Exam 3 Practice Question Adult 1

7. The client is 4 hours post-lobectomy for lung cancer. Which assessment data warrant immediate intervention by the nurse? 1. Intake of 1500 mL IV and output of 1000 mL. 2. 450 mL of bright red drainage in the chest tube. 3. Complaining of pain at a 10 on a 1-10 scale. 4. Absent lung sound o the side of surgery.

2. 450 mL of bright red drainage in the chest tube.

A nurse is completing a preoperative teaching plan for a client who is scheduled to have a TKA. Which of the following should the nurse include in the teaching plan? (select all) a. Encourage complete autologous blood donation b. sit in a low reclining chair c. instruct the client to roll onto the operative hip d. use an abductor pillow when turning the client e. perform isometric exercises

a. Encourage complete autologous blood donation d. use an abductor pillow when turning the client e. perform isometric exercises

A nurse performs discharge teaching for a 58-yr-old woman after a left hip arthroplasty using the posterior approach. Which statement by the patient indicates teaching is successful? a. Leg-raising exercises are necessary for several months b. I should not drive for 2-3 weeks c. I will not have any restrictions now on hip and leg movement d. Blood tests will be done weekly while taking Lovenox

a. Leg-raising exercises are necessary for several months -Include leg raises in supine and prone positions -Driving not allowed for 4-6 weeks

Which of the following clinical manifestations should the healthcare provider anticipate observing in a patient diagnosed with severe osteoarthritis (OA) of the knee? a. Weight loss b. Knock knees c. Interosseous nodules d. Exertional dyspnea

b. Knock knees

The nurse is caring for a patient admitted to the nursing unit with osteomyelitis of the tibia. When completing a focused assessment, which symptom will the nurse expect? a. Nausea and vomiting b. Localized pain and warmth c. Paresthesia in the affected extremity d. Generalized bone pain throughout the leg

b. Localized pain and warmth

A nurse is assessing a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? (select all) a. Skin reddened over joint b. Pain when bearing weight c. Joint crepitus d. Swelling of the infected joint e Limited joint motion

b. Pain when bearing weight c. Joint crepitus d. Swelling of the infected joint e Limited joint motion

The client diagnosed with LC is being discharged. Which statement made by the client indicates that more teaching is needed? 1. It doesn't matter if I smoke now. I already have cancer. 2. I should see the oncologist at my scheduled appt. 3. If I begin to run a fever I should notify my HCP. 4. I should plan for periods of rest throughout the day.

1. It doesn't matter if I smoke now. I already have cancer.

A client with osteoporosis needs education about diet and ways to increase bone density. Which of the following should be included in the teaching plan? Select all that apply. 1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2. Choose good calcium sources, such as figs, broccoli, and almonds. 3. Use alcohol in moderation because a moderate intake has no known negative effects. 4. Try swimming as a good exercise to maintain bone mass. 5. Avoid the use of high-fat foods, such as avocados, salad dressings, and fried foods.

1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2. Choose good calcium sources, such as figs, broccoli, and almonds. 3. Use alcohol in moderation because a moderate intake has no known negative effects.

After teaching a group of clients with osteoarthritis about using regular exercise, which of the following client statements indicates effective teaching? 1. "Performing range-of-motion exercises will increase my joint mobility." 2. "Exercise helps to drive synovial fluid through the cartilage." 3. "Joint swelling should determine when to stop exercising." 4. "Exercising in the outdoors year-round promotes joint relaxation."

2. "Exercise helps to drive synovial fluid through the cartilage."

A nurse is teaching a client who has a new diagnosis of RA. Which of the following statements should the nurse include in the teaching? a. "You can expect morning stiffness when you get out of bed" b. "You can experience abdominal pain" b. "You can experience weight gain" c. "You can experience low blood sugar"

a. "You can expect morning stiffness when you get out of bed"

The patient has frostbite on the distal toes of both feet. The patient is scheduled for amputation of damaged tissue. Which assessment finding or diagnostic study is most objective in determining tissue viability? a. Arteriogram showing BVs b. Peripheral pulse palpation bilaterally c. Patches of black, indurated cold tissue d. Bilateral pale, cool skin below the ankles

a. Arteriogram showing BVs Determines viable tissue for salvage based on blood flow observed in real time and considered the hold standard for evaluating arterial perfusion - only thing that determines where tissue perfusion stops and amputation needs to occur

A 19-yr-old male patient has a plaster cast applied to the right arm for a Colles' fracture after a skateboarding accident. Which nursing action is most appropriate? a. Elevate right arm on two pillows for 24 hours b. Apply heating pad to reduce muscle spasms and pain c. Limit movement of thumb and fingers on right hand d. Place arm in sling to prevent movement

a. Elevate right arm on two pillows for 24 hours b - ice should be used to reduce swelling and inflammation d- active movements of shoulder should occur

A nurse is presenting information to a group of client at a health fair about measures to reduce the risk of amputation. Which of the following information should the nurse provide? (select all) a. Encourage clients who smoke to consider smoking cessation programs b. Encourage client who have DM to maintain blood glucose within the expected reference range c. Instruct clients to unplug electrical equipment when performing repairs d. Encourage clients who have vascular disease to maintain good foot care e. Advise clients to wait 2 hours after taking pain medication before driving

a. Encourage clients who smoke to consider smoking cessation programs b. Encourage client who have DM to maintain blood glucose within the expected reference range c. Instruct clients to unplug electrical equipment when performing repairs d. Encourage clients who have vascular disease to maintain good foot care

A nurse is caring for a client following a below-the-elbow amputation. Which of the following actions should the nurse take? (select all) a. Encourage dependent positioning of the residual limb b. Inspect for presence and amount of drainage c. Implement shrinkage inversion of the residual limb d. Wrap the residual limb in circular manner using gauze e. Assess for feelings of body image changes

a. Encourage dependent positioning of the residual limb b. Inspect for presence and amount of drainage c. Implement shrinkage inversion of the residual limb e. Assess for feelings of body image changes

A nurse is providing teaching for a client who has a history of low back injury. Which of the following instructions should the nurse give the client to prevent future problems with low back pain? (select all) a. Engage in regular exercise including walking b. Sit for up to 10 hr each day to rest the back c. Maintain wt within 25% of ideal body weight d. Create a smoking cessation plan e. Wear low-heeled shoes

a. Engage in regular exercise including walking d. Create a smoking cessation plan e. Wear low-heeled shoes

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? (select all) a. Heberden's nodes b. Swelling of all joints c. Small body frame d. Enlarged joint size e. Limp when walking

a. Heberden's nodes d. Enlarged joint size e. Limp when walking

A nurse is assessing a client who had an external fixation device applied 2 hr ago for a fracture of the left tibia and fibula. Which of the following findings is a manifestation of compartment syndrome? (select all) a. Intense pain when the client's left foot is passively moved b. Capillary refill of 3 seconds on the client's left toes c. Hard, swollen muscle in the client's left leg d. Burning and tingling of the client's left foot e. Client report of minimal pain relief following a second dose of opioid medication

a. Intense pain when the client's left foot is passively moved c. Hard, swollen muscle in the client's left leg d. Burning and tingling of the client's left foot e. Client report of minimal pain relief following a second dose of opioid medication

A 28-yr-old woman with a fracture of the proximal left tibia in a long leg cast and complains of severe pain and a prickling sensation in the left foot. The toes on the left foot are pale and cool. Which nursing action is a priority? a. Notify HCP immediately b. Elevate left leg above the level of the heart c. Administer prescribed morphine sulfate IV d. Apply ice packs over cast

a. Notify HCP immediately b - May lower venous pressure and slow arterial perfusion - do NOT do this d - Vasoconstriction and exacerbate compartment syndrome

A nurse assesses a 38-yr-old patient with joint pain and stiffness who was diagnosed with stage III rheumatoid arthritis (RA). Which additional characteristics should the nurse expect (select all that apply.)? a. Presence of nodules b. Consistent muscle strength c. Localized disease symptoms d. No destructive changes on x-ray e. Subluxation of joints without fibrous ankyloses f. Joint space narrowing and formation of osteophytes

a. Presence of nodules e. Subluxation of joints without fibrous ankyloses

A nurse is reviewing the health record of a client who has suspected ovarian cancer. Which of the following findings supports this diagnosis? (select all) a. Previous treatment for endometriosis b. Family history of colon cancer c. First pregnancy at age 24 d. Report of scant menses e. Use of oral contraceptives for 10 years

a. Previous treatment for endometriosis b. Family history of colon cancer

The nurse is caring for a 76-yr-old man who has undergone left total knee arthroplasty to relieve the pain of severe osteoarthritis. What care would be expected postoperatively? a. Progressive leg exercises to obtain 90-degree flexion b. Early ambulation with full wt bearing on left leg c. Bed rest for 3 days d. Immobilization of left knee in 30-degree flexion to prevent dislocation

a. Progressive leg exercises to obtain 90-degree flexion

When teaching a patient diagnosed with osteoarthritis (OA) about the benefits of exercise, which of the following types of exercise should the healthcare provider include in the teaching? a. Range of motion exercises b. Stretching exercises c. Weightlifting d. Swimming or other aquatics e. Jumping rope

a. Range of motion exercises b. Stretching exercises c. Weightlifting d. Swimming or other aquatics

A nurse in the emergency department is planning care for a client who has a right hip fracture. Which of the following immobilization devices should the nurse anticipate in the plan of care? a. Skeletal traction b. Buck's traction c. Halo traction d. Bryant's traction

b. Buck's traction

A patient with a history of osteoarthritis (OA) and repeated intra-articular corticosteroid injections is admitted to the medical unit with acute swelling of the left knee. The patient experiences pain on active or passive movement. The joint is warm to the touch and the patient has a low-grade fever. Which of these additional assessment findings support a diagnosis of septic arthritis? (select all) a. Positive anti-CCP antibody b. Cloudy synovial fluid c. Decreased serum neutrophil count d. Elevated ESR e. Positive serum rheumatoid factor

b. Cloudy synovial fluid d. Elevated ESR

The nurse completes an admission history for a 73-yr-old man with osteoarthritis scheduled for total knee arthroplasty. Which response is expected when asking the patient the reason for admission? a. Recent knee trauma b. Debilitating joint pain c. Repeated knee infections d. Onset of frozen knee joint

b. Debilitating joint pain

The nurse identifies a nursing diagnosis of pain related to muscle spasms for a 45-yr-old patient who has low back pain from a herniated lumbar disc. Which nursing intervention would be most appropriate? a. Provide gentle ROM to the lower extremities. b. Elevate the head of the bed 20 degrees and flex the knees. c. Place a small pillow under the patient's upper back to gently flex the lumbar spine. d. Place the bed in reverse Trendelenburg with the patient's feet firmly against the footboard.

b. Elevate the head of the bed 20 degrees and flex the knees. -To reduce pain, the nurse should elevate the head of the bed 20 degrees and have the patient flex the knees to avoid extension of the spine.

The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis. Which finding should the nurse expect when examining the patient's knees? a. Ulnar drift b. Pain with joint movement c. Red, swollen affected joints d. Stiffness that increases with movement

b. Pain with joint movement

A nurse is preparing a plan of care to prevent a client from developing flexion contractions following a below-the-knee amputation 24 hr ago. Which of the following actions should the nurse include in the plan of care? a. Limit any type of exercise to the residual limb for first 48 hr after surgery b. Position the client prone several times each day c. Wrap the stump in a figure-eight pattern d. Encourage sitting in a chair during the day

b. Position the client prone several times each day

A nurse is caring for a client who injured her lower back during a fall and describes sharp pain in her back and down her left leg. In which of the following positions should the nurse plan to place the client to attempt to decrease her pain? a. Prone without use of pillows b. Semi-Fowler's with a pillow under the knees c. High-Fowler's with the knees flat on the bed d. Supine with head flat

b. Semi-Fowler's with a pillow under the knees

Which of the following clinical manifestations should the healthcare provider anticipate observing in a patient diagnosed with rheumatoid arthritis (RA)? a. Bone spurs noted on x-ray b. Ulnar deviation c. Decreased synovial fluid d. Low-grade fever e. Increase CRP

b. Ulnar deviation d. Low-grade fever e. Increase CRP

The nurse is planning health promotion teaching for a 45-yr-old patient with asthma who is experiencing low back pain from herniated lumbar disc. What activity will the nurse include in an individualized exercise plan for the patient? a. Yoga b. Walking c. Calisthenics d. Weight lifting

b. Walking

The nurse is caring for patients in a primary care clinic. Which individual is most at risk to develop osteomyelitis caused by Staphylococcus aureus? a. 22-yr-old female patient with gonorrhea who is an IV drug user b. 48-yr-old male patient with muscular dystrophy and acute bronchitis c. 32-yr-old male patient with type 1 diabetes mellitus and stage IV pressure ulcer d. 68-yr-old female patient with hypertension who had a knee arthroplasty 3 years ago

c. 32-yr-old male patient with type 1 diabetes mellitus and stage IV pressure ulcer

When entering the grocery store, a patient trips on the curb and sprains the right ankle. Which initial care is appropriate (select all that apply.)? a. Apply ice directly to skin b. Apply heat to ankle q2 hours c. Administer anti-inflammatory meds d. Compress ankle using elastic bandage e. Rest and elevate ankle above heart f. Perform passive/active ROM

c. Administer anti-inflammatory meds d. Compress ankle using elastic bandage e. Rest and elevate ankle above heart - appropriate care for sprain is RICE

When assessing a patient diagnosed with osteoarthritis (OA), the healthcare provider looks for which characteristic of this condition? a. Waddling gait b. Decreased grip strength c. Joint crepitus d. Bilateral joint swelling

c. Joint crepitus

A 42-yr-old man underwent amputation below the knee on the left leg after a recent heavy farm machinery accident. Which intervention should the nurse include in the plan of care? a. Sit in chair for 1-2 hours 2x/day b. Dangle residual limb 20-30 mins/6 hours c. Lie prone with hip extended for 30 mins 4x/day d. Elevate residual limb on pillow for 4-5 days after surgery

c. Lie prone with hip extended for 30 mins 4x/day

An older adult is diagnosed with Paget's disease. Which finding would indicate improvement in the condition? a. Waddling gait b. Curvature in affected bones c. Lower serum alkaline phosphatase d. Uptake of radiolabeled bisphosphonate in affected bones

c. Lower serum alkaline phosphatase - Paget's disease - excessive bone resorption and replacement of normal marrow with vascular fibrous connective tissue. A normalizing alkaline phosphatase indicates bone resorption has slowed or stopped.

The nurse is completing discharge teaching with an 80-yr-old male patient who is recovering from a right total hip arthroplasty by posterior approach. Which patient action indicates further instruction is needed? a. Use elevated toilet seat b. Sit with feet flat on floor c. Maintains hip in adduction and internal rotation d. Verifies need to notify future caregivers about the prosthesis

c. Maintains hip in adduction and internal rotation

The nurse is caring for a patient placed in Buck's traction before open reduction and internal fixation of a left hip fracture. Which care can be delegated to the LPN/LVN? a. Assess skin integrity around traction boot b. Determine correct body alignment to enhance traction c. Remove wts from traction when turning d. Monitor pain intensity and administer prescribed analgesics

d. Monitor pain intensity and administer prescribed analgesics

A 58-yr-old woman with breast cancer is admitted for severe back pain related to a vertebral compression fracture. The patient's laboratory values include serum potassium of 4.5 mEq/L, serum sodium of 144 mEq/L, and serum calcium of 14.3 mg/dL. Which signs and symptoms will the nurse expect the patient to exhibit? a. Anxiety, irregular pulse, and weakness b. Muscle stiffness, dysphagia, and dyspnea c. Hyperactive reflexes, tremors, and seizures d. Nausea, vomiting, and altered mental status

d. Nausea, vomiting, and altered mental status - Breast cancer can metastasize to the bone, vertebrae is common, high Calcium as result of damaged bone (normal is 8.6-10.2)

The client diagnosed with lung cancer is in an investigational program and receiving a vaccine to treat the cancer. Which information regarding investigational regimens should the nurse teach? 1. Investigational regimens provide a better chance of survival for the client. 2. Investigational treatments have not been proved helpful to clients. 3. Clients will be paid to participate in a investigational program. 4. Only clients that are dying qualify for investigational treatments.

2. Investigational treatments have not been proved helpful to clients.

The nurse is discussing cancer statistics with a group from the community. Which information about death rates from lung cancer is accurate? 1. LC is the number 2 cause of cancer deaths in both men and women. 2. LC is the number 1 cause of cancer deaths in both men and women. 3. LC deaths are not significant in relation to other cancers. 4. LC deaths have continued to increase in the male population.

2. LC is the number 1 cause of cancer deaths in both men and women.

A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of her left eye. Correct interpretation of this assessment finding indicates which of the following? 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.

2. Possible retinal degeneration.

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?" Which of the following responses by the nurse would be most appropriate? 1. "It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation." 2. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3. "That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it." 4. "Every person is different. What works for one client may not always be effective for another."

4. "Every person is different. What works for one client may not always be effective for another."

A patient's treatment regimen for tuberculosis (TB) includes rifampin (Rifadin). When teaching the patient about rifampin, which of the following information should be included? (select all) a. "Call the clinic if you experience any unusual bruising or bleeding." b. " If the medication causes stomach upset, you may take it with food." c. "You should switch from contact lenses to glasses during your treatment." d. "It's recommended that you abstain from alcohol during your treatment." e. "You will need to take your medication for two full weeks."

a. "Call the clinic if you experience any unusual bruising or bleeding." c. "You should switch from contact lenses to glasses during your treatment." d. "It's recommended that you abstain from alcohol during your treatment."

The client is admitted to the outpatient surgery center for a bronchoscopy to rule out lung cancer. Which info should the nurse teach? 1. The test will confirm the MRI results. 2. The client can eat and drink immediately after the test. 3. The HCP can do a biopsy of the tumor through the scope. 4. There is no discomfort associated with this procedure.

3. The HCP can do a biopsy of the tumor through the scope.

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults that are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 4. Adults who possess the genetic link, specifically HLA-DR4.

A nurse is assessing a client who has a casted compound fracture of the femur. Which of the following findings is a manifestation of fat emboli? a. Altered mental status b. Reduced bowel sounds c. Swelling of the toes distal to the injury d. Pain with passive movement of the foot distal to the energy

a. Altered mental status

A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following statements by the client indicates an understanding of the teaching? (select all) a. "I will clean the pins twice a day" b. "I will use a separate cotton swab for each pin" c. "I will report loosening of the pins to my doctor" d. "I will move my leg by lifting the device in the middle" e. "I will report increased redness at the pin sites"

a. "I will clean the pins twice a day" b. "I will use a separate cotton swab for each pin" c. "I will report loosening of the pins to my doctor"

The healthcare provider is teaching a student how to administer a tuberculin skin test (TST). Which of the following statements describes the correct technique? a. "Keep the bevel of the needle up." b. "Be sure to massage the area after you remove the needle." c. "Hold the syringe at a 45 degree angle." d. "Pinch the skin slightly before inserting the needle."

a. "Keep the bevel of the needle up."

The healthcare provider is assessing a patient recovering from a total knee replacement. Which of these assessment findings indicates the patient is at risk of developing a complication from the surgery? a. Pale toenail beds b. Hemoglobin 12.5 g/dL c. Homan's sign negative d. Incision site edema

a. Pale toenail beds

A patient has been diagnosed with latent tuberculosis infection (LTBI). Which of the following statements are true about the patient? (select all) a. The patient will not be able to transmit TB to others. b. The patient may not report symptoms characteristic of TB. c. Respiratory specimens for acid-fast bacteria will be positive. d. Interferon-gamma release assay (IGRA) results will be positive. e. The results of a chest radiograph will be negative.

a. The patient will not be able to transmit TB to others. b. The patient may not report symptoms characteristic of TB. d. Interferon-gamma release assay (IGRA) results will be positive.

The nurse is caring for a patient hospitalized with a herniated lumbar disc and an exacerbation of chronic bronchitis. Which breakfast choice would be most appropriate for the patient to select from the breakfast menu? a. bran muffin b. scrambled eggs c. puffed rice cereal d. buttered white toast

a. bran muffin - has the most fiber to prevent constipation and straining with defecation which would increase the low back pain

A nurse is providing information about TB to a group of clients at a local community center. Which of the following manifestations should the nurse include in teaching? (Select all) a. persistent cough b. weight gain c. fatigue d. night sweats e. purulent sputum

a. persistent cough c. fatigue d. night sweats e. purulent sputum

A nurse working in an outpatient clinic is assessing a client who has RA. The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (select all) a. recent influenza b. decrease ROM c. hypersalivation d. increased BP e. pain at rest

a. recent influenza - exacerbating factors, such as a recent illness like influenza, are indicative in clients who have RA b. decrease ROM e. pain at rest

The healthcare provider is evaluating the tuberculin skin test (TST) for a patient who has a diagnosis of human immunodeficiency virus (HIV). The skin test is positive if the area of induration is at least __ mm? a. 1 b. 5 c. 10 d. 15

b. 5

A nurse is working with a 73-yr-old patient with osteoarthritis. Which description of the disorder should be included in the teaching plan? a. Joint destruction caused by an autoimmune process b. Degeneration of articular cartilage in synovial joints c. Overproduction of synovial fluid resulting in joint destruction d. Breakdown of tissue in non-weight-bearing joints by enzymes

b. Degeneration of articular cartilage in synovial joints

A nurse is providing information about capsaicin cream to a client who reports continuous knee pain from osteoarthritis. Which of the following information should the nurse include in the discussion? a. Continuous pain relief is provided b. Inspect for skin irritation and cuts prior to application c. Cover the area with tight bandages after application d. Apply the medication every 2 hr during the day

b. Inspect for skin irritation and cuts prior to application

The nurse assesses which of the following clinical manifestations in a client with osteomyelitis? Select all that apply: a. Cool extremities b. Nausea c. Restlessness c. Night sweats d. Petechial rash e. Fever

b. Nausea c. Restlessness c. Night sweats e. Fever

The nurse, assisting in applying a cast to a client with a broken arm, knows that? a. The cast should be covered until it dries b. The wet cast should be handled with the palms of hands c. The cast material should be dipped several times into the warm water d. The casted extremity should be placed on a cloth-covered surface

b. The wet cast should be handled with the palms of hands

A nurse is caring for a client who has RN. Which of the following lab tests are used to diagnose this disease? (select all) a. urinalysis b. erythrocyte sedimentation rate (ESR) c. BUN d. antinuclear antibody (ANA) titer e. WBC count

b. erythrocyte sedimentation rate (ESR) - elevated in pts with RA d. antinuclear antibody (ANA) titer - positive result in pts with RA e. WBC count - decreased in pts with RA

The nurse is admitting a patient who complains of new onset of lower back pain. To differentiate between the pain of a lumbar herniated disc from other causes, what is the best question for the nurse to ask the patient? a. "Is the pain worse in the morning or in the evening?" b. "Is the pain sharp and stabbing or burning and aching?" c. "Does the pain radiate down the buttock or into the leg?" d. "Is the pain totally relieved by acetaminophen (Tylenol)?"

c. "Does the pain radiate down the buttock or into the leg?"

A patient is being treated for tuberculosis (TB) with isoniazid (INH). Which of these assessment findings would indicate that the patient is experiencing an adverse reaction to the medication? (select all) a. Fever and loss of appetite b. Gouty attacks in the toes c. Dark urine and yellow-ish skin d. Painful urination and flank pain e. Peripheral neuropathy

c. Dark urine and yellow-ish skin e. Peripheral neuropathy

During the screening process for tuberculosis (TB), the healthcare provider notes that the patient received the bacilli Calmette-Guérin (BCG) vaccination several years ago. Which of the following is the best method to determine this patient's TB status? a. Bronchoscopy for acid-fast bacteria (AFB) smear and culture b. Tuberculin skin test (TST) c. Interferon-gamma release assay (IGRA) d. Computerized tomography (CT)

c. Interferon-gamma release assay (IGRA)

The nurse prepares a client for a bone scan. What priority assessment should the nurse perform for this client? a. History of claustrophobia b. Current vital signs c. Presence of IV access d. Presence of metallic implants such as a pacemaker or aneurysm clips

c. Presence of IV access - A bone scan involves administering a radioisotope to visualize the bone for diagnostic purposes. It is critical that the nurse ensure that the client has IV access for injection of the radioisotope prior to the procedure

The tuberculin skin test (TST) results for a patient who has been diagnosed with human immunodeficiency virus (HIV) is negative. How should the healthcare provider interpret this test result? a. Poor technique was used when administering the TST. b. The examiner failed to palpate the patient's arm thoroughly. c. The patient is unable to mount an immune response to the test. d. The patient has not been exposed to the tuberculosis bacteria.

c. The patient is unable to mount an immune response to the test.

This morning a 21-yr-old male patient had a long leg cast applied, and he asks to crutch walk before dinner. Which statement explains why the nurse will decline the patient's request? a. "No one is available to assist and accompany the patient" b. "The cast is not dry yet, may be damaged while using crutches" c. "Rest, ice, compression and elevation are in process to decrease pain" d. "Excess edema and complications are prevented when the leg is elevated for 24 hours"

d. "Excess edema and complications are prevented when the leg is elevated for 24 hours"

A nurse is caring for a client who had an above-the-knee amputation. The client reports a sharp, stabbing type of phantom pain. Which of the following actions should the nurse take? a. Facilitate counseling services b. Encourage use of cold therapy c. Question whether the pain is real d. Administer an antieplieptic medication

d. Administer an antieplieptic medication

A nurse is reviewing the health record of a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure? a. Age 78 b. History of cancer c. Previous joint replacement d. Bronchitis 2 weeks ago

d. Bronchitis 2 weeks ago

The nurse formulates a nursing diagnosis of Impaired physical mobility related to decreased muscle strength for an older adult patient recovering from left total knee arthroplasty. What nursing intervention is appropriate? a. Promote vitamin C and calcium intake in the diet b. Provide passive ROM to all joints q4 hours c. Keep left leg in extension and abduction to prevent contractures d. Encourage isometric quad-setting exercises at least 4x/day

d. Encourage isometric quad-setting exercises at least 4x/day

The patient is brought to the emergency department after a car accident and is diagnosed with a femur fracture. What nursing intervention should the nurse implement at this time to decrease risk of a fat embolus? a. Administer Lovenox b. Provide ROM c. Apply SCDs d. Immobilize fracture preoperatively

d. Immobilize fracture preoperatively

When caring for a patient who has been diagnosed with active tuberculosis, which of the following personal protection equipment will the healthcare provider wear? a. Sterile gloves b. Eye goggles c. Surgical mask d. Personal respirator

d. Personal respirator

The healthcare provider administers a tuberculin skin test (TST) to a patient and gives instructions to return in 48 to 72 hours so the results can be interpreted. These instructions are based on the knowledge that a positive TST is the result of a ___ hypersensitivity reaction. a. Type I b. Type II c. Type III d. Type IV

d. Type IV

Which of the following statements should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to withdraw fluid from your joint." 3. "The procedure, although not painful, will provide immediate relief." 4. "We'll want you to keep your joint active after the procedure to increase blood flow." 5. "You will need to wear a compression bandage for several days after the procedure."

1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to withdraw fluid from your joint." 5. "You will need to wear a compression bandage for several days after the procedure."

Which of the following statements indicates that the client with osteoarthritis understands the effects of capsaicin (Zostrix) cream? 1. "I always wash my hands right after I apply the cream." 2. "After I apply the cream, I wrap my knee with an elastic bandage." 3. "I keep the cream in the cabinet above the stove in the kitchen." 4. "I also use the same cream when I get a cut or a burn."

1. "I always wash my hands right after I apply the cream."

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching? 1. "I will take my vitamins while I'm on this drug." 2. "I must not drink any alcohol while I'm taking this drug." 3. "I should brush my teeth after every meal." 4. "I will continue taking my birth control pills."

1. "I will take my vitamins while I'm on this drug."

2. A client with rheumatoid arthritis states, "I can't do my household chores without becoming tired. My knees hurt whenever I walk." Which nursing diagnosis would be most appropriate? 1. Activity intolerance related to fatigue and pain. 2. Self-care deficit related to increasing joint pain. 3. Ineffective coping related to chronic pain. 4. Disturbed body image related to fatigue and joint pain.

1. Activity intolerance related to fatigue and pain.

The nurse writes a problem of 'impaired gas exchange' for a client diagnosed with cancer of the lung. Which interventions should be included for the plan of care? Select all that apply. 1. Apply O2 via nasal cannula. 2. Have the dietician plan for 6 small meals per day. 3. Place the client in resp. isolation. 4. Assess vital signs for fever. 5. Listen to lung sounds every shift.

1. Apply O2 via nasal cannula. 2. Have the dietician plan for 6 small meals per day. 4. Assess vital signs for fever. 5. Listen to lung sounds every shift.

A physician orders a lengthy X-ray examination for a client with osteoarthritis. Which of the following actions by the nurse would demonstrate client advocacy? 1. Contact the X-ray department and ask the technician if the lengthy session can be divided into shorter sessions. 2. Contact the physician to determine if an alternative examination could be scheduled. 3. Provide a dose of acetaminophen (Tylenol). 4. Cancel the examination because of the hard X-ray table.

1. Contact the X-ray department and ask the technician if the lengthy session can be divided into shorter sessions.

The client diagnosed with lung cancer has been told that the cancer has metastasized to the brain. Which intervention should the nurse implement? 1. Discuss implementing an advance directive. 2. Explain the use of chemotherapy for brain involvement. 3. Teach the client to discontinue driving. 4. Have the significant other make decisions for the client.

1. Discuss implementing an advance directive.

A client with osteoarthritis will undergo an arthrocentesis on his painful edematous knee. What should be included in the nursing plan of care? Select all that apply. 1. Explain the procedure. 2. Administer preoperative medication 1 hour before surgery. 3. Instruct the client to immobilize the knee for 2 days after the surgery. 4. Assess the site for bleeding. 5. Offer pain medication.

1. Explain the procedure. 4. Assess the site for bleeding. 5. Offer pain medication.

The client diagnosed with osteoarthritis states, "My friend takes steroid pills for her rheumatoid arthritis. Why don't I take steroids for my osteoarthritis?" Which of the following is the best explanation? 1. Intra-articular corticosteroid injections are used to treat osteoarthritis. 2. Oral corticosteroids can be used in osteoarthritis. 3. A systemic effect is needed in osteoarthritis. 4. Rheumatoid arthritis and osteoarthritis are two similar diseases.

1. Intra-articular corticosteroid injections are used to treat osteoarthritis.

A postmenopausal client is scheduled for a bone-density scan. To plan for the client's test, what should the nurse communicate to the client? 1. Request that the client remove all metal objects on the day of the scan. 2. Instruct the client to consume foods and beverages with a high content of calcium for 2 days before the test. 3. Inform the client that she will need to ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4. Tell the client that she should report any significant pain to her physician at least 2 days before the test.

1. Request that the client remove all metal objects on the day of the scan.

When can airborne infection isolation for a patient with pulmonary tuberculosis (TB) be discontinued? 1. Once isoniazid drug therapy has been initiated 2. After three consecutive acid-fast bacillus (AFB) smears are negative 3. After effective instruction on the use of a high-efficiency particulate air (HEPA) mask 4. When two consecutive negative x-ray results are confirmed

2. After three consecutive acid-fast bacillus (AFB) smears are negative`

Which psychosocial problem would the nurse write for the client diagnosed with LC metastasis to the brain? 1. Seizures 2. Grieving 3. Body Image 4. Nutrition

2. Grieving

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit? 1. "I can use heat and cold as often as I want." 2. "With heat, I should apply it for no longer than 20 minutes at a time." 3. "Heat-producing liniments can be used with other heat devices." 4. "Ten to 15 minutes per application is the maximum time for cold applications."

3. "Heat-producing liniments can be used with other heat devices."

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3. Early morning stiffness

Which clinical manifestation would the nurse expect to find in newly diagnosed intrinsic LC? 1. Dysphagia 2. Foul smelling breath 3. Hoarseness 4. Weight loss

3. Hoarseness

At which of the following times should the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? 1. At bedtime. 2. On arising. 3. Immediately after a meal. 4. On an empty stomach.

3. Immediately after a meal.

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3. Maintaining usual ways of accomplishing tasks.

A nurse is planning discharge teaching for a client who had a THA. Which of the following should the nurse include in the teaching? (Select all) a. Clean the incision daily with soap and water b. Turn the toes inward when sitting or lying c. sit in a straight-backed armchair d. Bend at the waist when putting on socks e. Use a raised toilet seat

a. Clean the incision daily with soap and water c. sit in a straight-backed armchair e. Use a raised toilet seat

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate? 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which of the following, if stated by the client, would indicate the need for additional teaching? 1. Pushing with palms when rising from a chair. 2. Holding packages close to the body. 3. Sliding objects. 4. Carrying a laundry basket with clinched fingers and fists.

4. Carrying a laundry basket with clinched fingers and fists.

The client with oat cell carcinoma tells the nurse, "i am so tired of all this. I might as well just end it all." Which should be the nurse's first response? 1. "This must be hard for you. Would you like to talk?" 2. Tell the HCP of the client's statement. 3. Refer client to social worker. 4. Find out if the client has a plan to carry out suicide.

4. Find out if the client has a plan to carry out suicide.

The nurse is taking the social history of a client diagnosed with SCLC. Which information is significant for this disease? 1. Worked with asbestos for a short time many years ago. 2. Has no family Hx of this type of lung cancer. 3. Has numerous tattoos on upper and lower arms. 4. Has smoked 2 packs of cigarettes/day for 20 years.

4. Has smoked 2 packs of cigarettes/day for 20 years.

Which of the following should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis? 1. Anemia. 2. Osteoporosis. 3. Weight loss. 4. Local joint pain.

4. Local joint pain.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion.

The nurse teaches a 64-yr-old man with gouty arthritis about food that may be consumed on a low-purine diet. The patient's choice of which food item would indicate an understanding of the instructions? a. Eggs b. Liver c. Salmon d. Chicken

a. Eggs

A nurse is admitting a client to the orthopedic unit following a total knee arthroplasty. Which of the following actions by the nurse are appropriate? (Select all) a. Check continuous passive motion device settings b. Palpate dorsal pedal pulses c. Place a pillow behind the knee d. Elevate heels off the bed e. Apply heat therapy to incision

a. Check continuous passive motion device settings b. Palpate dorsal pedal pulses d. Elevate heels off the bed

9. The patient had tibia and fibula fractures repaired using open reduction internal fixation. A fiberglass cast is in place. She wants to know when she can resume exercise classes. To answer this question, the nurse must understand the stages of union occur in what order? (Answer with a letter followed by a comma and a space (e.g. A, B, C, D).) __ a. Ossificationb. Granulationc. Remodelingd. Consolidatione. Callus formationf.

Fracture hematoma Fracture hematoma -> granulation -> callus formation -> ossification -> consolidation -> remodeling

A nurse is completing discharge teaching to a client who had a wound debridement for osteomyelitis. Which of the following information should the nurse include in the teaching? a. Antibiotic therapy should continue for 3 months b. Relief of pain indicates the infection is eradicated c. Airborne precautions are used during wound care d. Expect paresthesia distal to the wound

a. Antibiotic therapy should continue for 3 months

A nurse is providing information to a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include in the information? (select all) a. Apply heat to joints to alleviate pain b. Ice inflamed joints following activity c. Install an elevated toiled seat d. Take tub baths e. Complete high-energy activities in the morning

a. Apply heat to joints to alleviate pain b. Ice inflamed joints following activity c. Install an elevated toiled seat e. Complete high-energy activities in the morning

A nurse is assessing an older adult client who has arteriosclerosis and is scheduled for a possible right lower extremity amputation. Which of the following are expected findings in the affected extremity? (select all) a. Skin cool to touch from mid-calf to the toes b. Lower legs appearing dusky when client is sitting c. Palpable pounding pedal pulse d. Lack of hair on lower leg e. Blackened areas on several toes

a. Skin cool to touch from mid-calf to the toes b. Lower legs appearing dusky when client is sitting d. Lack of hair on lower leg e. Blackened areas on several toes

An injured soldier underwent left leg amputation 2 weeks ago, but now reports shooting pain and heaviness in the left leg. What action by the nurse is supported by research findings? a. Use mirror therapy b. Give opioid analgesics c. Rebadge residual limb d. Show pt the leg is gone

a. Use mirror therapy

A patient diagnosed with rheumatoid arthritis (RA) is prescribed methotrexate (Rheumatrex). To reduce the risk of a common adverse effect of this medication, the healthcare provider should advise the patient to avoid consuming which of the following? a. alcohol b. Aged cheese c. Caffeine d. Green, leafy vegetables

a. alcohol

A 66-yr-old man with type 2 diabetes mellitus and atrial fibrillation has begun taking glucosamine and chondroitin for osteoarthritis. Which question is most important for the nurse to ask? a. "Do you have any numbness or tingling in your feet?" b. "Have you noticed any bruising or bleeding?" c. "Have you had any dizzy spells when standing up?" d. "Did you have any hypoglycemic reactions?"

b. "Have you noticed any bruising or bleeding?" - Glucosamine and chondroitin are dietary supplements commonly used to treat osteoarthritis. Both may increase the risk of bleeding. Patients with atrial fibrillation routinely take an anticoagulant to reduce the risk of venous thromboembolism and stroke. Use of glucosamine and chondroitin along with an anticoagulant may precipitate excessive bleeding. Glucosamine may decrease the effectiveness of insulin or other drugs used to control blood glucose, and hyperglycemia may occur.

A home health nurse is teaching a client who has active TB. The provider has prescribed the following medication regimen: isoniazid 250 mg PO daily, rifampin 500 mg PO daily, pyrazinamide 750 mg PO daily, and ethambutol 1 mg PO daily. Which of the following client statements indicate the client understand the teaching? (Select all) a. "I can substitute one medication for another if I run out because they all fight infection" b. "I will wash my hands each time i cough" c. "I will wear a mask when I am in a public area" d. "I am glad i dont have to have any more sputum specimens" e. "I dont need to worry where i go once I start taking my medications"

b. "I will wash my hands each time i cough" c. "I will wear a mask when I am in a public area" d- sputum cultures every 2-4 weeks until 3 come back negative

A nurse is teaching a client who has TB. Which of the following statements should the nurse include in the teaching? a. "You will need to continue to take the multimedication regiment for 4 months" b. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication" c. "You will need to reamin hospitalized for treatment" d. "You will need to wear a mask at all times"

b. "You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication" a- take for 6-12 months d- mask in public

When teaching a patient diagnosed with rheumatoid arthritis (RA) about disease management, the healthcare provider should include which of the following in the teaching plan? a. "Reduce your consumption of red meat, seafood, and beer to prevent painful attacks." b. "Your joints are sensitive to temperature, so avoid applying heat or cold packs to your joints." c. "Call our office if you experience chest pain, especially if it gets worse when you lie down." d. "To decrease joint pain, you should remember to try to sleep in a flexed position."

c. "Call our office if you experience chest pain, especially if it gets worse when you lie down."

A nurse is preparing to administer a new prescription for isoniazid (INH) to a client who has TB. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? a. "You might notice yellowing of your skin" b. "You might experience pain in your joints" c. "You might notice tingling of your hands" d. "You might experience loss of appetite"

c. "You might notice tingling of your hands" abd - rifampin a - pyrazinamide

A nurse is caring for a client who has a new diagnosis of TB and has been placed on a multimedication regimen. Which of the following instructions should the nurse give the client related to ethambutol? a. "your urine can turn a dark orange" b. "watch for a change in the sclera of your eyes" c. "watch for any changes in vision" d. "Take vitamin B6 daily"

c. "watch for any changes in vision" a- rifampin d- isoniazid

The healthcare provider is assessing the hands of a patient and notes bony enlargements of the patient's joints, as pictured here. The joints are hard, painless, and some of the fingers are deviated from the midline. The healthcare provider suspects these findings are a result of which of the following? a. Ostemyelitis b. Uric acid deposits c. Actions of T-cells d. Joint wear and tear

d. Joint wear and tear

When the healthcare provider gently squeezes a patient's hand the patient cries out in pain. The finger joints are swollen and spongy to palpation. Which additional finding is most consistent with a diagnosis of rheumatoid arthritis (RA)? a. Decreased bone mineral density b. Pain and swelling of the big toe d. Clicking sound when opening/closing the mouth d. Swan-neck deformity of the fingers

d. Swan-neck deformity of the fingers

Assessment findings for a patient include the following: Body mass index (BMI) of 40 Low erythrocyte sedimentation rate (ESR). A patient reports morning pain and stiffness which resolves after moving for several minutes. This assessment data supports a diagnosis of which of the following? a. Psoriatic arthritis b. Osteoarthritis c. Gouty arthritis d. Rheumatoid arthritis

b. Osteoarthritis