answer.. are the most likely main contributing causes of his stroke. - CORRECT ANSWERsmoking history, hypertension The nurse recognizes that which of the following range-of-motion movements in Vernon Russell's hip may be affected by his left-sided hemiplegia? (Select all that apply.) - CORRECT ANSWER-Abduction, Adduction, Internal rotation...

Mr. Russell has an order for vital signs and neurological checks every 4 hoursWhich assessment findings) would indicate an abnormal finding? (Select all that apply) - CORRECT ANSWER-Decreased level of consciousness Unequal Pupils Mr. Russell experienced dysphagia and mild left-sided weakness following his stroke. The nurse knows which of the following symptom(s) are concerning for stroke? (Select all that apply) - CORRECT ANSWER-Communication difficulties Sensory deficits Aspiration pneu...

Mr. Russell experienced dysphagia and mild left-sided weakness following his stroke. The nurse knows which of the following symptom(s) are concerning for stroke? (Select all that apply.) a. Community Difficulties b. Sensory deficits c. Hearing loss d. Aspiration pneumonia e. Decreased peristalsis f. Cognition level - CORRECT ANSWER-A B D F Mr. Russell has an order for vital signs and neurological checks every 4 hours. Which assessment finding(s) would indicate an abnormal finding? (Sel...

The nurse is assessing a patient's joints. What should the nurse include in this assessment? - CORRECT ANSWER-Color, Size, Symmetry The nurse is assessing a patient's gait. Which factor(s) should the nurse observe as the patient ambulates in the room? (Select all that apply.) - CORRECT ANSWER-Base of support, Stride, Arm swing, Posture When completing passive range-of-motion (ROM) exercises, the nurse bends the patient's foot so that the toes point upward. Which skeletal muscle mo...

a patient has been admitted with a diagnosis of stroke, and the nurse has received orders to hold warfarin until labs results are received. What lab result does the nurse anticipate reviewing prior to administering this medication? a. D-dimer b. PT/ INR c. Platelets d. hemoglobin - CORRECT ANSWER-b. PT/INR PT/INR is used to detect a bleeding disorder or excessive clotting disorder and used to monitor how well blood thinning medication is working (warfarin) a nurse is caring for a patien...

The nurse is caring for a patient who is suspected of having a stroke. What should be the nurse's first action to ensure patient safety when it appears the patient is having difficulty swallowing prescribed oral medication? -Hold this dose of medication and make the patient NPO. -Notify the provider of the suspected problem. -Schedule an immediate speech therapist swallow study. -Educate the patient to the substantial risk of aspiration associated with a stroke. - CORRECT ANSWER--Hold ...

When taking a patient's health history, which of the following does the nurse identify as risk factor(s) for having a stroke? (Select all that apply.) A. Smoking B. Diabetes C. Recent weight loss D. Hypertension E. Asthma - CORRECT ANSWER-A B D A patient is experiencing dysphagia following a stroke. How should the nurse position the patient when administering medications? A. High Fowler's B. Supine C. Semi-Fowler's D. Left lateral - CORRECT ANSWER-A Which observation(s) sup...

A patient is experiencing dysphagia following a stroke. How should the nurse position the patient when administering medications? - CORRECT ANSWER-High Fowlers When taking a patient's health history, which of the following does the nurse identify as risk factors) for having a stroke? (Select all that apply.) - CORRECT ANSWERHypertension Smoking Diabetes The nurse is caring for a patient who is suspected of having a stroke. What should be the nurse's first action to ensure patient sa...

Which observation report the possibility that a patient had a stroke -coughing -hoarseness -Regurgitation of mouth Vomiting and nausea are not associated with aspiration The nurse is evaluating a patient fall risk. Which would the nurse include assessing the patient fall risk - History of fall one month ago -Large number of medications that cause hypo tension -Assistive devices Impaired vision loss is not associated with fall risk A patient is dysphagia following a stroke. How should ...

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when helping a person walk, you are - CORRECT ANSWER-to the side and slightly behind the person you recognize which of the following accurately describes when passive range of motion is performed a. when the person cannot exercise by themselves b. when the person can move and exercise without assistance c. when the person exercises without assistance d. when therapy is only done by the physical therapist - CORRECT ANSWER-a. when the person cannot exercise by themselves you are reviewing...

what is the most important goal for you in telling a resident why a procedure is needed - CORRECT ANSWER-it helps the resident feel more safe and secure you protect a residents's privacy during a bath by - CORRECT ANSWER-closing the privacy curtain a resident did not get to the bathroom in time. they had a bowel movement in their clothing. after you clean them up, you make them stay in their room to prevent an accident from happing in the dining room. this is - CORRECT ANSWER-involuntar...

These measures reduce friction and shearing: - CORRECT ANSWER-roll person + use friction-reducing devices (ex: cotton drawsheets, turning pads + slide sheets) Explain how you would move or transfer each of the following persons: A. A male resident with a dependence level 4: Total dependance - CORRECT ANSWER-Person is lifted + transferred w/ full-sling mechanical. Have another staff member to help. Logrolling - CORRECT ANSWER-turning the person as a unit, in alignment, with one motion She...

a person's thinking, mood, behavior, function and ability to relate to others are affected. which is correct a. the person has a mental health disorder b. the person has false beliefs c. the person has severe mood swings d. the person has paranoia - CORRECT ANSWER-a. the person has a mental health disorder you are unhappy with your supervisor. you call in sick because of a headache. which defense mechanism are you using a. denial b. conversion c. substitution d. reaction formation...

What does the skin protect against? Prevents bacteria and other substances from entering the body. Prevents excess water from leaving the body Helps regulate body temp The hips and shoulders are ___ joints. ball and socket When you're lifting a heavy object, what should you do? Lift from your legs. Bend knees and squat What do you do to the bed when you're giving bedside care? Lift the bed to a comfortable level To protect yourself from injury, it is best to Avoid twisting Regu...