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Mrs Bago, 80 years old, is a resident of the rest home where you are on
student placement. Whilst playing cards in the day room with a fellow
resident she became unresponsive without warning for about 30 seconds. Five
minuteshave passed and she has now regained consciousness and is lying on
her bed, after being taken there by her career.The Activities Coordinator
reported that she had some slurring of speech immediately after regaining
consciousness.
Which of the following would be most appropriate for you as the student
nurse to do next?
A. Leave Mrs Bago to go and talk to the other residents about what happened.
B. Perform a Glasgow Coma Score (GCS).
C. Refer the patient for immediate follow-up.
D. Ask if the patient has ever had a seizure
B. Perform a glasgow coma scale
When performing a physical examination of Winnie which of the following
would be most appropriate?
A. Allow Winnie to remain dressed.
B. Omit intrusive parts of the exam.
C. Dim the room light.
D. Try to minimise position changes for her.
D. Try to minimise position changes for her
Which test would be most appropriate to perform when assessing Winnies eye
muscle strength and cranial nerve function?
A. Visual fields test.
B. Cover test.
,C. Corneal light reflex test.
D. Extra ocular movement test.
D. Extra ocular movement test
Which of the following nursing assessments will give you objective data
relating to the functioning of Winnies cerebellum?
A. Vital signs.
B. Coordination.
C. Glasgow Coma Score
D. Cardiac function.
B. Coordination
The registered nurse is having difficulty eliciting a patellar reflex. Which of
the following would be most appropriate for the nurse to have Winnie do?
A. Lock the fingers together and pull against each other.
B. Stretch the arms over head.
C. Squeeze a thigh with the opposite hand.
D. Clench the jaw tightly.
A. Lock the fingers together and pull against each other
Winnies patellar reflex is normal. Which of the following is the correct
number to document this?
A. 2+
B. 3+
C. 4+
D. 5+
A. 2+
Which of the following would be the most likely sign of a frontal lobe
contusion?
A. Inability to hear high-pitched sounds
B. Difficulty speaking
C. Blurred vision
D. Loss of tactile sensation
B. Difficulty speaking
, You are a Practice Nurse working in a GP surgery. Joyce, a 73-year-old widow
presents to you for a blood pressure check. She has a past medical history of a
Myocardial Infarction 8 years ago, has rheumatoid arthritis and also type 2
diabetes. Joyce tells you she has increasing Right calf pain on walking. Her
feet are always cold and she would also like you to look at a lesion on her
Right lower leg that will not heal.
For which patient condition would you most likely expect a capillary refill
time longer than two seconds?
A. Malignant melanoma.
B. Inflammatory bowel disease.
C. Peripheral vascular disease.
D. Multiple sclerosis.
C. Peripheral vascular disease
Which one of the following is a myth about pain in the older adult?
A. Opioids are often the drug of choice for some types of pain, and are to be
used cautiously.
B. Older patients may have more than one source of pain.
C. There is a greater likelihood of having developed a pathological condition
that may be accompanied by
pain.
D. Elderly people who are confused or cognitively impaired do not have pain.
D. Elderly people who are confused or cognitively impaired do not have pain.
Which of the following represents the break in sounds between the first and
second sounds when auscultating Joyce's blood pressure?
A. Diastolic value.
B. Korotkoff sounds.
C. Auscultatory gap.
D. Phase V.
C. Auscultatory gap
4. The nurse is preparing to assess Joyce's apical impulse. The nurse would
palpate at which location?