Medsurg CAQs #6

A client has a craniotomy for a meningioma. For which response should the nurse assess the client in the postanesthesia care unit? 1 Dehydration 2 Blurred vision 3 Wound infection 4 Narrowing pulse pressure

2

An x-ray film indicates that an older client has a fractured femur. The client asks the nurse, "Will I be able to walk again?" What is the best response by the nurse? 1 "I have no idea because only time will tell." 2 "You only broke a bone. It could have been worse." 3 "You'll walk again. This is a common issue in older people." 4 "Tell me more about your concerns about being able to walk."

4

The nurse is providing postoperative care to a client who had surgery in which a hip prosthesis was inserted. An abductor splint is in place. When should the nurse remove the splint? 1 When the client gets up to sit in a chair 2 If the client needs a change of position 3 Once the client's edema and pain have ceased 4 During the client's skin care and physical therapy

4

Upon palpation, the nurse identifies spongy swelling caused by synovial fluid. Which joint was most likely palpated? 1 Biaxial joint 2 Pivotal joint 3 Synovial joint 4 Temporomandibular joint

4

A nurse is caring for a patient who has paraplegia. Which behavior indicates understanding about the nursing team's responsibility in relation to pressure ulcers? 1 Inspecting the skin daily 2 Providing a rubber cushion on which to sit 3 Massaging body lotion over reddened areas 4 Applying a heating pad to bony prominences

1

After a left cataract extraction, a client reports severe discomfort in the operated eye. The nurse concludes that this problem may be caused by which condition? 1 Hemorrhage into the eye 2 Expected postoperative discomfort 3 Isolation related to sensory deprivation 4 Pressure on the eye from the protective shield

1

What is the function of a client's cranial nerve VI? 1 Movement of the eye with levator muscle 2 Movement of the eye with lateral rectus muscles 3 Movement of the eye with medial rectus muscles 4 Movement of the eye with superior oblique muscles

2

What does the nurse instruct a client to do while performing McMurray's test? 1 To raise the leg to 60 degrees 2 To abduct the arm to 90 degrees 3 To flex, rotate, and extend the knees 4 To flex the knee to 30 degrees and pull the tibia forward

3

What should the nurse emphasize when providing discharge instructions for a client with the diagnosis of Addison disease? 1 Limit physical activity. 2 Restrict sodium in the diet. 3 Continue steroid replacement therapy. 4 Schedule frequent health care appointments.

3

Which cranial nerve emerges from the client's medulla? 1 Trochlear 2 Trigeminal 3 Hypoglossal 4 Oculomotor

3

Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities? 1 Thermography 2 Plethysmography 3 Duplex venous doppler 4 Somatosensory evoked potential

3

A client returns from the postanesthesia care unit after a right rotator cuff repair. What should the nurse do when performing a neurovascular assessment? 1 Monitor for a pulse deficit. 2 Obtain hourly blood pressure readings. 3 Assess for capillary refill in the nail beds. 4 Place the shoulder through range-of-motion exercises.

3

A client who is diagnosed as having a herniated nucleus pulposus reports pain. What should the nurse most likely conclude is the cause of this client's pain? 1 Inflammation of the lamina of the involved vertebra 2 Shifting of two adjacent vertebral bodies out of alignment 3 Compression of the spinal cord by the extruded nucleus pulposus 4 Increased pressure of cerebrospinal fluid within the vertebral column

3

Which antiinfective agent may lead to blindness if not used correctly by the client in prescribed amounts? 1 Bromfenac 2 Natamycin 3 Trifluridine 4 Gentamicin

4

A nurse observes dorsiflexion of the big toe and fanning of other toes when the lateral side of a client's foot is stroked with an applicator stick during a neurologic examination. What should the nurse document in the client's medical record? 1 "Has intact plantar reflexes" 2 "Exhibits a positive Babinski sign" 3 "Demonstrates normal sensory function" 4 "Able to perform active range of motion"

2

A client has surgery for the creation of burr holes after sustaining head trauma. Which early clinical manifestation of meningeal irritation does the nurse assess in the client? 1 Sunset eyes 2 Kernig sign 3 Plantar reflex 4 Homans sign

2

A client with arthritis is to begin long-term steroid therapy. Which statement indicates to the nurse that the client understands the instructions about this medication? 1 "My urine may become discolored." 2 "I should avoid crowds in enclosed areas." 3 "Weight loss can occur with this medication." 4 "The medication should be taken between meals."

2

A nurse is caring for a client who will have a below-the-knee amputation with an immediate postoperative prosthesis. The client asks the nurse the advantage of having an immediate prosthesis. What should the nurse explain is the advantage? 1 Decreases phantom limb sensations 2 Encourages a normal walking pattern 3 Reduces the incidence of wound infection 4 Allows for fitting of the prosthesis before discharge

2

Which assessment finding supports the nurse's conclusion that a prosthesis for a client with an above-the-knee amputation fits correctly? 1 Skin that is cool to the touch 2 Shrinking of the residual limb 3 Absence of phantom limb pain 4 Evenly darkened skin of the residual limb

4

Which structure connects the client's tibia to the femur at the knee joint? 1 Fascia 2 Bursae 3 Tendons 4 Ligaments

4

While assessing a client, the nurse suspects that the client has acute osteomyelitis. Which symptoms in the client support the nurse's suspicion? Select all that apply. 1 Foot ulcer 2 Temperature of 102° F 3 Erythema of the affected area 4 Tenderness of the affected area 5 Drainage from the affected area

2, 3, 4

In caring for the client with burr holes for a subdural hematoma postoperatively on day 2, the nurse notes the client has an increased temperature to 101.3 F° (38.5° C). What does the nurse understand about this reaction? 1 This is a normal assessment for the client with a subdural hematoma. 2 This is a normal reaction day 2 postoperatively, and the nurse will administer acetaminophen as prescribed by the healthcare provider. 3 Because the client has burr holes, this is not an accurate measurement. 4 The client is exhibiting signs of an infection, and the healthcare provider needs to be notified.

4

The primary healthcare provider prescribes one unit of packed red blood cells to be administered to the client who suffered a hip fracture. Several minutes after the start of the infusion, the client reports itching. Upon further assessment, the nurse observes hives on the client's chest. Which action should the nurse take next? 1 Call the primary healthcare provider to obtain a prescription for an antihistamine. 2 Flush packed red blood cells with 5% dextrose and 0.45% normal saline. 3 Slow down the rate of the infusion. 4 Stop the transfusion immediately.

4

A 50-year-old male client has difficulty communicating because of expressive aphasia after a cerebrovascular accident (CVA, also known as a "brain attack"). When the nurse asks the client how he is feeling, his wife answers for him. How should the nurse address this behavior? 1 Ask the wife how she knows how the client feels. 2 Instruct the wife to let the client answer for himself. 3 When the wife leaves return to speak with the client. 4 Acknowledge the wife but look at the client for a response.

4

A 65-year-old client tells the nurse, "I see some particles that float within my field of vision." What may be the cause of this condition? 1 Opacities in the lens 2 Dilator muscle atrophy 3 Atrophy of nerve fibers 4 Liquefaction and detachment of the vitreous membrane

4

A client is experiencing diplopia, ptosis, and mild dysphagia. Myasthenia gravis is diagnosed, and an anticholinergic medication is prescribed. The nurse is planning care with the client and spouse. What instruction is the priority? 1 Eat foods that are pureed. 2 Perform range-of-motion exercises. 3 Take a stool softener daily. 4 Take the medication according to a specific schedule.

4

A client visits a primary healthcare provider with a report of burning and a sharp pain in the sole of the foot that intensifies in the morning. Which abnormal condition does the nurse anticipate in the client? 1 Torticollis 2 Pes planus 3 Tenosynovitis 4 Plantar fasciitis

4

A client's tibia is fractured in a motor vehicle accident, and a cast is applied. The nurse should assess for which manifestation indicating damage to major blood vessels caused by the fractured tibia? 1 Increased blood pressure 2 Prolonged edema in the thigh 3 Increased skin temperature of the foot 4 Prolonged reperfusion of the toes after blanching

4

According to the common scale for grading muscle strength, what rating will be given to a client who can complete range of motion with some resistance? 1 1 2 2 3 3 4 4

4

A client is admitted to the hospital after having a tonic-clonic seizure and is diagnosed with a seizure disorder. Which is most important for the nurse to include in a teaching program? 1 Explain ways to prevent physical trauma from occurring during a seizure. 2 Teach that anticonvulsant medications should be taken on an empty stomach. 3 Teach the client that the symptoms and treatment of seizure disorders are similar, regardless of the cause. 4 Explain to the client that it is not necessary to tell others of the illness because medication will control seizures.

1

The nurse is caring for a client who underwent surgery for a brain tumor. On assessment, the nurse suspects meningitis in the client. Which finding would help confirm the nurse's suspicion? 1 Positive Kernig sign 2 Glasgow coma score: 10 3 Absence of nuchal rigidity 4 Negative Brudzinski sign

1

When completing a neurologic assessment, the nurse determines that a client has a positive Romberg test. Which finding supports the nurse's conclusion? 1 Inability to stand with feet together when eyes are closed 2 Fanning of toes when the sole of the foot is firmly stroked 3 Dilation of pupils when focusing on an object in the distance 4 Movement of eyes toward the opposite side when head is turned

1

A recently hospitalized client with multiple sclerosis is concerned about generalized weakness and fluctuating physical status. What is the priority nursing intervention for this client? 1 Encourage bed rest. 2 Space activities throughout the day. 3 Teach the limitations imposed by the disease. 4 Have one of the client's relatives stay at the bedside.

2

Which factor does the nurse consider most likely contributes to the increased incidence of hip fractures in older adults? 1 Carelessness 2 Fragility of bone 3 Sedentary existence 4 Rheumatoid diseases

2

Which hormone increases the rate of protein synthesis in a client? 1 Estrogen 2 Thyroxine 3 Parathormone 4 Vitamin D

2

A college athlete sustained a complete transection of the spinal cord while practicing on a trampoline. The healthcare provider explains that return of function to the lower extremities is not likely to occur. Two weeks later, the client verbalizes the need to get out of the hospital to practice for an upcoming tournament. Which is the nurse's most appropriate conclusion about the client's statement? 1 Exhibiting denial 2 Verbalizing a fantasy 3 No longer able to adapt 4 Motivated to recover mobility

1

A client who had a brain attack (stroke) is admitted to the hospital with right-sided hemiplegia. For what reason does the nurse recognize the importance of identifying restrictions of mobility or neuromuscular abnormalities? 1 Shortening and eventual atrophy of the muscles will occur. 2 Hypertrophy of the muscles eventually will result from disuse. 3 Rigid extension can occur, making therapy painful and difficult. 4 Decreased movement on the affected side predisposes the client to infection.

1

A client with rheumatoid arthritis arrives in the clinic stating, "I don't take any medications because they are too expensive." The client reports that family members are arranging for the medications to be obtained from another country. What is the nurse's best response? 1 Discuss alternative solutions with the client. 2 Encourage the client to use any method possible to obtain the medications. 3 Contact the primary healthcare provider immediately to discuss the client's plan. 4 Explain that medical regimens must be followed to continue to receive care in the clinic.

1

Which alternative therapy may be beneficial for the nurse to discuss with a client who has terminal bone cancer? 1 Biofeedback 2 Radiotherapy 3 Bariatric therapy 4 Radioactive implants

1

An older client experiences a cerebral vascular accident (CVA) and has right-sided hemiplegia and expressive aphasia. The client's children ask the nurse which functions will be impaired. Which abilities does the nurse explain will be affected? 1 Stating wishes verbally 2 Recognizing familiar objects 3 Comprehending written words 4 Understanding verbal communication

1

In which part of the client's body is the amphiarthroidial joint located? 1 Pelvis 2 Elbow 3 Cranium 4 Shoulder

1

Which clinical indicator does the nurse expect to identify when assessing a client admitted with a herniated lumbar disk? 1 Pain radiating to the hip and leg 2 Stiffness in shoulders 3 Paralysis of both lower extremities 4 Overgrowth of tissue on the lower back

1

Which disorder of the foot is caused by continual pressure over bony prominences? 1 Corn 2 Plantar wart 3 Hammer toe 4 Hallux rigidus

1

Which radiographic test is used to view the entire skeleton? 1 Bone scan 2 Gallium and thallium scan 3 Computed tomography (CT) 4 Magnetic resonance imaging (MRI) scan

1

After surgery for a fractured hip, a client states, "I don't remember when I have ever been so uncomfortable." What should the nurse's initial response be? 1 Notify the primary healthcare provider. 2 Use distraction techniques. 3 Medicate the client as prescribed. 4 Perform a complete pain assessment.

4

Which structure protects a client's internal organs, supports blood cell production, and stores minerals? 1 Joints 2 Bones 3 Muscles 4 Cartilages

2

A client is scheduled for head and neck surgery. Although the healthcare provider has explained the surgery, the client still has moderate to severe anxiety. Which action should the nurse take initially? 1 Attempt to discover what the client is concerned about. 2 Elaborate on what the healthcare provider has already said. 3 Teach the client to use the suction equipment preoperatively. 4 Plan for postoperative communication because a tracheostomy is likely.

1

The medical history of a client with osteoporosis indicates renal calculi. Which medication would be contraindicated? 1 Os-cal 2 Raloxifene 3 Ibandronate 4 Zoledronic acid

1

A nurse teaches about osteochondroma. Which information should the nurse include in the teaching session? 1 It is a common malignant tumor. 2 It occurs most often in the age group of 10 to 25. 3 It has a high rate of local occurrence after surgery. 4 It frequently arises in cancellous ends of arm and leg bones.

2

A nurse begins planning for the discharge of a client who had a brain attack (cerebrovascular accident, CVA) with residual hemiparesis and hemianopsia. Which information should the nurse include in the discharge teaching plan for this client? 1 Necessity for bed rest at home 2 Use of oxygen therapy at home 3 Significance of a safe environment 4 Need for decreased protein in the diet

3

Non-weight bearing with crutches has been prescribed for a client with a leg injury. The nurse provides teaching before ambulation is begun. To facilitate walking with crutches, what is the most important activity the nurse should teach the client? 1 Sit up in a chair to help strengthen back muscles. 2 Keep the unaffected leg in extension and abduction. 3 Exercise the triceps, finger flexors, and elbow extensors. 4 Use a trapeze frequently to strengthen the biceps muscles.

3

The nurse is caring for a client who has a tumor of the cerebellum. What is the client most likely to exhibit? 1 Frequent loss of consciousness 2 Absence of the knee-jerk reflex 3 Inability to execute smooth movements 4 Inability to execute voluntary movements

3

To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixation. Because the client keeps slipping down in bed, increased countertraction is prescribed. How does the nurse increase the countertraction? 1 Elevate the head of the bed. 2 Add more weight to the traction. 3 Raise the foot of the bed slightly. 4 Tie a chest restraint around the client.

3

A nurse provides education to a client with myasthenia gravis about how to prevent myasthenic crisis. The nurse evaluates that the teaching is effective when the client makes which statement? 1 "I'll take an antihistamine at the first sign of a cold." 2 "I should skip a dose of pyridostigmine bromide (Mestinon) if it upsets my stomach." 3 "We've told our daughter to wait to visit until her cold is better." 4 "The healthcare provider may need to adjust the dosage of my medication if I'm more active."

4

Which treatment is beneficial for a client with muscle spasm? 1 Thermotherapy 2 Muscle massage 3 Frequent position changes 4 Muscle-strengthening exercise regimen

1

While interacting with a client, the nurse notices a lack of coordination in the client's speech. What could be the reason behind this condition? 1 Cranial nerve lesion 2 Occipital lobe lesion 3 Parietal cortex lesion 4 Limbic lobe lesion

1

A registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for correction? 1 "I should walk on scatter rugs at home." 2 "I should drink 3000 mL of water every day." 3 "I should eat fruits and vegetables six times a day." 4 "I should exercise the joints above and below the cast daily."

1

Which child is at the highest risk for blunt trauma associated with the indirect entry (hematogenous stage) of microorganisms? 1 8-year-old boy 2 10-year-old girl 3 13-year-old girl 4 14-year-old boy

1

X-ray films reveal that a client has closed fractures of the right femur and tibia. In addition, multiple soft-tissue contusions are present. Which action is most important for the nurse to take? 1 Perform a neurovascular assessment of the extremity. 2 Reassure the client that these injuries are not that serious. 3 Gather equipment needed for the application of skeletal traction. 4 Prepare the client for a surgical reduction of the injured extremity.

1

A nurse is performing the history and physical examination of a client with Parkinson disease. Which assessments identified by the nurse support this diagnosis? Select all that apply. 1 Nonintention tremors 2 Frequent bouts of diarrhea 3 Masklike facial expression 4 Hyperextension of the neck 5 Rigidity to passive movement

1,3,5

Which drug is used in the treatment of a client with intervertebral disc disease? 1 Etidronate 2 Zoledronic acid 3 Cyclobenzaprine 4 Salmon calcitonin

3

Which principle should the nurse consider when assisting a client with crutches to learn the four-point gait? 1 Elbows should be kept in rigid extension. 2 Most of the weight should be supported by axillae. 3 The client must be able to bear weight on both legs. 4 The affected extremity should be kept off the ground.

3

Which synovial joint movement is involved in turning the client's palm downward? 1 Eversion 2 Inversion 3 Pronation 4 Supination

3