Nokea
The son of a client diagnosed with ALS asks the nurse, 'Is there any chance that I could get this disease?' Which statement by the nurse would be most appropriate?
- A. It must be scary to think you might get this disease.'
- B. No, this disease is not genetic or contagious.'
- C. ALS does have a genetic factor and runs in families.'
- D. If you are exposed to the same virus, you may get the disease.'
Correct Answer: C
Rationale: About 5–10% of ALS cases are familial, with a genetic component (C). Reflecting fear (A) is vague, denying genetics (B) is incorrect, and viral causes (D) are not established.
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The nurse assesses the client, who was injured in a diving accident 2 hours earlier. The client is breathing independently but has no movement or muscle tone from below the area of injury. A CT scan reveals a fracture of the C4 cervical vertebra. The nurse should plan interventions for which problem?
- A. Complete spinal cord transection
- B. Spinal shock
- C. An upper motor neuron injury
- D. Quadriplegia
Correct Answer: B
Rationale: A complete spinal cord transection results in no reflexes or movement distal to the injury. With a C4 injury, the client initially would have some difficulty breathing due to edema of the spinal cord that occurs above the level of the injury. The client is experiencing spinal shock that manifests within a few hours after the injury. Hypotension, flaccid paralysis, and absence of muscle contractions occur. Spinal shock lasts 7 to 20 days, and the SCI cannot be classified accurately until spinal shock resolves. An injury of the upper motor neuron results in spastic paralysis. Quadriplegia, now termed tetraplegia, is paralysis involving all four extremities.
The client asks the nurse, 'What causes Creutzfeldt-Jakob disease?' Which statement would be the nurse's best response?
- A. The person must have been exposed to an infected prion.'
- B. It is mad cow disease, and eating contaminated meat is the cause.'
- C. This disease is caused by a virus that is in stagnant water.'
- D. A fungal spore from the lungs infects the brain tissue.'
Correct Answer: A
Rationale: Creutzfeldt-Jakob disease is caused by prions (A), infectious proteins. Mad cow (B) is a variant but not the sole cause, and viral (C) or fungal (D) causes are incorrect.
Which teaching topics should the nurse cover before discharge? Select all that apply.
- A. Dietary restrictions
- B. Avoiding heavy lifting
- C. Staying out of bright sunlight
- D. Missed doses
- E. Bruising or blood in urine
- F. Need for frequent laboratory work
Correct Answer: A,D,E,F
Rationale: Warfarin requires dietary consistency, instructions on missed doses, monitoring for bleeding (bruising/blood in urine), and frequent INR checks.
When the nurse observes that the client has difficulty swallowing the capsule of medication, which action is best to take?
- A. Soak the capsule in water until soft.
- B. Tell the client to chew the capsule.
- C. Moisten the capsule in the client's mouth.
- D. Offer water before giving the capsule.
Correct Answer: D
Rationale: Offering water before giving the capsule aids swallowing without altering the medication's integrity.
The nurse plans to show the spouse of the client with a suspected epidural hematoma where the epidural hematoma occurs in the brain. Which illustration should the nurse select when teaching the client’s spouse?
- A. Illustration A
- B. Illustration B
- C. Illustration C
- D. Illustration D
Correct Answer: B
Rationale: This illustration shows a subdural hematoma, which occurs below the dura. This illustration shows an epidural hematoma, which occurs between the skull and the dura. This illustration shows normal brain structures. An intracerebral hematoma occurs within the brain tissue and can result in brain herniation as shown in this illustration.