adult health 2 hesi (3 sets)
A female patient's complex
symptomatology over the past year has
culminated in a diagnosis of systemic
lupus erythematosus (SLE). Which of
the patient's following statements
demonstrates the need for further
teaching about the disease?
A. "I'll try my best to stay out of the sun
this summer."
B. "I know that I probably have a high
chance of getting arthritis."
C. "I'm hoping that surgery will be an
option for me in the future."
D. "I understand that I'm going to be
vulnerable to getting infections." - c.
SLE carries an increased risk of
infection, sun damage, and arthritis.
Surgery is not a key treatment modality
for SLE.
,Midazolam (Versed) has been ordered
for a patient to be administered by
injection 30 minutes prior to a
colonoscopy. The nurse informs the
patient that one of the most common
side effects of this medication is which
effect?
A. Decreased heart rate
B. Amnesia
C. Constipation
D. Dry mouth - b. Versed is known to
cause amnesia and anxiolysis as well as
sedation and is therefore commonly
used prior to certain procedures.
The nurse is caring for a patient
admitted with a spinal cord injury
following a motor vehicle accident. The
patient exhibits a complete loss of
motor, sensory, and reflex activity below
,the injury level. The nurse recognizes
this condition as which of the following?
A. Central cord syndrome
B. Spinal shock syndrome
C. Anterior cord syndrome
D. Brown-Séquard syndrome - b. About
50% of people with acute spinal cord
injury experience a temporary loss of
reflexes, sensation, and motor activity
that is known as spinal shock. Central
cord syndrome is manifested by motor
and sensory loss greater in the upper
extremities than the lower extremities.
Anterior cord syndrome results in motor
and sensory loss but not reflexes.
Brown-Séquard syndrome is
characterized by ipsilateral loss of motor
function and contralateral loss of
sensory function.
Which of the following clinical
manifestations would the nurse interpret
, as representing neurogenic shock in a
patient with acute spinal cord injury?
A. Bradycardia
B. Hypertension
C. Neurogenic spasticity
D. Bounding pedal pulses - a.
Neurogenic shock is due to the loss of
vasomotor tone caused by injury and is
characterized by hypotension and
bradycardia. Loss of sympathetic
innervation causes peripheral
vasodilation, venous pooling, and a
decreased cardiac output.
The nurse is caring for a patient
admitted 1 week ago with an acute
spinal cord injury. Which of the following
assessment findings would alert the
nurse to the presence of autonomic
dysreflexia?
A. Tachycardia
A female patient's complex
symptomatology over the past year has
culminated in a diagnosis of systemic
lupus erythematosus (SLE). Which of
the patient's following statements
demonstrates the need for further
teaching about the disease?
A. "I'll try my best to stay out of the sun
this summer."
B. "I know that I probably have a high
chance of getting arthritis."
C. "I'm hoping that surgery will be an
option for me in the future."
D. "I understand that I'm going to be
vulnerable to getting infections." - c.
SLE carries an increased risk of
infection, sun damage, and arthritis.
Surgery is not a key treatment modality
for SLE.
,Midazolam (Versed) has been ordered
for a patient to be administered by
injection 30 minutes prior to a
colonoscopy. The nurse informs the
patient that one of the most common
side effects of this medication is which
effect?
A. Decreased heart rate
B. Amnesia
C. Constipation
D. Dry mouth - b. Versed is known to
cause amnesia and anxiolysis as well as
sedation and is therefore commonly
used prior to certain procedures.
The nurse is caring for a patient
admitted with a spinal cord injury
following a motor vehicle accident. The
patient exhibits a complete loss of
motor, sensory, and reflex activity below
,the injury level. The nurse recognizes
this condition as which of the following?
A. Central cord syndrome
B. Spinal shock syndrome
C. Anterior cord syndrome
D. Brown-Séquard syndrome - b. About
50% of people with acute spinal cord
injury experience a temporary loss of
reflexes, sensation, and motor activity
that is known as spinal shock. Central
cord syndrome is manifested by motor
and sensory loss greater in the upper
extremities than the lower extremities.
Anterior cord syndrome results in motor
and sensory loss but not reflexes.
Brown-Séquard syndrome is
characterized by ipsilateral loss of motor
function and contralateral loss of
sensory function.
Which of the following clinical
manifestations would the nurse interpret
, as representing neurogenic shock in a
patient with acute spinal cord injury?
A. Bradycardia
B. Hypertension
C. Neurogenic spasticity
D. Bounding pedal pulses - a.
Neurogenic shock is due to the loss of
vasomotor tone caused by injury and is
characterized by hypotension and
bradycardia. Loss of sympathetic
innervation causes peripheral
vasodilation, venous pooling, and a
decreased cardiac output.
The nurse is caring for a patient
admitted 1 week ago with an acute
spinal cord injury. Which of the following
assessment findings would alert the
nurse to the presence of autonomic
dysreflexia?
A. Tachycardia
