Exam 4 Practice Questions

A patient status post a hypophysectomy had drainage on the moustache dressing. Which complication is the patient at risk for if the glucose level of the drainage is 50 mg/dL? A. Diabetes B. Meningitis C. Hypoplycemia D. Visual deterioration

B

Following a gastrectomy performed for peptic ulcer disease, the patient is ready for discharge. Which instructions would the nurse include in discharge teaching? A. Take fluids along with meals B. Reduce protein and fats in the diet C. Divide meals into six small feedings D. Use concentrated sweets like honey, jam and jelly

C To prevent dumping syndrome after gastrectomy, the patient should avoid large meals, instead dividing meals into six small meals to avoid overloading the intestines at mealtimes. Fluids should not be taken with meals

The nurse is completing a neurovascular assessment on a patient with a tibial fracture and a cast. The patient's foot is pulseless, pale and cool, the patient reports numbness in the foot. The nurse suspects which condition? A. Paresthesia B. Pitting edema C. Poor venous return D. Compartment syndrome

D The nurse should suspect compartment syndrome with one or more of the six Ps. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome. Pitting edema is not evident

Which cause is associated with central diabetes insipidus? A. The presence of a brain tumor B. Renal damage from long-standing hypertension C. Drug therapy with lithium for bipolar disorder D. Structural lesion in the thirst center

A

Which finding would the nurse assess in a patient who has hypothyroidism? A. Weight gain B. Heat intolerance C. Warm, moist skin D. Hyperpigmentation

A

Which laboratory test is used to identify the presence of a small amount of blood in gastric secretions and stools? A. Guaiac test B. Liver enzyme studies C. Complete blood count (CBC) D. Serum amylase determination

A

The nurse would implement which nursing action when caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Initiate seizure precautions B. Elevate the patient to a semi-Fowler's position C. Increase fluid intake to at least 1500 mL/24 hours D. Infuse prescribed hypotonic IV solution, such as 0.45% saline

A

Which assessment parameter is of highest priority when caring for a patient undergoing a water deprivation test? A. Patient weight B. Serum glucose C. Arterial blood gases D. Patient temperature

A

A patient experiences a greenstick fracture. The nurse reviews the patient's x-ray results and expects which finding? a. An incomplete fracture with one side splintered and the other side bent b. A fracture with more than two fragments; the smaller fragments appear to be floating c. The line of the fracture extends across and down the bone d. The line of the fracture extends in a spiral direction along the bone shaft

A A greenstick fracture is an incomplete fracture with one side splintered and the other side bent. A comminuted fracture is a fracture with more than two fragments; the smaller fragments appear to be floating. An oblique fracture is when the line of the fracture extends across and down the bone. A spiral fracture is when the line of the fracture extends in a spiral direction along the bone shaft.

Which patient statement about a bone scan for osteomyelitis indicates a need for further teaching? A. "Before the test, I should refrain from voiding" B. "Two hours before the test, I will receive an injection of radioisotope" C. "The test is noninvasive; I should not have pain during the procedure" D. "The test will take about an hour; I should remain in a supine position during the procedure"

A Bone scan is a radiographic technique that helps diagnose malignant lesions in the bone. When explaining the procedure, the nurse should instruct the patient to empty the bladder before the test because it prevents discomfort in the patient.

Which instructions will the nurse include when educating a patient with rheumatoid arthritis (RA) about small joint protection? A. Do not knit or sew for long periods B. Wring water from sponges when cleaning C. Try to carry laundry baskets with your fingers D. Complete all vacuuming of rooms in a single timeframe

A Education for a patient with RA regarding small joint protection includes avoiding knitting and sewing for long periods due to the use of the small joints. Pressing water from a sponge instead of wringing it protects the small joints. Holding the laundry basket with the arms rather than the fingers alleviates pressure on the small joints. Rest is encouraged between vacuuming rooms to provide relief from a constant grip of the handle.

Which type of fracture is most common in adults greater than 65 years of age? A. Hip fracture B. Pelvic fracture C. Colles' fracture D. Fracture of the humerus

A Hip fractures are most common in older adults with 90% of these fractures occurring as a result of a fall. Colles' fracture is a fracture of the distal radius and is one of the most common fractures in adults of any age. Pelvic fractures range from benign to life threatening, depending on the mechanism of injury and associated vascular insult. Only a small percentage of all fractures are pelvic fractures. This type of injury is associated with a high mortality rate. Fractures of the humerus involve the shaft of the humerus and are common among young and middle-aged adults

The nurse plans care for a patient who has a fractured femur. During the 24 to 48 hours after the fracture, the nurse monitors the patient for the development of which complication? A. Fat embolism syndrome B. Renal calculi C. Muscle Atrophy D. Bone demineralization

A Pressure on the bone marrow or an increase in catecholamines can mobilize fatty acids and the development of fat globules in the bloodstream. These fat globules travel to the lung and become lodged, causing pulmonary symptoms. Renal calculi, muscle atrophy and bone demineralization are potential complications of immobility; however, they would develop much later than 72 hours after the fracture

A patient with a history of peptic ulcer disease has presented to the emergency department with severe abdominal pain and a rigid, board-like abdomen. Which intervention would the nurse anticipate? A. Providing IV fluids and inserting a nasogastric (NG) tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in a high Fowler's position

A Severe abdominal pain and a rigid, board like abdomen may indicate a possible perforated peptic ulcer. Treatment requires IV replacement of fluid losses and continued gastric aspiration by NG tube

A patient who has been on high dose of antibiotics for a year reports a sore mouth. The nurse finds bluish-white "milk-curd" lesions in the mouth. Which medication would the nurse expect to be prescribed? A. Nystatin B. Calcium carbonate C. Omeprazole D. Metoclopramide

A Sore mouth and bluish-white "milk-curd" lesions on the mucosa of mouth indicate oral candidiasis caused by infection with yeast-like fungus. Oral candidiasis is caused by prolonged use of high-dose antibiotics. Nystatin is the expected treatment

Which intervention is the priority for a patient who has a severe headache and slightly yellow drainage on the dressing to the incisional area following a spinal surgery? A. Inform the surgeon immediately B. Send the drainage sample for culture C. Administer an analgesic for the headache D. Apply a new dressing on the incisional area

A The presence of yellowish drainage on the dressing after spinal surgery, along with patient reports of a headache, may indicate leakage of cerebrospinal fluid. Therefore, the nurse should inform the surgeon to determine the supportive interventions. The drainage sample does not necessarily need to be sent for culture because there are no other signs of infection such as a fever. Analgesics are administered to treat the headache; however, they will not help to resolve the cause of the headache. A new dressing should be applied to the incisional area if the dressing is soiled. However, this intervention may not help to prevent cerebrospinal fluid leakage

A patient is admitted to the orthopedic surgical unit for a fracture of the left tibia. Which instructions does the nurse give concerning the prevention of venous thromboembolism (VTE)? Select all that apply. A. Wear compression gradient stockings B. Dorsiflex and plantar flex the ankle of the left leg C. Perform range-of-motion (ROM) exercises on the right leg D. Increase the intake of calcium E. Take vitamin D supplements

A, B, C Because of the high risk of VTW in the orthopedic surgical pt, measures should be taken to prevent it. Beside wearing compression gradient stocking or using intermittent pneumatic compression devices the pt should dorsiflex and plantar flex the ankle of an affected lower extremity against resistance and perform ROM exercises on the unaffected leg. Calcium and vit C supplementation are given to pts with osteopenia or osteoporosis; they do not prevent VTE

Which factors may lead to the development of a hiatal hernia by increasing intraabdominal pressure? Select all that apply. A. Ascites B. Obesity C. Pregnancy D. Fatty foods E. Peppermint

A, B, C Factors increasing intraabdominal pressure include ascites, obesity, and pregnancy. They may lead to the development of a hiatal hernia.

Which clinical manifestations of severe serum sodium level decline would the nurse assess in a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. A. Coma B. Lethargy C. Confusion D. Headache E. Tachycardia F. Hypovolemic shock

A, B, C, D

Which actions would the nurse take when caring for a patient status post a transsphenoidal hypophysectomy? Select all that apply. A. Monitoring the pupillary response B. Elevating the head of the patient's bed C. Observing the patient for any signs of bleeding D. Advising the patient to brush his or her teeth twice daily E. Monitoring extremity strength to detect neurological complications

A, B, C, E

Which nursing interventions would be included in the plan of care for a patient exhibiting exophthalmos? Select all that apply A. Apply artificial tears B. Tape the eyelids lightly for sleeping, if needed C. Ask the patient to exercise the intraocular muscles D. Place the patient in a supine position E. Teach the patient to eat a low-salt diet

A, B, C, E

Which interventions will the nurse include when preparing a patient for a MRI procedure? Select all that apply. A. Offer ear plugs or music B. Inform the patient to remain still throughout the procedure C. Ensure that patient is not wearing metal such as zippers or jewelry D. Ensure that the patient is shaved completely, and also catheterize the patient E. Explain that the machine will make loud tapping noises intermittently, and there is no cause for alarm

A, B, C, E The nurse should inform the pt that the procedure is painless. Offer ear plugs or music to listen to so that the patient will be relaxed during the procedure. Inform the pt to remain still throughout procedure. The pt should have no metal on the clothing. Explain to the pt that the machine will make loud tapping noises intermittently and there is no cause for alarm. Inform pts who are claustrophobic that they may experience symptoms during examination. Administer an antianxiety agent if indicated and ordered. The procedure in noninvasive, so pt does not need to be shaved or catheterized

Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? Select all that apply. A. Weight loss B. Protrusion of the eyeballs C. Thick, cold, and dry skin D. Elevated BP E. Purplish-red marks on the abdomen

A, B, D

Which items that may aggravate the symtpoms of gastroesophageal reflux disease (GERD) would the nurse explain to a patient with that condition? Select all that apply. A. Caffeine B. Chocolate C. Dietary Fiber D. Cigarette smoking E. High protein Foods

A, B, D GERD results when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus. An incompetent lower esophageal sphincter (LES) is a common cause of gastric reflux. Decreased LES pressure can be caused by certain foods and drugs.

Which medications increase the risk of ulcer development? Select all that apply. A. Aspirin B. Ibuprofen C. Stool softeners D. Corticosteroids E. Anticoagulants

A, B, D, E NSAIDs corticosteroids, and anticoagulants are ulcerogenic drugs that inhibit the synthesis of prostaglandins, increase gastric acid secretion and reduce the integrity of the mucosal barrier. These medications increase the risk of ulcer development

An 85-year old patient reports a loss of appetite and no desire to eat at mealtimes. The nurse recalls which age-related changes that may be affecting the patient's appetite? Select all that apply. A. Difficulty chewing food B. Decreased sense of salty and sweet C. Increased saliva production D. Loss of ability to feel satiety E. Indigestion

A, B, E Several age-related changes may affect the older adult's appetite and ability to eat. Difficulty chewing is related to loss of teeth, dental implants, or dentures that are the result of age-related gingival retraction. Older adults have decreased numbers of taste buds and a decreased sense of taste, especially salty and sweet.

Which information will the nurse include when teaching a patient who is anxious about undergoing an arthrocentesis? Select all that apply. A. Local anesthesia and aseptic preparation are used B. This procedure can be performed at the bedside or in an examination room C. This procedure is performed to visualize and examine interior of the joint cavity D. There are serious complications, such as respiratory distress, related to the procedure E. This procedure is performed to obtain samples of synovial fluid or to remove excess fluid from the joint cavity

A, B, E The nurse should explain to the patient that arthrocentesis involves an incision or puncture of the joint capsule to obtain samples of synovial fluid or remove excess fluid from within the joint cavity. Local anesthesia and aseptic preparation are used before the needle is inserted into the joint and fluid is aspirated. It is useful in the diagnosis of joint inflammation, infection, meniscal tears, and subtle fractures. The procedure is done at the bedside or in an examination room. Respiratory distress is not a complication.

The nurse provides postoperative care for a patient following an external fixation of the tibia. The nurse identifies that it is critical to include which patient assessments? Select all that apply. A. Indications of infection B. Manifestations of cast syndrome C. Pin loosening D. A Lachman's test E. Indications of remodeling

A, C External fixation is often used as an attempt to salvage extremities that otherwise might require amputation. Because the use of an external device is a long-term process, ongoing assessment for pin loosening and infection is critical. After vertebral injuries, a body jacket brace is used for immobilization and support for stable spine injuries of the thoracic or lumbar spine. After application of the brace, the nurse should assess the patient for the development of superior mesenteric artery syndrome (cast syndrome). A Lachman's test is performed to determine an anterior cruciate ligament (ACL) tear. Remodeling is part of bone healing; it is accomplished as excess callus is resorbed and trabecular bone is laid down.

Which are characteristics specific to rheumatoid arthritis (RA)? Select all that apply. A. Common effusions B. Overweight patient C. Young to middle-age onset D. Stiffness lasting an hour to all day E. Localized disease with a variable progressive course

A, C, D The onset of RA occurs in a young to middle-aged patients. Effusions are common, and stiffness can last from an hour to all day. Weight loss or maintained weight occurs with RA. It is a systemic, not localized, disease with exacerbations and remissions.

Interprofessional care for the management of osteoarthritis (OA) may be utilized for which treatment goals? Select all that apply. A. Managing pain B. Curing osteoarthritis C. Prevention of disability D. Managing inflammation E. Improving joint function

A, C, D, E Interprofessional care for the patient diagnosed with osteoarthritis focuses on pain management, prevention of disability, managing inflammation, and improving joint function. Osteoarthritis cannot be cured.

Which musculoskeletal assessment findings are normal? Select all that apply. A. Muscle strength 5/5 B. No spinal curvature C. No muscle atrophy or asymmetry D. No joint swelling, deformity or crepitation E. Full range of motion of all joints without pain F. No tenderness on palpation of spine, joints or muscles

A, C, D, E, F The components of a normal MS system include muscle strength of 5/5, no muscle atrophy or asymmetry, no joint swelling, deformity or crepitation, a full ROM of all joints without pain or laxity, and no tenderness on palpation of spine, joints or muscles. The spine should have ordinary spinal curvatures, not an absence of curvature

A patient with a family history of colon cancer undergoes a screening colonoscopy. After the procedure, the nurse performs which interventions? Select all that apply. A. Obtains vital signs B. Checks for return of the gag reflex C. Assesses for abdominal cramping D. Assesses for abdominal distention E. Administers an enema to empty the bowel F. Monitors for tenesmus

A, C, D, F After a colonoscopy procedure, the vital signs should be checked to observe changes in temperature. The patient should be observed for abdominal cramping, rectal bleeding and abdominal distention. Abdominal cramps are caused due to the stimulation of peristalsis as the bowel is constantly inflated with air during the procedure.

Which joints are diarthrodial joints? Select all that apply. A. Hinge joint of the knee B. Ligaments joining the vertebrae C. Fibrous connective tissue of the skull D. Ball and socket joint of the shoulder or hip E. Cartilaginous connective tissue of the pubis joint

A, D The diarthrodial (synovial) joints include the hinge joint of the knee and elbow, the ball-and-socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, saddle and gliding joints of the wrist and hand.

The nurse has applied Buck's traction to a patient who has sustained a fractured femur. Which are the main purposes of this type of traction? Select all that apply. A. To reduce muscle spasms B. To reduce the risk for a fat embolsim C. To repair the fracture without surgery D. To immobilize and stabilize the fracture E. To reduce the amount of analgesics required F. To allow the nursing staff to care for the patient more easily

A, D, Buck's traction is used to stabilize and immobilize a fractured femur. This type of traction decreases the risk for further injury until surgery can be performed and can also ease painful muscle spasms. It may also reduce the risk for a fat embolism. It may be used long term until the pt is able to undergo surgery, but this is not the preferred treatment. It does not necessarily allow the nursing staff to care for the patient more easily

Which instructions would the nurse give when teaching a patient about prevention of peptric ulcers? Select all that apply. A. Avoid smoking B. Consume raw, uncooked food C. Use nonsteroidal anti-inflammatory drugs (NSAIDs) for treatment of pain D. Wash hands thoroughly with soap after using the restroom and before eating E. Report symptoms of gastric irritation, such as nausea and epigastric pain, to the health care provider

A, D, E

Which assessment finding would be increased in a patient with diabetes insipidus? A. Temperature B. Urine output C. Serum glucose D. BP

B

Which complication would the nurse suspect due to a patient's loss of intrinsic factor after gastrectomy? A. Bile reflux gastritis B. Pernicious anemia C. Dumping syndrome D. Postprandial hypoglycemia

B

Which condition is associated with decreased triiodothyronine (T) and thyroxine (T) levels and an increased TSH (thyroidstimulating hormone) level? A. Hypoparathyroidism B. Hypothyroidism C. Hyperthyroidism D. Hyperparathyroidism

B

Which nursing intervention is most important for a patient with diabetes insipidus? A. Providing dietary education B. Monitoring fluid intake and output C. Assessing for constipation every day D. Obtaining a finger-stick blood glucose level

B

Which symptom would the nurse expect to be relieved after a patient who has gastroesophageal reflux disease (GERD) takes an oral dose of aluminum hydroxide/magnesium hydroxide? A. Diarrhea B. Heartburn C. Constipation D. Lower Abdominal Pain

B

Which symptom would the nurse expect to see in a patient suspected of having hypothyroidism? A. Diaphoresis B. Constipation C. Heat intolerance D. Systolic hypertension

B

Which syndrome would be suspected in a patient who has Addison's disease along with other endocrine conditions? A. Hashimoto's thyroiditis B. Autoimmune polyglandular syndrome C. Multiple endocrine neoplasia D. Syndrome of inappropriate antidiuretic hormone (SIADH)

B

Which term is used for vomited fluid with a coffee-ground appearance? A. Melena B. Hematemesis C. Occult bleeding D. Mallory-Weiss tear

B

A patient diagnosed with acromegaly has developed speech difficulties and asks what is causing the problem. Which response by the nurse is accurate? A. "You have developed the condition from numbness of the vocal cords" B. "You have developed the condition due to overgrowth of the tongue" C. "You have developed the condition for an overgrowth of soft tissue in the neck" D. "You have developed the condition related to upper airway narrowing"

B (6)

Which action does the nurse take to prepare a patient for a video capsule endoscopy study? A. Have the patient return to the procedure room for removal of the capsule B. Inform the patient that the procedure involves swallowing a video capsule C. Instruct the patient to maintain a clear liquid diet the morning of the study D. Explain to the patient that no bowel preparation is required for the study

B A VCE study involves the patient swallowing a vitamin-sized capsule with camera, which provides endoscopic visualization of the gastrointestinal (GI) tract. The capsule is disposable and and will pass naturally with the bowel movement, although the monitoring device will need to be removed. Eight hours after swalloing the device, the patient should return to have the monitoring device removed. The patient will be NPO for eight hours before the procedure. The patient may have bowel preparation similar to colonoscopy

The patient has a hard, painless ulcer on the upper lip. Which treatment would the nurse expect the health care provider to prescribe? A. Glossectomy B. Surgical Excision C. Mandibulectomy D. Hemiglossectomy

B A hard, painless ulcer is a sign of oral cancer affecting the lip. Surgical excision of the ulcer is the treatment option for cancer of the lip. Glossectomy is the complete removal of the tongue. It is performed when the tongue becomes cancerous.

The nurse teaches a nursing student about a safe home environment for the patient who has undergone an orthopedic surgery. Which statement made by the student indicates the need for further education? A. "The home environment should be free of any electrical cords on the floor" B. "To promote independent living skills, home assistance should be discouraged" C. "To allow for free movement of the patient, throw rugs should be removed" D. "Door frames should be wide enough for free movement of the patient with a walker

B A patient who has undergone orthopedic surgery will require assistance for a few weeks after the surgery. The patient will need help performing simple daily activities such as tying shoes. The home environment should be free of any electric cords on the floor to prevent accidents from electric shock. Throw rugs should be removed to prevent falls. Door frames should be wide enough for the free movement of a patient with a walker so that there is no dislocation of the operated joint during the movement.

Which term will the nurse use to describe fixation of the knee joint of a patient with a long-standing history of rheumatoid arthritis? A. Atrophy B. Ankylosis C. Crepitation D. Contracture

B Ankylosis is stiffness of fixation of a joint, often caused by chronic joint inflammation and destruction and may be associated with rheumatoid arthritis. Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement. Contracture is resistance of movement of muscles or joints due to fibrosis of supporting tissues

Which complication occurs when cancer erodes through the esophagus and into the aorta? A. Choking B. Hemorrhage C. Hoarseness D. Blood-flecked regurgitation

B Hemorrhage occurs when esophageal cancer erodes through the esophagus and into the aorta. Choking and hoarseness occur when the tumor is in the upper third of the esophagus.

The nurse provides information to a patient related to a fecal occult blood test. The instructions will include keeping the diet free of which item for 24 to 48 hours before the test? A. Shellfish B. Red meat C. Fatty foods D. Iron supplements

B If the stool is Hemoccult-positive, it contains trace blood. A false-positive reading may occur if the patient has ingested significant amounts of red meat in the 24 to 48 hours before the test. Iron supplements, shellfish and increased intake of fatty foods will not cause false-positive findings on a test for occult blood

Which symptoms in a patient with a hiatal hernia would indicate reflux? A. Jaundice, ascites, and edema B. Heartburn, regurgitation and dysphagia C. Pelvic pain, fever and abdominal rigidity D. Abdominal cramps, diarrhea and anorexia

B The most common symptom of a hiatal hernia is heartburn, also known as pyrosis. It results from reflux of gastric secretions into the esophagus.

Which statement by the student nurse indicates understanding of treatment for acute osteomyelitis? A. "Oral antibiotics often are required for several months" B. "IV antibiotics are usually required for several weeks" C. "Surgery is almost always necessary to remove the dead tissue that is likely to be present" D "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."

B The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. In adults with chronic osteomyelitis, oral therapy with a fluoroquinolone for six to eight weeks may be prescribed instead of IV antibiotics. Oral antibiotics also may be given for four to eight weeks after acute IV therapy is done to ensure the infection is resolved. Surgery may be used for chronic osteomyelitis, which may include debridement of the devitalized and infected tissue and irrigation of the affected bone with antibiotics. Antibiotics are not commonly injected into the affected area.

A patient is at risk for developing a deep vein thrombosis after a knee replacement surgery. Which intervention reduces the risk of this complication? A. Applying heat to the operative site B. Administering prophylactic anticoagulant drugs C. Providing intermittent positive pressure ventilation D. Restricting the range of motion of the unaffected lower extremity

B To decrease the risk for thromboembolism after knee replacement surgery, a patient is treated with prophylactic anticoagulant drugs. Heat is applied during the initial postoperative period to decrease swelling. However, heat does not affect the development of a deep vein thrombosis. Intermittent positive pressure ventilation is administered during fat embolism syndrome. Restricting the range of motion of the unaffected lower extremity would result in thromboembolism.

A patient has a history of gastrointestinal (GI) bleeding. Which action of the patient's caregiver increases the risk of recurrent GI bleeding in this patient. A. The caregiver encourages the patient to practice deep-breathing exercises B. The caregiver administers aspirin daily to the patient on an empty stomach C. The caregiver allows the patient to drink an ounce of alcohol once a month D. The caregiver gives the patient an analgesic along with a proton pump inhibitor

B Traces of blood in the vomit indicate GI bleeding. When given on an empty stomach, aspirin irritates the GI mucosa and causes GI bleeding.

A patient is admitted with gastrointestinal bleeding. Which findings would support the nurse's conclusion that the patient is in shock? Select all that apply. A. Warm skin B. Rapid, weak pulse C. Slow capillary refill D. High BP E. Increased temperature

B, C

Which symptoms would the nurse assess in a patient who has Addison's disease? Select all that apply. A. Weight gain B. Hyperpigmentation C. Weakness and fatigue D. Orthostatic hypotension E. Thin skin with ecchymosis

B, C, D

A patient is suspected of having fat embolism syndrome (FES) following a traumatic femur fracture. Which assessment data gathered by the nurse supports this suspicion? Select all that apply. A. Increased hematocrit B. Chest pain C. Mental status change D. Petechiae on the anterior chest wall E. Increased partial pressure of arterial oxygen

B, C, D FES is characterized by a classic triad of symptoms, including respiratory changes such as chest pain, dyspnea, and cyanosis; mental status change including restlessness, confusion and memory loss; and skin changes including petechiae of the neck, anterior chest wall, bucacal mucosa and conjunctiva

An older adult may experience which musculoskeletal system changes? Select all that apply. A. Increased bone density B. Earlier fatigue with activity C. Decreased basal metabolic rate D. Increased risk for cartilage erosion E. Increased water in discs between vertebrae

B, C, D Many functional problems experienced by older adults are related to changes in the MS system. Change may affect older adult's ability to complete self-care tasks and pursue other usual activities. MS assessment difference for older adults include earlier fatigue with activity, decreased basal metabolic rate, and increased risk for cartilage erosion that leads to direct contact between bone ends and overgrowth of bone around joint margins. Older adults may experience decreased bone density and strength, which increases their risk for osteopenia and osteoporosis. There is a loss of water from discs between vertebrae.

The nurse is caring for a patient with a fractured femur. Which are appropriate nursing actions? Select all that apply. A. Alternating between heat and cold applications to the affected extremity B. Elevating the extremity C. Marking the location of pulses D. Assessing for compartment syndrome E. Applying ice packs to the injury area F. Giving tetanus prophylaxis if there is a break in skin integrity

B, C, D, E, F The nurse should evelcate the injured limb if possible, apply ice packs to affected area, give tetanus prophylaxis if there is a break in skin integrity, assess and treat pain, and mark the location of pulses to aid repeat assessment. Heat should not be applied until after the acute phase (24 hrs) to reduce swelling and provide comfort

Which discharge instructions does the nurse give to a patient with a cast? Select all that apply. A. Use talcum powder under the cast as needed B. Keep the extremity elevated as much as possible C. Take pain medications only when the pain is unbearable D. Report a fever or a foul order coming from beneath the cast E. Report itching under the cast because it could indicate an infection F. Keep the extremity in a dependent position as much as possible

B, D A fever and a foul odor coming from beneath the cast may indicate an infection and requires immediate attention. The extremity should be elevated as much as possible to prevent edema. No product such as talcum powder, cornstarch or lotion should be put down a cast to relieve itching because this may increase the risk for infection. If pain is present, then the pt should take pain medication before reaching an unbearable level. Itching under the cast is normal and does not need to be reported to the PCP, but the pt must be advised to avoid scratching because breaks in the skin under the cast can easily become infected.

Which nursing interventions would the nurse implement for a patient status after a subtotal thyroidectomy? Select all that apply. A. Monitor potassium levels B. Administer analgesics for postoperative pain C. Place the patient supine with the head supported on pillows D. Assess for signs of tetany E. Assess the patient every two hours for signs of bleeding

B, D, E

Which pre-procedure teaching would the nurse provide to a patient who is having a non-contrast MRI scan for radiologic evaluation of the pituitary gland? Select all that apply. A. Inform the patient that a six-hour fast is required B. Explain that the test is noninvasive C. Assess serum blood urea nitrogen (BUN) and creatinine (Cr) D. Assure the patient that the test is painless E. Inform the patient of the need to lie still during the procedure

B, D, E

Which condition is a cause of upper gastrointestinal (GI) bleeding? Select all that apply. A. Cholecystitis B. Stomach cancer C. Oral candidiasis D. Esophageal varices E. Nonsteroidal anti-inflammatory drugs (NSAIDs)

B, D, E Esophageal varices, stomach cancer, and NSAIDs are common causes of an upper GI bleed. Oral candidiasis and cholecystitis are not associated with an upper GI bleed

The nurse discusses amputations with a group of nursing students. The nurse states that candidates for amputation surgery are patients with which history findings? Select all that apply. A. Ulcerative colitis B. Diabetes C. Myasthenia Gravis D. Osteomyelitis E. Peripheral vascular disease (PVD)

B, D, E Most amputations are done due to PVD, especially in older patients with diabetes. Other common reasons for amputation include thermal injuries, tumors, osteomyelitis, and congenital limb disorders. Ulcerative colitis and myasthenia gravis do not lead to gangrene in the limbs or to amputation.

A patient with gastroesophageal reflux disease reports to the nurse, "I feel like there is a hot, bitter liquid in my mouth" Which finding would the nurse document in the patient's medical record? A. Dysphagia B. Regurgitation C. Hypersalivation D. Hyperchlorhydria

BRegurgitation is described as a hot, bitter, or sour liquid coming into the throat or mouth. Dysphagia is difficulty swallowing food.

A patient with a peptic ulcer begins vomiting. Which type of vomitus is associated with bleeding in the stomach? A. Fecal B. Bilious C. "Coffee ground" D. Undigested food

C

The nurse would perform patient teaching related to which diagnostic test for a patient with a history of diabetes insipidus? A. Thyroid scan B. Fasting glucose test C. Water-deprivation test D. Oral glucose tolerance

C

Which common cause of gastritis is also linked to development of stomach cancer? A. Syphilis B. Cytomegalovirus C. Helicobacter pylori D. Mycobacterium species

C

Which finding would the nurse assess in a patient admitted with Addison's disease? A. Goiter B. Oversized hands and feet C. "Bronze" skin tone D. Weight gain

C

A patient who underwent abdominal surgery complains of sweating, weakness, palpitations, and dizziness 20 minutes after a meal. Upon auscultation, the nurse find the patient to have borborygmi. Which complication would the nurse suspect in the patient? A. Achalasia B. Bile reflux gastritis C. Dumping syndrome D. Postprandial hypoglycemia

C A patient experiencing sweating, weakness, palpitations, and dizziness 20 minutes after eating is suffering from dumping syndrome. The dizziness soon after eating is caused by a sudden decreased in the plasma volume, which is confirmed by the laboratory test.

Which education will the nurse include about Lyme disease for a patient bitten by a tick? A. Lyme disease occurs in about 3 cases per 100,000 persns B. Lyme disease symptoms can mimic those of system lupus erythematosus (SLE) C. A bullseye rash occurs in about 80% of infected patients at the site of the tick bite D. Most cases occur along the southeastern and Gulf Coast area of the US

C About 80% of patients diagnosed with Lyme disease develop erythema migrans (EM), which is a skin lesion that appears at the site of the tick bite between 2 to 30 days after exposure. It is the most common vector-borne disease in the United States, with 7.9 cases per 100,000 persons. SLE is a chronic, multisystem inflammatory autoimmune disease that affects the skin, joints, and serous membranes and follows an unpredictable course. Most U.S. cases of Lyme disease occur in three areas: along the northeastern states from Maryland to northern Massachusetts, in the midwestern states of Wisconsin and Minnesota, and along the northwestern coast of California and Oregon

Which statement made by a patient who has achalasia would indicate a need for further teaching? A. "I should eat slowly" B. "I can drink fluids with meals" C. "I should only eat liquified food" D. "I can sleep with my head elevated"

C Achalasia is a condition in which peristalsis of the lower two thirds of the esophagus is absent. Patients with achalasia are not restricted to liquified foods; they can also eat semisoft foods

After a patient has undergone an esophagogastroduodenoscopy (EGD), which is the nursing priority? A. Provide warm saline gargles for relief of sore throat B. Assess the patient's bowel sounds C. Keep the patient NPO until the gag reflex returns D. Address the patient's anxieties about the results of the EGD

C After an EGD, it is essential to keep patient NPO until gag reflex returns. The nurse should gently tickle the back of the patient's throat to determine reflex. The patient should remain NPO until the gag reflex returns, so offering warm saline gargles is not safe. Assessing the patient's bowel sounds and addressing the patient's anxieties are important but not the priority

The nurse is teaching about home care to a patient with gastrointestinal reflux disease (GERD). Which statement made by the patient indicates the need for further teaching? A. "I should not bend over after eating" B. "I should sleep with the head of the bed elevated" C. "I should lie down for two to three hours after eating" D. "I should avoid eating within three hours of bedtime."

C After eating, the patient should wait for three hours to lie down. This will help maintain gravity, which in turn prevents the development of acid reflux. The patient should not bend over after eating

A patient is scheduled for a upper GI series to diagnose abnormalities in the esophagus. Which instruction does the nurse include when preparing the patient for this procedure? A. Avoid smoking one hour before the test B. Barium will be instilled into the rectum and colon C. Stools may remain white for up to 72 hours after the test D. Maintain a clear liquid diet for eight hours before the test

C An upper GI series is a radiographic study in which the patient drinks a contrast medium. The nursing responsibility is the same as the small bowel series. The patient should be informed that the stool may be white up to 72 hours after the procedure as a part of elimination of the contrast. Patients should avoid smoking after midnight. The patient should be NPO for at least eight hours before the test

A patient with a leg fracture is scheduled for a fasciotomy. Which complication is identified as having caused the need for this type of surgery? A. Infection B. Fat embolism syndrome C. Compartment syndrome D. Venous thromboembolism

C Compartment syndrome is characterized by swelling and increased pressure within a limited space, which presses and compromises the function of the blood vessels, nerves, and/or tendons that run through that compartment. Surgical decompression of soft tissue is done through fasciotomy.

A patient has greenish yellow nasogastric tube drainage 24 hours after a gastrectomy. Which action would the nurse take? A. Remove the nasogastric tube B. Notify the health care provider C. Document it as a normal finding D. Place the patient in a supine position

C Discharge of bloody, greenish to yellow drainage from the nasogastric tube for 8 to 12 hours after insertion is a common observation.

How would the nurse document a patient's report of pain and discomfort in the upper abdomen? A. Pyrosis B. Halitosis C. Dyspepsia D. Stomatitis

C Dyspepsia is discomfort or pain in the upper abdomen. Pyrosis or heartburn is a burning, tight sensation that is felt intermittently beneath the lower sternum and spreads toward the throat or jaw. Halitosis is foul-swelling breath in patient with achalasia.

A patient has a sliding hiatal hernia. Which interventions will help prevent the patient from experiencing heartburn and dyspepsia? A. Keep the patient NPO B. Put the bed in the Trendelenburg position C. Have the patient eat four to six smaller meals each day D. Have the patient lie flat for two hours after eating each meal

C Eating smaller meals during the day will decrease the gastric pressure and the symptoms of hiatal hernia. Keeping the patient NPO or in a Trendelenburg position are not safe or realistic for a long period of time for any patient. Tell the patient not to lie down for two to three hours after eating, wear tight clothing around the waist or bend over because those actions will increase the discomfort

Which term describes flexion of the ankle and toes toward the shin? A. Inversion B. Eversion C. Dorsiflexion D. Plantar flexion

C Flexion of the ankle and toes towards the shin is called dorsiflexion. Eversion refers to turning of the sole outward away from midline of body. Inversion means turning of the sole inward toward the midline of body. Plantar flexion means flexion of the ankle and toes toward the plantar surface of the foot

Which laboratory finding may be associated with metastic bone cancer in the left leg? A. Calcium 7.5 mg/dL B. Sodium 130 mEq/L C. Calcium 11.0 mg/dL D. Potassium 6.5 mEq/L

C High serum calcium levels are seen with metastatic bone cancer as a result of calcium being released from damaged bones. A patient with metastatic bone cancer may present with a calcium level of 11.0 mg/dL, which is higher than normal (8.5 to 10.5 mg/dL). Calcium 7.5 mg/dL is a low serum calcium level. Although a sodium level of 130 mEq/L and a potassium level of 6.5 mEq/L are not normal (sodium 135 to 145 mEq/L; potassium 3.5 to 5.5 mEq/L), neither sodium nor potassium levels are affected by metastatic bone cancer.

Which term describes repetitive physical activity that results in osteoarthritis? A. Trauma B. Joint instability C. Mechanical stress D. Neurologic disorder

C Mechanical stress occurs due to repetitive physical activities, such as sports, and can result in osteoarthritis. Pain and loss of reflexes may be a result of a neurologic disorder. Dislocations, fractures that lead to avascular necrosis, or uneven stress on cartilage are examples of trauma; these do not result in osteoarthritis. Damage to supporting structures can result in joint instability

A patient with a cast for a fracture radius reports, "My fingers feel numb." Which is a priority nursing action? A. Elevating the arm on two pillows B. Notifying the health care provider C. Performing a neurovascular assessment D. Encouraging the patient to exercise the fingers

C Numbess distal to a casted extremity is an indication of decreased circulation, nerve compression and possibly compartment syndrome. The nurse should perform a full neurovascular assessment to determine the extent of the problem. After the assessment, the arm may be elevated on two pillows while the HCP is notified. The nurse should encourage movement of the fingers, but this action is not the priority

Which finding supports the nurse's conclusion that a patient has oral candidiasis? A. Formation of an abscess B. Development of pustules C. Curdlike lesions on mucosa D. Erythroplakia

C Oral candidiasis is an inflammation of the mouth caused by Candida albicans. It is characterized by pearly, bluish-white "milk-curd" membranous lesions on the mucosa of the mouth and larynx.

The nurse will encourage which nonpharmacologic treatment for a patient with osteomalacia? A. Wear a corest B. Use a firm mattress C. Increase exposure to sunlight D. Start a high-impact program

C Osteomalacia is caused by vitamin D deficiency, which can be helped by exposure to sunlight and ultraviolet rays. In Paget's disease, the patient may be required to wear a corset or light brace to relieve back pain and provide support when in an upright position. Along with the corset, a firm mattress should be used to provide back support and relieve pain. The patient with osteomalacia should be discouraged from high-impact aerobics and activities such as running, lifting, and twisting because they put too much stress on the bones.

Which finding is the most common indication of esophageal cancer? A. Weight loss B. Regurgitation C. Progressive dysphagia D. Epigastric pain during swallowing

C Progressive dysphagia is the most common symptom of esophageal cancer and may be described as a substernal feeling, as if food were not passing. Initially, the dysphagia occurs only with meat, then with soft foods, and eventually with liquids. Weight loss, regurgitation, and epigastric pain during swallowing are also symptoms of esophageal cancer, but they occur later and are not the most common symtpoms

Which condition does the nurse suspect if a patient experiences a severe injury to the ligament around the humerus bone? a. Strain b. Sprain c. Dislocation d. Subluxation

C Severe injury of the ligamentous structures surrounding the humerus is a dislocation. A strain is an excessive stretching of the muscle, its fascial sheath, or a tendon. A sprain generally represents an injury to the ligamentous structures surrounding a joint. Subluxation is a partial displacement of the joint surface.

Which nursing intervention is the priority for a patient hospitalized with osteomyelitis who has a prescription for bed rest with bathroom privileges, with the affected foot elevated on two pillows? A. Ambulate the patient to the bathroom every two hours B. Ask the patient about preferred activities to relieve boredom C. Perform frequent position changes and range-of-motion (ROM) exercises D. Allow the patient to dangle legs at the bedside every two to four hours

C The patient is at risk for atelectasis of the lungs and for contractures because of prescribed bed rest. For this reason, the nurse should place the priority on changing the patient's position frequently to promote lung expansion and performing ROM exercises to prevent contractures. Assisting the patient to the bathroom will keep the patient safe because the patient is in pain, but it may not be needed every two hours. Providing activities to relieve boredom will assist the patient to cope with the bed rest but is not the priority intervention. Dangling the legs every two to four hours may be too painful.

Which statement by the student nurse indicates understanding of the cause of severe pain associated with a tumor on the left leg? A. "This is a side effect of radiation therapy" B. "The pain medication must not be working" C. "The tumor may be pressing on nerves near the bone" D. "If one does not get enough exercise, the leg will stiffen up"

C When the tumor presses on nerves or other organs, it causes severe pain. The question does not discuss any medications or doses that would be given for pain. Radiation therapy actually is used to help to decrease the pain. Exercising will actually help to decrease the pain as well.

A nurse has just received a report from the emergency department on a patient admitted with a closed head injury after falling down a flight of stairs. The nurse is reviewing the patient's lab results: sodium level of 128 mEq/L, serum osmolality of 271 mOsm/kg, and a urine specific gravity of 1.030. This data is indicative of which condition? A. Diabetes insipidus B. Cushing syndrome C. Primary hyperparathyroidism D. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

D

Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone? A. Antidiuretic hormone (ADH) B. Follicle-stimulating hormone (FSH) C. Thyroid-stimulating hormone (TSH) D. Adrenocorticotropic horomone (ACTH)

D

Which characteristic is seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)? A. Polyuria B. Serum hyperosomlality C. Dilutional hypernatremia D. Fluid retention

D

Which complication would the nurse anticipate for an older adult patient taking nonsteroidal anti-inflammatory drugs (NSAIDs)? A. Achalasia B. Duodenal ulcer C. Stomach cancer D. Silent peptic ulcer

D

Which course of action would be taken if a patient has developed Cushing syndrome due to the prolonged administration of corticosteroid hormonal therapy? A. Withholding therapy for a few days B. Conversion to an alternate-week regimen C. Abrupt discontinuance of corticosteroids D. Gradual discontinuance of corticosteroids

D

Which disorder is characterized by fat pads on the back of the neck, an increased abdominal girth, a "buffalo hump", and a "moon" face? A. Acromegaly B. Conn's disease C. Graves' disease D. Cushing syndrome

D

Which intervention would be done immediately if a patient with adrenocortical insufficiency develops Addisonian crisis? A. Administer fludrocortisone daily B. Advise an increased intake of salt C. Decrease the glucocorticoid dosage D. Administer large volumes of saline and dextrose

D

Which activity pattern will the nurse suggest for a patient with osteoarthritis (OA)? A. Bed rest with bathroom privileges B. Daily high-impact aerobic exercise C. Frequent rest periods with minimal exercise D. Regular exercise program that involves walking

D A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with OA. A balance of rest and activity is needed. The patient should not be instructed to maintain bed rest. High impact aerobic exercises would cause stress to affected joints and further damage. The patient should rest frequently while maintaining a regular exercise program.

A patient with a fracture of the femur has the extremity in skeletal traction and is encouraged to use an overhead trapeze apparatus. Which is the primary purpose of the overhead trapeze? A. To assist with leg exercises B. To enhance breathing and lung expansion C. To promote circulation throughout the body D. To facilitate independent movement while the patient is in bed

D An overhead trapeze will facilitate independent movement in bed. It also maintains range of motion for the upper extremities and strengthens the biceps. assisting with leg exercise, enhancing breathing and lung expansion and promoting circulation throughout the body are secondary benefits

The nurse is assessing a patient who has a traumatic leg injury. Which intervention is the most important in the initial assessment? A. Assess the patient's pain level B. Realign the extremity into the appropriate position C. Check for full or partial loss of feeling and sensation D. Determine the extremity's color and temperature in the area of the injury

D Baseline assessments are very important. It is most important to assess the extremity's color and temperature in the area of the injury to determine any venous or arterial insufficiency. If arterial or venous blood flow in the are is blocked, the area could become ischemic and die. Assessing temperature is crucial to determine circulation and perfusion to the extremity, and any change in temp in the extremity should be reported promptly to the health care provider. Assessing the pt's pain is importnat but not as crucial as determining any arterial insufficiency. Realigning the injury can lead to further damage or cause vascular insufficiency. Loss of snesation may be a late sign of neurovascular damage

Which gastrointestinal secretion is essential for cobalamin absorption in the ileum? A. Maltase B. Enterokinase C. Hydrochloric acid D. Intrinsic factor

D Intrinsic factor is essential for cobalamin absorption in ileum. Maltase helps convert maltose to two glucose molecules. Hydrochloric acid helps in the conversion of pepsinogen to pepsin. Enterokinase helps to convert trypsinogen to trypsin

Which interdisciplinary team member can help to increase patient independence with assistive devices that simplify tasks for a patient with rheumatoid arthritis (RA)? A. Physical therapist B. Health care provider C. Social services worker D. Occupational therapist

D Occupational therapy is utilized to increase the patient's independence by simplifying tasks such as the use of assistive devices and modifying eating utensils. Physical therapy is used to improve mobility, strength, and flexibility. A social services worker assists patients in accessing services and education related to their health condition. The health care provider oversees the patient's medical condition. While this patient may require the services of a social services worker, physical therapist, and health care provider, the task of promoting independence with assistive devices falls in the occupational therapist's scope.

The nurse will document a score of 2/5 on the Muscle Strength Scale based on which assessment findings? A. A barely detectable flicker with palpation B. Active movement against gravity and some resistance C. Active movement against gravity but not against resistance D. Active movement of the body part with elimination of gravity

D The nurse assigns a score of 2 if the patient has active movement of the body part against gravity. If the patient has a barely detectable flicker or trace of muscle contraction upon palpation, the nurse will assign a score of 1. The nurse will assign a score of 4 if the patient shows active movements of the body part against gravity and some resistance

The nurse provides postoperative care following a patient's total hip replacement surgery that was done using posterior approach. Which nursing action indicates an effective intervention? A. Allow the patient to sit on chairs without arms B. Allow the patient to cross legs at the knees or ankles C. Allow the patient to perform daily activities, for example, putting on shoes and socks D. Allow the patient to use a pillow between the legs for the first six weeks after surgery

D The nurse should allow the patient to use a pillow between the legs for the first six weeks after surgery. It should be used when lying on the nonoperative side or when in a supine position to maintain the joint in abduction and prevent dislocation of the new joint. Sitting on chairs without arms will lead to a sudden flexing of the body more than 90 degrees, resulting in destabilization of the prosthesis. Crossing of the legs at the knees or ankles affects healing of the soft tissue of the hip joint, leading to predisposition of the joint. Performing daily activities such as putting on shoes and socks that require flexing the body more than 90 degrees will lead to damage of the soft tissue. Therefore, it should be avoided until at least six weeks after the surgery.

The nurse is providing discharge education for a patient with a fiberglass cast and includes which information? A. It must not get wet B. Remove padding if it is too bulky under the cast C. It will need to be replaced every one to two weeks D. For itching, direct a hair dryer on a cool setting under the cast

D The nurse should tell the pt to use a hair dryer on cool setting for itching inside the cast. A fiberglass cast is relatively waterproof. The pt should not remove padding under the cast. A fiberglass cast may remain on the pt for the duration of the treatment and does not require replacement

The patient who is being admitted with severe abdominal pain vomits a large amount of emesis that looks like coffee grounds. Which action would the nurse take first? A. Ask the patient about the timing of the last meal B. Complete the documentation of the admission assessment C. Monitor the patient for any further episodes of nausea and vomiting D. Check vital signs and notify the health care provider about the patient's condition

D Vomitus with a "coffee ground" appearance is related to gastric bleeding in which blood changes to dark brown as a result of its interaction with hydrochloric acid.

The nurse reviews the treatment plan for a patient with compartment syndrome and questions which items that are listed on the plan? Select all that apply. A. Removing the bandage B. Bivalving of the cast C. Reducing traction weight D. Apply cold compresses E. Elevating the limb above heart level

D, E Elevating the extremity may lower venous pressure and slow arterial perfusion. Therefore, the extremity should not be elevated about heart level in case of compartment syndrome. Similarly, apply cold compresses may result in vasoconstriction and exacerbate compartment syndrome. It may also be necessary to remove or loosen the bandage and split the cast in half (bivalving). Reducing traction weight may also decrease external circumferential pressures

Which interventions will the nurse include to prepare a patient for a CT scan of the knee joint? Select all that apply. A. Ensure that the knee is shaved completely B. Administer local anesthesia and obtain a blood sample C. Inform the patient that procedure typically causes sharp pain D. Inform the patient of the importance of remaining still during the proceudre E. If a contrast medium is being used, verify that patient does not have shellfish allergy

D, E While preparing for CT scan, the nurse should inform the pt that it is important to remain still during the proceudre. If a contrast medium is being used, verify that the patient does not have a shellfish allergy. A CT scan is not expected to be painful, although the pt may have a feeling of warmth and flushing with the contrast medium injection.