ATI RN
Health Assessment Neurological System NCLEX Questions Quizlet Questions
Question 1 of 5
Initial treatment of the patient with a fracture should include
Correct Answer: D
Rationale: In the context of initial treatment for a patient with a fracture, the correct answer is D) Immobilization of the area. Immobilization is crucial to prevent further damage, promote proper healing, and reduce pain. By stabilizing the fracture site through immobilization, the risk of displacement or further injury is minimized. This allows the body to initiate the healing process effectively. Option A) Surgical reduction of the fracture involves a more invasive approach and is usually reserved for complex fractures or cases where conservative management fails. Option B) Insertion of internal fixation device is a surgical intervention that may be needed in certain fractures but is not typically the initial treatment. Understanding the importance of prompt immobilization in the initial phase of fracture management is essential for healthcare providers, especially nurses and allied health professionals involved in patient care. It ensures that they can provide timely and appropriate interventions to optimize patient outcomes and prevent complications. By grasping this concept, healthcare professionals can contribute to the overall well-being and recovery of patients with fractures.
Question 2 of 5
A female client informs the nurse that she overstretched her arm muscles when lifting a heavy suitcase, and now experiences inflammation, some tenderness, and muscle spasms. Which of the following problems is she most likely to have?
Correct Answer: A
Rationale: The correct answer is A) Strain. A strain is an injury to a muscle or tendon due to overstretching or overuse. In this scenario, the client developed inflammation, tenderness, and muscle spasms after overstressing her arm muscles, which are common symptoms of a strain. Option B) Contusion refers to a bruise caused by blunt force trauma, not by overstretching, so it is incorrect in this context. Option C) Sprain involves the stretching or tearing of ligaments, not muscles or tendons, so it is not the most likely problem in this case. Option D) Avulsion fracture occurs when a tendon or ligament pulls off a piece of bone, which is different from the client's presentation of muscle overstretching. Educationally, understanding the differences between strain, contusion, sprain, and avulsion fracture is crucial for healthcare providers, especially nurses, to accurately assess and diagnose musculoskeletal injuries. Recognizing the specific characteristics and causes of each type of injury helps in providing appropriate care and treatment to clients.
Question 3 of 5
A patient has unilateral facial paralysis and is unable to close his or her right eye. He or she is diagnosed with Bell's palsy. He or she asks the physician if there is any special care required for his or her eye. What is the best response?
Correct Answer: D
Rationale: The best response to the patient's question is option D) Yes, you will need to instill artificial teardrops and use an eye patch. This is the correct answer because in Bell's palsy, the inability to close the affected eye can lead to dryness, irritation, and potential damage to the cornea due to inadequate lubrication and protection. Instilling artificial teardrops helps keep the eye moist and prevents complications associated with dryness. Additionally, using an eye patch can help protect the eye from foreign objects, dust, and inadvertent trauma since the patient cannot close the eye properly. Option A) No, since the symptoms will go away in a few weeks is incorrect because while Bell's palsy often resolves on its own, proper eye care is essential during the recovery period to prevent complications. Option B) Wear sunglasses is incorrect because although sunglasses may offer some protection from environmental elements, they do not address the primary issue of inadequate eye closure and dryness in Bell's palsy. Option C) Increase fluid intake to prevent dryness of the eye is incorrect because while adequate hydration is important for overall health, it alone will not provide sufficient lubrication and protection for the affected eye in Bell's palsy. In an educational context, understanding the specific care needs for patients with Bell's palsy is crucial for nurses and healthcare professionals to prevent potential eye complications and ensure optimal recovery. Proper eye care can help mitigate discomfort, promote healing, and prevent long-term damage to the eye. Educating patients about the importance of using artificial teardrops and eye patches can empower them to actively participate in their care and promote positive outcomes.
Question 4 of 5
What key point will you teach the patient scheduled for endoscopic carpal tunnel release surgery?
Correct Answer: A
Rationale: The correct answer is A) Pain and numbness will be experienced for several days to weeks. In an educational context, it is crucial to teach the patient scheduled for endoscopic carpal tunnel release surgery about what to expect postoperatively. This includes informing them about the common symptoms they may experience. Option A is correct because after carpal tunnel release surgery, it is typical for patients to continue experiencing pain and numbness for a period of days to weeks as the surgical site heals and the nerves recover. This information prepares the patient for a realistic recovery timeline and helps manage their expectations. Option B is incorrect because immediately after surgery, the patient will likely still need assistance due to postoperative pain, limited mobility, and potential restrictions on hand use. Option C is incorrect because while there may be some drainage initially after surgery, it is not typically described as "large with lots of drainage." Dressings are usually changed during follow-up appointments as needed. Option D is incorrect because it is unrealistic to expect that pain and paresthesia will completely disappear immediately after surgery. It takes time for the body to heal and for symptoms to gradually improve. By understanding and conveying the realistic postoperative expectations to the patient, healthcare providers can facilitate better patient outcomes through informed decision-making and appropriate self-care management during the recovery period.
Question 5 of 5
What would the nurse document if the client is unresponsive except to superficial, relatively mild painful stimuli to which the client makes some purposeful motor response?
Correct Answer: B
Rationale: In this scenario, the correct answer is B) Client is in a stuporous state. Stupor is a state of near-unconsciousness or insensibility where the individual can only be aroused by vigorous or repeated stimuli. In this case, the client is unresponsive except to superficial, mild painful stimuli, indicating a deeper level of unconsciousness beyond somnolence or lethargy. Option A) Client is somnolent or lethargic, implies drowsiness or sluggishness, which does not accurately describe a client who responds only to painful stimuli. Option C) Client is semicomatose, suggests a partial state of coma, which is not as specific as stupor in this context. Option D) Client is comatose, indicates a deep state of unconsciousness with no response to stimuli, which does not align with the client's partial response. Educationally, understanding the nuances of altered states of consciousness is crucial in nursing practice, especially in assessing and managing neurologically compromised patients. Recognizing the differences between somnolence, stupor, semicoma, and coma can guide appropriate interventions and help in accurately communicating the patient's condition to the healthcare team.