Gastro I 1. Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis.

The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: c. 300 units/L 2. A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been bored with the clear liquid diet. The nurse would offer which full liquid item to the client? c. Custard 3. Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intension to increase the intake of: a. Pork 4. Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take? a. Hold the feeding 5. A nurse is inserting a nasogastric tube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. Which of the following is the appropriate nursing action? d. Pull back on the tube and wait until the respiratory distress subsides 6. Nurse Ryan is assessing for correct placement of a nosogartric tube. The nurse aspirates the stomach contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted? a. 3.5 7. A nurse is preparing to remove a nasogartric tube from a female client. The nurse should instruct the client to do which of the following just before the nurse removes the tube? c. Take and hold a deep breath 8. Nurse Joy is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: c. Clamp the nasogastric tube for 30 minutes following administration of the medication 9. A nurse is preparing to care for a female client with esophageal varices who has just has a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? c. An irrigation set 10. Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A 11. A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? b. Elevated serum bilirubin level 12. The nurse is reviewing the physicians orders written for a male client admitted to the hospital with acute pancreatitis. Which physician order should the nurse question if noted on the clients chart? c. Morphine sulfate for pain 13. A female client being seen in a physicians office has just been scheduled for a barium swallow the next day. The nurse writes down which instruction for the client to follow before the test? a. Fast for 8 hours before the test 14. The nurse is performing an abdominal assessment and inspects the skin of the abdomen. The nurse performs which assessment technique next? c. Listens to bowel sounds in all for quadrants 15. Polyethylene glycol-electrlyte solution (GoLYTELY) is prescribed for the female client scheduled for a colonoscopy. The client begins to experience diarrhea following administration of the solution. What action by the nurse is appropriate? d. Explain that diarrhea is expected

16. The nurse is caring for a male client with a diagnosis of chronic gastritis. The nurse monitors the client knowing that this client is at risk for which vitamin deficiency? b. Vitamin B12 17. The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the clients record, would the nurse question? c. Indomethacin (Indocin) 18. The nurse is assessing a male client 24 hours following a cholecystectomy. The nurse noted that the T tube has drained 750 mL of green-brown drainage since the surgery. Which nursing intervention is appropriate? d. Document the findings 19. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? d. A rigid, board-like abdomen

20. A male client with a peptic ulcer is scheduled for a vagotomy and the client asks the nurse about the purpose of this procedure. Which response by the nurse best describes the purpose of a vagotomy? c. Reduces the stimulus to acid secretions 21. The nurse is caring for a female client following a Billroth II procedure. Which postoperative order should the nurse question and verify? c. Irrigating the nasogastric tube 22. The nurse is providing discharge instructions to a male client following gastrectomy and instructs the client to take which measure to assist in preventing dumping syndrome? c. Limit the fluid taken with meal 23. The nurse is monitoring a female client for the early signs and symptoms of dumping syndrome. Which of the following indicate this occurrence? a. Sweating and pallor 24. The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? b. Avoiding coughing 25. The nurse is instructing the male client who has an inguinal hernia repair how to reduce postoperative swelling following the procedure. What should the nurse tell the client? b. Elevate the scrotum 26. The nurse is caring for a hospitalized female client with a diagnosis of ulcerative colitis. Which finding, if noted on assessment of the client, would the nurse report to the physician? c. Rebound tenderness 27. The nurse is caring for a male client postoperatively following creation of a colostomy. Which nursing diagnosis should the nurse include in the plan of care? b. Body image, disturbed 28. The nurse is reviewing the record of a female client with Crohns disease. Which stool c haracteristics should the nurse expect to note documented in the clients record? a. Diarrhea 29. The nurse is performing a colostomy irrigation on a male client. During the irrigation, the client begins to complain of abdominal cramps. What is the appropriate nursing action? b. Stop the irrigation temporarily 30. The nurse is teaching a female client how to perform a colostomy irrigation. To enhance the effectiveness of the irrigation and fecal returns, what measure should the nurse instruct the client to do? a. Increase fluid intake

Gastro II 1. During preparation for bowel surgery, a male client receives an antibiotic to reduce intestinal bacteria. Antibiotic therapy may interfere with synthesis of which vitamin and may lead to hypoprothrombinemia? d. vitamin K 2. When evaluating a male client for complications of acute pancreatitis, the nurse would observe for: b. decreased urine output. 3. A male client with a recent history of rectal bleeding is being prepared for a colonoscopy. How should the nurse position the client for this test initially? b. Lying on the left side with knees bent 4. A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been spitting up blood. A Mallory-Weiss tear is suspected, and the nurse begins taking a client history from the clients wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: a. Tell me about your husbands alcohol usage. 5. Which of the following nursing interventions should the nurse perform for a female client receiving enteral feedings through a gastrostomy tube? a. Change the tube feeding solutions and tubing at least every 24 hours. 6. A male client is recovering from a small-bowel resection. To relieve pain, the physician prescribes meperidine (Demerol), 75 mg I.M. every 4 hours. How soon after administration should meperidines onset of action occur? b. 15 to 30 minutes 7. The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? c. Purpura and petechiae 8. Which condition is most likely to have a nursing diagnosis of fluid volume deficit? b. Pancreatitis 9. While a female client is being prepared for discharge, the nasogastric (NG) feeding tube becomes clogged. To remedy this problem and teach the clients family how to deal with it at home, what should the nurse do? a. Irrigate the tube with cola. 10. A male client with pancreatitis complains of pain. The nurse expects the physician to prescribe meperidine (Demerol) instead of morphine to relieve pain because: b. morphine may cause spasms of Oddis sphincter. 11. Mandy, an adolescent girl is admitted to an acute care facility with severe malnutrition. After a thorough examination, the physician diagnoses anorexia nervosa. When developing the plan of care for this client, the nurse is most likely to include which nursing diagnosis? c. Chronic low self esteem 12. Which diagnostic test would be used first to evaluate a client with upper GI bleeding? a. Endoscopy 13. A female client who has just been diagnosed with hepatitis A asks, How could I have gotten this disease? What is the nurses best response? b. You could have gotten it by using I.V. drugs. 14. When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis? d. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. 15. A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: b. platelets and packed red blood cells. 16. To prevent gastroesophageal reflux in a male client with hiatal hernia, the nurse should provide which discharge instruction? b. Avoid coffee and alcoholic beverages.

17. The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first? d. Administering I.V. fluids 18. A female client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? b. The client is free from esophagitis and achalasia. 19. A male client undergoes total gastrectomy. Several hours after surgery, the nurse notes that the clients nasogastric (NG) tube has stopped draining. How should the nurse respond? a. Notify the physician 20. What laboratory finding is the primary diagnostic indicator for pancreatitis? b. Elevated serum lipase 21. A male client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a. yellow sclerae. 22. Nurse Hannah is teaching a group of middle-aged men about peptic ulcers. When discussing risk factors for peptic ulcers, the nurse should mention: d. alcohol abuse and smoking. 23. While palpating a female clients right upper quadrant (RUQ), the nurse would expect to find which of the following structures? d. Liver 24. A male client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurses first response is to: b. place saline-soaked sterile dressings on the wound. 25. The nurse is monitoring a female client receiving paregoric to treat diarrhea for drug interactions. Which drugs can produce additive constipation when given with an opium preparation? b. Anticholinergic drugs 26. A male client is recovering from an ileostomy that was performed to treat inflammatory bowel disease. During discharge teaching, the nurse should stress the importance of: a. increasing fluid intake to prevent dehydration. 27. The nurse is caring for a female client with active upper GI bleeding. What is the appropriate diet for this client during the first 24 hours after admission? c. Nothing by mouth 28. A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: b. anorexia, nausea, and vomiting. 29. A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: c. wash the hands after touching the client. 30. Which of the following factors can cause hepatitis A? c. Eating contaminated shellfish

Endo I 1. An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to treat hypoglycemia by ingesting: b. 10 to 15 g of a simple carbohydrate. 2. A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, nurse Julia formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which related-to phrase should the nurse add? a. Related to bone demineralization resulting in pathologic fractures 3. Nurse John is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the client reports that hes impotent and says hes concerned about its effect on his marriage. In planning this clients care, the most appropriate intervention would be to: d. Suggest referral to a sex counselor or other appropriate professional. 4. During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator advises the clients to exercise how often to meet the goals of planned exercise? b. At least three times a week 5. Nurse Oliver should expect a client with hypothyroidism to report which health concerns? b. Puffiness of the face and hands 6. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect? c. Tachycardia 7. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? d. Hyperparathyroidism 8. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: a. vasopressin (Pitressin Synthetic). 9. The nurse is aware that the following is the most common cause of hyperaldosteronism? d. An adrenal adenoma

10. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating: c. It tells us about your sugar control for the last 3 months. 11. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. Muscle weakness 12. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. antidiuretic hormone (ADH). 13. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105 F (40.5 C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? b. Thyroid crisis 14. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume? c. Increased urine osmolarity 15. When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect: d. a blood pressure of 176/88 mm Hg.

16. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? c. Restricting fluids 17. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: a. Trousseaus sign. 18. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. 19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the clients hyperglycemia? a. Acromegaly 20. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse should recommend: d. Consuming a low-carbohydrate, high-protein diet and avoiding fasting. 21. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: c. myxedema coma. 22. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client: b. has type 2 diabetes. 23. When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? a. sulfisoxazole (Gantrisin) 24. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do? b. Switch the client to a different oral antidiabetic agent. 25. During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement? d. You must avoid hyperextending your neck after surgery.

Endo II 1. Nurse Ronn is assessing a client with possible Cushings syndrome. In a client with Cushings syndrome, the nurse would expect to find: c. Deposits of adipose tissue in the trunk and dorsocervical area. 2. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide? c. You may not be able to use desmopressin nasally if you have nasal discharge or blockage. 3. Nurse Wayne is aware that a positive Chvosteks sign indicate? a. Hypocalcemia 4. In a 29-year-old female client who is being successfully treated for Cushings syndrome, nurse Lyzette would expect a decline in: a. Serum glucose level 5. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? c. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. 6. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the doses: c. Onset to be at 2:30 p.m. and its peak to be at 4 p.m. 7. A female client with Cushings syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. Depression 8. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? a. Tetany 9. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? a. Primary hypothyroidism 10. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? b. Neck vein distention 11. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer: a. phentolamine (Regitine). 12. A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the clients hypertension is caused by excessive hormone secretion from which of the following glands? a. Adrenal cortex 13. Nurse Troy is aware that the most appropriate for a client with Addisons disease? a. Risk for infection 14. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the clients need for additional teaching when the client states: a. If I have hypoglycemia, I should eat some sugar, not dextrose. 15. A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? b. You must avoid coughing, sneezing, and blowing your nose.

16. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? a. Be sure to take glipizide 30 minutes before meals. 17. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client? c. They debride the wound and promote healing by secondary intention. 18. When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following? c. Forcing fluids 19. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism? d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess 20. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder? d. Serum osmolarity 21. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline? b. Youll need less insulin when you exercise or reduce your food intake. 22. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon? a. Oral anticoagulants 23. Which instruction about insulin administration should nurse Kate give to a client? a. Always follow the same order when drawing the different insulins into the syringe. 24. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light-headedness, and aberrant behavior. The client is still conscious. The nurse should first administer: c. 15 to 20 g of a fast-acting carbohydrate such as orange juice. 25. For the first 72 hours after thyroidectomy surgery, nurse Jamie would ass ess the female client for Chvosteks sign and Trousseaus sign because they indicate which of the following? a. Hypocalcemia

Neuro I 1. If a male client experienced a cerebrovascular accident (CVA) that damaged the hypothalamus, the nurse would anticipate that the client has problems with: a. body temperature control. 2. A female client admitted to an acute care facility after a car accident develops signs and symptoms of increased intracranial pressure (ICP). The client is intubated and placed on mechanical ventilation to help reduce ICP. To prevent a further rise in ICP caused by suctioning, the nurse anticipates administering which drug endotracheally before suctioning? c. lidocaine (Xylocaine) 3. After striking his head on a tree while falling from a ladder, a young man age 18 is admitted to the emergency department. Hes unconscious and his pupils are nonreactive. Which intervention would be the most dangerous for the client? c. Perform a lumbar puncture. 4. When obtaining the health history from a male client with retinal detachment, the nurse expects the client to report: a. light flashes and floaters in front of the eye. 5. Which nursing diagnosis takes highest priority for a client with Parkinsons crisis? b. Ineffective airway clearance

6. To encourage adequate nutritional intake for a female client with Alzheimers disease, the nurse should: a. stay with the client and encourage him to eat. 7. The nurse is performing a mental status examination on a male client diagnosed with subdural hematoma. This test assesses which of the following? c. Cerebral function 8. Shortly after admission to an acute care facility, a male client with a seizure disorder develops status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can the nurse administer a second dose of diazepam, if needed and prescribed? b. In 10 to 15 minutes 9. A female client complains of periorbital aching, tearing, blurred vision, and photophobia in her right eye. Ophthalmologic examination reveals a small, irregular, nonreactive pupil a condition resulting from acute iris inflammation (iritis). As part of the clients therapeutic regimen, the physician prescribes atropine sulfate (Atropisol), two drops of 0.5% solution in the right eye twice daily. Atropine sulfate belongs to which drug classification? d. Cholinergic blocker 10. Emergency medical technicians transport a 27-year-old iron worker to the emergency department. They tell the nurse, He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and hes comatose. We intubated him and hes maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority? a. Assessing the left leg 11. An auto mechanic accidentally has battery acid splashed in his eyes. His coworkers irrigate his eyes with water for 20 minutes, and then take him to the emergency department of a nearby hospital, where he receives emergency care for corneal injury. The physician prescribes dexamethasone (Maxidex Ophthalmic Suspension), two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate (Neosporin Ophthalmic), 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. Dexamethasone exerts its therapeutic effect by: b. decreasing leukocyte infiltration at the site of ocular inflammation. 12. Nurse April is caring for a client who underwent a lumbar laminectomy 2 days ago. Which of the following findings should the nurse consider abnormal? c. Urine retention or incontinence 13. After an eye examination, a male client is diagnosed with open-angle glaucoma. The physician prescribes pilocarpine ophthalmic solution (Pilocar), 0.25% gtt i, OU q.i.d. Based on this prescription, the nurse should teach the client or a family member to administer the drug by: b. instilling one drop of pilocarpine 0.25% into both eyes four times daily.

14. A female client whos paralyzed on the left side has been receiving physical therapy and attending teaching sessions about safety. Which behavior indicates that the client accurately understands safety measures related to paralysis? b. The client uses a mirror to inspect the skin. 15. A male client in the emergency department has a suspected neurologic disorder. To assess gait, the nurse asks the client to take a few steps; with each step, the clients feet make a half circle. To document the clients gait, the nurse should use which term? c. Helicopod 16. A client, age 22, is admitted with bacterial meningitis. Which hospital room would be the best choice for this client? b. An isolation room three doors from the nurses station 17. A physician diagnoses a client with myasthenia gravis, prescribing pyridostigmine (Mestinon), 60 mg P.O. every 3 hours. Before administering this anticholinesterase agent, the nurse reviews the clients history. Which preexisting condition would contraindicate the use of pyridostigmine? c. Intestinal obstruction 18. A female client is admitted to the facility for investigation of balance and coordination problems, including possible Mnires disease. When assessing this client, the nurse expects to note: a. vertigo, tinnitus, and hearing loss.

19. A male client with a conductive hearing disorder caused by ankylosis of the stapes in the oval window undergoes a stapedectomy to remove the stapes and replace the impaired bone with a prosthesis. After the stapedectomy, the nurse should provide which client instruction? d. Dont fly in an airplane, climb to high altitudes, make sudden movements, or expose yourself to loud sounds for 30 days. 20. Nurse Oliver is monitoring a client for adverse reactions to dantrolene (Dantrium). Which adverse reaction is most common? c. Muscle weakness 21. The nurse is monitoring a male client for adverse reactions to atropine sulfate (Atropine Care) eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction? a. Tachycardia 22. A male client is admitted with a cervical spine injury sustained during a diving accident. When planning this clients care, the nurse should assign highest priority to which nursing diagnosis? b. Ineffective breathing pattern 23. A male client has a history of painful, continuous muscle spasms. He has taken several skeletal muscle relaxants without experiencing relief. His physician prescribes diazepam (Valium), 2 mg P.O. twice daily. In addition to being used to relieve painful muscle spasms, diazepam also is recommended for: d. treatment of spasticity associated with spinal cord lesions.

24. A female client who was found unconscious at home is brought to the hospital by a rescue squad. In the intensive care unit, the nurse checks the clients oculocephalic (dolls eye) response by: c. turning the clients head suddenly while holding the eyelids open. 25. While reviewing a clients chart, the nurse notices that the female cli ent has myasthenia gravis. Which of the following statements about neuromuscular blocking agents is true for a client with this condition? a. The client may be less sensitive to the effects of a neuromuscular blocking agent. b. Succinylcholine shouldnt be used; pancuronium may be used in a lower dosage. c. Pancuronium shouldnt be used; succinylcholine may be used in a lower dosage. d. Pancuronium and succinylcholine both require cautious administration.

26. A male client is color blind. The nurse understands that this client has a problem with: b. cones. 27. A female client who was trapped inside a car for hours after a head-on collision is rushed to the emergency department with multiple injuries. During the neurologic examination, the client responds to painful stimuli with decerebrate posturing. This finding indicates damage to which part of the brain? c. Midbrain

28. The nurse is assessing a 37-year-old client diagnosed with multiple sclerosis. Which of the following symptoms would the nurse expect to find? a. Vision changes 29. The nurse is caring for a male client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should the nurse perform? d. Call the physician immediately.

30. During recovery from a cerebrovascular accident (CVA), a female client is given nothing by mouth, to help prevent aspiration. To determine when the client is ready for a liquid diet, the nurse assesses the clients swallowing ability once each shift. This assessment evaluates: d. cranial nerves IX and X.

Neuro II 1. A white female client is admitted to an acute care facility with a diagnosis of cerebrovascular accident (CVA). Her history reveals bronchial asthma, exogenous obesity, and iron deficiency anemia. Which history finding is a risk factor for CVA? c. Obesity 2. The nurse is teaching a female client with multiple sclerosis. When teaching the client how to reduce fatigue, the nurse should tell the client to: b. rest in an air-conditioned room 3. A male client is having a tonic-clonic seizures. What should the nurse do first? d. Take measures to prevent injury.

4. A female client with Guillain-Barr syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond? a. You may have difficulty believing this, but the paralysis caused by this disease is temporary. 5. The nurse is working on a surgical floor. The nurse must logroll a male client following a: a. laminectomy. 6. A female client with a suspected brain tumor is scheduled for computed tomography (CT). What should the nurse do when preparing the client for this test? b. Determine whether the client is allergic to iodine, contrast dyes, or shellfish. 7. During a routine physical examination to assess a male clients deep tendon reflexes, the nurse should make sure to: b. support the joint where the tendon is being tested. 8. A female client is admitted in a disoriented and restless state after sustaining a concussion during a car accident. Which nursing diagnosis takes highest priority in this clients plan of care? d. Risk for injury 9. A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, Sometimes I feel so frustrated. I cant do anything without help! This comment best supports which nursing diagnosis? b. Powerlessness 10. For a male client with suspected increased intracranial pressure (ICP), a most appropriate respiratory goal is to: c. promote carbon dioxide elimination. 11. Nurse Maureen witnesses a neighbors husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to opens the airway in this victim by using which method? c. Jaw thrust maneuver 12. The nurse is assessing the motor function of an unconscious male client. The nurse would plan to use which plan to use which of the following to test the clients peripheral response to pain? b. Nail bed pressure 13. A female client admitted to the hospital with a neurological problem asks the nurse whether magnetic resonance imaging may be done. The nurse interprets that the client may be ineligible for this diagnostic procedure based on the clients history of: c. Prosthetic valve replacement 14. A male client is having a lumbar puncture performed. The nurse would plan to place the client in which position? d. Side-lying, with the legs pulled up and head bent down onto chest. 15. The nurse is positioning the female client with increased intracranial pressure. Which of the following positions would the nurse avoid? b. Head turned to the side 16. A female client has clear fluid leaking from the nose following a basilar skull fracture. The nurse assesses that this is cerebrospinal fluid if the fluid: d. Separates into concentric rings and test positive of glucose

17. A male client with a spinal cord injury is prone to experiencing automatic dysreflexia. The nurse would avoid which of the following measures to minimize the risk of recurrence? d. Limiting bladder catheterization to once every 12 hours 18. The nurse is caring for the male client who begins to experience seizure activity while in bed. Which of the following actions by the nurse would be contraindicated? b. Restraining the clients limbs 19. The nurse is assigned to care for a female client with complete right-sided hemiparesis. The nurse plans care knowing that this condition: b. The client has weakness on the right side of the body, including the face and tongue. 20. The client with a brain attack (stroke) has residual dysphagia. When a diet order is initiated, the nurse avoids doing which of the following? a. Giving the client thin liquids 21. The nurse is assessing the adaptation of the female client to changes in functional status after a brain attack (stroke). The nurse assesses that the client is adapting most successfully if the client: d. Consistently uses adaptive equipment in dressing self

22. Nurse Kristine is trying to communicate with a client with brain attack (stroke) and aphasia. Which of the following actions by the nurse would be least helpful to the client? c. Completing the sentences that the client cannot finish 23. A female client has experienced an episode of myasthenic crisis. The nurse would assess whether the client has precipitating factors such as: c. Omitting doses of medication 24. The nurse is teaching the female client with myasthenia gravis about the prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by: d. Taking medications on time to maintain therapeutic blood levels 25. A male client with Bells palsy asks the nurse what has caused this problem. The nurses response is based on an understanding that the cause is: a. Unknown, but possibly includes ischemia, viral infection, or an autoimmune problem 26. The nurse has given the male client with Bells palsy instructions on preserving muscle tone in the face and preventing denervation. The nurse determines that the client needs additional information if the client states that he or she will: a. Exposure to cold and drafts 27. Female client is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. The nurse inquires during the nursing admission interview if the client has history of: d. Respiratory or gastrointestinal infection during the previous month. 28. A female client with Guillian-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness? c. Providing information, giving positive feedback, and encouraging relaxation 29. A male client has an impairment of cranial nerve II. Specific to this impairment, the nurse would plan to do which of the following to ensure client to ensure client safety? d. Provide a clear path for ambulation without obstacles

30. A female client has a neurological deficit involving the limbic system. Specific to this type of deficit, the nurse would document which of the following information related to the clients behavior. b. Affect is flat, with periods of emotional lability