Question

A client diagnosed with amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the client best make known his wishes for care as his disease progresses?

Answer 1

Correct Answers:

Prepare an advance directive and choose a health care power of attorney

Rationale :

🧠Advance directives legally document the client’s treatment preferences before they lose decision-making capacity.

📜Appointing a health care power of attorney ensures a trusted surrogate can interpret wishes when situations are nuanced.

🧩These tools reduce family conflict and guide clinicians when the disease progresses or emergencies arise.

🛡️They are proactive, patient-centered strategies endorsed for progressive neurodegenerative illnesses like ALS.

📌Core Message

Prioritize advance care planning—an advance directive plus a health care proxy best protect and communicate evolving wishes in progressive ALS.

Answer 2

Correct Answers:

Purpura
Petechiae
Hematuria

Rationale :

🩸Thrombocytopenia causes impaired primary hemostasis, leading to mucocutaneous bleeding signs.

🔍Petechiae reflect capillary hemorrhage from low platelet counts and are classic early findings.

🟣Purpura (larger, non-blanching lesions) arise from cutaneous bleeding due to platelet deficiency.

🚽Hematuria represents internal bleeding risk in the urinary tract when platelets are insufficient.

📌Core Message

Low platelets produce mucocutaneous bleeding—look for petechiae, purpura, and hematuria, not primary organ failure signs.

Answer 3

Correct Answers:

Subdural hematoma

Rationale :

🧠Subdural hematomas can present acutely after trauma or chronically as slow venous bleeding, especially in older adults.

⏳The bridging veins mechanism allows both rapid and gradual blood accumulation.

👵Age-related brain atrophy increases vein vulnerability, predisposing to chronic forms.

🧪Clinical course ranges from immediate deficits to insidious cognitive changes, fitting both timelines.

📌Core Message

Subdural hematomas uniquely occur in acute and chronic forms due to bridging vein injury and slow venous bleeding potential.

Answer 4

Correct Answers:

Turn the patient onto their side and hold them in that position until the seizure has resolved

Rationale :

🛑While a lateral position is appropriate, physically restraining a seizing patient is unsafe and can cause injury.

🕒Timing the seizure is essential to identify status epilepticus and guide escalation.

👕Removing restrictive clothing helps airway/breathing and reduces injury risk.

🧴Suctioning secretions is appropriate if accessible, but never force the mouth open due to dental/airway trauma risk.

📌Core Message

In seizures, support airway and safety without restraint; time events and avoid forcing anything into the mouth.

Answer 5

Correct Answers:

Autonomic dysreflexia
Increased risk of pressure injuries
DVT

Rationale :

⚡In lesions at or above T6 (C7 included), autonomic dysreflexia is a dangerous hypertensive emergency triggered by noxious stimuli.

🛏️Immobility markedly raises risk for pressure injuries, requiring vigilant prevention.

🩹Reduced mobility and venous stasis elevate DVT risk; prophylaxis and monitoring are key.

🧠Increased ICP and sodium wasting are not typical complications of spinal cord injuries without associated brain pathology.

📌Core Message

For C7 SCI, monitor for autonomic dysreflexia, prevent pressure injuries, and mitigate DVT risk; brain-specific syndromes don’t apply here.

Answer 6

Correct Answers:

False

Rationale :

🧠Parkinson’s disease stems from dopamine deficiency in the substantia nigra, not excess.

⚖️Loss of dopamine creates relative cholinergic dominance, producing motor symptoms.

🧩This imbalance underlies bradykinesia, rigidity, tremor, and postural instability.

💊Therapy aims to restore dopamine signaling or reduce acetylcholine effects, correcting the imbalance.

📌Core Message

Parkinson’s features dopamine loss leading to relative acetylcholine dominance—the opposite of increased dopamine.

Answer 7

Correct Answers:

54

Rationale :

🧮Convert 1.5 L to 1500 mL for drop calculations.

⏱️Seven hours equals 420 minutes.

🔢Multiply 1500 mL × 15 gtt/mL = 22,500 gtt total.

📉Divide 22,500 ÷ 420 ≈ 53.6, which rounds to 54 gtts/min for clinical practice.

📌Core Message

Use (volume × drop factor) ÷ minutes and round to set safe, practical drip rates.

Answer 8

Correct Answers:

Presence of lytic lesions
Elevation of M protein levels
Dehydration
Precipitous increase in serum creatinine levels

Rationale :

🦴Lytic bone lesions are classic in multiple myeloma, causing bone pain and fractures.

🧫Elevated monoclonal (M) protein reflects clonal plasma cell proliferation.

💧Hypercalcemia and renal tubular effects lead to dehydration in many patients.

🧪Light-chain nephropathy and hypercalcemia commonly cause a rise in creatinine, not a fall.

📌Core Message

Multiple myeloma features bone lysis, monoclonal protein excess, dehydration, and renal impairment with increased creatinine.

Answer 9

Correct Answers:

Verbal response
Motor response
Eye opening

Rationale :

🧠The GCS quantifies level of consciousness using Eye opening, Verbal response, and Motor response to create a standardized score.

📝Each domain has defined criteria with numeric values that sum to a total from 3–15.

🚫Functions like swallowing are not part of GCS because they don’t directly reflect arousal or higher cortical response.

🎭Emotional response is excluded since it’s subjective and not a reliable indicator of neurologic responsiveness.

📌Core Message

The GCS assesses eye opening, verbal, and motor responses—not swallowing or emotions.

Answer 10

Correct Answers:

1.9

Rationale :

🧮Concentration: 200 mcg/5 mL = 40 mcg/mL.

📏Required volume: 75 mcg ÷ 40 mcg/mL = 1.875 mL.

🔄Rounded to the tenth per instruction: 1.9 mL.

✅This ensures the ordered dose is delivered accurately using the stock concentration.

📌Core Message

Convert to mcg/mL, compute volume = dose/concentration, then round to the tenth → 1.9 mL.

1 :
A client diagnosed with amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the client best make known his wishes for care as his disease progresses?

2 :
What symptom should you assess for in your client who has thrombocytopenia secondary to the chemotherapy they have been receiving? (Select all that apply)

3 :
Which type of brain bleed has both an acute form and a chronic form?

4 :
You are holding an in-service for new nurses to discuss proper nursing management during an active seizure. All of the following are acceptable except:

5 :
A patient with a C7 spinal cord injury is ready to be discharged home. A family member asks you to review potential complications one more time. What complications do you include in your teaching? (Select all that apply)

6 :
Parkinson’s Disease is a neurodegenerative disease caused by increased dopamine production which causes it to dominate acetylcholine.

7 :
Your patient is ordered 1.5 L of NS to be infused over 7 hours. You are using tubing that is 15 gtt/mL. What is the gtts/min rate?

8 :
The nurse is assessing the patient suspected of having multiple myeloma. The nurse should expect to address what clinical manifestation that is highly characteristic of this problem? (Select all that apply)

9 :
The Glasgow Coma Scale (GCS) scores Level of Consciousness on a number of different factors. Which of the following are included on the GCS? (Select all that apply)

10 :
Doctor’s Order: Synthroid 75 mcg IV. Available: 200 mcg/5 mL. How much do you administer (round to the tenth)?

1 : A client diagnosed with amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the client best make known his wishes for care as his disease progresses?

2 : What symptom should you assess for in your client who has thrombocytopenia secondary to the chemotherapy they have been receiving? (Select all that apply)

3 : Which type of brain bleed has both an acute form and a chronic form?

4 : You are holding an in-service for new nurses to discuss proper nursing management during an active seizure. All of the following are acceptable except:

5 : A patient with a C7 spinal cord injury is ready to be discharged home. A family member asks you to review potential complications one more time. What complications do you include in your teaching? (Select all that apply)

6 : Parkinson’s Disease is a neurodegenerative disease caused by increased dopamine production which causes it to dominate acetylcholine.

7 : Your patient is ordered 1.5 L of NS to be infused over 7 hours. You are using tubing that is 15 gtt/mL. What is the gtts/min rate?

8 : The nurse is assessing the patient suspected of having multiple myeloma. The nurse should expect to address what clinical manifestation that is highly characteristic of this problem? (Select all that apply)

9 : The Glasgow Coma Scale (GCS) scores Level of Consciousness on a number of different factors. Which of the following are included on the GCS? (Select all that apply)

10 : Doctor’s Order: Synthroid 75 mcg IV. Available: 200 mcg/5 mL. How much do you administer (round to the tenth)?

1 :
A client diagnosed with amyotrophic lateral sclerosis (ALS) is overwhelmed by his diagnosis and the known complications of the disease. How can the client best make known his wishes for care as his disease progresses?

2 :
What symptom should you assess for in your client who has thrombocytopenia secondary to the chemotherapy they have been receiving? (Select all that apply)

3 :
Which type of brain bleed has both an acute form and a chronic form?

4 :
You are holding an in-service for new nurses to discuss proper nursing management during an active seizure. All of the following are acceptable except:

5 :
A patient with a C7 spinal cord injury is ready to be discharged home. A family member asks you to review potential complications one more time. What complications do you include in your teaching? (Select all that apply)

6 :
Parkinson’s Disease is a neurodegenerative disease caused by increased dopamine production which causes it to dominate acetylcholine.

7 :
Your patient is ordered 1.5 L of NS to be infused over 7 hours. You are using tubing that is 15 gtt/mL. What is the gtts/min rate?

8 :
The nurse is assessing the patient suspected of having multiple myeloma. The nurse should expect to address what clinical manifestation that is highly characteristic of this problem? (Select all that apply)

9 :
The Glasgow Coma Scale (GCS) scores Level of Consciousness on a number of different factors. Which of the following are included on the GCS? (Select all that apply)

10 :
Doctor’s Order: Synthroid 75 mcg IV. Available: 200 mcg/5 mL. How much do you administer (round to the tenth)?