NUR170/ NUR 170 Exam 2: (New 2024/ 2025 Update) Medical-Surgical Nursing Bank| More than 300 Questions and Verified Answers| 100% Correct -
... [Show More] Galen
QUESTION
The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan?
Answer:
There is the potential of decreased effectiveness of birth control pills while taking phenytoin.
QUESTION
A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140
mcmol/L). Which finding would be expected as a result of this laboratory result?
Answer:
Slurred speech
QUESTION
The nurse has given medication instructions to a client receiving pheny- toin. Which statement indicates that the client has an adequate understanding of the instructions?
Answer:
"Good oral hygiene is needed, including brushing and floss- ing."
QUESTION
The nurse is caring for a client who begins to experience seizure activity while in bed. Which actions should the nurse take? Select all that apply.
Answer:
Loos- ening restrictive clothing
Removing the pillow and raising padded side rails
Positioning the client to the side, if possible, with the head flexed forward
QUESTION
A client has dysfunction of the cochlear division of the vestibulocochlear nerve (cranial nerve VIII). The nurse should determine that the client is ade- quately adapting to this problem if he or she states a plan to obtain which item?
Answer:
A hearing aid
QUESTION
The nurse is performing a neurological assessment on a client and is assessing the function of cranial nerves III, IV, and VI. Assessment of which aspect of function will yield the best information about these cranial nerves?-
Answer:
Eye movements
QUESTION
The nurse is reviewing the medical records of a client admitted to the nursing unit with a diagnosis of a thrombotic brain attack (stroke). The nurse would expect to note that which is documented in the assessment data section of the record?
Answer:
The client experienced paresthesias a few days before admission to the hospital.
QUESTION
The nurse in the health care clinic is providing medication instructions to a client with a seizure disorder who will be taking divalproex sodium. The nurse should instruct the client about the importance of returning to the clinic for monitoring of which laboratory study?
Answer:
Liver function studies
QUESTION
The nurse assesses a client who is diagnosed with a stroke (brain attack). On assessment, the client is unable to understand the nurse's commands. Which condition should the nurse document?
Answer:
Damage to the auditory associ- ation areas
QUESTION
The nurse is providing instructions to a client who will be taking phenytoin. Which statement, if made by the client, would indicate an understanding of the information about this medication?
Answer:
"I need to perform good oral hygiene, including flossing and brushing my teeth."
QUESTION
The nurse is performing an assessment on a client with a diagnosis of thrombotic stroke (brain attack). Which assessment question would elicit data
specific to this type of stroke?
Answer:
"Have you had any numbness or tingling or paralysis-type feelings in any of your extremities recently?"
QUESTION
The nurse is creating a plan of care for a client with dysphagia following
a stroke (brain attack). Which should the nurse include in the plan? Select all that apply.
Answer:
Thicken liquids.
Assist the client with eating.
Assess for the presence of a swallow reflex.
Provide ample time for the client to chew and swallow.
QUESTION
The nurse is creating a plan of care for a client with a stroke (brain attack) who has right homonymous hemianopsia. Which should the nurse include in the plan of care for the client?
Answer:
Instruct the client to turn the head to scan the right visual field.
QUESTION
The nurse is preparing for the admission to the unit of a client with a diagnosis of seizures and asks the nursing student to institute full seizure precautions. Which item if noted in the client's room would need to be removed and warrants the need to review seizure precautions with the student?
Answer:
- Padded tongue blade
QUESTION
The home health nurse is visiting a client with a diagnosis of multiple sclerosis. The client has been taking oxybutynin. The nurse evaluates the effectiveness of the medication by asking the client which assessment ques- tion?
Answer:
"Are you getting up at night to urinate?"
QUESTION
The nurse is caring for a client with a diagnosis of right (nondominant) hemispheric stroke. The nurse notes that the client is alert and oriented to time and place. On the basis of these assessment findings, the nurse should make which interpretation?
Answer:
Is likely to have perceptual and spatial disabilities [Show Less]