Principles Medsurg2 Jersey College
Questions with Complete Solutions
(Latest 2025)
A client has muscle rigidity with passive range of motion, a tremor that is
present at rest and absent while feeding himself, and has slow motor
movements. These clinical manifestations are consistent with which
disorder? - Correct Answers✅Parkinson's Disease
A nurse is caring for a client with Parkinson's disease who takes levodopa
routinely. He has a temperature of 103 degrees Fahrenheit, increased muscle
rigidity, and a decreased level of consciousness. Which of the following is
true? These clinical manifestations are consistent with - Correct
Answers✅NMS
A client is admitted for a complaint of lower extremities weakness which has
progressively gotten worse over the last 2 months. When assessing the client
the nurse observes lower extremity muscle wasting and 4+ patellar reflexes
bilaterally. These clinical manifestations are consistent with which disorder? -
Correct Answers✅ALS
A male client with a history of prostate cancer is admitted for severe,
uncontrolled pain in his lumbar back. He denies any recent injury but doesn't
want to get out of bed. When reporting these findings to the primary care
provider, the nurse would emphasize which finding? - Correct Answers✅hx
of prostate cancer
A nurse is preparing to complete the discharge teaching for a client with a
spinal cord injury. Which of the following clinical manifestations should the
nurse educate the client about when discussing reasons to seek emergent
medical care? - Correct Answers✅Headache and profuse facial diaphoresis
A nurse is caring for a client with an acute spinal cord injury. The unlicensed
assistive personnel reports that the client is unresponsive. Which of the
following clinical manifestations suggests that the client is experiencing
neurogenic shock? - Correct Answers✅Heart rate of 50, blood pressure of
80/40 mmHg and a low cardiac output
,Principles Medsurg2 Jersey College
Questions with Complete Solutions
(Latest 2025)
Which of the following nursing interventions is appropriate for the nurse to
implement to prevent complications related to immobility in an unconscious
client? - Correct Answers✅remove and apply foot splints q2h
The nurse is caring for a client with bronchogenic carcinoma. The client
develops syndrome of inappropriate antidiuretic hormone (SIADH). Which of
the following assessment findings is consistent with this condition? Select all
that apply. - Correct Answers✅1. Crackles and wheezes
2. Sodium 120 mg/dL
3. Excessive weight gain
A 79 year old female client with nausea and vomiting has a temperature of
99.5 degrees fahrenheit. Which of the following is the most likely cause of
the client's abnormal temperature? - Correct Answers✅dehydration
The nurse is caring for a client who has a hyperreflexic bladder. Which of the
following assessment findings suggest that treatment with an antispasmodic
was effective? - Correct Answers✅pt voids q4-6h
The nurse is caring for a pregnant client with active genital herpes simplex 2
infection. During the delivery process the neonate is at the greatest risk for
developing which of the following disorders? - Correct Answers✅encephalitis
An otherwise healthy client with a severe closed head injury is brought to the
emergency department. Assessment findings reveal that the client is brain
dead. The nurse understands that brain death means which of the following?
- Correct Answers✅The client requires ventilatory support
,Principles Medsurg2 Jersey College
Questions with Complete Solutions
(Latest 2025)
A client is brought to the emergency department by ambulance and is
unconscious. The nurse understands that the level of consciousness can
change for all of the following reasons except? - Correct
Answers✅immobility
A client with a history of alcohol abuse is admitted for alcohol withdrawal.
The nurse should observe the client closely for which of the following
complications? - Correct Answers✅seizure activity
When caring for a client with increased intracranial pressure, the nurse
knows that which of the following is true? - Correct Answers✅Cerebral spinal
fluid production is decreased to help compensate for the increased volume.
When caring for a client who has an acute deep vein thrombosis of the right
leg and is being treated with heparin, the nurse avoids performing which of
the following actions? - Correct Answers✅Massaging the lower extremities
The nurse is caring for a client on a mechanical ventilator. The client is
receiving continuous feeding via a gastrostomy tube. Which of the following
actions should the nurse take to prevent complications? Select all that apply.
- Correct Answers✅1. Keep the head of the bed elevated at 30 degrees
2. Maintain the cuff pressure at 15 mmH
An unconscious client with a closed head injury has a dilated left pupil that is
slow to respond to light. Which of the following abnormalities best explain
the client's clinical manifestations? - Correct Answers✅Oculomotor nerve
compression
A client was recently admitted to the emergency department after falling
down a flight of stairs. The client is complaining of nausea along with a
headache and requests pain medication. The nurse observes that the client
, Principles Medsurg2 Jersey College
Questions with Complete Solutions
(Latest 2025)
is restless. Which of the following actions by the nurse is a priority? - Correct
Answers✅Check the client's visual acuity
A nurse is caring for a client with a closed head injury. The client has become
increasingly lethargic, complains of a headache, and clears his throat
spontaneously. His BP is 120/70, pulse is 80, respirations are 18 and his
oxygen saturation is 98%. Which of the following nursing diagnoses is
appropriate? - Correct Answers✅Ineffective cerebral tissue perfusion related
to increased intracranial pressure.
Clients with a closed head injury, a subdural hematoma, an epidural
hematoma or a subarachnoid hemorrhage are at an increased risk for which
of the following complications? - Correct Answers✅respiratory failure
A client with a brain tumor is receiving dexamethasone (decadron). The
nurse should monitor the client for which of the following clinical
manifestations? - Correct Answers✅edema
A client who recently had a kidney transplant is inquiring about having the
nasal influenza vaccination for the upcoming flu season. Which response by
the nurse is most appropriate? - Correct Answers✅'Because of your recent
transplant, I would consult your physician about the flu vaccination.'
A nurse is caring for an unconscious client who extends his elbows, pronates
his arms, flexes his wrists and points his toes. Which of the following is true?
- Correct Answers✅This is a sign of severe neurologic damage.
When caring for a client who sustained a lower motor neuron injury and is
paralyzed from the waist down, the nurse anticipates which of the following
findings? - Correct Answers✅Flaccid paralysis
Questions with Complete Solutions
(Latest 2025)
A client has muscle rigidity with passive range of motion, a tremor that is
present at rest and absent while feeding himself, and has slow motor
movements. These clinical manifestations are consistent with which
disorder? - Correct Answers✅Parkinson's Disease
A nurse is caring for a client with Parkinson's disease who takes levodopa
routinely. He has a temperature of 103 degrees Fahrenheit, increased muscle
rigidity, and a decreased level of consciousness. Which of the following is
true? These clinical manifestations are consistent with - Correct
Answers✅NMS
A client is admitted for a complaint of lower extremities weakness which has
progressively gotten worse over the last 2 months. When assessing the client
the nurse observes lower extremity muscle wasting and 4+ patellar reflexes
bilaterally. These clinical manifestations are consistent with which disorder? -
Correct Answers✅ALS
A male client with a history of prostate cancer is admitted for severe,
uncontrolled pain in his lumbar back. He denies any recent injury but doesn't
want to get out of bed. When reporting these findings to the primary care
provider, the nurse would emphasize which finding? - Correct Answers✅hx
of prostate cancer
A nurse is preparing to complete the discharge teaching for a client with a
spinal cord injury. Which of the following clinical manifestations should the
nurse educate the client about when discussing reasons to seek emergent
medical care? - Correct Answers✅Headache and profuse facial diaphoresis
A nurse is caring for a client with an acute spinal cord injury. The unlicensed
assistive personnel reports that the client is unresponsive. Which of the
following clinical manifestations suggests that the client is experiencing
neurogenic shock? - Correct Answers✅Heart rate of 50, blood pressure of
80/40 mmHg and a low cardiac output
,Principles Medsurg2 Jersey College
Questions with Complete Solutions
(Latest 2025)
Which of the following nursing interventions is appropriate for the nurse to
implement to prevent complications related to immobility in an unconscious
client? - Correct Answers✅remove and apply foot splints q2h
The nurse is caring for a client with bronchogenic carcinoma. The client
develops syndrome of inappropriate antidiuretic hormone (SIADH). Which of
the following assessment findings is consistent with this condition? Select all
that apply. - Correct Answers✅1. Crackles and wheezes
2. Sodium 120 mg/dL
3. Excessive weight gain
A 79 year old female client with nausea and vomiting has a temperature of
99.5 degrees fahrenheit. Which of the following is the most likely cause of
the client's abnormal temperature? - Correct Answers✅dehydration
The nurse is caring for a client who has a hyperreflexic bladder. Which of the
following assessment findings suggest that treatment with an antispasmodic
was effective? - Correct Answers✅pt voids q4-6h
The nurse is caring for a pregnant client with active genital herpes simplex 2
infection. During the delivery process the neonate is at the greatest risk for
developing which of the following disorders? - Correct Answers✅encephalitis
An otherwise healthy client with a severe closed head injury is brought to the
emergency department. Assessment findings reveal that the client is brain
dead. The nurse understands that brain death means which of the following?
- Correct Answers✅The client requires ventilatory support
,Principles Medsurg2 Jersey College
Questions with Complete Solutions
(Latest 2025)
A client is brought to the emergency department by ambulance and is
unconscious. The nurse understands that the level of consciousness can
change for all of the following reasons except? - Correct
Answers✅immobility
A client with a history of alcohol abuse is admitted for alcohol withdrawal.
The nurse should observe the client closely for which of the following
complications? - Correct Answers✅seizure activity
When caring for a client with increased intracranial pressure, the nurse
knows that which of the following is true? - Correct Answers✅Cerebral spinal
fluid production is decreased to help compensate for the increased volume.
When caring for a client who has an acute deep vein thrombosis of the right
leg and is being treated with heparin, the nurse avoids performing which of
the following actions? - Correct Answers✅Massaging the lower extremities
The nurse is caring for a client on a mechanical ventilator. The client is
receiving continuous feeding via a gastrostomy tube. Which of the following
actions should the nurse take to prevent complications? Select all that apply.
- Correct Answers✅1. Keep the head of the bed elevated at 30 degrees
2. Maintain the cuff pressure at 15 mmH
An unconscious client with a closed head injury has a dilated left pupil that is
slow to respond to light. Which of the following abnormalities best explain
the client's clinical manifestations? - Correct Answers✅Oculomotor nerve
compression
A client was recently admitted to the emergency department after falling
down a flight of stairs. The client is complaining of nausea along with a
headache and requests pain medication. The nurse observes that the client
, Principles Medsurg2 Jersey College
Questions with Complete Solutions
(Latest 2025)
is restless. Which of the following actions by the nurse is a priority? - Correct
Answers✅Check the client's visual acuity
A nurse is caring for a client with a closed head injury. The client has become
increasingly lethargic, complains of a headache, and clears his throat
spontaneously. His BP is 120/70, pulse is 80, respirations are 18 and his
oxygen saturation is 98%. Which of the following nursing diagnoses is
appropriate? - Correct Answers✅Ineffective cerebral tissue perfusion related
to increased intracranial pressure.
Clients with a closed head injury, a subdural hematoma, an epidural
hematoma or a subarachnoid hemorrhage are at an increased risk for which
of the following complications? - Correct Answers✅respiratory failure
A client with a brain tumor is receiving dexamethasone (decadron). The
nurse should monitor the client for which of the following clinical
manifestations? - Correct Answers✅edema
A client who recently had a kidney transplant is inquiring about having the
nasal influenza vaccination for the upcoming flu season. Which response by
the nurse is most appropriate? - Correct Answers✅'Because of your recent
transplant, I would consult your physician about the flu vaccination.'
A nurse is caring for an unconscious client who extends his elbows, pronates
his arms, flexes his wrists and points his toes. Which of the following is true?
- Correct Answers✅This is a sign of severe neurologic damage.
When caring for a client who sustained a lower motor neuron injury and is
paralyzed from the waist down, the nurse anticipates which of the following
findings? - Correct Answers✅Flaccid paralysis
