Advanced Concepts Quiz Three Review

The nurse is assisting with the care of a patient after a traumatic brain injury. The patient experiences a seizure and exhibits bilateral jerking of the extremities. Which type of seizure activity does the nurse recognize?

• Partial

• Chronic

• Tonic-clonic

• Petit mal

The nurse is hired by a family to provide care for a family member diagnosed with Alzheimer disease. Which action related to safety is most important for the nurse to implement?

• Help the patient make lists for tasks to be completed.

• Make sure that all doors are locked where potential risk exists.

• Monitor for signs or behaviors related to the patient's physical needs.

• Regenerate interest in activities, acquaintances, or surroundings.

The nurse is planning care for a patient with a migraine headache. Which actions does the nurse include in this plan of care? SELECT ALL THAT APPLY

• Provide a dark, quiet environment.

• Administer sumitriptan (Imitrex) as prescribed.

• Encourage rest

• Offer caffeinated beverages.

The nurse is providing care for a patient who was diagnosed with Parkinson disease 12 years prior. Which symptoms places the patient at the greatest risk for a fall?

• Increased cognition

• Dysphagia

• Shuffling gait

• Resting tremors

A patient comes into the emergency department with symptoms of a stroke that began 2 hours ago. Diagnostic testing confirms an ischemic stroke is present. What medications should the nurse anticipate will be delivered?

• Heparin

• Clopidogrel

• Warfarin

• Tissue-type plasminogen activator (tPA)

The nurse is involved in a BP clinic in the community, and an individual with possible stroke symptoms is brought for evaluation. Which findings in the FAST (face, arms, speech, and time) assessment indicate the need to call emergency personnel? SELECT ALL THAT APPLY

• The patient sways when asked to stand still with eyes closed.

• The patient is unable to follow directions during the assessment.

• The patient is unable to repeat a stated phrase exactly as it was stated.

• The patient's face shows signs of uneven symmetry when asked to smile.

• When asked to close the eyes and hold arms straight in front, one arm drifts downward.

The nurse is preparing to assist a patient with eating who is recovering from a stroke. What action should the nurse take?

• Have the patient sip liquids in small amounts with a straw.

• Place the patient in a semi-Fowler position to promote swallowing.

• Check the patient's mouth periodically for presence of pocketed food.

• Feed patient rapidly.

A mother of two young children has a 1-year history of MS and recently stopped helping in the children's classrooms because of fatigue and weakness. What advice should the nurse give to help the patient best cope with the problem?

• You need to realize that you may not be able to do the things you used to do.

• You may plan to be there for shorter visits so you can rest.

• Get plenty of sleep the night before you help give you the stamina you need.

• Take your medication after you finish helping and you may have a better energy level.

The nurse is caring for a patient experiencing an acute exacerbation of multiple sclerosis (MS). Which pathophysiological change leads to the symptoms of MS?

• Myelin buildup in the central nervous system

• Demyelination and destruction of nerve fibers

• Gamma aminobutyric acid (GABA) deficiency

• Reduced acetylcholine receptors with impaired nerve impulse transmission

The nurse is assisting with the care of a patient admitted following a fall resulting in a head injury. Which finding is a change in level of consciousness and should be reported to the RN?

• Verbal commands are completed as stated.

• The patient arouses quickly from a state of drowsiness.

• The patient falls asleep in the middle of a sentence.

• The patient withdraws from mild pain stimulation