EPILEPSY QUESTIONS

1. Although the characteristics of a seizure may differ from person to person,

seizures are caused by the same thing:

A. A sudden change in how brain cells send electrical signals to one another

B. A sudden change in how the spinal cord and brain talk to each other

C. A sudden change in blood flow in the brain

D. A sudden change in oxygen flow in the body

You are assessing a patient's chest when you detect a crackling or crunching
sensation under the skin. What is this called?

Subcutaneous emphysema

A crackling or crunching sensation under the skin due to trapped air is called
subcutaneous emphysema. Paradoxical motion is one side moving independently
from the other, as in a flail segment in the chest. Distention is the condition of
being stretched, inflated, or larger than normal. Pneumothorax is a collapsed lung.

Which of the following terms BEST describes a list of potential diagnoses that is
compiled early in the assessment of the patient?

Differential diagnosis

A differential diagnosis is a list of potential diagnoses that is compiled early in

the assessment of the patient. An EMS diagnosis is a diagnosis that is obtained
by prehospital providers. Red flags are concerning findings that are found
typically in the primary assessment. Critical thinking is the process of using
reasoning to arrive at an appropriate conclusion.

Which of the following terms describes an analytical process that helps someone
think through a problem in an organized and efficient manner?

Critical thinking

Which of the following is a term that means a rapid assessment of the head, neck,
chest, abdomen, pelvis, extremities, and posterior of the body to detect signs and
symptoms of injury?

Rapid trauma assessment

Rapid trauma assessment means a rapid assessment of the head, neck, chest,
abdomen, pelvis, extremities, and posterior of the body to detect signs and
symptoms of injury. Past medical history reviews the problems a patient has had
previous to today. SAMPLE is a mnemonic that is used to assist in obtaining a
history. History of the present illness describes the situations leading up to the
problem of the moment.

A 66-year-old male patient has slipped on the ice, fallen, and broken his ankle.
During your assessment, he states that he has diabetes. This statement would be
considered part of the:

past medical history.

Which of the choices is TRUE about the difference between a sign and a
symptom?

A condition that must be described by the patient is a symptom.

Symptoms are described by the patient but cannot be determined by the EMT; an
example is the presence of nausea. Signs, by contrast, are measured or observed
by the EMT.

During which of the following would the EMT thoroughly examine the patient's
face, ears, nose, eyes, and mouth?

Detailed physical examination

A 9-year-old female has fallen from a tree. She complains of belly pain. After
completing a primary assessment, which of the following techniques would be
MOST useful to complete a physical examination on this patient?

Palpation

Which of the following physical examination steps would BEST fit the
examination of a conscious medical patient with a respiratory complaint?

Lung sound evaluation

You ask your patient, "What does your discomfort in your chest feel like?" This
would be an example of:

an open-ended question.
Which of the following might be found when the EMT inspects the patient's
chest?

Bruising

Where should you listen for breath sounds?

Midclavicular and midaxillary lines on both sides of chest

What is the primary goal of the EMS approach to diagnosis?

To rule out life threats

The primary goal of EMS diagnosis is to rule out life threats. Assessing and
curing may be possible but are far less common. Definitive diagnosis and long-
term treatments are typically left to physicians.

Which of the following terms is sometimes described as an attitude of inquiry?

Critical thinking

Which of the following clinical findings would indicate that you should conduct
a modified secondary assessment rather than a full head-to-toe secondary
assessment?

No significant mechanism of injury

Normally, a modified secondary assessment is appropriate for a trauma patient
with no significant mechanism of injury, no altered mental status, no evidence of
multiple injuries, and no critical finding.

Which of the following diagnostic shortcuts would make the EMT say, "This
patient has the same thing my last patient had"?

Availability

Availability would cause the EMT to recall a recent diagnosis and apply it to a
current patient. Overconfidence occurs when the provider has a higher confidence
in his or her own ability than is reasonable under the circumstances. Confirmation
bias occurs when a provider attempts to use findings to support a conclusion that
he or she has previously reached. Illusory correlation is the perception of a
relationship between two choices when only an insignificant or absolutely no
relationship actually exists.

The emergency department physician is assessing a patient when she is told that
the patient has a sudden onset of tearing pain in the abdomen that radiates to the
back. The patient is pale and hypotensive. Which of the following BEST
describes this information?

Red flag

While these are all assessment findings, tearing abdominal pain, one of the classic
signs and symptoms of a dissecting abdominal aneurysm, is considered a red flag.
Which of the following questions is appropriate to ask a patient with neurological
deficits?

"Have you had a headache?"

Your patient is unresponsive, has an unusual odor on his breath, and is incontinent
of urine. You should suspect:

an endocrine emergency.

Altered mental status; unusual breath odor; incontinence; and excessive hunger,
thirst, and urination indicate a diabetic (endocrine) emergency. Although the
patient could have a cardiac complaint or a neurological complaint, the unusual
odor would push you more toward an endocrine issue. This situation is not likely
to be a respiratory problem.

Which of the following would you assess during the physical examination of your
cardiac patient?

Ankle edema

While you would ask your patient whether he or she has taken nitroglycerin, this
is not part of the physical examination. Palpating the abdomen and checking for
unusual breath odors are not usually indicated immediately for a cardiac patient.

In obtaining the patient's history, which of the following is considered a sign?

Tachycardia
Signs are measurable or observable (e.g., pulse, BP, skin color), whereas
symptoms are what the patient tells you (e.g., pain, difficulty breathing, nausea,
dizziness).

Next Question

Which of the following patients is MOST likely to experience hives?

Patient with an allergic reaction

In which of the following emergencies would your patient most likely present
with a chief complaint of headache?

Neurological

A patient with a neurological emergency is most likely to present with a headache

as a chief complaint. Cardiovascular problems typically present with chest
discomfort, dyspnea, or nausea. Respiratory issues typically present with
breathing difficulty. Endocrine emergencies are typically associated with altered
mental status.

A 59-year-old male complains of vomiting blood. He denies any trauma. You

should suspect:

a gastrointestinal problem.
Blood in vomit or stool indicate a gastrointestinal problem. Although immune
system problems can sometimes cause nausea, they typically do not lead to blood
in the vomit. Endocrine and respiratory system problems do not usually involve
vomiting.

Which of the following additional history components would best assist you in
the evaluation of a conscious medical patient with an immune system problem?

Time of exposure to an allergen

The most common immune system problems are allergic reactions. Therefore,
inquiring about exposure to an allergen would be most appropriate. Dyspnea on
exertion is typically associated with cardiovascular complaints. Menstrual history
is typically associated with obstetric or gynecological issues. Hunger and thirst
are common in endocrine emergencies.

Where should the EMT begin when performing a rapid physical examination on
an unresponsive medical patient?

Head

Which of the following is TRUE about the rapid head-to-toe examination that is
conducted on the unresponsive medical patient?

It is a rapid secondary assessment, similar to that conducted on a trauma patient.

Assess the unresponsive medical patient much as you would a trauma patient.
Begin with the primary assessment, conduct a rapid head-to-toe examination (the
rapid secondary assessment), and finally take a brief history from family or
friends. This examination is much more brief than the one that is used on a
conscious medical patient. Although it may be repeated, it need not be repeated
every 15 minutes. It will not initially include a blood glucose level.

The secondary assessment, when conducted on an unresponsive medical patient,

can be defined as:

a systematic assessment that is aimed at quickly identifying undiscovered life

threats.

Which of the following should you do FIRST when examining an unresponsive

medical patient?

Perform a rapid physical examination.

A 40-year-old male has cut his finger in an industrial accident. You perform the
scene size-up, conduct a primary assessment, and determine his chief complaint.
You should next:

Perform secondary assessment

The correct steps in a patient with no significant mechanism of injury include

determining the chief complaint, performing secondary assessment, obtaining
baseline vital signs, and obtaining past medical history. Therefore, the next most
appropriate step would be to perform a secondary assessment.
A 25-year-old female had a minor fall from her motorcycle while stopped in
traffic. She did not lose consciousness, and the accident was simply the result of
a loss of balance with the motorcycle. Which of the following systems would be
MOST important to assess first during the secondary assessment?

Musculoskeletal

A 14-year-old female is complaining of knee pain after a fall on the playground.

Witnesses state that she had no unconsciousness and stood immediately after
falling. She is now alert and complaining of no other pain or injury. After
completing a primary assessment, you should next:

assess the patient's knee and leg.

The SAMPLE history would be obtained after assessment of the likely injury.

Your patient fell from the roof of a house. What action should you take BEFORE
assessing the ABCs?

Manual stabilization of the head and neck

For which of the following patients should you request ALS response?

A 14-year-old girl who is unresponsive after a jet ski accident

Your patient is a 68-year-old female who responds to verbal stimuli by moaning.
Her rapid physical examination is unremarkable. Which of the following actions
is recommended before making a decision to call for ALS?

Assess baseline vital signs.

A decision to call for ALS is generally made after assessing baseline vital signs.
Because this patient has an altered mental status, starting advanced providers is a
high priority and likely outweighs the immediate need to obtain history and
medications.

Which of the following statements is TRUE about the rapid trauma assessment?

The rapid trauma assessment should be performed at the scene.

Which of the following indicates the possibility of hypovolemic shock?

Flat jugular veins in a supine patient

Hypovolemia is a key indicator of a critical trauma patient. Flat jugular veins

should make the EMT think of blood loss and therefore hypovolemia. Paradoxical
movement would suggest a flail chest. Decreased breath sounds and
hyperresonance would suggest pneumothorax.

In which of the components of OPQRST would you learn that the patient is
having crushing pain?

Q
In which part of OPQRST would you learn that your patient became dizzy after
working in the garden?

What process would you use to discover the circumstances surrounding the chief
complaint of the responsive medical patient?

OPQRST-ASPN

The acronym OPQRST-ASPN stands for onset, provocation/palliation, quality,

region/radiation, severity, time, associated symptoms, and pertinent negatives.
Adhering to this acronym will ensure that you address all critical aspects of the
patient history. SAMPLE refers to more general patient history. PERRL is a
mnemonic that is used to assess pupils. AVPU is a memory aid that is used to
asses consciousness.

You are dispatched to a residence for a 34-year-old male who is complaining of

severe abdominal pain that has persisted for the past two hours. On arrival, the
patient tells you that he would rate the pain as a 9 on a 1 to 10 scale. To what part
of the OPQRST would this information apply?

Which of the following questions might you ask a patient when you come to the
"P" in the SAMPLE history mnemonic?
"Have you ever had this problem before?"

Because the "P" in SAMPLE stands for pertinent past medical history, the most
appropriate question is "Have you had this problem before?" How the patient is
feeling today would refer to S, as in symptoms. Medications would refer to M,
and allergies would refer to A.

You are called to an elementary school where a 7-year-old girl has reportedly had
a seizure in her classroom and is now responsive only to painful stimulus. Which
of the following is likely your BEST source of this patient's history of present
illness?

The patient's teacher

The best source of patient information right now is the teacher, who may have
witnessed the seizure and can tell you about any similar problems in the past.
Although the patient's mother and pediatrician likely have more information, it is
unlikely that they will be available in the immediate time frame.

Next Question

A mnemonic or memory aid that is used to help the EMS provider remember the
information that must be included in a patient history is:

SAMPLE.
When your patient tells you that he had a heart valve replaced two years ago, this
is considered:

pertinent past medical history.

You are assessing a 12-year-old male who recently had a seizure. He is currently
alert. You ask him how he is feeling right now. He replies, "My back hurts."
Which of the following elements of SAMPLE history have you used when asking
this question?

What is the purpose of repeating the assessment of your patient's chief complaint
during reassessment?

To determine the effectiveness of your treatment plan

The effectiveness of your treatment is measured by the patient's improvement;

failure to improve may be indicative of the need for an alteration of your
management plan. Although continued conversation with the patient does
establish trust, that is not the most important element.

Next Question

Which of the following might be discovered in the reassessment?

Change in respiratory rate and quality

Which of the following BEST describes the purpose of repeating the primary
assessment?

To recheck for ongoing life-threatening problems

A 6-year-old male has fallen on his outstretched arm, causing a possible fracture.
His vital signs have remained essentially the same throughout transport. How
would you describe his condition?

Unchanged

For which of the following patients is it essential to perform the detailed physical
examination while en route?

A 27-year-old bull rider who was trampled on the chest by a bull

Which of the following statements is TRUE about EMS diagnosis and treatment?

The EMT may begin treatment before a definitive diagnosis has been reached.

Which of the following represents a significant mechanism of injury?

Pedestrian hit by automobile

Which of the following would be completed ONLY on a trauma patient with a

significant mechanism of injury?

Rapid trauma assessment

The rapid trauma assessment is conducted only for the patient with a significant
mechanism of injury. The other steps would be completed on any trauma patient,
regardless of severity.

Which of the following actions should be performed after the rapid trauma
assessment in a patient who has been shot in the chest?

Assess baseline vital signs.

You should assess baseline vital signs after performing a rapid trauma assessment
for a patient with a significant MOI. This step provides a basis of patient stability
as well as a set of vital signs to compare against future sets. Stabilization is likely
not necessary in penetrating trauma. The chief complaint would likely already be
known. Past medical history would be determined later.

The secondary assessment of the conscious medical patient is primarily focused

on:

patient history.

Because a conscious medical patient can communicate, the focus of the secondary
assessment will be history. Vital signs, physical examination, and bystander
reports will be relevant but not more important than history.

Next Question
The secondary assessment of the conscious medical patient has four parts: history
of the present illness, past medical history, physical examination, and:

vital signs.

The four elements of the secondary assessment for a conscious medical patient
are history of the present illness, past medical history, physical examination, and
vital signs. Although the other findings may be important, they are additional to
the four key components.

Which of the following terms means that a sign or symptom suggests the
possibility that a problem is very serious?

Red flag

Which of the following situations would prevent you from performing a

reassessment on a 9-year-old female who was found at the bottom of a swimming
pool?

Life-saving interventions

Reassessment should always be completed. The exception would be when life-

saving interventions have the more immediate priority.

Which of the following terms BEST describes a list of potential diagnoses that is
compiled early in the assessment of the patient?

...
1 Which of the following terms describes a condition of being stretched, inflated,
or larger than normal?

Distention

You are treating a patient who has chest pain and difficulty breathing. The
secondary assessment should first evaluate the:

cardiovascular system.

Which of the following terms refers to diagnostic shortcuts?

Heuristics

Another word for diagnostic shortcuts is heuristics. Representativeness means

that when you encounter a patient with a certain group of signs and symptoms
that resemble a particular condition, you assume that the patient has that
condition. Confirmation bias occurs when the clinician looks for evidence to
support his or her preconceived diagnosis. Availability is the urge to think of
things because they are more easily recalled, often because of a recent exposure.

Which of the following BEST describes the difference between the detailed
physical examination and the rapid trauma assessment?

The rapid trauma assessment looks only for threats to life and limb, while the
detailed physical examination takes more time and is more in depth.
A 25-year-old male complains of a migraine headache. The scene is safe, and you
choose to begin your assessment. Which of the following questions would be
MOST appropriate to begin with?

"What can you tell me about your headache?"

"What can you tell me about your headache?" is an open-ended question that
requires the patient to describe his condition in his own words. This question
would be best to begin with, as it would give you an accurate portrayal of what is
going on in the patient's own words. "Are you having pain?" is a closed-ended
question that can be answered with a "yes or no" and offers little information. "Is
your pain sharp?" can put your words into the patient's mouth and can sometimes
lead patients. Allergies may be important but not as the focus of the first question.

Which of the following is represented by the "P" in OPRST?

Provocation

What action should be taken immediately after determining the chief complaint
and eliciting information about how the patient was injured for a trauma patient
with no significant mechanism of injury?

performing secondary assessment

A 16-year-old female is complaining of abdominal pain. Because her parents are

in the room, how might you handle asking her whether she is possibly pregnant?

Ask her while en route, when her parents cannot hear.

Which of the following diagnostic shortcuts means looking for evidence that
supports the diagnosis one already has in mind?

Confirmation bias

When should you obtain a set of baseline vital signs on an unresponsive pediatric
medical patient?

After the rapid physical examination

Baseline vital signs are assessed after the rapid physical examination and before
the past medical history. Obtaining vital signs early provides immediate
information on patient condition and provides a basis from which to compare later
vital signs. Remember that past medical history may not be available for an
unresponsive patient.

While doing the secondary assessment, you are focusing on lung sounds, JVD,
and ankle edema. Your patient most likely has:

a cardiovascular complaint.

Which of the following is done at the same time whether or not a trauma patient
has a significant mechanism of injury?

Primary assessment
A 16-year-old male is found unresponsive in an alley. There are cans of spray
paint and plastic bags nearby. Which of the following should be done FIRST?

Manage any immediate life threats.

Besides checking for wounds, tenderness, and deformities, what should the EMT
look for during the rapid trauma assessment of the abdomen?

Firmness or softness

Which of the following best describes the process of tailoring history to the chief
complaint?

Asking questions that are pertinent to the patient's most immediate problem

A 19-year-old male is found seated, grasping his left humerus, after colliding with
another player during a rugby match. Which of the following techniques of
assessment would be used to identify his body position and general condition as
you approach?

Observation

17 Which of the following questions is appropriate to ask in assessing for

pertinent past history in a SAMPLE history?

"Do you have any other medical problems?"

Which of the following terms BEST describes a grating sound or feeling of bones
rubbing together?
Crepitation

Which of the following should you consider when deciding whether ALS
personnel should be requested?

Would ALS-level care benefit the patient?

20 While en route to the hospital, your 67-year-old male chest pain patient breaks
out in a sweat and becomes very pale. He clutches his chest. You should next:

reassess.

You are called to a college party, where you find an unresponsive 19-year-old
female. There is much evidence of alcohol consumption at the party. Which of
the following behaviors are you demonstrating if you rapidly conclude that the
patient is intoxicated?

Anchoring

A 13-year-old girl is awake but groggy and belligerent. You are told that your
patient's boyfriend just broke up with her, so she got into her parents' liquor
cabinet and drank a large quantity of alcohol. Who is likely your best source of
information about the patient's condition?

Her friend who called for help

In which of the following emergencies would you expect to see neck and face
edema?
Immune system

Why should you check baseline vital signs in the unresponsive medical patient?

To provide a place from which to compare later vital signs

Which of the following is the technique of physical examination that requires the
use of a stethoscope?

Auscultation

An 81-year-old female is complaining of chest pain. After asking her to describe

the current problem and history of the present illness, you should NEXT:

ask the patient whether she has any past medical history.

A 22-year-old female was found severely hyperventilating and was visibly upset.
Her initial vital signs were P 130, R 40, BP 190/100. With coaching and
compassionate care, she has calmed down. Her repeat vital signs are P 100, R 28,
BP 160/88. Which of the following would best describe this trend in vital signs?

Returning to normal

During the rapid trauma assessment of the victim of a boating accident, you note
that part of the patient's chest wall is moving in the direction opposite that of the
rest of the chest. What is the cause of this movement?

Two or more ribs are broken at two or more places, causing a floating segment of
ribs.
2. Seizures can be caused by:

A. Brain injury that left scar tissue or other damage

B. Infection that left scar tissue in or caused other damage to the brain

C. Exposure to a toxic substance

D. Malfunctioning gene

E. All of the above

3. Epilepsy is most likely to begin in which age group?

A. Early childhood

B. Adolescence

C. Middle age

D. Age over 65

E. A, B and D

4. A person with epilepsy needs how much extra sleep a night?

A. One hour

B. Two hours

C. Three hours

D. No extra sleep

5. In some states, if you have epilepsy, you can get a driver's license only if:

A. You haven't had a seizure in three months

B. You haven't had a seizure in a year

C. Your health care provider has written a note saying you are free of seizures
D. All of the above

6. Although exercise is good for people with epilepsy, some sports are not
appropriate. Which of these is/are not?

A. Mountain climbing

B. Swimming

C. Football

D. All of the above

7. Alcohol can be dangerous for a person with epilepsy because:

A. It can interfere with medication used to control seizures

B. It can cause seizures

C. It can cause a heart attack

D. A and B

8. How does a health care provider diagnose epilepsy?

A. History or description of seizures

B. A test called an electroencephalogram (EEG)

C. A test called positron emission tomography (PET)

D. A and B

9. Which is the most common treatment for epilepsy?

A. Surgery

B. Special diet

C. Medication

D. An implanted electrical device

10. Neurons in the brain are tasked with handling and transmitting information.
There are different types of neurons, such as excitatory and inhibitory. Excitatory
neurons release the neurotransmitter _____________, while inhibitory neurons
release the neurotransmitter ________________.*

A. GABA, glutamate

B. Norepinephrine, GABA

C. Glutamate, GABA

D. Dopamine, glutamate

The answer is C. Excitatory neurons release glutamate and inhibitory neurons

release GABA.

12. You’re assessing your patient load for the patients who are at MOST risk for
seizures. Select all the patients below that are at risk:*

A. A 32-year-old with a blood glucose of 20 mg/dL.

B. A 63-year-old whose CT scan shows an ischemic stroke.

C. A 72-year-old who is post opt day 5 from open heart surgery.

D. A 16-year-old with bacterial meningitis.

E. A 58-year-old experiencing ETOH withdrawal.

The answers are A, B, D, and E. All the patients are at risk except option C.
Remember all the risk factors: illness (especially CNS types like bacterial
meningitis), fever, electrolyte/metabolic issues (low blood sugar, acidosis etc),
ETOH (alcohol) withdraw, brain injury, STROKE, congenital brain defects,
tumors etc.
13. A patient with a history of epilepsy is taking Phenytoin. The patient’s morning
labs are back, and the patient’s Phenytoin level is 7 mcg/mL. Based on this
finding, the nurse will?*

A. Assess the patient for a rash

B. Initiate seizure precautions

C. Hold the next dose of Phenytoin

D. Continue to monitor the patient

The answer is B. A normal Phenytoin level is 10 to 20 mcg/mL. The patient’s

level is low; therefore, the patient is at risk for seizures. The nurse should initiate
seizure precautions. Remember a patient being under medicated is a trigger for
developing a seizure.

14. You’re educating a 25-year-old female about possible triggers for seizures.
Which statement requires you to re-educate the patient about the triggers?*

A. “I’m at risk for seizure activity during my menstrual cycle.”

B. “I will limit my alcohol intake to 2 glasses of wine per day.”

C. “It’s important I get plenty of sleep.”

D. “I will be sure to stay hydrated, especially during hot weather.”

The answer is B. The patient should avoid all alcohol because it can lead to a
seizure. Hormone shifts (menstrual cycle, ovulation, pregnancy) sleep
deprivation, and dehydration can lead to a seizure.

15. True or False: A patient who is experiencing a tonic-clonic seizure is

experiencing a focal (partial) seizure.*

True

False
Answer FALSE: A patient who is experiencing a tonic-clonic seizure is
experiencing a GENERALIZED seizure. This type of seizure affects both sides
of the brain.

16. A 7-year-old male patient is being evaluated for seizures. While in the child’s
room talking with the child’s parents, you notice that the child appears to be
daydreaming. You time this event to be 10 seconds. After 10 seconds, the child
appropriately responds and doesn’t recall the event. This is known as what type
of seizure?*

A. Focal Impaired Awareness (complex partial)

B. Atonic

C. Tonic-clonic

D. Absence

The answer is D. This is an absence seizure and is most common in children. The
hallmark of it is staring that appears to be like a daydreaming state. It is very short
and the post ictus stage of this type of seizure is immediate.

17. Your patient has a history of epilepsy. While helping the patient to the
restroom, the patient reports having this feeling of déjà vu and seeing spots in
their visual field. Your next nursing action is to?

A. Continue assisting the patient to the restroom and let them sit down.

B. Initiate the emergency response system.

C. Lay the patient down on their side with a pillow underneath the head.

D. Assess the patient’s medication history.

The answer is C. The patient is reporting signs and symptoms of an aura (this is
a warning sign before a seizure event). Lay the patient down on their side with a
pillow underneath the head and remove any restrictive clothing. Also, time the
seizure. If the seizure lasts more than 5 minutes or if the patient starts to have
seizures back-to-back activate the emergency response system.

18. Keeping the previous question in mind, the patient is now experiencing
characteristics of a tonic-clonic seizure. The seizure started at 1402 and it is now
1408, and the patient is still experiencing a seizure. The nurse should?

A. Continue to monitor the patient

B. Suction the patient

C. Initiate the emergency response system

D. Restrain the patient to prevent further injury

The answer is C. Tonic-clonic seizures should last about 1-3 minutes. If the
seizure lasts MORE than 5 minutes, the patient needs medical treatment FAST to
stop the seizure…. this is known as status epilepticus

19. Your patient has entered the post ictus stage for seizures. The patient’s seizure
presented with an aura followed by body stiffening and then recurrent jerking.
The patient had incontinence and bleeding in the mouth from injury to the tongue.
What is an expected finding in this stage based on the type of seizure this patient
experienced?

A. Crying and anxiety

B. Immediate return to baseline behavior

C. Sleepy, headache, and soreness

D. Unconsciousness

The answer is C. Tonic-clonic seizures should last about 1-3 minutes. If the
seizure lasts MORE than 5 minutes, the patient needs medical treatment FAST to
stop the seizure…. this is known as status epilepticus
11. You’re developing discharge instructions to the parents of a child who
experiences atonic seizures. What information below is important to include in
the teaching?

A. “This type of seizure is hard to detect because the child may appear like he or
she is daydreaming.”

B. “Be sure your child wears a helmet daily.”

C. “It is common for the child to feel extremely tired after experiencing this type
of seizure.”

D. “Avoid high fat and low carbohydrate diets.”

The answer is B. This type of seizure leads to a sudden loss of muscle tone. The
patient will go limp and fall, which when this happens the head is usually the first
part of the body to hit the floor or an object nearby. It is important the child wears
a helmet daily to protect their head from injury. Option A is a characteristic of an
absence seizure. Option C is a characteristic of a tonic-clonic seizure during the
post ictus stage. And option D is wrong because some patients benefit from this
type of diet known as the ketogenic diet.

12. You’re assessing a patient who recently experienced a focal type seizure
(partial seizure). As the nurse, you know that which statement by the patient
indicates the patient may have experienced a focal impaired awareness (complex
partial) seizure?*

A. “My friend reported that during the seizure I was staring off and rubbing my
hands together, but I don’t remember doing this.”

B. “I remember having vision changes, but it didn’t last long.”

C. “I woke up on the floor with my mouth bleeding.”

D. “After the seizure I was very sleepy, and I had a headache for several hours.”
The answer is A. The patient will experience an alternation in consciousness
(hence the name focal IMPAIRED awareness) AND will perform an action
without knowing they are doing it called automatism like lip-smacking, rubbing
the hands together etc. With a focal onset AWARE seizure (also called partial
simple seizure) the patient is aware and will remember what happens (like vision
changes etc.).

12. You have a patient who has a brain tumor and is at risk for seizures. In the
patient’s plan of care you incorporate seizure precautions. Select below all the
proper steps to take in initiating seizure precautions:*

A. Oxygen and suction at bedside

B. Bed in highest position

C. Remove all pillows from the patient’s head

D. Have restraints on stand-by

E. Padded bed rails

F. Remove restrictive objects or clothing from patient’s body

G. IV access

The answers are A, E, F, and G. The bed needs to be in the LOWEST position
possible, a pillow should be underneath the patient’s head to protect it from
injury, AVOID using restraints (this can cause musculoskeletal damage).

13. You’re patient is scheduled for an EEG (electroencephalogram). As the nurse

you will:*

A. Keep the patient nothing by mouth.

B. Hold seizure medications until after the test.

C. Allow the patient to have coffee, milk, and juice only.

D. Wash the patient’s hair prior to the test.

E. Administer a sedative prior to the test.

The answers are B and D. An EEG is a painless procedure that will assess the
patient’s brain activity (if a seizure occurs during the test this can allow the
physician to determine what type of seizure it is). Therefore, the nurse would hold
seizure medications (this can affect the test) and would NOT allow the patient to
have caffeine like coffee or stimulant drugs (the patient can eat prior to the test
just NO caffeine). The patient’s hair should be cleaned prior to the test so the
technician can apply the electrodes and get them to stick to the scalp easily. A
sedative is not needed before this test.

14. A patient is taking Phenytoin for treatment of seizures. Which statement by

the patient requires you to re-educate the patient about this medication?*

A. “Every morning I take this medication with a full glass of milk with my
breakfast.”

B. “I know it is important to have my drug levels checked regularly.”

C. “I will report a skin rash immediately to my doctor.”

D. “This medication can lower my body’s ability to clot and fight infection.”

The answer is A. This medication should NOT be taken with milk products or
antacids because it affects absorption. All the other options are correct.

15. The nurse is ordered to administer Lorazepam to a patient experiencing status

epilepticus. As a precautionary measure, the nurse will also have what reversal
agent on standby?*

A. Narcan

B. Flumazenil
C. Calcium Chloride

D. Idarucizumab

The answer is B. Flumazenil is the reversal agent for Lorazepam, which is a

benzodiazepine.

16. A patient who is having a tonic-clonic seizure is prescribed Phenobarbital.

During administration of this drug, it is important the nurse monitors for:*

A. Respiratory depression

B. Hypertension

C. Disseminated intravascular clotting

D. Hypotension

E. Fever

The answers are A and D. This medication stimulates the GABA receptors and
helps with inhibitory neurotransmission. It can lead to respiratory depression and
hypotension, therefore, it is very important the nurse monitors the patient for this.

17. An 8-year-old child, who is not responding to anti-seizure medications, is

prescribed to start a ketogenic diet. This diet will include:*

A. High carbohydrates and high fat

B. Low fat, high salt, and high carbohydrates

C. High fat and low carbohydrates

D. High glucose, high fat, and low carbohydrates

The answer is C. This is a type of diet used in the pediatric population with
epilepsy whose seizures cannot be controlled by medication. It is a high fat and
low carb diet.
1. True or False: Tuberculosis is a contagious bacterial infection caused by
mycobacterium tuberculosis and it only affects the lungs.*

True

False

Answer: FALSE…. tuberculosis is a contagious bacterial infection caused by

mycobacterium tuberculosis that affects the lungs AND other systems of the body
like the joints, kidneys, brain, spine, liver etc.

2. A 55-year old male patient is admitted with an active tuberculosis infection.

The nurse will place the patient in ___________________ precautions and will
always wear _____________________ when providing patient care?

A. droplet, respirator

B. airborne, respirator

C. contact and airborne, surgical mask

D. droplet, surgical mask

The answer is B. A patient with ACTIVE TB is contagious. The bacterium,

mycobacterium tuberculosis which causes TB, is so small that it can stay
suspended in the air for hours to days. Therefore, the nurse will place the patient
in AIRBORNE precautions. In addition, a special mask must be worn called a
respirator (as referred to as an N95 mask…. a surgical mask does NOT work with
this condition).

3. Which statement is correct regarding mycobacterium tuberculosis?

A. This bacterium is an anaerobic type of bacteria.

B. It is an alkali bacterium that stains bright red during an acid-fast smear test.

C. It is known as being an aerobic type of bacteria.

D. It’s an acid-fact bacterium that stains bright green during an acid-fast smear
test.

The answer is C. Mycobacterium tuberculosis is AEROBIC (it thrives in

conditions that are high in oxygen), and it is an ACID-FAST bacterium, which
means when it is stained during an acid-fast smear it will turn BRIGHT RED.

4. Your patient with a diagnosis of latent tuberculosis infection needs a

bronchoscopy. During transport to endoscopy, the patient will need to wear?*

A. N95 mask

B. Surgical mask

C. No special PPE is needed

D. Face mask with shield

The answer is C. Patients with a latent tuberculosis infection are NOT contagious.
Therefore, no special PPE is needed for the patient during transport. HOWEVER,
if the patient had ACTIVE tuberculosis, they would need to wear a surgical mask
during transport.

5. You are assessing your newly admitted patients who are all presenting with
atypical signs and symptoms of a possible lung infection. The physician suspects
tuberculosis. So, therefore, the patients are being monitored and tested for the
disease. Select all the risk factors below that increases a patient’s risk for
developing tuberculosis:*

A. Diabetes

B. Liver failure

C. Long-term care resident

D. Inmate
E. IV drug user

F. HIV

G. U.S. resident

The answers are C, D, E, and F. Remember from our lecture we discussed the
risk factors for developing TB and to remember them I said remember the
mnemonic “TB Risk”. It stands for tight living quarters (LTC resident, prison,
homeless shelter etc.), below or at the poverty line (homeless), refugee (especially
in high risk countries), immune system issue such as HIV, substance abusers (IV
drugs or alcohol), Kids less than the age of 5….all these are risk factors.

6. Your patient is diagnosed with a latent tuberculosis infection. Select all the
correct statements that reflect this condition:*

A. “The patient will not need treatment unless it progresses to an active

tuberculosis infection.”

B. “The patient is not contagious and will have no signs and symptoms.”

C. “The patient will have a positive tuberculin skin test or IGRA test.

D. “The patient will have an abnormal chest x-ray.”

E. “The patient’s sputum will test positive for mycobacterium tuberculosis.”

The answers are B and C. The patient WILL need medical treatment to prevent
this case of LBTI from developing into an active TB infection later on. The
patient will NOT have an abnormal chest x-ray or a positive sputum test. This is
only in active TB.

7. A 52-year old female patient is receiving medical treatment for a possible

tuberculosis infection. The patient is a U.S. resident but grew-up in a foreign
country. She reports that as a child she received the BCG vaccine (bacille
Calmette-Guerin vaccine). Which physician’s order below would require the
nurse to ask the doctor for an order clarification?*

A. PPD (Mantoux test)

B. Chest X-ray

C. QuantiFERON-TB Gold (QFT)

D. Sputum culture

The answer is A. Patients who have received the BCG vaccine will have a false
positive on a PPD (Mantoux test), which is the tuberculin skin test. The BCG
vaccine is a vaccine to prevent TB. It is given in foreign countries to children to
prevent TB. Therefore, the person has already been exposed to the bacteria via
vaccine and will have a false positive. A QuantiFERON-TB Gold test is a better
option for this patient. It is a blood test.

8. You’re teaching a group of long-term care health givers about the signs and
symptoms of tuberculosis. What signs and symptoms will you include in your
education?*

A. Cough for a minimum of 6 weeks

B. Night sweats

C. Weight gain

D. Hemoptysis

E. Chills

F. Fever

G. Chest pain
The answers are B, D, E, F, and G. Option A is wrong because a cough should be
present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the
patient will experience weight LOSS (not gain).

9. A patient has a positive PPD skin test that shows an 8 mm induration. As the
nurse you know that:*

A. The patient will need to immediately be placed in droplet precautions and

started on a medication regime.

B. The patient will need a chest x-ray and sputum culture to confirm the test
results before treatment is provided.

C. The patient will need an IGRA test to help differentiate between a latent
tuberculosis infection versus an active tuberculosis infection.

D. The patient will need to repeat the skin test in 48-72 hours to confirm the
results.

The answer is B. A positive PPD result does NOT necessarily mean the patient
has an active infection of TB. The patient will need a chest x-ray and sputum
culture to determine if mycobacterium tuberculosis is present and then treatment
will be based on those results. The IGRA test does NOT differentiate between
LTBI or an active TB infection. Patients are placed in airborne precautions (NOT
droplet) if they have ACTIVE TB

10. A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient
to report back to the office in _________ so the results can be interpreted?*

A. 24-48 hours

B. 12-24 hours

C. 48-72 hours

D. 24-72 hours
The answer is C. The patient should report back in 48-72 hours. If they fail to, the
test must be repeated.

11. A 48-year old homeless man, who is living in a local homeless shelter and is
an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What
is considered a positive result?*

A. 5 mm induration

B. 15 mm induration

C. 9 mm induration

D. 10 mm induration

The answer is D. 15 mm induration is positive in ALL people regardless of health

history or risk factors. However, for patients who are homeless (living in
homeless shelter) and are IV drug users, a 10 mm or more is considered positive.

12. The physician orders an acid-fast bacilli sputum culture smear on a patient
with possible tuberculosis. How will you collect this?*

A. Collect 2 different sputum specimens 12 hours apart

B. Collect 3 different sputum specimens (one in the morning, afternoon, and at

night)

C. Collect 3 different sputum specimens on 3 different days

D. Collect 2 different sputum specimens on 2 different days

The answer is C. This is how an AFB sputum culture is collected.

13. A patient receiving medical treatment for an active tuberculosis infection asks
when she can starting going out in public again. You respond that she is no longer
contagious when:*

A. She has 3 negative sputum cultures

B. Her signs and symptoms improve

C. She has completed the full medication regime

D. Her chest x-ray is normal

E. She has been on tuberculosis medications for about 3 weeks

The answers are A, B, and E. These are all criteria for when a patient with active
TB can return to public life (school, work, running errands). Until then they are
still contagious and must stay home in isolation.

14. As the nurse you know that one of the reasons for an increase in multi-drug-
resistant tuberculosis is:*

A. Incorrect medication ordered

B. Increase in tuberculosis cases nationwide

C. Incorrect route of drug ordered

D. Noncompliance due to duration of medication treatment needed

The answer is D. Patients must be on medication treatment for about 6-12 months
(depending on the type of TB the patient has). This leads to noncompliant issues.
DOT (directly observed therapy) is now being instituted so compliance is
increased. This is where a public health nurse or a trained DOT worker will
deliver the medication and watch the patient swallow the pill until treatment is
complete.

15. Your patient, who is receiving Pyrazinamide, report stiffness and extreme
pain in the right big toe. The site is extremely red, swollen, and warm. You notify
the physician and as the nurse you anticipated the doctor will order?*

A. Calcium level

B. Vitamin B6 level
C. Uric acid level

D. Amylase level

The answer is C. This medication can increase uric acid levels which can lead to
gout. The patient’s signs and symptoms are classic findings in a gout attack.

16. You note your patient’s sweat and urine is orange. You reassure the patient
and educate him that which medication below is causing this finding?*

A. Ethambutol

B. Streptomycin

C. Isoniazid

D. Rifampin

The answer is D. This medication will cause body fluids to turn orange.

17. A patient with active tuberculosis is taking Ethambutol. As the nurse you
make it priority to assess the patient’s?*

A. hearing

B. mental status

C. vitamin B6 level

D. vision

The answer is D. This medication can cause inflammation of the optic nerve.
Therefore, it is very important the nurse asks the patient about their vision. If the
patient has blurred vision or reports a change in colors, the MD must be notified
immediately.

18. A patient taking Isoniazid (INH) should be monitored for what deficiency?*

A. Vitamin C
B. Calcium

C. Vitamin B6

D. Potassium

The answer is C. This medication can lead to low Vitamin B6 levels. Most
patients will take a supplement of B6 while taking this medication.

19. A patient is taking Streptomycin. Which finding below requires the nurse to
notify the physician?

A. Patient reports a change in vision.

B. Patient reports a metallic taste in the mouth.

C. The patient has ringing in their ears.

D. The patient has a persistent dry cough.

The answer is C. This medication can lead to low Vitamin B6 levels. Most
patients will take a supplement of B6 while taking this medication.

20. Which of the following antituberculous drugs can cause damage to the eighth
cranial nerve?

A. Streptomycin

B. Isoniazid

C.Para-aminosalicylic acid

D.Ethambutol hydrochloride

DIABETES MELLITUS

1. Which of the following symptoms do NOT present in hyperglycemia?*

A. Extreme thirst

B. Hunger
C. Blood glucose <60 mg/dL

D. Glycosuria

2. Type 1 diabetics typically have the following clinical characteristics:*

A. Thin, young with ketones present in the urine

B. Overweight, young with no ketones present in the urine

C. Thin, older adult with glycosuria

D. Overweight, adult-aged with ketones present in the urine

3. A patient with diabetes has a morning glucose of 50. The patient is sweaty,
cold, and clammy. Which of the following nursing interventions is the MOST
important?*

A. Recheck the glucose level

B. Give the patient ½ cup (4 oz) of fruit juice

C. Call the doctor

D. Keep the patient nothing by mouth

4. Which of the following patients is at most risk for Type 2 diabetes?*

A. A 6 year old girl recovering from a viral infection with a family history of
diabetes.

B. A 28 year old male with a BMI of 49.

C. A 76 year old female with a history of cardiac disease.

D. None of the options provided.

5. The _____ ______ secrete insulin which are located in the _______.*

A. Alpha cells, liver

B. Alpha cells, pancreas

C. Beta cells, liver

D. Beta cells, pancreas

6. A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the

following treatments do you expect the patient to be started on initially?*

A. Diet and exercise regime

B. Metformin BID by mouth

C. Regular insulin subcutaneous

D. None, monitoring at this time is sufficient enough

7. Which of the following statements are true regarding Type 2 diabetes

treatment?*

A. Insulin and oral diabetic medications are administered routinely in the

treatment of Type 2 diabetes.

B. Insulin may be needed during times of surgery or illness.

C. Insulin is never taken by the Type 2 diabetic.

D. Oral medications are the first line of treatment for newly diagnosed Type 2
diabetics.

8. What statement or statements are INCORRECT regarding Diabetic

Ketoacidosis?*

A. DKA occurs mainly in Type 1 diabetics.

B. Ketones are present in the urine in DKA.

C. Cheyne-stokes breathing will always present in DKA.

D. Severe hypoglycemia is a hallmark sign in DKA.

E. Options C & D

9. A patient who has diabetes is nothing by mouth as prep for surgery. The patient
states they feel like their blood sugar is low. You check the glucose and find it to
be 52. The next nursing intervention would be to:*

A. Administer Dextrose 50% IV per protocol

B. Continue to monitor the glucose

C. Give the patient 4 oz of fruit juice

D. None, this is a normal blood glucose reading

10. A Type 2 diabetic may have all the following signs or symptoms EXCEPT:*

A. Blurry vision

B. Ketones present in the urine

C. Glycosuria

D. Poor wound healing

4. A 63-year-old woman has been taking prednisone (Deltasone) daily for several
years after a kidney transplant to prevent organ rejection. What is most important
for the nurse to assess?

A. Staggering gait

B. Ruptured tendon

C. Back or neck pain

D. Tardive dyskinesia

C. Back or neck pain

Osteoporosis with resultant fractures is a frequent and serious complication of
systemic corticosteroid therapy. The ribs and vertebrae are affected the most, and
patients should be observed for signs of compression fractures (back and neck
pain). Phenytoin (Dilantin) is an antiseizure medication. An adverse effect of
phenytoin is an ataxic (or staggering) gait. A rare adverse effect of ciprofloxacin
(Cipro) and other fluoroquinolones is tendon rupture, usually of the Achilles
tendon. The highest risk is in people age 60 and older and in people taking
corticosteroids. Antipsychotics and antidepressants may cause tardive dyskinesia,
which is characterized by involuntary movements of the tongue and face.

5. The home care nurse visits an 84-year-old woman with pneumonia after her
discharge from the hospital. Which assessment finding would the nurse expect
because of age-related changes in the musculoskeletal system?

A. Positive straight-leg-raising test

B. Muscle strength is scale grade 3/5

C. Lateral S-shaped curvature of the spine

D. Fingers drift to the ulnar side of the forearm

B. Muscle strength is scale grade 3/5

Decreased muscle strength is an age-related change of the musculoskeletal

system caused by decreased number and size of the muscle cells. The other
assessment findings indicate musculoskeletal abnormalities. A positive straight-
leg-raising test indicates nerve root irritation from intervertebral disk prolapse
and herniation. An ulnar deviation or drift indicates rheumatoid arthritis due to
tendon contracture. Scoliosis is a lateral curvature of the spine.

6. The nurse admits a 55-year-old female with multiple sclerosis to a long-term

care facility. Which finding is of most immediate concern to the nurse?

A. Ataxic gait

B. Radicular pain

C. Severe fatigue

D. Urinary retention

A. Ataxis gait

An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in

individuals with gait instability or visual or cognitive impairments. The other
signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also
occur in the patient with multiple sclerosis and need to be managed, but are not
the priority.

7. A 57-year-old postmenopausal woman is scheduled for dual-energy x-ray

absorptiometry (DXA). Which statement, if made by the patient to the nurse,
indicates understanding of the procedure?

A. "The bone density in my heel will be measured."

B. "This procedure will not cause any pain or discomfort."

C. "I will not be exposed to any radiation during the procedure."

D. "I will need to remove my hearing aids before the procedure."

B. "This procedure will not cause any pain or discomfort."

Dual-energy x-ray absorptiometry (DXA) is painless and measures the bone mass
of spine, femur, forearm, and total body with minimal radiation exposure. A
quantitative ultrasound (QUS) evaluates density, elasticity, and strength of bone
using ultrasound of the calcaneus (heel). Magnetic resonance imaging would
require removal of objects such as hearing aids that have metal parts.

8. A 42-year-old man who is scheduled for an arthrocentesis arrives at the

outpatient surgery unit and states, "I do not want this procedure done today."
Which response by the nurse is most appropriate?

A. "When would you like to reschedule the procedure?"

B. "Tell me what your concerns are about this procedure."

C. "The procedure is safe, so why should you be worried?"

D. "The procedure is not painful because an anesthetic is used."

B. "Tell me what your concerns are about this procedure."

The nurse should use therapeutic communication to determine the patient's

concern about the procedure. The nurse should not provide false reassurance. It
is not appropriate for the nurse to assume the patient is concerned about pain or
to assume the patient is asking to reschedule the procedure.

9. The bone cells that function in the resorption of bone tissue are called

a.osteoids
b.osteocytes

c.osteoclasts

d.osteoblasts

c.osteoclasts

Osteoclasts participate in bone remodeling by assisting in the breakdown of bone

tissue.

10. While performing passive range of motion for a patient, the nurse puts the
ankle joint through the movements of (select all that apply)

a.flexion and extension.

b.inversion and eversion.

c.pronation and supination

d.flexion, extension, abduction, and adduction.

e.pronation, supination, rotation, and circumduction.

a.flexion and extension.

b.inversion and eversion.

Common movements that occur at the ankle include inversion, eversion, flexion,
and extension.

11. To prevent muscle atrophy, the nurse teaches the patient with a leg
immobilized in traction to perform (select all that apply)
a.flexion contractions.

b.tetanic contractions.

c.isotonic contractions.

d.isometric contractions.

e.extension contractions.

d.isometric contractions

Isometric contractions increase the tension within a muscle but do not produce
movement. Repeated isometric contractions make muscles grow larger and
stronger. Muscular atrophy (i.e., decrease in size) occurs with the absence of
contraction that results from immobility.

12. A patient with tendonitis asks what the tendon does. The nurse's response is
based on the knowledge that tendons

a.connect bone to muscle.

b.provide strength to muscle.

c.lubricate joints with synovial fluid.

d.relieve friction between moving parts.

a.connect bone to muscle

Tendons are composed of dense, fibrous connective tissue that contains bundles
of closely packed collagen fibers arranged in the same plane for additional
strength. They connect the muscle sheath to adjacent bone.
13. The increased risk for falls in the older adult is most likely due to

a.changes in balance.

b.decrease in bone mass.

c.loss of ligament elasticity.

d.erosion of articular cartilage.

a.changes in balance

Aging can cause changes in a person's sense of balance, making the person
unsteady, and proprioception may be altered. The risk for falls also increases in
older adults partly because of a loss of strength.

14. While obtaining subjective assessment data related to the musculoskeletal

system, it is particularly important to ask a patient about other medical problems
such as

a.hypertension.

b.thyroid problems.

c.diabetes mellitus.

d.chronic bronchitis.

c.diabetes mellitus
The nurse should question the patient about past medical problems because
certain illnesses are known to affect the musculoskeletal system directly or
indirectly. These diseases include tuberculosis, poliomyelitis, diabetes mellitus,
parathyroid problems, hemophilia, rickets, soft tissue infection, and
neuromuscular disabilities.

15. When grading muscle strength, the nurse records a score of 3, which indicates

a.no detection of muscular contraction.

b.a barely detectable flicker of contraction.

c.active movement against full resistance without fatigue.

d.active movement against gravity but not against resistance.

d. active movement against gravity but not against resistance

Muscle strength score of 3 indicates active movement only against gravity and
not against resistance

16. A normal assessment finding of the musculoskeletal system is

a.no deformity or crepitation.

b.muscle and bone strength of 4.

c.ulnar deviation and subluxation.

d.angulation of bone toward midline.

a.no deformity or crepitation

Normal physical assessment findings of the musculoskeletal system include
normal spinal curvatures; no muscle atrophy or asymmetry; no joint swelling,
deformity, or crepitation; no tenderness on palpation of muscles and joints; full
range of motion of all joints without pain or laxity; and muscle strength score of
5

17. A patient is scheduled for an electromyogram (EMG). The nurse explains

that this diagnostic test involves

a.incision or puncture of the joint capsule.

b.insertion of small needles into certain muscles.

c.administration of a radioisotope before the procedure.

d.placement of skin electrodes to record muscle activity.

b.insertion of small needles into certain muscles

Electromyography (EMG) is an evaluation of electrical potential associated with

skeletal muscle contraction. Small-gauge needles are inserted into certain
muscles and attached to leads that record electrical activity of muscle. Results
provide information related to lower motor neuron dysfunction and primary
muscle disease

18. A 54-year-old patient admitted with cellulitis and probable osteomyelitis

received an injection of radioisotope at 9:00 AM before a bone scan. The nurse
should plan to send the patient for the bone scan at what time?

A. 9:30 PM
B. 10:00 AM

C. 11:00 AM

D. 1:00 PM

C. 11:00 AM

A technician usually administers a calculated dose of a radioisotope 2 hours

before a bone scan. If the patient was injected at 9:00 AM, the procedure should
be done at 11:00 AM. 10:00 AM would be too early; 1:00 PM and 9:30 PM would
be too late.

19. A 54-year-old patient is about to have a bone scan. In teaching the patient
about this procedure, the nurse should include what information?

A. Two additional follow-up scans will be required.

B. There will be only mild pain associated with the procedure.

C. The procedure takes approximately 15 to 30 minutes to complete.

D. The patient will be asked to drink increased fluids after the procedure.

D. The patient will be asked to drink increased fluids after the procedure.

Patients are asked to drink increased fluids after a bone scan to aid in excretion
of the radioisotope, if not contraindicated by another condition. No follow-up
scans and no pain are associated with bone scans that take 1 hour of lying supine.

20. Musculoskeletal assessment is an important component of care for patients

on what type of long-term therapy?
A. Corticosteroids

B. β-Adrenergic blockers

C. Antiplatelet aggregators

D. Calcium-channel blockers

A. Corticosteroids

Corticosteroids are associated with avascular necrosis and decreased bone and
muscle mass. β-blockers, calcium-channel blockers, and antiplatelet aggregators
are not commonly associated with damage to the musculoskeletal system.

21. A female patient with a long-standing history of rheumatoid arthritis has

sought care because of increasing stiffness in her right knee that has culminated
in complete fixation of the joint. The nurse would document the presence of
which problem?

A. Atrophy

B. Ankylosis

C. Crepitation

D. Contracture

B. Ankylosis

Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced

movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or
tendons). Atrophy is a flabby appearance of muscle leading to decreased function
and tone. Crepitation is a grating or crackling sound that accompanies movement.

22. The nurse is performing a musculoskeletal assessment of an 81-year-old

female patient whose mobility has been progressively decreasing in recent
months. How should the nurse best assess the patient's range of motion (ROM)
in the affected leg?

A. Observe the patient's unassisted ROM in the affected leg.

B. Perform passive ROM, asking the patient to report any pain.

C. Ask the patient to lift progressive weights with the affected leg.

D. Move both of the patient's legs from a supine position to full flexion.

A. Observe the patient's unassisted ROM in the affected leg.

Passive ROM should be performed with extreme caution and may be best avoided
when assessing older patients. Observing the patient's active ROM is more
accurate and safer than asking the patient to lift weights with her legs.

23. In reviewing bone remodeling, what should the nurse know about the
involvement of bone cells?

A. Osteoclasts add canaliculi.

B. Osteoblasts deposit new bone.

C. Osteocytes are mature bone cells.

D. Osteons create a dense bone structure.

B. Osteoblasts deposit new bone.

Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts
deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian
systems create a dense bone structure, but these are not involved with bone
remodeling.

24. When working with patients, the nurse knows that patients have the most
difficulties with diarthrodial joints. Which joints are included in this group of
joints? (Select all that apply.)

A. Hinge joint of the knee

B. Ligaments joining the vertebrae

C. Fibrous connective tissue of the skull

D. Ball and socket joint of the shoulder or hip

E. Cartilaginous connective tissue of the pubis joint

A. Hinge joint of the knee

D. Ball and socket joint of the shoulder or hip

The diarthrodial joints include the hinge joint of the knee and elbow, the ball and
socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the
condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and
cartilaginous connective tissue joining the vertebrae and pubis joint and the
fibrous connective tissue of the skull are synarthrotic joints.

25. An 82-year-old patient is frustrated by her flabby belly and rigid hips. What
should the nurse tell the patient about these frustrations?
A. "You should go on a diet and exercise more to feel better about yourself."

B. "Something must be wrong with you because you should not have these
problems."

C. "You have arthritis and need to go on nonsteroidal antiinflammatory drugs

(NSAIDs)."

D. "Decreased muscle mass and strength and increased hip rigidity are normal
changes of aging."

D. "Decreased muscle mass and strength and increased hip rigidity are normal
changes of aging."

The musculoskeletal system's normal changes of aging include decreased muscle

mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees;
decreased fine motor dexterity; and slowed reaction times. Going on a diet and
exercising will help but not stop these changes. Telling the patient "Something
must be wrong with you..." will not be helpful to the patient's frustrations.

26. A 50-year-old patient is reporting a sore shoulder after raking the yard. The
nurse should suspect which problem?

A. Bursitis

B. Fasciitis

C. Sprained ligament

D. Achilles tendonitis

A. Bursitis
Bursitis is common in adults over age 40 and with repetitive motion, such as
raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by
straining the ligament that supports the arch. Achilles tendonitis is an
inflammation of the tendon that attaches the calf muscle to the heel bone, not the
shoulder, and causes pain with walking or running. A sprained ligament occurs
when a ligament is stretched or torn from a direct injury or sudden twisting of the
joint, not repetitive motion.

Question 1

Marlisa has been diagnosed with diabetes mellitus type 1. She asks Nurse Errol
what this means. What is the best response by the nurse? Select all that apply.

A “Your alpha cells should be able to secrete insulin, but cannot.”

B “The exocrine function of your pancreas is to secrete insulin.”

C “Without insulin, you will develop ketoacidosis (DKA).”

D “The endocrine function of your pancreas is to secrete insulin.”

E “It means your pancreas cannot secrete insulin.”

Question 2

Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a blood sugar of
563. Nurse AJ administers insulin lispro (Humalog) intravenously (IV). What
does the best evaluation of the nurse reveal? Select all that apply.
A The nurse could have given the insulin subcutaneously.

B The nurse should have contacted the physician.

C The nurse should have used regular insulin (Humulin R).

D The nurse used the correct insulin.

Question 3

Ben injects his insulin as prescribed, but then gets busy and forgets to eat. What
will the best assessment of the nurse reveal?

A The client will be very thirsty.

B The client will complain of nausea.

C The client will need to urinate.

D The client will have moist skin.

Question 4

A clinical instructor teaches a class for the public about diabetes mellitus. Which
individual does the nurse assess as being at highest risk for developing diabetes?

A The 50-year-old client who does not get any physical exercise

B The 56-year-old client who drinks three glasses of wine each evening

C The 42-year-old client who is 50 pounds overweight

D The 38-year-old client who smokes one pack of cigarettes per day

Question 5

Steven John has type 1 diabetes mellitus and receives insulin. Which laboratory
test will the nurse assess?

A Potassium
B AST (aspartate aminotransferase)

C Serum amylase

D Sodium

Question 6

Jansen is receiving metformin (Glucophage). What will be the best plan of the
nurse with regard to patient education with this drug? Select all that apply.

A It stimulates the pancreas to produce more insulin.

B It must be taken with meals.

C It decreases sugar production in the liver.

D It inhibits absorption of carbohydrates.

E It reduces insulin resistance.

Question 7

Serafica who has diabetes mellitus type 1 is found unresponsive in the clinical
setting. Which nursing action is a priority? arrange from 1 to 4.

1. Treat the client for hypoglycemia.

2. Call the physician STAT.

3. Assess the vital signs.

4. Call a code.

A 1, 2, 3, 4

B 1, 3, 2, 4

C 3, 1, 2, 4

D 4, 3, 2, 1
Question 8

Serge who has diabetes mellitus is taking oral agents, and is scheduled for a
diagnostic test that requires him to be NPO. What is the best plan of the nurse
with regard to giving the client his oral medications?

A Administer the oral agents immediately after the test.

B Notify the the diagnostic department and request orders.

C Notify the physician and request orders.

D Administer the oral agents with a sip of water before the test.

Question 9

A client diagnosed with type 1 diabetes receives insulin. He asks the nurse why
he can’t just take pills instead. What is the best response by the nurse?

A “Insulin must be injected because it needs to work quickly.”

B “Insulin can’t be in a pill because it is destroyed in stomach acid.”

C “Have you talked to your doctor about taking pills instead?”

D “I know it is tough, but you will get used to the shots soon.”

Question 10

Nurse Andy has finished teaching a client with diabetes mellitus how to
administer insulin. He evaluates the learning has occurred when the client makes
which statement?

“I should check my blood sugar immediately prior to the

A
administration.”

B “I should provide direct pressure over the site following the injection.”

C “I should use the abdominal area only for insulin injections.”

D “I should only use calibrated insulin syringe for the injections.”

Question 11

Genevieve has diabetes type 1 and receives insulin for glycemic control. She tells
the nurse that she likes to have a glass of wine with dinner. What will the best
plan of the nurse for client education include?

A The alcohol could cause pancreatic disease.

B The alcohol could cause serious liver disease.

C The alcohol could predispose you to hypoglycemia.

D The alcohol could predispose you to hyperglycemia.

Question 12

Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a client with
diabetes mellitus. When will the nurse administer this medication?

A When the client is eating

B Thirty minutes before meals

C fifteen minutes before meals

D When the meal trays arrive on the floor

Question 13

Nurse Matt makes a home visit to the client with diabetes mellitus. During the
visit, Nurse Matt notes the client’s additional insulin vials are not refrigerated.
What is the best action by the nurse at this time?

A Instruct the client to label each vial with the date when opened.

B Tell the client there is no need to keep additional vials.

C Have the client place the insulin vials in the refrigerator.

D Have the client discard the vials.

Question 14

During the morning rounds, Nurse AJ accompanied the physician in every

patient’s room. The physician writes orders for the client with diabetes mellitus.
Which order would the nurse validate with the physician?

A Use Humalog insulin for sliding scale coverage.

B Metformin (Glucophage) 1000 mg per day in divided doses.

C Administer regular insulin 30 minutes prior to meals.

D Lantus insulin 20U BID.

Question 15

Gary has diabetes type 2. Nurse Martha has taught him about the illness and
evaluates learning has occurred when the client makes which statement?

A “My cells have increased their receptors, but there is enough insulin.”

B “My peripheral cells have increased sensitivity to insulin.”

C “My beta cells cannot produce enough insulin for my cells.”

D “My cells cannot use the insulin my pancreas makes.”

Question 16

The principal goals of therapy for older patients who have poor glycemic control
are:

A Enhancing quality of life.

B Decreasing the chance of complications.

C Improving self-care through education.

D All of the above.

Question 17

Which of the following is accurate pertaining to physical exercise and type 1

diabetes mellitus?

A Physical exercise can slow the progression of diabetes mellitus.

B Strenuous exercise is beneficial when the blood glucose is high.

Patients who take insulin and engage in strenuous physical exercise

C
might experience hyperglycemia.

Adjusting insulin regimen allows for safe participation in all forms of

D
exercise.

Question 18

Harry is a diabetic patient who is experiencing a reaction of alternating periods

of nocturnal hypoglycemia and hyperglycemia. The patient might be manifesting
which of the following?

A Uncontrolled diabetes

B Somogyi phenomenon

C Brittle diabetes

D Diabetes insipidus

Question 19

Dr. Hugo has prescribed sulfonylureas for Rebecca in the management of

diabetes mellitus type 2. As a nurse, you know that the primary purpose of
sulfonylureas, such as long-acting glyburide (Micronase), is to:
A Induce hypoglycemia by decreasing insulin sensitivity.

B Improve insulin sensitivity and decrease hyperglycemia.

C Stimulate the beta cells of the pancreas to secrete insulin.

D Decrease insulin sensitivity by enhancing glucose uptake.

Question 20

Rosemary has been taking Glargine (Lantus) to treat her condition. One of the
benefits of Glargine (Lantus) insulin is its ability to:

Release insulin rapidly throughout the day to help control basal

A
glucose.

Release insulin evenly throughout the day and control basal glucose
B
levels.

Simplify the dosing and better control blood glucose levels during the
C
day.

Cause hypoglycemia with other manifestation of other adverse

D
reactions.

Question 21

A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes

mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels,
and polyphagia, the gerontology nurse should anticipate which of the following
secondary medical diagnoses?

A Impaired glucose tolerance

B Gestational diabetes mellitus

C Pituitary tumor
D Pancreatic tumor

Question 22

An older woman with diabetes mellitus visits the clinic concerning her condition.
Of which of the following symptoms might an older woman with diabetes
mellitus complain?

A Anorexia

B Pain intolerance

C Weight loss

D Perineal itching

Question 23

Gregory is a 52-year-old man identified as high-risk for diabetes mellitus. Which

laboratory test should a nurse anticipate a physician would order for him? (Select
all that apply.)

A Fasting Plasma Glucose (FPG)

B Two-hour Oral Glucose Tolerance Test (OGTT)

C Glycosylated hemoglobin (HbA1C)

D Finger stick glucose three times daily

Question 24

According to the National Diabetes Statistics Report, diabetes remains as one of

the leading causes of death in the United States since 2010. Which of the
following factors are risks for the development of diabetes mellitus? Select all
that apply.

A Age over 45 years

B Overweight with a waist/hip ratio >1

C Having a consistent HDL level above 40 mg/dl

D Maintaining a sedentary lifestyle

Question 25

During a visit in the hospital, the student nurses are asked which of the following
persons would most likely be diagnosed with diabetes mellitus. They are correct
if they answered a 44-year-old:

A Caucasian woman.

B Asian woman.

C African-American woman.

D Hispanic male.

Question 26

An ailing 70-year-old woman with a diagnosis of type 2 diabetes mellitus has

been ill with pneumonia. The client’s intake has been very poor, and she is
admitted to the hospital for observation and management as needed. What is the
most likely problem with this patient?

A Insulin resistance has developed.

B Diabetic ketoacidosis is occurring.

C Hypoglycemia unawareness is developing.

D Hyperglycemic hyperosmolar non-ketotic coma.

Question 27

Daniel is diagnosed of having hyperthyroidism (Graves’ disease). Which of the

following is a drug of choice for his condition?
A Furosemide (Lasix)

B Digoxin (Lanoxin)

C Propranolol (Inderal)

D Propylthiouracil (PTU)

Question 28

Which of the following medications are most likely to cause hypothyroidism?

(Select all that apply.)

A Acetylsalicylic acid (aspirin)

B Furosemide (Lasix)

C Docusate sodium (Colace)

D Rifampin (Rifadin)

Question 29

After visiting the physician, Angela found out that she has a thyroid problem. In
line with her condition, which of the following diagnostic studies is done to
determine the size and composition of the thyroid gland?

A Thyroid scan with RAI 123I

B Electrocardiography

C Ultrasonography

D Venous duplex Doppler study

Question 30

Nurse Gil is caring for a patient with a diagnosis of hypothyroidism. Which

nursing diagnosis should the nurse most seriously consider when analyzing the
needs of the patient?
A High risk for aspiration related to severe vomiting

B Diarrhea related to increased peristalsis

C Hypothermia related to slowed metabolic rate

D Oral mucous membrane, altered related to disease process