Nokea
The nurse is caring for a client with peripheral neuropathy of the lower extremities. Which intervention would be appropriate to prevent injury to the client's feet?
- A. Perform Semmes-Weinstein monofilament test
- B. Review the client's most recent blood glucose level
- C. Obtain a prescription for gabapentin
- D. Teach the client about appropriate footwear
Correct Answer: D
Rationale: Teaching about appropriate footwear prevents injuries in peripheral neuropathy by protecting insensate feet.
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Which statement below relating to pain and pain perception is accurate?
- A. Allodynia is the pathophysiological absence of pain when a painful stimulus is applied.
- B. Scientific evidence does not support the presence of pain during neonatal circumcision.
- C. Hyperalgesia is the opposite of hyperpathia, both of which are abnormal pain responses.
- D. The perception of pain and its impact on clients vary greatly among individuals.
Correct Answer: D
Rationale: Pain perception varies widely due to individual physiological and psychological factors.
The nurse is caring for a client with a concussion. Which assessment finding indicates that the client is experiencing a complication?
- A. Reports of a persistent headache
- B. Glasgow Coma Scale 13
- C. Heart rate 56
- D. Drowsiness
Correct Answer: C
Rationale: Bradycardia (heart rate 56) suggests increased intracranial pressure, a concussion complication.
The nurse is caring for a client with newly prescribed sumatriptan. The nurse understands that this medication is intended to treat which condition?
- A. Peripheral artery disease
- B. Accelerated hypertension
- C. Migraine headache
- D. Angina
Correct Answer: C
Rationale: Sumatriptan is a triptan specifically used to treat migraine headaches by constricting blood vessels and reducing inflammation. It is not used for peripheral artery disease, hypertension, or angina.
A nurse is caring for a client on bed rest following a spinal cord injury. When positioning the client's feet, which position would prevent the client from developing foot drop?
- A. Supination
- B. Dorsiflexion
- C. Hyperextension
- D. Abduction
Correct Answer: B
Rationale: Dorsiflexion prevents foot drop by maintaining proper foot alignment.
A client presents to the emergency department with symptoms of muscle weakness, double vision, and difficulty swallowing. The nurse suspects botulism poisoning. Which of the following statements accurately describes botulism?
- A. Botulism is caused by a bacterial infection with Clostridium difficile.
- B. Botulism is primarily transmitted through contaminated water sources.
- C. Botulism toxin acts by enhancing muscle contractions and reflexes.
- D. Botulism toxin inhibits the release of acetylcholine at neuromuscular junctions.
Correct Answer: D
Rationale: Botulism toxin inhibits acetylcholine release, causing muscle weakness.