1. The nurse determines that teaching about management of migraine headaches has been effective when the patient says which of the following? a . I can take the (Topamax) as soon as a headache starts. b . A glass of wine might help me relax and prevent a headache. c . I will lie down someplace dark and quiet when the headaches begin. d . I should avoid taking aspirin and sumatriptan (Imitrex) at the same tim ANS: C 2. The nurse will assess a 67-year-old patient who is experiencing a cluster headache for a . nuchal rigidity. b . unilateral ptosis. c . projectile vomiting. d . throbbing, bilateral facial pain. ANS: B 3. While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic- clonic seizure. Which action should the nurse take? a . Insert an oral airway during the seizure to maintain a patent airway. b . Restrain the patients arms and legs to prevent injury during the seizur c . Time and observe and record the details of the seizure and postictal st d . Avoid touching the patient to prevent further nervous system stimulat ANS: C 4. A high school teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, I cannot teach anymore, it will be too upsetting if I have a seizure at work. Which response by the nurse is best? a . You might benefit from some psychologic counseling. b . Epilepsy usually can be well controlled with medications. c . You will want to contact the Epilepsy Foundation for assistance. d . The Department of Vocational Rehabilitation can help with work retrai ANS: B 5. A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication? a . Inspect the oral mucosa. b . Listen to the lung sounds. c . Auscultate the bowel tones. d . Check pupil reaction to light. ANS: A 6. A patient reports feeling numbness and tingling of the left arm before experiencing a tonic-clonic seizure. The nurse determines that this history is consistent with what type of seizure? a . Focal b . Atonic c . Absence d Myoclonic . ANS: A 7. When obtaining a health history and physical assessment for a 36-year-old female patient with possible multiple sclerosis (MS), the nurse should a . assess for the presence of chest pain. b . inquire about urinary tract problems. c . inspect the skin for rashes or discoloration. d . ask the patient about any increase in libido. ANS: B 8. A 31-year-old woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a . MS symptoms may be worse after the pregnancy. b . Women with MS frequently have premature labor. c . MS is associated with an increased risk for congenital defects. d . Symptoms of MS are likely to become worse during pregnancy. ANS: A Maintenance 9. A 49-year-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a . Recommendation to drink at least 4 L of fluid daily b . Need to avoid driving or operating heavy machinery c . How to draw up and administer injections of the medication d . Use of contraceptive methods other than oral contraceptives ANS: C 10. Which information about a 60-year-old patient with MS indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a . The patient has relapsing-remitting MS. b . The patient walks a mile a day for exercise. c . The patient complains of pain with neck flexion. d . The patient has an increased serum creatinine level. ANS: D 11. Which action will the nurse plan to take for a 40-year-old patient with multiple sclerosis (MS) who has urinary retention caused by a flaccid bladder? a . Decrease the patients evening fluid intake. b . Teach the patient how to use the Cred method. c . Suggest the use of adult incontinence briefs for nighttime only. d . Assist the patient to the commode every 2 hours during the day. ANS: B 12. A 73-year-old patient with Parkinsons disease has a nursing diagnosis of impaired physical mobility related to bradykinesia. Which action will the nurse include in the plan of care? a . Instruct the patient in activities that can be done while lying or sitting. b . Suggest that the patient rock from side to side to initiate leg moveme c Have the patient take small steps in a straight line directly in front of t . feet. d Teach the patient to keep the feet in contact with the floor and slide th . forward. ANS: B 13. A 62-year-old patient who has Parkinsons disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dose? a . The patient has a chronic dry cough. b . The patient has four loose stools in a day. c . The patient develops a deep vein thrombosis. d . The patients blood pressure is 92/52 mm Hg. ANS: D 14. The nurse advises a patient with myasthenia gravis (MG) to a . perform physically demanding activities early in the day. b . anticipate the need for weekly plasmapheresis treatments. c . do frequent weight-bearing exercise to prevent muscle atrophy. d . protect the extremities from injury due to poor sensory perception. ANS: A 15. Which medication taken by a patient with restless legs syndrome should the nurse discuss with the patient? a . Multivitamin (Stresstabs) b . Acetaminophen (Tylenol) c . Ibuprofen (Motrin, Advil) d . Diphenhydramine (Benadryl) ANS: D 16. A 64-year-old patient who has amyotrophic lateral sclerosis (ALS) is hospitalized with pneumonia. Which nursing action will be included in the plan of care? a . Assist with active range of motion (ROM). b . Observe for agitation and paranoia. c . Give muscle relaxants as needed to reduce spasms. d . Use simple words and phrases to explain procedures. ANS: A 17. A 40-year-old patient is diagnosed with early Huntingtons disease (HD). When teaching the patient, spouse, and children about this disorder, the nurse will provide information about the a . use of levodopa-carbidopa (Sinemet) to help reduce HD symptoms. b . prophylactic antibiotics to decrease the risk for aspiration pneumonia. c option of genetic testing for the patients children to determine their o . HD risks. d lifestyle changes of improved nutrition and exercise that delay disease . progression. ANS: C 18. When a 74-year-old patient is seen in the health clinic with new development of a stooped posture, shuffling gait, and pill rollingtype tremor, the nurse will anticipate teaching the patient about a . oral corticosteroids. b . antiparkinsonian drugs. c . magnetic resonance imaging (MRI). d . electroencephalogram (EEG) testing. ANS: B 19. A 22-year-old patient seen at the health clinic with a severe migraine headache tells the nurse about having other similar headaches recently. Which initial action should the nurse take? a . Teach about the use of triptan drugs. b . Refer the patient for stress counseling. c . Ask the patient to keep a headache diary. d . Suggest the use of muscle-relaxation techniques. ANS: C 20. A hospitalized patient complains of a bilateral headache, 4/10 on the pain scale, that radiates from the base of the skull. Which prescribed PRN medications should the nurse administer initially? a . Lorazepam (Ativan) b . Acetaminophen (Tylenol) c . Morphine sulfate (Roxanol) d . Butalbital and aspirin (Fiorinal) ANS: B 21. A 46-year-old patient tells the nurse about using acetaminophen (Tylenol) several times every day for recurrent bilateral headaches. Which action will the nurse plan to take first? a . Discuss the need to stop taking the acetaminophen. b Suggest the use of biofeedback for headache control. . c . Describe the use of botulism toxin (Botox) for headaches. d . Teach the patient about magnetic resonance imaging (MRI). ANS: A 22. The health care provider is considering the use of sumatriptan (Imitrex) for a 54-year-old male patient with migraine headaches. Which information obtained by the nurse is most important to report to the health care provider? a . The patient drinks 1 to 2 cups of coffee daily. b . The patient had a recent acute myocardial infarction. c . The patient has had migraine headaches for 30 years. d . The patient has taken topiramate (Topamax) for 2 months. ANS: B 23. The nurse observes a patient ambulating in the hospital hall when the patients arms and legs suddenly jerk and the patient falls to the floor. The nurse will first a . assess the patient for a possible head injury. b . give the scheduled dose of divalproex (Depakote). c . document the timing and description of the seizure. d . notify the patients health care provider about the seizure. ANS: A 24. Which prescribed intervention will the nurse implement first for a patient in the emergency department who is experiencing continuous tonic-clonic seizures? a . Give phenytoin (Dilantin) 100 mg IV. b . Monitor level of consciousness (LOC). c . Obtain computed tomography (CT) scan. d . Administer lorazepam (Ativan) 4 mg IV. ANS: D 25. The home health registered nurse (RN) is planning care for a patient with a seizure disorder related to a recent head injury. Which nursing action can be delegated to a licensed practical/vocational nurse (LPN/LVN)? a . Make referrals to appropriate community agencies. b . Place medications in the home medication organizer. c . Teach the patient and family how to manage seizures. d . Assess for use of medications that may precipitate seizures. ANS: B 26. A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinsons disease. Which information is most important for the nurse to report to the health care provider? a . Shuffling gait b . Tremor at rest c . Cogwheel rigidity of limbs d . Uncontrolled head movement ANS: D 27. Which nursing diagnosis is of highest priority for a patient with Parkinsons disease who is unable to move the facial muscles? . Activity intolerance b . Self-care deficit: toileting c . Ineffective self-health management d . Imbalanced nutrition: less than body requirements ANS: D 28. Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a . Pupil size b . Grip strength c . Respiratory effort d . Level of consciousness ANS: C 29. Following a thymectomy, a 62-year-old male patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a . Auscultate the patients bowel sounds. b . Notify the patients health care provider. c . Administer the prescribed PRN antiemetic drug. d . Give the scheduled dose of prednisone (Deltasone). ANS: B 30. A hospitalized 31-year-old patient with a history of cluster headache awakens during the night with a severe stabbing headache. Which action should the nurse take first? a . Start the ordered PRN oxygen at 6 L/min. b . Put a moist hot pack on the patients neck. c . Give the ordered PRN acetaminophen (Tylenol). d . Notify the patients health care provider immediately. ANS: A 31. Which intervention will the nurse include in the plan of care for a patient with primary restless legs syndrome (RLS) who is having difficulty sleeping? a . Teach about the use of antihistamines to improve sleep. b . Suggest that the patient exercise regularly during the day. c . Make a referral to a massage therapist for deep massage of the legs. d . Assure the patient that the problem is transient and likely to resolve. ANS: B 32. Which information about a 72-year-old patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication? a . Patient has generalized tonic-clonic seizures. b . Patient experiences an aura before seizures. c . Patients most recent blood pressure is 156/92 mm Hg. d . Patient has minor elevations in the liver function tests. ANS: D 33. After change-of-shift report, which patient should the nurse assess first? a . Patient with myasthenia gravis who is reporting increased muscle wea b . Patient with a bilateral headache described as like a band around my c Patient with seizures who is scheduled to receive a dose of phenytoin . (Dilantin) d Patient with Parkinsons disease who has developed cogwheel rigidity o . arms ANS: A MULTIPLE RESPONSE 1. A 27-year-old patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patients assigned room (select all that apply)? a . Side-rail pads b . Tongue blade c . Oxygen mask d . Suction tubing e . Urinary catheter f. Nasogastric tube ANS: A, C, D 2. A patient with Parkinsons disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the plan of care (select all that apply)? a . Use an elevated toilet seat. b . Cut patients food into small pieces. c . Provide high-protein foods at each meal. d . Place an armchair at the patients bedside. e . Observe for sudden exacerbation of symptoms. ANS: A, B, D Chapter 44: Liver, Pancreas, and Biliary Tract: LEWIS MULTIPLE CHOICE 1. A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric) phase of the patients illness, the nurse would expect serologic testing to reveal a . antibody to hepatitis D (anti-HDV). b . hepatitis B surface antigen (HBsAg). c . anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d . anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). ANS: D 2. Administration of hepatitis B vaccine to a healthy 18-year-old patient has been effective when a specimen of the patients blood reveals a . HBsAg. b . anti-HBs. c . anti-HBc IgG. d . anti-HBc IgM. ANS: B 3. A 36-year-old male patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a . Schedule the patient for HCV genotype testing. b . Administer the HCV vaccine and immune globulin. c . Teach the patient about ribavirin (Rebetol) treatment. d . Explain that the infection will resolve over a few months. ANS: A 4. The nurse will plan to teach the patient diagnosed with acute hepatitis B about a . side effects of nucleotide analogs. b . measures for improving the appetite. c . ways to increase activity and exercise. d . administering a-interferon (Intron A). ANS: B 5. The nurse administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for a . leukopenia. b . hypokalemia. c . polycythemia. d . hypoglycemia. ANS: A 6. Which information given by a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a . The patient had a blood transfusion in 2005. b . The patient used IV drugs about 20 years ago. c . The patient frequently eats in fast-food restaurants. d . The patient traveled to a country with poor sanitation. ANS: B 7. A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate? a . Is there any history of IV drug use? b . Do you use any over-the-counter drugs? c . Are you taking corticosteroids for any reason? d . Have you recently traveled to a foreign country? ANS: B 8. Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a . Hemoglobin b . Temperature c . Activity level d . Albumin level ANS: D 9. Which topic is most important to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis? a . Maintaining good nutrition b . Avoiding alcohol ingestion c . Taking lactulose (Cephulac) d . Using vitamin B supplements ANS: B 10. A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix). due. Which action should the nurse take? a . Administer both drugs. b . Administer the spironolactone. c . Withhold the spironolactone and administer the furosemide. d . Withhold both drugs until discussed with the health care provider. ANS: B 11. Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a . Request that the patient stand on one foot. b . Ask the patient to extend both arms forward. c . Request that the patient walk with eyes closed. d . Ask the patient to perform the Valsalva maneuver. ANS: B 12. Which finding indicates to the nurse that lactulose (Cephulac) is effective for a 72-year-old man who has advanced cirrhosis? a . The patient is alert and oriented. b . The patient denies nausea or anorexia. c . The patients bilirubin level decreases. d . The patient has at least one stool daily. ANS: A 13. A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a . Instruct the patient to cough every hour. b . Monitor the patient for shortness of breath. c . Verify the position of the balloon every 4 hours. d . Deflate the gastric balloon if the patient reports nausea. ANS: B…… TO BE CONTINUED
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