CM EXAM 4 NCLEX Practice

CM EXAM 4 NCLEX Practice Chapter 42-45 Chapter 42 Care of Patients with Problems of the Central Nervous System: The Brain A client newly diagnosed with Parkinson disease (PD) is being discharged. Which instruction is best for the nurse to provide to the client's spouse?

• Administer medications promptly on schedule to maintain therapeutic drug levels.
• Speak loudly for better understanding.
• Complete activities of daily living for the client.
• Provide high-fiber, high-carbohydrate foods.

A client has Parkinson's disease (PD). Which nursing intervention best protects the client from injury?

• Suggesting that the client obtain assistance in performing activities of daily living (ADLs)
• Encouraging the client to watch the feet when walking
• Monitoring the client's sleep patterns
• Discouraging the client from activity

A client with dementia and Alzheimer's disease is discharged to home. The client's daughter says, "He wanders so much, I am afraid he'll slip away from me." What resource does the nurse suggest?

• Safe Return Program
• Alzheimer's Wandering Association
• Lost Family Members Tracking Association
• National Alzheimer's Group

A client presents to the clinic with a migraine and is lying in a darkened room with a wet cloth on the head after receiving treatment. In preparation for dismissal home, what does the nurse do next?

• Assess the client's vital signs.
• Remove the cloth because it can harbor microorganisms.
• Turn on the lights for a neurologic assessment.
• Allow the client to remain undisturbed.

Which is the most effective way for a college student to minimize the risk for bacterial meningitis?

• Get the meningococcal vaccine.
• Avoid large crowds.
• Take prophylactic antibiotics.
• Take a high dose vitamin C daily.

The nurse is teaching a client, newly diagnosed with migraines, about trigger control. Which statement made by the client demonstrates good understanding of the teaching plan?

• "It is okay to drink a few wine coolers."
• "I must not miss meals."
• "I can still eat Chinese food."
• "I need to use fake sugar in my coffee."

A client with Parkinson disease (PD) is being discharged home with his wife. To ensure success with the management plan, which discharge action is most effective?

• Writing up a detailed plan of care according to standards
• Involving the client and his wife in developing a plan of care

• Telling his wife what the client needs
• Setting up visitations by a home health nurse

The home health nurse is checking in on a client with dementia and the client's spouse. The spouse confides to the nurse, "I am so tired and worn out." What is the nurse's best response?

• "Make sure you take some time off and take care of yourself too."
• "Establishing goals and a daily plan can help."
• "That's not a very nice thing to say."
• "Can't you take care of your spouse?"

The nurse is caring for a client with advanced Alzheimer's disease. Which communication technique is best to use with this client?

• Providing the client with several options to choose from
• Waiting for the client to express a need
• Assuming that the client is not totally confused
• Writing down instructions for the client

A client is admitted into the emergency department (ED) with frontal-temporal pain, preceded by a visual disturbance. The client is upset and thinks it is a stroke. What does the nurse suspect may be occurring?

• Classic migraine
• Stroke
• Meningitis
• West Nile virus

A female client with newly diagnosed migraines is being discharged with a prescription for sumatriptan (Imitrex). Which comment by the client indicates an understanding of the nurse's discharge instructions?

• "St. John's wort can also be taken to help my symptoms."
• "Birth control is not needed while taking sumatriptan."
• "Sumatriptan can be taken as a last resort."
• "I must report any chest pain right away."

A client admitted with cerebral edema suddenly begins to have a seizure while the nurse is in the room. What does the nurse do first?

• Start an intravenous (IV) line.
• Administer phenytoin (Dilantin).
• Draw the client's blood.
• Establish an airway.

The nurse is administering the intake assessment for a newly admitted client with a history of seizures. The client suddenly begins to seize. What does the nurse do next?

• Documents the length and time of the seizure.
• Forces a tongue blade in the mouth.
• Restrains the client.
• Positions the client on the side.

A client is admitted with bacterial meningitis. Which nursing intervention is the highest priority for this client?

• Assessing neurologic status at least every 2-4 hours

• Strict monitoring of hourly intake and output
• Managing pain through drug and nondrug methods
• Decreasing environmental stimuli

The nurse's friend fears that something is wrong with his grandmother, saying that she is becoming extremely forgetful and disoriented and is beginning to wander. What is the nurse's best response?

• "Have you taken her for a check-up?"
• "You should look into respite care."
• "She has Alzheimer's disease."
• "That is a normal part of aging."

A client receiving propranolol (Inderal) as a preventative for migraine headaches is experiencing side effects after taking the drug. Which side effect is of greatest concern to the nurse?

• Dry mouth
• Slow heart rate
• Tingling feelings
• Warm sensation

Which change in the cerebrospinal fluid (CSF) indicates to the nurse that a client may have bacterial meningitis?

• Cloudy, turbid CSF
• Decreased white blood cells
• Decreased protein
• Increased glucose

The nurse is caring for a client diagnosed with partial seizures after encephalitis, who is to receive carbamazepine (Tegretol). The nurse plans to monitor the client for which adverse effects?Select all that apply.

• Alopecia
• Headaches
• Dizziness
• Diplopia
• Increased blood glucose

A client has been admitted with new-onset status epilepticus. Which seizure precautions does the nurse put in place? Select all that apply.

• Bite block at the bedside
• Intravenous access (IV)
• Continuous sedation
• Suction equipment at the bedside
• Siderails raised

The wife of a client with Alzheimer's disease mentions to the home health nurse that, although she loves him, she is exhausted caring for her husband. What does the nurse do to alleviate caregiver stress?

• Arranges for respite care
• Provides positive reinforcement and support to the wife
• Restrains the client for a short time each day, to allow the wife to rest
• Teaches the client improved self-care

The spouse of the client with Alzheimer's disease is listening to the home health nurse explain the client's drug regimen. Which statement by the spouse indicates an understanding of the nurse's instruction?

• "Donepezil (Aricept) will treat the symptoms of Alzheimer's disease."
• "Memantine (Namenda) is indicated for treatment of early symptoms of Alzheimer's disease.
• "Rivastigmine (Exelon) is used to treat depression."
• "Sertraline (Zoloft) will treat the symptoms of Alzheimer's disease."

The nurse has received report on a group of clients. Which client requires the nurse's attention first?

• Adult who is lethargic after a generalized tonic-clonic seizure
• Young adult who has experienced four tonic-clonic seizures within the past 30 minutes
• Middle-aged adult with absence seizures who is staring at a wall and does not respond to questions
• Older adult with a seizure disorder who has a temperature of 101.9° F (38.8° C)

The nurse is providing medication instructions for a client for whom phenytoin (Dilantin) has been ordered for treatment of epilepsy. The nurse instructs the client to avoid which beverage?

• Apple juice
• Grape juice
• Grapefruit juice
• Prune juice

The nurse is reviewing the history of a client who has been prescribed topiramate (Topamax) for prevention of migraines. The nurse plans to contact the primary care provider (PCP) if the client has which condition?

• Bipolar disorder
• Diabetes mellitus
• Glaucoma
• Hypothyroidism

A client is being discharged to home with progressing stage I Alzheimer's disease. The family expresses concern to the nurse about caring for their parent. What is the priority for best continuity of care?

• Assigning a case manager
• Ensuring that all family questions are answered before discharge
• Providing a safe environment
• Referring the family to the Alzheimer's Association

A client with early-stage Alzheimer's disease is admitted to the surgical unit for a biopsy. Which client problem is the priority?

• Potential for injury related to chronic confusion and physical deficits
• Risk for reduced mobility related to progression of disability
• Potential for skin breakdown related to immobility and/or impaired nutritional status
• Lack of social contact related to personality and behavior changes
• The nurse assesses an older adult with a diagnosis of severe, late-stage Alzheimer’s disease.

Which assessment findings would the nurse expect for this client? (Select all that apply.)

• Acute confusion
• Hallucinations
• Wandering
• Urinary incontinence