1. Which of the following might be an appropriate nursing diagnosis for an epileptic client?
A) Dysreflexia B) Risk for Injury C) Urinary Retention D) Unbalanced Nutrition
2. A young boy is recently diagnosed with a seizure disorder. Which of the following statements by the boys mother indicates a need for further teaching by the nurse?
A) 'I should make sure he gets plenty of rest.' B) 'I should get him a medic alert bracelet.' C) 'I should lay him on his back during a seizure.' D) 'I should loosen his clothing during a seizure.'
3. Which of the following nursing diagnoses might be appropriate as Parkinson - s disease progresses and complications develop?
A) Impaired Physical Mobility B) Dysreflexia C) Hypothermia D) Impaired Dentition
4. Which of the following neurological disorders is characterized by writhing, twisting movements of the face and limbs?
A) epilepsy B) Parkinson - s C) muscular sclerosis D) Huntington - s chorea
5. Ashley and her boyfriend Chris, both 19 years old, are transported to the Emergency Department after being involved in a motorcycle accident. Chris is badly hurt, but Ashley has no apparent injuries, though she appears confused and has trouble focusing on what is going on around her. She complains of dizziness and nausea. Her pulse is rapid, and she is hyperventilating. The nurse should assess Ashleys level of anxiety as:
A) mild. B) moderate. C) severe. D) panic.
1. Right Answer: B Explanation: The epileptic client is at risk for injury due to the complications of seizure activity, such as possible head trauma associated with a fall. The other choices are not related to the question.Reduction of Risk Potential
2. Right Answer: C Explanation: A client having a seizure should be turned to the side to prevent aspiration of secretions. The other statements are correct and indicate adequate understanding of teaching.Reduction of Risk Potential
3. Right Answer: A Explanation: The client with Parkinsons disease can develop a shuffling gait and rigidity, causing impaired physical mobility. The other diagnoses do not necessarily relate to a client with Parkinsons disease. Reduction of Risk Potential
4. Right Answer: D Explanation: Huntingtons chorea is characterized by writhing, twisting movements of the face and limbs. The remaining options are neurological disorders that do not have such movements as part of their disease process. Reduction of Risk Potential
5. Right Answer: C Explanation: The person whose anxiety is assessed as severe is unable to solve problems and has a poor grasp of whats happening in his or her environment. Somatic symptoms such as those described by Ashley are usually present.Vital sign changes are observed. The individual with mild anxiety might report being mildly uncomfortable and might even find performance enhanced. The individual with moderate anxiety grasps less information about the situation, has some difficulty problem-solving, and might have mild changes in vital signs. The individual in panic demonstrates markedly disturbed behavior and might lose touch with reality. Psychosocial Integrity
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