Practice Exam 3 - NUR 141

The office nurse is reviewing the record of a client with a new diagnosis of osteoarthritis of the knees. Which facts from the client's history does the nurse note as risk factors for osteoarthritis? Select all that apply. A. Age of 64. B. History of long-term employment as a home health aide. C. BMI of 24. D. Family history of osteoarthritis. E. Sedentary lifestyle.

A. Age of 64. B. History of long-term employment as a home health aide. D. Family history of osteoarthritis. E. Sedentary lifestyle. Rationale: The development of osteoarthritis is common in those with a family history of the disease and those with repetitive joint strain (lifting patients alone in a home). Increases with age and in those with a sedentary lifestyle. Obesity can be a factor.

Which factors contribute to the development of osteoporosis in female clients? Select all that apply. A. Cigarette smoking. B. Moderate exercise. C. Use of street drugs. D. Familial predisposition. E. Inadequate intake of dietary calcium. F. Family history of anorexia nervosa.

A. Cigarette smoking. D. Familial predisposition. E. Inadequate intake of dietary calcium. F. History of anorexia nervosa. Rationale: Cigarette smoking is a high-risk behavior associated with an increased incidence of osteoporosis in later life. Familial predisposition is considered a risk factor for the development of osteoporosis. Inadequate calcium intake during the premenopausal years is a risk factor for the development of osteoporosis after menopause. Thin women with small frames are at higher risk.

Which factors can trigger a client's migraine attacks? Select all that apply. A. Fatigue B. Vertigo C. Aphasia D. Sleep problems E. Tingling sensations F. Hormonal fluctuations G. Specific foods like chocolate or cheese

A. Fatigue D. Sleep problems F. Hormonal fluctuations G. Specific foods like chocolate or cheese Rationale: Triggers for migraines are individual. Common triggers include - fatigue, stress, sleep deprivation, hormonal fluctuations, and diet. Common dietary triggers include - chocolate, cheeses (especially those high in tyramine), wine, yeast, fruits, nuts, tomatoes, olives, and vinegar.

Which educational topic is a high priority for the nurse providing education to a client with systemic lupus erythematous? A. Instructing about ways to protect the skin. B. Helping the client identify coping strategies. C. Teaching methods to monitor body temperature. D. Teaching about the effects of the disease on lifestyle.

A. Instructing about ways to protect the skin. Rationale: A client with systemic lupus erythematous is first taught to protect the skin to prevent infections.

Which manifestations are seen in an older adult with the diagnosis of dementia? Select all that apply. A. Resistance to change. B. Inability to recognize familiar objects. C. Preoccupation with personal appearance. D. Inability to concentrate on new activities. E. Tendency to dwell on the past.

A. Resistance to change. B. Inability to recognize familiar objects. D. Inability to concentrate on new activities. E. Tendency to dwell on the past. Rationale: Resistance to change is a clinical finding associated with dementia; these clients need structure & routines. An inability to recognize familiar objects (agnosia) is a typical cognitive dysfunction associated with dementia. A short attention span and little or no interest in new activities are typical of dementia. The past is where these clients feel comfortable.

In distinguishing between dementia and delirium, which factors are unique to delirium? Select all that apply. A. Slurred speech B. Lability of mood C. Long-term memory loss D. Visual or tactile hallucinations E. Insidious deterioration of cognition F. A fluctuating level of consciousness

A. Slurred speech D. Visual or tactile hallucinations F. A fluctuating level of consciousness Rationale: Delirium, a transient cognitive disorder caused by global dysfunction in cerebral metabolism, results in sparse or rapid speech that may be slurred, and visual or tactile hallucinations and illusions may occur with delirium because of altered cerebral function. Clients may fluctuate from hyper alert to difficult to arouse; they may lose orientation to time and place. Delirium is often accompanied by irritability and anxiety. Onset is abrupt (hours to days) and has an organic basis.

Which signs and symptoms are characteristic of Alzheimer's dementia? Select all that apply. A. Ambivalence B. Forgetfulness C. Flight of ideas D. Loose associations E. Expressive aphasia

B. Forgetfulness E. Expressive aphasia Rationale: Older clients who have dementia often have short-term memory loss. Clients in whom dementia is developing often have difficulty expressing themselves (expressive aphasia) or understanding the spoken word (receptive aphasia).

An older client's colonoscopy reveals the presence of extensive diverticulosis. Which type of diet would the nurse encourage the client to follow? A. Low-fat B. High-fiber C. High-protein D. Low-carbohydrate

B. High-fiber Rationale: A high-fiber diet is recommended for diverticulosis. Fiber promotes the passage of residue through the intestine, thereby preventing constipation. Constipation causes straining at stool; this increases intraluminal pressure, which can precipitate diverticulitis of diverticula.

The nurse reviews the medical records of a client who is eligible to receive hospice care. Which are the criteria for a client to receive this type of care? Select all that apply. A. When the client is nearing death. B. When the expected death of the client is within 6 months. C. When the client seeks no aggressive disease management. D. When a family member has signed an informed consent form. E. When the client refuses treatment for all disease processes.

B. When the expected death of the client is within 6 months. C. When the client seeks no aggressive disease management. Rationale: Clients who do not seek aggressive disease management and are expected to die in a span of 6 months are eligible for hospice care.

A client is concerned about developing ovarian cancer and reports information about her personal history. Which of the following client characteristics places her at high risk of ovarian cancer? A. Age 29 years. B. Began menstruation at 12 years of age. C. BRCA 1 positive. D. 22 years of age at birth of her first child.

C. BRCA 1 positive. Rationale: Familial cancer syndromes linked to BRCA 1 and BRCA 2 mutations present a high risk for ovarian, breast, and other reproductive cancers. Other risk factors include middle to older age, infertility, nulliparity, difficulty getting pregnant, or older age with the birth of first child.

Morphine has been prescribed for a client with frequent pain in a hospice home care program. Which information will the nurse provide regarding this pain management regimen? A. Medication addiction is a concern with this medication. B. Request the medication before the pain becomes severe. C. Dosages of the medication will be given automatically at regular intervals around the clock. D. Intermittent administration of the medication is possible after an intermittent lock is inserted.

C. Dosages of the medication will be given automatically at regular intervals around the clock. Rationale: This medication will be given routinely to maintain a continuous therapeutic blood level to keep the terminally ill client comfortable.

The nurse is caring for a client with chronic inflammation of the bowel. For which most serious complication would the nurse monitor in this client? A. Ileus B. Pain C. Perforation D. Obstruction

C. Perforation Rationale: Because of chronic inflammation, the colon becomes thin and may perforate, causing peritonitis. Perforation will lead to a life-threatening sepsis.

A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen? A. "I will closely follow a high-purine diet." B. "I will limit my fluid intake to 2L/day." C. I will stop my NSAID because I have been prescribed allopurinol." D. "I should avoid alcohol."

D. "I will avoid alcohol." Rationale: Alcohol can increase uric acid levels and exacerbate gout. Dietary purines should be limited, and fluid intake must be increased to prevent uric acid stones. Allopurinol is often given in combination with NSAIDs such as colchicine.

The nurse is assessing two clients. One client has ulcerative colitis, and the other client has Chron's disease. Which diagnostic finding is more likely to be identified in the client with ulcerative colitis than in the client with Chron's disease? A. Inclusion of transmural involvement of the small bowel wall. B. Higher occurrence of fistulas and abscesses from changes in the bowel wall. C. Pathology beginning proximally with intermittent plaques found along the colon. D. Involvement starting distally with rectal bleeding that spreads continuously up the colon.

D. Involvement starting distally with rectal bleeding that spreads continuously up the colon. Rationale: Ulcerative colitis involvement starts distally with rectal bleeding that spreads continuously up the colon to the cecum. In ulcerative colitis, pathology usually is in the descending colon; in Chron's disease, it is primarily in the terminal ileum, cecum, and ascending colon. Ulcerative colitis, as the name implies, affects the colon, not the small intestine. Intermittent areas of pathology occur in Chron's disease. In Ulcerative colitis, the pathology is in the inner layer and does not extend throughout the entire bowel wall; therefore, abscesses and fistulas are rare. Occur more frequently in Chron's disease.