med surg mod 12 questions ch 45, 46, 47

The nurse is assessing an older client who has bony nodules on finger joints (Heberden and Bouchard nodes). What priority question would the nurse want to ask as part of the client interview? "When did your bony nodules develop?" "How do you feel about having these bony nodules?" "Are you able to independently perform ADLs?" "Are your bony nodules painful or tender?"

"Are you able to independently perform ADLs?"

Buck's (skin) traction for a fractured hip is applied to a client while a urinary tract infection is treated before surgery. What instruction will the nurse give assistive personnel (AP) for providing client care related to the traction? "Inspect the pins in the traction for signs of infection." "Remove the boot every shift to inspect the skin." "Do not allow the traction weights to rest on the ground." "Remove traction weights when turning the client."

"Do not allow the traction weights to rest on the ground."

The nurse is planning health teaching for a client starting hydroxychloroquine for rheumatoid arthritis. What instruction would the nurse include in the teaching? "Be aware that the drug may cause secondary types of cancer." "Expect nausea and vomiting for the first week after starting the drug." "Have eye examinations every 6 months while on the drug." "Keep this medication in the refrigerator at all times."

"Have eye examinations every 6 months while on the drug."

The nurse has provided health teaching for a female client starting on methotrexate (MTX) for early rheumatoid arthritis. What statement by the client indicates a need for further teaching? "I will try to avoid crowds because I could easily get an infection." "I will start folic acid supplements which can help decrease side effects." "I can drink alcohol in small amounts at night to help me relax." "I will use strict birth control while I am taking this drug."

"I can drink alcohol in small amounts at night to help me relax."

A client who uses a computer for hours each day asks the nurse how to help prevent carpal tunnel syndrome (CTS). Which statement by the client indicates a need for further teaching? "I need to make sure I have an ergonomically sound computer station." "I need to exercise repetitively to strengthen my wrists." "I should stretch my fingers and wrists frequently during the day." "I may need to wear a wrist splint when my wrist gets inflamed."

"I need to exercise repetitively to strengthen my wrists."

A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? "I can't believe that this has happened to me. I can't stand to look at it." "I do not want any visitors while I'm in the hospital." "My spouse will be the only person to change my dressing." "It will take me some time to get used to this."

"It will take me some time to get used to this."

An older adult client who has osteoporosis is discharged from the hospital. What does the nurse include in health teaching related to the client's home safety? "Keep walkways free of clutter." "Keep light low to prevent glare." "Walk slowly on wet floor areas after mopping." "Use area rugs on tile floors."

"Keep walkways free of clutter."

A young female client whose mother and grandmother have osteoporosis asks whether she needs to take steps to prevent this disease in herself. What will the nurse tell this client? "Now is the time to begin building strong bones." "Your risk isn't present until age 50; we can talk about it then." "You do not have to worry about symptoms at your age." "You should begin to take steps to prevent disease at age 30."

"Now is the time to begin building strong bones."

A client who has osteopenia is prescribed to begin risedonate. What health teaching would the nurse include about this drug? "Take the drug with dinner or other meal or snack every day." "Remain in an upright position for 30 minutes after taking the drug." "Be sure to follow up with lab work to monitor your liver function." "Be sure to report any new bone pain or infection."

"Remain in an upright position for 30 minutes after taking the drug."

The nurse is caring for a client who has been treated for osteoporosis for 15 years and is starting on denosumab. What health teaching is appropriate for the nurse to include about this drug? "You will receive an IV infusion once a year by your provider." "Take the drug every morning with a glass of water." "Have a dental examination prior to beginning the drug." "See your primary health care provider for twice yearly injections."

"See your primary health care provider for twice yearly injections."

The nurse is caring for an older, alert adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? "I do not know how long my wife will be able to take care of me at home." "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." "I do not know how much longer my neighbor can continue to help clean my house." "The bus is coming to pick me up from the senior center three times a week so I can play cards."

"The bus is coming to pick me up from the senior center three times a week so I can play cards."

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan? "Avoid rigorous exercise." "Avoid contact sports." "Wear helmets when riding a motorcycle." "Avoid driving in inclement weather."

"Wear helmets when riding a motorcycle."

Which intervention would the nurse suggest to a client who has undergone a leg amputation to help cope with loss of the limb? Talking with a psychiatrist about the amputation Engaging in diversional activities to avoid focusing on the amputation Talking with an amputee close to the client's age who has a similar amputation Drawing a picture of how the client sees him- or herself

Talking with an amputee close to the client's age who has a similar amputation

The nurse is preparing to give apixaban for a client who recently had a total knee arthroplasty. What does the nurse recognize as the advantage of this drug over other anticoagulants? The client does not need to have labs drawn for PT or INR. The client only needs to take the drug while in the hospital. The client is not at risk for bleeding or bruising. The client does not need to wear sequential compression devices.

The client does not need to have labs drawn for PT or INR.

The nurse is caring for a postoperative client with total hip arthroplasty. What actions would the nurse take to prevent venous thromboembolism (VTE) postoperatively? (Select all that apply.) Select all that apply. A. Apply pneumatic or sequential compression devices. B. Administer anticoagulant therapy. C. Ambulate the client on the day of surgery. D. Elevate the client's legs. E. Keep the legs slightly abducted.

A. Apply pneumatic or sequential compression devices. B. Administer anticoagulant therapy. C. Ambulate the client on the day of surgery.

The nurse is caring for a client who is at risk for osteoporosis. What lifestyle changes might the client be able to implement to decrease this risk? (Select all that apply.) Select all that apply. A. Avoiding excessive alcohol consumption B. Increasing foods high in phosphorus C. Decreasing consumption of carbonated beverages D. Preventing a sedentary daily lifestyle E. Seeking a smoking cessation program, if needed F. Including more calcium-rich foods into the diet

A. Avoiding excessive alcohol consumption C. Decreasing consumption of carbonated beverages D. Preventing a sedentary daily lifestyle E. Seeking a smoking cessation program, if needed F. Including more calcium-rich foods into the diet

The nurse is caring for a client with a crush injury to the lower extremities. For which complication will the nurse monitor? A. Confusion B. Acute kidney injury C. Increased temperature D. Development of wound infection

A. Confusion

A client is admitted to the emergency department following a left severe ankle sprain caused by playing football with friends. What nursing actions will the nurse implement at this time? (Select all that apply.) Select all that apply. A. Elevate the left leg above the level of the heart. B. Tell the client to keep his left leg still. C. Apply an elastic wrap or ankle or compression brace. D. Administer morphine via IV push. E. Apply heat to promote blood flow and healing.

A. Elevate the left leg above the level of the heart. B. Tell the client to keep his left leg still. C. Apply an elastic wrap or ankle or compression brace.

The nurse recognizes that a client who has persistent pain may have difficulty with pain management after a total joint arthroplasty. What collaborative interventions are needed to help the client manage postoperative pain? (Select all that apply.) Select all that apply. A. Establish trust and explain the postoperative pain management plan. B. Consult the pain management team if needed and available. C. Plan continuing pain management after discharge. D. Use multimodal and alternative pain management modalities. E. Identify at-risk clients preoperatively using a comprehensive assessment.

A. Establish trust and explain the postoperative pain management plan. B. Consult the pain management team if needed and available. C. Plan continuing pain management after discharge. D. Use multimodal and alternative pain management modalities. E. Identify at-risk clients preoperatively using a comprehensive assessment.

The nurse is caring for a client with osteoarthritis (OA) in the left knee. What factor does the nurse suspect is the most likely cause of this client's OA? Trauma to the joint Aging Osteoporosis Familial history

Trauma to the joint

Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury? Lungs for bilateral normal breath sounds Urine specimen to assess for the red blood cells Pain score and level of alertness Skin to evaluate lacerations and abrasions

Urine specimen to assess for the red blood cells

The nurse is teaching a client preparing to have a total knee replacement about interventions to help prevent surgical infection. What interventions would the nurse include in this teaching? (Select all that apply.) Select all that apply. A. Using nasal mupirocin for at least a week before surgery B. Avoiding sleeping with pets in the client's bed C. Showering the night before and the morning of surgery with chlorhexidine D. Giving antibiotics before and after surgery for at least 3 days E. Sleeping on clean linen wearing clean nightwear

A. Using nasal mupirocin for at least a week before surgery B. Avoiding sleeping with pets in the client's bed C. Showering the night before and the morning of surgery with chlorhexidine E. Sleeping on clean linen wearing clean nightwear

A client was recently diagnosed with osteoarthritis and asks the nurse which over-the-counter drug would be the best to take? What would the nurse's recommendation be? Ibuprofen Acetaminophen Tramadol Gabapentin

Acetaminophen

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? Surgical repair of the rotator cuff Patient-controlled analgesia with morphine Activity limitations for the affected arm Prescribed exercises of the affected arm

Activity limitations for the affected arm

A client who had a right elective above-the-knee amputation reports severe pain in the right lower leg and foot. What is the nurse's best action at this time? Assess the level of the client's pain. Change the subject and talk about the client's hobbies. Distract the client with stories about the nurse's family. Remind the client that the lower leg was removed.

Assess the level of the client's pain.

The client's ankle heals, and his cast is removed. What teaching will the nurse provide regarding ongoing ankle care? A. "Scrub your lower leg and ankle to remove dead, scaly skin." B. "Wear a support stocking to prevent lower extremity swelling." C. "Keep your ankle in a low position to facilitate perfusion to the healed bone." D. "Exercise vigorously at least three times a day as advised by the physical therapist."

B. "Wear a support stocking to prevent lower extremity swelling."

A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 m) fall 2 days ago. The nurse plans to assess the client for which potential complications? (Select all that apply.) Select all that apply. A. Urinary tract infection (UTI) B. Acute compartment syndrome (ACS) C. Fat embolism syndrome (FES) D. Osteomyelitis E. Heart failure

B. Acute compartment syndrome (ACS) C. Fat embolism syndrome (FES) D. Osteomyelitis

The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the primary health care provider will request which supplement? Vitamin D3 Vitamin C Calcium Phosphorus

Vitamin D3

What will the nurse recommend as the most appropriate way to decrease the risk for osteoporosis in a client who has just been determined to be at high risk for the disease? Increase nutritional intake of phosphorus. Walk for 30 minutes three times a week. Increase nutritional intake of calcium. Engage in high-impact exercise, such as running.

Walk for 30 minutes three times a week.

The nurse is teaching a client about the use of crutches following a foot fracture. When adjusting the crutches to ensure a correct fit, what action will the nurse take? Ensure that each crutch fits firmly into the client's armpit. Be sure that the top of each crutch is well padded. Use the crutch on the affected side only. Check to see how many steps the client can take with the crutches.

Be sure that the top of each crutch is well padded.

Which is the most important nursing intervention/treatment for osteomyelitis? A. Administer pain medications B. Administer IVF'S C. Administer antibiotics D. Dressing changes

C. Administer antibiotics

The nurse is caring for a patient recovering from a THA using the direct lateral approach, what complication should the nurse be monitoring for? A. pneumonia B. paralytic ileus C. Hip dislocation D. VTE- Venous Thromboembolism

C. Hip dislocation

A 60-year-old man is brought to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no open wounds. The right foot is pale and cool to palpation, and a pulse is not detected. The client rates his pain as an "8" on a 0-to-10 scale. 1. What is the priority nursing action at this time? A. Prepare for reduction. B. Administer pain medication. C. Obtain a Doppler of the right foot pulse. D. Notify the health care provider of the lack of pulse.

C. Obtain a Doppler of the right foot pulse.

The nurse is preparing a client for a total hip arthroplasty today. What IV antibiotic would the nurse likely administer if the client has no drug allergies? Penicillin Clindamycin Vancomycin Cefazolin

Cefazolin

The nurse is caring for a client who has a continuous femoral nerve blockade following a total knee arthroplasty. What nursing assessment does the nurse need to perform to ensure client safety? Monitor vital signs frequently to detect early complications. Perform focused cardiovascular and respiratory assessments. Check that the client can dorsiflex and plantar flex the foot on the operative leg. Monitor for excessive blooding and bruising during the infusion.

Check that the client can dorsiflex and plantar flex the foot on the operative leg.

A client with an open fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is essential for the nurse to take first? Check the dorsalis pedis pulses. Administer the prescribed analgesic. Place a dressing on the affected area. Immobilize the left leg with a splint.

Check the dorsalis pedis pulses.

A client had a fractured tibia repair several weeks ago and tells the nurse that she has persistent burning pain, ongoing edema, and muscle spasms in her affected leg. For which chronic complication is the client at risk? Chronic osteomyelitis Complex regional pain syndrome Severe osteoporosis Compartment syndrome

Complex regional pain syndrome

The nurse is caring for a client who sustained a knee injury at work. The nurse explains that which diagnostic test best demonstrates soft tissue damage in the area of the injury? A. Knee x-ray B. Electromyography (EMG) C. Computed tomography (CT) D. Magnetic resonance imaging (MRI)

D. Magnetic resonance imaging (MRI)

The nurse is assessing a 38-year old client with a cast on the lower left extremity. Which early finding alerts the nurse to potential compartment syndrome? A. Toe numbness B. Left leg paralysis C. Decreased pulse in LLE D. More intense pain than expected from injury

D. More intense pain than expected from injury

A patient presents with probable osteomyelitis of his foot, he wants to ambulate to use the bathroom, what do you do? A. Get a bedside commode to use B. Get another caregiver to help C. Assess ambulation and allow if steady D. Offer a urinal to use in bed

D. Offer a urinal to use in bed don't want them getting up, increased risk for bone fracture

The nurse is caring for a patient recovering from a TKA using what common complication should the nurse be monitoring for? A. pneumonia B. paralytic ileus C. wound dehiscence D. VTE- Venous Thromboembolism

D. VTE- Venous Thromboembolism

The nurse is assessing an older adult client who has severe kyphosis. What psychosocial client problem would the nurse anticipate? Dementia Bipolar disorder Psychosis Depression

Depression

The nurse is caring for a client immediately after a vertebroplasty. In what position would the nurse most likely place the client? Prone for the first 1 to 2 hours High-Fowler for the first hour Side-lying for the first 2 hours Flat supine for the first 1 to 2 hours

Flat supine for the first 1 to 2 hours

The nurse is caring for a client with an inflamed, reddened, and severely painful first metatarsal joint. With what type of arthritis are these signs and symptoms associated? Rheumatoid arthritis Infectious arthritis Gouty arthritis Osteoarthritis

Gouty arthritis

Which risk factors are shared by male clients who have osteoporosis or osteomalcia? (Select all that apply.) Select all that apply. High alcohol intake Homelessness Low BMI A history of smoking Inadequate exposure to sunlight

High alcohol intake A history of smoking

The nurse is caring for a client with osteoarthritis who reports severe pain in both knees. What nonpharmacologic intervention is the most appropriate for the nurse to recommend for this client? Massage and hypnosis. Hot compresses or moist heating pad. Glucosamine and chondroitin combination. Ice packs used every 3 to 4 hours during the day.

Hot compresses or moist heating pad.

The nurse is developing a health teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? Take up knitting to slow down joint degeneration. Eat at least 2 yogurts every day. Wear supportive shoes at all times. Begin a jogging or running program.

Wear supportive shoes at all times.

A middle-age female client has osteoporosis and is at risk for developing vertebral fractures. She asks the nurse about exercises to help minimize this risk. Which exercise will the nurse recommend? Cycling Running Walking Yoga

Yoga

The nurse is caring for a client who has an external fixator for an open fracture of the tibia and fibula. What is the nurse's priority for care related to the fixator? Inspect the pins to monitor for infection and do not remove crusts. Make sure that the wound is managed using a moist wound healing method. Keep the leg covered to keep the extremity warm to promote circulation. Keep the extremity elevated to three pillows while in bed or in a chair.

Inspect the pins to monitor for infection and do not remove crusts.

A client is in skeletal traction for a complex femoral fracture. Which nursing intervention ensures proper care of this client? Ensure that weights are placed on the floor. Remove the traction weights only for bathing. Ensure that pins are not loose and tighten as needed. Inspect the skin at least every 8 hours.

Inspect the skin at least every 8 hours.

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? Keep the client's heels off the bed at all times. Reposition the client every 3 to 4 hours. Avoid the use of antiembolism stockings. Administer pain medication before deep-breathing exercises.

Keep the client's heels off the bed at all times.

A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse would instruct the client to notify the primary health care provider immediately if which change occurs? Absence of erythema and tenderness at the surgical site Ability to flex and extend the right knee Large amount of serosanguineous or bloody drainage Mild to moderate pain controlled with prescribed analgesics

Large amount of serosanguineous or bloody drainage

A client sustains a fracture of one arm and the primary health care provider applies a synthetic cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department? Monitor neuromuscular status for decreased circulation and sensation in the extremity. Check the fit of the cast by inserting a tongue blade between the cast and the skin. Apply a heating pad for 15 to 20 minutes four times daily to help with pain. Keep the cast covered with a soft towel to help it to dry quickly.

Monitor neuromuscular status for decreased circulation and sensation in the extremity.

A client in the emergency department receives moderate sedation while having a closed reduction of a fractured ankle. What is the nurse's priority assessment during this procedure? Check the client's blood pressure frequently. Monitor the client's pain level. Monitor the client's respiratory rate. Perform circulation checks before and after the procedure.

Monitor the client's respiratory rate.

A client is admitted to the same-day surgical center PACU after a bunionectomy. After assessing the client's ABCs, what is the priority assessment for the client? Muscle strength assessment Joint assessment Neurovascular assessment Neurologic assessment

Neurovascular assessment

The nurse is caring for a female client who has a right wrist ganglion which is interfering with her ability to do her job as an administrative assistant. What collaborative treatment would the nurse anticipate for this client? Physical therapy Occupational therapy Removal of the ganglion Intravenous antibiotic therapy

Removal of the ganglion

The nurse is caring for an older client who has a large bulky lower leg dressing with posterior splint to maintain alignment after closed reduction for an ankle fracture. Which client assessment finding would the nurse report to the primary health care provider or Rapid Response Team immediately? Affected foot slightly cooler than the other foot. Reports pain level is 4 on a 0-10 pain intensity scale. Pedal pulse on affected foot is 1+ and regular. Reports tingling and numbness in affected foot.

Reports tingling and numbness in affected foot.

The nurse suspects that a client may have plantar fasciitis if the client has which assessment finding? Dorsiflexion of any metatarsophalangeal (MTP) joint, with plantar flexion of the adjacent proximal interphalangeal (PIP) joint A small tumor in a digital nerve of the foot Severe pain in the arch of the foot, especially when getting out of bed Lateral deviation of the great toe; first metatarsal head becomes enlarged

Severe pain in the arch of the foot, especially when getting out of bed

The nurse is teaching a postmenopausal client about the need for bone health and screening. What diagnostic test would the nurse recommend? Serum Vitamin D Dual x-ray absorptiometry (DXA) Serum calcium and phosphorus Vertebral x-rays

Dual x-ray absorptiometry (DXA)

The nurse is reviewing the laboratory test results of a client with a recently diagnosed osteosarcoma. What abnormal laboratory finding would the nurse expect for this client? Elevated alkaline phosphatase Decreased hematocrit Increased calcium Increased white blood cell count

Elevated alkaline phosphatase