EYES AND EARS QUIZ:

A diagnostic clinical manifestation of glaucoma is:

-Presence of halo around lights

A nurse is caring for a patient after craniotomy for a removal of acoustic neuroma. Assessment
of which of the following nerves would identify a complication specifically with this surgery?

-Cranial nerve VIl, Facial nerve

A nurse is caring for patient who is hearing impaired. Which of the following approaches will
facilitate communication?

-Speak in a normal tone

A nurse is performing an assessment on a patient with a suspected cataract. The chief clinical
manifestation that the nurse would expect to note in the early stages of cataract formation is:

-Blurred vision

A patient is diagnosed with a disorder involving the inner ear. Which of the following is the most
common client complaint associated with a disorder involving this part of the ear

-Tinnitus

A patient is diagnosed with glaucoma. Which of the following assessment data gathered by a
nurse identify a risk factor associated with this eye disorder?

-Diabetes Mellitus

A patient is tested with Snellen chart. The results of the tests are documented as 20/60. A nurse
interprets this as:

-The patient can only read at a distance of 20feet what a person with normal vision can read at
60feet
A patient was diagnosed to have otosclerosis. Which of the following assessment of the nurse
would correlate highly with this diagnosis?

-Rinne test- Air conduction is shorter than bone conduction

A patient who underwent stapedectomy is admitted to the ward. The nurse should include the
following in the plan of care EXCEPT:

-Keep the patient flat on bed with affected ear up

A patient with Meniere’s disease is experiencing severe vertigo. Which instruction would the
nurse give to the patient to assist in controlling the vertigo?

-Avoid sudden head movements

Acute conjunctivitis is associated with:

-Moderate to copious ocular discharge

After cataract surgery, a patient is encourage to:

-Avoid bending the head below the waist

An incident of acute otitis media is usually associated with:

-Foul smelling otorrhea

Clinical symptoms of a detached retina include:

-All of the above

In preparation for cataract surgery, a nurse is to administer prescribed eye drops. The nurse
reviews the physician’s orders expecting which type of eye drops to be prescribed?

-A mydiatric agent
Myopia is corrected with what type of lens?

-A concave lens

One of your client’s has just undergone an ear surgery. Which of the following would be
appropriate in planning for his care?

-Daily irrigation of ear canal

The above patient eventually underwent surgery. To promote and maintain safety for a
client after a stapedectomy, what would be included in the nursing care plan?

-Implement fall precaution

The client tells the nurse that the eye doctor said the pressure in her right eye was 19 and
asks if this is normal. What is the appropriate answer?

-19 is within normal range

The nurse assessing a client with an impacted cerumen would be aware that the presenting
clinical manifestation will be:

-Conductive hearing disorder

The nurse caring for a 72-year old woman recently diagnosed with Meniere’s disease would
know that the nursing diagnosis most frequently associated with this problem is

-Risk for Injury related to hearing loss

The nurse would recommend that a client with Meniere’s disease avoid snack foods such as:

-Canned goods

When a client with Meniere’s disease experiences an episode of vertigo with nausea, the
nurse would advise the client to:
-Remain stationary for 5 minutes

Which statement made by a client with conjunctivitis indicates the need for further
teaching?

-I will prescribed eye drops at room temperature

While doing an ear irrigation for a patient with impacted cerumen, the nurse should observe
the following:

-All of the above

Absence of red reflex indicates which of the following eye disorders_____?

-Cataract

As nurse Seth was assign to a patient with macular degeneration, you will not expect to
extract the following date as risk factor for this condition_____:

-Myopia

Mr Kevin ask the nurse “Is complete vision will return upon treating my glaucoma?” The
most appropriate response is_____:

-Although some vision has been lost and cannot be restored, further loss may be prevented
by adhering to the treatment plan

Mr Rebadulla has been diagnosed to have Meniere’s disease. All but one are the following
should Mr Rebadulla avoid to prevent acute attack of the disease except:

-Fruit juices
NERVOUS QUIZ:

The nurse correctly positions the patient for lumbar puncture in

-Lateral recumbent position with knees flexed.

What is the priority nursing assessment in the first 24 hours after admission for the client with
thrombotic CVA?

-Pupil size and papillary responses

The client with Parkinson’s disease has a nursing diagnosis of Risk for falls related to abnormal gait
documented in the nursing care plan. The nurse assesses the client expecting to observe which type of
gait:

-Unsteady and staggering

The nurse observes the client’s right eye does not close totally. Based on the finding, which nursing
intervention is most appropriate?

-Place an eye patch over the completely closed right eye

A woman in her early 30’s has recently been diagnosed with multiple sclerosis. The nurse has taught the
patient’s husband about the course of illness and what problems might occur in the future. Which
statement by the husband indicates a need for further teaching?

-“She might end up having intermittent short term memory loss”

The nurse is reviewing the biographic data and history for the patient with Myasthenia gravis. What
does the nurse expect to see included in the patient’s records?

-Muscle weakness that increases with exertion or as the day wears on

A client is being switched from levodopa to carbidopa-levodopa (Sinemet). The nurse should monitor for
which if the following possible complications that can occur during the period of medication change and
dosage adjustment?
-Vital signs fluctuation

Which of the following is most effective in assessing the client with a head injury for the development of
diabetes insipidus?

-Measuring urine output hourly

What is the correct nursing intervention when a client with a head injury begins to have a clear drainage
from the nose?

-Give the client a white pad to collect the fluid

The client ask the nurse why she has migraine headache. What is the nurse’s best response?

-Migraine headache are believed to be caused by dilation of the cranial arteries

Riza, 24 y/o is admitted to the hospital with diagnosis of Guillain-Barre syndrome. The nurse inquires
during the nursing admission interview if the client has history of:

-Recent history of respiratory infections

Which clinical manifestation in a client does the nurse assess as a typical reaction to long-term
phenytoin (Dilantin) therapy?

-Excessive growth of gum tissue

Information provided by the patient that would help differentiate a hemorrhagic stroke from a
thrombotic stroke includes:

-Sudden onset of severe headache

When an unconscious client with multiple injuries arrives in the emergency room. Which of the
following nursing interventions receives the highest priority?

-Establishing an airway

3 months later, Mike was brought to the ER after being found having difficulty of breathing. The client is
experiencing a myasthenic crisis. Which of the following is the priority action of the following ordered
actions?
-Prepare ET set

Although an adverse reaction to Tensilon is considered rare, which medication should be readily
available to give as an antidote in case the patient should experience complications?

-Atropine sulfate

The healthcare provider is teaching a student about Parkinson disease (PD). Which of these statements
best describes the brain abnormality characteristic of the disease?

-Neurons in the substantia nigra begin to degenerate

When the nurse talks with a client with MS who has slurred speech, which nursing interventions is
contraindicated?

-Asking the client to speak louder when tired

The nurse determines that Baclofen (Lioresal) is accomplishing its intended purpose for client with MS
when it achieve which of the following?

-Relieves muscular spasticity

A client with MS is experiencing bowel incontinence and is starting a bowel retraining program. Which
strategy is inappropriate?

-Limiting fluid intake to 1000ml/day

Which of the following patients does the nurse recognize as the one with the highest risk for a stoke?

-A 65-year old man with hypertension

The nurse plans care for the patient with increased intracranial pressure with the knowledge that the
best way to position the patient is to:

-Elevate the head of the bed to 30 degrees

During admission of a patient with a severe head injury to the emergency department, the nurse places
the highest priority on assessment for:
-Patency of airway

Following a left hemisphere stroke, the patient has expressive (Broca’s) aphasia. Which intervention is
best to use when communicating with this patient?

-Develop a picture board that has objects and activities

The nurse is caring for the patient with relatively minor head injury after a bump to the head. The nurse
has the greatest concern about which symptom?

-Unequal pupils

A patient who has been prescribed the antiparkinsonian medication Sinemet, asks the healthcare
provider. “why am I getting these two medications?” Nurse best explains that:

-The carbidopa prevents the breakdown of the levodopa”

What is the priority intervention when suctioning an unconscious client admission to maintain cerebral
perfusion?

-Hyperoxygenate before and after suctioning

Which of the following is the most sensitive and reliable indicator of the patient’s neurologic status?

-level of consciousness

Which of the following medications may safely be administered to a patient with increased ICP? Select
all that apply.

1. Mannitol (Osmitrol) 25%.

2. Nembutal (Pentobarbital).

3. Morphine sulfate.

4. Prilosec (Omeprazole).

5. Demerol (Meperidine).

6. Valium ( Diazepam).

-1, 2, 4
The client is placed in right side lying position. Which of the following position is incorrect?

-The left arm is rested on the mattress with elbow flexed.

The three cardinal symptoms of Parkinson’s disease are EXCEPT:

-Chorea

Joan, 38 y/o, is diagnosed with Multiple Sclerosis (MS) is admitted to the medical unit. When assessing
the patient, which of the following will the healthcare expect to identify?

-Nystagmus and diplopia

A patient with right-sided hemiplegia and aphasia resulting from a stroke most likely has involvement of
the:

-Left middle cerebral artery

Which of the following result from parasympathetic nervous system stimulation? Select all that apply:

1. Dilation of peripheral blood vessel.

2. Increased secretion of insulin.

3. Increased blood glucose levels.

4. Contraction of the urinary bladder.

5. Increased salivation.

6. Constipation.

-1, 2, 4, 5

For the client who is experiencing expressive aphasia, which nursing interventions most helpful in
promoting communication?

-Using a picture board

The patient has sustained a traumatic brain injury. Which nursing intervention is best for the patient?

-Position to avoid extreme flexion

A male client with Bell’s Palsy asks the nurse what has caused this problem. The nurse’s response is
based on an understanding that the cause is:

-Unknown, but possibly includes long term tissue malnutrition and cellular hypoxia

When the nursing performs oral hygiene for an unconscious client, which nursing intervention is the
priority?

-Keep a suction machine available

A client from China tells the nurse, “If I could be among my people, I could receive acupuncture for this
pain.” The nurse should understand that acupuncture in the Asian culture is based on theory that it?

-Restores the balance of energy

The triad of symptoms the nurse would expect to find during assessment of patient with Parkinson’s
Disease is:

-Tremor, rigidity, bradykinesia

The nurse is assessing the patient with a diagnosis of Guillain-Barre syndrome (GBS). Which physical
finding is the nurse likely to observe?

-Sudden onset of weakness in the legs

Which goal is the most realistic and appropriate for a client diagnosed with Parkinson’s Disease?

-To maintain optimal body function

A patient has been diagnosed to have Myasthenia gravis. Which of the following nursing measures
should be included in his plan of care? Select all that apply:

1. Maintain adequate ventilation.

2.Administer cholinergic on time.

3. Start meal with hot soup or beverage.

4. Administer medications20-30 mins. A.C.

5. Cover each eye alternately for strabismus

-1, 2, 4, 5

The patient with increased intracranial pressure (ICP) is receiving Decadron (Dexamethasone). Which of
the following nursing measures should be included in the plan of care? Select all that apply.

1. Monitor blood glucose levels.

2. Observe for Melena or Hematemesis

3. Measure and record fluid intake and output, vital signs, and weight.

4. Protect patient from infection

5. Question order of Zantac (Ranitidine).

-1, 3, 4

A client experiencing mood swings after CVA and often has episodes of tearfulness that are distressing
to the family. Which is the best technique for the nurse to instruct the family members to try when the
client experiences a crying episodes?

-Attempt to divert the clients attention

During routine assessment of a patient with Guillain-Barre Syndrome, the nurse finds the patient to be
short of breath. The be short of breath. The patient’s respiratory distress is caused by:

-Immobility resulting from ascending paralysis

Which of the following is an initial sign of Parkinson’s disease?

-Tremors

A patient is diagnosed to have multiple sclerosis. He experiences electric shock sensation radiating down
the spine or into the limbs with flexion of the neck. This sign is known as:

-Lhermitte’s sign

The patient was involved in a car collision. Which of the following is typical characteristic sign of
concussion?

-Amnesia regarding the event

The nurse is teaching the family of the client with dysphagia about decreasing the risk of aspiration
while eating. Which of the following strategies is inappropriate?

-Restricting the diet to liquid until swallowing improves

ORTHO QUIZ:

When preparing the teaching plan for a client about crutch walking using a two-point gait pattern.
Which of the following would the nurse include?

-Advance the crutch on one side and simultaneously advance and bear weight on the opposite foot,
repeat on the opposite side

After amputation of a lower extremity, the following are appropriate nursing measures EXCEPT:

-Keep tourniquet readily available at the bedside

Which of the following would be appropriate to include when preparing a client for magnetic resonance
imaging (MRI) to evaluate a ruptured disc?

-Checking for previous complaints of claustrophobia

To attain maximum effect of Milwaukee brace in the client with Scoliosis. The following instructions
should be given by the nurse EXCEPT:

-Remain in bed most of the time

Fracture is suspected when the nurse observes the following EXCEPT:

-increase in the length of the limb

A nurse is conducting a health screening among females at the mall to assess those who are at high risk
for developing osteoporosis. Which of the following questions is most appropriate to be asked by the
nurse in relation to development of osteoporosis?

-Are you taking corticosteroids?

After arthrocentesis, nursing care includes:

-Rest the affected joint for 8-24hours

A client with spinal cord injury asks the nurse why the dietician has recommended that she decrease her
total daily intake of calcium. Which of the following responses by the nurse would provide the most
accurate information?

-Lack of weight bearing causes demineralization of the leg bone

The nurse determines that the client who has had a lumbar laminectomy with a spinal fusion
understand his postoperative instruction when he places himself in which of the following positions
when sitting in a chair.

-With the feet flat on the floor

After a bilateral lumbar laminectomy at L5-S1, which of the following is a priority nursing diagnosing for
the client in immediate postoperative phase?

-Impaired physical mobility related to back pain

Which of the following activities would the nurse instruct the client with low back pain to avoid?

-Exceeding prescribed exercise program

At which of the following time would the nurse instruct the client take ibuprofen (motrin), prescribed for
left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

-immediately after the meal

Which of the following medications would be prescribed first for a client with rheumatoid arthritis?

-Aspirin

Bone scan is done by:

-Injecting radioisotope per IV and X-rays are taken

If effective traction must be maintained, the following nursing measures must be maintained EXCEPT:

-Remove weights intermittently

A client with a hip fracture has undergone surgery for insertion of femoral head prosthesis. Which of the
following activities would the nurse instruct the client to avoid?

-Crossing the legs while sitting down

Regardless of the type of cast material used, the nurse identifies a knowledge deficit when the client
makes which of the following statements about the care of his cast?

-I can pull out cast padding to scratch inside the cast

While the nurse is providing preoperative teaching, the client says, “I hate the idea of being an invalid
after they cut off my leg.” Which of the following would the nurse’s most therapeutic response?

-Tell me more about how you’re feeling

After teaching a client required to wear a back brace after a spinal fusion, which of the following client
statements indicated effective teaching about skin protection measure with the brace?

-I should wear a thin cotton undershirt under the brace

A client with gout had been prescribed a diet purine-rich food. Which of the following foods would the
nurse teach him avoid eating?

-Anchovies, sardines, sweet breads, and lentils

Which of the following will contribute to the development of primary gout? Select all the apply:

1. Beer and Wine.

2. Eggs and milk.

3. Beef and pork.

4. Butter and Fruits.

5. Clams and oysters.

6. Green beans and peanuts.

7. Salted anchovies and sardines.

-1, 3, 5, 6, 7
A client with spinal cord injury who has been active in sports and outdoor activities talks almost
obsessively about his past activities. In tears, one day he asks the nurse, “Why can’t I stop talking about
those things? I know those are gone forever.” Which of the following responses by the nurse conveys
the best understanding of the client’s behavior?

-Reviewing your losses is a way to help you work through your grief and loss

Which of the following nursing measures is specifically important for the client with crutch field tong:

-Massage the back of the head

While the nurse is providing preoperative teaching, the client says, “I hate the idea of being an invalid
after they cut off my leg.” Which of the following would the nurse’s most therapeutic response?

-Tell me more about how you’re feeling

The appropriate nursing measure to prevent displacement of the prosthesis after a right total hip
replacement for arthritis is to place the patient in which of the following positions:

-The right leg abducted

Tessie, a 75-year-old retiree is admitted in the hospital with rheumatoid arthritis. She complained of
joint pains in her knee. Which of the following activity will reduce the pain?

-Rest and support inflamed joints

A client has been diagnosed to have rheumatoid arthritis. Which of the following are expected
manifestations of the client? Select all that apply:

1. Morning stiffness.

2. Pain-on-nonuse of joints.

3. Subcutaneous nodules.

4. Symmetrical affectation of joints.

5. Common among obese elderly.

6. Commonly affects cartilage of joints.

7. Commonly affects weight-bearing joints.

-1, 2, 3, 4

The following are indications that a client with fracture of the leg is experiencing compartment
syndrome EXCEPT:

-Redness of the site and distal to the affected area

On a visit to the clinic, a client reports the onset of early symptom of rheumatoid arthritis. Which of the
following would the nurse most likely assess?

-Early morning stiffness

The nurse is planning care for the client with a femoral fracture who is in balanced suspension traction.
Which of the following would be the nurse least likely to include in the plan of care?

-Personal hygiene with a complete bedbath

A client has been diagnosed to have bone cancer. The nurse expects to find which of the following
laboratory results?

-Elevated phosphorus levels

After a laminectomy, the client states, “The doctor said that I can do anything I want to”. Which of the
following activities, if stated by the client indicated the need for further teaching?

-Sweeping the front porch

A client who had an above-the-knee amputation is to use crutches until the prosthesis is properly fitted.
When teaching the client about using the crutches the nurse instructs the client to support her weight
primarily in which of the following body areas?

-Hands

A patient has been diagnosed to have rheumatoid arthritis. The following are characteristic
manifestations of the patient:

-Pain on non-use of joints, subcutaneous nodules, elevated ESR

Which early morning activity helps to reduce the symptoms associated with rheumatoid arthritis?
-Holding a cup of tea

A client with history of severe rheumatoid arthritis undergoes surgery. Postoperatively, the client’s right
leg is placed in a continuous passive motion (CPM) device. Which of the following would the nurse
perform when caring for a client receiving CPM therapy?

-Maintaining proper position of the joint on the CPM machine.

A one-year-old child has a fracture at the left femur. He is placed in Brayant’s traction. The reason for
elevation of his both legs at 90-degree angle is

-His weight is not adequate to provide sufficient countertraction so, his entire body must be used

When teaching a woman with spinal cord injury and quadriplegia about her sexual health, the nurse
assesses her understanding of her current sexual function. Which of the following statements by the
client indicated a good understanding of her sexual functioning?

-I can participate in sexual activity but might not experience orgasm

Carpal tunnel syndrome occurs due to the injury of which of the following nerve?

-Median nerve

A client who had an above- the-knee amputation is to use crutches until the prosthesis properly fitted.
When teaching the client about using the crutches the nurse instructs the client to support her weight
primarily on which of the following areas?

-Hands

The teaching program of a patient with SLE (Systemic Lupus Erythematous) should include emphasis on
which of the following?

-Walk in shaded areas

Which of the following actions would be the priority for a client who has been in postanesthesia care
unit (PACU) for 45 minutes after an above-the-knee amputation and develops a dime – sized bright red
spot on the ace bandage above the amputation site.

-Drawing a mark around the side

A client is diagnosed with rheumatoid arthritis, and the nurse describes the disorder to the client. Which
statement by the client indicated a lack of understanding about the disorder?

-It is a localized disease that attacks primarily the large joints of the body

Which of the following is inappropriate nursing action when caring for the client with cast?

-Keep the casted extremity dependent on the mattress

ANSWER LANG:

Advance the crutch on one side and simultaneously advance and bear weight on the opposite foot,
repeat on the opposite side.

The nurse caring for a patient with Sjogren’s syndrome will discuss the likelihood that the patient may
also develop which of the following?

-Tooth decay

To prevent deformities of the knee joints in a client with an exacerbation of rheumatoid arthritis, the
nurse should:

-Encourage motion of the joint within the limits of pain

To prevent edema at the site of sprain, the nurse should do which of the following:

-Apply cold compress on the area for the first 72 hours

The client with a fractured tibia has been taking methocarbamol (Robaxin). When teaching the client
about this drug, which of the following would the nurse include as the drug’s primary effect?

-Relief of muscle spasm

The client has been diagnosed to have osteoarthritis. Which of the following manifestations are
expected of the client? Select all that apply:

1. Pain-on-nonuse of joints.
2. Pain-on-use of joints.

3. Heberden’s nodes.

4. Bouchard’s nodes.

5. Felty’s syndrome.

6. Asymmetrical affection of joints.

-2, 3, 4, 6