Introductory Medical Surgical Nursing 11th Edition by Barbara K. Tim
Introductory Medical Surgical Nursing 11th Edition by Barbara K. Tim
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Chapter 37, Caring for Clients With Central and Periphera
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
| 1. | The nurse is caring for a client with trigeminal neuralgia (tic douloureux). The care plan for this client reflects the client’s problem eating due to jaw pain. To assist the client in meeting the adequate nutritional needs, what should the nurse suggest? | |
| A) | Take small meals of nutrient and calorie-dense food. | |
| B) | Increase the intake of calcium and proteins. | |
| C) | Include additional servings of fruits and raw vegetables. | |
| D) | Include fish, liver, and chicken in diet. | |
| Ans: | A | |
| Feedback: | ||
| To help a client with trigeminal neuralgia who suffers pain in the jaws meet his or her nutritional needs, the nurse should offer small meals of soft consistency. Foods may be pureed to minimize jaw movements when eating. There is no need for the client to increase the intake of fruits and raw vegetables, calcium, or proteins during trigeminal neuralgia. In addition, an increased intake of fruits and raw vegetables requires excessive chewing, potentially increasing the incidence of jaw pain. The nurse should avoid offering meat and fish in the diet because they also require excessive chewing by the client. | ||
| 2. | An older client complains of a constant headache. A physical examination shows papilledema. What may the symptoms indicate in this client? | |
| A) | Epilepsy | |
| B) | Trigeminal neuralgia | |
| C) | Hypostatic pneumonia | |
| D) | Brain tumor | |
| Ans: | D | |
| Feedback: | ||
| Headache and papilledema are symptoms of a brain tumor, although these symptoms do appear less often in the older adult. Symptoms of epilepsy include seizure activity, whereas symptoms of trigeminal neuralgia would be pain in the jaws or facial muscles. Hypostatic pneumonia develops due to immobility or prolonged bed rest in older clients. Choices A, B, and C are not associated with papilledema or constant headache. | ||
| 3. | A client you are caring for experiences a seizure. What would be a priority nursing action? | |
| A) | Restrain the client during the seizure. | |
| B) | Insert a tongue blade between the teeth. | |
| C) | Protect the client from injury. | |
| D) | Suction the mouth during the convulsion. | |
| Ans: | C | |
| Feedback: | ||
| The nursing action for a client experiencing a seizure should be to protect the client from being injured. To ensure this, the nurse should turn the client to one side and not restrain client’s movements. Inserting a tongue blade between the teeth is not as important as protecting the client from injury. The mouth and the pharynx of the client should be suctioned only after the seizure. | ||
| 4. | You are the nurse caring for a client with Guillain-Barré syndrome (GBS). The client also has an ascending paralysis. Knowing the potential complications of the disorder, what should you keep always ready at the bedside? | |
| A) | Nebulizer and thermometer | |
| B) | Intubation tray and suction apparatus | |
| C) | Blood pressure apparatus | |
| D) | Incentive spirometer | |
| Ans: | B | |
| Feedback: | ||
| Progressive GBS can move to the upper areas of the body and affect the muscles of respiration. If the respiratory muscles are involved, endotracheal intubation and mechanical ventilation become necessary. A spirometer is used to evaluate the client’s ventilation capacity. A blood pressure apparatus, nebulizer, and thermometer are not required because generally a client with GBS does not show signs of increased blood pressure or temperature. | ||
| 5. | The critical care nurse is caring for a client with bacterial meningitis. The client has developed cerebral vasculitis and increased ICP. What neurologic sequelae might this client develop? | |
| A) | Damage to the nerves that facilitate vision and hearing | |
| B) | Damage to the vagal nerve | |
| C) | Damage to the olfactory nerve | |
| D) | Damage to the facial nerve | |
| Ans: | A | |
| Feedback: | ||
| Neurologic sequelae in survivors include damage to the cranial nerves that facilitate vision and hearing. Sequelae to meningitis do not include damage to the vagal nerve, the olfactory nerve, or the facial nerve. | ||
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