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NUR265 Practice Questions Exam #3 latest 2023.
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lOMoARcPSD|7293922NUR265 Practice Questions Exam #3
latest 2023
EXAM # 3 MED SURG 265
1. The nurse has provided information to a client who was recently diagnosed with
trigeminal neuralgia (tic douloureux). Which of the following client statements would
require additional teaching by the nurse?
“I may require surgery if my pain does not subside.”
“I may need to take a seizure medication for
treatment.” “Chewing may increase the pain in my
face.”
“I will tape my affected eye closed at bedtime.”
Taping the eye closed is not an appropriate intervention for patients with trigeminal
neuralgia. The other choices are appropriate for a patient with trigeminal neuralgia. Page
1000 eating can make the pain with this disorder worse, the first choice for drug therapy
is carbamazepine. Surgery may be needed.
2. The nurse has provided teaching to a client who was just diagnosed with Bell’s palsy.
Which of the following would be an expected finding?
Sharp stabbing pain on the affected side.
Treatment with corticosteroids for three
months. Correct!
Paralysis of the eye, forehead, and cheek.
Numbness and tingling of the hands and feet.
Bell's Palsy presents with paralysis of the facial muscles, this usually resolves in a few
months.
3. The nurse is caring for a client who has encephalitis. Which of the following client
findings would indicate to the nurse that the client has developed an early indicator
of a change in neurological status?
The development of a red macular rash.
The development of irritability and confusion.
A report of nausea and
vomiting. Pupils that react
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sluggishly to light.
Changes in mental status is an early sign of neuro decline
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4. The newly-hired nurse is caring for a client who has encephalitis and increased
intracranial pressure (ICP). It would require follow up by the preceptor if the newly-
hired nurse indicates that a priority action is to report
a change in pupil size from 6 mm to 8 mm over the past two
hours. the development of projectile vomiting.
a change in blood pressure from 120/82 mm Hg to 170/60 mm Hg.
sensitivity to noise and light.
Sensitivity to noise and light is expected with these patients and not the priority. The
preceptor would follow up for this. Projectile vomiting would be a concern. In severe
cases of encephalitis, the patient may have increased ICP resulting from cerebral edema,
hemorrhage, and necrosis of brain tissue. Monitor vital signs for indications of a widened
pulse pressure, bradycardia, and irregular respirations. The pupils become increasingly
dilated and less responsive to light. Left untreated, increased ICP leads to herniation of
the brain tissue and possibly death.
5. The nurse is admitting a client who has meningitis caused by Haemophilus influenzae.
Which of the following actions would be appropriate for the nurse to take?
Wear a surgical mask when working within three feet of the client.
Place the client in a room with another client who requires contact
precautions. Place the client in a private room with monitored negative
airflow.
Wear disposable gloves when entering the client’s room.
H Influenzae meningitis requires mask to be worn when working within 3 feet of the
patient. Page 940. Private room is needed but not the negative air flow.
6. The nurse is admitting a client who presented to the emergency department (ED) with
chills, a stiff neck, and a temperature of 101.5⁰F. Once appropriate blood cultures have
been obtained and the client has had a lumbar puncture (LP) performed, which of the
following actions would be a priority for the nurse to take?
Administer prescribed acetaminophen for a temperature > 101.5⁰F.
Maintain a quiet environment for the client.
Administer the prescribed broad-spectrum antibiotic.
Determine if the client has photophobia.
Administer antibiotic is the correct priority intervention.
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