Ms Exam

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A client admitted to outpatient surgery for a cataract extraction on the right eye. The client asks the nurse, what causes cataracts in old people? Which of the following statements should form the basis for the nurse’s response? Cataracts most commonly a. Are a result of chronic systemic disease b. Are a result of aging process c. Are a a result of injuries sustained early in life d. Are a result of prolonged use of drugs A client asks; “What does the lens of my eye do?” the nurse should explain that the lens of the eye: a. produces aqueous humor b. holds the rods and cones c. focuses light rays to the retina d. regulates the amount of light entering the eye The client with a cataract tells the nurse that she is afraid of being awake during eye surgery. Which of the following responses of the nurse would be the most appropriate? a. “Have you ever had any reactions to local anesthetics in the past?” b. “What is it that disturbs you about the idea of being awake?” c. “By using a local anesthetic, you won’t have nausea and vomiting after the surgery.” d. “There is really nothing to fear about being awake. You’ll be given a medication that will help you relax.” A client with a cataract would most likely complain of what symptoms? a. Halos and rainbows around lights b. Eye pain and irritations which worsens at night c. Blurred and hazy visions d. Eye strain and headache when doing close work A client is scheduled for removal of a cataract OD. Before surgery, the nurse is to instill eye drops of phenylephrine Hcl into the client OD. This preparation acts in the eye to a. Dilation of the pupil and the blood vessels b. Dilation of the pupil and constriction of the blood vessels c. Constriction of pupil and blood vessels d. Constriction of pupils and dilation of blood vessels A short time after cataract surgery, the client complains of nausea. Which of the following represents the nurse’s best course of action? a. Instruct the client to take a few deep breaths until nausea subsides b. Explain that this is a common feeling that will pass quickly c. Tell the client to call the nurse promptly, if vomiting occurs d. Medicate the client with an anti emetic as ordered. After returning home, the client will need to continue to instill eye drops in the affected eye. The client is instructed to apply slight pressure against the nose at the inner canthus of the eye after instilling the eye drops. The rationale that supports applying pressure is that it a. Prevents the medication from entering the tear duct b. Prevents the drug from running down the patient’s face c. Allows the sensitive cornea to adjust to the medication d. Facilitates the distribution of the medication over the eye surface A client with detachment of the retina asks the nurse why it is necessary to patch both of her eyes. The nurse’s reply should be based on the knowledge that eye patches serve to: a. Reduce rapid eye movements b. Decrease the irritation caused by the light entering the damaged eye c. Protect the injured eye from infection d. Rest the eye to promote healing Which of the following statements would provide the best guide for activity for a client who has been treated for retinal detachment during the rehabilitation period? a. Activity is resumed gradually, the client can resume her usual activities in 5 to 6 weeks b. Activity level is determined by the client’s tolerance; she can be active as she wishes c. Activity levels will be restricted for several months, so she could plan on being sedentary d. Activity can be returned to normal and may include regular aerobic exercise the client who has been treated for chronic open angle glaucoma for 5 years asks the clinic nurse, “How does glaucoma damage my eyesight?” the nurses reply should be based on the knowledge that COAG a. result from chronic eye inflammation b. causes increased intraocular pressure

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c. leads to the detachment of the retina d. is caused by decreased blood flow to the retina Which of the following signs and symptoms is most commonly experienced by clients with COAG? a. Eye pain b. Excessive lacrimation c. Colored light flashes d. Decreasing peripheral vision The nurse observes the client while he instills his eye drops. The client says, “I just try to hit the middle of my eyeball so the drops don’t run out of my eye.” The nurse explains to the client that the method he is now using may cause a. Scleral staining b. Corneal injury c. Excessive lacrimation d. Systematic drug absorption The client with glaucoma is scheduled for minor surgical procedure.which of the following orders would require clarification or correction before the nurse carry it out? a. Administer morphine sulfate b. Administer atropine sulfate c. Teach deep breathing exercises d. Teach leg exercises Which of the following clinical manifestations would the nurse associate with acute angle-closure glaucoma? a. Gradual loss of central vision b. Acute light sensitivity c. Loss of color vision d. Sudden eye pain A 27y/o woman is admitted for elective nasal surgery for a deviated septum. Which of the following would be an important initial clue that bleeding was occurring even if the nasal drip pad remained dry and intact? a. Complaints of nausea b. Repeated swallowing c. Rapid respiratory rate d. Feeling of anxiety The client is ready for discharge after surgery for a deviated septum. Which of the following discharge instructions would be appropriate? a. Avoid activities that elicit the valsalva maneuver b. Take aspirin to control nasal discomfort c. Avoid brushing the teeth until the nasal packing is removed d. Apply heat to the nasal area to control swelling Which of the following statements would indicate to the nurse that the client who has undergone repair of her nasal septum has understood the discharge instructions? a. “I should not shower until my packing is removed.” b. “I will take stool softeners and modify my diet to prevent constipation” c. “Coughing every 2 hours is important to prevent respiratory complications.” d. “It is important to blow my nose each day to remove the dried secretions.” A 75 y/o client who has been taking furosemide regularly for 4mos tells the nurse that he is having trouble hearing. What would be the nurse’s best response to this statement? a. Tell the client that because he is 75 y/o, his hearing deteriorates. b. Have the client report the hearing loss immediately to physician. c. Schedule the client for audiometric testing and a hearing aid. d. Tell the client that the hearing loss is only temporary, when the system adjusts with the furosemide, his hearing will improve. Which of the following describes the effect of hearing aid for a client with sensorineural hearing loss? a. It makes sounds louder and clearer b. It has no effect on hearing c. It makes sounds louder but not clearer d. It improves the clients ability to separate words from background noise A client states that she was told she has sensorineural hearing loss and asks the nurse that this sensorineural hearing loss results from which of the following condition? a. Presence of fluid and cerumen in the external canal

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Sclerosis of the bones of the middle ear Damage to the cochlear or vestibulocochlear nerve d. Emotional disturbance resulting in functional hearing loss A 65 y/o man complains of hearing loss and a sensation of fullness in both ears. The nurse examines his ears with the understanding that a common cause of hearing loss in older adults is related to: a. Accumulation of cerumen in the external canal b. Accumulation of cerumen in the internal canal c. External otitis d. Exostosis The best method to remove cerumen from a client’s ear involves a. Inserting a cotton tipped applicator into the external canal b. Irrigating the ear gently c. Using aural suction d. Using a cerumen curette To prepare the irrigation solution used for removal of cerumen, the nurse uses: a. Normal saline b. Sterile water c. Antiseptic solution d. Lactated ringers solution A 26 y/o client has a history of chronic otitis media. Which of the following procedures is the most common surgical intervention for chronic otitis media? a. Ossiculoplasty b. Tympanoplasty c. Mastoidectomy d. Myringotomy A client is about to have tympanoplasty. She is asking the nurse what the surgical procedure involves. The nurse begins the conversation by a. Assessing what the client’s doctor has told her b. Describing the surgical procedure c. Educating the client that the procedure will close the perforation and prevent recurrent infection d. Informing the client that the procedure will improve her hearing A classic triad of symptoms associated with Meniere’s disease is vertigo, tinnitus and: a. Headache b. Otitis media c. Fluctuating hearing loss d. Vomiting Which of the following statements of the client would indicate that she understands the expected course of Meniere’s disease? a. “The disease process will gradually extent to the eyes.” b. ”Control of the episodes is usually possible, but a cure is not yet available.” c. “Continued medication will cure the disease.” d. “Bilateral deafness is an inevitable outcome of the disease.”

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28. The potential injury during an attack of Meniere’s disease is great. The nurse should instruct the client to take which immediate action when experiencing vertigo? a. “Place your head between your knees.” b. “Concentrate on deep breathing.” c. “Close your eyes tightly.” d. “Assume a reclining flat position.” 29. The nurse would anticipate all of the following drugs may be used in the attempt to control the symptoms of Meniere’s disease except: a. Antihistamines b. Antiemetics c. Diuretics d. Glucocorticoids 30. When assessing an older adult with macular degeneration the nursed would expect to find: a. Loss of central vision b. Loss of peripheral vision c. Total blindness

d. Blurring of vision 31. A 75 y/o male client has a history of macular degeneration. While he is in the hospital, the priority nursing goal will be: a. To provide education regarding community services for clients with adult macular degeneration (AMD) b. To provide heath care regarding his condition c. To promote a safe, effective environment d. To improve vision 32. when admitting a blind female client to the hospital, the nurse should: a. Ask the client to have someone with her at all times b. Encourage her to stay in bed until the nurse can assist c. Orient the client to the room environment by providing opportunity to touch objects d. Allow time for client to orient to the environment 33. Although the following measures might be useful in reducing the visual disability of a client with AMD, which measures should the nurse teach the client primarily as a safe precaution? a. Wear a patch over one eye b. Place personal items on the sighted side c. Lie in bed with the unaffected side toward the door d. Turn the head from side to side when walking 34. The physician has prescribed timolol ophthalmic drops and gentamicin ophthalmic ointment for a client with glaucoma and conjunctivitis. When administering eye drops and eye ointments to the same client, the nurse should: a. Administer the drops, wait 5 minutes, and administer the ointment b. Administer the two medications together c. Administer the ointment, wait 30 minutes and administer the drops d. Ask the physician to prescribe both medications as drops or ointments 35. The nurse is caring for a client with suspected retinal detachment of the right eye. Which subjective finding is common in clients with retinal detachment? a. Dull, throbbing pain b. Veil-like loss of vision c. Sudden blindness d. Loss of color discrimination 36. A client is to be discharged following removal of a cataract on her right eye. The nurse should tell the client to: a. Wear the metal eye shield only during waking hours b. Report any eye pain to the doctor immediately c. Refrain from using a pillow under the bed d. Avoid wearing dark glasses indoors 37. An elderly client with glaucoma has been prescribed Timolol eye drops. Timoptic should be used with caution in clients with history of: a. Diabetes b. Gastric ulcers c. Emphysema d. Pancreatitis 38. The nurse is teaching a patient with detached retina who underwent scleral buckling on the left eye. The procedure included gas injection into the vitreous. Which of the following statements indicates that the patient understands the nurse’s instructions? a. “I should lie on my abdomen with my head turned to the right.” b. “I should lie face down with my head turned to the left.” c. “I’ll lie face up with my head turned to the right.” d. “I should lie on my back with my head turned to the left.” 39. The nurse is providing care for a client following cataract removal surgery. In which position should the nurse place the patient? a. Right side lying b. Prone c. Supine d. Trendelenburg 40. When assessing a client with glaucoma, a nurse expects which of the following findings? a. Complaints of double vision b. Complaints of halos around lights c. Intraocular pressure of 15mmHg d. Soft globe on palpation

41. A client with Bell’s palsy is distressed about the change in facial appearance. The nurse tells the client about which of the following characteristics of Bell’s palsy to help the client cope with the disorder? a. The symptoms will completely go away once the tumor is removed b. It usually resolves when treated with vasodilators c. It is similar to stroke, but all symptoms will go away eventually. d. It is not caused by stroke, and many clients recover in 3 to 5 weeks. 42. A physician is writing medication orders for a client with Bell’s palsy. The nurse reviews the clients record for an order which of the following medications commonly used to decrease edema of nerve tissue: a. Naprosyn (Aleve) b. Prednisone (Deltasone) c. ASA (Aspirin) d. Ibuprofen (Motrin) 43. A client with trigeminal neuralgia asks the nurse what can be done to minimize the episodes of pain, the nurse response is based on the understanding that the symptoms can be triggered by: a. Infection or stress b. Excessive watering of the eyes or nasal stuffiness c. Sensations of pressure or extremes in temperature d. Hypoglycemia and fatigue 44. A client has been diagnosed with Bell’s palsy. The nurse assesses the client to see if which of the following signs and symptoms is visible? a. Speech difficulties and facial droop b. Twitching of one side of the face and ruddy cheeks c. Eye paralysis and ptosis of both eyes d. Fixed pupil and an elevated eyelid on one side 45. A client is admitted to the hospital in myesthenic crisis. A nurse questions the family about the occurrence of which of the following precipitating factors for this event? a. Not taking prescribed medication b. Taking excess prescribed medication c. Getting more sleep than usual d. A decrease in food intake recently 46. Benztropine mesylate (Cogentin) is prescribed to a client with a diagnosis of Parkinsosn’s disease. The clinic nurse is reinforcing instructions to the client regarding the medication and tells the client to: a. Avoid driving if drowsiness or dizziness occurs b. Expect difficulty swallowing while taking this medication c. Sped time sitting in the sun to enhance effectiveness of the medication d. Expect episodes of vomiting and constipation while taking this medication 47. A nurse is reviewing the nursing care plan for a patient with a right cerebrovascular accident (CVA) who has left side deficits. The nurse notes a nursing diagnosis of unilateral neglect. The nurse would tell a family member who is assisting the client that it would be helpful to do which of the following? a. Approach the client from the right side b. Teach the client to scan the environment c. Move the commode and chair to the left side d. Place bedside articles on the left side 48. A physician has prescribed nimodipine for a client with subarachnoid hemorrhage. The nurse administering the first dose tells the client that this medication is a: a. Ca-channel blocker used to decrease the blood pressure b. Ca-channel blocker used to decrease cerebral blood vessel spasm c. Beta-adrenergic blocker used to decrease blood pressure d. Vasodilator that has an affinity for cerebral blood vessels. 49. A nurse is in the room with a client when a seizure begins. The client’s entire body becomes rigid, and the muscles in all four extremities alternate between relaxation and contraction. Following the seizure, the nurse documents that the client has experienced: a. Absent seizure b. Generalized tonic-clonic seizure c. Simple partial seizure d. Complex partial seizure

50. A client has an order for seizure precautions. The nurse avoids doing which of the following when planning care of the client? a. Monitor the client closely while the client is showering b. Push the lock-out button on the electric bed to keep the bed in the lowest position c. Keep all the lights on in the room at night d. Assist the client to ambulate in the hallway 51. When performing the history and physical examination of a client with Parkinson’s disease, the nurse should assess the client for: a. Frequent bouts of diarrhea b. Hyperextension of neck c. Low itched monotonous voice d. Increase in appetite and weight gain 52. While assessing a client with Parkinson’s disease, the nurse identifies bradykinesia when the client exhibits: a. Muscle flaccidity b. Intentional tremor c. Paralysis of the limbs d. Lack of spontaneous movement 53. A nurse is caring for a client who is comatose. The nurse notes in the chart that the client is exhibiting decerebrate posturing. Based on this documented finding, the nurse expects to note which of the following? a. Extension of the extremities after a stimulus b. Flexion of the extremities after a stimulus c. Upper extremity flexion with lower extremity extension d. Upper extremity extension with lower extremity flexion 54. The nurse is caring for a comatose patient who has suffered a closed head injury.which intervention should the nurse implement to prevent an increase in the ICP? a. Suctioning the airway every hour b. Elevating the head of the bed 15 to 40 degrees c. Turning the patient and changing his position every hour d. Marinating a well-lit room 55. The nurse explains to the patients family that which of the following disorders is characterized by progressive degeneration of the cerebral cortex? a. Alzheimer’s disease b. Epilepsy c. Guillain-barre syndrome d. Stroke 56. To encourage adequate nutritional intake for a patient with moderate Alzheimer’s disease, the nurse should: a. Stay with the patient and encourage him to eat b. Help the patient fill out his menu c. Give the patient privacy during meals d. Fill out the menu for the patient 57. The nurse is caring for a client with increase ICP/ which procedure is contraindicated in this case? a. EEG b. Skull x-rays c. Lumbar tap d. CT scan 58. An adult has a medical dx of increased ICP and is being cared for in the neurological unit.the nursing care plan includes positioning the head in proper alignment. The nurse realizes that these actions are effective because they act by: a. Making it easier for the client to breath b. Preventing valsalva maneuver c. Promoting venous drainage d. Reducing pain 59. Which of the following reduces cerebral edema by constricting cerebral veins? a. Dexamethasone b. Mechanical hyperventilation c. Mannitol d. Ventriculostomy 60. A nurse is obtaining a GCS on a client. The score is as follows: BEO: 3, BMR: 6, BVR: 4. the nurse interprets these findings as the client:

a. b. c. d.

Opens eyes to speech, obeys verbal commands and is confused Opens eyes to pain, decorticates to pain, and does not speak Opens eyes to pain, no motor response, and has inappropriate speech Opens eyes spontaneously, obeys commands, and is oriented