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The nurse instructs a client who has a neurological deficit regarding nutrition and diet. What should the client do?
- A. Eat two large meals instead of frequent small meals.
- B. Consume a diet low in fiber.
- C. Chew foods quickly.
- D. Be sure to take fluids frequently.
Correct Answer: D
Rationale: Staying hydrated is crucial for clients with neurological deficits to prevent constipation and urinary tract infections.
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The limbic system includes the:
- A. amygdala, hypothalamus, hippocampus
- B. hypothalamus, medulla, hippocampus
- C. hippocampus, pons, thalamus
- D. cerebellum, pons, hypothalamus
Correct Answer: A
Rationale: The limbic system is a group of brain structures involved in emotion, memory, and motivation. It includes the amygdala, which processes fear and emotional responses; the hypothalamus, which regulates hormones and homeostasis; and the hippocampus, which is essential for forming and retrieving memories. These structures work together to integrate emotional and cognitive processes, playing a key role in behavior and survival.
To assess the patient's deep tendon reflexes, the nurse should:
- A. Use a reflex hammer to test responses in the biceps, triceps, and patellar tendons.
- B. Measure the patient's temperature.
- C. Inspect the patient's gait.
- D. Check the patient's level of consciousness.
Correct Answer: A
Rationale: Deep tendon reflexes are tested using a reflex hammer to elicit responses in specific tendons. Temperature, gait, and level of consciousness are unrelated to reflex testing.
A few weeks after the injury, the nurse notices that Joe seems to be pulling his legs away from her during the bath. Which of the following statements provides the best explanation of the patient's leg movement?
- A. He is embarrassed about having to be bathed
- B. Muscle spasms are beginning to occur
- C. Paralysis is diminishing due to reduction in edema
- D. He is adjusting negatively to his disability
Correct Answer: B
Rationale: Muscle spasms are common in spinal cord injury recovery.
What is the major focus for care today for a patient who is 1 day post-operative after a left below-the-knee amputation?
- A. To attain pain control for phantom pain.
- B. To monitor for signs of sufficient tissue perfusion.
- C. To assist the patient to ambulate as soon as possible.
- D. To elevate the residual limb when the patient is supine.
Correct Answer: B
Rationale: Ensuring adequate tissue perfusion is critical in the immediate post-operative period to prevent complications.
Regarding the cutaneous nerve supply to arm and forearm
- A. C3/4 supply pectoral and upper shoulder
- B. Branches of the brachial plexus supply arm and forearm
- C. C4/5/6/T1 supply the majority of the arm
- D. ?
Correct Answer: B
Rationale: The brachial plexus, formed from C5-T1, supplies the cutaneous innervation of the arm and forearm. Specific branches include the median, ulnar, and radial nerves.