test 4 med surg

A nurse is preparing a client who is to receive hyaluronic acid (Synvisc) injection for osteoarthritis. Which of the following statements by the nurse is appropriate?

"Hyaluronic acid is made from the combs of chickens."

A client is complaining of dull flank pain. List the order of the steps the nurse should take in conducting the physical assessment for this client. 1. Instruct the client. 2. Assess the general appearance. 3. Position the client. 4. Inspect the abdomen for color, contour, symmetry, and distention

1, 3, 2, 4 Explanation: A quick survey of the client enables the nurse to identify any immediate problem as well as the client's ability to participate in the assessment. Begin the examination with the client in a supine position with the abdomen exposed from the nipple line to the pubis. Assess general appearance and inspect the client's skin for color, hydration status, scales, masses, indentations, or scars.

The nurse is caring for the following clients. After receiving the shift report, which client should the nurse assess first? 1. The client with a total knee replacement who is complaining of a cold foot. 2. The client diagnosed with osteoarthritis who is complaining of stiff joints. 3. The client who needs to receive a scheduled intravenous antibiotic. 4. The client diagnosed with back pain who is scheduled for a lumbar myelogram.

1. A cold foot in a client who has had surgery may indicate a neurovascular compromise and must be assessed first. A client with osteoarthritis is expected to have stiff joints. A routine medication is not priority over a potential complication of surgery. A routine diagnostic procedure does not have priority over a potential complication of surgery. TEST-TAKING HINT: The test taker must take a systematic approach when answering prioritizing questions. First, the test taker must determine if any client is experiencing a life-threatening or life-altering complication such as loss of a limb. The test taker must determine if the sign/symptom is expected for the disease or condition.

1. A nurse in a provider's office is obtaining a history from a client who is being evaluated for benign prostatic hyperplasia (BPH). Which of the following findings are indicative of this condition? (Select all that apply.) A. Backache B. Frequent urinary tract infections C. Weight loss D. Hematuria E. Urinary incontinence

1. A. INCORRECT: Backache occurs in the presence of prostate cancer that has spread to other areas of the body. B. CORRECT: In the presence of BPH, pressure on urinary structures leads to urinary stasis, which in turn promotes the occurrence of urinary tract infections. C. INCORRECT: Weight loss occurs in the presence of prostate cancer. D. CORRECT: Painless hematuria occurs in the presence of BPH. E. CORRECT: Overflow incontinence occurs in the presence of BPH due to an increased volume of residual urine. NCLEX® Connection: Physiological Adaptations, Pathophysiology

1. A nurse is completing the admission assessment of a client who has a kidney stone. Which of the following is an expected finding? A. Bradycardia B. Diaphoresis C. Nocturia D. Bradypnea

1. A. INCORRECT: Tachycardia is a clinical manifestation associated with a client who has a kidney stone. B. CORRECT: Diaphoresis is a clinical manifestation associated with a client who has a kidney stone. C. INCORRECT: Oliguria is a clinical manifestation associated with a client who has a kidney stone. D. INCORRECT: Tachypnea is a clinical manifestation associated with a client who has a kidney stone. NCLEX® Connection: Physiological Adaptations, Pathophysiology

The client asks, "What does an elevated PSA test mean?" On which scientific rationale should the nurse base the response? 1. An elevated PSA can result from several different causes. 2. An elevated PSA can be only from prostate cancer. 3. An elevated PSA can be diagnostic for testicular cancer. 4. An elevated PSA is the only test used to diagnose BPH.

1. An elevated PSA can be from urinary retention, BPH, prostate cancer, or prostate infarct. An elevated PSA does not indicate only prostate cancer. PSA does not diagnose testicular cancer. An elevated PSA and digital examination are used in combination to diagnose BPH or prostate cancer. TEST-TAKING HINT: Answer options "2" and "4" have the word "only"; an absolute word should cause the test taker to eliminate them as possible answers. Options with words such as "always," "never," and "only" are usually incorrect.

Which statement indicates the client diagnosed with calcium phosphate renal calculi understands the discharge teaching for ways to prevent future calculi formation? 1. "I should increase my fluid intake, especially in warm weather." 2. "I should eat foods containing cocoa and chocolate." 3. "I will walk about a mile every week and not exercise often." 4. "I should take one (1) vitamin a day with extra calcium."

1. An increased fluid intake ensuring 2 to 3 L of urine a day prevents the stone-forming salts from becoming concentrated enough to precipitate. Cocoa and chocolate are high in calcium and should be avoided or the amount should be decreased to help prevent formation of calcium phosphate renal stones. Physical activity prevents bone absorption and possible hypercalciuria; therefore, the nurse should instruct the client to walk daily to help retain calcium in bone. The renal calculi are caused by calcium; therefore, the client should not increase calcium intake. TEST-TAKING HINT: This is a urinary problem and fluid is priority. Therefore, the test taker should select an option addressing fluid, and there is only one option addressing oral intake.

The nurse writes the problem of "pain" for a client diagnosed with lumbar strain. Which nursing interventions should be included in the plan of care? Select all that apply. 1. Assess pain on a 1-to-10 scale. 2. Administer pain medication prn. 3. Provide a regular bedpan for elimination. 4. Assess surgical dressing every four (4) hours. 5. Perform a position change by the log roll method every two (2) hours

1. An objective method of quantifying the client's pain should be used. 2. Once the nurse has determined the client is stable and not experiencing complications, the nurse can medicate the client. A regular bedpan is high and could cause pain for a client diagnosed with back pain. The client should be given a fracture pan. There is no surgical dressing. The client has not been to surgery, so log rolling is not necessary. TEST-TAKING HINT: Two of the options, "4" and "5," apply to postsurgical cases and could be eliminated.

Which interventions should be included in the discharge teaching for a client who had a total hip replacement? Select all that apply. 1. Discuss the client's weight-bearing limits. 2. Request the client demonstrate use of assistive devices. 3. Explain the importance of increasing activity gradually. 4. Instruct the client not to take medication prior to ambulating. 5. Tell the client to ambulate with open-toed house shoes.

1. Clients need to understand the amount of weight bearing to prevent injury. 2. Teaching the safe use of assistive devices is necessary prior to discharge. 3. Increases in activity should occur slowly to prevent complications. Using medication therapy, including analgesics, anti-inflammatory agents, or muscle relaxants, should be taught so the client is comfortable while ambulating. The client should ambulate with well-fitted, supported, closed-toed shoes such as a tennis shoe or walking shoe. TEST-TAKING HINT: The test taker should apply basic concepts to all surgeries. Many times the test taker may not be familiar with the specific surgery, but by using discharge teaching applicable to all clients, a choice can be made.

The charge nurse is making assignments. Which client should be assigned to the new graduate nurse? 1. The client diagnosed with aseptic meningitis who is complaining of a headache and the light bothering his eyes. 2. The client diagnosed with Parkinson's disease who fell during the night and is complaining of difficulty walking. 3. The client diagnosed with a cerebrovascular accident whose vitals signs are P 60, R 14, and BP 198/68. 4. The client diagnosed with a brain tumor who has a new complaint of seeing spots before the eyes.

1. Headache and photophobia are expected clinical manifestations of meningitis. The new graduate could care for this client. This client has had an unusual occurrence (fall) and now has a potential complication (a fracture). The experienced nurse should take care of this client. These vital signs indicate increased intracranial pressure. The more experienced nurse should care for this client. This could indicate a worsening of the tumor. This client is at risk for seizures and herniation of the brainstem. The more experienced nurse should care for this client. TEST TAKING HINT: The test taker should determine if the clinical manifestations are expected as part of the disease process. If they are, a new graduate can care for the client; if they are not expected occurrences, a more experienced nurse should care for the client.

The occupational health nurse is teaching a class on the risk factors for developing osteoarthritis (OA). Which is a modifiable risk factor for developing OA? 1. Being overweight. 2. Increasing age. 3. Previous joint damage. 4. Genetic susceptibility.

1. Obesity is a well-recognized risk factor for the development of OA and it is modifiable because the client can lose weight. Increasing age is a risk factor, but there is nothing the client can do about getting older, except to die. Previous joint damage is a risk factor, but it is not modifiable, which means the client cannot do anything to change it. Genetic susceptibility is a result of family genes, which the client cannot change; it is a nonmodifiable risk factor. TEST-TAKING HINT: The adjective "modifiable" is the key to selecting the correct answer. Only option "1" contains anything the client has control over changing or modifying.

The 34-year-old male client presents to the outpatient clinic complaining of numbness and pain radiating down the left leg. Which further data should the nurse assess? 1. Posture and gait. 2. Bending and stooping. 3. Leg lifts and arm swing. 4. Waist twists and neck mobility.

1. Posture and gait will be affected if the client is experiencing sciatica (pain radiating down a leg resulting from pressure on the sciatic nerve). The client with pain and numbness is not able to bend or stoop and should not be asked to do so. Leg lifts will not give the nurse the needed information and could cause this client pain; also, the lower extremity, not the upper extremity, is being assessed. Waist twists will not assess the mobility of the lower extremity, and neck mobility is assessed if a cervical neck problem is suspected. TEST-TAKING HINT: Anatomical positioning and the function of spinal nerves rule out options "3" and "4."

The nurse is performing an admission assessment on a client diagnosed with GERD. Which signs and symptoms would indicate GERD? 1. Pyrosis, water brash, and flatulence. 2. Weight loss, dysarthria, and diarrhea. 3. Decreased abdominal fat, proteinuria, and constipation. 4. Midepigastric pain, positive H. pylori test, and melena.

1. Pyrosis is heartburn, water brash is the feeling of saliva secretion as a result of reflux, and flatulence is gas—all symptoms of GERD. Gastroesophageal reflux disease does not cause weight loss. There is no change in abdominal fat, no proteinuria (the result of a filtration problem in the kidney), and no alteration in bowel elimination for the client diagnosed with GERD. Midepigastric pain, a positive H. pylori test, and melena are associated with gastric ulcer disease. TEST-TAKING HINT: Frequently, incorrect answer options will contain the symptoms of a disease of the same organ system.

The nurse is discussing the importance of an exercise program for pain control to a client diagnosed with OA. Which intervention should the nurse include in the teaching? 1. Wear supportive tennis shoes with white socks when walking. 2. Carry a complex carbohydrate while exercising. 3. Alternate walking briskly and jogging when exercising. 4. Walk at least 30 minutes three (3) times a week.

1. Safety should always be discussed when teaching about exercises. Supportive shoes will prevent shin splints. Colored socks have dye and may cause athlete's foot, which is why white socks are recommended. Clients with diabetes mellitus should carry complex carbohydrates with them. Osteoarthritis occurs most often in weight-bearing joints. Exercise is encouraged, but jogging increases stress on these joints. For exercising to help pain control, the client must walk daily, not three (3) times a week. Walking at least 30 minutes three (3) times a week is appropriate for weight loss. TEST-TAKING HINT: The test taker can rule out option "3" as an answer because the stem says "pain control"; option "1" is correct for any exercise program

2. The nurse caring for a client diagnosed with GERD writes the client problem of "behavior modification." Which intervention should be included for this problem? 1. Teach the client to sleep with a foam wedge under the head. 2. Encourage the client to decrease the amount of smoking. 3. Instruct the client to take over-the-counter medication for relief of pain. 4. Discuss the need to attend Alcoholics Anonymous to quit drinking.

1. The client should elevate the head of the bed on blocks or use a foam wedge to use gravity to help keep the gastric acid in the stomach and prevent reflux into the esophagus. Behavior modification is changing one's behavior. The client should be encouraged to quit smoking altogether. Referral to support groups for smoking cessation should be made. The nurse should be careful when recommending OTC medications. This is not the most appropriate intervention for a client with GERD. The client should be instructed to discontinue using alcohol, but the stem does not indicate the client is an alcoholic. TEST-TAKING HINT: Clients are encouraged to quit, not decrease, smoking. Current research indicates smoking is damaging to many body systems, including the gastrointestinal system. The test taker should not assume anything not in the stem of a question.

Which intervention should the nurse include when preparing a teaching plan for the client with chronic prostatitis? 1. Sit in a warm sitz bath for 10 to 20 minutes several times daily. 2. Sit in the chair with the feet elevated for two (2) hours daily. 3. Drink at least 3,000 mL of oral fluids, especially tea and coffee, daily. 4. Stop broad-spectrum antibiotics as soon as the symptoms subside.

1. The client should sit in a warm sitz bath for 10 to 20 minutes several times each day to provide comfort and assist with healing. Clients should avoid sitting for extended periods because it increases the pressure. Oral fluids should be consumed to satisfy thirst but not to push fluids to dilute the medication levels in the bladder. Broad-spectrum antibiotics are administered for 10 to 14 days and should not be stopped until all medications are taken by the client. TEST-TAKING HINT: The test taker must know basic concepts when answering questions; this includes the need for the client to take all prescribed antibiotics. If the test taker is unsure of option "3," drinking plenty of tea and coffee should indicate this is an incorrect answer because these are high in caffeine.

The client diagnosed with renal calculi is scheduled for a 24-hour urine specimen collection. Which interventions should the nurse implement? Select all that apply. 1. Check for the ordered diet and medication modifications. 2. Instruct the client to urinate, and discard this urine when starting collection. 3. Collect all urine during 24 hours and place in appropriate specimen container. 4. Insert an indwelling catheter in client after having the client empty the bladder. 5. Instruct the UAP to notify the nurse when the client urinates.

1. The health-care provider may order certain foods and medications when obtaining a 24-hour urine collection to evaluate for calcium oxalate or uric acid. 2. When the collection begins, the client should completely empty the bladder and discard this urine. The test is started after the bladder is empty. 3. All urine for 24 hours should be saved and put in a container with preservative, refrigerated, or placed on ice as indicated. Not following specific instructions will result in an inaccurate test result. The urine is obtained in some type of urine collection device such as a bedpan, bedside commode, or commode hat. The client is not catheterized.The nurse can delegate placing the urine output in the proper container to the UAP; therefore, the UAP does not need to notify the nurse when the client urinates. TEST-TAKING HINT: This is an alternate-type question that has more than one correct answer. The test taker must be knowledgeable of specific laboratory tests.

The client is 12-hours post-lumbar laminectomy. Which nursing interventions should be implemented? 1. Assess ability to void and log roll the client every two (2) hours. 2. Medicate with IV steroids and keep the bed in a Trendelenburg position. 3. Place sandbags on each side of the head and give cathartic medications. 4. Administer IV anticoagulants and place on O2 at eight (8) L/min.

1. The lumbar nerves innervate the lower abdomen. The bladder is in the lower abdomen. The client will be required to lie flat, and this is a difficult position for many clients, especially males, to be in to void. Clients are log rolled every 2 hours. The client should be receiving IV pain medication, not steroids. A Trendelenburg position is head down. Sandbags keep the neck still, but the surgical area is in the lumbar region, so there is no reason the client cannot turn the head; also, cathartic medications are harsh laxatives. The client will be receiving subcutaneous anticoagulant medications to prevent deep vein thrombosis, but IV anticoagulant therapy is not warranted. Eight (8) L/min of oxygen is high-flow oxygen and is used for a client in respiratory distress who does not have carbon dioxide narcosis. TEST-TAKING HINT: The test taker must note the adjective "lumbar"; this can rule out option "3." Knowledge of medication classifications would rule out options "2" and "4.

The client returned from surgery after having a TURP and has a P 110, R 24, BP 90/40, and cool and clammy skin. Which interventions should the nurse implement? Select all that apply. 1. Assess the urine in the continuous irrigation drainage bag. 2. Decrease the irrigation fluid in the continuous irrigation catheter. 3. Lower the head of the bed while raising the foot of the bed. 4. Contact the surgeon to give an update on the client's condition. 5. Check the client's postoperative creatinine and BUN

1. The nurse should assess the drain postoperatively. 3. The head of the bed should be lowered and the foot should be elevated to shunt blood to the central circulating system. 4. The surgeon needs to be notified of the change in condition. The client is hemorrhaging, so the nurse should increase the irrigation fluid to clear the red urine, not decrease the rate. These laboratory values assess kidney function, not the circulatory system, so this is not an appropriate intervention. TEST-TAKING HINT: When the test taker reads vital signs with the blood pressure decreased and the pulse and respiratory rate elevated, the test taker should recognize the signs and symptoms of shock.

The nurse and the unlicensed assistive personnel (UAP) are caring for clients on a medical-surgical unit. Which task should not be assigned to the UAP? 1. Feed the 69-year-old client diagnosed with Parkinson's disease who is having difficulty swallowing. 2. Turn and position the 89-year-old client diagnosed with a pressure ulcer secondary to Parkinson's disease. 3. Assist the 54-year-old client diagnosed with Parkinson's disease with toilet-training activities. 4. Obtain vital signs on a 72-year-old client diagnosed with pneumonia secondary to Parkinson's disease.

1. The nurse should not delegate feeding a client who is at risk for complications during feeding. This requires judgment that the UAP is not expected to possess. Unlicensed assistive personnel can turn and position clients with pressure ulcers. The nurse should assist in this at least once during the shift to assess the wound area. The UAP can assist the client to the bathroom every two (2) hours and document the results of the attempt. The UAP can obtain the vital signs on a stable client. TEST TAKING HINT: When reading the answer options in a question in which the nurse is delegating to an unlicensed-assistive personnel, read the stem carefully. Is the question asking what to delegate or what not to delegate? Anything requiring professional judgment should not be delegated.

Which statement indicates discharge teaching has been effective for the client who is postoperative TURP? 1. "I will call the surgeon if I experience any difficulty urinating." 2. "I will take my Proscar daily, the same as before my surgery." 3. "I will continue restricting my oral fluid intake." 4. "I will take my pain medication routinely even if I do not hurt."

1. This indicates the teaching is effective. Clients do not need to take Proscar postoperatively. There is no reason to restrict the client's fluid intake. Pain medication should be taken as needed. TEST-TAKING HINT: If the test taker is not sure of the correct answer, selecting an option addressing notifying a health-care provider is usually an appropriate choice.

2. A nurse is caring for a client who has a left renal calculus and an indwelling urinary catheter. Which of the following assessment findings requires immediate intervention by the nurse? A. Flank pain that radiates to the lower abdomen B. Client report of nausea C. Absent urine output for 2 hr D. Client report of feeling sweaty

2. A. INCORRECT: Flank pain radiating to the lower abdomen is a finding associated with renal calculus, but there is another finding that requires immediate intervention by the nurse. B. INCORRECT: Client report of nausea is a finding associated with renal calculus, but there is another finding that requires immediate intervention by the nurse. C. CORRECT: When using the acute vs. chronic approach to care, no urine output for 2 hr requires immediate intervention by the nurse. This indicates kidney dysfunction, and the provider should be notified immediately. D. INCORRECT: Diaphoresis is a finding associated with renal calculus, but there is another finding that requires immediate intervention by the nurse. NCLEX® Connection: Physiological Adaptations, unexpected Response to Therapies

2. A nurse is caring for a client who has a new diagnosis of benign prostatic hyperplasia (BPH). The nurse should anticipate a prescription for which of the following medications? A. Oxybutynin (Ditropan) B. Diphenhydramine (Benadryl) C. Ipratropium (Atrovent) D. Tamsulosin (Flomax)

2. A. INCORRECT: Oxybutynin is an anticholinergic medication that is used to treat overactive bladder. Anticholinergic medications are contraindicated for a client who has BPH. Oxybutynin causes urinary retention. B. INCORRECT: Diphenhydramine is an antihistamine and is contraindicated for a client who has BPH. Diphenhydramine causes urinary retention. C. INCORRECT: Ipratropium is an anticholinergic used to treat asthma and other respiratory conditions. Anticholinergic medications are contraindicated for a client who has BPH. Ipratropium causes urinary retention. D. CORRECT: Tamsulosin is an alpha-adrenergic receptor antagonist that relaxes the bladder outlet and the prostate gland, which improves urinary flow. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration

The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? 1. Monitor the client's urinary output. 2. Assess the client's pain and rule out complications. 3. Increase the client's oral fluid intake. 4. Use a safety gait belt when ambulating the client.

2. Assessment is the first part of the nursing process and is priority. The renal colic pain can be so intense it can cause a vaso-vagal response, with resulting hypotension and syncope. The client's urinary output should be monitored, but it is not the first nursing intervention. Increased fluid increases urinary output, which will facilitate movement of the renal stone through the ureter and help decrease pain, but it is not the first intervention. Ambulation will help facilitate movement of the renal stone through the ureter and safety is important, but it is not the first intervention. TEST-TAKING HINT: Remember, if the question asks which intervention is first, all four (4) options may be appropriate for the client's diagnosis but only one has priority. Assessment is the first part of the nursing process and it is the first intervention a nurse should implement if the client is not in distress.

The nurse is caring for a client with a TURP. Which expected outcome indicates the client's condition is improving? 1. The client is using the maximum amount allowed by the PCA pump. 2. The client's bladder spasms are relieved by medication. 3. The client's scrotum is swollen and tender with movement. 4. The client has passed a large, hard, brown stool this morning.

2. Bladder spasms are common, but being relieved with medication indicates the condition is improving. Using the maximum amount of medication does not indicate the client is achieving pain management. Scrotal edema and tenderness do not indicate improvement. Clients are administered laxatives or stool softeners to prevent constipation, which could cause increased pressure. TEST-TAKING HINT: The stem asks which option indicates the client is improving. Needing maximum medication (option "1") and scrotal edema (option "3") do not indicate the client is getting better. A bowel movement has nothing to do with the prostate.

The nurse is administering 0730 medications to clients on a medical orthopedic unit. Which medication should be administered first? 1. The daily cardiac glycoside to a client diagnosed with back pain and heart failure. 2. The routine insulin to a client diagnosed with neck strain and type 1 diabetes. 3. The oral proton pump inhibitor to a client scheduled for a laminectomy this a.m. 4. The fourth dose of IV antibiotic for a client diagnosed with a surgical infection.

2. Clients with type 1 diabetes are insulin dependent. This medication should be administered before the client eats. This could be administered after breakfast if necessary. There is nothing in the action of the medication requiring before breakfast medication administration. This medication should be held until after surgery. The client has already received three (3) doses of IV antibiotic. This medication could be given after the insulin. TEST-TAKING HINT: The nurse must decide which medication has priority by determining the action of the medication, the route of administration, and the diagnosis of the client

The client is one (1) day postoperative TURP. Which task should the nurse delegate to the UAP? 1. Increase the irrigation fluid to clear clots from the tubing. 2. Elevate the scrotum on a towel roll for support. 3. Change the dressing on the first postoperative day. 4. Teach the client how to care for the continuous irrigation catheter.

2. Elevating the scrotum on a towel for support is a task that can be delegated to the UAP. This intervention requires analysis and should not be delegated. The surgeon changes the first dressing; therefore, this cannot be delegated. A TURP does not have a dressing. The nurse is responsible for teaching. TEST-TAKING HINT: Teaching, assessing, evaluating, and intervening for clients who are unstable cannot be delegated to an unlicensed assistive personnel (UAP).

The client diagnosed with Parkinson's disease (PD) is being admitted with a fever and patchy infiltrates in the lung fields on the chest x-ray. Which clinical manifestations of PD would explain these assessment data? 1. Masklike facies and shuffling gait. 2. Difficulty swallowing and immobility. 3. Pill rolling of fingers and flat affect. 4. Lack of arm swing and bradykinesia.

2. Difficulty swallowing places the client at risk for aspiration. Immobility predisposes the client to pneumonia. Both clinical manifestations place the client at risk for pulmonary complications. Masklike facies is responsible for lack of expression and is part of the motor manifestations of Parkinson's disease but is not related to the symptoms listed. Shuffling is also a motor deficit and does pose a risk for falling, but fever and patchy infiltrates on a chest x-ray do not result from a gait problem. They are manifestations of a pulmonary complication. Pill rolling of fingers and flat affect do not have an impact on the development of pulmonary complications. Arm swing and bradykinesia are motor deficits. TEST TAKING HINT: The nurse must recognize the clinical manifestations of a disease and the resulting bodily compromise. In this situation, fever and patchy infiltrates on a chest x-ray indicate a pulmonary complication. Options "1," "3," and "4" focus on motor problems and could be ruled out as too similar. Only option "2" includes dissimilar information.

Which statement made by the client indicates to the nurse the client may be experiencing GERD? 1. "My chest hurts when I walk up the stairs in my home." 2. "I take antacid tablets with me wherever I go." 3. "My spouse tells me I snore very loudly at night." 4. "I drink six (6) to seven (7) soft drinks every day."

2. Frequent use of antacids indicates an acid reflux problem. Pain in the chest when walking up stairs indicates angina. Snoring loudly could indicate sleep apnea but not GERD. Carbonated beverages increase stomach pressure. Six (6) to seven (7) soft drinks a day would not be tolerated by a client with GERD. TEST-TAKING HINT: The stem of the question indicates an acid problem. The drug classification of antacid, or "against acid," provides the test taker a hint as to the correct answer.

The nurse observes red urine and several large clots in the tubing of the normal saline continuous irrigation catheter for the client who is one (1) day postoperative TURP. Which intervention should the nurse implement? 1. Remove the indwelling catheter. 2. Titrate the NS irrigation to run faster. 3. Administer protamine sulfate IVP. 4. Administer vitamin K slowly.

2. Increasing the irrigation fluid will flush out the clots and blood. The indwelling catheter should not be removed because doing so may result in edema, which, in turn, may obstruct the urethra and not allow the client to urinate. Protamine is the reversal agent for heparin, an anticoagulant. Vitamin K is the reversal agent for the anticoagulant warfarin (Coumadin). TEST-TAKING HINT: The test taker should eliminate options "3" and "4" because both are medications and the problem is with continuous irrigation, which does not require medications.

1. The male client tells the nurse he has been experiencing "heartburn" at night that awakens him. Which assessment question should the nurse ask? 1. "How much weight have you gained recently?" 2. "What have you done to alleviate the heartburn?" 3. "Do you consume many milk and dairy products?" 4. "Have you been around anyone with a stomach virus?"

2. Most clients with GERD have been self-medicating with over-the-counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem. Clients with heartburn are frequently diagnosed as having GERD. GERD can occasionally cause weight loss but not weight gain. Milk and dairy products contain lactose, which are important if considering lactose intolerance but are not important for "heartburn." Heartburn is not a symptom of a viral illness. TEST-TAKING HINT: Clients will use common terms such as "heartburn" to describe symptoms. The nurse must be able to interpret or clarify the meaning of terms used with the client. Part of the assessment of a symptom requires determining what aggravates and alleviates the symptom.

The client is diagnosed with osteoarthritis. Which sign/symptom should the nurse expect the client to exhibit? 1. Severe bone deformity. 2. Joint stiffness. 3. Waddling gait. 4. Swan-neck fingers.

2. Pain, stiffness, and functional impairment are the primary clinical manifestations of OA. Stiffness of the joints is commonly experienced after resting but usually lasts less than 30 minutes and decreases with movement. Severe bone deformity is seen in clients diagnosed with rheumatoid arthritis. A waddling gait is usually seen in women in their third trimester of pregnancy or in older children with congenital hip dysplasia. Swan-neck fingers are seen in clients with rheumatoid arthritis. TEST-TAKING HINT: The test taker can have difficulty distinguishing clinical manifestations of two similar sounding diseases, osteoarthritis and rheumatoid arthritis. Both diseases involve the joints and cause pain and stiffness. Remember, rheumatoid arthritis can permanently disfigure the client, leading to "bone deformity" and "swan-neck fingers."

Which intervention is most important for the nurse to implement for the client diagnosed with rule-out renal calculi? 1. Assess the client's neurological status every two (2) hours. 2. Strain all urine and send any sediment to the laboratory. 3. Monitor the client's creatinine and BUN levels. 4. Take a 24-hour dietary recall during the client interview.

2. Passing a renal stone may negate the need for the client to have lithotripsy or a surgical procedure. Therefore, all urine must be strained, and a stone, if found, should be sent to the laboratory to determine what caused the stone. Assessment is important, but the neurological system is not priority for a client with a urinary problem. These are laboratory studies evaluating kidney function, but they are not pertinent when passing a renal stone. These values do not elevate until at least half the kidney function is lost. A dietary recall can be done to determine what types of foods the client is eating that may contribute to the stone formation, but it is not the most important intervention. TEST-TAKING HINT: Remember, if the question asks for "most important," more than one of the options could be appropriate but only one is most important. Assessment is priority if the client is not in distress, but the test taker should make sure it is appropriate for the situation.

Which clinical manifestations should the nurse expect to assess for the client diagnosed with a ureteral renal stone? 1. Dull, aching flank pain and microscopic hematuria. 2. Nausea; vomiting; pallor; and cool, clammy skin. 3. Gross hematuria and dull suprapubic pain with voiding. 4. The client will be asymptomatic.

2. The severe flank pain associated with a stone in the ureter often causes a sympathetic response with associated nausea; vomiting; pallor; and cool, clammy skin. Dull flank pain and microscopic hematuria are manifestations of a renal stone in the kidney. Gross hematuria and suprapubic pain when voiding are manifestations of a stone in the bladder. Kidney stones and bladder stones may produce no signs/symptoms, but a ureteral stone always causes pain on the affected side because a ureteral spasm occurs when the stone obstructs the ureter. TEST-TAKING HINT: Options "1" and "3" both have assessment data indicating bleeding. The test taker can usually eliminate these as possible answers or eliminate the other two options not addressing blood. Renal stones are painful; therefore, option "4" could be eliminated as a possible answer.

The client diagnosed with cervical disk degeneration has undergone a laminectomy. Which interventions should the nurse implement? 1. Position the client prone with the knees slightly elevated. 2. Assess the client for difficulty speaking or breathing. 3. Measure the drainage in the Jackson Pratt bulb every day. 4. Encourage the client to postpone the use of narcotic medications.

2. The surgical position of the wound places the client at risk for edema of tissues in the neck. Difficulty speaking or breathing should alert the nurse to a potentially life-threatening problem. "Prone" means on the abdomen. On the abdomen with the knees flexed is an uncomfortable position, placing the spine in an unnatural position. The drainage from a JP drain should be emptied and monitored every shift. The client should be kept as comfortable as possible. TEST-TAKING HINT: The nurse must know the meaning of the common medical term prone and realize this would be uncomfortable for the client, thus eliminating option "1." The time frame of "every day" makes option "3" wrong.

Which client goal is most appropriate for a client diagnosed with OA? 1. Perform passive range-of-motion exercises. 2. Maintain optimal functional ability. 3. Client will walk three (3) miles every day. 4. Client will join a health club.

2. The two main goals of treatment for OA are pain management and optimizing functional ability of the joints to ensure movement of the joints. This is an intervention, not a goal, and "passive" means the nurse performs the range of motion, which should not be encouraged. Most clients with OA are elderly, are overweight, and have a sedentary lifestyle, so walking three (3) miles every day is not a realistic or safe goal. Joining a health club is an intervention, and the fact the client joins the health club doesn't mean the client will exercise. TEST-TAKING HINT: The test taker must remember a goal is the measurable outcome of nursing interventions based on the client problem/diagnosis. Interventions are not goals; therefore, the test taker could eliminate options "1" and "4" as possible answers.

The occupational health nurse is preparing an in-service for a group of workers in a warehouse. Which information should be included to help prevent on-the-job injuries? 1. Increase sodium and potassium in the diet during the winter months. 2. Use the large thigh muscles when lifting and hold the weight near the body. 3. Use soft-cushioned chairs when performing desk duties. 4. Have the employee arrange for assistance with household chores.

2. These are instructions to prevent back injuries as a result of poor body mechanics. Increased calcium, not potassium or sodium, is helpful in preventing orthopedic injuries. Increasing sodium intake could prevent water loss in a non-air-conditioned warehouse in the summer months, not the winter months. Soft-cushioned chairs are not ergonomically designed. Soft-cushioned chairs promote poor body posture. This might help the client prevent back injuries at home, but it does not prevent job-related injuries. TEST-TAKING HINT: The question is asking for information which will prevent on-the-job back injuries. Option "4" can be ruled out because of this. The two (2) electrolytes in option "1" are not associated with orthopedic injuries or bones, thus ruling out this option.

The nurse is conducting a support group for clients diagnosed with Parkinson's disease and their significant others. Which information regarding psychosocial needs should be included in the discussion? 1. The client should discuss feelings about being placed on a ventilator. 2. The client may have rapid mood swings and become easily upset. 3. Pill-rolling tremors will become worse when the medication is wearing off. 4. The client may automatically start to repeat what another person says.

2. These are psychosocial manifestations of PD. These should be discussed in the support meeting. This is information that should be discussed when filling out an advance directive form. A ventilator is used to treat a physiological problem. The reduction in the unintentional pill-rolling movement of the hands is controlled at times by the medication; this is a physiological problem. Echolalia is a speech deficit in which the client automatically repeats the words or sentences of another person; this is a physiological problem. TEST TAKING HINT: Psychosocial problems should address the client's feelings or interactions with another person.

The HCP prescribes glucosamine and chondroitin for a client diagnosed with OA. What is the scientific rationale for prescribing this medication? 1. It will help decrease the inflammation in the joints. 2. It improves tissue function and retards breakdown of cartilage. 3. It is a potent medication which decreases the client's joint pain. 4. It increases the production of synovial fluid in the joint.

2. This is the rationale for administering these medications. NSAIDs or glucocorticoids help decrease inflammation of the joints. Narcotic and nonnarcotic analgesics help decrease the client's pain. There is no medication at this time to help increase synovial fluid production, but surgery can increase the viscosupplementation in the joint. TEST-TAKING HINT: There are some questions requiring the test taker to have the knowledge, and there are no test-taking hints to help with selecting the right answer.

The client admitted with a diagnosis of a fractured hip who is in Buck's traction is complaining of severe pain. Which intervention should the nurse implement? 1. Adjust the patient-controlled analgesia (PCA) machine for a lower dose. 2. Ensure the weights of the Buck's traction are off the floor and hang freely. 3. Raise the head of the bed to 45 degrees and the foot to 15 degrees. 4. Turn the client on the affected leg using pillows to support the other leg.

2. Weights from traction should be off the floor and hanging freely. Buck's traction is used to reduce muscle spasms preoperatively in clients who have fractured hips. The health-care provider orders the dosage on a PCA. Unless a range of dosages or a new order is obtained, a lower dose will not help pain. Raising the head of the bed or the foot will alter the traction. Turning the client to the affected side could increase pain rather than relieve it. TEST-TAKING HINT: This intervention is a form of assessment, assessing the equipment being used for the client's condition. Remember to apply the nursing process

An 88-year-old client is admitted to the orthopedic floor with the diagnosis of fractured pelvis. Which intervention should the nurse implement first? 1. Insert an indwelling catheter. 2. Administer a Fleet's enema. 3. Assess the abdomen for bowel sounds. 4. Apply Buck's traction.

3. Assessing the bowel sounds should be the first intervention to determine if an ileus has occurred. This is a common complication of a fractured pelvis. Inserting an indwelling catheter is a good intervention, but it is not the first intervention. A tear or injury to the bladder should be suspected. Administering a Fleet's enema should not be implemented until internal bleeding has been ruled out. Buck's traction is not used to treat a fractured pelvis. It is used to treat a fractured hip. TEST-TAKING HINT: When prioritizing two equal options, usually, assessing is the answer.

The client with a history of renal calculi calls the clinic and reports having burning on urination, chills, and an elevated temperature. Which instruction should the nurse discuss with the client? 1. Increase water intake for the next 24 hours. 2. Take two (2) Tylenol to help decrease the temperature. 3. Come to the clinic and provide a urinalysis specimen. 4. Use a sterile 4 × 4 gauze to strain the client's urine.

3. A urinalysis can assess for hematuria, the presence of white blood cells, crystal fragments, or all three, which can determine if the client has a urinary tract infection or possibly a renal stone, with accompanying signs/symptoms of UTI. The client needs to be evaluated for a possible urinary tract infection, which may accompany renal calculi. Therefore, the clinic nurse should not give advice without knowing what is wrong with the client. The nurse should not recommend any medication (even Tylenol) unless the nurse is absolutely sure what is wrong with the client. The client needs to strain the urine if there is a possibility of renal calculi, which these signs/symptoms do not support. Further diagnostic testing is needed to determine the presence of renal calculi. TEST-TAKING HINT: Fever, chills, and burning on urination require some type of assessment. Therefore, the test taker should select an option that helps determine what is wrong with the client and "3" is the only such option.

3. A nurse is reviewing discharge instructions with a client who had spontaneous passage of a calcium phosphate kidney stone. Which of the following should be included in the teaching? (Select all that apply.) A. Limit intake of food high in animal protein. B. Reduce sodium intake. C. Strain urine for 48 hr. D. Report burning with urination to the provider. E. Increase fluid intake to 3 L/day.

3. A. CORRECT: The client should limit the intake of food high in animal protein, which contains calcium phosphate. B. CORRECT: The client should limit intake of sodium, which affects the precipitation of calcium phosphate in the urine. C. INCORRECT: Straining urine is not indicated once the stone has passed. D. CORRECT: The client should report burning with urination to the provider because this can be an indication of infection. E. CORRECT: The client should increase fluid intake to 3 L/day. A decrease in fluid intake can cause dehydration, which increases the risk of stone formation. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures

3. A nurse is instructing a client who is scheduled for a transurethral resection of the prostate (TURP) about his postoperative care. Which of the following information should the nurse include in the teaching? A. "You may have a continuous sensation of needing to void even though you have a catheter." B. "You will be on bed rest for the first 2 days after the procedure." C. "You will be instructed to limit your fluid intake after the procedure." D. "Your urine should be clear yellow the evening after the surgery."

3. A. CORRECT: To reduce the risk of postoperative bleeding, the client will have a catheter with a large balloon that places pressure on the internal sphincter of the bladder. Pressure on the sphincter causes a continuous sensation of needing to void. B. INCORRECT: The client is ambulated early in the postoperative period to reduce the risk of deep-vein thrombosis and other complications that occur due to immobility. C. INCORRECT: The client is encouraged to increase his fluid intake unless contraindicated by another condition. A liberal fluid intake reduces the risks of urinary tract infection and dysuria. D. INCORRECT: The client's urine is expected to be pink the first 24 hr after surgery. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures

The nurse is admitting the client with OA to the medical floor. Which statement by the client indicates an alternative form of treatment for OA? 1. "I take medication every two (2) hours for my pain." 2. "I use a heating pad when I go to bed at night." 3. "I wear a copper bracelet to help with my OA." 4. "I always wear my ankle splints when I sleep."

3. Alternative forms of treatment have not been proved efficacious in the treatment of a disease. The nurse should be nonjudgmental and open to discussions about alternative treatment, unless it interferes with the medical regimen. Medication is a standard therapy and is not considered an alternative therapy. A heating pad is an accepted medical recommendation for the treatment of pain for clients with OA. Conservative treatment measures for OA include splints and braces to support inflamed joints. TEST-TAKING HINT: The test taker needs to read the stem carefully to be able to determine what the question is asking. There is only one option with alternative-type treatment, which is option "3"; options "1," "2," and "4" are accepted treatment options listed in a textbook.

Which disease is the client diagnosed with GERD at greater risk for developing? 1. Hiatal hernia. 2. Gastroenteritis. 3. Esophageal cancer. 4. Gastric cancer.

3. Barrett's esophagus results from long-term erosion of the esophagus as a result of reflux of stomach contents secondary to GERD. This is a precursor to esophageal cancer. A hiatal hernia places the client at risk for GERD; GERD does not predispose the client for developing a hiatal hernia. Gastroenteritis is an inflammation of the stomach and intestine, usually caused by a virus. The problems associated with GERD result from the reflux of acidic stomach contents into the esophagus, which is not a precursor to gastric cancer. TEST-TAKING HINT: The test taker may associate hiatal hernia with GERD. One can be a result of the other, and this can confuse the test taker. If the test taker did not have any idea of the correct answer, option "3" has the word "esophageal" in it, as does the stem of the question, and, therefore, the test taker should select this as the correct answer.

The nurse is caring for clients on a medical-surgical floor. Which clients should be assessed first? 1. The 65-year-old client diagnosed with seizures who is complaining of a headache that is a "2" on a 1-to-10 scale. 2. The 24-year-old client diagnosed with a T10 spinal cord injury who cannot move his toes. 3. The 58-year-old client diagnosed with Parkinson's disease who is crying and worried about her facial appearance. 4. The 62-year-old client diagnosed with a cerebrovascular accident who has a resolving left hemiparesis.

3. Body image is a concern for clients diagnosed with PD. This client is the one client who is not experiencing expected sequelae of the disease. A headache of "2" on a 1-to-10 scale is a mild headache. A spinal cord injury at T10 involves deficits at approximately the waist area. Inability to move the toes would be expected. This client is getting better; "resolving" indicates an improvement in the client's clinical manifestations. TEST TAKING HINT: At times a psychological problem can have priority. All the physical problems are expected and are not life threatening or life altering.

The client diagnosed with PD is being discharged on carbidopa/levodopa (Sinemet), an antiparkinsonian drug. Which statement is the scientific rationale for combining these medications? 1. There will be fewer side effects with this combination than with carbidopa alone. 2. Dopamine D requires the presence of both of these medications to work. 3. Carbidopa makes more levodopa available to the brain. 4. Carbidopa crosses the blood-brain barrier to treat Parkinson's disease.

3. Carbidopa enhances the effects of levodopa by inhibiting decarboxylase in the periphery, thereby making more levodopa available to the central nervous system. Sinemet is the most effective treatment for PD. Carbidopa is never given alone. Carbidopa is given together with levodopa to help the levodopa cross the blood-brain barrier. Levodopa is a form of dopamine given orally to clients diagnosed with PD. Carbidopa does not cross the blood-brain barrier. TEST TAKING HINT: The nurse must be knowledgeable of the rationale for administering a medication for a specific disease.

The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? 1. Allow any of the client's favorite foods as long as the amount is limited. 2. Have the client perform eructation exercises several times a day. 3. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes. 4. Encourage the client to consume a glass of red wine with one (1) meal a day.

3. Clients should eat small, frequent meals and limit fluids with the meals to prevent reflux into the esophagus from a distended stomach. The client is instructed to avoid spicy and acidic foods and any food producing symptoms. Eructation means belching, which is a symptom of GERD. Clients are encouraged to forgo all alcoholic beverages because alcohol relaxes the lower esophageal sphincter and increases the risk of reflux. TEST-TAKING HINT: The word "any" in option "1" should give the test taker a clue that, unless there are absolutely no dietary restrictions, this is an incorrect answer. Option "2" requires knowledge of medical terminology.

The laboratory data reveal a calcium phosphate renal stone for a client diagnosed with renal calculi. Which discharge teaching intervention should the nurse implement? 1. Encourage the client to eat a low-purine diet and limit foods such as organ meats. 2. Explain the importance of not drinking water two (2) hours before bedtime. 3. Discuss the importance of limiting vitamin D-enriched foods. 4. Prepare the client for extracorporeal shock wave lithotripsy (ESWL).

3. Dietary changes for preventing renal stones include reducing the intake of the primary substance forming the calculi. In this case, limiting vitamin D will inhibit the absorption of calcium from the gastrointestinal tract. 1 is appropriate for the client who has uric acid stones. The nurse should recommend drinking one (1) to two (2) glasses of water at night to prevent concentration of urine during sleep. 4 is a treatment for an existing renal stone, not a discharge teaching intervention for a client who has successfully passed a renal calculus. TEST-TAKING HINT: The test taker should remember to read the question carefully. The question asks for a "discharge teaching" intervention. This rules out option "4," which is a treatment, as a potential answer

The occupational health nurse is planning health promotion activities for a group of factory workers. Which activity is an example of primary prevention for clients at risk for low back pain? 1. Teach back exercises to workers after returning from an injury. 2. Place signs in the work area about how to perform first aid. 3. Start a weight-reduction group to meet at lunchtime. 4. Administer a nonnarcotic analgesic to a client complaining of back pain.

3. Excess weight increases the workload on the vertebrae. Weight-loss activities help to prevent back injury. Teaching back exercises to a client who has already experienced a problem is tertiary care. Placing signs with instructions about how to render first aid is a secondary intervention, not primary prevention. Administering a nonnarcotic analgesic to a client with back pain is an example of secondary or tertiary care, depending on whether the client has a one-time problem or a chronic problem with back pain. TEST-TAKING HINT: Primary care is any activity which will prevent an illness or injury.

The nurse finds small, fluid-filled lesions on the margins of the client's surgical dressing. Which statement is the most appropriate scientific rationale for this occurrence? 1. These were caused by the cautery unit in the operating room. 2. These are papular wheals from herpes zoster. 3. These are blisters from the tape used to anchor the dressing. 4. These macular lesions are from a latex allergy.

3. Fluid-filled blisters are from a reaction to the tape and usually occur along the margins of the dressing where the tape was applied. These are not burns from the cautery unit. Such burns are located in or near the incision site and are usually black. Herpes simplex lesions occur in a linear pattern along a dermatome. Skin reactions to latex are local irritations or generalized dermatitis, not blisters. TEST-TAKING HINT: If the test taker does not know the answer, the test taker might think about the dressing because the lesions are on the side of the dressing. How is a dressing anchored to the skin? Answer: with tape. The test taker should choose the option having the word "tape."

The client one (1) day postoperative total hip replacement complains of hearing a "popping sound" when turning. Which assessment data should the nurse report immediately to the surgeon? 1. Dark red-purple discoloration. 2. Equal length of lower extremities. 3. Groin pain in the affected leg. 4. Edema at the incision site.

3. Groin pain or increasing discomfort in the affected leg and the "popping sound" indicate the leg has dislocated, which should be reported immediately to the HCP for a possible closed reduction. Bruising is common after a total hip replacement. When a dislocation occurs, the affected extremity will be shorter. Edema at the incision site is common, but an increase in edema or redness should be reported. TEST-TAKING HINT: The nurse should notify the surgeon of abnormal, unexpected, or life-threatening assessment data; if the test taker did not have an idea of the answer, pain is always a good choice because pain means something is wrong—it may be expected pain, but it may mean a complication

Which is a common cognitive problem associated with Parkinson's disease? 1. Emotional lability. 2. Depression. 3. Memory deficits. 4. Paranoia

3. Memory deficits are cognitive impairments. The client may also develop a dementia. Emotional lability is a psychosocial problem, not a cognitive one. Depression is a psychosocial problem. Paranoia is a psychosocial problem. TEST TAKING HINT: The test taker must know the definitions of common medical terms. "Cognitive" refers to mental capacity to function.

The client diagnosed with OA is a resident in a long-term care facility. The resident is refusing to bathe because she is hurting. Which instruction should the nurse give the unlicensed assistive personnel (UAP)? 1. Allow the client to stay in bed until the pain becomes bearable. 2. Tell the UAP to give the client a bed bath this morning. 3. Try to encourage the client to get up and go to the shower. 4. Notify the family the client is refusing to be bathed.

3. Pain will decrease with movement, and warm or hot water will help decrease the pain. The worst thing the client can do is not move. Clients with OA should be encouraged to move, which will decrease the pain. A bed bath does not require as much movement from the client as getting up and walking to the shower. Notifying the family will not address the client's pain, and the client has a right to refuse a bath, but the nursing staff must explain why moving and bathing will help decrease the pain. TEST-TAKING HINT: Allowing clients to stay in bed only increases complications of immobility and will increase the client's pain secondary to OA. Clients with chronic illnesses should be encouraged to be as independent as possible. The family should only be notified if a significant situation has occurred.

The client diagnosed with Parkinson's disease is being discharged. Which statement made by the significant other indicates an understanding of the discharge instructions? 1. "All of my spouse's emotions will slow down now just like his body movements." 2. "My spouse may experience hallucinations until the medication starts working." 3. "I will schedule appointments late in the morning after his morning bath." 4. "It is fine if we don't follow a strict medication schedule on weekends.

3. Scheduling appointments late in the morning gives the client a chance to complete ADLs without pressure and allows the medications time to give the best benefits. The emotions of a person diagnosed with PD are labile. The client has rapid mood swings and is easily upset. Hallucinations are a sign that the client is experiencing drug toxicity. The client should take the prescribed medications at the same time each day to provide a continuous drug level. TEST TAKING HINT: The test taker could eliminate option "2" because hallucinations are never an expected part of legal medication administration.

The client diagnosed with renal calculi is scheduled for lithotripsy. Which postprocedure nursing task is the most appropriate to delegate to the UAP? 1. Monitor the amount, color, and consistency of urine output. 2. Teach the client about care of the indwelling Foley catheter. 3. Assist the client to the car when being discharged home. 4. Take the client's postprocedural vital signs.

3. The UAP could assist the client to the car once the discharge has been completed. The urine must be assessed for bleeding and cloudiness. Initially the urine is bright red, but the color soon diminishes and cloudiness may indicate an infection. This assessment should not be delegated to a UAP. Teaching cannot be delegated to a UAP. The nurse should teach and evaluate the effectiveness of the teaching. The kidney is highly vascular. Hemorrhaging and resulting shock are potential complications of lithotripsy, so the nurse should not delegate vital signs postprocedure. TEST-TAKING HINT: There are some basic rules about delegation: the nurse cannot delegate assessment, teaching, evaluation, or any task requiring judgment.

The client is complaining of joint stiffness, especially in the morning. Which diagnostic tests should the nurse expect the health-care provider to order to R/O osteoarthritis? 1. Full-body magnetic resonance imaging scan. 2. Serum studies for synovial fluid amount. 3. X-ray of the affected joints. 4. Serum erythrocyte sedimentation rate (ESR).

3. X-rays reveal loss of joint cartilage, which appears as a narrowing of the joint space in clients diagnosed with OA. MRIs are not routinely ordered for diagnosing OA. There is no serum laboratory test to measure synovial fluid in the joints. An ESR is a diagnostic laboratory test for rheumatoid arthritis, not osteoarthritis. TEST-TAKING HINT: If the test taker is guessing which answer is correct and knows osteo- means "bone," the only option with any specific connection to bones is an x-ray. This selection is an educated guess.

The nurse is preparing a client diagnosed with GERD for surgery. Which information warrants notifying the HCP? 1. The client's Bernstein esophageal test was positive. 2. The client's abdominal x-ray shows a hiatal hernia. 3. The client's WBC count is 14,000/mm3. 4. The client's hemoglobin is 13.8 g/dL.

3. The client's WBC count is elevated, indicating a possible infection, which warrants notifying the HCP. In a Bernstein test, acid is instilled into the distal esophagus, causing immediate heartburn for a client diagnosed with GERD. This would not warrant notifying the HCP. Hiatal hernias are frequently the cause of GERD; therefore, this finding would not warrant notifying the HCP. This is a normal hemoglobin result and would not warrant notifying the HCP. TEST-TAKING HINT: When the test taker is deciding when to notify a health-care provider, the answer should be data not normal for the disease process or signaling a potential or life-threatening complication.

The nurse working on a medical-surgical floor feels a pulling in the back when lifting a client up in the bed. Which should be the first action taken by the nurse? 1. Continue working until the shift is over and then try to sleep on a heating pad. 2. Go immediately to the emergency department for treatment and muscle relaxants. 3. Inform the charge nurse and nurse manager on duty and document the occurrence. 4. See a private health-care provider on the nurse's off time but charge the hospital

3. The first action is to notify the charge nurse so a replacement can be arranged to take over care of the clients. The nurse should notify the nurse manager or house supervisor. An occurrence report should be completed, documenting the situation. This provides the nurse with the required documentation to begin a worker's compensation case for payment of medical bills. The nurse should not continue working, and this is self-diagnosing and treating. The nurse may go to the emergency department, but this is not the first action. The nurse has the right to see a private health-care provider in most states, but this is not the first action. TEST-TAKING HINT: When the test taker is determining a priority, then all of the answers may be appropriate interventions, but only one is implemented first. The test taker should read the full stem, identifying the important words and making sure he or she understands what the question is asking

The nurse is working with an unlicensed assistive personnel (UAP). Which action by the UAP warrants immediate intervention? 1. The UAP feeds a client two (2) days postoperative cervical laminectomy a regular diet. 2. The UAP calls for help when turning to the side a client who is post-lumbar laminectomy. 3. The UAP is helping the client who weighs 300 pounds and is diagnosed with back pain to the chair. 4. The UAP places the call light within reach of the client who had a disk fusion.

3. The legs of any client diagnosed with back pain can give out and collapse at any time, but a large client diagnosed with back pain is at increased risk of injuring the UAP as well as the client. The nurse should intervene before the client or UAP becomes injured. Clients two (2) days postoperative laminectomy should be eating a regular diet. The client who has undergone a lumbar laminectomy is log rolled. It requires four (4) people or more to log roll a client. This action helps ensure safety for the client. TEST-TAKING HINT: This question is an "except" question. All the options but one contain interventions which should be implemented.

To which member of the health-care team should the nurse refer the client diagnosed with OA who is complaining of not being able to get in and out of the bathtub? 1. Physiatrist. 2. Social worker. 3. Physical therapist. 4. Counselor

3. The physical therapist is able to help the client with transferring, ambulation, and other lower extremity difficulties. A physiatrist is a physician who specializes in physical medicine and rehabilitation, but the nurse should not refer the client to this person just because the client is having difficulty with transfers. The social worker does not address this type of physical problem. Social workers address issues concerning finances, placement, and acquiring assistive devices. A counselor is not able to help the client learn how to get in and out of the bathtub. TEST-TAKING HINT: The nurse must know the roles of all the health-care team members.

The charge nurse is making assignments. Staffing includes a registered nurse with five (5) years of medical-surgical experience, a newly graduated registered nurse, and two (2) unlicensed assistive personnel (UAPs). Which client should be assigned to the most experienced nurse? 1. The 39-year-old client diagnosed with lower esophageal dysfunction who is complaining of pyrosis. 2. The 54-year-old client diagnosed with Barrett's esophagus who is scheduled to have an endoscopy this morning. 3. The 46-year-old client diagnosed with gastroesophageal reflux disease who has wheezes in all five (5) lobes. 4. The 68-year-old client who is three (3) days postoperative for hiatal hernia and needs to be ambulated four (4) times today.

3. This client is exhibiting symptoms of asthma, a complication of GERD. This client should be assigned to the most experienced nurse. Pyrosis is heartburn and is expected in a client diagnosed with GERD. The new graduate can care for this client. Barrett's esophagus is a complication of GERD; new graduates can prepare a client for a diagnostic procedure. This client can be cared for by the new graduate, and ambulating can be delegated to the unlicensed assistive personnel (UAP). TEST-TAKING HINT: The most experienced nurse should be assigned to the client whose assessment and care require more experience and knowledge about the disease process, potential complications, and medications. The term "most experienced" in the stem is the key to answering this question.

The nurse is caring for clients on an orthopedic floor. Which client should be assessed first? 1. The client diagnosed with back pain who is complaining of a "4" on a 1-to-10 scale. 2. The client who has undergone a myelogram who is complaining of a slight headache. 3. The client two (2) days post-disk fusion who has T 100.4, P 96, R 24, and BP 138/78. 4. The client diagnosed with back pain who is being discharged and whose ride is here.

3. This client is postoperative and now has a fever. This client should be assessed and the health-care provider should be notified. Mild back pain is expected with this client. Lumbar myelograms require access into the spinal column. A small amount of cerebrospinal fluid may be lost, causing a mild headache. The client should stay flat in bed to prevent this from occurring. A discharged client does not have priority over a surgical infection. TEST-TAKING HINT: Options "1" and "2" contain assessment data expected for the procedure.

The client who is postoperative TURP asks the nurse, "When will I know if I will be able to have sex after my TURP?" Which response is most appropriate by the nurse? 1. "You seem anxious about your surgery." 2. "Tell me about your fears of impotency." 3. "Potency can return in six (6) to eight (8) weeks." 4. "Did you ask your doctor about your concern?"

3. This is usually the length of time clients need to wait prior to having sexual intercourse; this is the information the client wants to know. The client wants information and the nurse should provide facts. The client may need to talk with his surgeon, but it should be after the nurse answers the client's question. TEST-TAKING HINT: The client is asking for factual information and the nurse should provide this information. Options "1" and "2" are therapeutic responses addressing feelings, and option "4" is passing the buck—the nurse can discuss this with the client.

The client is diagnosed with a uric acid stone. Which foods should the client eliminate from the diet to help prevent reoccurrence? 1. Beer and colas. 2. Asparagus and cabbage. 3. Venison and sardines. 4. Cheese and eggs.

3. Venison, sardines, goose, organ meats, and herring are high-purine foods, which should be eliminated from the diet to help prevent uric acid stones. Beer and colas are foods high in oxalate, which can cause calcium oxalate stones. Asparagus and cabbage are foods high in oxalate, which can cause calcium oxalate stones. Cheese and eggs are foods that help acidify the urine and do not cause the development of uric acid stones. TEST-TAKING HINT: The nurse has to be knowledgeable of foods included in specific diets. This is memorizing, but the test taker must have this knowledge to answer questions evaluating types of diets for specific diseases and disorders.

The nurse is administering morning medications at 0730. Which medication should have priority? 1. A proton pump inhibitor. 2. A nonnarcotic analgesic. 3. A histamine receptor antagonist. 4. A mucosal barrier agent.

4. A mucosal barrier agent must be administered on an empty stomach for the medication to coat the stomach. Proton pump inhibitors can be administered at routine dosing times, usually 0900 or after breakfast. Pain medication is important, but a nonnarcotic medication, such as Tylenol, can be administered after a medication, which must be timed. A histamine receptor antagonist can be administered at routine dosing times. TEST-TAKING HINT: Basic knowledge of how medications work is required to administer medications for peak effectiveness. There are very few medications requiring a specific time. The test taker should memorize these specific medications.

4. A nurse is completing teaching for a client who is scheduled for extracorporeal shock wave lithotripsy (ESWL). Which of the following statements made by the client indicates understanding of the teaching? A. "I will be fully awake during the procedure." B. "Lithotripsy will reduce my chances of having stones in the future." C. "I will report any bruising that occurs to my doctor." D. "Straining my urine following the procedure is important."

4. A. INCORRECT: The client receives moderate (conscious) sedation for this procedure. The client is not fully awake. B. INCORRECT: Lithotripsy does not decrease the recurrence rate of kidney stones. The procedure breaks the stone into fragments so they will pass into urine. C. INCORRECT: Bruising is an expected finding following lithotripsy and does not need to be reported to the provider. D. CORRECT: A client is instructed to strain urine following lithotripsy to verify that the stone has been passed. NCLEX® Connection: Basic Care and Comfort, Nutrition and oral Hydration

4. A nurse is providing discharge instructions to a client who is postoperative from a TURP. Which of the following instructions should the nurse include? (Select all that apply.) A. Avoid sexual intercourse for 3 months after the surgery. B. If urine appears bloody, stop activity and rest. C. Avoid drinking caffeinated beverages. D. Take a stool softener once a day. E. Treat pain with ibuprofen (Motrin).

4. A. INCORRECT: The client should follow the provider's instructions, which typically includes avoidance of sexual intercourse for 2 to 6 weeks after the surgery. B. CORRECT: Excessive activity may cause recurrence of bleeding. The client should rest to promote reclotting at the incisional site. C. CORRECT: Caffeine is a bladder stimulant and should be avoided. D. CORRECT: The client should take a stool softener to keep the stool soft and thus prevent the complication of bleeding at the time of a bowel movement. E. INCORRECT: The client should avoid taking nonsteroidal anti-inflammatory medications because they can cause bleeding. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures

Which data support to the nurse the client's diagnosis of acute bacterial prostatitis? 1. Terminal dribbling. 2. Urinary frequency. 3. Stress incontinence. 4. Sudden fever and chills.

4. Clients with acute bacterial prostatitis will frequently experience a sudden onset of fever and chills. Clients with chronic prostatitis have milder symptoms. Terminal dribbling is a symptom of BPH. Urinary frequency is a sign of a UTI. Stress incontinence occurs in women who urinate when coughing, running, or jumping. TEST-TAKING HINT: The words "acute" and "bacterial" should cue the test taker into the specific symptoms of infection. Symptoms for any infection are fever and chills.

The client diagnosed with OA is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which instruction should the nurse teach the client? 1. Take the medication on an empty stomach. 2. Make sure to taper the medication when discontinuing. 3. Apply the medication topically over the affected joints. 4. Notify the health-care provider if vomiting blood.

4. NSAIDs are well known for causing gastric upset and increasing the risk for peptic ulcer disease, which could cause the client to vomit blood. This medication should be taken with food to prevent gastrointestinal distress. Glucocorticoids, not NSAIDs, must be tapered when discontinuing. Topical analgesics are applied to the skin; NSAIDs are oral or intravenous medications. TEST-TAKING HINT: The worst-scenario option is "4," which has blood in the answer. If the test taker did not know the answer, then selecting an option with blood in it is most appropriate.

The nurse researcher is working with clients diagnosed with Parkinson's disease. Which is an example of an experimental therapy? 1. Stereotactic pallidotomy/thalamotomy. 2. Dopamine receptor agonist medication. 3. Physical therapy for muscle strengthening. 4. Fetal tissue transplantation

4. Fetal tissue transplantation has shown some success in PD, but it is an experimental and highly controversial procedure. A stereotactic pallidotomy and/or thalamotomy are surgeries that use CT or MRI scans to localize specific areas of the brain in which to produce lesions in groups of brain cells through electrical stimulation or thermocoagulation. These procedures are done when medication has failed to control tremors. Dopamine receptor agonists are medications that activate the dopamine receptors in the striatum of the brain. Physical therapy is a standard therapy used to improve the quality of life for clients diagnosed with PD. TEST TAKING HINT: The test taker should not overlook the adjective "experimental." This would eliminate at least option "3," physical therapy, and option "2," which refers to standard dopamine treatment, even if the test taker was not familiar with all of the procedures.

The nurse is discharging a client who had a total hip replacement. Which statement indicates further teaching is needed? 1. "I should not cross my legs because my hip may come out of the socket." 2. "I will call my HCP if I have a sudden increase in pain." 3. "I will sit on a chair with arms and a firm seat." 4. "After three (3) weeks, I don't have to worry about infection."

4. Infections are possible months after surgery. Clients should monitor temperatures and report any signs of infection. Clients should not cross their legs because the position increases the risk for dislocation. If the client experiences a sudden increase in pain, redness, edema, or stiffness in the joint or surrounding area, the client should notify the HCP. Clients should sleep on firm mattresses and sit on chairs with firm seats and high arms. These will decrease the risk of dislocating the hip joint. TEST-TAKING HINT: Note the stem is asking about the need for "further teaching." This means the test taker is looking for an unexpected option. This is an "except" question. Sometimes, if the test taker will change the question and say "the client understands the teaching," then the option with an incorrect statement is the answer

The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus of L4-5. Which scientific rationale explains the incidence of a ruptured disk in the elderly? 1. The client did not use good body mechanics when lifting an object. 2. There is an increased blood supply to the back as the body ages. 3. Older clients develop atherosclerotic joint disease as a result of fat deposits. 4. Clients develop intervertebral disk degeneration as they age.

4. Less blood supply, degeneration of the disk, and arthritis are reasons elderly people develop back problems. Back pain occurs in 80% to 90% of the population at different times in their lives. Although not using good body mechanics when lifting an object may be a reason for younger clients to develop a herniated disk, it is not the reason most elderly people develop back pain. There is a decreased blood supply as the body ages. Older clients develop degenerative joint disease. Fat does not deposit itself in the nucleus pulposus. TEST-TAKING HINT: The clue in this question is "elderly." The answer must address a problem occurring as a result of aging.

The nurse is admitting a client with the diagnosis of Parkinson's disease. Which assessment data support this diagnosis? 1. Crackles in the upper lung fields and jugular vein distention. 2. Muscle weakness in the upper extremities and ptosis. 3. Exaggerated arm swinging and scanning speech. 4. Masklike facies and a shuffling gait.

4. Masklike facies and a shuffling gait are two clinical manifestations of PD. Crackles and jugular vein distention indicate heart failure, not PD. Upper extremity weakness and ptosis are clinical manifestations of myasthenia gravis. The client has very little arm swing, and scanning speech is a clinical manifestation of multiple sclerosis. TEST TAKING HINT: Option "3" refers to arm swing and speech, both of which are affected by PD. The test taker needs to decide if the adjectives used to describe these activities—"exaggerated" and "scanning"—are appropriate. They are not, but masklike facies and shuffling gait are.

The client with possible renal calculi is scheduled for a renal ultrasound. Which intervention should the nurse implement for this procedure? 1. Ask if the client is allergic to shellfish or iodine. 2. Keep the client NPO eight (8) hours prior to the ultrasound. 3. Ensure the client has a signed informed consent form. 4. Explain the test is noninvasive and there is no discomfort.

4. No special preparation is needed for this noninvasive, nonpainful test. A conductive gel is applied to the back or flank and then a transducer is applied, which produces sound waves, resulting in a picture. An ultrasound does not require administration of contrast dye. Food, fluids, and ordered medication are not restricted prior to this test. This is not an invasive procedure, so a signed consent is not required. TEST-TAKING HINT: The nurse must be aware of preprocedure and postprocedure teaching and care. The test taker must know the invasive and noninvasive diagnostic tests in general. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are a few of the noninvasive diagnostic tests.

The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy (EGD). Which statement indicates the client understands the discharge instructions? 1. "I should not eat for at least one (1) day following this procedure." 2. "I can lie down whenever I want after a meal. It won't make a difference." 3. "The stomach contents won't bother my esophagus but will make me nauseous." 4. "I should avoid orange juice and eating tomatoes until my esophagus heals."

4. Orange juice and tomatoes are acidic, and the client diagnosed with GERD should avoid acidic foods until the esophagus has had a chance to heal. The client is allowed to eat as soon as the gag reflex has returned. An esophagogastroduodenoscopy is a diagnostic procedure, not a cure. Therefore, the client still has GERD and should be instructed to stay in an upright position for two (2) to three (3) hours after eating. Stomach contents are acidic and will erode the esophageal lining. TEST-TAKING HINT: This question assumes the test taker has knowledge of diagnostic procedures for specific disease processes.

The client is diagnosed with an acute episode of ureteral calculi. Which client problem is priority when caring for this client? 1. Fluid volume loss. 2. Knowledge deficit. 3. Impaired urinary elimination. 4. Alteration in comfort.

4. Pain is priority. The pain can be so severe a sympathetic response may occur, causing nausea; vomiting; pallor; and cool, clammy skin. The client's fluid volume is increased and there is usually not a fluid volume loss. Knowledge deficit is important to help prevent future renal calculi, but this is not priority when the client is in pain, which will occur with an acute episode. Impaired urinary elimination may occur, but it is not priority for the client with an acute episode of calculi. TEST-TAKING HINT: Remember Maslow's hierarchy of needs: airway and pain are priority. No option mentions possible airway problems, so pain is priority.

The client has been diagnosed with OA for the last seven (7) years and has tried multiple medical treatments and alternative treatments but still has significant joint pain. Which psychosocial client problem should the nurse identify? 1. Severe pain. 2. Body image disturbance. 3. Knowledge deficit. 4. Depression.

4. The client experiencing chronic pain often experiences depression and hopelessness. Pain is a physiological problem, not a psychosocial problem. A client with OA does not have bone deformities; therefore, body image disturbance is not appropriate. After seven (7) years of OA and multiple treatment modalities, knowledge deficit is not appropriate for this client. TEST-TAKING HINT: The adjective "psychosocial" should help the test taker rule out option "1." The test taker needs to read the stem carefully. This client has had a problem for years, and, therefore, option "3" could be ruled out as a correct answer.

The nurse caring for a client diagnosed with Parkinson's disease writes a problem of "impaired nutrition." Which nursing intervention would be included in the plan of care? 1. Consult the occupational therapist for adaptive appliances for eating. 2. Request a low-fat, low-sodium diet from the dietary department. 3. Provide three (3) meals per day that include nuts and whole-grain breads. 4. Offer six (6) meals per day with a soft consistency.

4. The client's energy levels will not sustain eating for long periods. Offering frequent and easy-to-chew (soft) meals of small proportions is the preferred dietary plan. Adaptive appliances will not help the client's shaking movements and are not used for clients with Parkinson's disease. Clients with Parkinson's disease are placed on high-calorie, high-protein, soft or liquid diets. Supplemental feedings may also be ordered. If liquids are ordered because of difficulty chewing, then the liquids should be thickened to a honey or pudding consistency. Nuts and whole-grain food would require extensive chewing before swallowing and would not be good for the client. Three large meals would get cold before the client can consume the meal, and one-half or more of the food would be wasted. TEST TAKING HINT: The correct answer for a nursing problem question must address the actual problem.

The nurse is caring for a client diagnosed with GERD. Which nursing interventions should be implemented? 1. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications. 2. Have the client remain upright at all times and walk for 30 minutes three (3) times a week. 3. Instruct the client to maintain a right lateral side-lying position and take antacids before meals. 4. Elevate the head of the bed (HOB) 30 degrees and discuss lifestyle modifications with the client.

4. The head of the bed should be elevated to allow gravity to help in preventing reflux. Lifestyle modifications of losing weight, making dietary modifications, attempting smoking cessation, discontinuing the use of alcohol, and not stooping or bending at the waist all help to decrease reflux. The client is encouraged to lie with the head of the bed elevated, but this is difficult to achieve when on the stomach. NSAIDs inhibit prostaglandin synthesis in the stomach, which places the client at risk for developing gastric ulcers. The client is already experiencing gastric acid difficulty. The client will need to lie down at some time, and walking will not help with GERD. If lying on the side, the left side-lying position, not the right side, will allow less chance of reflux into the esophagus. Antacids are taken one (1) and three (3) hours after a meal. TEST-TAKING HINT: Option "2" has an "all," which should alert the test taker to eliminate this option. If the test taker has no idea of the answer, lifestyle modifications are an educated guess for most chronic problems.

The nurse is caring for the client who has had a total hip replacement. Which data indicate the surgical treatment is effective? 1. The client states the pain is at a "3" on a 1-to-10 scale. 2. The client has a limited ability to ambulate. 3. The client's left leg is shorter than the right leg. 4. The client ambulates to the bathroom.

4. The hip should have functional motion and the client should be able to ambulate to the bathroom. This indicates surgical treatment has been effective. Minimal pain is expected in a postoperative client but it does indicate surgical treatment is effective. The client should be able to ambulate with almost full mobility. A shorter leg indicates a dislocation of the hip. TEST-TAKING HINT: With musculoskeletal problems, functional movement is priority. Also note option "2" has the word "limited" and "3" has "one leg shorter than the other," both of which are negative outcomes, so the test taker could eliminate these options.

The nurse is planning the care for a client diagnosed with Parkinson's disease. Which would be a therapeutic goal of treatment for the disease process? 1. The client will experience periods of akinesia throughout the day. 2. The client will take the prescribed medications correctly. 3. The client will be able to enjoy a family outing with the spouse. 4. The client will be able to carry out activities of daily living.

4. The major goal of treating PD is to maintain the ability to function. Clients diagnosed with PD experience slow, jerky movements and have difficulty performing routine daily tasks. Akinesia is lack of movement. The goal in treating PD is to maintain mobility. This could be a goal for a problem of noncompliance with the treatment regimen but not a goal for treating the disease process. This might be a goal for a psychosocial problem of social isolation. TEST TAKING HINT: The test taker should match the goal to the problem. A "therapeutic goal" is the key to answering this question.

The client with a TURP who has a continuous irrigation catheter complains of the need to urinate. Which intervention should the nurse implement first? 1. Call the surgeon to inform the HCP of the client's complaint. 2. Administer the client a narcotic medication for pain. 3. Explain to the client this sensation happens frequently. 4. Assess the continuous irrigation catheter for patency.

4. The nurse should always assess any complaint before dismissing it as a commonly occurring problem. The nurse should not call a surgeon until all assessment is completed. A pain medication should not be administered until the cause of the problem is determined and all complications are ruled out. Telling a client that what he is experiencing is expected without assessing the situation is dangerous. TEST-TAKING HINT: When the question requires the test taker to decide which intervention should be first, assessment is usually first. If the test taker has no idea which intervention is correct, the test taker should choose assessment.

The client had surgery to remove a kidney stone. Which laboratory assessment data warrant immediate intervention by the nurse? 1. A serum potassium level of 3.8 mEq/L. 2. A urinalysis shows microscopic hematuria. 3. A creatinine level of 0.8 mg/100 mL. 4. A white blood cell count of 14,000/mm3.

4. The white blood cell count is elevated; normal is 5,000 to 10,000/mm3. This potassium level is within normal limits, 3.5 to 5.5 mEq/L. Hematuria is not uncommon after removal of a kidney stone. A normal creatinine level is 0.8 to 1.2 mg/100 mL. TEST-TAKING HINT: The nurse must know normal laboratory data and be able to apply the normal and abnormal results to specific diseases and disorders.

Which nursing diagnosis is priority for the client who has undergone a TURP? 1. Potential for sexual dysfunction. 2. Potential for an altered body image. 3. Potential for chronic infection. 4. Potential for hemorrhage.

4. This is a potentially life-threatening problem. TURPs can cause a sexual dysfunction, but if there were a sexual dysfunction, it is not priority over a physiological problem such as hemorrhaging. This is not a life-threatening problem. This client has had this problem preoperatively. TEST-TAKING HINT: A basic concept the test taker must know is, for most surgeries, the highest priority problem is hemorrhaging. Hemorrhaging is life threatening.

The nurse is preparing the preoperative client for a total hip replacement (THR). Which intervention should the nursing implement postoperatively? 1. Keep an abduction pillow in place between the legs at all times. 2. Cough and deep breathe at least every four (4) to five (5) hours. 3. Turn to both sides every two (2) hours to prevent pressure ulcers. 4. Sit in a high-seated chair for a flexion of less than 90 degrees.

4. Using a high-seated toilet and chair will help prevent dislocation by limiting the flexion to less than 90 degrees. The abduction pillow should be kept between the legs while in bed to maintain a neutral position and prevent internal rotation. The client should deep breathe and cough at least every two (2) hours to prevent atelectasis and pneumonia. The client will need to turn every two (2) hours but should not turn to the affected side. TEST-TAKING HINT: Option "1" has the word "all"; an absolute word such as this usually eliminates the option as a possible correct answer. Nursing usually does not have situations involving absolutes.

5. A nurse is teaching a client who has a new prescription for finasteride (Proscar) about the medication. A. Therapeutic Uses: Identify the therapeutic use of this medication for this client. B. Client Education: Identify four instructions the nurse should include.

5. A. Finasteride inhibits 5-alpha reductase and enzyme, which converts testosterone to dihydrotesterone. Production of testosterone in the prostate gland is reduced, which in turn reduces the size of prostate tissue. B. Client Education ● The medication must be taken on a long-term basis. It may take as long as a year before the effects of the medication are evident. ● Impotence and a decreased libido are possible adverse effects. ● Report breast enlargement to the provider. ● Finasteride is teratogenic to the male fetus. The medication can be absorbed through the skin. Pregnant women should not be in contact with tablets. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration

5. A nurse is completing discharge instructions with a client who has spontaneously passed a calcium oxalate stone. Which of the following foods should the nurse instruct the client to avoid? (Select all that apply.) A. Red meat B. Black tea C. Cheese D. Whole grains E. Spinach

5. A. INCORRECT: Red meat contains struvite (magnesium ammonium phosphate) and does not need to be avoided. B. CORRECT: Black tea contains calcium oxalate and should be avoided. C. INCORRECT: Cheese contains struvite (magnesium ammonium phosphate) and does not need to be avoided. D. INCORRECT: Whole grains contains struvite (magnesium ammonium phosphate) and do not need to be avoided. E. CORRECT: Spinach contains calcium oxalate and should be avoided. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures

The nurse emptied 2,000 mL from the drainage bag of a continuous irrigation of a client who had a transurethral resection of the prostate (TURP). The amount of irrigation in the bag hanging was 3,000 mL at the beginning of the shift. There was 1,800 mL left in the bag eight (8) hours later. What is the correct urine output at the end of the eight (8) hours? _________

800 mL.First, determine the amount of irrigation fluid: 3,000 - 1,800 = 1,200 mL of irrigation fluid Then, subtract 1,200 mL of irrigation fluid from the drainage of 2,000 mL to determine the urine output:2,000 - 1,200 = 800 mL of urine output TEST-TAKING HINT: The test taker should use the drop-down calculator for the NCLEX-RN examination

A client admitted to the hospital with a diagnosis of gout has also been diagnosed with uric acid renal calculi. When planning meals for this client, which diet will the nurse anticipate? A) Low-purine diet B) Low-sodium diet C) A diet high in calcium D) A diet low in calcium

A) A low-purine diet is appropriate in the management of a client with uric acid renal calculi. A low-sodium diet is useful in the management of a client with cystine renal calculi, and a diet limiting foods high in calcium is useful when managing a client with calcium phosphate renal calculi.

A client with a history of gastroesophageal reflux disorder (GERD) presents with metabolic alkalosis. Based on the data reviewed in the client's history, which medication does the nurse suspect contributed to the current diagnosis? A) Aluminum hydroxide B) Omeprazole C) Ranitidine D) Metoclopramide

A) Aluminum hydroxide antacids neutralize gastric acid. Overuse of antacids may cause metabolic acidosis. Omeprazole, ranitidine, and metoclopramide are all GERD medications that do not cause metabolic alkalosis.

In which of the following ways do calcium phosphate stones differ from uric acid and cystine stones? A) Calcium phosphate stones are associated with alkaline urine, while uric acid and cystine stones are associated with acid urine. B) Calcium phosphate stones are associated with acid urine, while uric acid and cystine stones are associated with alkaline urine. C) Calcium phosphate stones are associated with alkaline urine, while uric acid and cystine stones are associated with neutral urine. D) Calcium phosphate stones are associated with neutral urine, while uric acid and cystine stones are associated with acid urine.

A) Calcium phosphate stones are associated with alkaline urine, while uric acid and cystine stones are associated with acid urine. None of the types of stones discussed are associated with urine that has a neutral pH.

The nurse is presenting a program at a senior center on how to survive a fall. Which statement by a program participant indicates that this person needs clarification about what emergency actions to take after a fall? A) "I should crawl to a phone on the affected side to keep it stable against a hard surface." B) "I should try to cover myself with a blanket while I wait for help to arrive." C) "To call for help, I can scoot on my bottom to a low wall-mounted phone." D) "If possible, I can crawl to a stairway and use the stairs to lift up to a standing position."

A) Clients at risk for falls and hip fractures should be taught how to notify emergency services in the event of a fall and injury. These clients should be instructed to turn onto the stomach and crawl to the phone, or to scoot to the phone using the buttocks on the uninjured side. And another option is to crawl to a stairway and use the stairs to gradually lift the body to a standing position. While waiting for help to arrive, clients should cover themselves with a blanket if possible to help prevent shock.

Lab results are back for a client who has limiting joint pain. Synovial fluid analysis shows no uric acid crystals or bacteria. The client asks what the test results mean. How should the nurse respond? A) "These test results mean that your joint pain is likely not caused by gout or septic arthritis." B) "These test results mean that your joint pain is likely not related to any form of arthritis." C) "These test results mean that your joint pain is likely caused by either rheumatoid arthritis or septic arthritis." D) "These test results mean that your joint pain is likely caused by either cancer of the joint or gout."

A) Gout is caused by the collection of uric acid crystals in a joint. The absence of uric acid crystals in the synovial fluid (joint fluid) makes gout unlikely. Septic arthritis is caused by infection, so the absence of bacteria makes sepsis unlikely. However, this test does not rule out osteoarthritis or rheumatoid arthritis, so these are still possible diagnoses. Although the nurse may provide information related to which conditions have been ruled out, providing a medical diagnosis is outside the nurse's scope of practice.

A middle-aged female client states to the nurse, "I have noticed a slight tremor in my left hand when it's at rest. I think I might have Parkinson disease because my mother had it." Which response by the nurse is the most appropriate? A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." B) "You shouldn't worry too much, because Parkinson disease has a higher prevalence in males." C) "It is unlikely that you have the same illness as your mother." D) "You probably don't have Parkinson disease. Your mother was probably exposed to a toxin that caused her illness."

A) In some individuals, Parkinson disease (PD) is inherited; approximately 15% to 25% of individuals with PD have a relative with PD. The nurse should not tell the client it is unlikely she has the same illness as her mother. Exposure to toxins is one theory for the development of the illness; however, the nurse has no way of knowing whether the client's mother was exposed to toxins or if that was the cause for her disease. Men are at higher risk for PD, with 50% more men than women developing the disease, but this does not eliminate the client's risk of having the disease, especially given her mother's diagnosis.

The nurse is planning care for a client with osteoarthritis of the hip. Which intervention would be appropriate for this client? A) Provide moist heat packs to the affected joint 3 times each day. B) Instruct the client on the importance of strict bedrest. C) Provide nonsteroidal anti-inflammatory drugs (NSAIDs) when pain becomes severe. D) Provide opioid pain medication as prescribed.

A) Interventions appropriate for a client with osteoarthritis (OA) include NSAIDs, moist heat, active range-of-motion exercises, proper posture and body mechanics, and assistive devices to safely maintain independence with activities of daily living. Opioid medication is not typically prescribed for the treatment of OA. NSAIDs are most effective if taken before the pain is severe. The client should be encouraged to be mobile, not on strict bedrest.

A client complains of a right-hand tremor, increasing weakness, and muscles that feel tight. The nurse notes that the client has poor voice volume and facial muscles that do not move easily. The nurse recognizes that these symptoms are consistent with which condition? A) Parkinson disease B) Spinal cord injury C) Cerebrovascular accident D) Multiple sclerosis

A) Manifestations of Parkinson disease include unintentional tremor, slowed movements, low amplitude of speech, expressionless face, and muscle rigidity. The client is complaining of or exhibiting all these symptoms, suggesting a diagnosis of Parkinson disease. These symptoms are not manifestations of multiple sclerosis, spinal cord injury, or a cerebrovascular accident

The nurse is caring for a client with osteoarthritis. Which factor in the client's history and physical assessment would the nurse recognize as a risk factor for developing this condition? A) Body mass index of 36.5 B) History of esophageal reflux disease C) Client plays tennis three times each week D) Blood pressure of 136/78 mmHg

A) Obesity increases the risk of developing osteoarthritis (OA), because the added weight increases stress on weight-bearing joints, causing the joints to wear down more quickly. This client has a body mass index of 36.5, which is considered obese. Moderate recreational exercise (such as tennis three times per week) has been shown to decrease the chance of developing OA and slow the progression of manifestations when OA is present. Esophageal reflux is not associated with OA. Blood pressure is not a known risk factor for the development of OA.

A novice nurse is providing care to clients on a urology unit. When providing care to a group of clients, which client does the novice nurse identify as being at the greatest risk for developing urinary stones? A) A 35-year-old woman with quadriplegia from an auto accident B) A 65-year-old man with a recent history of myocardial infarction C) A 50-year-old man with type 2 diabetes mellitus D) A 25-year-old woman with several episodes of urinary infection

A) The 35-year-old woman with quadriplegia from an auto accident experiences prolonged immobility, which will increase calcium loss from bones and therefore increase the chance of calcium stones precipitating in the urinary system. A 65-year-old man with a recent history of myocardial infarction, 50-year-old man with type 2 diabetes mellitus, and 25-year-old woman with several episodes of urinary infection do not have as great a risk because they do not remain immobile for long periods of time.

The nurse is planning care for a client with acute back pain who is a single mother of two small children and works part-time as a receptionist. Based on this information, which nursing intervention is the highest priority? A) Instructing the client in appropriate body mechanics for lifting and ways to modify her work environment B) Suggesting that the client take time off from work until her back is healed C) Obtaining an order for nonsteroidal anti-inflammatory drugs (NSAIDs) from the client's healthcare provider D) Suggesting that the client's children be taken care of by an extended family member until the client's back is healed

A) The client is at risk for Ineffective Health Management, given that she has two small children who need care and a part-time job that is sedentary. To help the client better manage her health, the nurse should provide instruction on appropriate body mechanics for lifting and ways to modify her work environment. The client may or may not be prescribed NSAIDs. Suggesting that the client take time off from work or have extended family members care for her children may or may not be appropriate and should not be included in the plan of care.

The nurse is assessing an older adult client in a long-term care facility after a fall. Which finding requires priority action? A) The injured leg is shortened and externally rotated. B) Redness and severe swelling are found at the hip joint. C) Pain is relieved by moving the affected extremity. D) The client is repeatedly flexing the injured leg at the hip.

A) The client with a fractured hip is often in extreme pain and assumes a position with the leg on the affected side shortened and externally rotated because of gravity and the pull of the muscles. Any movement of the leg on the side of the affected hip is likely to cause severe muscle spasms and further pain. Redness and swelling are the classic signs of inflammation not immediately present after hip fracture. Extreme pain associated with hip fracture prevents any voluntary movement in the leg.

The nurse is providing care to a client who is experiencing back pain. Which of the following items in the client's history is a known risk factor for disc herniation? A) 49 years of age B) Female gender C) Short stature D) Anorexia

A) The client's age is a known risk factor; herniated discs are most common between the ages of 30 and 50, because discs naturally degenerate with age. Other risk factors include male gender, tall height, and excess weight (which is extremely uncommon in clients with anorexia).

A client with BPH is experiencing urinary retention and bladder distention. The nurse understands that, without proper treatment, the client is at risk for complications such as diverticula, hydroureter, and hydronephrosis. Which issue related to the client's condition is most important to address in order to reduce the risk for these complications? A) The enlarging mass of prostatic tissue must be reduced. B) Straining during urination must be avoided. C) Bladder pain must be managed. D) The weak urinary stream must be strengthened.

A) The enlarging mass contributes to distention of the bladder, so this is the most important issue to address to avoid diverticula, hydroureter, and hydronephrosis. Straining during urination and weak stream are associated with voiding rather than urinary retention and are less critical to avoiding complications. Bladder pain is associated with storage rather than retention and should be addressed but is not critical to avoiding complications.

The client admitted with benign prostatic hyperplasia (BPH) is prescribed an alpha-adrenergic blocker, prazosin (Minipress), for the treatment of BPH. When providing care to this client, which assessment is a priority related to this medication? A) Blood pressure B) Pain rating C) Respiratory rate D) Temperature

A) The medication prazosin (Minipress) is an alpha-adrenergic blocker that may cause first-dose phenomenon (severe hypotension and syncope) and tachycardia. When administering this medication to a client diagnosed with BPH, the priority assessment is the client's blood pressure.

For a 9-month-old infant, which finding is inconsistent with GERD? A) Weight gain B) Vomiting C) Irritability D) Wheezing

A) Weight gain would be normal and not a clinical manifestation of GERD in a client aged 9 months. Clinical manifestations of GERD in children younger than 1 year may include spitting up, vomiting, irritability, poor weight gain, and arching of the back during feedings. Respiratory symptoms such as choking, wheezing, and coughing may also occur.

The nurse is providing care to a client whose medication therapy for the treatment of renal calculi has failed. Based on this data, which treatment option does the nurse anticipate for this client? A) Lithotripsy B) Surgical removal C) Dietary control D) Initiation of IV fluids

A) When medication fails to dissolve stones, the preferred method of treatment is lithotripsy, which is using sound waves to crush the stones so they can be passed out of the urinary system. Depending on the location of the stones, surgery may be the next step in the treatment process. Diet and fluids are used to prevent further stone formation.

In clients with Parkinson disease, increasing doses of and long-term exposure to levodopa can cause which of the following conditions? A) Dyskinesia B) Insomnia C) Hypertension D) Compulsive behavior

A) With increasing doses and long-term exposure, levodopa usually causes dyskinesia, which may become less tolerable for the client than the symptoms of PD. Insomnia and hypertension are not side effects of levodopa. Compulsive behavior is a side effect of dopamine antagonists, not levodopa.

The nurse is providing discharge instructions to an older adult client who is recovering from a fractured hip. The client is planning to stay with an adult child, who is included in the discharge teaching. Which statements on the part of the client indicate appropriate understanding of the information presented by the nurse? Select all that apply. A) "I have signed a contract with Lifeline." B) "We are removing the area rugs in the hallway." C) "I've borrowed a toilet seat riser from the equipment closet." D) "I will be sure to take oxycodone before I go downstairs in the morning." E) "I can help with housework while I'm staying at my child's house."

A, B, C) Statements regarding the use of an emergency alert service and a toilet seat riser indicate appropriate understanding of the information presented. Picking up loose area rugs can help decrease the risk of falls. Pain medication should not be taken when there is a risk of a fall, particularly prior to going down a set of stairs. The nurse should assess the housework that the client wants to help with while living with the adult child. Many housework tasks will be inappropriate.

A client is diagnosed with benign prostatic hyperplasia (BPH). Which topics are appropriate for the nurse to include in the teaching session related to the client's condition? Select all that apply. A) Self-care B) Nutrition C) Surgical approaches to treatment D) Pharmacologic approaches to treatment E) Permanent urinary catheterization

A, B, C, D) When conducting teaching for a client who is diagnosed with BPH, the nurse will include information regarding self-care, nutrition, surgical approaches for treatment, and pharmacologic approaches for treatment. Permanent urinary catheterization is not an appropriate topic to include in the teaching session.

A client with osteoarthritis (OA) of the knees and hips returns for a 3-month follow-up visit with the provider. The nurse calculates that the client's body mass index (BMI) is now 22. The client reports starting a water aerobics and running program three times per week. The client is also using hot packs for edema for 20 minutes and cold packs for pain for 40 minutes daily. After evaluating the client's actions, which follow-up interventions should the nurse plan? Select all that apply. A) Reinforce the correct use of hot packs. B) Suggest the client replace running with a lower impact exercise. C) Explain the risk of injury associated with use of cold packs. D) Advise the client to continue weight loss. E) Congratulate the client on starting water aerobics.

A, B, C, E) The nurse should congratulate the client on starting water aerobics because it is a low-impact exercise mode. The nurse should also congratulate the client on the weight loss. Note, however, that a BMI of 22 is ideal, so continued weight loss should not be encouraged. The client should be informed that using cold packs for more than 30 minutes may cause skin injury. The nurse should also reinforce that hot packs are used to decrease pain and ice packs are used for edema (swelling). Finally, the nurse should suggest that the client replace the high impact exercise of running with a lower impact exercise such as walking or biking.

The mother of a preadolescent client meets with the school nurse to discuss the client's recent diagnosis of scoliosis. Which interventions would be appropriate for the nursing diagnosis of Disturbed Body Image related to deformity and brace? Select all that apply. A) Including the student and family in a meeting to elicit her feelings about scoliosis and wearing a brace B) Offering to arrange a meeting for the student with an 8th grader who has scoliosis C) Encouraging the student and family to register for home schooling to minimize the risk of ridicule D) Teaching the student and family about clothing that will hide the brace E) Suggesting that the pediatrician prescribe an anti-anxiety agent for the student

A, B, D) In this scenario, important interventions related to a diagnosis of Disturbed Body Image include attentive listening, offering a support group or person, and teaching the student and family about clothes that will hide the brace. Avoiding other children and community encounters will increase the client's risk of social isolation. There is not enough information to indicate a problem that requires pharmacologic management.

The nurse is providing care for a client with renal calculi. Which expected outcomes will the nurse include in this client's plan of care? Select all that apply. A) The client rates pain at a 2 on a scale of 0-10 and states that a 2 is acceptable. B) The client is able to comfortably perform activities of daily living (ADLs). C) The client demonstrates a fluid intake of 800-1000mL/day. D) The client remains free of signs and symptoms of infection. E) The client chooses the appropriate diet to prevent the reoccurrence of renal calculi.

A, B, D, E) While straining of the client's urine may indicate that the stone has passed, it is important to assess the client for possible complications. Client outcomes should include the client's rating pain at 3 or less on a 0-10 scale and being comfortable enough to perform own ADLs, the client demonstrating an adequate fluid intake of 2-3 liters a day, the client's choosing the appropriate diet to prevent the reoccurrence of renal calculi, and the client's remaining free of signs and symptoms of infection.

The nurse gives discharge instructions to an adult client who sustained a bicycle fall and underwent open reduction and internal fixation of a fractured hip. After the teaching is complete, which statements by the client indicate appropriate understanding of the information presented? Select all that apply. A) "I will use my abduction pillow while sleeping to maintain proper hip alignment." B) "I will use a high toilet seat to prevent excess flexion of my hip." C) "I only need to use my walker during physical therapy appointments." D) "I will take my prescribed ibuprofen to decrease the risk for deep vein thrombosis." E) "I might experience bruising because of the warfarin I've been prescribed."

A, B, E) Statements regarding use of an abduction pillow to maintain proper hip alignment; use of a high toilet seat to prevent excess flexion of the hip; and awareness that warfarin presents an increased risk for bruising all indicate client adequate understanding. The nurse should remind the client to use the walker at all times until told otherwise. The nurse should also explain that warfarin, not ibuprofen, is prescribed to decrease the risk for deep vein thrombosis.

A preadolescent client is recovering from spinal fusion surgery for scoliosis. Which nursing interventions should the nurse carry out to address comfort and mobility? Select all that apply. A) Reposition every 2 hours. B) Monitor intake and output. C) Encourage and assist with range of motion (ROM) exercises every 4 hours while awake. D) Administer pain medication around the clock. E) Encourage incentive spirometer use every 4 hours while awake.

A, C, D) Interventions that address movement restrictions and/or pain in a preadolescent client recovering from spinal fusion include repositioning every 2 hours, encouraging and assisting with ROM exercises every 4 hours while awake, and administering pain medication around the clock. All of these interventions relate to a diagnosis of Impaired Physical Mobility. The use of an incentive spirometer may be appropriate after surgery, but it would relate to a diagnosis of Impaired Tissue Perfusion and not a diagnosis involving pain or restricted movement. Monitoring intake and output would be applicable for a diagnosis of Fluid Volume Excess or Fluid Volume Deficit.

The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD). Which of the following interventions are supported by research? Select all that apply. A) Low-intensity treadmill training B) Walking barefoot indoors C) Use of resistance bands D) Active and passive range-of-motion exercises E) High-intensity treadmill training

A, C, D, E) Research studies have shown improvements on the 6-minute walk test of individuals with PD after participation in low-intensity and high-intensity treadmill training, strength training (such as with resistance bands), and range-of-motion exercises. Use of shoes with non-slip soles is advised.

An adult client with a BMI of 39 who smokes 1 pack of cigarettes per day is admitted to the hospital with chest pressure. After myocardial infarction is ruled out, the client is diagnosed with erosive esophagitis through upper GI endoscopy. The client now refuses all medications and states, "I'm not getting hooked on any pills." What would the nurse recommend for the multidisciplinary collaborative plan? Select all that apply. A) Assess the client's readiness for change in smoking cessation and weight loss. B) Interview the client and spouse for a 24-hour recall of usual food content, intake, and meal times. C) Enlist the client's son to elevate the foot of the client's bed at home 6 inches. D) Offer the client a surgical consult to reduce the necessity of medication. E) Omit the pharmacist notification of the Multidisciplinary Team meeting about the client.

A,B) Weight loss and smoking cessation will improve the symptoms of GERD. Determining food types, amounts, and times of consumption can help the client avoid foods that stimulate acid production and avoid eating prior to lying down. The head of the bed should be elevated and the team should recommend this to the client rather than enlisting the client's son. A surgical consult should come from the primary provider and will not necessarily reduce the need for medication. The pharmacist should be included in the Multidisciplinary Team meeting to give input to strategies to improve the client's receptivity to medication therapy.

A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The nurse should anticipate prescriptions for which of the following medications? (Select all that apply.) A.Antacids B.Histamine2 receptor antagonists C.Opioid analgesics D.Fiber laxatives E.Proton pump inhibitors

A. CORRECT: Antacids neutralize gastric acid which irritates the esophagus during reflux. B. CORRECT: Histamine2 receptor antagonists decrease acid secretion, which contributes to reflux. C. Opioid analgesics are not effective in treating GERD. D. Fiber laxatives are not effective in treating GERD. E. CORRECT: Proton pump inhibitors decrease gastric acid production, which contributes to reflux.

A nurse is teaching a client who has a hiatal hernia. Which of the following client statements indicates an understanding of the teaching? A."I can take my medications with soda." B. "Peppermint tea will increase my indigestion." C. "Wearing an abdominal binder will limit my symptoms." D."I will drink hot chocolate at bedtime to help me sleep." E. "I can lift weights as a way to exercise."

A. Carbonated beverages decrease LES pressure and should be avoided by the client who has a hiatal hernia. B. CORRECT: Peppermint decreases LES pressure and should be avoided by the client who has a hiatal hernia C. Tight restrictive clothing or abdominal binders should be avoided by the client who has a hiatal hernia, as this increases intra‐abdominal pressure and causes the protrusion of the stomach into the thoracic cavity. D. The client should avoid consuming anything immediately prior to bedtime. Additionally, chocolate relaxes the lower esophageal sphincter and should be avoided by a client who has a hiatal hernia E. Heavy lifting and vigorous activities are to be avoided in the client who has a hiatal hernia.

A nurse is completing an assessment of a client who has GERD. Which of the following is an expected finding? A. Absence of saliva B. Loss of tooth enamel C. Sweet taste in mouth D. Absence of eructation

A. Hypersalivation is an expected finding in a client who has GERD. B. CORRECT: Tooth erosion is an expected finding in a client who has GERD. C. A client who has GERD would report a bitter taste in the mouth. D. Increased burping is an expected finding in a client who has GERD.

A nurse is admitting a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? A. Propranolol B. Metoclopramide C. Ranitidine D. Vasopressin

A. Propranolol is not used for clients who are actively bleeding. It can be given prophylactically to decrease portal hypertension. B. Metoclopramide decreases motility of the esophagus and stomach. C. Histamine2‐receptor antagonists are administered following surgical procedures for bleeding esophageal varices. D. CORRECT: Vasopressin constricts blood vessels and is used to treat bleeding esophageal varices.

A nurse is reinforcing teaching with a client who has PD and has received a prescription for bromocriptine (Parlodel). Which of the following instructions should the nurse include in the teaching? A. Rise slowly when standing B. Increase carbohydrate intake C. Limit exposure to heat D. Report any skin discolorations

A. Rise slowly when standing rationale: An adverse effect of Parlodel is orthostatic hypotension

A nurse is completing discharge teaching to a client who is postoperative following fundoplication. Which of the following statements by the client indicates understanding of the teaching? A. "When sitting in my lounge chair after a meal, I will lower the back of it." B. "I will try to eat three large meals a day." C. "I will elevate the head of my bed on blocks." D. "When sleeping, I will lay on my left side."

A. The client is instructed to remain upright after eating following a fundoplication. B. The client is instructed to avoid large meals after a fundoplication. C. CORRECT: After a fundoplication, the client is instructed to elevate the head of the bed to limit reflux. D After a fundoplication, the client is instructed to sleep on the right side.

Which of the following treatment options would least likely be considered for a 71-year-old client with osteoarthritis (OA)? A) Physical therapy B) Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) C) Weekly tai chi sessions D) Administration of narcotics

B) Acetaminophen is a first-line medication for older adults due to its efficacy and safety. Narcotics are a second-line choice, because they are safer than NSAIDs for older adults. Mindfulness exercises and complementary health approaches such as yoga or tai chi may assist older adults in increasing mobility and reducing pain levels. Physical therapy is especially important in older adults to maintain or improve mobility of joint(s).

The nurse is providing care to a client who is diagnosed with mild benign prostatic hyperplasia (BPH) who is experiencing urinary retention. Which goal is the most appropriate for this client? A) The client will increase fluid intake to at least 2-3 liters daily. B) The client lists over-the-counter medications to be avoided. C) The client will voice an understanding of the importance of the use of antiembolic stockings and compression devices. D) The client will use a T-binder or scrotal support properly.

B) Avoiding over-the-counter medications can lessen or prevent the symptoms associated with mild benign prostatic hyperplasia (BPH). An increased fluid intake can assist in preventing burning on urination after catheter removal and reduces the risk of a urinary tract infection. There is no indication that this client had surgery or had a catheter placed. The use of antiembolic stockings and compression devices reduces the risk of developing a thromboembolism. There is no indication that this client had surgery or is at risk for developing a thromboembolism. The use of a T-binder or scrotal support is for those clients that have undergone surgery and are in need of scrotal support and support of the surgical dressing. There is no indication that this client had surgery or had a catheter placed.

A client presents to the urologist with complaints of getting up to urinate several times a night and difficulty starting a stream of urine. After medical testing is completed, a diagnosis of benign prostatic hyperplasia (BPH) is made. After conducting teaching regarding BPH, which statement by the client indicates the need for further education? A) "Alpha blockers can be used to control my symptoms." B) "I know I will get cancer of the prostate because of this." C) "As my condition progresses, I may need to consider surgical management." D) "There are nonsurgical treatment options available."

B) BPH is a benign condition that that is not considered a precursor to cancer. It is caused by an increase in size of the prostate gland and is seen in older males. Alpha blockers will help control the symptoms. There are nonsurgical treatments available, such as medication to shrink the gland along with surgical management, such as resection.

The nurse on the medical unit is admitting an older adult client whose primary symptoms include fatigue, pruritus, and pain in the right flank area. When conducting this client's assessment, which technique is the least appropriate? A) Palpation over the costovertebral angles and flanks B) Blunt percussion over the costovertebral angles and flanks C) Palpation of the lower pole of both kidneys D) Capturing of both kidneys

B) Blunt percussion in a frail older individual is contraindicated. Instead, palpation of the costovertebral angles and flanks can be used to reveal any pain or tenderness. All other assessments are appropriate.

The nurse is providing care to a client in the healthcare clinic. The client's brother was recently diagnosed with benign prostatic hyperplasia (BPH), and the client wants to know if he is also at risk. Which item in the client's history increases the risk for BPH? A) Decreased levels of progesterone B) Increased levels of estrogen C) 35 years of age D) Testicle removal due to cancer

B) Clients with increased levels of estrogen are at an increased risk for developing BPH. Clients younger than 40 years of age are at a decreased risk for BPH. Having testicles removed prior to puberty due to cancer also decreases the risk of BPH.

The nurse completes a teaching session for a young adult client who was recently diagnosed with Parkinson disease (PD). Which client statement indicates this teaching has been effective? A) "I could have prevented PD with diet and exercise." B) "I probably have a genetic mutation that caused my PD." C) "My brain contains too much of a chemical called dopamine." D) "Most people with PD first experience symptoms when they are about my age."

B) Early-onset PD is likely due to a genetic mutation. Increasing age is a risk factor for the disease, and diagnosis as a young adult is uncommon. PD is associated with decreased dopamine levels in the brain, not an excess of dopamine. Although consuming a healthy, pesticide-free diet is recommended, dietary intake has not been definitively linked to development of PD.

An older adult client with bilateral osteoarthritis of the knees tells the nurse, "I know I need to lose weight, but exercising makes my knees ache." What instruction should the nurse provide to this client? A) "You should discuss knee replacement surgery with your physician." B) "Exercising the muscles in your legs might be hard now, but over time, it will help protect your knees." C) "Try eating a reduced-calorie diet for several months before attempting exercise." D) "You need to stretch your muscles, because stretching is the only form of exercise that improves osteoarthritis."

B) Encouraging exercise is an important aspect of nursing care for clients with osteoarthritis (OA). Exercise can increase flexibility, improve blood flow, and help clients lose weight. Over time, these factors can help protect the joints against further deterioration and pain. The nurse should not counsel the client to follow a reduced-calorie eating plan for several months before attempting exercise. The client may or may not want to have knee replacement surgery. Stretching is just one type of exercise that will benefit clients with OA. The other components, strengthening and aerobic exercise, can be obtained through walking, swimming, and isometric, isotonic, and resistive exercises.

The nurse is evaluating care provided to a client with osteoarthritis (OA). Which client statement indicates to the nurse that interventions for OA have been successful? A) "I had to take early retirement and now stay at home all day and rest my legs." B) "I am sleeping throughout the night and have not missed any work because of knee pain." C) "I am moving from my two-story house into the first floor of my daughter's home so I won't have to walk steps anymore." D) "I changed my work hours so now I work part time and have a nursing assistant who helps me bathe twice a week at home."

B) Expected outcomes for the care of a client with OA include independence with activities of daily living, minimal lifestyle impact because of OA, and controlled pain that allows for rest and sleep. Of the client statements provided, only the one about improved sleep and pain not interfering with work indicates achievement of these outcomes. A client who changes work hours and has a nursing assistant for bathing is experiencing a reduction in activities of daily living and a significant impact in lifestyle. A client who is moving in with a daughter is experiencing significant lifestyle impact. A client who retires early and stays at home all day is also experiencing a significant impact in lifestyle.

The nurse is triaging a client who presents to the urgent care clinic with symptoms of severe flank pain with spasms, nausea, vomiting, and oliguria. The client states that the pain was initially intermittent and radiated from the lower back to the lower quadrants of the abdomen. Which action by the nurse is the most appropriate? A) Complete the physical assessment. B) Consult a urologist immediately. C) Instruct the client to increase fluids. D) Obtain a urine specimen for culture.

B) Hydroureter is a complication that occurs when a renal calculus moves into the ureter and blocks and dilates the ureter. Symptoms include severe pain and spasms, nausea, vomiting, and diminished volume of urine. Hydroureter is a medical emergency that can lead to shock, infection, and subsequent impaired renal function; medical collaboration should be initiated immediately. All other options, while important to complete, would not be appropriate in an emergency situation.

Which statement most accurately describes why benign prostatic hyperplasia is more common in older men than in younger men? A) An increase in androgen production occurs with age, and increased androgens trigger prostatic growth. B) Hyperplasia of stromal and epithelial cells in the prostate gland occurs over a long period of time. C) A decrease in estrogen levels occurs over time and results in an increase in the size of the individual cells within the prostate. D) Frequency of urinary tract infections increases with age, and frequent UTIs contribute to changes in the prostate.

B) Hyperplasia is an increase in the number of cells; in the case of BPH, hyperplasia occurs in the cells of the prostate over a long period of time. As men age, androgen production decreases rather than increases. Estrogen levels increase with age rather than decreasing. UTIs are often a result rather than a cause of BPH.

On the first postoperative day after spinal fusion, the nurse assesses a client and notes the following vital signs: T 39.2°C, BP 100/50 mmHg, HR 118, and RR 23. Drainage at the client's incision site is clear and tests positive for glucose. Which assessment parameter indicates the highest risk for surgical wound infection? A) Temperature B) Incisional drainage positive for glucose C) Heart rate 118 bpm D) Presence of incisional drainage

B) Incisional drainage isn't necessarily problematic; however, the presence of glucose in this drainage is indicative of cerebrospinal fluid (CSF). A CSF leak increases the risk of infection of the surgical site and meninges. Temperature above 38°C is a fever. Fever may be a sign of infection anywhere in the body, not just at the surgical wound site. Similarly, the client's heart rate could be elevated for numerous reasons.

The nurse instructs a client with Parkinson disease (PD) about levodopa/carbidopa. Which client statement indicates that this teaching has been effective? A) "I should eat a high-protein diet when taking this medication." B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." C) "This medication will not affect my blood pressure medications." D) "Given enough time, this medication will cure my Parkinson disease."

B) Levodopa/carbidopa is a medication that boosts dopamine levels in clients with PD. This medication commonly causes orthostatic hypotension, so clients must take care when changing positions from lying to standing. Clients should also avoid eating protein-rich meals when taking this medication, as a high-protein diet may interfere with levodopa absorption from the GI tract. There is no medication that is known to cure Parkinson disease. Care must be taken if clients are also taking medications to lower their blood pressure because a cumulative effect may occur, leading to hypotension and increased risk for falling.

The nurse educator is speaking with a group of students about renal disorders. Which statement is appropriate for the educator to include regarding renal stones? A) Older adult clients are particularly at risk for urolithiasis. B) Young- or middle-adult men are at an increased risk for stones. C) Women have a greater risk overall than men. D) Frequency of stones is greater in the northern United States.

B) Men who are in young to middle adulthood are affected 2-3 times more than women of that age. The frequency of the occurrence of renal stones in the United States is greatest in the southern and midwestern states.

A client in the initial stages of Parkinson disease (PD) would most likely exhibit which of the following symptoms? A) Bilateral rigidity B) Unilateral tremors C) Bilateral tremors D) Unilateral rigidity

B) Motor symptoms associated with PD usually begin unilaterally, not bilaterally. For most clients, the earliest motor symptom is tremors; rigidity usually develops later in the course of the disease.

Which of the following terms is used to describe osteoarthritis (OA) that is caused by an underlying condition, such as injury, congenital malformation, or metabolic disease? A) Idiopathic B) Secondary C) Localized D) Generalized

B) OA can be classified as either idiopathic or secondary. Idiopathic OA has no identifiable cause. Idiopathic OA can be further divided into localized or generalized, with localized OA affecting one or two joints and generalized OA affecting three or more joints. Secondary OA is caused by an underlying condition, such as injury; congenital malformation; metabolic, endocrine, or neuropathic disease; or other medical cause.

The nurse is providing care to several clients in an outpatient clinic. Which client is at high risk of developing gastroesophageal reflux disorder (GERD)? A) A client who is 6 weeks pregnant B) A client who is morbidly obese C) A client who follows a strict vegetarian diet D) A client who drinks one glass of wine monthly

B) Obesity is a risk factor for GERD. Pregnancy is an increasing risk factor in the later stages due to pressure on the stomach. A vegetarian diet is not a risk factor for GERD. Rare alcohol consumption is not as strong a risk factor for GERD as morbid obesity.

A client seeking treatment for severe knee pain has worked in a factory for 30 years in a position requiring repetitive lifting and carrying of 20- to 40-pound boxes. Based on the client's history, the nurse should anticipate which initial recommendation from the multidisciplinary healthcare team? A) Joint replacement surgery B) Pharmacologic therapy C) Referral for a disability application D) Intermittent use of a cane

B) Of these options, pharmacologic therapy would be the most likely initial intervention. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and joint injections are all possible options. Joint replacement should be delayed as long as possible because artificial joints often require replacement within 15-20 years. There is not enough information to determine whether applying for disability is appropriate at this time. A cane is not indicated at this time.

A nurse is caring for four clients with renal calculi. Of these clients, which one should the nurse identify as having the highest likelihood of requiring surgery to remove the calculi? A) A 7-year-old with calcium phosphate stones of the bladder B) A 78-year-old client with struvite stones of the kidney C) A 31-year-old expectant mother with calcium oxalate stones of the kidney D) A 46-year-old with uric acid stones of the bladder

B) Older individuals are less likely to pass a stone spontaneously and are more likely to require surgical intervention for stones than younger clients, so the 78-year-old client should be considered at the highest risk for surgery. Additionally, struvite stones are more often treated with surgical intervention than other types of stones. Surgery is also contraindicated in pregnant clients.

A postmenopausal client asks the nurse what she can do to prevent fracturing her hips, as her mother and grandmother both experienced this health problem. Which response by the nurse is most appropriate? A) "You should avoid all types of exercise." B) "You should consider a smoking cessation program." C) "You should limit your exposure to the sun." D) "You should use throw rugs throughout your home."

B) One modifiable risk factor for hip fractures is smoking. Women who smoke have a greater risk of fracture because smoking reduces bone density in menopausal and postmenopausal women. The client should not be instructed to avoid exercise; exercise will enhance the client's gait, balance, and musculoskeletal strength. Limiting sun exposure will not impact the client's risk of experiencing a hip fracture. The nurse should not instruct the client to use throw rugs throughout the home because this could cause tripping, leading to a fall.

Which condition or symptom is most common in clients with a herniated cervical disc? A) Sciatica B) Stiff neck and shoulder pain C) Changes in knee and ankle reflexes D) Cauda equina syndrome

B) Sciatica, cauda equina syndrome, and changes in knee and ankle reflexes are all symptoms associated with lumbar disc herniation. Herniation of the cervical discs is more commonly associated with numbness, tingling, muscle spasms, and weakness in the upper body, as well as stiff neck and shoulder pain that radiates to the arms and fingers.

A client with Parkinson disease (PD) ambulates with a shuffling gait and leans slightly forward. When seated, the client conducts a conversation, reads, and is able to self-feed without assistance. Which nursing diagnosis is a priority for this client? A) Ineffective Coping B) Impaired Physical Mobility C) Imbalanced Nutrition: More than Body Requirements D) Anxiety

B) The client demonstrates a shuffled gait with forward leaning when ambulating. When seated, the client is able to converse, read, and self-feed. Of the diagnoses listed, the one with the highest priority would be Impaired Physical Mobility. Imbalanced Nutrition would not be a priority, as the client can feed himself. There is no evidence to support the diagnoses of Ineffective Coping or Anxiety at this time.

The nurse is providing care to a client who returns to the medical-surgical unit after herniated disc surgery. The client's vitals are as follows: HR 100, RR 22, BP 130/86 mmHg, T 98.8°F, and pain rating of 7 on a scale of 0 to 10. Which nursing diagnosis is the highest priority for this client based on these assessment data? A) Impaired Physical Mobility B) Acute Pain C) Activity Intolerance D) Chronic Pain

B) The client is currently experiencing acute pain as evidenced by elevated vital signs and a pain rating of 7 on a 0-to-10 scale. Thus, the priority nursing diagnosis is Acute Pain. Impaired Physical Mobility and Activity Intolerance are appropriate diagnoses in light of the client's surgical procedure, but they are not the highest priority. The client was likely experiencing chronic pain prior to the surgery, and it probably contributed to the need for the procedure.

The nurse is providing follow-up care for a client was recently diagnosed with benign prostatic hyperplasia (BPH). Which nursing diagnosis is the priority for the nurse to include in the client's plan of care? A) Chronic Pain B) Impaired Urinary Elimination C) Constipation D) Diarrhea

B) The priority diagnosis for a client diagnoses with BPH is Impaired Urinary Elimination. Acute pain, not chronic pain, is also an appropriate diagnosis. Clients with BPH have problems associated with urinary elimination, not bowel elimination. Constipation and Diarrhea are not appropriate nursing diagnoses for this client.

A client with a BMI of 35 is recovering from total hip replacement surgery and experiencing pain that is exacerbated with movement. The client says to the nurse, "I live alone. How will I ever be able to return to my home?" Based on this information, which is the priority nursing diagnosis for this client? A) Overweight B) Acute Pain C) Impaired Physical Mobility D) Ineffective Coping

B) The priority nursing diagnosis is Acute Pain. Unless this pain is controlled, the client will not be able to participate in interventions to address the nursing diagnosis of Impaired Physical Mobility. The diagnoses of Ineffective Coping and Overweight can be addressed after Acute Pain and Impaired Physical Mobility have been addressed.

The nurse is planning care for a client with osteoarthritis. Which nursing diagnosis would have the highest priority? A) Fatigue B) Chronic Pain C) Ineffective Coping D) Disturbed Body Image

B) When providing care to a client diagnosed with osteoarthritis, priority diagnoses would include Chronic Pain, Impaired Physical Mobility, and Self-Care Deficit. Thus, of the diagnoses identified for this client, Chronic Pain would be the highest priority. Once this diagnosis has been addressed, the nurse and client can focus on the lower priority diagnoses of Fatigue, Ineffective Coping, and Disturbed Body Image.

A client is recovering from surgery to repair a fractured hip. Which actions by the nurse may reduce this client's risk for osteomyelitis in the postoperative period? Select all that apply. A) Assess for pain every 1-2 hours. B) Use sterile technique for dressing changes. C) Assess wound for size, color, and drainage. D) Administer antibiotics as prescribed. E) Administer anticoagulants as prescribed.

B, C, D) Interventions that can reduce the client's risk for infection include using sterile technique for dressing changes; assessing the wound for size, color, and drainage; and administering antibiotics as prescribed. Assessing for pain every 1-2 hours is appropriate for the nursing diagnosis of Acute Pain, but it does not help reduce the risk of osteomyelitis. Administering anticoagulants per order is appropriate for the client who is at risk for deep vein thrombosis (DVT), but again, it does not help reduce the risk of osteomyelitis.

A client is being evaluated for Parkinson disease (PD). Which findings on the Unified Parkinson Disease Rating Scale (UPDRS) would be considered positive for PD? Select all that apply. A) Diarrhea B) Dystonia C) Retropulsion D) Hyperphonia E) Festination

B, C, E) The UPDRS rates clients in 42 different areas of function. Positive findings for PD include retropulsion (the tendency to fall backward), festination (rapid walking as if trying to run), and dystonia (twisting and repetitive movements). Diarrhea and hyperphonia (loud voice) are not symptoms of PD. Constipation and hypophonia (soft voice) are symptoms of PD.

A nurse is assessing a client for manifestations of PD. Which of the following are expected findings? SATA A. Decreased vision B. Pill-rolling C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression

B. Pill-rolling C. Shuffling gait D. Drooling F. Lack of facial expression rationale: refer to "physical findings of PD" card above

A nurse is developing a plan of care for the nutritional needs of a client who has stage 4 PD. Which actions should the nurse include in the plan of care? SATA A. Provide three large balanced meals B. Record diet and fluid intake C. Document weight every other week D. Place client in Fowler's position to eat E. Offer nutritional supplements between meals

B. Record diet and fluid intake E. Offer nutritional supplements between meals rationale: weight should be recorded weekly

The nurse is providing care to a client who is diagnosed with mild benign prostatic hyperplasia (BPH). Which lifestyle change is appropriate for this client? A) Increasing caffeine intake B) Increasing alcohol intake C) Urinating at first urge D) Using over-the-counter antihistamines

C) A client who is diagnosed with mild BPH is often treated with lifestyle changes and a "watchful waiting" approach. Urinating at first urge is a lifestyle change that is appropriate for this client. The client should also eliminate caffeine and alcohol from the diet. It is also important for this client to avoid using over-the-counter antihistamines.

The nurse is planning care for the client with chronic pain from herniated intervertebral discs who is also experiencing constipation. Which intervention should the nurse carry out to address constipation? A) Restrict foods high in fiber. B) Avoid the use of stool softeners. C) Encourage fluid intake of 2500-3000 mL each day. D) Medicate for pain around the clock.

C) A client with a herniated intervertebral disc could have problems with constipation because of reduced mobility. Interventions to alleviate and prevent constipation include encouraging fluid intake of 2500-3000 mL each day, encouraging foods high in fiber, and administering stool softeners to clients who cannot tolerate a high-fiber diet. Medicating for pain around the clock should be avoided if possible, because most pain medications have constipation as a side effect.

A client presents at the emergency department reporting a burning pain in the chest of a 7 on a 0 to 10 pain scale. Gastroesophageal reflux disorder (GERD) secondary to hiatal hernia is diagnosed. Based on this data, which is the priority nursing diagnosis? A) Dysfunctional Gastrointestinal Motility B) Anxiety C) Acute Pain D) Ineffective Health Maintenance

C) Acute pain management is the priority of nursing care. Anxiety may be decreased by relieving pain. Dysfunctional gastrointestinal motility and ineffective health maintenance are less urgent.

The nurse is planning care for a client who is 1 day postoperative after spinal fusion surgery. Which of the following is an appropriate outcome for this client? A) The client will remain in prone position. B) The client will maintain urine output at 20 mL per hour. C) The client will use the incentive spirometer every 2 hours. D) The client will void 12 hours after surgery.

C) An appropriate outcome for this client is the use of an incentive spirometer every 2 hours. The client is not expected to remain in a prone position, urine output should be at least 30 mL per hour, and the client should void within 8 hours of surgery.

The nurse is explaining the alteration in normal function to a client recently diagnosed with gastrointestinal reflux disease (GERD). Which etiology contributing to GERD will the nurse include in the teaching session? A) Transient constriction of the lower esophageal sphincter B) Decreased pressure within the stomach C) Incompetent lower esophageal sphincter D) Prolonged constriction of the upper esophageal sphincter

C) An incompetent lower esophageal sphincter remains open, allowing gastric acid to reflux into the esophagus. The lower esophageal sphincter is normally constricted except during swallowing. Increased pressure in the stomach can cause acid to reflux into the esophagus. The action of the upper esophageal sphincter is not a cause of GERD.

The nurse has implemented a care plan for an adult client with gastroesophageal reflux disorder (GERD). On the next clinic visit, which statement by the client indicates adherence to the plan of care? A) "I can wear snug spandex camisoles if I feel comfortable." B) "I have switched from margaritas to wine." C) "I've lost 6 pounds because I eat every 3 hours and never before bed." D) "I take a Tums with the ranitidine to make it work better."

C) Appropriate client outcomes are freedom from pain and knowledge of lifestyle changes to manage GERD. Weight loss, small, frequent meals, and avoiding lying down within 3 hours of eating indicate correct management. Tight-fitting clothing such as spandex camisoles can worsen GERD, regardless of whether the client feels comfortable wearing them. Changing from margaritas to wine will not improve GERD. Antacids such as Tums should be avoided within 1 hour before or after an H2-receptor blocker like ranitidine.

A client is recovering from prostate surgery on a medical-surgical unit. The client will be ready for discharge within the next few days. Which teaching point is appropriate for this client? A) The client should not drive for 6 weeks after surgery. B) The client should call the healthcare provider immediately for any bleeding. C) The client should incorporate fruit juice in his diet. D) The client should avoid heavy lifting for 2 weeks after surgery.

C) The client should be encouraged to incorporate fruit juice in his diet to help keep bowel movements regular and soft, as straining for bowel movements after surgery can cause increased pressure in the prostate area. The client may not drive for 2 weeks after surgery. The client is taught to avoid heavy lifting for 4-8 weeks after discharge and to call the doctor for heavy bleeding, though minor bleeding when defecating, coughing, or exercising is normal.

A client with osteoarthritis tells the nurse she has difficulty walking to the bathroom first thing in the morning. Which nursing action would assist this client? A) Suggesting a family member provide the client with a bedpan B) Discussing the option of residing in an assisted-living facility C) Consulting with physical therapy for an assistive walking device such as a walker or cane D) Suggesting the client use a bedside commode at home

C) Assistive devices are items used to maintain, increase, or improve function. The client describes difficulty walking to the bathroom in the morning. The best intervention to help this client would be to consult with physical therapy for an assistive walking device such as a walker or cane. The use of a bedside commode or bedpan may help with the immediate need to use the bathroom, but the client will still have difficulty ambulating in the morning. The option of residing in an assisted-living facility might be premature for this client.

The nurse is planning care for a client with Parkinson disease (PD). Which of the following nursing interventions aimed at the client's spouse would best support the client's continued mobility? A) Suggesting that the spouse use a blender to make foods easier for the client to swallow B) Reviewing the client's medication administration schedule with the spouse C) Instructing the spouse to ambulate the client at least four times a day D) Instructing the spouse on proper turning and repositioning techniques

C) Because exercise fosters not just mobility but also independence and self-esteem, the intervention that would be most appropriate is for the nurse to instruct the spouse to ambulate the client at least four times a day. Instructing on turning and repositioning techniques would not support physical mobility. Blending foods to aid with swallowing would not support physical mobility. Reviewing the medication administration schedule would not support physical mobility.

The nurse is caring for a 30-year-old female client who was recently diagnosed with Parkinson disease (PD). Which of the following statements should the nurse include in the teaching for this client? A) "Having the early-onset form of PD puts you at greater risk for dementia." B) "If you get pregnant, it is highly unlikely that you will be able to carry the baby to term." C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." D) "You can continue using birth control pills, because PD medications do not have an impact on their efficacy."

C) Clients with early-onset PD generally have a slower disease progression and a lower rate of dementia than clients who develop the disease later in life. The effect of PD medication on the efficacy of birth control pills is not known, so clients should be urged to consider other forms of contraception. Many women with PD have successfully carried healthy babies to full term.

A client is undergoing surgery for a fractured hip. The surgeon has stated that careful attention will be paid to preserving the epiphyseal plate. Which client will require this precaution during surgery? A) A postmenopausal woman with paraplegia B) A 32-year-old man who is a competitive body builder C) A prepubescent girl who is a vegetarian D) An 85-year-old woman with osteoporosis

C) Epiphyseal plates are unique joints that produce growth of bone length in children. There is an epiphyseal plate that lies between the head and neck of the femur that must be preserved during hip surgery in pediatric clients to prevent obstruction of bone growth. Of the clients listed here, only the prepubescent female is young enough to have an epiphyseal plate. All of the other clients are older than 18-25 years of age, when the epiphyseal plate closes.

The nurse is evaluating care provided to a client recovering from hip replacement surgery. Which piece of documentation in the medical record indicates that the client has achieved the expected outcome for pain management? A) The client states pain is a 6 on a numeric pain scale of 0 to 10 prior to evening care. B) The client is crying and requesting pain medication prior to morning care. C) The client is using a PCA pump around the clock and rates pain as a 2 on a numeric pain scale of 0 to 10. D) The client refuses pain medication prior to physical therapy. Pain is rated as a 7 on a numeric pain scale of 0 to 10.

C) Expected outcomes for pain management following hip replacement surgery are to minimize pain to a client rating of 3 or lower via medication administration, including use of patient-controlled analgesia (PCA) as appropriate. Completely eliminating pain is an unrealistic goal. Thus, only the client who is using the PCA pump and has a pain rating of 2 on a 0-to-10 scale has achieved an expected outcome for pain management.

A hip fracture that occurs in the trochanter region would be classified as a(n) A) intracapsular fracture. B) intercapsular fracture. C) extracapsular fracture. D) subcapsular fracture.

C) Hip fractures are broadly classified as either intracapsular or extracapsular. Intracapsular hip fractures occur at the head or neck of the femur within the capsule of the hip joint. Extracapsular hip fractures occur within the trochanter region, which is between the neck and diaphysis of the femur. Extracapsular fractures can be further divided into intertrochanteric or subtrochanteric. The terms intercapsular and subcapsular are not used to describe fractures of the hip.

A client with urinary calculi is admitted to the hospital. When planning care for this client, which goal is most appropriate? A) The client will lose 25 pounds in 3 months. B) The client will ambulate three times a day. C) The client will request pain medication at the onset of pain. D) The client will shower independently.

C) Intense pain is the hallmark of urinary calculi, or kidney stones, that are passing through the urinary system. The nurse teaches the client to request pain medication at the onset of pain in order to provide faster relief. The client with urinary calculi is able to ambulate and shower independently. Dietary changes will need to be made to prevent further formation of stones, but weight loss is not necessarily a goal with this disease process.

Which of the following procedures would be most appropriate to repair a finger joint that is affected by severe osteoarthritis (OA)? A) Osteotomy B) Joint resurfacing C) Joint fusion D) Internal fixation

C) Joint fusion is used to permanently fuse two or more bones together at a joint using pins, plates, screws, and rods. It is often recommended for badly damaged smaller joints, such as the spine, wrist, ankle, finger, or toe. Osteotomy is usually performed on the knee and hip and entails surgical removal of a wedge of bone above or below the joint to realign the joint and shift the weight away from the damaged portion of the joint. Joint resurfacing, which involves removing a small amount of bone at the articulating surface of the joint and fitting a metal replacement over the end of the bone, is often performed for hip and shoulder joints. Internal fixation is used to fix fractures, not to address osteoarthritis.

A nurse is teaching the parents of a client who was recently diagnosed with osteoarthritis (OA) about their child's condition. Which statement by the parents indicates the need for further instruction? A) "Our daughter's OA is likely related to a joint injury she sustained last year." B) "Most kids with OA usually have only one or two affected joints." C) "Because our daughter developed OA as a child, she is more likely to become disabled as a result of this condition." D) "Our daughter may outgrow her OA as she ages."

C) Juvenile OA is usually secondary to a congenital abnormality, genetic condition, or joint injury. It typically occurs only in the one or two joints affected by the abnormality or injury. Children with OA are less likely to become disabled and may outgrow the condition as they age. Thus, the parents' statement about an increased likelihood of disability indicates the need for further instruction.

Why do clients with Parkinson disease (PD) nearly always take carbidopa in combination with levodopa? A) Carbidopa minimizes the conversion of levodopa to dopamine within the brain, thus minimizing levodopa's unwanted side effects. B) Carbidopa enhances levodopa's conversion to dopamine throughout the body, thus intensifying levodopa's effectiveness. C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. D) Carbidopa prevents levodopa's conversion to dopamine in the brain, thus intensifying levodopa's effectiveness.

C) Levodopa is a natural chemical that can cross the blood—brain barrier and be converted directly to dopamine in the brain. Levodopa can also be converted to dopamine outside the brain, which leads to the most common side effects of nausea and orthostatic hypotension. Therefore, levodopa is almost always given in combination with carbidopa, which prevents levodopa from converting to dopamine until it reaches the brain.

Which of the following is not a common clinical manifestation of Parkinson disease (PD)? A) Restless leg syndrome B) Cogwheel rigidity C) Malignant hypertension D) Pill-rolling

C) Malignant hypertension is not a clinical manifestation of PD; orthostatic hypotension is more commonly associated with this disease. All of the other conditions listed here (restless leg syndrome, cogwheel rigidity, and pill-rolling) are frequently observed in clients with PD.

The nurse is providing teaching to the client recently diagnosed with osteoarthritis. Which statement by the nurse is correct? A) "Osteoarthritis is most commonly seen in thin, small-built female clients." B) "Osteoarthritis is a result of joint inflammation." C) "Osteoarthritis occurs due to erosion of cartilage in the joints." D) "Osteoarthritis is a metabolic bone disease."

C) Osteoarthritis is characterized by progressive erosion of the cartilage within joints. It is not a metabolic bone disease; examples of such diseases include osteoporosis, osteomalacia, and Paget disease. Thin, small-built female clients are at increased risk for osteoporosis, not osteoarthritis. In fact, osteoarthritis is more commonly associated with obesity than with slight build. Finally, joint inflammation is a characteristic of rheumatoid arthritis, not osteoarthritis.

A pediatric client is diagnosed with gastroesophageal reflux disorder (GERD). The nurse is observing a return demonstration of the caregiver preparing and feeding the infant formula. Which observation demonstrates correct procedure for preventing GERD symptoms? A) Burping the infant after 4 ounces of formula are taken B) Thinning the formula with water prior to feeding C) Positioning the infant upright for a minimum of 30 minutes D) Warming the formula prior to feeding

C) Positioning the infant upright for 30 minutes after a feeding can reduce GERD symptoms. Infants with GERD should be burped after every 1-2 ounces of formula are taken. Prethickened formulas can also reduce GERD symptoms. Warming the formula does not impact GERD symptoms.

The nurse is providing care to a client who is diagnosed with benign prostatic hyperplasia (BPH). The client's primary concern is burning and difficulty when urinating. Based on this data, which nursing diagnosis is the priority for this client? A) Fluid Volume Overload B) Fluid Volume Deficit C) Acute Pain D) Deficient Knowledge

C) The client is experiencing burning and other difficulties during urination. The burning indicates the client is experiencing pain and would indicate a priority nursing diagnosis of acute pain. There is no evidence of fluid volume overload, fluid volume deficit, or knowledge deficit.

A client is admitted to the emergency department and diagnosed with renal colic after experiencing symptoms for 1 week, including those associated with the body's sympathetic response to severe pain. When planning care for this client, which nursing diagnosis is the most appropriate? A) Risk for Constipation B) Risk for Disuse Syndrome C) Imbalanced Nutrition D) Activity Intolerance

C) The client with renal colic of lengthy duration is at risk for imbalanced nutrition from the resulting nausea. Activity intolerance, risk for constipation, and risk for disuse syndrome are not as appropriate because the symptoms of urinary calculi do not lead to these diagnoses.

The nurse is evaluating the care of a client with Parkinson disease (PD). Which finding indicates an improvement in the client's nutritional status? A) The client filled out the menu card for each meal. B) The client coughs frequently when drinking fluids. C) The client was able to feed himself and had no weight change in 1 week. D) The client had a 4-pound weight loss in 1 week.

C) The finding that the client was able to feed himself and had no weight change in 1 week is indicative of an improvement in nutritional status. The client filling out the menu card does not indicate that the client actually consumed any of the meal. If the client coughs frequently when drinking fluids, it could indicate that interventions to address nutritional status have not been effective. The client's losing 4 pounds in 1 week would not support an improvement in nutritional status.

The first day after surgery to repair a fractured hip sustained from a fall, an older adult client refuses to ambulate but states, "I will consider it tomorrow." In this situation, which is the priority action by the nurse? A) Coordinate personnel to assist with ambulation B) Document the client's refusal C) Assess why the client is refusing to ambulate D) Notify the healthcare provider

C) The first thing the nurse should do is assess why the client is refusing to ambulate. The client might be fearful of falling, given that a prior fall resulted in a fractured hip. Following this assessment, the nurse could plan interventions that would facilitate ambulation, such as controlling pain and reducing the fear of falling. It is premature to notify the healthcare provider. The nurse should not force the client to get out of bed. Documenting the client's refusal is appropriate, but after determining the reason for the refusal.

Which region of the spine is the most common location of herniated discs? A) Cervical region B) Thoracic region C) Lumbar region D) Sacral region

C) The most common location of herniated discs is the lumbar region (L4-L5 and L5-S1), followed by the cervical region (C5-C6 and C6-C7).

The nurse is caring for a middle-aged male client who is experiencing urinary retention. The client asks the nurse if it is possible that he is experiencing benign prostatic hyperplasia (BPH). During the client history, the client reports that he is of Japanese descent. Which response by the nurse is the most appropriate? A) "No, you are not old enough to have BPH." B) "Your symptoms are not consistent with BPH." C) "You are considered low-risk for BPH." D) "Where did you get an idea that you might have BPH?"

C) The nurse must always provide honest responses to client questions. The nurse should tell the client that due to his ethnicity, he is considered low-risk for developing BPH. While age does increase the risk of BPH, it is not the only factor to consider. The client is experiencing urinary retention, which is consistent with BPH. Asking a client where he got that idea is demeaning.

The wife of a client with Parkinson disease (PD) expresses frustration about trying to communicate with her husband. What can the nurse do to facilitate communication between the client and spouse? A) Recommend that the client and spouse learn sign language. B) Suggest that the spouse obtain a hearing aid. C) Consult with speech therapy for exercises to aid the client with speech and language. D) Suggest the client and spouse communicating by writing.

C) The spouse is frustrated with the client's impaired verbal communication. The best intervention would be to consult with speech therapy for exercises to aid the client with speech and language. The spouse does not need a hearing aid. The spouse and client do not need to learn sign language in order to communicate. The client may or may not be able to write because of hand tremors, so it may not be appropriate for the nurse to suggest that the client and spouse communicate via writing.

An adolescent client with scoliosis has a Cobb angle of 32 degrees. Given this information, what treatment will the nurse likely need to prepare the client for? A) This client will not need specific treatment. B) The nurse will prepare the client for physical therapy. C) The nurse will prepare the client for wearing a brace. D) The nurse will prepare the client for undergoing spinal fusion surgery.

C) Typically, clients with Cobb angles less than 15 degrees do not require treatment. Clients with Cobb angles of 15 to 25 degrees are treated conservatively with physical therapy, whereas clients with Cobb angles between 25 and 40 degrees are advised to wear a corrective brace. For clients with Cobb angles in excess of 40 degrees, spinal fusion surgery is the most effective option.

The nurse is caring for a client diagnosed with benign prostatic hyperplasia (BPH) who is experiencing an increase in symptoms. Which statement by the client would best explain the source of the increased symptoms? A) "I have decreased oral intake at night." B) "I recently had a vasectomy." C) "I am using an over-the-counter cold medication for a cold." D) "I am drinking very little caffeine."

C) Use of cold medications can increase symptoms because of their anticholinergic properties. Avoiding caffeine and decreasing oral intake at night may resolve symptoms. A vasectomy does not affect the symptoms of BPH.

Which of the clients described below are at increased risk for back problems? Select all that apply. A) A 45-year-old man who has played golf three times a week for the past 20 years B) An 18-year-old woman who has been a distance runner since middle school C) A 62-year-old man who is a heavy truck mechanic and has a body mass index (BMI) of 30 D) A 12-year-old boy who has a history of cerebral palsy and a current BMI of 21 E) A 78-year-old man with a 40 pack-year smoking history who was recently widowed

C, D, E) Factors that increase the risk of herniated intervertebral discs include male gender, age (clients over 30 are at higher risk), obesity, history of smoking, and regularly engaging in heavy lifting. This means both the 62-year-old client and the 78-year-old client have multiple traits that put them at elevated risk of disc herniation. Risk factors for scoliosis include age of between 9 and 15 and history of cerebral palsy; thus, the 12-year-old client is at elevated risk for this condition. Neither playing golf nor running track causes a high risk of back problems.

The nurse is documenting the interdisciplinary team report on an adolescent client who has a 35-degree Cobb angle confirmed by x-ray. What interventions should the nurse anticipate being included in the collaborative plan of care for this client? Select all that apply. A) Obtaining a physical therapy consult prior to surgical intervention B) Maintaining the existing curvature with no increase C) Bracing for 12-23 hours per day and providing a support group referral D) Administering nonopioid analgesics and a TLSO or Milwaukee brace E) Instructing the client on exercises and appropriate support groups

C, D, E) Treatment of children with a Cobb angle between 25 and 45 degrees consists of bracing for 12-23 hours per day with a TLSO or Milwaukee brace, mild pain medication, counseling or support group referral, and exercise to improve posture and maintain or increase spine flexibility. Mild scoliosis requires observation every 3-6 months. Severe scoliosis requires surgical intervention and subsequent physical therapy.

A nurse is caring for a client who displays signs of stage 3 PD. Which of the following actions should the nurse include in the plan of care? A. Recommend a community support group B. Integrate a daily exercise routine C. Provide a walker for ambulation D. Consult with dietitian

C. Provide a walker for ambulation rationale: Stage 3 = physical movements slow, affects walking more

A client admitted to the hospital with a diagnosis of inflammatory bowel disease has also been diagnosed with calcium phosphate renal calculi. When planning care for this client, which type of medication does the nurse anticipate based on the data? A) Antibiotic B) Allopurinol C) Nonsteroidal anti-inflammatory drug (NSAID) D) Thiazide diuretic

D) A thiazide diuretic is used to prevent the formation of calcium stones. Allopurinol is often prescribed to prevent stones that tend to form in acidic urine (uric acid). Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and discomfort and may reduce the amount of narcotic analgesia required for acute renal colic. Antibiotics are used to help prevent struvite stones.

A client is recovering from minimally invasive surgery due to a diagnosis of benign prostatic hyperplasia (BPH). After assessing the client, the nurse expects which outcome for this client? A) Bowel continence B) Absence of pain C) No postoperative treatment D) Urinary continence

D) After surgery and removal of the catheter, the client should return to urinary continence as expected. The client will need postoperative teaching and will experience some amount of discomfort. Most clients, due to pain and swelling in the area, may have problems with constipation immediately following the surgical intervention.

In planning care for a 32-year-old pregnant client with worsening GERD in her second trimester, which teaching would be inappropriate? A) Eat smaller and more frequent meals. B) Avoid foods that are known to be triggers for GERD. C) Proton pump inhibitors (PPIs) are safe to use, with the exception of omeprazole. D) The use of antacids containing sodium bicarbonate is recommended.

D) Antacids that contain sodium bicarbonate can lead to fluid retention, and pregnant women should avoid using them. Antacids that contain calcium carbonate, which do not cause fluid retention, may be an appropriate alternative. For clients with mild-to-moderate GERD, lifestyle modifications may be enough to control symptoms. Eating small, frequent meals and avoiding foods that trigger symptoms may help. The majority of PPIs are considered safe for use by pregnant women; the exception is omeprazole. The FDA has concerns about fetal safety associated with maternal omeprazole use.

Clients with osteoarthritis (OA) can reduce their risk of further joint damage by doing which of the following? A) Applying topical analgesic creams as prescribed B) Avoiding movement of affected joints C) Taking acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) before joint pain becomes severe D) Receiving cortisone injections in affected joints no more than three times per year

D) Because frequent use of corticosteroids can cause joint damage, clients should receive cortisone injections in affected weight-bearing joints no more than three or four times per year. Avoiding movement of affected joints does not reduce the risk of joint damage; rather, it worsens the effects of OA. Applying topical analgesics and taking acetaminophen and NSAIDs reduces the pain of OA but does not reduce the risk of further joint damage.

The nurse is caring for a client with a history of kidney stones. The stones have been analyzed and are all composed of calcium phosphate. Based on this data, which foods should the nurse teach the client to avoid? A) Chicken, beef, and ham products B) Organ meats, sardines, and seafood C) Tomatoes, fruits, and nuts D) Flour, milk, and ice cream

D) Flour, milk, and milk products such as ice cream have high calcium levels and, therefore, are recommended to be reduced to decrease the risk of further episodes of calcium-containing calculi. Organ meats, sardines, seafood, tomatoes, fruits, nuts, chicken, beef, and ham products are not high in calcium and do not need to be restricted for this client.

A client with a history of urinary calculi presents with frequency, urgency, and dysuria. A urinalysis reveals formation of crystals in the urine, known as nucleation. Based on this finding, which statement is true about the composition of the client's urine? A) It has a high concentration of citrate and glycoproteins. B) It has a pH of 7.0. C) It contains trace amounts of blood. D) It has a high concentration of insoluble salt.

D) High insoluble salt concentration in the urine—known as supersaturation—leads to formation of crystals in the urine. Citrate and glycoproteins are protective substances in the urine that prevent crystals from forming and would be low in urine containing crystals. A pH of 7.0 is neutral, and urine crystals tends to be either acid or alkaline. While trace amounts of blood may be in the urine, blood is not a finding consistent with crystal formation.

Which of the following procedures used in the treatment of osteoarthritis (OA) involves removing a small amount of bone at the articulating surface of the joint and fitting a metal replacement over the end of the bone? A) Osteotomy B) Arthroplasty C) Arthroscopy D) Joint resurfacing

D) In joint resurfacing, a small amount of bone is removed at the articulating surface of the joint and a metal replacement is fitted over the end of the bone. Osteotomy involves surgical removal of a wedge of bone above or below the joint to realign the joint and shift the weight away from the damaged portion of the joint. Arthroscopy entails insertion of a small fiber optic light source, magnifying lens, and camera into the joint to visualize the joint structures. Arthroplasty is total joint replacement, in which a surgeon removes the damaged joint surfaces and replaces them with plastic, metal, or ceramic prostheses.

For non-elderly adult clients who fracture a hip, why is internal fixation or casting of the fracture generally preferred over hip replacement? A) Internal fixation or casting is preferred because it does not disturb the client's epiphyseal plate. B) Internal fixation or casting is preferred because of the lower risk of deep vein thrombosis. C) Internal fixation or casting is preferred because of the shorter recovery time. D) Internal fixation or casting is preferred because of the limited longevity of hip prostheses.

D) Non-elderly adults are likely to live beyond the decade or so anticipated lifespan of a replacement hip. Internal fixation and casting are the preferred treatment methods for these clients because hip replacement may eventually necessitate revision surgery, which carries a greater level of risk than the initial hip replacement surgery. Protection of the epiphyseal plate is not a concern in adult clients, because they no longer have epiphyseal plates. Internal fixation, casting, and hip replacement all carry a similar risk of deep vein thrombosis, and none of these methods offers a definitive benefit in terms of recovery time.

An older adult client experiences a hip fracture. Prior to the injury, the client had an active lifestyle. Based on this information, which surgical procedure should the nurse anticipate? A) Total hip replacement B) Open reduction and external fixation C) Arthroplasty D) Open reduction and internal fixation

D) Open reduction and internal fixation is the preferred surgical procedure to repair a fractured hip for older adult clients who are active and will be able to use crutches with partial weight bearing following surgery. A total hip replacement, also called arthroplasty, is generally performed only when severe arthritis or an underlying bone condition is present, which does not appear to be the case given this client's activity level prior to the injury. Open reduction and external fixation is not a surgical option for a fractured hip.

A client with chronic hip pain is diagnosed with osteoarthritis. Which instruction regarding home safety is most appropriate for the nurse to provide to this client? A) Walk up and down the steps at home as much as possible. B) Rest in a recliner. C) Place scatter rugs in high-traffic areas. D) Install grab bars in the bathroom near the commode and in the shower.

D) The client should be encouraged to install grab bars in the bathroom near the commode and in the shower. The client should be instructed not to overuse the affected joints with excessive stair climbing. Scatter rugs are a hazard to mobility and should be avoided. The client should also be instructed to sit in a straight-back chair, avoid slumping, and avoid use of a recliner.

The nurse is preparing to discharge a client who underwent lithotripsy for the treatment of a kidney stone. What should the nurse teach the client to prevent further complications of urinary calculi after discharge? A) "You will need to increase your oral fluid intake to 1 L/day." B) "It will be important that you not drive while taking pain medications." C) "It will be important to maintain a diet high in purines." D) "You will need to monitor for the signs and symptoms of a urinary tract infection (UTI)."

D) The client with stones may develop a UTI when formed stones obstruct urinary flow. These symptoms should be reported as early as possible to the primary care provider. By discharge, the stones should have passed and there would be no need for pain medication. Fluid intake per day should be 2.5-3.0 L. Foods high in purines, such as organ meats, are to be avoided.

During a home care visit, an older adult client begins to cry softly when asked about coping with back pain. The client states, "My back hurts bad all the time. I am so confused about all these tests and scared that the doctor wants me to have surgery." In this scenario, which of the following nursing interventions is the highest priority? A) Asking the client to rate the pain on a scale of 0 to 10 B) Explaining potential procedures in a way the client will understand C) Administering all pain medication as ordered D) Attentively listening to the client's thoughts and fears

D) The priority nursing intervention for a client who is ready to disclose emotions is to attentively listen to the client's thoughts and fears. If the nurse is asking about coping, a general back pain assessment and medication administration has already likely been completed. Explaining potential procedures will be done after the assessment is complete and the plan of care is set in place.

The nurse is providing care to a client who is diagnosed with benign prostatic hyperplasia (BPH). Which items in the client's health history indicate a risk factor for this diagnosis? Select all that apply. A) Excessive exercise B) Decreased fluid intake C) Diet high in milk D) 70 years of age E) African American ethnicity

D, E) Although the exact cause is unknown, risk factors associated with BPH include increasing age. No link has been made to fluid intake, milk or exercise.

A nurse is caring for a client who has PD and displays signs of bradykinesia. Which of the following is an appropriate action by the nurse? A. Allow the client extra time for verbal response to questions B. Complete passive ROM exercises C. Provide alternate form of communication D. Assist with hygiene as needed

D. Assist with hygiene as needed rationale: the other choices are important but hygiene help is needed. ROM should be active not passive

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following clinical manifestations should the nurse expect to find?

Heberden's nodes, enlarged joint size, limp when walking

The nurse is caring for an adult client diagnosed with GERD. Which condition is the most common comorbid disease associated with GERD? 1. Adult-onset asthma. 2. Pancreatitis. 3. Peptic ulcer disease. 4. Increased gastric emptying.

Of adult-onset asthma cases, 80% to 90% are caused by gastroesophageal reflux disease (GERD). Pancreatitis is not related to GERD. Peptic ulcer disease is related to H. pylori bacterial infections and can lead to increased levels of gastric acid, but it is not related to reflux. GERD is not related to increased gastric emptying. Increased gastric emptying would be a benefit to a client with decreased functioning of the lower esophageal sphincter. TEST-TAKING HINT: Some questions are knowledge based. There are no test-taking strategies for knowledge-based questions.

The client with a cervical neck injury as a result of a motor-vehicle accident is complaining of unrelieved pain after administration of a narcotic analgesic. Which alternative method of pain control is an independent nursing action? 1. Medicate the client with a muscle relaxant. 2. Heat alternating with ice applied by a physical therapist. 3. Watch television or listen to music. 4. Discuss surgical options with the health-care provider.

This is distraction and is an alternative method often recommended for the promotion of client comfort. The others surgeries are examples of collaborative care. TEST-TAKING HINT: The question asks for an alternative, independent type of care. Options "1," "2," and "4" are all collaborative care. If the test taker can find a common thread among three of the options, then the correct answer will be the other option.

A nurse is providing information to a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include in the information?

apply heat to joints to alleviate pain, ice inflamed joints following activity, install an elevated toilet seat, complete high-energy activities in the morning

A nurse is providing information about capsaicin (Capsin) cream to a client who reports continuous knee pain from osteoarthritis. Which of the information should the nurse include in the discussion?

inspect for skin irritation and cuts prior to application

A nurse is providing educational information on glucosamine to a group of clients at a health fair. Which of the following should the nurse include in the teaching?

the medication aids in the rebuilding of cartilage