CA 1

MODULE 4 ACTIVITIES:

Lesson 1
Nursing clinical scenarios integrating the nursing process, levels of care/prevention
in the nursing management of the Adult Client with an Eye or Ear Disorder:

TEST YOUR NURSING KNOWLEDGE

MULTIPLE CHOICE: Analyse the situation before you answer. Select and
write only the letter of choice.
1. The nurse is performing an otoscopic examination on a client with mastoiditis. On
examination of the tympanic membrane, which of the following would the nurse expect
to observe?
a. a pink-colored tympanic membrane
b. a pearly colored tympanic membrane
c. a transparent and clear tympanic membrane
d. tympanic membrane a red, dull, thick and immobile
Rationale:
2. A client with Meniere's disease is experiencing severe vertigo. Which instruction should
the nurse give to the client to assist in controlling the vertigo?
a. increase sodium in the diet
b. avoid sudden head movements
c. lie still and watch the television
d. increase fluid intake to 3L a day
Rationale: The nurse instructs the client to make slow head movements to prevent
worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce
the amount of endolymphatic fluid sometimes are prescribed. Lying still and watching
television will not control vertigo.

3. A nurse in the health care clinic is providing instructions to a client regarding the use of a
hearing aid. Which of the following statements would be appropriate for the nurse to
include?
a. the ear mold for the hearing aid should be washed with mild soap and water once a
month
b. the hearing aid should be removed from the ear at the end of the day then turned off
after removal
c. the hearing aid contains a lifelong battery so you will not need to be concerned about
changing batteries
d. the hearing aid should not be worn if an ear infection is present
Rationale:
4. The clinic nurse is preparing to provide care for a client who will need an ear irrigation to
remove impacted cerumen. Which of the following will the nurse avoid when performing
the irrigation?
a. position the client to turn the head so that the ear be irrigated is facing upward
b. warm the irrigating solution to a temperature that is close to body temperature
c. direct a slow steady stream of irrigation solution toward the upper wall of the ear
canal
d. position the client with the affected side down after irrigation
Rationale:

5. A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The
client has brought several bottles of medications prescribed by different specialists.
During the admission assessment, the client states, "Lately, I have been hearing some
roaring sounds in my ears, especially when I am alone." Which medication would the
nurse determine could be the cause of the client's complaint?
a. doxycycline
 b. acetazolamide
c. acetylsalicylic acid
d. diltiazem hydrochloride
Rationale:

6. a client asks for an explanation about glaucoma. The nurse explains that with glaucoma
there is:
a. a separation of the neural retina from the pigmented retina.
b. a curvature of the cornea that becomes unequal.
c. an opacity of the crystalline lens or its capsule.
d. an increase in the pressure within the eyeball.
Rationale: Damage optic nerve, the health of which is vital for good vision.

7. After cataract surgery, a client is taught how to self-administer eyedrops before

discharge. The nurse approves the technique when the client:
a. Squeezes the eye shut after instilling the eyedrops
b. Raises the upper eyelid with gentle traction
c. Places the drops on the cornea of the eye
d. Holds the dropper tip above the eye
Rationale: Drops are placed within the lower lid (conjunctival sac). To protect against
physical injury and infection, the dropper tip should not touch the eye. The lower lid is
retracted for placement of eyedrops. Squeezing the eyes shut after administration of the
medication should be avoided; this will squeeze medication out of the eye.

8. After surgery to repair retinal detachment, an older adult client returns to the post
anesthesia care unit with the affected eye patched. During the first 4 hours after surgery,
the nurse should notify the physician if the client:
a. Complains of sharp pain in the eye
b. Becomes disoriented
c. Cannot open the eye
d. Has not voided
Rationale:
9. When performing a neurologic check on a client with a head injury, the nurse identifies a
diminished corneal reflex. Appropriate nursing care for an absent corneal reflex includes:
a. Alternately taping the eyelids open and closed every 2 hours
b. Instilling artificial tears whenever necessary
c. Checking the corneal reflex every hour
d. Irrigating the eye every 4 hours
Rationale:
10. After an automobile accident, a client complains of seeing frequent flashes of light.
Which condition should the nurse suspect?
a. Cerebral concussion
b. Detached retina
c. Scleroderma
d. Glaucoma
Rationale: This symptom is caused by stimulation of retinal cells by ocular movement.

Lesson 2
Nursing clinical scenarios integrating the nursing process, levels of care/prevention in
the nursing management of the Adult Client with a Neurological Disorder:
 TEST YOUR NURSING KNOWLEDGE
MULTIPLE CHOICE: Analyse the situation before you answer. Select and write
only the letter of choice.

Situation: A., age 58, is taken to the emergency department by two police officers after he
tried to cut a supermarket manager with a piece of broken glass. He said he did this because
he was just laid off from his job, which he held for 30 years. He also said his wife recently
left him after 20 years of marriage because of his alcohol abuse and the physical abuse he
inflicted on her when he was drunk. In the emergency department, he becomes verbally
abusive to nursing staff members and demands to be released. When asked to be seated so
the nurse can take his blood pressure, he throws a chair across the room. Four staff members
are needed to control and restrain him.
A. is admitted to the psychiatric unit, placed in seclusion, and given haloperidol (haldol) 5 mg
I.M. After 1 1/2 hours, he appears calmer and is released from seclusion. Although still angry,
he is able to control himself from becoming physically or verbally abusive. He apologizes for
his behavior and says that he hopes he did not hurt anyone.

1. Which responses to A.'s apology is most therapeutic?

a. We are here to help you. We understand that you didn't mean to hurt us
b. Let's see how well you can control yourself from now on
c. It's fortunate no one was hurt. It will not be necessary to use restraints as long as you
can control your behavior
d. It was frightening and very dangerous. It is unpleasant to have to restrain someone

2. Based on A.'s history, reason for admission, and behavior in the emergency
department, the nurse records that the patient has a Potential for Violence directed to
others. Which goal is most appropriate for this nursing diagnostic category?
a. The client will verbalize anger rather than physical strike out
b. The client will not strike out more than once a day
c. The client will be placed in seclusion whenever he threatens anyone verbally or
physically
d. The client will not verbalize anger or strike out at anyone

3. A. refuses his 5pm 10mg dose of haloperidol P.O. He states, "I'm in control now. I
don't need any drugs." The nurse's responses to A. should be based on the
understanding that the client:
a. has the right to refuse treatment.
b. is potentially violent and must be medicated.
c. can be given haloperidol intramuscularly instead of orally.
d. must receive haloperidol at regular intervals to ensure the drug's effectiveness.

4. The nurse's initial priority when dealing with an assaultive or homicidal client is to:
a. keep the client away from others and under one-to-one supervision.
b. restore the client's self-control and prevent further loss of control.
c. allow the client to act out his frustrations, then establish a line of communication.
d. clear the area of objects that might harm the client or others.

5. One afternoon, the nurse hears A. yelling in the dayroom. He begin pushing chairs
into the wall and swings at other clients with a pool cue. The nurse should intervene
by:
a. administering a fast-acting sedative, as ordered.
b. telling the client to go to his room.
c. restraining the client, then calling for assistance.
d. following the initial steps of the planned team approach.

6. A. continues to swing the pool cue wildly. Which approach is safest in this situation?
 a. Approaching the clients as a team while holding a mattress and gently backing him
toward a wall
b. Using chairs or other objects as safety barriers while approaching the client
c. Keeping away from the client until he puts the pool cue down
d. Calling hospital security to subdue the client

7. Which nursing intervention is most important when restraining a violent client?

a. Reviewing hospital policy regarding how long the client can be restrained
b. Preparing a PRN dose of the client's psychotropic medication
c. Checking that the restraints have been applied correctly
d. Asking the client if he needs to use the bathroom or is thirsty

8. A client with closed head injury manifests increased urine output. What should the
nurse do next?
a. measure urine specific gravity
b. start an IV fluid
c. monitor blood glucose levels
d. administer mannitol drip

9. A 75-year old woman is admitted to a nursing home with a diagnosis of primary

dementia of the Alzheimer's type. In the nursing home, which of these behaviors of
the client is of greatest danger to her?
a. she wanders into other patient's room
b. she climbs over the side rails of her bed
c. she eats the food off other resident's plates
d. she refuses to change her clothes

10. A man with bipolar disorder, manic episode, has been traveling around the country,
dating multiple women and buying his dates expensive gifts. He is admitted to the
hospital when he becomes exhausted and is out of money. The nurse understands
that during a manic episode the client is most likely experiencing feelings of: a. Guilt
b. Grandeur
c. Worthlessness
d. Self-depreciation

Lesson 3
Nursing clinical scenarios integrating the nursing process, levels of care/prevention in
the nursing management of the Adult Client with a Musculoskeletal Disorder:

TEST YOUR NURSING KNOWLEDGE

MULTIPLE CHOICE: Analyse the situation before you answer. Select and
write only the letter of choice.

1. The nurse identifies that a client exhibits the characteristic gait associated with
Parkinson’s disease. When recording on the client’s record, the nurse should describe this
gait as:
a. Asymmetric
b. Scissoring
c. Shuffling
d. Ataxic
2. A client whose vertebral column at the level of T6 and T7 was completely crushed and
whose left leg was traumatically amputated above the knee is admitted to the ICU. When
performing an assessment the nurse would expect to find that the client was
experiencing:
a. Spastic paralysis of the extremities
b. Pain at the level of compression
c. Pain in the residual limb
d. Difficulty breathing

3. A client with rheumatoid arthritis asks the nurse about ways to decrease morning
stiffness. The nurse should suggest:
a. Planning a rest break periodically for about 15 minutes
b. Taking a hot tub bath or shower in the morning
c. Avoiding excessive physical stress and fatigue
d. Wearing loose but warm clothing

4. The nurse recognizes that stimulation of calcium deposition in the bone after a distal
femoral fracture is best achieved by:
a. Ingesting foods high in calcium
b. Normal aging process
c. Weight-bearing activity
d. Resting the extremity

5. After a long leg cast is removed, the client should be instructed to:
a. Put the leg through a full range of motion once daily
b. Elevate the leg if sitting for long periods of time
c. Cleanse the leg by scrubbing with a brisk motion
d. Report stiffness of the ankle

Lesson 4
Nursing clinical scenarios integrating the nursing process, levels of care/prevention in the
nursing management of the Adult Client with an Immune Disorder:

TEST YOUR NURSING KNOWLEDGE

MULTIPLE CHOICE: Analyse the situation before you answer. Select and
write only the letter of choice.

1. When assessing a client experiencing an acute episode of rheumatoid arthritis, the nurse
observes that the client’s finger joints are swollen. The nurse understands that this
swelling is most likely related to:
a. Escaped fluid from the capillaries, increasing interstitial fluids
b. Formation of bony spurs on the joint surfaces
c. Inflammation in the joint’s synovial lining
d. Urate crystals in the synovial tissue

2. The nurse should explain to a client with diabetes that self-monitoring of blood glucose is
preferred to urine glucose testing because it is:
a. Not influenced by drugs
b. Done by the client
c. Easier to perform
d. More accurate
3. On admission, the bloodwork of a young adult with leukemia indicates an elevated blood
urea nitrogen (BUN) and uric acid. The nurse is aware that these laboratory results may be
related to:
a. Hepatic encephalopathy
b. Hypermetabolic status
c. Thrombocytopenia
d. Lymphadenopathy

4. A client with multiple myeloma asks how the disease may progress. When teaching this
client, the nurse should discuss the possibility that:
a. The disease is exacerbated by exposure to ultraviolet rays
b. IV fluid therapy may be administered in the home
c. Frequent urinary tract infections may result
d. Blood transfusions may be necessary

5. A client has an exacerbation of systemic lupus erythematosus. The dosage of steroid

medication is increased, and a home health care nurse is to provide health teaching. To
reduce the frequency of exacerbations, the nurse should teach the client:
a. Signs of impending exacerbation
b. Measures to improve nutrition
c. Techniques to reduce stress
d. Basic principles of hygiene

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