A course review NCLEX prep Assure your mastery of medical-surgical nursing knowledge while honing your critical-thinking and test-taking skills. This popular resource features about 2, questions including more alternate-format questions that reflect the latest advances in medical-surgical nursing and the latest NCLEX-RN R test plan.

Each chapter is a self-contained unit. For each practice question, you'll find the answer, rationales for correct and incorrect responses, and a test-taking tip. The comprehensive exam at the end of each chapter assesses your strengths and weaknesses, identifying areas for further study. See what students are saying online about the previous edition A Must-Have! They really help. Score: 5. Cram Just the FACTS studyguides gives all of the outlines, highlights, and quizzes for your textbook with optional online comprehensive practice tests.

Only Cram is Textbook Specific. Accompanies: Explain to the client that there will be some discomfort during the procedure. The nurse enters the room as the client is beginning to have a tonic-clonic seizure. What action should the nurse implement first? Note the first thing the client does in the seizure. Determine if the client is incontinent of urine or stool.

Provide the client with privacy during the seizure. The client who just had a three 3 -minute seizure has no apparent injuries and is oriented to name, place, and time but is very lethargic and just wants to sleep. Perform a complete neurological assessment. Awaken the client every 30 minutes. Turn the client to the side and allow the client to sleep.

Interview the client to find out what caused the seizure. The unlicensed assistive personnel UAP is attempting to put an oral airway in the mouth of a client having a tonic-clonic seizure.

Which action should the primary nurse take? Help the UAP to insert the oral airway in the mouth. Tell the UAP to stop trying to insert anything in the mouth. Take no action because the UAP is handling the situation. Notify the charge nurse of the situation immediately. The client is prescribed phenytoin Dilantin , an anticonvulsant, for a seizure disorder. Which statement indicates the client understands the discharge teaching concerning this medication?

The client is admitted to the intensive care department ICD experiencing status epilepticus. Which collaborative intervention should the nurse anticipate? Administer an anticonvulsant medication by intravenous push.

Prepare to administer a glucocorticosteroid orally. The client has been newly diagnosed with epilepsy. Which discharge instructions should be taught to the client? Keep a record of seizure activity.

Take tub baths only; do not take showers. Avoid over-the-counter medications. Have anticonvulsant medication serum levels checked regularly.

Do not drive alone; have someone in the car. Which statement by the female client indicates that the client understands factors that may precipitate seizure activity? The nurse asks the male client with epilepsy if he has auras with his seizures. What are auras? The nurse educator is presenting an in-service on seizures.

Which disease process is the leading cause of seizures in the elderly? Cerebral vascular accident stroke. Brain atrophy due to aging. Brain Tumors The client is being admitted to rule out a brain tumor. Which classic triad of symptoms supports a diagnosis of brain tumor? Nervousness, metastasis to the lungs, and seizures. Headache, vomiting, and papilledema. Hypotension, tachycardia, and tachypnea. Abrupt loss of motor function, diarrhea, and changes in taste.

The client has been diagnosed with a brain tumor. Which presenting signs and symptoms help to localize the tumor position? Widening pulse pressure and bounding pulse. Diplopia and decreased visual acuity.

Bradykinesia and scanning speech. Hemiparesis and personality changes. The male client diagnosed with a brain tumor is scheduled for a magnetic resonance imaging MRI scan in the morning. The client tells the nurse that he is scared. Which response by the nurse indicates an appropriate therapeutic response? Tell me about what is scaring you. The client diagnosed with breast cancer has developed metastasis to the brain. Which prophylactic measure should the nurse implement?

Institute aspiration precautions. Refer the client to Reach to Recovery. Initiate seizure precautions. Teach the client about mastectomy care. The significant other of a client diagnosed with a brain tumor asks the nurse for help identifying resources. Which would be the most appropriate referral for the nurse to make? Social worker. Health-care provider. Occupational therapist. The nurse has written a care plan for a client diagnosed with a brain tumor.

Which is an important goal regarding self-care deficit? The client will maintain body weight within two 2 pounds. The client will execute an advance directive. The client will be able to perform three 3 ADLs with assistance. The client will verbalize feeling of loss by the end of the shift. The client diagnosed with a brain tumor was admitted to the intensive care unit with decorticate posturing. The client has purposeful movement with painful stimuli. The client has assumed adduction of the upper extremities.

The client is aimlessly thrashing in the bed. The client has become flaccid and does not respond to stimuli. The client is diagnosed with a pituitary tumor and is scheduled for a transsphenoidal hypophysectomy. Which preoperative instruction is important for the nurse to teach? There will be a large turban dressing around the skull after surgery. The client will not be able to eat for four 4 or five 5 days postop. The client should not blow the nose for two 2 weeks after surgery.

The client will have to lie flat for 24 hours following the surgery. The client has undergone a craniotomy for a brain tumor. Which data indicate a complication of this surgery? The client has an intake of 1, mL and an output of 3, mL.

The client complains of a raspy sore throat. The client experiences dizziness when trying to get up too quickly. The client diagnosed with a brain tumor has a diminished gag response. Make the client NPO until seen by the health-care provider. Place the client on a mechanically ground diet. Teach the client to direct food and fluid toward the unaffected side.

The client is diagnosed with a metastatic brain tumor, and radiation therapy is scheduled. It has helped my other tumors. Chemotherapy is only used as a last resort in caring for clients with brain tumors. The blood—brain barrier prevents medications from reaching the brain. Radiation therapy will have fewer side effects than chemotherapy. Metastatic tumors become resistant to chemotherapy and it becomes useless. The client is being discharged following a transsphenoidal hypophysectomy.

Which discharge instructions should the nurse teach the client? Sleep with the head of the bed elevated. Keep a humidifier in the room. Use caution when performing oral care. Stay on a full liquid diet until seen by the HCP. Notify the HCP if developing a cold or fever. Meningitis What is meningitis? The public health nurse is giving a lecture on potential outbreaks of infectious meningitis. Which population is most at risk for an outbreak?

Clients recently discharged from the hospital. Residents of a college dormitory. Individuals who visit a third world country. Employees in a high-rise office building. The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical manifestations would support the diagnosis of bacterial meningitis?

The nurse is assessing the client diagnosed with meningococcal meningitis. Which assessment data would warrant notifying the HCP? Purpuric lesions on the face. Complaints of light hurting the eyes. Dull, aching, frontal headache. Not remembering the day of the week. Which type of precautions should the nurse implement for the client diagnosed with septic meningitis?

Standard Precautions. Airborne Precautions. Contact Precautions. Droplet Precautions. The nurse is developing a plan of care for a client diagnosed with aseptic meningitis secondary to a brain tumor. The client will be able to complete activities of daily living. The client will be protected from injury if seizure activity occurs.

The client will be afebrile for 48 hours prior to discharge. The client will have elastic tissue turgor with ready recoil.

The nurse is preparing a client diagnosed with rule-out meningitis for a lumbar puncture. Which interventions should the nurse implement? Obtain an informed consent from the client or significant other. Have the client empty the bladder prior to the procedure.

Place the client in a side-lying position with the back arched. Instruct the client to breathe rapidly and deeply during the procedure. Explain to the client what to expect during the procedure. The nurse is caring for a client diagnosed with meningitis.

Which collaborative intervention should be included in the plan of care? Administer antibiotics. Obtain a sputum culture. Monitor the pulse oximeter. Assess intake and output. The client is diagnosed with meningococcal meningitis. Which preventive measure would the nurse expect the health-care provider to order for the significant others in the home?

The Haemophilus influenzae vaccine. Antimicrobial chemoprophylaxis. A day dose pack of corticosteroids. A gamma globulin injection. Which statement best describes the scientific rationale for alternating a nonnarcotic antipyretic and a nonsteroidal anti-inflammatory drug NSAID every two 2 hours to a female client diagnosed with bacterial meningitis? This regimen helps to decrease the purulent exudate surrounding the meninges. These medications will decrease intracranial pressure and brain metabolism.

This will help prevent a yeast infection secondary to antibiotic therapy. The client diagnosed with septic meningitis is admitted to the medical floor at noon. Administer an intravenous antibiotic. Provide a quiet, calm, and dark room. Weigh the client in hospital attire. The year-old client is admitted to the medical floor diagnosed with meningitis. Which assessment by the nurse has priority? Assess lung sounds. Assess the six cardinal fields of gaze.

Assess apical pulse. Assess level of consciousness. Which clinical manifestations of PD would explain these assessment data? Masklike facies and shuffling gait. Difficulty swallowing and immobility. Pill rolling of fingers and flat affect. Lack of arm swing and bradykinesia. Which statement is the scientific rationale for combining these medications? There will be fewer side effects with this combination than with carbidopa alone. Dopamine D requires the presence of both of these medications to work.

Carbidopa makes more levodopa available to the brain. Consult the occupational therapist for adaptive appliances for eating. Request a low-fat, low-sodium diet from the dietary department. Provide three 3 meals per day that include nuts and whole-grain breads. Offer six 6 meals per day with a soft consistency. The nurse and the unlicensed assistive personnel UAP are caring for clients on a medical-surgical unit. Which task should not be assigned to the UAP? The charge nurse is making assignments.

Which client should be assigned to the new graduate nurse? The client diagnosed with aseptic meningitis who is complaining of a headache and the light bothering his eyes.

The client diagnosed with a brain tumor who has a new complaint of seeing spots before the eyes. Which would be a therapeutic goal of treatment for the disease process?

The client will experience periods of akinesia throughout the day. The client will take the prescribed medications correctly. The client will be able to enjoy a family outing with the spouse. The client will be able to carry out activities of daily living.

Which is an example of an experimental therapy? Dopamine receptor agonist medication. Physical therapy for muscle strengthening. Fetal tissue transplantation. Which statement made by the significant other indicates an understanding of the discharge instructions? Which assessment data support this diagnosis? Crackles in the upper lung fields and jugular vein distention. Muscle weakness in the upper extremities and ptosis. Exaggerated arm swinging and scanning speech.

Masklike facies and a shuffling gait. Emotional lability. Memory deficits. Which information regarding psychosocial needs should be included in the discussion? The client should discuss feelings about being placed on a ventilator. The client may have rapid mood swings and become easily upset. Pill-rolling tremors will become worse when the medication is wearing off.

The client may automatically start to repeat what another person says. The nurse is caring for clients on a medical-surgical floor. Which client should be assessed first? The year-old client diagnosed with a T10 spinal cord injury who cannot move his toes.

The year-old client diagnosed with a cerebrovascular accident who has a resolving left hemiparesis. Substance Abuse The friend of an year-old male client brings the client to the emergency department ED. The client is unconscious and his breathing is slow and shallow. Ask the friend what drugs the client has been taking.

Initiate an IV infusion at a keep-open rate. Call for a ventilator to be brought to the ED. The chief executive officer CEO of a large manufacturing plant presents to the occupational health clinic with chronic rhinitis and requesting medication. On inspection, the nurse notices holes in the septum that separates the nasal passages. The nurse also notes dilated pupils and tachycardia.

Prepare to complete a drug screen urine test. Give the client an antihistamine and say nothing. The nurse is working with clients in a substance abuse clinic.

Tell Client A the nurse cannot discuss Client B with him. Find out how Client A got this information. Get in touch with Client B and have the client come to the clinic. A year-old female client who tried lysergic acid diethylamide LSD as a teen tells the nurse that she has bad dreams that make her want to kill herself.

Which is the explanation for this occurrence? The client is suicidal and should be on one-to-one precautions. The nurse observes a coworker acting erratically. Which action should the nurse take? Tell the coworker that the nurse will give all narcotic medications from now on. Do nothing until the nurse can prove the coworker has been using drugs. The client is diagnosed with Wernicke-Korsakoff syndrome as a result of chronic alcoholism.

For which symptoms would the nurse assess? Insomnia and anxiety. Visual or auditory hallucinations. Extreme tremors and agitation. Ataxia and confabulation. The client diagnosed with delirium tremens when trying to quit drinking cold turkey is admitted to the medical unit. Which medications would the nurse anticipate administering?

Thiamine vitamin B6 and librium, a benzodiazepine. Dilantin, an anticonvulsant, and Feosol, an iron preparation. Methadone, a synthetic narcotic, and Depakote, a mood stabilizer. Mannitol, an osmotic diuretic, and Ritalin, a stimulant. The client is withdrawing from a heroin addiction. Check vital signs every eight 8 hours. Place the client in a quiet, calm atmosphere. Have a consent form signed for HIV testing. Provide the client with sterile needles. Tell me about your concerns. Monitor the telemetry and vital signs every four 4 hours.

Encourage the client to verbalize the reason for using drugs. Provide a quiet, calm atmosphere for the client to rest. Place the client on bedrest and a low-sodium diet. The client diagnosed with substance abuse is being discharged from a drug and alcohol rehabilitation facility. Which information should the nurse teach the client? The nurse is working with clients and their families regarding substance abuse. Which statement is the scientific rationale for teaching the children new coping mechanisms?

The child needs to realize that the parent will be changing behaviors. The child will need to point out to the parent when the parent is not coping. Children tend to mimic behaviors of parents when faced with similar situations.

Which diagnostic test is used to confirm the diagnosis of ALS? Electromyogram EMG. Muscle biopsy. Serum creatine kinase CK. Pulmonary function test. The client is diagnosed with ALS.

Which client problem would be most appropriate for this client? Disuse syndrome. Altered body image. Fluid and electrolyte imbalance. Alteration in pain. The client is being evaluated to rule out ALS.

Muscle atrophy and flaccidity. Fatigue and malnutrition. Slurred speech and dysphagia. Weakness and paralysis. What will happen to me in the end?

You have to stay positive. You can live a long life. The client with ALS is admitted to the medical unit with shortness of breath, dyspnea, and respiratory complications. Which intervention should the nurse im- plement first? Elevate the head of the bed 30 degrees. Administer oxygen via nasal cannula. Obtain a pulse oximeter reading. The client is to receive a mL intravenous antibiotic over 30 minutes via an intravenous pump. At what rate should the nurse set the IV pump?

The nurse is caring for the following clients on a medical unit. Which client should the nurse assess first? The client with ALS who is refusing to turn every two 2 hours. The client with abdominal pain who is complaining of nausea.

The client who is complaining about not receiving any pain medication. As the disease progresses, which intervention should the nurse implement?

Discuss the need to be placed in a long-term care facility. Explain how to care for a sigmoid colostomy. Assist the client to prepare an advance directive. Teach the client how to use a motorized wheelchair. The client is in the terminal stage of ALS. Perform passive ROM every two 2 hours.

Maintain a negative nitrogen balance. Encourage a low-protein, soft-mechanical diet. Turn the client and have him cough and deep breathe every shift. The client with end-stage ALS requires a gastrostomy tube feeding. Which finding would require the nurse to hold a bolus tube feeding? A residual of mL. The abdomen is soft. Three episodes of diarrhea. The potassium level is 3.

The client diagnosed with ALS is prescribed an antiglutamate, riluzole Rilutek. Which instruction should the nurse discuss with the client? Take the medication with food. Do not eat green, leafy vegetables. Use SPF 30 when going out in the sun. Report any febrile illness. Encephalitis The nurse is admitting the client for rule-out encephalitis. Which interventions should the nurse assess to support the diagnosis of encephalitis?

Determine if the client has recently received any immunizations. Ask the client if he or she has had a cold in the last week. Check to see if the client has active herpes simplex 1. Find out if the client has traveled to the Great Lakes region. Assess for exposure to soil with fungal spores. The nurse is assessing the client admitted with encephalitis. Which data require immediate nursing intervention?

The client: 1. Has bilateral facial palsies. Has a recurrent temperature of Has a decreased complaint of headache. Comments that the meal has no taste. The client admitted to the hospital to rule out encephalitis is being prepared for a lumbar puncture.

Which instructions should the nurse teach the client regarding care postprocedure? Instruct that all invasive procedures require a written permission. Explain that this allows analysis of a sample of the cerebrospinal fluid. Tell the client to increase fluid intake to mL for the next 48 hours. Discuss that lying supine with the head flat will prevent all hematomas.

Each chapter is a self-contained unit. The comprehensive exam at the end of each chapter assesses your strengths and weaknesses, identifying areas for further study. A must buy for nursing school students!

I heard about these books to help with practice questions and boost test grades. These books are absolutely amazing. There are questions for nearly every subject matter and it really has helped bump up my test grades and my knowledge. An absolute must! The med surg bible. The rationales are great and so are the questions. Hundreds of questions per topic. This book saved my life!