ADULT HEALTH 3 EXAM-LATEST STUDY GUIDE

1. The nurse on the neurological unit is positioning a client who had a stroke two days ago and had left-sided hemiparesis. Which of the following actions by the nurse would be appropriate? Select all that apply. a. Positioning a rolled washcloth in the client’s left hand b. Placing a foam abduction wedge between the client’s legs c. Grasping the client’s left arm to pull the client from supine to a right side-lying position d. Securing the left arm in a sling e. Putting a trochanter roll on the outside of the client’s left hip when the client is supine. 2. The nurse is caring for a client who has expressive aphasia following a stroke. The nurse has taught the client’s spouse about ways to facilitate communication. Which of the following comments by the client’s spouse would require follow-up? a. “I wait after I ask my spouse a question, to give as much time as needed to answer.” b. “I ask my spouse questions like, ‘Do you like this movie?’ instead of ‘What do you think of this movie?’” c. “I act like I understand when I do not, so that my spouse will not become frustrated.” d. “I tell my spouse, ‘Point to what you want” so I do not get frustrated trying to understand.” 3. The nurse is caring for a client with increased intracranial pressure (ICP) who has developed syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following prescribed interventions should the nurse implement? a. Electrolyte restriction b. Electrolyte replacement c. Fluid replacement d. Fluid restriction 4. The nurse is planning care for a client who has a recent diagnosis of multiple sclerosis (MS). Which of the following interventions should the nurse include in the client’s care plan? a. Instruct the client on daily muscle stretching exercises b. Provide total assistance with all activities of daily living (ADLs) c. Encourage the client to follow a low-residue diet d. Encourage client to void every hour 5. The nurse is caring for a group of assigned clients. Which of the following client’s should the nurse see first? a. The client with ulcerative colitis who reports left lower quadrant abdominal pain and passing stools that appear bloody with mucus and pus. b. The client with breast cancer receiving prescribed chemotherapy whose platelet count is 52,000/uL and reports having shaking chills. c. The client with hepatitis B virus who was admitted with jaundice and now has changes in cognitive function. d. The client recovering from an ischemic stroke who has decreased lung sounds, productive cough and a temperature of 104.8 F. 6. The nurse is planning an education conference about anticoagulation and the direct factor Xa inhibitor medications. Select all that apply. a. Aspirin b. Coumadin c. Dipyridamole d. Rivaroxaban e. Apixaban 7. The nurse in an outpatient setting is assessing a client’s risk for ischemic stroke. The nurse should assess for which of the following conditions? Select all that apply. a. Atrial fibrillation b. Hemophilia c. Diabetes Mellitus d. Epilepsy e. Concussion f. Carotid Stenosis 8. The nurse is caring for a client with a traumatic brain injury (TBI) following a fall. Which of the following medications should the nurse anticipate being prescribed for the client to reduce cerebral edema? a. Mannitol b. Spirolactone c. Furosemide d. Hydrochlorothiazide 9. The nurse is preparing to administer prescribed dexamethasone 7.5 mg daily in divided doses every 6 hours to a client with vasogenic edema. The nurse has 10 mg/mL available. How many mL per dose should the nurse administer? Round your answer to the nearest tenth place. 0.2 10. The nurse is preparing to prescribe bevacizumab 10 mg/kg, IV, every 14 days for a client with a glioblastoma. The client weighs 160 lbs. The nurse has available 25 mg/mL. How many mL per dose should the nurse administer to the client? 29 11. The nurse is admitting a 16-year-old client who returned home early from summer camp with fever, severe headache, and vomiting. Which of the following prescribed interventions should the nurse implement first? a. Prepare the client for lumbar puncture b. Administer antibiotics and pain medication c. Decrease body temperature d. Collect a specimen for blood culture 12. The nurse is planning care for a client who has homonymous hemianopsia following a right hemispheric stroke. Which of the following interventions should the nurse include in the clients plan of care? a. Avoid using bright lights in the client’s room b. Position objects on the clients left side c. Stand in front of the client when speaking d. Tell the client how far or close objects are to the client 13. The nurse is caring for a client who had a right hemispheric stroke and has been evaluated by the speech therapist. The client has motor and visual deficits. During the clients first meal, since having a stroke, which of the following actions should the nurse take? a. Encourage the client to swallow twice after chewing each bite of food. b. Instruct the client to place food on the left side of the mouth c. Remind the client to rotate the head to scan for food items on the right side of the plate. d. Verify that all the client’s foods have been pureed. 14. The nurse has a prescription for a hypertonic saline solution for a client to be administered at 80 ml/her with a drop factor of 20 gtt/ml. How many gtt/min should the nurse administer to the client? 27 15. The nurse has provided information about urinary elimination to the spouse of a female client who recently had a stroke. Which of the following statements by the client’s spouse would indicate a correct understanding of the information? Select all that apply. a. “I will encourage bladder emptying every two hours.” b. “it is good to limit oral fluid intake after seven o’clock in the evening.” c. “It is best if pants have elastic waistbands instead of buttons.” d. “I will use a bedpan at nighttime and make sure I sit my spouse upright.” e. “I will learn how to care for a long-term urinary catheterization.” ....................................................................................................CONTINUE