med surg exam #3

a pt is admitted w pneumonia and shingles with draining lesions over the right anterior and posterior chest wall. Of the RN scheduled for the shift, which nurses may be assigned ro care for this pt? select all

43-yr old female who had pre exposure varicella vaccination 48 yr old male who had singles 1 yr prior 24 yr old female who has never had the pneumococcal vaccine

RN is instructing a pt on home care after a culture for bacterial infection + cellulitis. Which of the following info should the RN include in the teaching?

Apply warm compress to the affected area

RN is preparing to administer a scratch test to a pt who has possible food and environmental allergies. Which of the following actions should the RN perform prior to the procedure? select all

Asl the pt about previous reactions to allergens ask the pt about medications she took over the past several days inform the pt to expect itching at one site obtain emergency resuscitation equipment

RN is instructing pt who will have a total hip replacement tomorrow, which info is most important to include in the teaching plan at this time?

Assess the pts fears about the procedure only then will the pt hear anything else you are trying to teach them

Pt states I cannot do my household chores without becoming tired. My knees hurt whenever I walk. Which goal for this pt would take priority?

Conserve energy

A pt with an extracapsular hip fracture returns to the nursing unit after internal fixation and pin insertion w a drainage tube at the insertion site . Her husband asks why does she have this tube inserted in her hip? best response

Fluid will not be allowed to accumulate at the site

The RN has given instructions to a pt returning home after a knee arthroscopy. Which statement by the pt indicates that the instructions are understood?

I need to report a fever or swelling to my HCP

A RN is providing teaching for a pt who has stage 2 HIV diseases + is having difficult maintaining a normal weight. Which of the following statements by the pt should indicate to the RN understanding of the teaching?

I will add high-protein foods to my diet

A RN is providing teaching for a pt who has stage 3 HIV disease, which of the following statements by the pt would indicate to the RN an understanding of the teaching?

I will cook veggies before eating them *to kill bacteria that could cause opportunistic infections

After pt teaching about severe rheumatoid arthritis prescribed methotrexate, which statement indicates the need for further teaching?

I will take my vitamins while I am on this drug many contains folic acid, this medication is a folic acid antagonist

Pt has a closed fracture and just had a cast applied to the affected arm. Pt is complaining of intense pain. The RN elevates the limb, provides ice bad, and administers an analgesic, with little relief. Which problem may be causing this pain?

Impaired tissue perfusion

Pt diagnosed with osteoarthritis tells the RN, my friend takes steroid pills for her rheumatoid arthritis. Should I be taking steroids too? What should the RN explain to the pt?

Intra-articular corticosteroid injections are used to treat osteoarthritis *oral corticosteroids are avoided in osteoarthritis bc they can cause an acceleration of the disease

Pt has a WBC count of 20,000. The RN should conclude that the pt has which of the following?

Leukocytosis

Rn in an outpatient clinic is assessing a pt who reports night sweats + fatigue. He states he has a cough along w nausea and diarrhea. His temp is 100.6 orally. The pt is afraid he has HIV. Which of the following actions should the RN take?

Perform a physical assessment Determine when manifestations began Obtain a sexual hx

The RN manager is planning the clinical assignments for the day. Which staff members cannot be assigned to care for a pt w herpes zoster? select all

The RN who never had chicken pox the RN who never received the varicella-zoster vaccine

RN is performing health screenings at a health fair. Which of the following pts are at risk for osteoporosis? select all

a 40 yr old pt who takes prednisone for asthma a 45 yr old who takes phenytoin for seizures a 65 yr old who has a sedentary lifestyle 70 yr old who smoked for 50 yrs

Paget's disease (osteitis deformans)

a chronic bone disease of unknown cause, characterized by abnormal breakdown of bone tissue followed by abnormal bone formation more common in men, risk ^ w age + genetics nerves get compressed from overgrowth

osteoarthritis is

a degenerative joint disease with local manifestations such as local joint pain

Which info should the RN include in the teaching session when preparing a pt for arthrocentesis? select all

a local anesthetic agent may be injected into the joint site for your comfort a syringe and needle will be used to withdraw fluid from your joint you will need to wear a compression bandage for several days after the procedure

Pt is dx w scleroderma. Which intervention should the RN anticipate to be prescribed?

admin corticosteroids as prescribed for inflammation

RN is completing discharge teaching to a pt w a wound debridement for osteomyelitis. Which of the following info should the RN include in the teaching?

antibiotic therapy should continue for 3 months

RN is providing info about a new script for corticosteroid cream to pt who has mild psoriasis. which instructs should the RN include? select all

apply an occlusive dressing after application wear gloves after application to lesions on the hands avoid applying in skin folds

RN is providing info to a pt who has osteoarthritis of the hip and knee. Which of the following info should the RN include? select all

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

which statement should the RN include in teaching about clotrimazole topical cream?

apply the topical medication for up to 2 weeks after the fungal lesions are gone

The pt is complaining of low back pain that radiates down the left posterior thigh. The RN should ask the pt if the pain is worsened or aggravated by which factor?

bending or lifting

petechiae

broken capillaries results in small red or purple spots on skin

eccymosis

bruise - black, blue purple

RN is caring for a pt w a spinal cord injury. Pt is experiencing blurred vision and has a BP of 204/102 what should the RN do?

check the pts bladder for distention *pt is experiencing autonomic dysreflexia which is a medical emergency. RN should immediately assess for bladder distention and be prepared to catheterize the pt.

RN is planning to teach pt w GERD about substances to avoid. Which items should they include? select all

coffee, chocolate, peppermint, fried chicken

In monitoring pts response to DMARDs, which assessment findings would the RN consider acceptable responses? select all

control of symptoms during periods of emotional stress normal WBC, platelet, and neutrophil counts radiological findings that show no progression of joint degeneration an ^ in ROM in the affected joints 3 months into therapy

crust

dried residue of exudates ex. residue of impetigo

pt reports onset of early symptoms of rheumatoid arthritis. RN should conduct a focused assessment for:

early morning stiffness

RN is caring for a pt w osteomyelitis. Pt is taking an antibiotic but the infection has not resolved. The RN should advise the pt to...

eat a diet high in protein and vitamin C + D

Macule

flat, discolored spot on skin with sharp borders ex. freckle

RN is assessing pt w osteoarthritis of the knees and fingers. What should they expect to find? select all

heberden's nodes enlarged joint size limp when walking

pt w a hx of dermatitis takes corticosteroids on a regular basis. The RN should assess the pt for which of the following complications of therapy?

immunosupression

bulla

large distinct elevation with fluid ex. large friction or burn blister

fissure

linear crack in the skin ex. athletes foot

Which condition should the RN assess when completing the hx and physical exam of a pt diagnosed with osteoarthritis?

local joint pain

wheal

localized area of edema, often irregular and of variable size and color ex. hive, insect bite

RN is admitting an older adult pt who has suspected osteoporosis. Which of the following is an expected finding? select all

loss in height of 2" BMI of 21 kyphotic curve at upper thoracic spine history of lactose intolerance

following a total hip replacement the RN should position the pt by

maintaining the extremity in slight abduction using an abduction splint or pillows placed between the thighs

Neutropenia

neutrophil count less than 2,000 occurs in pts w viral infections, overwhelming bacterial infections, or are undergoing chemo, or radiation ^ risk for further infections

A RN is assessing a pt for HIV. The RN should identify that which of the following are risk factors associated with the virus? select all

perinatal exposure older adult woman occupational exposure

colony stimulating factors

play a key regulatory role in the growth and differentiation of bone marrow cells

The RN notes that the HCP has documented a diagnosis of herpes zoster (shingles) in the pts chart. Based on an understanding of the cause of this disorder, the RN determines that this definitive diagnosis was made by which diagnostic test?

positive culture results

RN is planning discharge teaching on home safety for an older adult pt who has osteoporosis. Which of the following info should be included in the teaching? select all

remove throw rugs in walkways use prescribed assistive devices removed clutter from environment maintain lighting of doorway areas

The RN is caring for a pt who had an above knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which Immediate action should the RN take?

rewrap the residual limb w an elastic compression bandage

pt with diabetes mellitus has had a right below knee amputation. Given the pts hx of DM, which complication is the pt at most risk for after surgery?

separation of wound edges

what should the RN instruct the pt with tinea capitis to do? select all

shampoo hair two or three times with selenium sulfide shampoo take antifungal medication as prescribed

Leukocytosis

total WBC count > 10,000 can indicate inflammation, infection, some malignancies, trauma, dehydration, stress, steroid use + thyroid storm

Leukopenia

total WBC count less than 4,000 can indicate drug toxicity, autoimmune disease, bone marrow failure, + some overwhelming infections

The RN is caring for a pt w gout. Which lab value would the RN expect to note in the pt?

uric acid level of 9 mg/dL

Pt w contact dermatitis has a new script for diphenhydramine. which of the following adverse effects should the RN monitor?

urinary retention adverse effect

The RN is applying a hand mitt restraint for the pt w pruritus. The RN should first:

verify the prescription to use the restraint

pustule

vesicle or bulla filled with purulent fluid ex. acne, carbuncle

pt has been admitted to the hospital with draining foot lesions What should the RN do? select all

admit the pt to a private room post a contact isolation sign on the door wear a protective gown when in the pts room wear gloves when providing direct care

The RN is teaching a pt with stomatitis about mouth care. Which instruction is most appropriate?

eat a soft, bland diet

an older adult has several ecchymotic areas on the left arm. The RN should further assess the pt for... select all

elder abuse self-inflicted injury ^ capillary fragility and permeability

During assessment of the pts mouth the RN notes the absence of saliva. The pt reports having pain behind the ear. The pt has been NPO for several days nut not can have liquids the RN should:

encourage the pt to suck on hard candy these s+s are indications that the pt may be developing parotitis, or inflammation of the parotid gland. this can develop from dehydration, poor oral hygiene, and prolonged npo status. prevention measures include stimulation of saliva

after teaching pt with osteoarthritis about the importance of regular exercise, which statement indicates the pt has understood the teaching?

exercise helps to drive synovial fluid through the cartilage *weight bearing exercise plays an important role in regenerating cartilage, which lacks a blood supply, by driving synovial fluid through the joint cartilage

RN is creating a care plan for a pt suffering from allergic rhinitis. Which of the following outcomes should the RN identify?

improved coping with lifestyle modification

Rn is assessing a pt for neurologic impairment after a total hip replacement. Which findings indicates impairment in the affected extremity?

inability to move

Morton's Neuroma

inflammation of the nerve typically between the 3rd and 4th metatarsals feels like a pebble in the shoe - tissue thickens

Pt being measured for crutches asks why the crutches cannot rest up underneath the arm for extra support. The RN responds knowing the which would most likely result from this improper crutch measurement?

injury to the brachial plexus nerves

A pt has early signs of oral cancer. TO conduct a focused assessment, what should the RN do? select all

inspect the mouth for inflammation + infection determine the presence of dysphagia monitor the pt's height + weight

Nursing considerations for estrogen hormone supplements

instruct pt of potential complications including DVT, breast + endometrial cancers reinforce monthly breast self-examinations estrogen should be given along with progesterone in women who still have their uterus

Pt with RA is taking high doses of a non-steroidal anti-inflammatory drug, the RN should instruct the pt to

take prescribed meds with food to lessen the likelihood of an upset stomach

Rn is caring for pt who had spinal fusion, w insertion of hardware. The RN would be most concerned w which assessment finding?

temp of 101.6 orally

RN is developing a care plan w a pt who had a laryngectomy 3 days ago. To assure adequate nutrition, what should the RN instruct the pt to do? select all

weigh weekly and report weight loss when eating, sit and lean slightly forward have serum albumin level checked regularly administer enteral tube feedings as prescribed

The school RN is performing pediculosis capitis (head lice) assessments. Which assessment finding indicates that a child has a positive head check?

white sacs attached to the hair shaft in the occipital area

The RN is caring for a pt who has just returned from surgery to treat a fractured mandible. The jaws are wired. Which items should always be available at this pts bedside? select all

wire cutters suction equipment

telangiectasia

skin lesion due to permanently enlarged and dilated blood vessels that are visible

vesicle

small distinct elevation with fluid ex. blister caused by herpes simplex

RN is caring for a pt w multiple sclerosis. The RN recognizes the autoimmune etiology of this disease and the potential benefits of what treatment?

stem cell transplantation

an older adult pt is in stage 2 of parkinson's disease is being discharged w cellulitis of the RLE. The RN should base the discharge plan on which info? select all

the pt is at risk for skin breakdown the pt is at risk for falls or injuries

Nodule, tumor

Palpable, solid, elevated mass Nodules with distinct borders Tumors extending deep into the dermis ex. wart (nodule) large lipoma (tumor)

Prevention of skin breakdown and maintenance of skin integrity among older pts is important bc they are at a greater risk secondary to:

altered protective pressure sensation

rheumatoid arthritis has systemic manifestations such as

anemia and osteoporosis weight loss can occur

Permethrin is prescribed for a child w scabies. The RN should give which instruction to the parents regarding the use of this treatment?

apply the lotion to cool, dry skin at least 30 minutes after bathing

A pt w/ osteoarthritis will undergo an arthrocentesis on a painful edematous knee. What info should be included in the RN plan of care? select all

Explain the procedure Assess the site for bleeding Offer pain medication The HPC will administer a local anesthetic bleeding is expected after the procedure-check the dressing, pt may experience pain. Pt will rest the knee for 24 hrs and then begin ROM

interventions for pt undergoing foot surgery

Neurovascular assessment assess swelling + neurovascular status every 1 to 2 hrs for the first 24 hrs instruct pt in s+s to assess + report elevate foot use intermittent ice meds improve mobility prevent infection- pin care- clean on daily basis w 1/2 hydrogen peroxide + 1/2 h2o w qtip

Pt w a posterolateral total hip replacement 2 days ago. What info should the RN include in the pts plan of care? select all

Position a pillow between the legs to maintain abduction Allow the pt to be in the supine position or in the lateral position on the unoperated side Do not allow the pt to bend down to tie or slip on shoes Place ice on the incision after physical therapy

keloid

Thick scar resulting from excessive growth of fibrous tissue

Rn is conducting health screening for osteoporosis. Which pt is at greatest risk of developing this disorder?

a sedentary 65 yr old woman who smokes cigarettes

pt is admitted to hospital for treatment of acute cellulitis of the lower left leg. During the admission assessment, the RN expects to note which finding?

a skin infection of the dermis and underlying hypodermis

cherry angioma

a small, round, bright red blood vessel tumor on the skin, often on the trunk of the elderly

Who is at risk for developing rheumatoid arthritis (RA) select all

adults between ages of 20 and 50 years adults who have had an infectious disease with the Epstein-Barr virus adults who possess the genetic link, specifically HLA-DR4

a pt has a wound on the ankle that is not healing. The RN should assess the pt for which risk factors for delayed wound healing? select all

advancing age type 2 diabetes mellitus smoking

which factor puts an older adult at the greatest risk for impaired wound healing after abdominal surgery?

age 30 years, with poorly controlled diabetes

an infection control RN is presenting an inservice reviewing of the immune response. The RN describes the clumping effect that occurs when an antibody acts like a cross-link between two antigens. What process in the nurse explaining?

agglutination

Pt w a fracture develops compartment syndrome. Which sign should alert the RN to impending organ failure?

dark, scanty urine

Which problem related to changes of the integumentary system can result for the older adult undergoing abdominal surgery?

decreased healing

spider angioma (telangiectasia)

dilated radiating capillaries surrounding a central arteriole on the face, forearms, and hands radiating telangiectases blanch under diascopy, the center does not red in color f>m liver disease, young children, hyperestrogenic states treat with electrocautery and laser surgery up to 1.5cm

which findings should the RN expect to assess as normal skin changes in an elderly pt? select all

diminished hair on scalp and pubic area solar lentigo (liver spots) wrinkles xerosis (dryness)

The RN is assessing the skin of a pt w psoriasis after the pt has used a new topical treatment for 2 months. The RN identifies which characteristics as improvement in the manifestations of psoriasis? select all

thinner and decrease in number of reddish papules scarce amount of silvery-white scaly patches on the arms

Dupuytren's contracture

tissue underskin of palms goes into knots unknown cause usually in men > 50 treatment-needling in palm of hand + inject enzymes to help break up cord - or surgery

lichenification

leathery skin, in response to excessive itching or rubbing - outer layer of the skin naturally thickens

which info should be included in a teaching plan for a pt with osteoporosis? select all

maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals Choose good calcium sources, such as figs, broccoli and almonds Use alcohol in moderation bc a moderate intake has no known negative effects *weight bearing exercises like walking help bones, not swimming

which position would be most comfortable for a pt with a ruptured disc at L5-S1?

supine with the legs flexed

Pt has been diagnosed with herpes zoster (shingles) The RN should include with info in a teaching plan? select all

instruct the pt about taking antiviral agents as prescribed demonstrate how to apply wet to dry dressings explain how to follow proper hand hygiene techniques

The RN is assessing the LLE of a pt with type 2 insulin-requiring diabetes and cellulitis. What should the RN do?

instruct the pt to elevate the left lef when sitting in the chair

plaque

larger, flat, elevated solid surface ex. psoriasis

RN is caring for an older adult w shingles. The pt is experiencing pain related to open blisters on the pts abdomen and back. The pt is taking acyclovir and low-dose prednisone. The RN has several prescriptions available. what additional meds or care strategies to promote comfort may be helpful? select all

diphenhydramine 25mg by mouth every 6 hrs prn calamine lotion applied to affect areas acetaminophen 325mg by mouth every 6hrs prn diversionary activities to prevent pt scratching

osteomalacia

disease marked by softening of the bone caused by calcium and vitamin D deficiency in children called rickets

pt has allergic rhinitis. What intervention would be most likely to help the pt meet the goal of improved breathing pattern?

modify the environment to recude the severity of allergic symptoms

ketoconazole is prescribed for a pt with candidiasis. Which interventions should the RN include when administering this med? select all

monitor liver function studies instruct pt to avoid alcohol instruct pt to avoid exposure to the sun

plantar fascititis

most common cause of heel pain, stabbing pain first thing in the morning inflammation of the thick band of tissue from heel to ties

flatfoot (pes planus)

normal in infants + toddlers, arches can fall over time from obesity

The RN is teaching a pt with an arm cast about s+s of compartment syndrome. The RN determines the pt has understood the infor when he/she says the should report which early s+s of compartment syndrome?

numbness and tingling of the fingers

ulcer

opening in the skin caused by sloughing of necrotic tissue, extending past the epidermis ex. pressure ulcer, stasis ulcer

pt w open femoral fracture was discharged to home and reports having a fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. the RN should interpret these findings as?

osteomyelitis

The pt w AIDs is diagnosed w cutaneous kaposi's sarcoma. based on this dx the RN understands that this has been confirmed by which finding?

positive punch biopsy of the cutaneous lesions

A priority for nursing care for an older adult who has pruritus, is continuously scratching the affected areas and demonstrates agitation and anxiety regarding the itching is:

preventing infection

The RN is conducting allergy skin testing on a pt. Which post procedure interventions are most appropriate? select all

record site, date + time of test give the pt a list of potential allergens if identified

A pt with an intracapsular hip fracture, the RN should conduct a focused assessment to detect..

shortening of the affected leg

Papule

solid elevations w/o fluid w sharp borders ex. mole

which change in the integumentary system is associated with normal aging?

subcutaneous fat and extracellular water decrease

when teaching a pt w an extracapsular hip fracture being scheduled for surgical internal fixation w the insertion of a pin, the RN bases the teaching on the understanding that this surgical repair is the treatment of choice because

the pt is able to mobilize sooner

scale

thin or thick flake of skin varying in color, usually secondary to desquamated, dead epithelium ex. dandruff