MOCK EXAM

744. A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement? 1. A fall and further injury 2. Injury to the brachial plexus nerves 3. Skin breakdown in the area of the axilla 4. Impaired range of motion while the client ambulates

2. Injury to the brachial plexus nerves *nerve injury from resting weight on the crutches when they are too high under the arms

762. The nurse is administering an intravenous dose of methocarbamol to a client with a muscle skeletal injury. For which adverse effect should the nurse monitor? 1. Tachycardia 2. Rapid pulse 3. Bradycardia 4. Hypertension

3. Bradycardia *Intravenous administration of methocarbamol can cause hypotension and bradycardia.

757. Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions on administration of the medication. Which instruction should the nurse provide? 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4. Take the medication with a full glass of water after rising in the morning. *recautions need to be taken with the administration of alendronate to prevent gastrointestinal adverse effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

_____ is important for RA!

ROM

The day after having a right-below-the-knee amputation, a patient complains of pain in the right foot. which action in best for the nurse to take? a. explain the reasons for the phantom pain. b. administer prescribed analgesics to relieve the pain. c. loosen the compression bandage to decrease incisional pressure. d. inform the patient that this phantom pain will diminish over time.

b. administer prescribed analgesics to relieve the pain. *phantom pain is treated like any other postop pain.

The HCP has ordered the following interventions for a patient who is taking azathioprine for systemic lupus/ Which order will the nurse question? a. draw anti-dna blood titer b. administer varicella vaccine c. naproxen 200 mg d. famotidine 20 mg daily

b. administer varicella vaccine *live virus vaccines are contraindicated in a patient taking immunosuppressive medication!

Which information will the nurse include when preparing teaching materials for patients with exacerbations of rheumatoid arthritis? a. affected joints should not be exercised when pain is present. b. application of cold packs before exercise may decrease joint pain. c. exercises should be performed passively by someone other than the patient. d. walking may substitute ROM exercises on some days.

b. application of cold packs before exercise may decrease joint pain. *cold application is helpful in reducing pain during period of exacerbation of RA. joint pain will be chronic! so patients are instructed to exercise even when their joints hurt. ROM exercises are intended to strengthen joints and improve flexibility, so passive ROM is not sufficient by itself. recreational exercise such as walk should not replace ROM but used in conjuction.

A patient with gout has a new prescription of losartan (Cozaar) to control the condition. The nurse will plan to monitor: a. blood glucose b. blood pressure c. erythrocyte count (RBC) d. lymphocyte count (WBC)

b. blood pressure *losartan is a cardiac medication

Which statement by a 62-year-old patient who has had an above the knee amputation indicates that the nurses discharge teaching has been effective? a. i should elevate my residual limb on a pillow 2 or 3 times a day. b. i should lay flat on my abdomen for 30 mins 3 or 4 times a day. c. i should change the limb sock when it becomes soiled or each week. d. i should use lotion on the stump to prevent my skin from drying and cracking.

b. i should lay flat on my abdomen for 30 mins 3 or 4 times a day. *elevating the limb can cause flexion contracture. limb sock should be changed daily. lotion should not be used on the stump.

After the nurse has taught a 28-year-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management? a. i am going to join a soccer team to get more exercise. b. i will need to stop drinking so much coffee soda. c. i will call the doctor every time my symptoms get worse. d. i should avoid using over-the-counter medication for pain.

b. i will need to stop drinking so much coffee and soda. *caffeine and sugar are muscle irritants, vigorous exercise can worsen this condition; mild okay. symptom management: acetaminophen and ibuprofen.

A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is most appropriate? a. teach the patient about the adverse effects of the RA medications. b. suggest that the patient use over-the-counter artificial tears. c. reassure the patient that dry eyes are a common problem with RA. d. ask the health care provider about discontinuing methotrexate (Rheumatrex).

b. suggest that the patient use over-the-counter artificial tears. *dry eyes are a common extraarticular manifestation of RA.

Which assessment finding about a patient who has been using naproxen (naprosyn) for 6 weeks to treat OA is most important for the nurse to report to the HCP? a. the patient has gained 3 lbs. b. the patient has dark-colored stools. c. the patient's pain has become more severe. d. the patient is using capsaicin cream (zostrix).

b. the patient has dark-colored stools. *dark stools indicate gi bleeding caused by naproxen. weight gain and pain are concerns as well, however the biggest concern is apart of the ABCs as a circulation issue. capaicin can be used with oral medications.

which assessment information obtained by the nurse indicates that a patient with an exacerbation of RA is experiencing a side effect of prednisone? a. the patient has joint pain and stiffness. b. the patient's blood glucose is 165 c. the patient has experienced a recent 5 lb weight loss d. the patients ESR has increased

b. the patient's blood glucose is 165 *corticosteroids have the potential to cause diabetes. they increase bs, appetite for weight gain. ESR should go down instead of up if prednisone is effective.

A patient who has fibromyalgia tells the nurse, I feel depressed because I ache too much to play golf. The patient says the patin is usually at a level 7 (0 to 10 scale). Which patient goal has the highest priority when the nurse is developing the treatment plan? a. the patient will exhibit fewer signs of depression. b. the patient will say that the aching has decreased. c. the patient will state that the pain is at a level 2 out of 10. d. the patient will be able to play 1 to 2 rounds of golf.

d. the patient will be able to play 1 to 2 rounds of golf. *a nursing goal should be measurable, so we should look for an answer with numerical values! this eliminates 'a' and 'b'. 'c' can be eliminated because the question does not mention what the patient's desired pain goal is.

Heberden's nodes

fingers

diuretic use increases uric acid levels and can trigger

gout attacks

rheumatoid pain

improves with rest

what is gout

like renal calculi but in the joint; big toe

stiffness decreases with joint movement

osteoarthritis

arthritis

painful inflammation stiffness

joint redness

rheumatoid

A 67-year-old patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse chooses a nursing diagnosis of ineffective health maintenance when the nurse finds that the patient: a. is frustrated with the length of treatment required. b. takes and records the oral temp twice a day. c. is unable to plantar flex the foot on the affected side. d. uses crutches to avoid weight bearing on the affected leg.

c. is unable to plantar flex the foot on the affected side. *foot drop indicates that the foot is not being supported in neutral position.

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate (Rheumatrex). The patient tells the nurse, my arthritis is no that bad yet. The side effects of methotrexate are worse than the arthritis. The most appropriate response by the nurse is: a. you have the right to refuse to take the methotrexate. b. methotrexate is less expensive than some of the newer drugs. c. it is important to start methotrexate early to decrease the extent of joint damage. d. methotrexate is effective and has fewer side effects than some of the other drugs.

c. it is important to start methotrexate early to decrease the extent of joint damage. *DMARDs are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. though 'd' addresses the patient's statement, the most important thing for the nurse to communicate to the patient is that treatment should begin as soon as possible.

Which information obtained during the nurse's assessment of a 30-year-old patient's nutritional-metabolic pattern may indicate risk for musculoskeletal problems? a. patient takes a multivitamin daily. b. patient dislikes fruit and veg. c. patient is 5ft 2in and 180 lbs. d. patient prefers whole milk to nonfat milk.

c. patient is 5ft 2in and 180 lbs. *obesity; excessive weight puts stress on weight bearing joints!

A nurse who works on the orthopedic unit has just received the change-of-shift report. Which patient should the nurse assess first? a. patient who reports foot pain after hammertoe surgery. b. patient with low back pain and a positive straight-leg-raise test. c. patient who has not voided 10 hours after having a laminectomy. d. patient with osteomyelitis who has a temp of 100.5.

c. patient who has not voided 10 hours after having a laminectomy. *difficulty voiding indicates damage to the spinal nerves and should be further assessed and reported immediately!

Anakinra (Kineret) is prescribed for a 49-year-old patient who has RA. When teaching the patient about this drug, the nurse will include information about a. avoiding concurrently taking aspirirn. b. symptoms of GI bleeding. c. self-administration of subQ injections. d. taking the medication with at least 8 oz of water.

c. self-administration of subQ injections. *this medication is subQ. gi bleeding does not correlate with this med. the route is injected so there is not need for fluid. no issues with this med and NSAIDs/aspirin.

drug calculation (evaluate)

calculate the calculation!

The nurse teaching a support group of women with RA about how to manage activities of daily living suggests that they: a. stand rather than sit when performing household and yard chores. b. strengthen small hand muscles by wringing sponges or washcloths. c. protect the knee joints by sleeping with a small pillow under the knees. d. avoid activities that require repetitive use of the same muscles and joints.

d. avoid activities that require repetitive use of the same muscles and joints. *patients are advised to avoid repetitious movements. they should sit during household chores to decrease stress on joints. wringing can increase joint stress. RA patients should not flex joints for prolonged intervals of time, instead, legs and arms should be extended.

The nurse who notes that a 59-year-old female patient has lost 1 inch in height over the past 2 years will plan to teach the patient about: a. discography studies. b. myelographic testing. c. MRI d. dual-energy x-ray absorptiometry (DXA) musculoskeletal assessment (understanding or application)

d. dual-energy x-ray absortiometry *decreased height and the patient's age suggest that the patient may have osteoporosis and that bone density testing is needed.

After the nurse assesses a 78-year-old who uses naproxen daily for hand and knee OA management, which information is most important to report to the HCP? a. knee crepitation is noted with normal knee ROM b. patient reports embarrassment about having heberden's nodes c. patient's knee pain while golfing has increased over the past year d. lab BUN is elevated.

d. lab BUN is elevated. *renal toxicity! caused by NSAIDs

A 25-year-old female patient with lupus who has a facial rash and alopecia tells the nurse, I never leave my house because I hate the way I look. An appropriate nursing diagnosis for the patient is: a. activity intolerance related to fatigue and inactivity. b. impaired social interaction related to lack of social skills. c. impaired skin integrity related to itching and skin sloughing. d. social isolation related to embarrassment about the effects of lupus.

d. social isolation related to embarrassment about the effects of lupus.

the home health nurse is doing a follow-up visit to a 41-year-old patient with recently diagnosed RA. which assessment made by the nurse indicates that more patient teaching is needed? a. patient takes a 2 hr nap each day. b. patient has been taking 16 aspirins daily c. patient sits on a stool while preparing meals d. the patient sleeps with two pillows under the head

d. the patient sleeps with two pillows under the head * joints should remain in extended position to prevent contractures

The nurse determines that colchicine has been effective for the patient with an acute attack of gout upon finding: a. relief of joint pain b. increased urine output c. elevated serum uric acid d. increased WBC count gout (application)

a. relief of joint pain *colchicine is used for pain relief in 24-48 hrs by decreasing inflammation. increased urination has little to do with effectiveness of this medication. there should be a decrease in uric acid levels. there should be decrease in WBC.

During the assessment of a patient with fibromyalgia, the nurse would expect the patient to report which of the following? SATA a. sleep disturbances b. multiple tender points c. cardiac palpitations and dizziness d. multijoint pain with inflammation and swelling e. widespread bilateral, burning musculoskeletal pain fibromyalgia (evaluate)

a. sleep disturbances b. multiple tender points e. widespread bilateral, burning musculoskeletal pain

Which assessment findings are not typical of open fracture repair of the right radius bone and need to be reported to the HCP!? SATA a. serous wound drainage. b. right arm muscle spasms. c. right arm pain with movement. d. temp of 101.4. e. tachycardia, erythema and pain in the affected area. f. MRI confirmation as long as the patient does not have pacemaker. g. intervention: the nurse should anticipate long-term IV antibiotic therapy.

d. temp of 101.4. e. tachycardia, erythema and pain in the affected area. f. MRI confirmation as long as the patient does not have pacemaker. g. intervention: the nurse should anticipate long-term IV antibiotic therapy.

watch out for words like...

initial, onset, acute, mild, moderate, severe, advanced. look for these words before looking at answer choices.

stiffness worsens after rest

osteoarthritis

748. A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which complication is the client at most risk for after surgery? 1. Hemorrhage 2. Edema of the residual limb 3. Slight redness of the incision 4. Separation of the wound edges

4. Separation of the wound edges *diabetes increases the risk of wound infection. IMMEDIATELY postop, a patient is at risk for hemorrhage, edema. slight redness is normal as long as the incision is dry and intact.

743. A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? 1. "I need to avoid getting the cast wet." 2. "I need to cover the casted leg with warm blankets." 3. "I need to use my fingertips to lift and move my leg." 4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

1. "I need to avoid getting the cast wet." *a plaster cast must remain dry to keep its strength. handled with palms not fingertips until dry to avoid indentations. cool setting hairdryer relieves itch.

745. The nurse has given the client instructions about crutch safety. Which statements indicate that the client understands the instructions? Select all that apply. 1. "I should not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 3. "I can use crutch tips even when they are wet." 4. "I need to have spare crutches and tips available." 5. "When I'm using the crutches, my arms need to be completely straight."

1. "I should not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 4. "I need to have spare crutches and tips available." *only use tailored crutches

In which order will the nurse implement these collaborative interventions prescribed for a patient being admitted who has acute osteomyelitis with a temp of 101.2? a. obtain blood cultures. b. send to radiology for computed tomography (CT) scan of the right leg. c. administer gentamicin 60 mg IV. d. administer acetaminophen now and every 4 hrs PRN for fever. osteomyelitis (analysis)

1. (a) obtain blood cultures from two sites. 2. (c) administer gentamicin 60 mg IV. 3. (d) administer acetaminophen now and every 4 hrs PRN for fever. 4. (b) send to radiology for computed tomography (CT) scan of the right leg. * the highest priority for possible osteomyelitis is initiation of antibiotic therapy! but as nurses we always obtain specimen cultures before beginning antibiotic treatment. then the next priority is to address the fever. then the ct scan can stage and help determine the extent of infection is the lowest priority.

746. The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? 1. Clear mentation 2. Minimal dyspnea 3. Oxygen saturation of 85% 4. Arterial oxygen level of 78 mm Hg

1. Clear mentation *LOC changes indicate fat emboli

761. In monitoring a client's response to disease-modifying anti-rheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply. 1. Control of symptoms during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show no progression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after the injection is given 6. A low-grade temperature on rising in the morning that remains throughout the day

1. Control of symptoms during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show no progression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy *Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow the progression of joint degeneration. In addition, an improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding.

755. Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction should the nurse provide? 1. Drink 3000 mL of fluid a day. 2. Take the medication on an empty stomach. 3. The effect of the medication will occur immediately. 4. Any swelling of the lips is a normal expected response.

1. Drink 3000 mL of fluid a day *Clients taking allopurinol are encouraged to drink 3000 mL of fluid a day, unless otherwise contraindicated. A full therapeutic effect may take 1 week or longer. Allopurinol is to be given with, or immediately after, meals or milk. A client who develops a rash, irritation of the eyes, or swelling of the lips or mouth should contact the primary health care provider because this may indicate hypersensitivity.

736. The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? 1. "I can resume regular exercise tomorrow." 2. "I can't eat food for the remainder of the day." 3. "I need to stay off the leg entirely for the rest of the day." 4. "I need to report a fever or swelling to my health care provider."

4. "I need to report a fever or swelling to my health care provider."

The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this problem? 1. A 25-year-old woman who runs 2. A 36-year-old man who has asthma 3. A 70-year-old man who consumes excess alcohol 4. A sedentary 65-year-old woman who smokes cigarettes

4. A sedentary 65-year-old woman who smokes cigarettes *risk factors for osteoporosis include, female, postmenopause, low calcium diet, excessive alcohol, sedentary, tobacco use, long term corticosteroids, anticonvulsants.

The nurse suggests that a patient recently diagnosed with rheumatoid arthritis plan to start each day with: a. a warm bath followed by short rest b. a short routine of isometric exercises c. active ROM exercises d. stretching exercises to relieve joint stiffness

a. a warm bath followed by short rest *taking a warm shower or bath is recommended to relieve joint stiffness (which is worse in the morning). isometric exercises would stress the joints. stretching and ROM is done later in the day when joint stiffness is decreased.

Which finding will the nurse expect when assessing a 58-year-old client who has osteoarthritis (OA) of the knee? a. discomfort with joint movement. b. heberdens and bouchards nodes. c. redness and swelling of the knee joint. d. stiffness that increases with movement. osteoarthritis (evaluation)

a. discomfort with joint movement. *INITIAL symptoms of OA is pain caused by joint movement. heberdens nodules occur on the fingers.

for most patients who do not have bone infection, they need to be encouraged to... a. exercise

a. exercise so that they can strengthen their bones and muscles and stay as functional in their ADLs for as long as possible.

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will be included in the initial plan of care? a. immobilization of the left leg b. positioning the left leg in flexion c. assisted weight-bearing ambulation d. quadriceps-setting exercise repetitions

a. immobilization of the left leg *decreases pain and reduces the risk for pathological fractures; weight bearing exercises increases the risk for pathological fractures. flexion can cause contractures.

Which nursing action is correct when performing the straight-leg raising test for an ambulatory patient with back pain? a. raise the patient's legs to a 60-degree angle from the bed. b. place the patient initially in the prone position on the exam table. c. have the patient dangle both legs over the edge of the exam table. d. instruct the patient to elevate the legs and tense the abdominal muscles.

a. raise the patient's legs to a 60-degree angle from the bed.

Which result for a 30-year-old patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep

b. Elevated blood urea nitrogen (BUN) *elevated BUN and creatinine indicates possible lupus nephritis and a need to change in therapy to avoid further renal damage.

Which patient seen by the nurse at the outpatient clinic is most likely to require teaching about ways to reduce risk for OA? a. 38-year-old man who plays on a summer softball team b. 56-year-old man who is a member of a construction crew c. 56-year-old woman who works on an automotive assembly line d. 49-year-old woman who is newly diagnosed with diabetes

c. 56-year-old woman who works on an automotive assembly line *estrogen and repetitive motions. moderate exercise reduces risk for OA. diabetes is not an OA risk factor.

A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review? a. Rheumatoid factor (RF) b. Antinuclear antibody (ANA) c. Anti-Smith antibody (Anti-Sm) d. Lupus erythematosus (LE) cell prep

c. Anti-Smith antibody (Anti-Sm)

The nurse will anticipate the need to teach a 57-year-old patient who has osteoarthritis (OA) about which medication? a. Adalimumab (Humira) b. Prednisone (Deltasone) c. Capsaicin cream (Zostrix) d. Sulfasalazine (Azulfidine)

c. Capsaicin cream (Zostrix) *capsaicin cream blocks the transmission of pain impulses and is. helpful in treating OA. the other answer choices correlate with RA

The client arrives at the emergency department complaining of back spasms. The client states, "I have been taking 2 to 3 aspirin every 4 hours for the last week, and it hasn't helped my back." Since acetylsalicylic acid intoxication is suspected, the nurse should assess the client for which manifestation? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Photosensitivity

1. Tinnitus * Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. Hyperventilation may occur, because salicylate stimulates the respiratory center. Fever may result, because salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production

738. Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. 4. Expect tingling and numbness in the extremity. 5. Use a hair dryer set on a warm to hot setting to dry the cast. 6. Use a soft, padded object that will fit under the cast to scratch the skin under the cast.

1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. *plaster cast takes 24-72hrs to dry. elevate to reduce edema if prescribed. heat on the cast can cause burns to the skin. don't stick anything in the cast! skin integrity. monitor for numbness, coolness, diminished pulse, pain, swelling, circulatory impairment.

751. The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding? 1. Temperature of 101.6° F (38.7° C) orally 2. Complaints of discomfort during repositioning 3. Old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep-breathing exercises

1. Temperature of 101.6° F (38.7° C) orally

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? 1. "Alcohol is not contraindicated while taking this medication." 2. "Good oral hygiene is needed, including brushing and flossing." 3. "The medication dose may be self-adjusted, depending on side effects." 4. "The morning dose of the medication should be taken before a serum medication level is drawn."

2. "Good oral hygiene is needed, including brushing and flossing." * Typical antiseizure medication instructions include taking the prescribed daily dosage to keep the blood level of the medication constant and having a sample drawn for serum medication level determination before taking the morning dose. The client is taught not to stop the medication abruptly, to avoid alcohol, to check with a primary health care provider before taking over-the-counter medications, to avoid activities in which alertness and coordination are required until medication effects are known, to provide good oral hygiene, and to obtain regular dental care. The client should also wear a MedicAlert bracelet. Focus on the subject, an understanding of medication instructions for phenytoin. Using knowledge of general principles related to medication administration will assist you in eliminating options 1 and 3. From the remaining options, recall that medications generally are not taken just before determining therapeutic serum levels, because the results would be artificially high. This leaves oral hygiene as the correct option because of the risk of gingival hyperplasia.

756. Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder? 1. Myxedema 2. Kidney disease 3. Hypothyroidism 4. Diabetes mellitus

2. Kidney disease *Colchicine is used with caution in older clients, debilitated clients, and clients with cardiac, kidney, or gastrointestinal disease.

The nurse is caring for a client with chronic back pain. Codeine has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication? 1. Monitor radial pulse. 2. Monitor bowel activity. 3. Monitor apical heart rate. 4. Monitor peripheral pulses.

2. Monitor bowel activity. * While the client is taking codeine, the nurse would monitor vital signs and assess for hypotension. The nurse also should increase fluid intake, palpate the bladder for urinary retention, auscultate bowel sounds, and monitor the pattern of daily bowel activity and stool consistency, because the medication causes constipation. The nurse should monitor respiratory status and initiate deep breathing and coughing exercises. In addition, the nurse monitors the effectiveness of the pain medication.

747. The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome? 1. Cold, bluish-colored fingers 2. Numbness and tingling in the fingers 3. Pain that increases when the arm is dependent 4. Pain that is out of proportion to the severity of the fracture

2. Numbness and tingling in the fingers *numbness and tingling in the fingers is the earliest symptom of compartment syndrome. other later symptoms: pain unrelieved by opioids, and increases with limb elevation, pallor, coolness

754. A client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept, which is most important for the nurse to assess? 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. Whether the client is experiencing a metallic taste in the mouth and a loss of appetite

2. The white blood cell counts and platelet counts *pancytopenia

752. The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 1. Calcium level of 9.0 mg/dL (2.25 mmol/L) 2. Uric acid level of 9.0 mg/dL (540 mcmol/L) 3. Potassium level of 4.1 mEq/L (4.1 mmol/L) 4. Phosphorus level of 3.1 mg/dL (1.0 mmol/L)

2. Uric acid level of 9.0 mg/dL (540 mcmol/L) *the presence of uric acid in an aspirated sample of synovial fluid confirms the diagnosis.

750. A client is complaining of low back pain that radiates down the left posterior thigh. The nurse should ask the client if the pain is worsened or aggravated by which factor? 1. Bed rest 2. Ibuprofen 3. Bending or lifting 4. Application of heat

3. Bending or lifting *low back pain that radiates down one leg indicates disk herniation. assess to see what aggravates the pain

741. A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The recent occurrence of the fracture

3. Impaired tissue perfusion *most fracture pains are managed with rest, elevation, cold, analgesics. if not alleviated by these measures, report (neurovascular compromise)!

740. The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. Coolness and pallor of the extremity

3. Presence of a "hot spot" on the cast *infection under a cast is evidenced by odor, pus, and hot spots

749. The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take? 1. Apply ice to the site. 2. Call the primary health care provider (PHCP). 3. Rewrap the residual limb with an elastic compression bandage. 4. Apply a dry, sterile dressing and elevate the residual limb on 1 pillow.

3. Rewrap the residual limb with an elastic compression bandage. *replace bandage immediately with a fresh dressing to avoid excessive edema which could delay rehabilitation.

A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL (140 mcmol/L). Which finding would be expected as a result of this laboratory result? 1. Hypotension 2. Tachycardia 3. Slurred speech 4. No abnormal finding

3. Slurred speech *At a level higher than 30 mcg/mL (120 mcmol/L), ataxia and slurred speech occur.

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? 1. Pregnancy must be avoided while taking phenytoin. 2. The client may stop the medication if it is causing severe gastrointestinal effects. 3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4. There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin. *phenytoin increases estrogen metabolism. a client should not be instruction to stop anti seizure medication.

739. The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding? 1. Redness around the pin sites 2. Pain on palpation at the pin sites 3. Thick, yellow drainage from the pin sites 4. Clear, watery drainage from the pin sites

3. Thick, yellow drainage from the pin sites *infection

742. The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg? 1. Elevated for 3 hours, then flat for 1 hour 2. Flat for 3 hours, then elevated for 1 hour 3. Flat for 12 hours, then elevated for 12 hours 4. Elevated on pillows continuously for 24 to 48 hours

4. Elevated on pillows continuously for 24 to 48 hours *a casted extremity is elevated continuously for the first 24-48 hrs to minimize swelling and promote venous drainage.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements parkinsons 1 (application)

4. Impaired voluntary movements *Dyskinesia and impaired voluntary movements may occur with high dosages. nausea, anorexia, dizziness, and orthostatic hypotension, bradycardia, and akinesia are side effects of the medication

753. A client with a hip fracture asks the nurse about Buck's (extension) traction that is being applied before surgery and what is involved. The nurse should provide which information to the client? 1. Allows bony healing to begin before surgery and involves pins and screws 2. Provides rigid immobilization of the fracture site and involves pulleys and wheels 3. Lengthens the fractured leg to prevent severing of blood vessels and involves pins and screws 4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels *Buck's (extension) traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps immobilize the fracture. Traction does not allow for bony healing to begin or provide rigid immobilization. Traction does not lengthen the leg for the purpose of preventing blood vessel severance. This type of traction involves pulleys and wheels, not pins and screws.

737. The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention should the nurse take? 1. Try to reduce the fracture manually. 2. Assist the victim to get up and walk to the sidewalk. 3. Leave the victim for a few moments to call an ambulance. 4. Stay with the victim and encourage him or her to remain still.

4. Stay with the victim and encourage him or her to remain still. *immobilization unless there is danger in remaining where they are. stay with the victim and have someone else get help.

The nurse is caring for a client who begins to experience seizure activity while in bed. Which actions should the nurse take? Select all that apply. a. Loosening restrictive clothing. 2. Restraining the client's limbs. c. Removing the pillow and raising padded side rails. d. Positioning the client to the side, if possible, with the head flexed forward. e. Keeping the curtain around the client and the room door open so when help arrives they can quickly enter to assist. seizure 1 (application)

a. Loosening restrictive clothing. c. Removing the pillow and raising padded side rails. d. Positioning the client to the side, if possible, with the head flexed forward. *Nursing actions during a seizure include providing for privacy, loosening restrictive clothing, removing the pillow and raising padded side rails in the bed, and placing the client on 1 side with the head flexed forward, if possible, to allow the tongue to fall forward and facilitate drainage. The limbs are never restrained because the strong muscle contractions could cause the client harm. If the client is not in bed when seizure activity begins, the nurse lowers the client to the floor, if possible; protects the head from injury; and moves furniture that may injure the client.

After the nurse has finished teaching a 68-year-old patient with osteoarthritis of the right hip about how to manage the OA, which patient statement indicates a need for more teaching? a. I can take glucosamine to help decrease my knee pain. b. I will take a gram of acetaminophen every 4 hours. c. I will take a shower in the morning to help relieve stiffness. d. I can use a cane to decrease the pressure and pain in my hip.

b. I will take a gram of acetaminophen every 4 hours. *patient is trying to take way too much acetaminophen (which is hepatotoxic!). the glucosamine is good for the OA knee pain. the moist heat from the shower can help with morning stiffness in OA. the use of a cane is recommended to decrease pressure and pain in the hip.

Which statement by a patient with lupus indicates that the patient has understood the nurses teaching about the condition? a. I will exercise when I am tired. b. I will use sunscreen when I am outside. c. I should take birth control pills to keep from getting pregnant d. I should avoid aspirin or NSAIDs

b. I will use sunscreen when I am outside. *severe skin reactions can occur in patients with lupus who are exposed to the sun. teach balancing exercise with rest periods as needed. oral contraceptives can worsen lupus. NSAIDs are used to treat musculoskeletal problems commonly associated with SLE.

Which cerebrospinal fluid analysis result will be most important for the nurse to communicate to the health care provider? a. Specific gravity 1.007 b. Protein 65 mg/dL (0.65 g/L) c. Glucose 45 mg/dL (1.7 mmol/L) d. White blood cell (WBC) count 4 cells/mL neuro assessment (understanding or application)

b. Protein 65 mg/dL (0.65 g/L)

A 50-year-old patient is being discharged after a week of IV antibiotic therapy for acute osteomyelitis in the right leg. which information will be included in the discharge teaching? a. how to apply warm packs to the leg to reduce pain. b. how to monitor and care for the long-term IV catheter. c. the need for daily aerobic exercise to help maintain muscle strength. d. the reason for taking oral antibiotics for 7 to 10 days after discharge.

b. how to monitor and care for the long-term IV catheter. *acute osteomyelitis is treated with IV antibiotics rather than PO for several months. educate the patient to recognize the signs of infection such as a fever usually over 101, tachycardia, erythema and pain in the affected area. teach the patient how to care for the catheter during baths. surgery is last resort. avoid exercise and heat to prevent pathological fractures and infection spread.

Which action will the nurse include in the plan of care for a 33-year-old patient with a new diagnosis of rheumatoid arthritis? a. instruct the patient to purchase a soft mattress. b. suggest that the patient take a nap in the afternoon. c. teach the patient to use lukewarm water when bathing. d. suggest exercise with light weights several times a day.

b. suggest that the patient take a nap in the afternoon. *adequate rest (7 hrs a day) helps decrease fatigue and pain that are associated with RA. teach patient to avoid stressing joints, take warm water baths for stiffness, sleep on a firm mattress. when the disease process stabilizes, a therapeutic exercise program is developed by the physical therapist for flexibility, strength and the patient's overall endurance.

The nurse notices a circular lesion with a red border and clear center on the arm of an 18-year-old summer camp counselor who is in the clinic complaining of chill and muscle aches. What action should the nurse take next? a. palpate the abdomen. b. auscultate heart sounds. c. ask the patient about recent outdoor activity. d. question the patient about immunization history. lyme's disease 1 (application)

c. ask the patient about recent outdoor activity. *the lesion can be suspected to be lyme's disease (bullseye rash). find out if the patient has hiked recently or something where he would come into contact with bugs like deerticks!

A patient with rheumatoid arthritis being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? a. draw blood for rheumatoid factor analysis. b. teach the patient about injections for nodules. c. assess the nodules for skin breakdown or infection. d. discuss the need for surgical removal of the nodules.

c. assess the nodules for skin breakdown or infection. *rheumatoid nodules can break down or become infected. rheumatoid nodules are usually not surgically removed due to high probability of recurrence.

Which information will the nurse include when teaching a patient with acute low back pain? SATA a. sleep in a prone position with the legs extended. b. keep the knees straight when leaning forward to pick up something. c. avoid activities that require twisting if the back or prolonged sitting. d. symptoms of acute low back pain frequently improve in a few weeks. e. Ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) can be used to relieve pain. back pain 1 (application)

c. avoid activities that require twisting if the back or prolonged sitting. d. symptoms of acute low back pain frequently improve in a few weeks. e. Ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) can be used to relieve pain. *acute back pain usually starts to improve within 2 weeks. NSAIDs can help manage pain. teach the patient to avoid sleeping prone and keeping their legs extended as this can put strain on the back.

Which lab value will the nurse monitor to determine whether prednisone (Deltasone) has been effective for a 30-year-old patient with an acute exacerbation of RA? a. blood glucose test b. liver function test c. c-reactive protein level d. serum electrolyte levels

c. c-reactive protein level *c-reactive protein is a lab value relating to inflammation, the nurse would want to see a decrease in these levels; this will indicate effectiveness of the prednisone therapy.

after completing the health history, the nurse assessing the musculoskeletal system will begin by: a. having the patient move the extremities against resistance. b. feeling for the presence of crepitus during joint movement. c. observing the patient's boy build and muscle configuration. d. checking active and passive ROM for the extremities

c. observing the patient's boy build and muscle configuration. *inspection

which medication information will the nurse identify as a concern for a patients musculoskeletal status? a. patient takes a multivitamin and calcium supplement. b. patient takes hormone therapy to prevent hot flashes. c. patient has severe asthma and requires frequent therapy with oral corticosteroids. d. patient has migraine headaches treated with NSAIDs.

c. patient has severe asthma and requires frequent therapy with oral corticosteroids. *chronic corticosteroid use can lead to skeletal problems. HT can prevent osteoporosis.

After the HCP has recommended amputation for a patient who has a nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die that have an amputation. Which response by the nurse is best? a. you are upset, but you may lose the foot anyway. b. many people are able to function with foot prosthesis. c. tell me about when you know about your options for treatment. d. if you do not want an amputation, you do not have to have one.

c. tell me about when you know about your options for treatment. *first thing you do, is assess the patient's knowlege! otherwise how do you know what to say to him??

A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient's home routine indicates a need for teaching regarding gout management? a. the patient sleeps about 8 to 10 hours a night. b. the patient usually eats beef once or twice a week. c. the patient takes one aspirin a day to prevent angina. d. the patient usually drinks about 3 quarts of water daily.

c. the patient takes one aspirin a day to prevent angina. *aspirin interferes with the effectiveness of probenecid.

The nurse is planning care for a patient with hypertension and gout who has a red and painful great toe. Which nursing action will be included in the plan of care? a. gently palpate the toe to assess swelling. b. use pillows to keep the right foot elevated. c. use a footboard to hold bedding away from toe. d. teach the patient to avoid use of acetaminophen.

c. use a footboard to hold bedding away from toe. *any touch in the area of inflammation can increase the patient's pain, for this reason, bedding should be held away from the toe. pain is caused by urate crystals, so elevation does not help