Adult Med Surg 1 Test #4 practice Questions

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? a) "After menopause, the body's bone density declines, resulting in a gradual loss of height." b) "There may be some slight discrepancy between the measuring tools used." c) "The posture begins to stoop after middle age." d) "After age 40, height may show a gradual decrease as a result of spinal compression"

"After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

34. A patient has experienced occasional urinary incontinence in the weeks since his prostatectomy. In order to promote continence, the nurse should encourage which of the following? A) Pelvic floor exercises B) Intermittent urinary catheterization C) Reduced physical activity D) Active range of motion exercises

A Feedback: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment?

Signs of neurovascular compromise

Pulselessness, a very late sign of compartment syndrome, may signify

Lack of distal tissue perfusion

Elderly clients who fall are most at risk for which injuries?

Pelvic fractures

Which term refers to a fracture in which one side of a bone is broken and the other side is bent?

Greenstick

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

Nonunion

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse?

"CPM increases range of motion of the joint."

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "Using arm splints will prevent hyperflexion of the wrist." b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." c) "Surgery is the only sure way to manage this condition." d) "This condition is associated with various sports."

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

10. It is 2 days after a 42-year-old male patient's urinary diversion surgery. He continues to be critical of the hospital and the nursing care, even though the staff has spent time explaining the care to him. What is the most likely explanation for his behavior? a. He is angry about hospital policy. b. He is feeling neglected by the nursing staff. c. He is in denial of the effects of the surgery. d. He is reacting to the loss of self-esteem and altered body image.

ANS: D Persons with altered body image may react to the loss of self-esteem by behaving in a critical or derogatory manner. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1675 OBJ: 10 TOP: Coping KEY: Nursing Process Step: Assessment

8. A patient who is receiving continuous bladder irrigation following a transurethral resection of the prostate (TURP) complains of "spasm-like" pain over his lower abdomen. What should the initial intervention be by the nurse? a. Inform the nurse in charge b. Decrease the continuous bladder irrigation flow c. Administer the prescribed analgesic d. Check the catheter and drainage system for obstruction

ANS: D The patient who has a TURP may have continuous closed bladder irrigation or intermittent irrigation to prevent occlusion of the catheter with blood clots, which would cause bladder spasms. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

20. The patient is on postoperative day 1 after having undergone a TURP procedure. He has continuous bladder irrigation (CBI). Actual urine output during continuous bladder irrigation is calculated by: a. measuring and recording all fluid output in the drainage bag. b. measuring the total output and deducting the total of the irrigating and intravenous solutions. c. adding the total of the intravenous and irrigating solutions and then deducting the amount of output. d. measuring total output and deducting the amount of irrigating solution used.

ANS: D To determine urine output, the nurse will subtract the amount of irrigation fluid used with the Foley catheter output to calculate urine output. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

Open reduction

A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet? a) Green vegetables b) Red meat c) Bananas d) Vitamin D-fortified milk

Vitamin D-fortified milk Explanation: The nurse should advise the patient to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted

Which of the following diagnostics confirms Paget's disease? a) Blood calcium level b) X-ray c) Bone scan d) Bone biopsy

X-ray Explanation: X-rays confirm the diagnosis of Paget's disease. Local areas of demineralization and bone overgrowth produce characteristic mosaic patterns and irregularities. Bone scans demonstrate the extent of the disease. A bone biopsy may aid in the differential diagnosis.

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care?

"Keep your right leg elevated above heart level."

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? a) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." b) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." c) "Bunions are congenital and can't be prevented." d) "Bunions are caused by a metabolic condition called gout."

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You need to perform weight-bearing exercises twice a week." b) "You will receive IV antibiotics for 3 to 6 weeks." c) "You need to limit the amount of protein and calcium in your diet." d) "Use your continuous passive motion machine (CPM) 2 hours each day."

"You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks.

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

- Allowing the client to express grief - Encouraging the client to care for the residual limb - Introducing the client to local amputee support groups

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.)

- Excruciating pain - Decreased sensory function - Loss of motion

An older adult client experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.

- Loss of visual acuity - Muscle weakness - Adverse medication effects - Slowed reflexes

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

- wound infection - skin breakdown - pneumonia

Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point. A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client? ml

0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml.

12. The nurse notes the amount and color of the urine the patient with urolithiasis has voided. While using Standard Precautions, what should be the nurse's next action? a. Discard the urine b. Add the urine to a 24-hour collector c. Send the urine to the laboratory d. Strain the urine

ANS: D All urine should be strained. Because stones may be any size, even the smallest speck must be saved for assessment by the laboratory. PTS: 1 DIF: Cognitive Level: Application REF: Page 1697 OBJ: 8 TOP: Urolithiasis KEY: Nursing Process Step: Planning

19. A man tells the nurse that his father died of prostate cancer and he is concerned about his own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A) A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B) HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C) Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D) Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

A Feedback: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HPNCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

22. A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply. A) Phimosis B) Priapism C) Herpes simplex infection D) Increasing age E) Lack of circumcision

A,D,E Feedback: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of age), lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk factors.

31. A nurse is providing care for a patient who has recently been admitted to the postsurgical unit from PACU following a transuretheral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A) Closely monitoring the input and output of the bladder irrigation system B) Administering parenteral nutrition and fluids as ordered C) Monitoring the patient's level of consciousness and skin turgor D) Scanning the patient's bladder for retention every 2 hours

A Feedback: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

13. A patient has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens? A) Continuous inflow and outflow of irrigation solution B) Intermittent inflow and continuous outflow of irrigation solution C) Continuous inflow and intermittent outflow of irrigation solution D) Intermittent flow of irrigation solution and prevention of hemorrhage

A Feedback: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution.

24. A patient who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that he is experiencing occasional "dribbling" of urine. How should the nurse best respond to this patient's concern? A) Inform the patient that urinary control is likely to return gradually. B) Arrange for the patient to be assessed by his urologist. C) Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D) Teach the patient to perform intermittent self-catheterization.

A Feedback: It is important that the patient know that regaining urinary control is a gradual process; he may continue to dribble after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

2. As the body breaks down protein, nitrogen wastes are broken down into urea, ammonia, and: a. nitrogen. b. uric acid. c. nitrates. d. creatinine.

ANS: D As proteins break down, nitrogenous wastes—urea, ammonia, and creatinine—are produced. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1671 OBJ: 4 TOP: Physiology KEY: Nursing Process Step: Assessment

32. A 22-year-old male is being discharged home after surgery for testicular cancer. The patient is scheduled to begin chemotherapy in 2 weeks. The patient tells the nurse that he doesn't think he can take weeks or months of chemotherapy, stating that he has researched the adverse effects online. What is the most appropriate nursing action for this patient at this time? A) Provide empathy and encouragement in an effort to foster a positive outlook. B) Tell the patient it is his decision whether to accept or reject chemotherapy. C) Report the patient's statement to members of his support system. D) Refer the patient to social work.

A Feedback: Patients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the patient's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the patient's statement to members of his support system and there is no obvious need for a social work referral.

16. A 35-year-old man is seen in the clinic because he is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A) Chronic bacterial prostatitis B) Orchitis C) Benign prostatic hyperplasia D) Urolithiasis

A Feedback: Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The patient may experience nocturia, urgency, decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.

17. To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what? A) Report the planned use of dietary supplements to the physician. B) Decrease the intake of fluids to prevent urinary retention. C) Abstain from sexual activity for 2 weeks following the initiation of treatment. D) Anticipate a temporary worsening of urinary retention before symptoms subside.

A Feedback: Some herbal supplements are contraindicated with Proscar, thus their planned use should be discussed with the physician or pharmacist. The patient should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.

12. A public health nurse is teaching a health class for the male students at the local high school. The nurse is teaching the boys to perform monthly testicular self-examinations. What point would be appropriate to emphasize? A) Testicular cancer is a highly curable type of cancer. B) Testicular cancer is very difficult to diagnose. C) Testicular cancer is the number one cause of cancer deaths in males. D) Testicular cancer is more common in older men.

A Feedback: Testicular cancer is highly curable, particularly when it's treated in its early stage. Self-examination allows early detection and facilitates the early initiation of treatment. The highest mortality rates from cancer among men are with lung cancer. Testicular cancer is found more commonly in younger men.

11. A nurse is teaching a 53-year-old man about prostate cancer. What information should the nurse provide to best facilitate the early identification of prostate cancer? A) Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. B) Have a transrectal ultrasound every 5 years. C) Perform monthly testicular self-examinations, especially after age 60. D) Have a complete blood count (CBC), blood urea nitrogen (BUN) and creatinine assessment performed annually.

A Feedback: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that should be done yearly. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

30. A 29-year-old patient has just been told that he has testicular cancer and needs to have surgery. During a presurgical appointment, the patient admits to feeling devastated that he requires surgery, stating that it will leave him "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the patient's subsequent care? A) Disturbed Body Image Related to Effects of Surgery B) Spiritual Distress Related to Effects of Cancer Surgery C) Social Isolation Related to Effects of Surgery D) Risk for Loneliness Related to Change in Self-Concept

A Feedback: The patient's statements specifically address his perception of his body as it relates to his identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This patient is at risk for social isolation and loneliness, but there's no indication in the scenario that these diagnoses are present. There is no indication of spiritual element to the patient's concerns.

38. The nurse is leading a workshop on sexual health for men. The nurse should teach participants that organic causes of erectile dysfunction include what? Select all that apply. A) Diabetes B) Testosterone deficiency C) Anxiety D) Depression E) Parkinsonism

A,B,E Feedback: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic renal failure, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.

14. The patient with nephrosis complains about the need for bed rest. How would the nurse explain the benefit of bed rest? a. The recumbent position may initiate diuresis. b. It preserves the skin integrity. c. It lowers the level of albuminuria. d. It saves stress on joints.

ANS: A It is believed that the recumbent position helps initiate diuresis. PTS: 1 DIF: Cognitive Level: Application REF: Page 1707 OBJ: 8 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation

A nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what action should be included in the plan of care?

Assess the pin insertion site every 8 hours.

23. The patient has end-stage renal disease (ESRD) and is admitted to the hospital with a blood urea nitrogen (BUN) level of 48 mg/dL. An excessive elevation of BUN could result from: a. dehydration. b. disorientation. c. edema. d. catabolism.

ANS: B If the BUN is elevated, preventive nursing measures should be instituted to protect the patient from possible disorientation or seizures. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1711 OBJ: 8 TOP: ESRD KEY: Nursing Process Step: Assessment

44. In the nephrotic syndrome, the glomeruli are damaged by inflammation and allow small to pass through into the urine.

ANS: proteins In nephrotic syndrome, the glomeruli are damaged by inflammation and allow small proteins such as albumin to enter the urine. This creates a deficit of protein in the circulation volume (hypoalbuminemia), which leads to massive edema. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1707 OBJ: 8 TOP: Nephrotic syndrome KEY: Nursing Process Step: Assessment

40. is a term for severe generalized edema.

ANS: Anasarca The patient with nephritic syndrome has severe generalized edema (anasarca), anorexia, fatigue, and impaired renal function. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1707 OBJ: 8 TOP: Key term KEY: Nursing Process Step: Assessment

45. Put the sequence of blood flow in order of flow through the nephron. (Separate letters by a comma and space as follows: A, B, C, D) a. Reabsorption in loop of Henle b. Efferent arteriole c. Filtration in the glomerulus d. Reabsorption in proximal convoluted tubule e. Afferent arteriole f. Secretion in the distal convoluted tubule

ANS: E, C, D, A, F, B The blood enters the nephron via the afferent arteriole, is filtered through the glomerulus, reabsorption occurs in the proximal convoluted tubule, then the loop of Henle, then the distal convoluted tubule, and then out the efferent arteriole. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1673, Figure 49-3 OBJ: 2 TOP: Nephron action KEY: Nursing Process Step: Assessment

39. Exercises to increase muscle tone of the pelvic floor are known as exercises.

ANS: Kegel Women with weakened structures of the pelvic floor are prone to stress incontinence. For the female patient, Kegel exercises are helpful; 10 repetitions, 5 to 10 times a day, are suggested to improve muscle tone. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1685 OBJ: 8 TOP: Kegel exercises KEY: Nursing Process Step: Assessment

43. is a prostatic pain without evidence of infection or inflammation.

ANS: Prostatodynia Prostatodynia is a prostatic pain without evidence of infection of inflammation. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1692 OBJ: 8 TOP: Prostatodynia KEY: Nursing Process Step: Assessment

41. Acute glomerulonephritis is commonly a result of a preexisting infection of .

ANS: beta-hemolytic streptococci The health history commonly reveals that the onset of acute glomerulonephritis is preceded by beta-hemolytic streptococcal infection. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1708 OBJ: 8 TOP: Acute glomerulonephritis KEY: Nursing Process Step: Assessment

42. The prostatectomy technique, which involves an incision through the abdomen and the bladder, is a prostatectomy.

ANS: suprapubic A suprapubic prostatectomy involves an incision through the abdomen and the bladder with removal of the gland with the finger. PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 1702-1703, Table 49-3 OBJ: 3 TOP: Prostatectomy KEY: Nursing Process Step: Assessment

5. What portion of the nephron is involved with filtration? a. Glomerulus of the Bowman capsule b. Henle loop c. Proximal convoluted tubule d. Distal convoluted tubule

ANS: A Filtration of water and blood products occurs in the glomerulus of the Bowman capsule. PTS: 1 DIF: Cognitive Level: Application REF: Page 1673, Health Promotion OBJ: 8 TOP: Coping KEY: Nursing Process Step: Implementation

11. What should the nurse encourage, barring any other contraindication, when teaching a patient how to decrease the chance of further problems with urolithiasis? a. Increase his fluid intake b. Increase intake of dairy products c. Restrict his protein intake d. Take one baby aspirin daily

ANS: A Fluid intake should be encouraged to at least 2000 mL of fluid in 24 hours, unless contraindicated. PTS: 1 DIF: Cognitive Level: Application REF: Page 1682 OBJ: 8 TOP: Urolithiasis KEY: Nursing Process Step: Implementation

34. What should the nurse counsel the young man with chronic prostatitis to avoid? a. Cessation of intercourse b. Warm baths c. Stool softeners d. Continuing antibiotics when symptoms abate

ANS: A Frequent intercourse may be beneficial to the treatment of chronic prostatitis. Warm baths, stool softeners, and antibiotic therapy are also part of the medical treatment. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1693 OBJ: 8 TOP: Urinalysis KEY: Nursing Process Step: Assessment

33. To help a patient control incontinence, what should the nurse recommend the patient avoid? a. Spicy foods b. Citrus fruits c. Organ meats d. Shellfish

ANS: A Incontinence may be improved by omitting spicy foods, alcohol, and caffeine from the diet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1687 OBJ: 8 TOP: Incontinence KEY: Nursing Process Step: Implementation

21. A patient has nephrotic syndrome. Which statement made by the patient indicates understanding of the necessary diet modifications? a. "I will need to increase protein and decrease sodium intake." b. "I will need to drink more milk to get my calcium." c. "Carbohydrate restriction will be difficult." d. "Potassium restriction won't be hard since I don't like fruit."

ANS: A Medical management for nephrotic syndrome depends on the extent of tissue involvement and may include the use of corticosteroids and a low-sodium, high-protein diet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1707 OBJ: 8 TOP: Nephrotic syndrome KEY: Nursing Process Step: Evaluation

24. An intravenous pyelogram confirms the presence of a 4-mm renal calculus in the proximal left ureter of a newly admitted patient. Physician orders include meperidine (Demerol) 100 mg IM q4h PRN, strain all urine, and encourage fluids to 4000 mL/day. What should be the nurse's highest priority when planning care for this patient? a. Pain related to irritation of a stone b. Anxiety related to unclear outcome of condition c. Ineffective health maintenance related to lack of knowledge about prevention of stones d. Risk for injury related to disorientation

ANS: A Nursing diagnoses directed at pain control are of primary importance at the early stages of care. Opioid medications manage the pain well. PTS: 1 DIF: Cognitive Level: Application REF: Page 1677 OBJ: 8 TOP: Renal calculi KEY: Nursing Process Step: Planning

7. The nurse is aware that as a person ages there is a loss of the mechanism of the kidney due to a decrease in blood supply to the kidneys and loss of nephrons. a. filtering b. reabsorption c. sterile water. d. concentrating

ANS: A The filtering mechanism is most affected with aging. By the age of 70, the filtering mechanism is only 50% as efficient as at 40 years of age. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1675 OBJ: 5 TOP: Effect of aging KEY: Nursing Process Step: Planning

3. Because the kidneys are located in proximity to the vertebrae and are protected by the ribs, their location in documentation is referred to as: a. retroperitoneal. b. diaphragm-vertebral. c. costovertebral. d. urachal-peritoneal.

ANS: A The kidneys lie behind the parietal peritoneum (retroperitoneal). PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1672 OBJ: 1 TOP: Location of kidneys KEY: Nursing Process Step: Assessment

16. The patient is scheduled for a transurethral resection of the prostate. During preoperative teaching, what should the nurse emphasize about what the patient can expect after the procedure? a. Red drainage from the catheter b. Limited intake of fluids c. A sodium-restricted diet d. Incisional drainage

ANS: A The patient and family need to know that hematuria is expected after prostatic surgery. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

32. Which foods should the home health nurse counsel hypokalemic patients to include in their diet? a. Bananas, oranges, cantaloupe b. Carrots, summer squash, green beans c. Apples, pineapple, watermelon d. Winter squash, cauliflower, lettuce

ANS: A The use of most diuretics, with the exception of the potassium-sparing diuretics, requires adding daily potassium sources (e.g., baked potatoes, raw bananas, apricots, or navel oranges, cantaloupe, winter squash). PTS: 1 DIF: Cognitive Level: Application REF: Page 1681 OBJ: 7 TOP: Hypokalemia KEY: Nursing Process Step: Implementation

37. Which of the following are signs of fluid overload in the patient with nephrosis? (Select all that apply.) a. Increase in pulse rate b. Increase in daily weight c. Clear lung sounds d. Edema e. Labored respirations

ANS: A, B, D, E Signs and symptoms of fluid overload: changes in pulse rate, respirations, cardiac sounds, and lung fields. Increase in daily morning weights. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1681 OBJ: 7 TOP: Fluid overload KEY: Nursing Process Step: Assessment

36. Why are urinary tract infections (UTI) common in older adults? (Select all that apply.) a. Older adults have weakened musculature in the bladder and urethra. b. Older adults have urinary stasis. c. Older adults have increased bladder capacity. d. Older adults have diminished neurologic sensation. e. The effects of medications such as diuretics that many older adults take.

ANS: A, B, D, E Urinary frequency, urgency, nocturia, retention, and incontinence are common with aging. These occur because of weakened musculature in the bladder and urethra, diminished neurologic sensation combined with decreased bladder capacity, and the effects of medications such as diuretics. Older women are at risk for stress incontinence because of hormonal changes and weakened pelvic musculature. Inadequate fluid intake (less than 1000 to 2000 mL per 24 hours) can lead to urinary stasis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1675, Lifespan OBJ: 8 TOP: Urinary frequency KEY: Nursing Process Step: Assessment

35. The nurse reassures the patient recovering from acute glomerulonephritis that after all other signs and symptoms of the disease subside, it is normal to have some residual (select all that apply): a. proteinuria b. oliguria c. hematuria d. anasarca e. oliguria

ANS: A, C Proteinuria and hematuria may exist microscopically even when other symptoms subside. PTS: 1 DIF: Cognitive Level: Application REF: Page 1709 OBJ: 8 TOP: Acute glomerulonephritis KEY: Nursing Process Step: Implementation

38. The nurse is reviewing the urinalysis report on an assigned patient. The nurse recognizes which findings to be normal? (Select all that apply.) a. Turbidity clear b. pH 6.0 c. Glucose negative d. Red blood cells, 15 to 20 e. White blood cells

ANS: A, C The type and size of urinary catheter are determined by the location and cause of the urinary tract problem. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1676, Table 49-2 OBJ: 4 TOP: Urinalysis KEY: Nursing Process Step: Assessment

9. A 56-year-old patient with cancer of the bladder is recovering from a cystectomy with an ileal conduit. What is an important aspect in nursing interventions of the patient with an ileal conduit? a. Instructing the patient to void when the urge is felt. b. Maintaining skin integrity. c. Limiting oral intake to 1000 mL/day d. Limiting acid-ash foods.

ANS: B Care of the patient with an ileal conduit is a nursing challenge because of the continual drainage of urine through the stoma. Complications of this procedure are wound infection, dehiscence, and urinary leakage. The patient is urged to drink adequate fluids to flush the conduit. PTS: 1 DIF: Cognitive Level: Application REF: Page 1719 OBJ: 8 TOP: Cystectomy KEY: Nursing Process Step: Implementation

4. A home health patient with end-stage renal disease (ESRD) has a nursing diagnosis of powerlessness related to life-altering disease. Which nursing intervention would be most helpful? a. Ensure restricted protein intake to prevent nitrogenous product accumulation. b. Include the patient in making the plan of care. c. Counsel patient about end-of-life provisions. d. Write out a detailed schedule of physician's appointments.

ANS: B Listen to the patient and allow time for discussion about concerns and the plan of care to return some sense of control. End-of-life discussions are premature. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1713, Nursing Care Plan OBJ: 12 TOP: ESRD KEY: Nursing Process Step: Planning

31. Why are pediatric patients, especially girls, susceptible to urinary tract infections? a. Genetically females have a weaker immune system b. Females have a short and proximal urethra in relation to the vagina c. Girls are more sexually active than males d. Girls have a weakened musculature and sphincter tone

ANS: B Pediatric patients, especially girls, are susceptible to urinary tract infections because of the short urethra. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1691 OBJ: 1 TOP: Urinary anatomy KEY: Nursing Process Step: Assessment

26. A patient with cystitis is receiving phenazopyridine (Pyridium) for pain and is voiding a bright red-orange urine. What should the nurse do? a. Report this immediately b. Explain to the patient that this is normal c. Increase fluid intake d. Collect a specimen

ANS: B Pyridium will turn the urine reddish-orange. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680, Table 49-3 OBJ: 7 TOP: Cystitis KEY: Nursing Process Step: Implementation

18. A patient, age 69, is admitted to the hospital with gross hematuria and history of a 20-lb weight loss during the last 3 months. The physician suspects renal cancer. In obtaining a nursing history from this patient, the nurse recognizes which of the following as a significant risk factor for renal cancer? a. High caffeine intake b. Cigarette smoking c. Use of artificial sweeteners d. Chronic cystitis

ANS: B Risk factors include smoking; familial incidence; and preexisting renal disorders, such as adult polycystic kidney disease and renal cystic disease secondary to renal failure. PTS: 1 DIF: Cognitive Level: Application REF: Page 1698 OBJ: 8 TOP: Renal cancer KEY: Nursing Process Step: Assessment

6. When the home health patient is started on dialysis, the home health nurse refers the patient to a community support group that assists with the adjustments necessary to living with dialysis. Which group offers this service? a. National Kidney Foundation b. American Association of Kidney Patients c. American Red Cross d. Veterans Administration

ANS: B The American Association of Kidney Patients offer support to the patient and family as they adapt to living with dialysis. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1518 OBJ: 11 TOP: Community resources KEY: Nursing Process Step: Planning

27. The patient, age 43, has cancer of the urinary bladder. He has received a cystectomy with an ileal conduit. Which characteristics would be considered normal for his urine? a. Hematuria b. Clear amber with mucus shreds c. Dark bile-colored d. Dark amber

ANS: B There will be mucus present in the urine from the intestinal secretions. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1720 OBJ: 6 TOP: Ileal conduit KEY: Nursing Process Step: Assessment

15. What should the nurse instruct the patient to do before obtaining the urine specimen for a urine culture? a. Collect the urine for a 24-hour period b. Obtain a clean-catch specimen c. Bring in an early morning specimen d. Limit fluid intake to concentrate the urine

ANS: B Urine cultures are dependent on a clean-catch or catheterized specimen. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1691 OBJ: 8 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation

1. What is the hormone from the posterior pituitary gland that influences the amount of water that is eliminated with the urine? a. Pitocin b. Renin hormone c. Antidiuretic hormone (ADH) d. ACTH

ANS: C ADH causes the cells of the distal convoluted tubules to increase their rate of water reabsorption. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1674 OBJ: 3 TOP: Urine production KEY: Nursing Process Step: Assessment

13. The nurse assessing a patient who is taking furosemide (Lasix) finds an irregular pulse. This is likely a sign of: a. hypomagnesemia. b. hypernatremia. c. hypokalemia. d. hypercalcemia.

ANS: C The loop diuretic prototype, furosemide (Lasix), affects electrolytes and causes hypokalemia; the deficiency of the electrolyte can cause arrhythmias and muscle weakness. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680 OBJ: 7 TOP: Medications KEY: Nursing Process Step: Assessment

17. A male patient, age 71, has benign prostatic hypertrophy. He is recovering from a trans-urethral prostatic resection. The physician orders removal of the indwelling catheter 2 days after the TURP procedure. What might the patient experience after the catheter is removed? a. Burning on urination b. Passing of blood clots in the urine c. Dribbling of urine d. Coffee-colored urine

ANS: C The patient is informed that initially he may experience frequency and voiding small amounts with some dribbling. There should be no hematuria or clots after 2 days. PTS: 1 DIF: Cognitive Level: Application REF: Page 1702 OBJ: 8 TOP: Transurethral resection of prostate (TURP) KEY: Nursing Process Step: Implementation

22. What should the patient be encouraged to eat during the active phase of acute renal failure? a. A diet high in sodium b. A diet high in potassium c. A diet high in fats d. A diet high in fluid sources

ANS: C The patient with acute glomerulonephritis would need a high carbohydrate, high fat diet to maintain weight. Potassium and sodium are restricted as well as excess fluids. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1708 OBJ: 9 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation

25. A patient is receiving chlorothiazide (Diuril), a thiazide diuretic for hypertension. What nursing action is most important for prevention of complications? a. Measure output b. Increase fluid intake c. Assess for hypokalemia d. Assess for hypernatremia

ANS: C The thiazide diuretic, chlorothiazide (Diuril), affects electrolytes to cause hypokalemia (extreme potassium depletion in blood). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1680 OBJ: 7 TOP: Medications KEY: Nursing Process Step: Planning

29. The home health nurse suggests the use of complementary and alternative therapies to prevent and/or treat urinary tract infections (UTIs). Which of the following is an example of such therapies? a. Grape juice b. Caffeine c. Tea d. Cranberry juice

ANS: D Cranberry (Cranberry Plus, Ultra Cranberry) has been used to prevent urinary tract infections (UTIs), particularly in women prone to recurrent infection. It has also been used to treat acute UTI. Monitor patients for lack of therapeutic effect. Caffeine and tea will increase diuresis but not prevent UTI. PTS: 1 DIF: Cognitive Level: Application REF: Page 1689, Complementary and Alternative Therapy OBJ: 7 TOP: Complementary and alternative therapy KEY: Nursing Process Step: Assessment

30. Which action can reduce the risk of skin impairment secondary to urinary incontinence? a. Decreasing fluid intake b. Catheterization of the elderly patient c. Limiting the use of medication (diuretics, etc.) d. Frequent toileting and meticulous skin care

ANS: D Frequent toileting of the incontinent patient will prevent retained moisture in undergarments and bed linens and will preserve the integrity of the skin. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1676, Lifespan OBJ: 8 TOP: Urinary frequency KEY: Nursing Process Step: Assessment

19. As the nurse and the dietitian review a female patient's diet plan with her, she shouts that with her diabetes and now the kidney failure, there is just nothing she can eat. She says she might as well eat what she wants, because there is nothing she can do to help herself. Based on the patient's response, which nursing diagnosis does the nurse identify? a. Noncompliance, risk for, related to feelings of anger b. Imbalanced nutrition less than body requirements, related to knowledge deficit c. Anticipatory grieving, related to actual and perceived losses d. Ineffective coping, related to sense of powerlessness

ANS: D Ineffective coping due to the feeling of powerlessness against the multiorgan failure may result in aggressive or infantile behavior. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1712-1713, Nursing Care Plan OBJ: 12 TOP: Coping KEY: Nursing Process Step: Planning

28. A patient, age 78, has been admitted to the hospital with dehydration and electrolyte imbalance. She is confused and incontinent of urine on admission. Which nursing intervention does the nurse include in developing a plan of care? a. Restrict fluids after the evening meal b. Insert an indwelling catheter c. Assist the patient to the bathroom every 2 hours d. Apply absorbent incontinence pads

ANS: D Use of protective undergarments may help to keep the patient and the patient's clothing dry. Confused patients are high risk for falls. Restricting fluids will only decrease incontinence during the night and will exacerbate the dehydration and electrolyte imbalance. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1689 OBJ: 8 TOP: Incontinence KEY: Nursing Process Step: Implementation

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Apply a tourniquet.

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

Avascular necrosis may develop at the site if it is not promptly resolved.

Instructions for the patient with low back pain include that when lifting the patient should a) place the load away from the body. b) bend the knees and loosen the abdominal muscles. c) avoid overreaching. d) use a narrow base of support.

Avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles.

28. A patient who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on his sexual function. What aspect of prostate surgery should inform the nurse's response? A) Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B) All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C) Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D) Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

B Feedback: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

40. A patient presents to the emergency department with paraphimosis. The physician is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, what is usually indicated? A) Needle aspiration of the corpus cavernosum B) Circumcision C) Abstinence from sexual activity for 6 weeks D) Administration of vardenafil

B Feedback: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is Levitra and would not be used for paraphimosis.

25. A physician explains to the patient that he has an inflammation of the Cowper glands. Where are the Cowper glands located? A) Within the epididymis B) Below the prostate, within the posterior aspect of the urethra C) On the inner epithelium lining the scrotum, lateral to the testes D) Medial to the vas deferens

B Feedback: Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

15. A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patient's history, what might the nurse note that contributes to erectile dysfunction? A) The patient has been treated for a UTI twice in the past year. B) The patient has a history of hypertension. C) The patient is 66 years old. D) The patient leads a sedentary lifestyle.

B Feedback: Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems.

10. A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patient's history prior to instructing the patient on the use of this medication. What disorder will contraindicate the use of tadalafil (Cialis)? A) Cataracts B) Retinopathy C) Hypotension D) Diabetic nephropathy

B Feedback: Patients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. However, tadalafil (Cialis) and sildenafil (Viagra) are usually contraindicated with diabetic retinopathy.

23. A 75-year-old male patient is being treated for phimosis. When planning this patient's care, what health promotion activity is most directly related to the etiology of the patient's health problem? A) Teaching the patient about safer sexual practices B) Teaching the patient about the importance of hygiene C) Teaching the patient about the safe use of PDE-5 inhibitors D) Teaching the patient to perform testicular self-examination

B Feedback: Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.

21. A 35-year-old father of three tells the nurse that he wants information on a vasectomy. What would the nurse tell him about ejaculate after a vasectomy? A) There will be no ejaculate after a vasectomy, though the patient's potential for orgasm is unaffected. B) There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C) There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D) There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.

B Feedback: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.

4. A patient has been prescribed sildenafil. What should the nurse teach the patient about this medication? A) Sexual stimulation is not needed to obtain an erection. B) The drug should be taken 1 hour prior to intercourse. C) Facial flushing or headache should be reported to the physician immediately. D) The drug has the potential to cause permanent visual changes.

B Feedback: The patient must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting to the physician. Some visual disturbances may occur, but these are transient.

29. A patient has returned to the floor from the PACU after undergoing a suprapubic prostatectomy. The nurse notes significant urine leakage around the suprapubic tube. What is the nurse's most appropriate action? A) Cleanse the skin surrounding the suprapubic tube. B) Inform the urologist of this finding. C) Remove the suprapubic tube and apply a wet-to-dry dressing. D) Administer antispasmodic drugs as ordered.

B Feedback: The physician should be informed if there is significant leakage around a suprapubic catheter. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? a) Wrist-hand junction b) Proximal humerus c) Femur-hip area d) Distal femur around the knee

Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.

35. A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A) Abstaining from sexual intercourse for at least 14 days postprocedure B) Wearing a scrotal support garment C) Using sitz baths D) Applying a heating pad intermittently E) Staying on bed rest for 48 to 72 hours postprocedure

B,C Feedback: Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the patient to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse.

Based on the nursing assessment, the priority action the nurse should take is to notify the orthopedic health care provider immediately and prepare the client for fasciotomy.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours

The nurse recognizes that the client with osteomyelitis is at risk for: a) Bone abscess formation b) Impingement syndrome c) Metastatic bone disease d) Pathological fractures

Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.

The nurse recognizes that the client with osteomyelitis is at risk for: a) Metastatic bone disease b) Bone abscess formation c) Impingement syndrome d) Pathological fractures

Bone abscess formation Explanation: Bone abscess formation is a potential complication of osteomyelitis.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? a) Bone fracture b) Loss of estrogen c) Negative calcium balance d) Dowager's hump

Bone fracture Correct Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

Which of the following clinical manifestations would the nurse expect to find in a client who has Paget's disease? a) Dowager's hump b) Flexion deformity of the toe c) Bowing of the legs d) High arch of the foot

Bowing of the legs Explanation: Paget's disease is characterized by pain and bowing of the legs.

1. An adolescent is identified as having a collection of fluid in the tunica vaginalis of his testes. The nurse knows that this adolescent will receive what medical diagnosis? A) Cryptorchidism B) Orchitis C) Hydrocele D) Prostatism

C Feedback: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testes. Cryptorchidism is the most common congenital defect in males, characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.

18. A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A) Native Americans B) Caucasian Americans C) African Americans D) Asian Americans

C Feedback: African American men have a high risk of prostate cancer; furthermore, they are more than twice as likely to die from prostate cancer as men of other racial or ethnic groups.

20. A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on his right knee. While taking the patient's family history, he states, "My father died of prostate cancer at age 48." The nurse should instruct him on which of the following health promotion activities? A) The patient will need PSA levels drawn starting at age 55. B) The patient should have testing for presence of the CDH1 and STK11 genes. C) The patient should have PSA levels drawn regularly. D) The patient should limit alcohol use due to the risk of malignancy.

C Feedback: PSA screening is warranted by the patient's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the patient should be limited. However, this is not the most important health promotion intervention.

3. A nurse practitioner is assessing a 55-year-old male patient who is complaining of perineal discomfort, burning, urgency, and frequency with urination. The patient states that he has pain with ejaculation. The nurse knows that the patient is exhibiting symptoms of what? A) Varicocele B) Epididymitis C) Prostatitis D) Hydrocele

C Feedback: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation is indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it also may develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord.

26. A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin an assessment by doing which of the following? A)Briefly teaching the patient about normal sexual physiology B)Assuring the patient that what he says will be confidential C)Asking the patient if he is willing to discuss sexual functioning D)Ensuring patient privacy

C Feedback: The PLISSIT (permission, limited information, specific suggestions, intensive therapy) model of sexual assessment and intervention may be used to provide a framework for nursing interventions. By beginning with the patient's permission, the nurse establishes a patient-centered focus.

2. An uncircumcised 78-year-old male has presented at the clinic complaining that he cannot retract his foreskin over his glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem? A) Bowen's disease B) Peyronie's disease C) Phimosis D) Priapism

C Feedback: Phimosis is the term used to describe a condition in which the foreskin is constricted so that it cannot be retracted over the glans. Bowen's disease is an in situ carcinoma of the penis. Peyronie's disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.

27. A nurse is caring for a 33-year-old male who has come to the clinic for a physical examination. He states that he has not had a routine physical in 5 years. During the examination, the physician finds that digital rectal examination (DRE) reveals "stoney" hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A) A normal finding B) A sign of early prostate cancer C) Evidence of a more advanced lesion D) Metastatic disease

C Feedback: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is stony hard and fixed. This finding is not suggestive of metastatic disease.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:

Elevate the affected area.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?

Elevate the affected extremity and use cold applications.

14. A nurse is assessing a patient who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? A) Urinary tract infection B) Chronic pain C) Permanent vascular damage D) Future erectile dysfunction

C Feedback: The ischemic form of priapism, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of UTIs, chronic pain, or erectile dysfunction.

Which of the following inhibits bone resorption and promotes bone formation? a) Parathyroid hormone b) Corticosteroids c) Estrogen d) Calcitonin

Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: a) Impingement syndrome b) Carpal tunnel syndrome c) Dupuytren's contracture d) Morton's neuroma

Carpal tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome.

Which group is at the greatest risk for osteoporosis? a) African American women b) Men c) Caucasian women d) Asian women

Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

The nurse is assisting with the application of a cast. What will the nurse expect to be done first?

Cleaning the skin surface.

A client was playing softball and dislocated four fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Closed reduction

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?

Compound

A client comes to the emergency department and reports localized pain and swelling in the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. What will the nurse most likely suspect?

Contusion

Which would be consistent as a component of self-care activities for the client with a cast?

Cushion rough edges of the cast with tape

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do?

Cut a cast window.

36. A patient has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The patient has a continuous bladder irrigation system in place. The patient tells you he is experiencing bladder spasms and asks what you can do to relieve his discomfort. What is the most appropriate nursing action to relieve the discomfort of the patient? A) Apply a cold compress to the pubic area. B) Notify the urologist promptly. C) Irrigate the catheter with 30 to 50 mL of normal saline aS ordered. D) Administer a smooth-muscle relaxant as ordered.

D Feedback: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.

6. A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A) It is most common among men over 55. B) It is one of the least curable solid tumors. C) It typically does not metastasize. D) It is highly responsive to treatment.

D Feedback: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

8. A patient has just been diagnosed with prostate cancer and is scheduled for brachytherapy next week. The patient and his wife are unsure of having the procedure because their daughter is 3 months pregnant. What is the most appropriate teaching the nurse should provide to this family? A) The patient should not be in contact with the baby after delivery. B) The patient's treatment poses no risk to his daughter or her infant. C) The patient's brachytherapy may be contraindicated for safety reasons. D) The patient should avoid close contact with his daughter for 2 months.

D Feedback: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the patient returns home after the procedure. Exposure of others to radiation is minimal, but the patient should avoid close contact with pregnant women and infants for up to 2 months.

7. A nurse is planning the postoperative care of a patient who is scheduled for radical prostatectomy. What intraoperative position will place the patient at particular risk for the development of deep vein thrombosis postoperatively? A) Fowler's position B) Prone position C) Supine position D) Lithotomy position

D Feedback: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the patient is placed in a lithotomy position during surgery. During a prostatectomy, the patient is not placed in the supine, prone, or Fowler's position.

9. A patient has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this patient has chronic urinary retention? A) Hypertension B) Peripheral edema C) Tachycardia and other dysrhythmias D) Increased blood urea nitrogen (BUN)

D Feedback: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and renal failure can occur with chronic urinary retention and large residual volumes.

37. A patient confides to the nurse that he cannot engage in sexual activity. The patient is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this patient to assess his sexual functioning? A) Sperm count B) Ejaculation capacity tests C) Engorgement tests D) Nocturnal penile tumescence tests

D Feedback: Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep using various methods to determine number, duration, rigidity, and circumference of penile erections; the results help identify whether the erectile dysfunction is caused by physiologic and/or psychological factors. A sperm count would be done if the patient was complaining of infertility. Ejaculation capacity tests and engorgement tests are not applicable for assessment in this circumstance.

39. A patient has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The patient's interdisciplinary plan of care should prioritize which of the following interventions? A) Penile implant B) PDE-5 inhibitors C) Physical therapy D) Psychotherapy

D Feedback: Patients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.

33. A 57-year-old male comes to the clinic complaining that when he has an erection his penis curves and becomes painful. The patient's diagnosis is identified as severe Peyronie's disease. The nurse should be aware of what likely treatment modality? A) Physical therapy B) Treatment with PDE-5 inhibitors C) Intracapsular hydrocortisone injections D) Surgery

D Feedback: Surgical removal of mature plaques is used to treat severe Peyronie's disease. There is no potential benefit to physical therapy and hydrocortisone injections are not normally used. PDE-5 inhibitors would exacerbate the problem.

5. A patient is 24 hours postoperative following prostatectomy and the urologist has ordered continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A) Red wine colored B) Tea colored C) Amber D) Light pink

D Feedback: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light pink 24 hours after surgery.

Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years? a) Increased heel pain b) Bone spurs c) Diarrhea d) Decreased height

Decreased height Explanation: Clients with osteoporosis become shorter over time.

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do?

Discuss the complications that the client may experience if there is lack of cooperation with the care plan.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?

Dislocation of the hip

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)

The nurse is planning an education program for women of childbearing years. The nurse recognizes that primary prevention of osteoporosis includes: a) Having a DXA beginning at age 35 years b) Engaging in non-weight-bearing exercises daily c) Undergoing assessment of serum calcium levels every year d) Ensuring adequate calcium and vitamin D intake

Ensuring adequate calcium and vitamin D intake Explanation: Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure?

Excision of damaged joint fibrocartilage

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

Fat embolism syndrome

Which of the following was formerly called a bunion? a) Hallux valgus b) Plantar fasciitis c) Morton's neuroma d) Ganglion

Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? a) Hallux valgus b) Bunion c) Hammer toe d) Mallet toe

Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

Hemorrhage and shock

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?

Hypovolemic

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock

A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?

Inadequate immobilization

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?

Incomplete

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?

Infection

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? a) Initiating weight-bearing exercise routines b) Stopping estrogen therapy c) Taking a 300-mg calcium supplement to meet dietary guidelines d) Living a sedentary lifestyle to reduce the incidence of injury

Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

Which intervention should the nurse implement with the client who has undergone a hip replacement?

Instruct the client to avoid internal rotation of the leg.

A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?

Keep an elastic compression bandage on the ankle.

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Thoracic b) Lower lumbar c) Upper lumbar d) Cervical

Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes.

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse?

Notify the health care provider.

A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury?

Numbness and burning of the foot

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders? a) Osteoporosis b) Osteomalacia c) Osteitis deformans d) Osteomyelitis

Osteitis deformans Explanation: Osteitis deformans (Paget's disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft tissue infection, direct bone contamination, or hematogenous spread.

Which of the following is a metabolic bone disease that is characterized by inadequate mineralization of bone? a) Osteomalacia b) Osteomyelitis c) Osteoarthritis d) Osteoporosis

Osteomalacia Explanation: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Fat embolism b) Avascular necrosis c) Osteomyelitis d) Compartment syndrome

Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

Which is not a guideline for avoiding hip dislocation after replacement surgery.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? a) Monitor vital signs every 4 hours. b) Administer pain medication per client request. c) Examine surgical dressing every hour. d) Perform neuromuscular assessment every hour.

Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical.

The nurse recognizes that goal of treatment for metastatic bone cancer is to: a) Diagnose the extent of bone damage b) Promote pain relief and quality of life c) Cure the diseased bone and cartilage d) Reconstruct the bone with a prosthesis

Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative.

A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? a) Promoting range-of-motion (ROM) exercises b) Promoting weight-bearing exercises c) Maintaining protein levels d) Maintaining vitamin levels

Promoting weight-bearing exercises Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures.

Which of the following positions should be avoided in severe back pain? a) Prone b) Supine c) Head and thorax elevated 30 degrees d) Lateral recumbent

Prone Explanation: A prone position should be avoided because it accentuates lordosis (inward curvature of the spine). Lumbar flexion is increased by elevating the head and thorax 30 degrees using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head.

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women? a) Raloxifene b) Fosamax c) Denosumab d) Forteo

Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures.

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? a) plicamycin (Mithracin) b) methotrexate (Rheumatrex) c) penicillamine (Cuprimine) d) raloxifene (Evista)

Raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis.

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?

Sharp and piercing

A male client is to have an amputation. He is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client? a) Reduced urine output b) Signs of nausea and vomiting c) Occurrence of allergic reactions d) Signs of sepsis

Signs of sepsis Explanation: If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?

Sprain

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? a) Proteus vulgaris b) Escherichia coli c) Psuedomonas aeruginosa d) Staphylococcus aureus

Staphylococcus aureus Explanation: S. aureus causes over 50% of bone infections. Other organisms include P. vulgaris and P. aeruginosa, as well as E. coli.

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Wound packing c) Surgical debridement d) Vitamin supplements

Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

Morton's neuroma is exhibited by which of the following clinical manifestations? a) Inflammation of the foot-supporting fascia b) High arm and a fixed equinus deformity c) Longitudinal arch of the foot is diminished d) Swelling of the third (lateral) branch of the median plantar nerve

Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) The recommended daily allowance of calcium may be found in a wide variety of foods. b) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. c) To prevent fractures, the client should avoid strenuous exercise. d) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.

The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary.

Which statement describes external fixation?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Decrease the intake of vitamin A and D b) Walk or perform weight-bearing exercises outdoors c) Increase fiber in the diet d) Reduce stress

Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?

Weights hanging and touching the floor

There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?

avascular necrosis

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

contusion

Choice Multiple question - Select all answer choices that apply. Which of the following are clinical manifestations of impingement syndrome? Select all that apply. a) Pain b) Limited movement c) Shoulder tenderness d) Muscle spasms e) Atrophy

• Pain • Shoulder tenderness • Limited movement • Muscle spasms • Atrophy Explanation: The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear