200 Nursezone Medical-surgical Nursing Final Coaching Part 1 (1 To 25)
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SITUATION: A 34 year old woman with myasthenia gravis is taking pyridostigmine and prednisone. She is complaining of increased fatigue and weakness and has difficulty breathing The nurse caring for this patient would do which of the following first?
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Providing adequate ventilatory support
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Discontinue all cholinergic drugs until cholinergic effects subside
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Administer 1 mg atropine to counteract severe cholinergic reactions
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Increase doses of cholinergic drugs as long as the client responds positively to edrophonium treatment
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If you are preparing hard to be a nurse to work in the health sector, try these "200 NurseZone Medical-Surgical Nursing final coaching practice part 1 questions & answers." There are 25 questions to check your knowledge regarding how to handle patients in severe conditions. Do you think you can answer them all? You might have solved these questions in See moreyour nursing coaching class, so it won't be that much hard for you to solve the quiz. All the best!
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- 2.
SITUATION: A 34 year old woman with myasthenia gravis is taking pyridostigmine and prednisone. She is complaining of increased fatigue and weakness and has difficulty breathing A nurse observes a patient when the physician does the diagnostic test to confirm MG. The physician injects 2 mg test does of Edrophonium to the client. No untoward reaction occurred. Another 8 mg was injected and the patient suddenly lifts his weak hand without difficulty. The nurse knows that which test was done to diagnose MG?
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Interferon test
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Prostigmine test
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Mestinon test
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Tensilon test
Correct Answer
A. Tensilon testExplanation
The Tensilon test was done to diagnose MG. The physician injected a test dose of Edrophonium, a short-acting cholinesterase inhibitor, to the patient. When an additional dose of 8 mg was injected, the patient suddenly lifted their weak hand without difficulty. This positive response indicates that the patient has myasthenia gravis, as Edrophonium temporarily improves muscle strength in individuals with MG. The Tensilon test is commonly used to confirm the diagnosis of MG.Rate this question:
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- 3.
SITUATION: The diagnosis of degenerative neurologic disease is most often made in an out-patient setting. However, hospital admission may be necessary when acute relapses or life-threatening events occur The patient has an ascending paralysis to the level of the waist. Knowing the complications of the disorder, the nurse brings which of the following items into the client’s room?
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Flashlight and incentive spirometer
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Electrocardiographic monitoring electrodes and intubation tray
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Blood pressure cuff and suction machine
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Nebulizer and pulse oximeter
Correct Answer
A. Electrocardiographic monitoring electrodes and intubation trayExplanation
The patient's ascending paralysis to the level of the waist suggests a possible neurologic emergency, such as Guillain-Barre syndrome. This condition can lead to respiratory distress and the need for intubation. Electrocardiographic monitoring electrodes are necessary to monitor the patient's cardiac status, as autonomic dysfunction can occur. Therefore, bringing electrocardiographic monitoring electrodes and an intubation tray into the client's room would be appropriate in this situation.Rate this question:
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- 4.
SITUATION: Mr. Ambo is a 75 year old man with Parkinson’s disease. He is admitted to the hospital after experiencing severe nightmare and periods of confusion. During lucid periods, he is very disturbed by these manifestations. At other time, he believes that his wife is participating in a conspiracy to harm him Degenerative neurologic disorders pose a great challenge to the client, the family, and the caregiver. Which is true about Parkinson’s disease?
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It is an inflammatory disease of unknown origin that involves degeneration of the myelin sheath of peripheral nerves
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It is an idiopathic syndrome characterized by disability from tremor and rigidity
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It involves the degeneration of nor-epinephrine-producing cells in the substantia nigra
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It is an infectious disease caused by the Cytomegalovirus
Correct Answer
A. It is an idiopathic syndrome characterized by disability from tremor and rigidityExplanation
Parkinson's disease is an idiopathic syndrome, meaning its cause is unknown. It is characterized by disability from tremor and rigidity. This means that individuals with Parkinson's disease experience symptoms such as shaking/tremors and stiffness in their muscles, which can significantly impact their ability to move and perform daily activities. The disease is not caused by inflammation, an infectious agent like Cytomegalovirus, or the degeneration of the myelin sheath of peripheral nerves. The degeneration of nor-epinephrine-producing cells in the substantia nigra is also not a characteristic of Parkinson's disease.Rate this question:
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- 5.
SITUATION: A 34 year old woman with myasthenia gravis is taking pyridostigmine and prednisone. She is complaining of increased fatigue and weakness and has difficulty breathing Nurse Ludy knowledgeably tells a student nurse that the primary feature of Myasthenia Gravis is:
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Emotional disturbances and mental deterioration
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Increasing weakness with sustained muscle contraction
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Ascending weakness, usually beginning in the lower extremities
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Vague psychiatric or behavior changes suggesting a personality change
Correct Answer
A. Increasing weakness with sustained muscle contractionExplanation
The primary feature of Myasthenia Gravis is increasing weakness with sustained muscle contraction. This means that the patient experiences progressive muscle weakness and fatigue, particularly during activities that require continuous muscle use. This symptom is characteristic of the disease and distinguishes it from other conditions. The patient's complaint of increased fatigue and weakness, along with difficulty breathing, aligns with this primary feature of Myasthenia Gravis.Rate this question:
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- 6.
SITUATION: A 35 year old female, wheelchair bound, is diagnosed with multiple sclerosis. She has a neurogenic bladder. She complains of a sudden onset of generalized weakness, fever, and chills and is admitted to the hospital The most appropriate nursing diagnosis that a nurse could formulate regarding this client is:
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Impaired physical mobility related to generalized weakness
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Knowledge deficit related to diagnosis of MS
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Self-esteem disturbance related to loss of independence and fear of disability
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Altered urinary elimination related to bladder function
Correct Answer
A. Impaired physical mobility related to generalized weaknessExplanation
The most appropriate nursing diagnosis for this client is "Impaired physical mobility related to generalized weakness" because the client is experiencing sudden onset of weakness, which can affect her ability to move and perform activities of daily living. This nursing diagnosis addresses the client's current physical condition and the potential impact it may have on her mobility.Rate this question:
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- 7.
SITUATION: A 35 year old female, wheelchair bound, is diagnosed with multiple sclerosis. She has a neurogenic bladder. She complains of a sudden onset of generalized weakness, fever, and chills and is admitted to the hospital What do generalized weakness, fever and chills suggest to any client with MS?
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Exacerbation is caused by the neurogenic bladder and results in fever and chills
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Fever and chills manifests sepsis
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Fever and chills suggest infection that caused the exacerbation of MS leading to weakness
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The weakness suggests exacerbation. The fever and chills are not related to the exacerbation
Correct Answer
A. Fever and chills suggest infection that caused the exacerbation of MS leading to weaknessExplanation
The presence of fever and chills in a client with multiple sclerosis suggests an infection that has caused the exacerbation of their MS symptoms, leading to weakness. Infections can trigger or worsen MS symptoms, and the sudden onset of generalized weakness along with the presence of fever and chills indicates an infectious process. It is important to address and treat the infection to help alleviate the exacerbation of MS symptoms and improve the client's overall condition.Rate this question:
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- 8.
SITUATION: The diagnosis of degenerative neurologic disease is most often made in an out-patient setting. However, hospital admission may be necessary when acute relapses or life-threatening events occur Mr. Noble is admitted to the hospital with a diagnosis of Guillain-Barre syndrome. Nurse Patty inquires during the nursing admission interview if the client has a history of:
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Respiratory or gastrointestinal infection during the previous month
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Meningitis during the last 5 years
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Back injury or trauma to the spinal cord
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Seizures or trauma to the brain
Correct Answer
A. Respiratory or gastrointestinal infection during the previous monthExplanation
The nurse is asking about a history of respiratory or gastrointestinal infection during the previous month because Guillain-Barre syndrome is often preceded by an infection, most commonly a respiratory or gastrointestinal infection. This information is important because it helps to establish a potential trigger for the development of Guillain-Barre syndrome.Rate this question:
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- 9.
SITUATION: Mr. Ambo is a 75 year old man with Parkinson’s disease. He is admitted to the hospital after experiencing severe nightmare and periods of confusion. During lucid periods, he is very disturbed by these manifestations. At other time, he believes that his wife is participating in a conspiracy to harm him Can the client’s manifestations be related to treatment or to some other cause other than Parkinson’s disease?
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No, Parkinson’s disease usually affect the intellectual ability of a patient
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Yes, it can be a manifestation of Alzheimer’s disease
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No, in severe Parkinson’s the patient experiences dementia, paranoia and hallucination same with Alzheimer’s disease
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Yes, it can be a manifestation of Huntington’s disease
Correct Answer
A. Yes, it can be a manifestation of Alzheimer’s diseaseExplanation
The client's manifestations of severe nightmares, periods of confusion, and belief in a conspiracy can be symptoms of Alzheimer's disease. While Parkinson's disease primarily affects motor abilities, it can also lead to cognitive decline and dementia. However, the specific symptoms described in the situation are more commonly associated with Alzheimer's disease, which is characterized by memory loss, confusion, and paranoia.Rate this question:
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- 10.
SITUATION: By their very nature, degenerative neurologic disorders cause progressive decline in neurologic function. Some progress relatively quickly whereas others progress more gradually, sometimes over decades. A major goal intervention is to help client achieve an optimal level of functioning in light of chronic neurologic deficits A 72 year old female client has Alzheimer’s disease. Her caregiver phones the community health clinic and asks the nurse some advice on the care of this patient, all of the following are inappropriate, except:
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Never laugh with caregivers when talking to them. They might think it’s not a serious matter
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Encourage caregivers to share their knowledge and experience with newly assigned health care staff
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Invalidate the caregiver’s feelings of anger, guilt, exhaustion, and frustration
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Tell caregivers to complain to relatives and not disturb the clinic for irrational complaints regarding the patient with Alzheimer’s
Correct Answer
A. Encourage caregivers to share their knowledge and experience with newly assigned health care staffExplanation
The correct answer is "Encourage caregivers to share their knowledge and experience with newly assigned health care staff." This is inappropriate because it does not align with the goal of helping the client achieve an optimal level of functioning. Sharing knowledge and experience with newly assigned staff may not be helpful in improving the client's condition or providing appropriate care.Rate this question:
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- 11.
SITUATION: Mr. Ambo is a 75 year old man with Parkinson’s disease. He is admitted to the hospital after experiencing severe nightmare and periods of confusion. During lucid periods, he is very disturbed by these manifestations. At other time, he believes that his wife is participating in a conspiracy to harm him During her initial assessment, the nurse observes which cardinal features of Parkinson’s disease? Select all that apply: 1. Freezing movement; 2. Paranoia; 3. Flexed posture of the neck, trunk and limbs; 4. Hallucinations; 5. Tremor at rest; 6. Rigidity
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1, 3, 5, 6
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2, 3, 4
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1, 5, 6
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3, 4, 5, 6
Correct Answer
A. 1, 3, 5, 6Explanation
The nurse observes the cardinal features of Parkinson's disease, which include freezing movement, flexed posture of the neck, trunk, and limbs, tremor at rest, and rigidity. These symptoms are commonly seen in patients with Parkinson's disease and can significantly impact their daily functioning and quality of life. Paranoia and hallucinations are not cardinal features of Parkinson's disease, although they may occur in some patients as a result of the disease or medication side effects.Rate this question:
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- 12.
SITUATION: Mr. Ambo is a 75 year old man with Parkinson’s disease. He is admitted to the hospital after experiencing severe nightmare and periods of confusion. During lucid periods, he is very disturbed by these manifestations. At other time, he believes that his wife is participating in a conspiracy to harm him The nurse evaluates the health teaching on a client with Parkinson’s disase. Further teaching is required when the nurse observes the following, except:
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The client grips the arms of the chair to reduce embarrassing hand tremors
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The patient does range of motion exercises 3 times a week
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The mattress where the client is sleeping is bouncy and soft
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The client sleeps with 2 piles of pillow under his head
Correct Answer
A. The client grips the arms of the chair to reduce embarrassing hand tremorsExplanation
The client gripping the arms of the chair to reduce hand tremors is an appropriate action for someone with Parkinson's disease. Tremors are a common symptom of the disease, and gripping onto something can help stabilize the hands. The other options are all potential areas where further teaching may be required. Range of motion exercises should be done daily, not just 3 times a week, to maintain flexibility and prevent muscle stiffness. The mattress being bouncy and soft may not provide enough support for someone with Parkinson's, who may have difficulty with balance and coordination. Sleeping with two piles of pillows under the head can cause strain on the neck and may not provide proper support for sleep.Rate this question:
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- 13.
SITUATION: The diagnosis of degenerative neurologic disease is most often made in an out-patient setting. However, hospital admission may be necessary when acute relapses or life-threatening events occur Mr. Noble has ascending paralysis and is intubated and is receiving mechanical ventilation. Which of the following strategies would the nurse incorporate in the plan of care to help the client cope with this illness?
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Providing positive feedback and encouraging active range of motion
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Providing information, giving postage feedback, and encouraging relaxation
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Giving client full control over care decisions and restricting visitors
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Providing intravenously administered sedatives, reducing distractions, and limiting visitors
Correct Answer
A. Providing information, giving postage feedback, and encouraging relaxationExplanation
The nurse would incorporate the strategy of providing information, giving positive feedback, and encouraging relaxation in the plan of care to help the client cope with the illness of ascending paralysis and mechanical ventilation. This approach aims to empower the client with knowledge about their condition, which can reduce anxiety and improve their ability to cope. Giving positive feedback can boost the client's morale and motivation. Encouraging relaxation techniques can help the client manage stress and promote a sense of calmness.Rate this question:
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- 14.
SITUATION: A 34 year old woman with myasthenia gravis is taking pyridostigmine and prednisone. She is complaining of increased fatigue and weakness and has difficulty breathing The patient’s MG is in its early course. The physician recommends a thymectomy. The nurse in the surgical ward is preparing the client for surgery. Which action by the nurse will denote a violation of the bio-ethical principle non-maleficence?
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Removing dentures and contact lens in the client’s room
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Endorsing valuables to relatives
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Blood standby available
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Letting the patient void after giving preoperative medications
Correct Answer
A. Letting the patient void after giving preoperative medicationsExplanation
Letting the patient void after giving preoperative medications may denote a violation of the bio-ethical principle of non-maleficence because it can increase the risk of aspiration during surgery. It is important to ensure that the patient's bladder is empty before surgery to minimize the risk of complications.Rate this question:
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- 15.
SITUATION: By their very nature, degenerative neurologic disorders cause progressive decline in neurologic function. Some progress relatively quickly whereas others progress more gradually, sometimes over decades. A major goal intervention is to help client achieve an optimal level of functioning in light of chronic neurologic deficits Eaton-Lambert (Myasthenic) syndrome is a myasthenia-like condition in which weakness is noted in the limbs. Because MG can precede the development of cancer by many years, clients with this syndrome should be assessed for the development of cancer:
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Yearly
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Every six months
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Every 5 years
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Every month
Correct Answer
A. YearlyExplanation
Clients with Eaton-Lambert (Myasthenic) syndrome should be assessed for the development of cancer on a yearly basis. This is because myasthenia gravis (MG) can precede the development of cancer by many years. Regular assessments are important to detect any potential cancer development in these clients.Rate this question:
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- 16.
SITUATION: A 35 year old female, wheelchair bound, is diagnosed with multiple sclerosis. She has a neurogenic bladder. She complains of a sudden onset of generalized weakness, fever, and chills and is admitted to the hospital A variety of precipitating factors can precede the onset or an exacerbation of Multiple sclerosis. All of the following are precipitating factors of MS, except:
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Pregnancy
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Lactation
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Physical injury
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Emotional stress
Correct Answer
A. LactationExplanation
Lactation is not a precipitating factor of multiple sclerosis. Pregnancy, physical injury, and emotional stress are known to be precipitating factors that can trigger the onset or exacerbation of MS symptoms. However, lactation, which is the production of breast milk after childbirth, is not typically associated with the onset or exacerbation of MS symptoms.Rate this question:
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- 17.
SITUATION: A 35 year old female, wheelchair bound, is diagnosed with multiple sclerosis. She has a neurogenic bladder. She complains of a sudden onset of generalized weakness, fever, and chills and is admitted to the hospital With the nursing diagnosis of knowledge deficit related to diagnosis of MS. The nurse reiterates the following interventions to prevent exacerbations of MS to the patient, except:
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Identify aggravating factors that lead to exacerbations
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Increase the body’s resistance to illness with intake of citrus fruits
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Confront people who are making her life miserable and try to resolve it
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Avoid stressors such as tiring activities and having a negative outlook in life
Correct Answer
A. Confront people who are making her life miserable and try to resolve itExplanation
The correct answer is "Confront people who are making her life miserable and try to resolve it." This is not a recommended intervention for preventing exacerbations of MS. It is important for the patient to identify aggravating factors that lead to exacerbations, increase their body's resistance to illness with intake of citrus fruits, and avoid stressors such as tiring activities and having a negative outlook in life. However, confronting people who are making her life miserable may not be within the patient's control and may not necessarily prevent exacerbations of MS.Rate this question:
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- 18.
SITUATION: The diagnosis of degenerative neurologic disease is most often made in an out-patient setting. However, hospital admission may be necessary when acute relapses or life-threatening events occur Nurse Ofelia is evaluating the respiratory outcomes for the client. She determines that which of the following is the least optimal outcome for the client?
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Oxygen saturation of 97%
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Adventitious breath sounds
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Spontaneous breathing
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Vital capacity within normal change
Correct Answer
A. Adventitious breath soundsExplanation
Adventitious breath sounds indicate abnormal lung sounds, such as crackles or wheezes, which can be a sign of respiratory distress or underlying lung pathology. In the context of a client with degenerative neurologic disease, the presence of adventitious breath sounds suggests a worsening of respiratory function and may indicate a need for further intervention or medical attention. Therefore, adventitious breath sounds would be considered the least optimal outcome for the client.Rate this question:
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- 19.
SITUATION: Mr. Ambo is a 75 year old man with Parkinson’s disease. He is admitted to the hospital after experiencing severe nightmare and periods of confusion. During lucid periods, he is very disturbed by these manifestations. At other time, he believes that his wife is participating in a conspiracy to harm him The nurse observes changes in behavior on the patient and proceeds with a focused assessment to differentiate dementia and delirium. Choose all the assessments that are unique to delirium: 1. Impaired judgment; 2. Intervals of lucidity; 3. Distorted perceptions; 4. Hyperkinetic behavior; 5. Abrupt onset of symptoms
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1, 2, 5
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3, 4, 5
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2, 4, 5
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3, 4, 5
Correct Answer
A. 2, 4, 5Explanation
The assessments that are unique to delirium in this situation are intervals of lucidity, hyperkinetic behavior, and abrupt onset of symptoms. Impaired judgment and distorted perceptions can be seen in both dementia and delirium, so they are not unique to delirium.Rate this question:
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- 20.
SITUATION: By their very nature, degenerative neurologic disorders cause progressive decline in neurologic function. Some progress relatively quickly whereas others progress more gradually, sometimes over decades. A major goal intervention is to help client achieve an optimal level of functioning in light of chronic neurologic deficits A 40 year old man, diagnosed with Huntington’s disease chorea, was brought to the hospital. He is emaciated as a result of dysphagia. Which of the following nursing interventions is not appropriate?
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Include chopped meat and gravy with mashed potatoes in diet
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Allow visiting relatives to join in meal times
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Small frequent feedings should be avoided
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Instruct patient not to hold breath when swallowing
Correct Answer
A. Small frequent feedings should be avoidedExplanation
Small frequent feedings should be avoided. This is not an appropriate nursing intervention because the patient is emaciated as a result of dysphagia. Dysphagia is difficulty in swallowing, and in this case, it has caused the patient to become emaciated. Small frequent feedings are typically recommended for patients with dysphagia to prevent choking and aspiration. Therefore, avoiding small frequent feedings would not be beneficial for the patient's condition.Rate this question:
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- 21.
SITUATION: A 34 year old woman with myasthenia gravis is taking pyridostigmine and prednisone. She is complaining of increased fatigue and weakness and has difficulty breathing The nurse in the emergency department is suspecting a cholinergic crisis from the patient with myasthenia gravis. Aside from weakness and difficulty of breathing, what other signs and symptoms will the nurse anticipate:
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Severe respiratory distress and cyanosis
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Absent cough and swallow reflex
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Sudden marked increase in blood pressure due to hypoxia
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Apprehension, nausea, vomiting and abdominal cramps
Correct Answer
A. Apprehension, nausea, vomiting and abdominal crampsExplanation
In a cholinergic crisis, there is an excessive accumulation of acetylcholine due to overmedication with cholinesterase inhibitors like pyridostigmine. This leads to excessive stimulation of cholinergic receptors throughout the body, resulting in symptoms such as weakness, difficulty breathing, and increased fatigue. Additionally, cholinergic crisis can cause gastrointestinal symptoms such as nausea, vomiting, and abdominal cramps. Apprehension may also occur due to the respiratory distress caused by the crisis. Therefore, the nurse can anticipate these signs and symptoms in a patient experiencing a cholinergic crisis.Rate this question:
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- 22.
SITUATION: A 35 year old female, wheelchair bound, is diagnosed with multiple sclerosis. She has a neurogenic bladder. She complains of a sudden onset of generalized weakness, fever, and chills and is admitted to the hospital With the patient’s alteration in urinary elimination, the nurse conducts a health teaching to the client regarding self catheterization. Which statement when made by the client denotes effective teaching?
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“I could use the clean red rubber catheter for 2 weeks as long as it is washed properly”
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“I should maintain the sterility of the catheter when I sue it as home”
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“I could use the cle3an red rubber catheter for up to 1 week, as long as it is washed with running water”
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“After using the catheter I should wash it thoroughly with soap and water and keep it in a clean, tightly sealed plastic bag”
Correct Answer
A. “After using the catheter I should wash it thoroughly with soap and water and keep it in a clean, tightly sealed plastic bag”Explanation
The correct answer is "After using the catheter I should wash it thoroughly with soap and water and keep it in a clean, tightly sealed plastic bag". This statement denotes effective teaching because it emphasizes the importance of proper cleaning and storage of the catheter to prevent infection. Washing the catheter with soap and water helps to remove any bacteria or debris, and storing it in a clean, sealed bag helps to maintain its sterility. This demonstrates the client's understanding of the necessary steps for self-catheterization hygiene.Rate this question:
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- 23.
SITUATION: By their very nature, degenerative neurologic disorders cause progressive decline in neurologic function. Some progress relatively quickly whereas others progress more gradually, sometimes over decades. A major goal intervention is to help client achieve an optimal level of functioning in light of chronic neurologic deficits Supportive nursing care is an important aspect of managing Amyotrophic Lateral Sclerosis (ALS). Which is the most therapeutic intervention of the community health nurse when interacting with the client and the client’s family?
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Leave the client and family when they are discussing about problems regarding ALS
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Instruct patient on how to use a walker
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After doing morning care, assist patient with active range of motion exercises
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Discourage clients to complete advance directives
Correct Answer
A. Instruct patient on how to use a walkerExplanation
The most therapeutic intervention of the community health nurse when interacting with the client and the client's family in managing ALS is to instruct the patient on how to use a walker. This intervention helps the client maintain mobility and independence, which is crucial in managing the progressive decline in neurologic function associated with ALS. By providing instruction on using a walker, the nurse supports the client's optimal level of functioning and helps them adapt to their chronic neurologic deficits.Rate this question:
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- 24.
SITUATION: The diagnosis of degenerative neurologic disease is most often made in an out-patient setting. However, hospital admission may be necessary when acute relapses or life-threatening events occur Guillain-Barre syndrome is an inflammatory disease of unknown origin. Although many organism have been suspected, Campylobacter jejuni is the organism most often implicated. This gram-negative rod is found in:
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Shellfish
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Poultry
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The soil
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Airborne
Correct Answer
A. PoultryExplanation
Poultry is the correct answer because Campylobacter jejuni, the organism most often implicated in Guillain-Barre syndrome, is commonly found in poultry. This suggests that consuming contaminated poultry products may increase the risk of developing the syndrome.Rate this question:
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- 25.
SITUATION: By their very nature, degenerative neurologic disorders cause progressive decline in neurologic function. Some progress relatively quickly whereas others progress more gradually, sometimes over decades. A major goal intervention is to help client achieve an optimal level of functioning in light of chronic neurologic deficits A client is experiencing chronic insomnia. The nurse interprets that which of the following areas of the brain is involved?
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Temporal lobe and frontal lobe
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Limbic system and cerebral hemispheres
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Hippocampus and frontal lobe
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Reticular activating system and cerebral hemispheres
Correct Answer
A. Reticular activating system and cerebral hemispheresExplanation
The nurse interprets that the reticular activating system and cerebral hemispheres are involved in chronic insomnia. The reticular activating system is responsible for regulating wakefulness and sleep-wake transitions, while the cerebral hemispheres play a role in controlling sleep patterns and maintaining a regular sleep-wake cycle. Dysfunction in these areas can lead to difficulty falling asleep or staying asleep, resulting in chronic insomnia.Rate this question:
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Mar 05, 2024Quiz Edited by
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Jan 02, 2012Quiz Created by
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