MED SURG 1 FINAL EXAM QUESTIONS & ANSWERS
A nurse is caring for a client who is postprocedure following lumbar puncture and
reports a throbbing headache when sitting upright. Which of the following actions should
the nurse take? (Select all that apply)
a.) Use the Glasgow Coma Scale when assessing the client
b.) Assist the client to a supine position
c.) Administer an opioid medications
d.) Encourgae the client to increase fluid intake
e.) Instruct the client to perform deep breathing and coughing exercises - Answers -
b,c,d
A nurse is caring for a client who experienced a traumatic head injury and has an
intraventricular catheter (ventriculostomy) for ICP monitoring. The nurse should monitor
the client for which of the following complications related to the ventriculostomy?
a.) Headache
b.) Infection
c.) Aphasia
d.) Hypertension - Answers -b
A nurse is assessing a client for changes in the level of consciousness using the
Glasgow Coma Scale (GCS). The client opens his eyes when spoken to, speaks
incoherently, and moves his extremities when pain is applied. Which of the following
GCS scores should the nurse document?
a.) E2+V3+M5 = 10
b.) E3+V4+M4= 11
c.) E4+V5+M6= 15
d.) E2+V2+M4= 8 - Answers -b
A nurse is caring for a client who just experienced a generalized seizure. Which of the
following actions should the nurse perform first?
a.) Keep the client in a side-lying position
,b.) Document the duration of the seizure
c.) Reorient the client to the environment
d.) Provide client hygeine - Answers -a
A nurse is providing discharge instructions to a client who has a prescription for
phenytoin. Which of the following information should the nurse include?
a.) Consider taking an antacid on this medication
b.) Watch the receding gums when taking the medication
c.) Take the medication at the same time everyday
d.) Provide a urine sample to determine therapeutic levels of the medication - Answers -
c
A nurse is reviewing trigger factors that can cause seizure with a client who has a new
diagnosis of generalized seizures. Which of the following information should the nurse
include in this review? (Select all that apply)
a.) Avoid overwhelming fatigue
b.) Remove caffeinated products from diet
c.) Limit looking at flashing lights
d.) Perform aerobic exercise
e.) Limit episodic of hypoventilation
f.) Use of aerosol hairspray is reccomended - Answers -a,b,c
A nurse is completing discharge teaching to a client who has seizures and recieved a
vagal nerve simulator to decrease seizure activity. Which of the following statements
should the nurse include in the teaching?
a.) "It is safe to use microwaves that are 1220 watts or less."
b.) "You should avoid the use of CT scans with contrast."
c.) "You should place a magnet over the implantable device when you feel an aura
occuring."
, d.) "It is recommended that you use untrasound diathermy for pain management." -
Answers -c
A nurse is caring for a client who displays manifestations of stage III Parkinson's
disease. Which of the following actions should the nurse include?
a.) Recommend a community support group
b.) Integrate a daily exercise routine
c.) Provide a walker for ambulation
d.) Perform ADLs for the client - Answers -c
A nurse is developing a plan of care for the nutritional needs of a client who has stage
IV Parkinson's disease. Which of the following actions should the nurse iclude? (Select
all that apply)
a.) Provide three large balanced meals
b.) Record diet and fluid intake daily
c.) Document weight every other week
d.) Offer cold fluids such as mlkshakes
e.) Offer nuritional supplements between meals - Answers -b,d,e
A nurse is reinforcing teaching with a client who has Parkinson's disease and has a new
prescription for bromocriptine. Which of the following instructions should the nurse
include?
a.) Rise slowly when standing
b.) Expect urine to become dark-colored
c.) Avoid foods containing tyramine
d.) Report skin discoloration - Answers -a
A nurse is assessing a client for manifestations of Parkinson's disease. Which of the
following are expected findings? (Select all that apply)
a.) Decreased vision
b.) Pill-rolling tremor of the fingers
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