The nurse is reviewing the record for a client seen in the health care clinic and notes that the health care provider has documented a diagnosis of amyotrophic lateral sclerosis (ALS). Which initial clinical manifestation of this disorder should the nurse expect to see documented in the record?

mild clumsiness

altered mental status

muscle wasting

diminished gag reflex

Answer and Explanation

The Correct Answer is A

A. Mild clumsiness, such as difficulty with fine motor tasks (e.g., buttoning a shirt or writing), is often an early sign of ALS, reflecting initial weakness and muscle dysfunction.
B. ALS typically does not affect mental status in the early stages; cognitive functions remain intact in most patients.
C. Muscle wasting occurs as the disease progresses, but it is not usually the first sign.
D. A diminished gag reflex may develop later in the disease as bulbar involvement increases, but it is not an initial manifestation.

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Correct Answer is A

Explanation

A. The nurse should assess for alteration in peripheral circulation, such as changes in color, temperature, pulse, or sensation in the lower extremities. The abductor wedgekeeps the legs abducted to prevent dislocation of the hip, but if applied improperly, it may impair circulation or cause nerve compression.
B. Muscle spasms can occur after surgery but are not directly related to the use of an abduction wedge.
C. Compression fractures are not a typical concern in the immediate care of a patient with an abduction wedge after hip replacement.
D. While correct wedge size is important, the priorityis to monitor for complications such as compromised circulation.

A. A brief loss of consciousness accompanied by staring B. A period of sleepiness following the seizure during which arousal is difficult C. A sensory warning that a seizure is imminent D. A continuous seizure state in which seizures occur in rapid succession

Correct Answer is C

Explanation

A. A brief loss of consciousness with staring is characteristic of absence seizures, not an aura.
B. A period of sleepiness or confusion after a seizure is known as the postictal phase, not an aura.
C. An aurais a sensory warning sign(e.g., visual changes, strange smells, or feelings) that a seizure is about to occur. It is considered part of the seizure itself and can help predict its onset.
D. A continuous seizure state is known as status epilepticus, which is a medical emergency, but unrelated to the concept of an aura.

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The nurse is reviewing the record for a client seen in the health care clinic and notes that the health care provider has documented a diagnosis of amyotrophic lateral sclerosis (ALS). Which initial clinical manifestation of this disorder should the nurse expect to see documented in the record?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When caring for a patient who has an abductor wedge in place after a total hip replacement, for which finding should the nurse assess for?

Correct Answer is A

Explanation

A nurse is caring for a client who has a seizure disorder and reports experiencing an aura. The nurse should recognize the client is experiencing which of the following conditions?

Correct Answer is C

Explanation

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