PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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Exam 3 PN 2 Ch. 64, 46-48, 41-44
A nurse witnesses a client with late-stage Alzheimers disease eat breakfast.
Afterward the client states, I am hungry and want breakfast. How should the
nurse respond?
a. I see you are still hungry. I will get you some toast.
b. You ate your breakfast 30 minutes ago.
c. It appears you are confused this morning.
d. Your family will be here soon. Lets get you
dressed. ANS: A
Use of validation therapy with clients who have Alzheimers disease
involves acknowledgment of the clients feelings and concerns. This
technique has proved more effective in later stages of the disease, when
using reality orientation only increases agitation. Telling the client that he
or she already ate breakfast may agitate the client. The other statements
do not validate the clients concerns.
A nurse cares for a client with advanced Alzheimers disease. The clients
caregiver states, She is always wandering off. What can I do to manage
this restless behavior? How should the nurse respond?
a. This is a sign of fatigue. The client would benefit from a daily nap.
b. Engage the client in scheduled activities throughout the day.
c. It sounds like this is difficult for you. I will consult the social worker.
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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d. The provider can prescribe a mild sedative for
restlessness. ANS: B
Several strategies may be used to cope with restlessness and wandering.
One strategy is to engage the client in structured activities. Another is to
take the client for frequent walks. Daily naps and a mild sedative will not
be as effective in the management of restless behavior. Consulting the
social worker does not address the caregivers concern.
A nurse prepares to discharge a client with Alzheimers disease. Which
statement should the nurse include in the discharge teaching for this
clients caregiver?
a. Allow the client to rest most of the day.
b. Place a padded throw rug at the bedside.
c. Install deadbolt locks on all outside doors.
d. Provide a high-calorie and high-protein
diet. ANS: C
How do you treat lower back pain?
A nurse promotes the prevention of lower back pain by teaching clients at a
community center. Which instruction should the nurse include in this
education?
a. Participate in an exercise program to strengthen muscles.
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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,PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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b. Purchase a mattress that allows you to adjust the firmness.
c. Wear flat instead of high-heeled shoes to work each day.
d. Keep your weight within 20% of your ideal body
weight. ANS: A
Exercise can strengthen back muscles, reducing the incidence of low back
pain. The other options will not prevent low back pain.
A nurse plans care for a client with lower back pain from a work-related injury.
Which intervention should the nurse include in this clients plan of care?
e. Encourage the client to stretch the back by reaching toward the toes.
f. Massage the affected area with ice twice a day.
g. Apply a heating pad for 20 minutes at least four times daily.
h. Advise the client to avoid warm baths or
showers. ANS: C
Heat increases blood flow to the affected area and promotes healing of
injured nerves. Stretching and ice will not promote healing, and there is
no need to avoid warm baths or showers.
A nurse assesses clients at a community center. Which client is at greatest
risk for lower back pain?
a. A 24-year-old female who is 25 weeks pregnant
b. A 36-year-old male who uses ergonomic techniques
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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c. A 45-year-old male with osteoarthritis
d. A 53-year-old female who uses a
walker ANS: C
Osteoarthritis causes changes to support structures, increasing the
clients risk for low back pain. The other clients are not at high risk.
What happens with spinal cord injuries at level T5? Clinical manifestations?
A nurse assesses a client with a spinal cord injury at level T5. The clients
blood pressure is 184/95 mm Hg, and the client presents with a flushed
face and blurred vision. Which action should the nurse take first?
a. Initiate oxygen via a nasal cannula.
b. Place the client in a supine position.
c. Palpate the bladder for distention.
d. Administer a prescribed beta
blocker. ANS: C
The client is manifesting symptoms of autonomic dysreflexia. Common
causes include bladder distention, tight clothing, increased room
temperature, and fecal impaction. If persistent, the client could
experience neurologic injury.
Precipitating conditions should be eliminated and the physician notified.
The other actions would not be appropriate.
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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Exam 3 PN 2 Ch. 64, 46-48, 41-44
A nurse witnesses a client with late-stage Alzheimers disease eat breakfast.
Afterward the client states, I am hungry and want breakfast. How should the
nurse respond?
a. I see you are still hungry. I will get you some toast.
b. You ate your breakfast 30 minutes ago.
c. It appears you are confused this morning.
d. Your family will be here soon. Lets get you
dressed. ANS: A
Use of validation therapy with clients who have Alzheimers disease
involves acknowledgment of the clients feelings and concerns. This
technique has proved more effective in later stages of the disease, when
using reality orientation only increases agitation. Telling the client that he
or she already ate breakfast may agitate the client. The other statements
do not validate the clients concerns.
A nurse cares for a client with advanced Alzheimers disease. The clients
caregiver states, She is always wandering off. What can I do to manage
this restless behavior? How should the nurse respond?
a. This is a sign of fatigue. The client would benefit from a daily nap.
b. Engage the client in scheduled activities throughout the day.
c. It sounds like this is difficult for you. I will consult the social worker.
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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,PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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d. The provider can prescribe a mild sedative for
restlessness. ANS: B
Several strategies may be used to cope with restlessness and wandering.
One strategy is to engage the client in structured activities. Another is to
take the client for frequent walks. Daily naps and a mild sedative will not
be as effective in the management of restless behavior. Consulting the
social worker does not address the caregivers concern.
A nurse prepares to discharge a client with Alzheimers disease. Which
statement should the nurse include in the discharge teaching for this
clients caregiver?
a. Allow the client to rest most of the day.
b. Place a padded throw rug at the bedside.
c. Install deadbolt locks on all outside doors.
d. Provide a high-calorie and high-protein
diet. ANS: C
How do you treat lower back pain?
A nurse promotes the prevention of lower back pain by teaching clients at a
community center. Which instruction should the nurse include in this
education?
a. Participate in an exercise program to strengthen muscles.
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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,PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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b. Purchase a mattress that allows you to adjust the firmness.
c. Wear flat instead of high-heeled shoes to work each day.
d. Keep your weight within 20% of your ideal body
weight. ANS: A
Exercise can strengthen back muscles, reducing the incidence of low back
pain. The other options will not prevent low back pain.
A nurse plans care for a client with lower back pain from a work-related injury.
Which intervention should the nurse include in this clients plan of care?
e. Encourage the client to stretch the back by reaching toward the toes.
f. Massage the affected area with ice twice a day.
g. Apply a heating pad for 20 minutes at least four times daily.
h. Advise the client to avoid warm baths or
showers. ANS: C
Heat increases blood flow to the affected area and promotes healing of
injured nerves. Stretching and ice will not promote healing, and there is
no need to avoid warm baths or showers.
A nurse assesses clients at a community center. Which client is at greatest
risk for lower back pain?
a. A 24-year-old female who is 25 weeks pregnant
b. A 36-year-old male who uses ergonomic techniques
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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c. A 45-year-old male with osteoarthritis
d. A 53-year-old female who uses a
walker ANS: C
Osteoarthritis causes changes to support structures, increasing the
clients risk for low back pain. The other clients are not at high risk.
What happens with spinal cord injuries at level T5? Clinical manifestations?
A nurse assesses a client with a spinal cord injury at level T5. The clients
blood pressure is 184/95 mm Hg, and the client presents with a flushed
face and blurred vision. Which action should the nurse take first?
a. Initiate oxygen via a nasal cannula.
b. Place the client in a supine position.
c. Palpate the bladder for distention.
d. Administer a prescribed beta
blocker. ANS: C
The client is manifesting symptoms of autonomic dysreflexia. Common
causes include bladder distention, tight clothing, increased room
temperature, and fecal impaction. If persistent, the client could
experience neurologic injury.
Precipitating conditions should be eliminated and the physician notified.
The other actions would not be appropriate.
PN 2 EXAM 3 (Ch. 64, Ch. 46-46, 41-48) Questions And Answers
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