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Medical Surgical Nursing in Canada 2nd Edition Lewis Test Bank

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Medical Surgical Nursing in Canada 2nd Edition Lewis Test Bank

  • ISBN-10:1897422016
  • ISBN-13:978-1897422014

 

 

Description

Medical Surgical Nursing in Canada 2nd Edition Lewis Test Bank

  • ISBN-10:1897422016
  • ISBN-13:978-1897422014

 

 

 

 

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Free Nursing Test Questions:

Lewis: Medical-Surgical Nursing in Canada, 2nd Edition

 

Chapter 60: Nursing Management: Chronic Neurological Problems

 

Test Bank

 

           MULTIPLE CHOICE

 

  1. A client with a headache describes it as affecting both sides of his head with a moderate intensity that becomes worse when he is physically active. The nurse knows that the client’s clinical manifestations are characteristic of which of the following disorders?
a. Cluster headaches
b. Migraine headaches
c. Tension-type headaches
d. Headaches associated with trigeminal neuralgia

 

 

ANS: C

The International Headache Society (2004) classification system defines tension-type headache as involving at least two of the following characteristics: pressure or tightness sensation, mild to moderate severity, bilateral location, or worsening with physical activity.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1626

 

  1. A 20-year-old woman is seen at the health clinic with a severe migraine headache. The headaches began 3 months ago, and she has had four headaches since that time. During assessment, the client tells the nurse she is afraid to make social plans because she never knows when she will be incapacitated with the pain. What is the most appropriate nursing intervention in response to the client’s comments?
a. Refer the client for counselling to assist her with conflict resolution and stress reduction.
b. Suggest that the client keep a diary of headache episodes to identify precipitating factors.
c. Encourage the client to learn the holistic techniques of meditation and biofeedback to minimize the pain.
d. Reassure the client that the headaches are not serious and the pain can be controlled with a variety of drugs.

 

 

ANS: B

The initial nursing action should be further assessment of the precipitating causes of the headaches, quality and location of pain, and so on, which can be accomplished by the client keeping a diary of the headache episodes.

 

DIF:   Cognitive Level: Application        REF:  p. 1628

 

  1. When teaching a client about management of her migraine headaches, the nurse determines that teaching has been effective when the client gives which of the following responses?
a. “I will take the topiramate as soon as any headaches start.”
b. “The sumatriptan will help increase the blood flow to my brain.”
c. “I will try to lie down someplace dark and quiet when the headaches begin.”
d. “A glass of wine might help me relax and prevent headaches from developing.”

 

 

ANS: C

It is recommended that the client with a migraine rest in a dark, quiet area.

 

DIF:   Cognitive Level: Application        REF:  p. 1629

 

  1. What is the most important nursing tool in diagnosing the type and cause of a headache that a client has?
a. Magnetic resonance imaging (MRI) of the brain
b. Electromyography
c. The client history
d. Computed tomography (CT) imaging of the brain

 

 

ANS: C

Diagnosis of cluster headache is made primarily on the basis of the client’s symptoms; therefore, a thorough client history is required.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1627

 

  1. A client experiences cluster headaches that occur about every year for 2 months. During assessment of the client during an episode of the headache, what would the nurse expect to find?
a. Nuchal rigidity
b. Nausea and vomiting
c. Unilateral eyelid edema and ptosis
d. A severe, throbbing, bilateral headache

 

 

ANS: C

Unilateral eye edema, tearing, and ptosis are characteristic of cluster headaches.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1627 (Table 60-1)

 

  1. A client with migraine headaches is treated with sumatriptan (Imitrex). What information obtained by the nurse is most important to report to the physician?
a. The client has a history of a recent acute myocardial infarction.
b. The client has had migraine headaches for 30 years.
c. The client has been taking topiramate (Topamax) for 2 months.
d. The client has at least one to two cups of coffee daily.

 

 

ANS: A

The triptans cause coronary artery vasoconstriction and should be avoided in clients with coronary artery disease.

 

DIF:   Cognitive Level: Application        REF:  p. 1628

 

  1. When caring for a client with epilepsy who was hospitalized and successfully treated for status epilepticus, what is a precaution that the nurse should institute as part of the care?
a. Placing oxygen and suction equipment at the bedside
b. Assigning an assistant to stay with the client at all times
c. Keeping a tongue blade available to insert in case of a seizure
d. Instructing the client to stay in bed and call for assistance to go to the bathroom

 

 

ANS: A

Oxygen and suction equipment should be available at the bedside for a client who has epilepsy.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1638

 

  1. A client has a tonic–clonic seizure while the nurse is in the client’s room. During the seizure, what is it important for the nurse to do?
a. Insert an oral airway during the seizure to maintain a patent airway.
b. Restrain the client’s arms and legs to prevent injury during the seizure.
c. Avoid touching the client to prevent further stimulation of the nervous system.
d. Time the seizure and observe and record the details of the seizure and the postictal phase.

 

 

ANS: D

Because diagnosis and treatment of seizures are frequently based on the description of the seizure, recording the length and details of the seizure is important.

 

DIF:   Cognitive Level: Application        REF:  p. 1637

 

  1. The nurse witnesses a client with a seizure disorder as he suddenly jerks his arms and legs, falls to the floor, and regains consciousness immediately. What type of seizure is demonstrated by this client that the nurse must document?
a. An atonic seizure
b. A myoclonic seizure
c. A complex partial seizure with automatisms
d. A simple partial seizure with motor symptoms

 

 

ANS: A

An atonic (“drop attack”) seizure involves either a tonic episode or a paroxysmal loss of muscle tone and begins suddenly with the person falling to the ground. Consciousness usually returns by the time the person hits the ground, and normal activity can be resumed immediately.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1632

 

  1. After experiencing a generalized tonic–clonic seizure in the classroom, a 25-year-old high school teacher is evaluated and diagnosed with idiopathic epilepsy. The client cries when told of the diagnosis and tells the nurse that she can never go back to teaching after experiencing the seizure in front of her students. What is an appropriate nursing diagnosis for the client?
a. Anxiety related to loss of control during seizures
b. Hopelessness related to diagnosis of chronic illness
c. Disturbed body image related to new diagnosis of epilepsy
d. Ineffective role performance related to misinformation about epilepsy

 

 

ANS: D

The data indicate that the client has ineffective role performance caused by inadequate information about the disease because most clients are able to control seizures with medication.

 

DIF:   Cognitive Level: Application        REF:  p. 1633

 

  1. Following recovery from a stroke, a 68-year-old client developed complex partial seizures with motor symptoms beginning in the right arm with progression to unconsciousness. The physician prescribes phenytoin (Dilantin) for control of the seizures. Which of the following statements by the client indicates understanding of what self-care related to this drug includes?
a. “I should use soft swabs rather than a toothbrush to clean my mouth.”
b. “If I have a seizure, I should call an ambulance to take me to the hospital.”
c. “I will take the medication at the beginning of the seizure before I lose consciousness.”
d. “As I start this drug, I will need to have my blood taken frequently to check the level of the drug.”

 

 

ANS: D

Serum levels of phenytoin (Dilantin) may be checked to ascertain that a therapeutic level of the medication is achieved.

 

DIF:   Cognitive Level: Application        REF:  pp. 1634-1635

 

  1. When a client experiences a generalized tonic–clonic seizure in the emergency department after a head injury, all of the following orders are received. Which one will the nurse implement first?
a. Send to Radiology for a CT scan.
b. Administer midazolam (Versed).
c. Check capillary blood glucose.
d. Monitor level of consciousness.

 

 

ANS: B

To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure medications such as the benzodiazepines.

 

DIF:   Cognitive Level: Application        REF:  p. 1634 (Table 60-8)

 

  1. A client found in a tonic–clonic seizure reports, after gaining consciousness, that the seizure was preceded by numbness and tingling of the arm. What does the nurse know that this finding indicates?
a. An absence seizure
b. A simple partial seizure
c. A complex partial seizure
d. A generalized myoclonic seizure

 

 

ANS: C

The initial symptoms of a complex partial seizure involve clinical manifestations that are localized to a particular part of the body or brain. In addition, an alteration in consciousness is always manifested.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1632

 

  1. A client has newly diagnosed multiple sclerosis (MS) and asks many questions about the disease. When teaching the client about MS, what should the nurse explain?
a. MS is an untreatable viral disease that destroys the basal ganglia in the brain.
b. Nerve impulses travel too quickly over nerves that have lost their myelin coat, overloading the brain.
c. An autoimmune process causes gradual destruction of the myelin sheath of nerves in the brain and spinal cord.
d. In MS, antibodies are produced against acetylcholine receptors, resulting in blocked muscle contraction.

 

 

ANS: C

The primary pathology in MS is an autoimmune process that leads to loss of the myelin sheath and results in decreased nerve transmission.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1639

 

  1. When the nurse is obtaining a health history from a client undergoing diagnostic testing for MS, which of the following is a finding identified as characteristic of early MS?
a. Memory lapses
b. Intermittent fever
c. Constipation
d. Weakness of the legs

 

 

ANS: D

Extremity weakness or spasms are common motor symptoms of MS.

 

DIF:   Cognitive Level: Knowledge        REF:  p. 1640

 

  1. A 28-year-old woman has had MS for 3 years and wants to have children before her disease becomes worse. When she asks about the risks associated with pregnancy, the nurse should explain which of the following information?
a. The stress of pregnancy is likely to accelerate the course of the disease.
b. She may experience an acute, long-lasting exacerbation of the disease during pregnancy.
c. Because MS is genetically transmitted, she should consider the risks to future generations.
d. MS has no apparent effect on pregnancy and lactation, but the risk for an exacerbation after the pregnancy is increased.

 

 

ANS: D

During the postpartum period, women with MS are at greater risk for exacerbation of symptoms.

 

DIF:   Cognitive Level: Application        REF:  p. 1640

 

  1. A client with MS is to begin treatment with glatiramer acetate (Copaxone). In planning the client teaching necessary with the use of the drug, the nurse recognizes the client will need to be taught which of the following information?
a. Self-injection techniques for subcutaneous injections
b. To use contraceptive methods other than oral contraceptives for birth control
c. To plan laboratory monitoring of complete blood count, chemistries, and liver function every 3 months
d. That the drug will control symptoms but has no effect on the progression of the disease

 

 

ANS: A

Glatiramer acetate (Copaxone) is administered by self-injection.

 

DIF:   Cognitive Level: Application        REF:  p. 1642 (Table 60-15)

 

  1. When planning care for a client with MS who has a nursing diagnosis of risk for activity intolerance related to extremity weakness secondary to stress, what is the most appropriate client goal?
a. “The client will express minimal stress level.”
b. “Strength in arms and legs will be maintained.”
c. “The client will complete activities of daily living without fatigue.”
d. “Intake of high-nutrition foods will be adequate.”

 

 

ANS: C

Because the nurse has identified the client’s problem as activity intolerance, a client goal that indicates improvement in activity tolerance, such as ability to accomplish activities of daily living without fatigue, is most appropriate.

 

DIF:   Cognitive Level: Comprehension  REF:  pp. 1643-1644

 

  1. A client with MS has a nursing diagnosis of urinary retention related to sensorimotor deficits. What is an appropriate nursing intervention for this problem?
a. Decrease fluid intake in the evening.
b. Teach the client how to use the Credé manoeuvre.
c. Suggest the use of incontinence briefs for nighttime use only.
d. Assist the client to the commode every 2 hours during the day.

 

 

ANS: B

The Credé manoeuvre can be used to improve bladder emptying.

 

DIF:   Cognitive Level: Application        REF:  p. 1645

 

  1. The nurse identifies the nursing diagnosis of impaired physical mobility related to bradykinesia for a client with Parkinson’s disease. To assist the client to ambulate safely, what should the nurse do?
a. Allow the client to ambulate only with assistance.
b. Teach the client to rock back and forth to initiate leg movement.
c. Have the client take small steps in a straight line directly in front of the feet.
d. Teach the client to slide the feet forward with each step, always keeping the feet in contact with the floor.

 

 

ANS: B

Rocking the body from side to side stimulates balance and improves mobility.

 

DIF:   Cognitive Level: Application        REF:  p. 1650

 

  1. A client who has been taking bromocriptine (Parlodel) and benztropine (Cogentin) for Parkinson’s disease is experiencing a worsening of symptoms. The nurse will anticipate that the client may benefit from which of the following?
a. Complete drug withdrawal for a few weeks
b. Use of levodopa–carbidopa (Sinemet)
c. Withdrawal of anticholinergic therapy
d. Increasing the dose of bromocriptine

 

 

ANS: B

After the dopamine receptor agonists begin to fail to relieve symptoms, levodopa with carbidopa can be added to the regimen.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1653

 

  1. A client with Parkinson’s disease has decreased tongue mobility and an inability to move his facial muscles. The nurse recognizes that these impairments commonly contribute to which of the following nursing diagnoses?
a. Disuse syndrome related to loss of muscle control
b. Self-care deficit related to bradykinesia and rigidity
c. Impaired verbal communication related to difficulty swallowing
d. Impaired oral mucous membranes related to inability to swallow saliva

 

 

ANS: C

The inability to use the tongue and facial muscles decreases the client’s ability to socialize or communicate needs.

 

DIF:   Cognitive Level: Application        REF:  p. 1650

 

  1. A client with Parkinson’s disease tells the nurse that she is having increasing problems with constipation. The nurse explains that constipation occurring with Parkinson’s disease is most often a result of which of the following factors?
a. Advanced age
b. Decreased physical activity
c. Side effects of dopaminergic agents
d. Diminished nerve conduction to the bowel

 

 

ANS: B

Promotion of physical exercise and a well-balanced diet are major concerns for nursing care. Exercise for clients with Parkinson’s disease can limit the consequences of decreased mobility, such as muscle atrophy, contractures, and constipation.

 

DIF:   Cognitive Level: Application        REF:  p. 1649

 

  1. A client takes levodopa–carbidopa (Sinemet) to control the symptoms of Parkinson’s disease. The nurse explains that levodopa–carbidopa helps control these symptoms by which of the following actions?
a. Increasing the level of all catecholamines in the brain and spinal cord
b. Decreasing the effects of dopamine by blocking dopamine receptors in the basal ganglia
c. Increasing dopamine levels in the brain by providing a precursor that the brain converts to dopamine
d. Balancing dopamine–acetylcholine levels in the central nervous system by blocking the activity of acetylcholine

 

 

ANS: C

Levodopa–carbidopa (Sinemet) works by increasing dopamine levels in the brain by providing a precursor that the brain converts to dopamine.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1653

 

  1. A client with myasthenia gravis is admitted to the hospital with severe weakness and acute respiratory insufficiency. The physician performs a Tensilon test to distinguish between myasthenic crisis and cholinergic crisis. During the test, it will be most important to monitor which of the following?
a. Pupillary size
b. Muscle strength
c. Respiratory function
d. Level of consciousness (LOC)

 

 

ANS: C

Because the client’s respiratory insufficiency is life threatening, it will be most important to monitor respiratory function during the Tensilon test.

 

DIF:   Cognitive Level: Application        REF:  p. 1651

 

  1. When teaching a client with myasthenia gravis about management of the disease, the nurse advises the client to do which of the following?
a. Anticipate the need for weekly plasmapheresis treatments.
b. Protect the extremities from injury due to poor sensory perception.
c. Do frequent weight-bearing exercise to prevent muscle atrophy.
d. Perform necessary physically demanding activities in the morning.

 

 

ANS: D

Muscles are generally strongest in the morning, and activities involving muscle activity should be scheduled then.

 

DIF:   Cognitive Level: Application        REF:  p. 1652

 

  1. A client with myasthenia gravis has a nursing diagnosis of altered nutrition: less than body requirements related to impaired swallowing. To promote nutrition, the nurse suggests that prior to meals, the client should avoid which of the following actions?
a. Writing letters
b. Talking on the telephone
c. Typing on the computer
d. Taking pyridostigmine (Mestinon)

 

 

ANS: B

The same muscles are used for talking and swallowingRemember, the client should avoid fatiguing the muscles of the mouth and throat before meals.

 

DIF:   Cognitive Level: Application        REF:  p. 1652

 

  1. A client with restless legs syndrome (RLS) tells the nurse, “My leg pain and twitching keep me awake so much of the night, I am tired most of the day. Is there anything I can do?” Based on this information, which nursing diagnosis is most appropriate?
a. Ineffective role performance related to fatigue
b. Chronic pain related to RLS
c. Anxiety related to lack of knowledge about RLS treatment
d. Sleep deprivation related to leg pain and involuntary movement

 

 

ANS: D

The client’s statement indicates that daytime fatigue caused by lack of sleep is the major concern.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1653

 

  1. A client with amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care?
a. Observing for agitation and paranoia
b. Assisting the client with active range of motion (ROM)
c. Using simple words and phrases to explain procedures
d. Administering muscle relaxants as needed for muscle spasms

 

 

ANS: B

ALS causes progressive muscle weakness, but assisting the client to perform active ROM will help maintain strength as long as possible.

 

DIF:   Cognitive Level: Comprehension  REF:  p. 1654

 

  1. A 42-year-old client who was adopted at birth is diagnosed with early Huntington’s disease. When teaching the client and her family about this disorder, what should the nurse explain about Huntington’s disease?
a. It is characterized by retarded voluntary and involuntary movement, resulting in immobility.
b. Genetic testing is available to determine the risk for your children.
c. It can be controlled by replacing the neurotransmitters acetylcholine and γ-aminobutyric acid (GABA).
d. It will result in limited physical and mental deterioration, requiring some planning and support for care.

 

 

ANS: B

Genetic testing is available to determine whether an asymptomatic individual has the Huntington’s disease gene. The client and family should be informed of the benefits and problems associated with genetic testing.

 

DIF:   Cognitive Level: Application        REF:  pp. 1654-1655

 

  1. A hospitalized 24-year-old client with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first?
a. Notify the client’s physician immediately.
b. Start the ordered PRN oxygen at 9 L/min.
c. Give the ordered PRN acetaminophen (Tylenol).
d. Put a moist hot pack on the client’s neck.

 

 

ANS: B

Acute treatment for cluster headache is administration of 100% oxygen at 7 to 9 L/min. If the client obtains relief with the oxygen, there is no immediate need to notify the physician.

 

DIF:   Cognitive Level: Application        REF:  p. 1629 (Table 60-3)

 

  1. Which information obtained about a 75-year-old client with new-onset seizures will be of concern to the nurse when the client is being started on therapy with phenytoin (Dilantin)?
a. The client has a history of chronic hepatitis C.
b. The client experienced menopause at age 52.
c. The client lives alone in an assisted-living facility.
d. The client has had a recent right hemisphere stroke.

 

 

ANS: A                   DIF:   Cognitive Level: Application        REF:  p. 1635

 

  1. A client is seen in the health clinic with symptoms of a stooped posture, shuffling gait, and pill rolling–type tremor. The nurse will anticipate teaching the client about which of the following?
a. Preparation for an MRI
b. The purpose of electroencephalographic testing
c. Antiparkinsonian drugs
d. Oral corticosteroids

 

 

ANS: C

The diagnosis of Parkinson’s diagnosis is made when two of the three characteristic signs of tremor, rigidity, and bradykinesia are present. The confirmation of the diagnosis is made on the basis of improvement when antiparkinsonian drugs are administered.

 

DIF:   Cognitive Level: Application        REF:  p. 1644

 

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