Test Bank NSG 210 Caring for Clients With Neurologic Deficits Questions & Answer sand Rationale,100% CORRECT
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NSG 210
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NSG 210
Test Bank NSG 210 Caring for Clients With Neurologic Deficits Questions & Answer sand Rationale
1.A client with a neurologic deficit has been admitted to your unit. The nurse caring for the client is assessing the client and observes significant changes in the client's status. Which of the followi...
test bank nsg 210 caring for clients with neurologic deficits questions amp answer sand rationale
a client with a neurologic deficit has been admitted to your unit the nurse caring for the client i
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Test Bank NSG 210 Caring for Clients With Neurologic Deficits
Questions & Answer sand Rationale
1.A client with a neurologic deficit has been admitted to your unit. The nurse
caring for the client is assessing the client and observes significant changes
in the client's status. Which of the following action should the nurse perform
immediately?
A) Use the Glasgow Coma Scale.
B) Use the Mini-Mental Status Examination.
C) Report the change to the physician.
D) Monitor the blood pressure.
Ans: C
Feedback:
When significant changes occur, the nurse should immediately report them
to the physician. The nurse uses the Glasgow Coma Scale or other
neurologic assessment tools, such as the Mini-Mental Status Examination, to
perform the neurologic assessments to evaluate the client's status. The nurse
maintains the blood pressure to ensure adequate cerebral oxygenation.
2.When a nurse is caring for a client diagnosed with neurologic deficit who
has begun responding to those around him, what therapy should the nurse
suggest to help strengthen muscles that are under voluntary control?
A) Occupational therapy
B) Range-of-motion (ROM) exercises
C) Recreational therapy
D) Physiotherapy
Ans: A
Feedback:
Occupational therapy is designed to help strengthen muscles that are under
voluntary control. ROM exercises maintain joint flexibility and prevent
permanent contractures. Participation in recreational therapies increases
socialization time.
3.A nursing instructor is teaching the senior nursing class about clients with
neurologic disorder. The instructor tells the students that these clients are at
risk of disuse syndrome due to musculoskeletal inactivity and neuromuscular
impairment. What nursing intervention helps prevent plantar flexion?
A) Use of parallel bars or a walker
B) Application of an abdominal binder
C) Use of a footboard
Page 1
,D) Use of a flotation mattress
Ans: C
Feedback:
A footboard positions the foot and ankle in such a way as to prevent plantar
flexion. Parallel bars help the client with impaired mobility to support body
weight and move forward before ambulating independently. An abdominal
binder prevents dizziness and faintness. A flotation mattress helps relieve
pressure when the client is lying down and sitting.
Page 2
, 4. You are caring for an 82-year-old client who needs bladder training.
You know that bladder training is difficult for older adult clients with
neurologic deficit because of what?
A) Urinary incontinence
B) Urinary retention
C) Decreased energy expenditure
D) Relaxation of the internal bladder
sphincter Ans: D
Feedback:
An age-related delay in the relaxation of the internal bladder sphincter may
make bladder training difficult. Urinary incontinence, urinary retention, and
decreased energy expenditure are not the factors that make bladder training
difficult for older adult clients with neurologic deficit.
5. Whatwould the nurse do to best assist the client in increasing peristalsis and
encouraging defecation after suffering from a neurologic deficit?
A) Help the client to the bathroom at a particular time each day.
B) Administer a low-volume enema each day at the same time.
C) Encourage liquids throughout the day.
D) Encourage a high-fiber diet.
Ans: A
Feedback:
Helping the client to the bathroom at a particular time each day increases
peristalsis and encourages defecation because of the physical activity
involved in getting out of bed.
Administering a low-volume enema stimulates a bowel movement. Increase
in fluid intake and a high-fiber diet will aid in normalizing bowel
movements.
6. Which
of the following assessment tools should the nurse use to perform
a neurologic assessment?
A) Cutaneous triggering
B) Mini-Mental Status Examination
C) Credé's maneuver
D) Mechanical lift
Ans: B
Feedback:
The nurse uses assessment tools such as the Mini-Mental Status
Page 3
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