Midterm Review Questions Chapters: 62, 63. 64

Question 1

A patient is being admitted with a possible stroke. Which information from the nursing assessment indicates that the patient is more likely to be having a hemorrhagic stroke than a thromboembolic stroke?

a. The patient has intermittent bouts of atrial fibrillation.

b. The patient has had brief episodes of right-sided hemiplegia.

c. The patient has a history of treatment for infective endocarditis.

d. The patient reports that the symptoms began with a severe headache.

Answer 1

d. The patient reports that the symptoms began with a severe headache.

Question 2

A patient being admitted with a stroke has right-sided facial drooping and right-sided arm and leg paralysis. Which other finding would the nurse expect?

a. Impulsive behavior

b. Right-sided neglect

c. Hyperactive left-sided tendon reflexes

d. Difficulty comprehending instructions

Answer 2

d. Difficulty comprehending instructions

Question 3

The health record indicates that a patient has an occluded left posterior cerebral artery. Which finding would the nurse anticipate?

a. Dysphasia

b. Confusion

c. Visual deficits

d. Poor judgment

Answer 3

c. Visual deficits

Question 4

Which information about clopidogrel (Plavix) will the nurse provide to the patient who has cerebral atherosclerosis?

a. Monitor and record the blood pressure daily.

b. Call the health care provider if stools are tarry.

c. Clopidogrel will dissolve clots in the cerebral arteries.

d. Clopidogrel will reduce cerebral artery plaque formation.

Answer 4

b. Call the health care provider if stools are tarry.

Question 5

A female patient who had a stroke 24 hours ago has expressive aphasia. Which intervention would the nurse use to help the patient communicate?

a. Ask questions that the patient can answer with “yes” or “no.”

b. Develop a list of words that the patient can read and practice reciting.

c. Have the patient practice her facial and tongue exercises with a mirror.

d. Prevent embarrassing the patient by answering for her if she does not respond.

Answer 5

a. Ask questions that the patient can answer with “yes” or “no.”

Question 6

Which concern would the nurse anticipate for a patient who had a right hemisphere stroke?

a. Right-sided hemiplegia

b. Speech-language deficits

c. Denial of deficits and impulsiveness

d. Depression and distress about disability

Answer 6

c. Denial of deficits and impulsiveness

Question 7

A left-handed patient with left-sided hemiplegia has difficulty feeding himself. Which intervention would the nurse include in the plan of care?

a. Provide a wide variety of food choices.

b. Provide oral care before and after meals.

c. Assist the patient to eat with the right hand.

d. Teach the patient the “chin-tuck” technique.

Answer 7

c. Assist the patient to eat with the right hand.

Question 8

A patient has a ruptured cerebral aneurysm and subarachnoid hemorrhage. Which intervention will the nurse include in the plan of care?

a. Apply intermittent pneumatic compression stockings.

b. Assist to dangle on edge of bed and assess for dizziness.

c. Encourage patient to cough and deep breathe every 4 hours.

d. Insert an oropharyngeal airway to prevent airway obstruction.

Answer 8

a. Apply intermittent pneumatic compression stockings.

Question 9

A patient will attempt oral feedings for the first time after having a stroke. After assessing the gag reflex, which action would the nurse take?

a. Order a varied pureed diet.

b. Assess the patient’s appetite.

c. Assist the patient into a chair.

d. Offer the patient a sip of juice.

Answer 9

c. Assist the patient into a chair.

Question 10

A 70-year-old female patient with left-sided hemiparesis arrives by ambulance to the emergency department. Which action would the nurse take first?

a. Take the patient’s blood pressure.

b. Check the respiratory rate and effort.

c. Assess the Glasgow Coma Scale score.

d. Send the patient for a computed tomography (CT) scan.

Answer 10

b. Check the respiratory rate and effort.

Question 11

Several weeks after a stroke, a patient has impaired awareness of bladder fullness, resulting in urinary incontinence. Which intervention would the nurse plan to begin an effective bladder training program?

a. Limit fluid intake to 1200 mL daily to reduce urine volume.

b. Assist the patient onto the bedside commode every 2 hours.

c. Use an external catheter to protect the skin and prevent embarrassment.

d. Perform intermittent catheterization after each voiding to check for residual urine.

Answer 11

b. Assist the patient onto the bedside commode every 2 hours.

Question 12

A patient who has a history of a transient ischemic attack (TIA) has an order for aspirin 160 mg daily. The patient says, “I don’t need the aspirin today. I don’t have a fever.” Which action would the nurse take?

a. Document that the patient refused the aspirin.

b. Tell the patient that the aspirin is used to prevent a fever.

c. Explain that the aspirin is ordered to decrease stroke risk.

d. Call the health care provider to clarify the medication order.

Answer 12

c. Explain that the aspirin is ordered to decrease stroke risk.

Question 13

A patient in the clinic reports a recent episode of dysphasia and left-sided weakness at home that resolved after 2 hours. Which medication topic would the nurse anticipate teaching the patient?

a. tPA

b. Aspirin

c. Warfarin

d. Nimodipine

Answer 13

b. Aspirin

Question 14

A patient with a left-brain stroke suddenly bursts into tears when family members visit. How would the nurse respond?

a. Use a calm voice to ask the patient to stop the crying behavior.

b. Explain to the family that depression is normal following a stroke.

c. Have the family members leave the patient alone for a few minutes.

d. Teach the family that emotional outbursts are common after strokes.

Answer 14

d. Teach the family that emotional outbursts are common after strokes.

Question 15

Which stroke risk factor for a 48-year-old male patient in the clinic is most important for the nurse to address?

a. The patient is 25 pounds above the ideal weight.

b. The patient drinks a glass of red wine with dinner daily.

c. The patient’s usual blood pressure (BP) is 170/94 mm Hg.

d. The patient works at a desk and relaxes by watching television.

Answer 15

c. The patient’s usual blood pressure (BP) is 170/94 mm Hg.

Question 16

A patient in the emergency department with sudden-onset right-sided weakness is diagnosed with an intracerebral hemorrhage. Which information about the patient is most important to communicate to the health care provider?

a. The patient’s speech is difficult to understand.

b. The patient’s blood pressure (BP) is 144/90 mm Hg.

c. The patient takes a diuretic because of a history of hypertension.

d. The patient has atrial fibrillation and takes warfarin (Coumadin).

Answer 16

d. The patient has atrial fibrillation and takes warfarin (Coumadin).

Question 17

A patient with left-sided weakness that began 60 minutes earlier is admitted to the emergency department. Which prescribed diagnostic test would be done first?

a. Complete blood count (CBC)

b. Chest radiograph (chest x-ray)

c. Computed tomography (CT) scan

d. 12-Lead electrocardiogram (ECG)

Answer 17

c. Computed tomography (CT) scan

Question 18

A patient with a stroke has progressively increasing weakness and decreasing level of consciousness. Which patient problem would the nurse determine has the highest priority for the patient?

a. Sensory deficit

b. Risk for aspiration

c. Musculoskeletal problem

d. Risk for impaired skin integrity

Answer 18

b. Risk for aspiration

Question 19

Which information about the patient who had a subarachnoid hemorrhage is most important to communicate to the healthcare provider?

a. The patient reports having a stiff neck.

b. The patient’s blood pressure (BP) is 90/50 mm Hg.

c. The patient reports a severe and unrelenting headache.

d. The cerebrospinal fluid (CSF) report shows red blood cells (RBCs)

Answer 19

b. The patient’s blood pressure (BP) is 90/50 mm Hg.

Question 20

While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action would the nurse take?

a. Insert an oral airway during the seizure to maintain a patent airway.

b. Restrain the patient’s arms and legs to prevent injury during the seizure.

c. Time and observe and record the details of the seizure and postictal state.

d. Avoid touching the patient to prevent further nervous system stimulation.

Answer 20

c. Time and observe and record the details of the seizure and postictal state.

Question 21

A high school teacher who has been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, “I cannot teach anymore. It will be too upsetting if I have a seizure at work.” How would the nurse respond to specifically address the patient’s concern?

a. “You might benefit from some psychologic counseling.”

b. “Epilepsy usually can be well controlled with medications.”

c. “You will want to contact the Epilepsy Foundation for assistance.”

d. “The Department of Vocational Rehabilitation can help with work retraining.”

Answer 21

b. “Epilepsy usually can be well controlled with medications.”

Question 22

A patient has been taking phenytoin (Dilantin) for 2 years. Which action would the nurse take when evaluating possible adverse effects of the medication?

a. Inspect the oral mucosa.

b. Listen to the lung sounds.

c. Auscultate the bowel sounds.

d. Check pupil reaction to light.

Answer 22

a. Inspect the oral mucosa.

Question 23

A patient reports feeling numbness and tingling of the left arm before experiencing a seizure.

Which type of seizure would the nurse suspect?

a. Focal-onset

b. Atonic

c. Absence

d. Myoclonic

Answer 23

a. Focal-onset

Question 24

The nurse observes a patient ambulating in the hospital hall. The patient’s arms and legs suddenly jerk and the patient falls to the floor. Which action would the nurse take first?

a. Give the scheduled Divalproex (Depakote).

b. Document the timing and description of the seizure.

c. Check the environment for sources of potential injury.

d. Notify the patient’s health care provider about the seizure.

Answer 24

c. Check the environment for sources of potential injury.

Question 25

Which prescribed intervention would the emergency department nurse implement first for a patient who is experiencing continuous tonic-clonic seizures?

a. Give phenytoin (Dilantin) 100 mg IV.

b. Monitor level of consciousness (LOC).

c. Administer lorazepam (Ativan) 4 mg IV.

d. Obtain computed tomography (CT) scan.

Answer 25

c. Administer lorazepam (Ativan) 4 mg IV.

Question 26

A patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson’s disease. Which assessment finding would indicate to the nurse that a change in the medication or dosage may be needed?

a. Shuffling gait

b. Tremor at rest

c. Cogwheel rigidity of limbs

d. Uncontrolled head movement

Answer 26

d. Uncontrolled head movement

Question 27

Which patient problem would the nurse identify as of highest priority for a patient who has Parkinson’s disease and is unable to move the facial muscles?

a. Activity intolerance

b. Negative self-image

c. Musculoskeletal problem

d. Nutritionally compromised

Answer 27

d. Nutritionally compromised

Question 28

Which information about a patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administering the medication?

a. Patient has tonic-clonic seizures.

b. Patient experiences an aura before seizures.

c. Patient’s most recent blood pressure is 156/92 mm Hg.

d. Patient has slight elevations in liver function test results.

Answer 28

d. Patient has slight elevations in liver function test results.

Question 29

A patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment would the nurse have available in the patient’s assigned room? (Select all that apply.)

a. Side rail pads
b. Tongue blade
c. Oxygen mask
d. Suction tubing
e. Urinary catheter
f. Nasogastric tube

Answer 29

a. Side rail pads
c. Oxygen mask
d. Suction tubing

Question 30

A patient with Parkinson’s disease is admitted to the hospital for treatment of pneumonia.

Which interventions would the nurse include in the plan of care? (Select all that apply.)

a. Provide an elevated toilet seat.

b. Cut patient’s food into small pieces.

c. Serve high-protein foods at each meal.

d. Place an armchair at the patient’s bedside.

e. Observe for sudden exacerbation of symptoms.

Answer 30

a. Provide an elevated toilet seat.
b. Cut patient’s food into small pieces.
d. Place an armchair at the patient’s bedside.

Question 31

A patient hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information would indicate that the patient is experiencing delirium rather than dementia?

a. The patient was oriented and alert when admitted.

b. The patient’s speech is fragmented and incoherent.

c. The patient is oriented to person but disoriented to place and time.

d. The patient has a history of increasing confusion over several years.

Answer 31

a. The patient was oriented and alert when admitted.

Question 32

Which intervention will the nurse include in the plan of care for a patient with mild dementia who is admitted for other health problems?

a. Provide complete personal hygiene care for the patient.

b. Remind the patient frequently about being in the hospital.

c. Reposition the patient frequently to avoid skin breakdown.

d. Place suction at the bedside to decrease the risk for aspiration.

Answer 32

b. Remind the patient frequently about being in the hospital.

Question 33

Which action would the nurse incorporate during a mental status examination of a patient with delirium?

a. Wait until the patient is well-rested.

b. Administer an anxiolytic medication.

c. Choose a place without distracting stimuli.

d. Reorient the patient during the examination.

Answer 33

c. Choose a place without distracting stimuli.

Question 34

The nurse is concerned about a postoperative patient’s risk for injury during an episode of delirium. Which intervention would the nurse implement initially?

a. Secure the patient in bed using a soft chest restraint.
b. Ask the health care provider to prescribe an antipsychotic drug.
c. Assign assistive personnel (AP) to stay with and reorient the patient.
d. Instruct family members to remain with the patient and prevent injury.

Answer 34

c. Assign assistive personnel (AP) to stay with and reorient the patient.

Question 35

A patient seen in the outpatient clinic is newly diagnosed with mild cognitive impairment (MCI). Which action will the nurse include in the plan of care?

a. Suggest a move into an assisted living facility.

b. Schedule the patient for more frequent appointments.

c. Ask family members to supervise the patient’s daily activities.

d. Discuss the preventive use of acetylcholinesterase medications.

Answer 35

b. Schedule the patient for more frequent appointments.

Question 36

A patient is diagnosed with moderate dementia after having multiple strokes. Which assessment finding would the nurse expect?

a. Excessive nighttime sleepiness.

b. Difficulty eating and swallowing.

c. Loss of recent and long-term memory.

d. Fluctuating ability to perform simple tasks.

Answer 36

c. Loss of recent and long-term memory.

Question 37

Which action will help the nurse determine whether a new patient’s confusion is caused by dementia or delirium?

a. Ask about a family history of dementia.

b. Administer the Mini-Mental Status Exam.

c. Use the Confusion Assessment Method tool.

d. Obtain a list of the patient’s usual medications.

Answer 37

c. Use the Confusion Assessment Method tool.

Question 38

A patient is being evaluated for Alzheimer’s disease (AD). Which information would the nurse explain to the patient’s adult children?

a. Brain atrophy detected by an MRI would confirm the diagnosis of AD.

b. New drugs can reverse AD deterioration dramatically in some patients.

c. The most important risk factor for AD is a family history of the disorder.

d. A diagnosis of AD is made only after other causes of dementia are ruled out.

Answer 38

d. A diagnosis of AD is made only after other causes of dementia are ruled out.

Question 39

Which nursing action will be most effective in ensuring daily medication compliance for a patient with mild dementia?

a. Setting the medications up monthly in a medication box

b. Having the patient’s family member administer the medication

c. Posting reminders to take the medications in the patient’s house

d. Calling the patient weekly with a reminder to take the medication

Answer 39

b. Having the patient’s family member administer the medication

Question 40

A patient who has severe Alzheimer’s disease (AD) is being admitted to the hospital for surgery. Which intervention will the nurse include in the plan of care?

a. Encourage the patient to discuss events from the past.

b. Maintain a consistent daily routine for the patient’s care.

c. Reorient the patient to the date and time every 2 to 3 hours.

d. Provide the patient with current newspapers and magazines.

Answer 40

b. Maintain a consistent daily routine for the patient’s care.

Question 41

A patient with Alzheimer’s disease (AD) who is being admitted to a long-term care facility has had several episodes of wandering away from home. Which action will the nurse include in the plan of care?

a. Reorient the patient several times daily.

b. Have the family bring in familiar items.

c. Place the patient in a room close to the nurses’ station.

d. Remind the patient not to wander from the nursing unit.

Answer 41

c. Place the patient in a room close to the nurses’ station.

Question 42

The day shift nurse at the long-term care facility learns that a patient with dementia experienced sundowning late in the afternoon on the previous two days. Which action would the nurse take?

a. Keep window blinds open during the day.

b. Have the patient take a mid-morning nap.

c. Provide hourly orientation to time and place.

d. Move the patient to a quiet room in the afternoon.

Answer 42

a. Keep window blinds open during the day.

Question 43

Which initial action would the nurse take for a patient with moderate dementia who develops increased restlessness and agitation?

a. Reorient the patient to time, place, and person.

b. Administer a PRN dose of lorazepam (Ativan).

c. Assess for factors that might be causing discomfort.

d. Assign assistive personnel (AP) to stay in the patient’s room

Answer 43

c. Assess for factors that might be causing discomfort.

Question 44

Which hospitalized patient will the nurse assign to the room closest to the nurses’ station?

a. Patient with Alzheimer’s disease who has long-term memory deficit

b. Patient with vascular dementia who takes medications for depression

c. Patient with new-onset confusion, restlessness, and irritability after surgery

d. Patient with dementia who has an abnormal Mini-Mental State Examination

Answer 44

c. Patient with new-onset confusion, restlessness, and irritability after surgery

Question 45

After change-of-shift report on the memory care unit, which patient with dementia will the nurse assess first?

a. Patient who has not had a bowel movement for 5 days

b. Patient who has a stage II pressure ulcer on the coccyx

c. Patient who is refusing to take the prescribed medications

d. Patient who developed a new cough after eating breakfast

Answer 45

d. Patient who developed a new cough after eating breakfast

Question 46

The spouse of a 67-yr-old male patient with early stage Alzheimer’s disease (AD) tells the nurse, “I am exhausted from worrying all the time. I don’t know what to do.” Which initial actions would the nurse take? (SATA)

a. Suggest that a long-term care facility be considered.

b. Offer ideas for ways to distract or redirect the patient.

c. Teach the spouse about adult day care as a possible respite.

d. Ask what the spouse knows and thinks about dementia care options.

e. Suggest that the spouse consult with the physician for antianxiety drugs.

Answer 46

b. Offer ideas for ways to distract or redirect the patient.
c. Teach the spouse about adult day care as a possible respite.
d. Ask what the spouse knows and thinks about dementia care options.

Question 47

Which actions would the nurse incorporate when communicating with a patient who has moderate Alzheimer’s disease? (Select all that apply.)

a. Use kind endearments such as “honey” or “sweetie.”

b. Give verbal directions supported by using gestures or pictures.

c. Correct the patient when the patient makes errors in naming items.

d. Give detailed explanations before beginning a procedure or therapy.

e. Redirect the patient to another activity when the patient is frustrated.

Answer 47

b. Give verbal directions supported by using gestures or pictures.
e. Redirect the patient to another activity when the patient is frustrated.