The side Effects of Phenytoin

The nurse is teaching the parents of a preschool child with epilepsy about the side effects of Phenytoin (Dilantin). Which of the following should be included?
A. The child can experience of overgrowth of the gums requiring good dental care.
B. The child may appear lethargic.
C. The child may develop hypertrophy of subcutaneous facial tissue.
D. The child may develop diarrhea
E. The child may develop blurred vision.
1) A, B, C, D, E
2) A, B, C
3) A, D, E
4) B, C, D,E

2. A client with diabetes tells the nurse that she has heard about hypoglycemia and wants to know how to manage it. What will the nurse tell her? Select all apply
A. Begin treatment if her blood glucose is 5 mmol/L
B. Drink 175 ml of fruit juice
C. Avoid sweet foods containing fat
D. Eat cheese and crackers if the next meal is more than one hour away
E. Recheck blood glucose in 15 minutes after the first treatment

3. The nurse instructs a client with diabetes mellitus about a healthy eating plan. Which statement by the client indicates that teaching was successful?
A. “I may have a hypoglycemic reaction if I drink alcohol on an empty stomach.”
B. “I should include more fibre in my diet than a person who does not have diabetes.”
C. “I plan to lose 10 kg this year by following a high-protein diet.”
D. “If I use an insulin pump, I will not need to limit the amount of saturated fat in my diet.”
4. A client with diabetic neuropathy has been receiving gabapentin and tramadol and finds these medications are no longer effective in relieving the neuropathic pain. According to the consensus statement from the Canadian Pain Society on neuropathic pain, the next medication to be recommended will be which of the following?
A. Botulinum toxin
B. A benzodiazepine (lorazepam)
C. Cannabis
D. Methadone

5. The nurse is discussing macrovascular complications with a diabetic client. She asks why she needs to worry about these complications. What explanation will the nurse provide to her?
A. These complications cannot be eliminated by reduction of risk factors such as smoking and obesity
B. These complications occur more frequently in women with Type 2 diabetes
C. These complications can occur with a higher frequency and earlier onset than in the non-diabetic population
D. These complications result from widening of the blood vessel membranes
E. These complications can be prevented by close monitoring of ketones in the urine

6. When a client with Type 2 diabetes has the flu with symptoms of nausea and vomiting what health teaching is necessary? Select all that apply.
A. 1.Supplement with carbohydrate containing fluids
B. 2.Stop taking oral anti-hyperglycemic medication
C. 3.Go to the emergency department if vomiting occurs more than twice in 12 hours
D. 4.Continue to take oral anti-hyperglycemic medication
E. 5.Check blood glucose by self-monitoring every 4 hours

7. The nurse is assessing a client’s technique of self-monitoring of blood glucose (SMBG) as part of diabetes management. Which of the following actions indicate a need for further teaching?
A. Says the result of 6.1 mmol/L indicates good blood sugar control
B. Chooses a puncture site in the centre of the finger pad
C. Washes the puncture site using soap and warm water
D. Hangs the arm down for a minute before puncturing the site
1) A, C, E
2) B, C, D, E
3) A, B
4) B, C, D

8. Physical activity recommendations (CDA, 2013) for clients with diabetes include which of the following measures?
A. Aerobic exercise totaling at least 150 minutes per week
B. Resistance exercise 3 times per week
C. Flexibility exercise 3 times per week
D. Range of motion exercise at least 60 minutes per week

9. A client with multiple sclerosis has urinary retention caused by a flaccid bladder.  Which action will the nurse take?

10. A client is prescribed: Digoxin 125mcg PO.  The nurse has in supply: Digoxin 0.25mg tablets.  How much will the nurse give for a single dose?
0.5 tablet

11. In the article, Stroke survivors’ experiences of the fundamentals of care: A qualitative analysis (Kitson et al., 2013), the authors suggest which of the following were behaviours demonstrated by staff that stroke survivors found helpful?
A. Taking a structured approach to recovery that involved goal setting
B. Providing care in a respectful, personalized, and timely way
C. Setting small, personalized targets in partnership with staff
D. Developing detailed plans of care with the interdisciplinary team
12. A client with right-sided paralysis related to a thrombotic stroke develops constipation.  Which action should the nurse take first?
A. Provide incontinence briefs to wear during the day
B. Assist the client to the bathroom every 2 hours
C. Administer a bisacodyl (Dulcolax) suppository every day
D. Arrange for three servings per day of cooked vegetables or fruits
13. Which of these laboratory values, noted by the nurse when reviewing the chart of a patient with diabetes, indicates the need for further assessment of the patient?
A. Fasting blood glucose of 6.5 mmol/L
B. A1C of 4.9%
C. A1C of 5.8%
D. Noon blood glucose of 3.2 mmol/L

14. initial acute care to manage a client’s intracranial pressure immediately after a stroke should include which of the following interventions?
A. Avoiding neck flexion of the client
B. Assessment of the client’s level of consciousness
C. Monitor the client’s respiratory status
D. Ask the client to smile and grin
E. Ensure hip flexion to 90 degrees
1) B, C
2) A, B, C, D, E
3) A, B, C, D
4) A, E
5) A, B,D,E

15. According to Beacham & Deatrick (2015) in Children with chronic conditions: Perspectives on condition management, which of the following are included as some of the dimensions addressed in the article? Select all that apply.
1) A,B,C
2) A,B
3) A,C
4) B,C,D
16. A client who has a history of a transient ischemic attack (TIA) has an order for Aspirin 160 mg daily. When the nurse is administering the medications, the client says, “I don’t need the Aspirin today. I don’t have any aches or pains.” Which of the following actions should the nurse take?
A. Tell the client that the Aspirin is used to prevent aches
B. Explain that the Aspirin is ordered to decrease stroke risk
C. Document that the Aspirin was refused by the client
D. Call the health care provider to clarify the medication order

17. The nurse is admitting a client who had a stroke and is experiencing right-sided arm and leg paralysis and facial drooping on the right side. Which of the following clinical manifestations should the nurse expect to find?
A. Hyperactive left-sided reflexes
B. Impaired time concepts
C. Impulsive behavior
D. Difficulty in understanding commands

18. When developing a plan to decrease stroke risk, which risk factor is most important for the nurse to address?
A. The client’s blood pressure is normally 170/90 mm Hg
B. The client works at a desk and relaxes by watching television
C. The client smokes a pack of cigarettes daily
D. The client is 11.3 kg above the ideal weight

19. The nurse is explaining to the parents of a child with asthma methods to reduce exposure to airborne allergens and irritants.  These methods should include which of the following? Select all that apply.
A. Keep humidity in the home between 30 and 50%.
B. Ensure the child’s bedroom is fully carpeted.
C. Keep the child indoors while the lawn is being mowed.
D. Wash bed linens every week in hot water.

20. A client with multiple sclerosis is started on prednisone (Apo-Prednisone) 25 mg PO BID. What client teaching should the nurse include?
A. Increase your oral intake of fluids to at least 4000 mL every day.
B. Avoid contact with people who have contagious illnesses.
C. Brush your teeth at least 4 times a day with a firm toothbrush.
D. Immediately stop taking the prednisone if you feel depressed.
Answer: B
Explanation:(A) Fluid retention is a side effect of prednisone. The nurse should teach clients to weigh themselves daily and to observe for signs of edema. If these signs of fluid retention occur, they should notify the physician. (B) Prednisone, a glucocorticoid, suppresses the normal immune response making the client more susceptible to infections. (C) An increase in bleeding tendencies is a side effect of prednisone therapy. The nurse should teach clients to use preventive measures (i.e., electric razors and soft toothbrushes). (D) Depression and personality changes are side effects of prednisone therapy. Prednisone should never be discontinued abruptly.

21. A rehabilitation nurse is conducting an assessment of a newly admitted client using the Functional Independence Measure (FIM). Which items will the nurse assess? Select all that apply.

A. The level of pain the client experiences during transfers using a validated Pain Scale
B.  The level of assistance the client requires transferring to the toilet
C. Whether the client can use a wheelchair, walk independently or with assistance
D. Whether verbal prompts are required reminding the client to use their walker when walking
E. Determine the degree of skin integrity the client has to support self-care efforts

22. Which clinical manifestation should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis?

23. The nurse teaches a client with COPD how to perform pursed lip breathing when she experiences SOB with activity.  How will this technique assist her respirations?

A. People with COPD must develop a sophisticated ability to identify subtle changes in their symptoms.
B. People with COPD must develop a support network to help identify subtle changes in their symptoms.
C. People with COPD can easily recognize subtle changes in their symptoms.
D. People with COPD can easily recognize subtle changes within the hospital but are challenged when at home.

24. nurse caring for a client with COPD assesses her weight and height and obtains a BMI of 17 Which of the following interventions should the nurse teach the client?

25. The nurse is completing a physical assessment on a client with COPD.  Which of the   following signs will the client display?
A. Dry, flaky skin
B. Decrease in red blood cell production
C. Weight loss
D. Long, thin fingers
E. Prolonged expiratory phase of respiration

26. According to Brandt (2012) in Study of older adults’ use of self-regulation for COPD self-management informs an evidence-based patient teaching plan, which of the following statements is true for people with COPD?

1) c,e
2) b,c,e
3) b,e
4) a,c,d

27. Which of the following diagnostic studies are indicated for a client with Crohn’s Disease? Select all that apply.
A. Electrolyte blood test
B. Blood urea nitrogen test
C. Testing of stool for occult blood
D. Bone marrow biopsy
E. Sigmoidoscopy with biopsy

28. After teaching a client with IBD about the recommended low-residue diet, the nurse identifies a need for further instruction when the client chooses which of the following foods from the menu for dinner.
A. Boneless chicken breast
B. Canned peaches
C. Cooked carrots
D. Fried fish
29. In the article, “Effects of caregiver burden on quality of life and coping strategies utilized by caregivers of adult patients with inflammatory bowel disease” by Parekh et al, (2017), which of the following factors were associated with a lower quality of life (QOL) among caregivers of adults with IBD? Select all that apply.

A. Lack of employment options for caregiver
B. Personal history of psychiatric illness
C. Presence of a dependent [other than the patient] in the home
D. The caregiver engaged in spiritual activities
E. Caring for patients with active IBD exacerbation

30. A client hospitalized with an acute exacerbation of ulcerative colitis is having 14 to 16 bloody stools a day and crampy abdominal pain associated with the diarrhea. What will the nurse plan to implement?
A. Place the client on NPO status
B. Assess serum sodium and potassium levels
C. Assess BUN and creatinine levels
D. Administer IV corticosteroids
E. Initiate parental nutrition

31. Which of the following findings were identified from Mantini and Ogden’s (2016) research in the article, “A qualitative study of patients’ experience of living with inflammatory bowel disease: A preliminary focus on the notion of adaptation”, reflect the impact on everyday life for a client with IBD?

A. Clients felt confident in their ability to manage their symptoms.
B. Clients felt their family and friends had a good understanding of the effects of IBD.
C. Clients felt their relationships could become strained.
D. Clients felt confident in the effectiveness of their prescribed medic