1. The diabetic educator is teaching a class on diabetes type 1 and is discussing sick-day rules.

Which interventions should the diabetes educator include in the discussion? Select all that
apply:
A. Take diabetic medication even if unable to eat the clients normal diabetic diet
B. If unable to eat, drink liquids equal to the clients normal caloric intake
C. It is not necessary to notify the health-care provider if ketones are in the urine
D. Test blood glucose levels and test urine ketones once a day and keep a record
E. Call the health-care provider if glucose levels are higher than 180 mg/dL.

2. The client is admitted to the ICU diagnosed with DKA. Which interventions should the nurse
implement? Select all that apply.
A. Maintain adequate ventilation
B. Asses fluid volume status
C. Administer intravenous potassium
D. Check for urinary ketones

5. Monitor intake and output3. 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. 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
6. 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.

7. 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 &and D

8. 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.

9. 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

10. The client with type 2 diabetes controlled with biguanide oral diabetic medication is
scheduled for a computed tomography (CT) scan with contrast of the abdomen to evaluate
pancreatic function. Which intervention should the nurse implement?
1. Provide a high-fat diet 24 hours prior to test
2. Hold the biguanide medication for 48 hours prior to test
3. Obtain an informed consent form for the test
4. Administer pancreatic enzymes prior to the test.
1. A patient is being treated for increased intracranial pressure. Which activities below should
the patient avoid performing?
A. Coughing
B. Sneezing
C. Talking
D. Valsalva maneuver
E. Vomiting
F. Keeping the head of the bed between 30- 35 degrees

2. A patient is experiencing hyperventilation and has a PaCO2 level of 52. The patient has an
ICP of 20 mmHg. As the nurse you know that the PaCO2 level will?
A. cause vasoconstriction and decrease the ICP
B. promote diuresis and decrease the ICP
C. cause vasodilation and increase the ICP
D. cause vasodilation and decrease the ICP

3. Which patient below is at MOST risk for increased intracranial pressure?

A. A patient who is experiencing severe hypotension.
B. A patient who is admitted with a traumatic brain injury.
C. A patient who recently experienced a myocardial infarction.
D. A patient post-op from eye surgery.

4. A patient with increased ICP has the following vital signs: blood pressure 99/60, HR 65,
Temperature 101.6 ‘F, respirations 14, oxygen saturation of 95%. ICP reading is 21 mmHg.
Based on these findings you would?
A. Administered PRN dose of a vasopressor.
B. Administer 2 L of oxygen.
C. Remove extra blankets and give the patient a cool bath.
D. Perform suctioning.

5. Which of the following is contraindicated in a patient with increased ICP?

A. Lumbar puncture
B. Midline position of the head
C. Hyperosmotic diuretics
D. Barbiturates medications
6. A patient who experienced a cerebral hemorrhage is at risk for developing increased ICP.
Which sign and symptom below is the EARLIEST indicator the patient is having this
complication?
A. Bradycardia
B. Decerebrate posturing
C. Restlessness
D. Unequal pupil size

7. Select all the signs and symptoms that occur with increased ICP:
A. Decorticate posturing
B. Tachycardia
C. Decrease in pulse pressure
D. Cheyne-stokes
E. Hemiplegia
F. Decerebrate posturing

8. You’re maintaining an external ventricular drain. The ICP readings should be?
A. 5 to 15 mmHg
B. 20 to 35 mmHg
C. 60 to 100 mmHg
D. 5 to 25 mmHg

9. Which patient below with ICP is experiencing Cushing’s Triad? A patient with the following:
A. BP 150/112, HR 110, RR 8
B. BP 90/60, HR 80, RR 22
C. BP 200/60, HR 50, RR 8
D. BP 80/40, HR 49, RR 12

10. While positioning a patient in bed with increased ICP, it important to avoid?
A. Midline positioning of the head
B. Placing the HOB at 30-35 degrees.
C. Preventing flexion of the neck.
D. Flexion of the hips
1. Your patient, who has a spinal cord injury at T3, states they are experiencing a throbbing
headache. What is your NEXT nursing action?
A. Perform a bladder scan
B. Perform a rectal digital examination
C. Assess the patient’s blood pressure
D. Administer a PRN medication to alleviate pain and provide a dark, calm environment.

2. You’re performing a head-to-toe assessment on a patient with a spinal cord injury at T6. The
patient is restless, sweaty, and extremely flushed. You assess the patient’s blood pressure and
heart rate. The patient’s blood pressure is 140/98 and heart rate is 52. You look at the patient’s
chart and find that their baseline blood pressure is 106/76 and heart rate is 72. What action
should the nurse take FIRST?
A. Reassess the patient’s blood pressure.
B. Check the patient’s blood glucose.
C. Position the patient at 90 degrees and lower the legs.
D. Provide cooling blankets for the patient.

3. You’re providing an in-service to a group of new nurse graduates on the causes of autonomic
dysreflexia. Select all the most common causes you will discuss during the in-service:
A. Hypoglycemia
B. Distended bladder
C. Sacral pressure injury
D. Fecal impaction
E. Urinary tract infection

4. After taking all the necessary steps for a patient who has developed autonomic dysreflexia,
what should the nurse assess FIRST as a possible cause of this condition?
A. Skin break down
B. Blood glucose
C. Possible bladder irritant
D. Last bowel movement
5. The physician orders Nitropaste for a patient who has developed autonomic dysreflexia.
Which finding would require the nurse to hold the ordered dose of Nitropaste and notify the
physician?
A. The patient’s blood pressure is 130/80.
B. The patient reports a throbbing headache.
C. The patient’s lower extremities are pale and cool.
D. The patient states they took Sildenafil 12 hours ago.

6. A patient is receiving treatment for a complete spinal cord injury at T4. As the nurse you know
to educate the patient on the signs and symptoms of autonomic dysreflexia. What signs and
symptoms will you educate the patient about? Select all that apply:
A. Headache
B. Low blood glucose
C. Sweating
D. Flushed below site of injury.
E. Hypertension

7. In autonomic dysreflexia, the nurse would expect what finding below the site of the spinal
cord injury?
A. Flushed lower body
B. Pale and cool lower extremities
C. Low blood pressure
D. Absent reflexes

8. Which statements are TRUE about autonomic dysreflexia? Select all that apply:
A. “Autonomic dysreflexia is an exaggerated reflex response by the parasympathetic nervous
system that results in severe hypertension due to a spinal cord injury.”
B. “Autonomic dysreflexia causes a slow heart rate and severe hypertension.”
C. “Autonomic dysreflexia is less likely to occur in a patient who has experienced a lumbar
injury.”
D. “The first-line of treatment for autonomic dysreflexia is an antihypertensive medication.”
1) SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse
is going to make an initial assessment. One day, the patient complained of difficulty in walking.
Your response would be
A. You will need a cane for support
B. Walk erect with eyes on horizon
C. I’ll get you a wheelchair
D. Don’t force yourself to walk

2) Nurse Carol is assessing a client with Parkinson’s disease. The nurse recognize bradykinesia
when the client exhibits:
A. Intentional tremor
B. Paralysis of limbs
C. Muscle spasm
D. Lack of spontaneous movement

4) SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse
is going to make an initial assessment. The patient was prescribed with levodopa. What is the
action of this drug?
A. Increase dopamine availability
B. Activates dopaminergic receptors in the basal ganglia
C. Decrease acetylcholine availability
D. Release dopamine and other catecholamine from neurological storage sites

5) A shuffling gait is typically associated with the patient who has:

A. Parkinson’s disease
B. Multiple sclerosis
C. Raynaud’s disease
D. Myasthenia gravis
6) SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse
is going to make an initial assessment. Which of the following is a characteristic of a patient with
advanced Parkinson’s disease?
A. Disturbed vision
B. Forgetfulness
C. Mask like facial expression
D. Muscle atrophy

7) SITUATION: A 65 year old woman was admitted for Parkinson’s Disease. The charge nurse
is going to make an initial assessment. You are discussing with the dietician what food to avoid
with patients taking levodopa?
A. Vitamin C rich food
B. Vitamin E rich food
C. Thiamine rich food
D. Vitamin B6 rich food

8) All of these nursing activities are included in the care plan for a 78-year-old man with
Parkinson’s disease who has been referred to your home health agency. Which ones will you
delegate to a nursing assistant (NA)? (Choose all that apply).
A. Check for orthostatic changes in pulse and bloods pressure.
B. Monitor for improvement in tremor after levodopa (L-dopa) is given.
C. Remind the patient to allow adequate time for meals.
D. Monitor for abnormal involuntary jerky movements of extremities.
E. Assist the patient with prescribed strengthening exercises.
F. Adapt the patient’s preferred activities to his level of function.

9) Which of the following is the most common cause of dementia among elderly persons?
A. Parkinson’s disease
B. Multiple sclerosis
C. Amyotrophic lateral sclerosis
D. Alzheimer’s disease
10) The nurse should instruct the patient with Parkinson’s disease to avoid which of the
following?
A. Walking in an indoor shopping mall
B. Sitting on the deck on a cool summer evening
C. Walking to the car on a cold winter day
D. Sitting on the beach in the sun on a summer day

1. When assessing a patient with newly diagnosed trigeminal neuralgia, the nurse will ask the
patient about
a. triggers that lead to facial pain.
b. visual problems caused by ptosis.
c. poor appetite caused by a loss of taste.
d. decreased sensation on the affected side

2. During assessment of the patient with a recurrence of symptoms of trigeminal neuralgia, the
nurse should
a. examine the mouth and teeth thoroughly.
b. have the patient clench and relax the jaw and eyes.
c. identify trigger zones by lightly touching the affected side.
d. gently palpate the face to compare skin temperature bilaterally.

3. A patient with trigeminal neuralgia has a glycerol rhizotomy. During a follow-up visit after the
rhizotomy, the nurse will evaluate that the patient has had a successful outcome for the surgery
if the patient
a. uses an eye shield at night to protect the cornea from injury.
b. develops and implements a daily routine of facial exercises.
c. is careful to chew foods on the unaffected side of the mouth.
d. talks about enjoying social activities with family and friends.
4. When the nurse is planning care for a hospitalized patient who is experiencing an acute
episode of trigeminal neuralgia, an appropriate action to include is
a. teach facial and jaw relaxation techniques.
b. assess intake and output and dietary intake.
c. apply ice packs for no more than 20 minutes.
d. spend time at the bedside talking with the patient.

5. When teaching patients who are at risk for Bell's palsy because of previous herpes simplex
infection, which information should the nurse include?
a. "You should call the doctor if pain or herpes lesions occur near the ear."
b. "Treatment of herpes with antiviral agents will prevent development of Bell's palsy."
c. "Medications to treat Bell's palsy work only if started before paralysis onset."
d. "You may be able to prevent Bell's palsy by doing facial exercises regularly."

6. A patient with Bell's palsy refuses to eat while others are present because of embarrassment
about drooling. The best response by the nurse to the patient's behavior is to
a. respect the patient's desire and arrange for privacy at mealtimes.
b. offer the patient liquid nutritional supplements at frequent intervals.
c. discuss the patient's concerns with visitors who arrive at mealtimes.
d. teach the patient to chew food on the unaffected side of the mouth.

7. The nurse is helping a client with a spinal cord injury to establish a bladder retraining
program. Which strategies may stimulate the client to void? Select all that apply.
a. Stroking the client's inner thigh
b. Pulling on the client's pubic hair
c. Initiating intermittent straight catheterization
d. Pouring warm water over the client's perineum
e. Tapping the bladder to stimulate the detrusor muscle
f. Reminding the client to void in a urinal every hour while awake
8. A client with a spinal cord injury at level C3 to C4 is being cared for by the nurse in the
emergency department (ED). What is the priority nursing assessment?
a. Determine the level at which the client has intact sensation.
b. Assess the level at which the client has retained mobility.
c. Check blood pressure and pulse for signs of spinal shock.
d. Monitor respiratory effort and oxygen saturation level.

9. A patient with a neck fracture at the C5 level is admitted to the intensive care unit. During
initial assessment of the patient, the nurse recognizes the presence of neurogenic shock on
finding
a. hypotension, bradycardia, and warm extremities.
b. involuntary, spastic movements of the arms and legs.
c. hyperactive reflex activity below the level of the injury.
d. lack of movement or sensation below the level of the injury.

10. When caring for a patient who experienced a T1 spinal cord transection 2 days ago, which
collaborative and nursing actions will the nurse include in the plan of care? Select all that apply
a. Urinary catheter care
b. Nasogastric (NG) tube feeding
c. Continuous cardiac monitoring
d. Avoidance of cool room temperature
e. Administration of H2 receptor blockers