NUR 2520 MegSurg 2 Exam 3 Practice Questions

A nurse is teaching a client how to follow a low-purine diet as prescribed by the provider for the management of gout. Which of the following statements indicates the client understands the teaching?

"I should avoid eating liver and other organ meats"

A nurse is reviewing the cause of gout with a group of nurses. Which of the following statements should the nurse make?

"The intra-articular deposition of urate crystals causes inflammation."

*During assessment of the patient with fibromyalgia, the nurse would expect the patient to report which of the following (select all that apply)?* a. Sleep disturbances b. Multiple tender points c. Cardiac palpitations and dizziness d. Multijoint inflammation and swelling e. Widespread bilateral, burning musculoskeletal pain

A, B, E

*Which actions will the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur (select all that apply)?* a. Monitor serum calcium. b. Teach about the need for strict bed rest. c. Discontinue use of sustained-release opioids. d. Support the left leg when repositioning the patient. e. Support family and patient as they discuss the prognosis.

A, D, E

*When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." The most appropriate response by the nurse is* a. "You have the right to refuse to take the methotrexate." b. "Methotrexate is less expensive than some of the newer drugs." c. "It is important to start methotrexate early to decrease the extent of joint damage." d. "Methotrexate is effective and has fewer side effects than some of the other drugs."

C

*Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis?* a. Ask the patient about any nausea. b. Obtain the patient's oral temperature. c. Review the patient's serum creatinine. d. Change the prescribed wet-to-dry dressing.

C

*Which discharge instruction will the emergency department nurse include for a patient with a sprained ankle?* a. Keep the ankle loosely wrapped with gauze. b. Apply a heating pad to reduce muscle spasms. c. Use pillows to elevate the ankle above the heart. d. Gently move the ankle through the range of motion.

C

*Which information obtained during the nurse's assessment of a patient's nutritional-metabolic pattern may indicates increased risk for musculoskeletal problems?* a. The patient takes a multivitamin daily. b. The patient dislikes fruits and vegetables. c. The patient is 5 ft, 2 in tall and weighs 180 lb. d. The patient prefers whole milk to nonfat milk.

C

*Which information will the nurse teach seniors at a community recreation center about ways to prevent fractures?* a. Tack down scatter rugs in the home. b. Expect most falls to happen outside the home. c. Buy shoes that provide good support and are comfortable to wear. d. Get instruction in range-of-motion exercises from a physical therapist.

C

*Which laboratory result is important to communicate to the health care provider for a patient who is taking methotrexate to treat rheumatoid arthritis (RA)?* a. Rheumatoid factor is positive. b. Fasting blood glucose is 90 mg/dL. c. The white blood cell (WBC) count is 1500/µL. d. The erythrocyte sedimentation rate is elevated.

C

*Which medication information will the nurse identify as a potential risk to a patient's musculoskeletal system?* a. The patient takes a daily multivitamin and calcium supplement. b. The patient takes hormone replacement therapy (HRT) to prevent "hot flashes." c. The patient has severe asthma requiring frequent therapy with oral corticosteroids. d. The patient has headaches treated with nonsteroidal antiinflammatory drugs (NSAIDs).

C

*Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?* a. Check ability to plantar and dorsiflex the foot. b. Determine the patient's readiness to ambulate. c. Log roll the patient from side to side every 2 hours. d. Ask about pain management with the patient-controlled analgesia (PCA).

C

*Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce the risk for osteoarthritis (OA)?* a. A 56-yr-old man who has a sedentary office job b. A 38-yr-old man who plays on a summer softball team c. A 56-yr-old woman who works on an automotive assembly line d. A 38-yr-old woman who is newly diagnosed with diabetes mellitus

C

*Which statement by the patient indicates a good understanding of the nurse's teaching about a new short-arm synthetic cast?* a. "I can get the cast wet as long as I dry it right away with a hair dryer." b. "I should avoid moving my fingers and elbow until the cast is removed." c. "I will apply an ice pack to the cast over the fracture site off and on for 24 hours." d. "I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast."

C

*Which information will the nurse include when teaching a patient with acute low back pain (select all that apply)?* a. Sleep in a prone position with the legs extended. b. Keep the knees straight when leaning forward to pick something up. c. Expect symptoms of acute low back pain to improve in a few weeks. d. Avoid activities that require twisting of the back or prolonged sitting. e. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.

C, D, E

*A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Which information from the patient's health history is important for the nurse to report to the health care provider related to the methotrexate?* a. The patient had a history of infectious mononucleosis as a teenager. b. The patient is trying to get pregnant before her disease becomes more severe. c. The patient has a family history of age-related macular degeneration of the retina. d. The patient has been using large doses of vitamins and health foods to treat the RA.

B

*A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first?* a. Patient who reports foot pain after hammertoe surgery b. Patient who has not voided 10 hours after a laminectomy c. Patient with low back pain and a positive straight-leg-raise test d. Patient with osteomyelitis who has a temperature of 100.5° F (38.1° C)

B

*A patient complains of shoulder pain when the nurse moves the patient's arm behind the back. Which question should the nurse ask?* a. "Are you able to feed yourself without difficulty?" b. "Do you have difficulty when you are putting on a shirt?" c. "Are you able to sleep through the night without waking?" d. "Do you ever have trouble lowering yourself to the toilet?"

B

*A patient has scleroderma manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) syndrome. Which action will the nurse include in the plan of care?* a. Avoid use of capsaicin cream on hands. b. Keep the environment warm and draft free. c. Obtain capillary blood glucose before meals. d. Assist to bathroom every 2 hours while awake.

B

*A patient hospitalized with polymyositis has joint pain; erythematous facial rash; eyelid edema; and a weak, hoarse voice. The safety priority for the patient is addressing the* a. acute pain. b. risk for aspiration. c. disturbed visual perception. d. risk for impaired skin integrity.

B

*A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention by the nurse?* a. The patient uses crutches with a swing-to gait. b. The patient leans over to pull on shoes and socks. c. The patient sits straight up on the edge of the bed. d. The patient bends over the sink while brushing teeth.

B

*A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching?* a. How to apply warm packs to the leg to reduce pain b. How to monitor and care for a long-term IV catheter c. The need for daily aerobic exercise to help maintain muscle strength d. The reason for taking oral antibiotics for 7 to 10 days after discharge

B

*A patient who is to have no weight bearing on the left leg is learning to walk using crutches. Which observation by the nurse indicates the patient can safely ambulate independently?* a. The patient moves the right crutch with the right leg and then the left crutch with the left leg. b. The patient advances the left leg and both crutches together and then advances the right leg. c. The patient uses the bedside chair to assist in balance as needed when ambulating in the room. d. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

B

*A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective?* a. "I will keep my back straight when I lift above than my waist." b. "I will begin doing exercises to strengthen and support my back." c. "I will tell my boss I need a job where I can stay seated at a desk." d. "I can sleep with my hips and knees extended to prevent back strain."

B

*A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will the nurse include in the initial plan of care?* a. Quadriceps-setting exercises b. Immobilization of the left leg c. Positioning the left leg in flexion d. Assisted weight-bearing ambulation

B

*A patient with gout has a new prescription for losartan (Cozaar) to control the condition. The nurse will plan to monitor* a. blood glucose. b. blood pressure. c. erythrocyte count. d. lymphocyte count.

B

*A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action will be included in the plan of care?* a. Logroll the patient every 2 hours. b. Assist the patient with ambulation. c. Discuss the need for genetic testing with the patient. d. Teach the patient about the muscle biopsy procedure.

B

*A patient with psoriatic arthritis and back pain is receiving etanercept (Enbrel). Which finding is most important for the nurse to report to the health care provider?* a. Red, scaly patches are noted on the arms. b. Crackles are auscultated in the lung bases. c. Hemoglobin is 11.1g/dL, and hematocrit is 35%. d. Patient has continued pain after first week of etanercept therapy.

B

*A patient with two school-age children has recently been diagnosed with rheumatoid arthritis (RA) and tells the nurse that home life is very stressful. Which initial response by the nurse is most appropriate?* a. "You need to see a family therapist for some help with stress." b. "Tell me more about the situations that are causing you stress." c. "Your family should understand the impact of your rheumatoid arthritis." d. "Perhaps it would be helpful for your family to be involved in a support group."

B

*A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included?* a. "You will not be able to serve a tennis ball again." b. "You will begin work with a physical therapist tomorrow." c. "Keep the shoulder immobilizer on for the first 4 days to minimize pain." d. "The surgeon will use the drop-arm test to determine the success of surgery."

B

*A young adult arrives in the emergency department with ankle swelling and severe pain after twisting an ankle playing basketball. Which of these prescribed Interprofessional interventions will the nurse implement first?* a. Send the patient for ankle x-rays. b. Wrap the ankle and apply an ice pack. c. Administer naproxen (Naprosyn) 500 mg PO. d. Give acetaminophen with codeine (Tylenol #3).

B

*After being hospitalized for 3 days with a right femur fracture, a patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first?* a. Stay with the patient and offer reassurance. b. Administer prescribed PRN O2 at 4 L/min. c. Check the patient's legs for swelling or tenderness. d. Notify the health care provider about the symptoms.

B

*After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. The first action the nurse should take is to* a. report the patient's complaint to the surgeon. b. check the chart for preoperative assessment data. c. check the vital signs for indications of hemorrhage. d. turn the patient to the left to relieve pressure on the right leg.

B

*After the nurse has finished teaching a patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching?* a. "I can exercise every day to help maintain joint motion." b. "I will take 1 g of acetaminophen (Tylenol) every 4 hours." c. "I will take a shower in the morning to help relieve stiffness." d. "I can use a cane to decrease the pressure and pain in my hip."

B

*An assessment finding for a 55-yr-old patient that alerts the nurse to the presence of osteoporosis is* a. bowed legs. b. a loss of height. c. the report of frequent falls. d. an aversion to dairy products.

B

*Before assisting a patient with ambulation 2 days after total hip arthroplasty, which action is most important for the nurse to take?* a. Observe output from the surgical drain. b. Administer prescribed pain medication. c. Instruct the patient about benefits of early ambulation. d. Change the dressing and document the wound appearance.

B

*The day after a having a right below-the-knee amputation, a patient complains of pain in the missing right foot. Which action is most important for the nurse to take?* a. Explain the reasons for the pain. b. Administer prescribed analgesics. c. Reposition the patient to assure good alignment. d. Inform the patient that this pain will diminish over time.

B

*The health care provider has prescribed the following interventions for a patient who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question?* a. Draw anti-DNA blood titer. b. Administer varicella vaccine. c. Naproxen (Aleve) 200 mg BID. d. Famotidine (Pepcid) 20 mg daily.

B

*The nurse determines additional instruction is needed when a patient diagnosed with scleroderma makes which statement?* a. "Paraffin baths can be used to help my hands." b. "I should lie down for an hour after each meal." c. "Lotions will help if I rub them in for a long time." d. "I should perform range-of-motion exercises daily."

B

*The nurse notes crackling sounds and a grating sensation with palpation of an older patient's elbow. How will this finding be documented?* a. Torticollis b. Crepitation c. Subluxation d. Epicondylitis

B

*The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with* a. a brief routine of isometric exercises. b. a warm bath followed by a short rest. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness.

B

*The nurse will instruct the patient with a fractured left radius that the cast will need to remain in place* a. for several months. b. for at least 3 weeks. c. until swelling of the wrist has resolved. d. until x-rays show complete bony union.

B

*The nurse's discharge teaching for a patient who has had a repair of a fractured mandible will include information about* a. administration of nasogastric tube feedings. b. how and when to cut the immobilizing wires. c. the importance of high-fiber foods in the diet. d. the use of sterile technique for dressing changes.

B

*When administering alendronate (Fosamax) to a patient with osteoporosis, the nurse will* a. ask about any leg cramps or hot flashes. b. assist the patient to sit up at the bedside. c. be sure that the patient has recently eaten. d. administer the ordered calcium carbonate.

B

*When caring for a patient who is using Buck's traction after a hip fracture, which action can the nurse delegate to unlicensed assistive personnel (UAP)?* a. Remove and reapply traction periodically. b. Ensure the weight for the traction is hanging freely. c. Monitor the skin under the traction boot for redness. d. Check for intact sensation and movement in the affected leg.

B

*Which action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the orthopedic clinic?* a. Grade leg muscle strength for a patient with back pain. b. Obtain blood sample for uric acid from a patient with gout. c. Perform straight-leg-raise testing for a patient with sciatica. d. Check for knee joint crepitation before arthroscopic surgery.

B

*Which action will the nurse include in the plan of care for a patient with a new diagnosis of rheumatoid arthritis (RA)?* a. Instruct the patient to purchase a soft mattress. b. Encourage the patient to take a nap in the afternoon. c. Teach the patient to use lukewarm water when bathing. d. Suggest exercise with light weights several times daily.

B

*Which action will the nurse take first when a patient is seen in the outpatient clinic with neck pain?* a. Provide information about therapeutic neck exercises. b. Ask about numbness or tingling of the hands and arms. c. Suggest the patient alternate the use of heat and cold to the neck. d. Teach about the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

B

*Which action will the urgent care nurse take for a patient with a possible knee meniscus injury?* a. Encourage bed rest for 24 to 48 hours. b. Apply an immobilizer to the affected leg. c. Avoid palpation or movement of the knee. d. Administer intravenous opioids for pain management.

B

*Which assessment finding for a patient using naproxen (Naprosyn) to treat osteoarthritis is likely to require a change in medication?* a. The patient has gained 3 lb. b. The patient has dark-colored stools. c. The patient's pain affects multiple joints. d. The patient uses capsaicin cream (Zostrix).

B

*Which assessment information obtained by the nurse indicates a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone?* a. The patient has joint pain and stiffness. b. The patient's blood glucose is 165 mg/dL. c. The patient has experienced a recent 5-pound weight loss. d. The patient's erythrocyte sedimentation rate (ESR) has increased.

B

*Which finding will the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee?* a. Presence of Heberden's nodules b. Discomfort with joint movement c. Redness and swelling of the knee joint d. Stiffness that increases with movement

B

*Which information in a 67-yr-old woman's health history will alert the nurse to the need for a more focused assessment of the musculoskeletal system?* a. The patient sprained her ankle at age 13. b. The patient's mother became shorter with aging. c. The patient takes ibuprofen for occasional headaches. d. The patient's father died of complications of miliary tuberculosis.

B

*Which information obtained by the nurse about a patient with a lumbar vertebral compression fracture requires an immediate report to the health care provider?* a. Patient refuses to be turned due to back pain. b. Patient has been incontinent of urine and stool. c. Patient reports lumbar area tenderness to palpation. d. Patient frequently uses oral corticosteroids to treat asthma.

B

*Which information will the nurse include when preparing teaching materials for a patient with an exacerbation of rheumatoid arthritis?* a. Affected joints should not be exercised when pain is present. b. Applying cold packs before exercise may decrease joint pain. c. Exercises should be performed passively by someone other than the patient. d. Walking may substitute for range-of-motion (ROM) exercises on some days.

B

*Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about management of the condition?* a. Exercise by taking long walks. b. Do daily deep-breathing exercises. c. Sleep on the side with hips flexed. d. Take frequent naps during the day.

B

*Which information will the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) about self-management?* a. Symptoms usually progress as patients become older. b. A gradual increase in daily exercise may help decrease fatigue. c. Avoid use of over-the-counter antihistamines or decongestants. d. A low-residue, low-fiber diet will reduce any abdominal distention.

B

*Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis?* a. Blood glucose b. C-reactive protein c. Serum electrolytes d. Liver function tests

B

*Which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a patient with scleroderma?* a. Monitor for difficulty in breathing. b. Document the patient's oral intake. c. Check finger strength and movement. d. Apply capsaicin (Zostrix) cream to hands.

B

*Which nursing intervention will be included in the plan of care after a patient with a right femur fracture has a hip spica cast applied?* a. Avoid placing the patient in prone position. b. Ask the patient about abdominal discomfort. c. Discuss remaining on bed rest for several weeks. d. Use the cast support bar to reposition the patient.

B

*Which result for a patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider?* a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep

B

*Which statement by a patient who has had an above-the-knee amputation indicates the nurse's discharge teaching has been effective?* a. "I should elevate my residual limb on a pillow 2 or 3 times a day." b. "I should lie flat on my abdomen for 30 minutes 3 or 4 times a day." c. "I should change the limb sock when it becomes soiled or each week." d. "I should use lotion on the stump to prevent skin drying and cracking."

B

*Which statement by a patient with systemic lupus erythematosus (SLE) indicates the patient has understood the nurse's teaching about the condition?* a. "I will exercise even if I am tired." b. "I will use sunscreen when I am outside." c. "I should avoid nonsteroidal anti-inflammatory drugs." d. "I should take birth control pills to avoid getting pregnant."

B

A patient has a long-arm plaster cast applied for fracture immobilization. Until the cast has completely dried, the nurse should a. keep the left arm in dependent position. b. avoid handling the cast using fingertips. c. place gauze around the cast edge to pad any roughness. d. cover the cast with a small blanket to absorb the dampness.

B

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which nursing assessment finding indicates a potential complication of the fracture? a. The patient states the pelvis feels unstable. b. Abdomen is distended and bowel sounds are absent. c. The patient complains of pelvic pain with palpation. d. Ecchymoses are visible across the abdomen and hips.

B

A nurse is assessing a client who has systemic lupus erythematosus and is taking hydroxychloroquine. The nurse should report which of the following adverse effects to the provider immediately?

Blurred vision

*A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia following densitometry testing. In teaching the woman, the nurse explains that* a. with a family history of osteoporosis, there is no way to prevent or slow bone resorption. b. estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. c. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. d. calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

D

*A factory line worker has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about* a. surgical options. b. elbow injections. c. wearing a left wrist splint. d. modifying arm movements.

D

*A patient reporting painful urination and knee pain is diagnosed with reactive arthritis. The nurse will plan to teach the patient about the need for several months of therapy with* a. methotrexate b. anakinra (Kineret). c. etanercept (Enbrel). d. doxycycline (Vibramycin).

D

*After change-of-shift report, which patient should the nurse assess first?* a. Patient with a repaired mandibular fracture who is complaining of facial pain b. Patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated c. Patient with an unrepaired Colles' fracture who has right wrist swelling and deformity d. Patient with repaired right femoral shaft fracture who is complaining of tightness in the calf

D

*The day after a 60-yr-old patient has open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, the nurse identifies the priority nursing diagnosis as* a. activity intolerance related to deconditioning. b. risk for constipation related to prolonged bed rest. c. risk for impaired skin integrity related to immobility. d. risk for infection related to disruption of skin integrity.

D

*The home health nurse is making a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates more patient teaching is needed?* a. The patient takes a 2-hour nap each day. b. The patient has been taking 16 aspirins each day. c. The patient sits on a stool while preparing meals. d. The patient sleeps with two pillows under the head.

D

*The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information requires a discussion with the health care provider about an urgent change in the treatment plan?* a. Knee crepitation is noted with normal knee range of motion. b. Patient reports embarrassment about having Heberden's nodes. c. Patient's knee pain while golfing has increased over the last year. d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

D

*After the health care provider recommends amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die than have an amputation. Which response by the nurse is best?* a. "You are upset, but you may lose the foot anyway." b. "Many people are able to function with a foot prosthesis." c. "Tell me what you know about your options for treatment." d. "If you do not want an amputation, you do not have to have it."

C

*An appropriate nursing intervention for a patient who has acute low back pain and muscle spasms is to teach the patient to* a. keep both feet flat on the floor when prolonged standing is required. b. twist gently from side to side to maintain range of motion in the spine. c. keep the head elevated slightly and flex the knees when resting in bed. d. avoid the use of cold packs because they will exacerbate the muscle spasms.

C

*Anakinra (Kineret) is prescribed for a patient with rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about* a. avoiding concurrent aspirin use. b. symptoms of gastrointestinal (GI) bleeding. c. self-administration of subcutaneous injections. d. taking the medication with at least 8 oz of fluid.

C

*Based on the information in the accompanying figure obtained for a patient in the emergency room, which action will the nurse take first?* *History* Age 23 years Right lower leg injury *Physical Assessment* Reports severe right lower leg pain Reports feeling short of breath Bone protruding from right lower leg *Diagnostic Exams* CBC: WBC 9400/µL; Hgb 11.6 g/dL Right leg x-ray; right tibial fracture a. Administer the prescribed morphine 4 mg IV. b. Contact the operating room to schedule surgery. c. Check the patient's O2 saturation using pulse oximetry. d. Ask the patient about the date of the last tetanus immunization.

C

*The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which statement by a patient indicates additional patient teaching is needed?* a. "I will need to participate in physical therapy after surgery." b. "I wish I did not need to have chemotherapy after this surgery." c. "I did not have this bone cancer until my leg broke a week ago." d. "I can use the patient-controlled analgesia (PCA) to manage postoperative pain."

C

*The nurse is planning care for a patient with hypertension and gout who has a red, painful right great toe. Which nursing action will be included in the plan of care?* a. Gently palpate the toe to assess swelling. b. Use pillows to keep the right foot elevated. c. Use a footboard to hold bedding away from the toe. d. Teach the patient to avoid use of acetaminophen (Tylenol).

C

*The nurse notices a circular lesion with a red border and clear center on the arm of a summer camp counselor who is in the clinic complaining of chills and muscle aches. Which action should the nurse take to follow up on that finding?* a. Palpate the abdomen. b. Auscultate the heart sounds. c. Ask the patient about recent outdoor activities. d. Question the patient about immunization history.

C

*The nurse should reposition the patient who has just had a laminectomy and diskectomy by* a. instructing the patient to move the legs before turning the rest of the body. b. having the patient turn by grasping the side rails and pulling the shoulders over. c. placing a pillow between the patient's legs and turning the entire body as a unit. d. turning the patient's head and shoulders first, followed by the hips, legs, and feet.

C

*The nurse will anticipate the need to teach a patient who has osteoarthritis (OA) about which medication?* a. Prednisone b. Adalimumab (Humira) c. Capsaicin cream (Zostrix) d. Sulfasalazine (Azulfidine)

C

*The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action should the nurse take first?* a. Take the blood pressure. b. Assess patient orientation. c. Check the O2 saturation. d. Observe for facial asymmetry.

C

*The nurse evaluating effectiveness of prescribed calcitonin and ibandronate (Boniva) for a patient with Paget's disease will consider the patient's* a. oral intake. b. daily weight. c. grip strength. d. pain intensity.

D

*The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should document the patient's muscle strength as level* a. 0 b. 1 c. 2 d. 3

D

*When a patient arrives in the emergency department with a facial fracture, which action will the nurse take first?* a. Assess for nasal bleeding and pain. b. Apply ice to the face to reduce swelling. c. Use a cervical collar to stabilize the spine. d. Check the patient's alertness and orientation.

C

*When giving home care instructions to a patient who has comminuted left forearm fractures and a long-arm cast, which information should the nurse include?* a. Keep the left shoulder elevated on a pillow or cushion. b. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs). c. Call the health care provider for numbness of the hand. d. Keep the hand immobile to prevent soft tissue swelling.

C

*The nurse is caring for a patient who is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which statement by the patient indicates a need for additional instruction?* a. "I should not cross my legs while sitting." b. "I will use a toilet elevator on the toilet seat." c. "I will have someone else put on my shoes and socks." d. "I can sleep in any position that is comfortable for me."

D

*The nurse who notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years will plan to teach the patient about* a. discography studies. b. myelographic testing. c. magnetic resonance imaging (MRI). d. dual-energy x-ray absorptiometry (DXA).

D

*The nurse will determine more teaching is needed if a patient with discomfort from a bunion says, "I will* a. give away my high-heeled shoes." b. take ibuprofen (Motrin) if I need it." c. use the bunion pad to cushion the area." d. only wear sandals, no closed-toe shoes."

D

*A 25-yr-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." The nurse will plan interventions with the patient to address the nursing diagnosis of* a. social isolation. b. activity intolerance. c. impaired skin integrity. d. impaired social interaction.

A

*A patient has a new order for magnetic resonance imaging (MRI) to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse should consult with the health care provider before scheduling the MRI?* a. The patient has a pacemaker b. The patient is claustrophobic c. The patient wears a hearing aid d. The patient is allergic to shellfish

A

*A patient undergoes left above-the-knee amputation with an immediate prosthetic fitting. When the patient arrives on the orthopedic unit after surgery, the nurse should* a. assess the surgical site for hemorrhage. b. remove the prosthesis and wrap the site. c. place the patient in a side-lying position. d. keep the residual limb elevated on a pillow.

A

*When assessing for Tinel's sign in a patient with possible right carpal tunnel syndrome, the nurse will ask the patient about* a. weakness in the right little finger. b. burning in the right elbow and forearm. c. tremor when gripping with the right hand. d. tingling in the right thumb and index finger.

D

*A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately?* a. The blood pressure is 86/50 mm Hg. b. The patient says the knee pain is severe. c. The white blood cell count is 11,500/µL. d. The patient is taking ibuprofen (Motrin).

A

*Which action will the nurse include in the plan of care for a patient who had a cemented right total knee arthroplasty?* a. Avoid extension of the right knee beyond 120 degrees. b. Use a compression bandage to keep the right knee flexed. c. Teach about the need to avoid weight bearing for 4 weeks. d. Start progressive knee exercises to obtain 90-degree flexion.

D

*Which assessment finding for a patient who has had surgical reduction of an open fracture of the right radius requires notification of the health care provider?* a. Serous wound drainage b. Right arm muscle spasms c. Right arm pain with movement d. Temperature 101.4° F (38.6° C)

D

*Which finding for a 77-yr-old patient seen in the outpatient clinic requires further nursing assessment and intervention?* a. Symmetric joint swelling of fingers b. Decreased right knee range of motion c. Report of left hip aching when jogging d. History of recent loss of balance and fall

D

*A patient who has had open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for the first time. Which action should the nurse take?* a. Check the patient's prescribed weight-bearing status. b. Use a mechanical lift to transfer the patient to the chair. c. Delegate the transfer to nursing assistive personnel (NAP). d. Decrease the pain medication before getting the patient up.

A

*Which finding in a patient with a Colles' fracture of the left wrist is most important to communicate immediately to the health care provider?* a. Swelling is noted around the wrist. b. The patient is reporting severe pain. c. The wrist has a deformed appearance. d. Capillary refill to the fingers is prolonged.

D

*Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective?* a. Pancakes with syrup and bacon b. Whole wheat toast and fresh fruit c. Egg-white omelet and a half grapefruit d. Oatmeal with skim milk and fruit yogurt

D

*A patient who has had open reduction and internal fixation (ORIF) of left lower leg fractures continues to complain of severe pain in the leg 15 minutes after receiving the prescribed IV morphine. Pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next?* a. Notify the health care provider. b. Assess the incision for redness. c. Reposition the left leg on pillows. d. Check the patient's blood pressure.

A

*A patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of* a. sertraline (Zoloft). b. famotidine (Pepcid). c. hydrochlorothiazide. d. oxycodone (Roxicodone).

A

*A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which information will the nurse teach?* a. "Check and clean the pin insertion sites daily." b. "Remove the external fixator for your shower." c. "Remain on bed rest until bone healing is complete." d. "Take prophylactic antibiotics until the fixator is removed."

A

*A patient with dermatomyositis is receiving long-term prednisone therapy. Which assessment finding by the nurse is important to report to the health care provider?* a. The patient has painful hematuria. b. Acne is noted on the patient's face. c. Fasting blood glucose is 112 mg/dL. d. The patient has an increased appetite.

A

*A patient with left knee pain is diagnosed with bursitis. The nurse will explain that bursitis is an inflammation of* a. a fluid-filled sac found at some joints. b. a synovial membrane that lines the joint. c. the connective tissue joining bones within a joint. d. the fibrocartilage that acts as a shock absorber in the knee.

A

*A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. The nurse will plan to* a. explain the procedure. b. start an IV line for contrast medium injection. c. give an oral sedative 60 to 90 minutes before the procedure. d. screen the patient for allergies to shellfish or iodine products.

A

*After the nurse has taught a 28-yr-old with fibromyalgia, which statement by the patient indicates a good understanding of effective self-management?* a. "I will need to stop drinking so much coffee and soda." b. "I am going to join a soccer team to get more exercise." c. "I will call the doctor every time my symptoms get worse." d. "I should avoid using over-the-counter medications for pain."

A

*The nurse determines that colchicine has been effective for a patient with an acute attack of gout upon finding* a. reduced joint pain. b. increased urine output. c. elevated serum uric acid. d. increased white blood cells (WBC).

A

*The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests they should* a. avoid activities requiring repetitive use of the same muscles and joints. b. protect the knee joints by sleeping with a small pillow under the knees. c. stand rather than sit when performing daily household and yard chores. d. strengthen small hand muscles by wringing out sponges or washcloths.

A

*The occupational health nurse will teach the patient whose job involves many hours of typing to* a. obtain a keyboard pad to support the wrist. b. do stretching exercises before starting work. c. wrap the wrists with compression bandages every morning. d. avoid using nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.

A

*Which action will the nurse include in the plan of care for a patient with newly diagnosed ankylosing spondylitis?* a. Advise the patient to sleep on the back with a flat pillow. b. Emphasize that application of heat may worsen symptoms. c. Schedule annual laboratory assessment for the HLA-B27 antigen. d. Assist patient to choose physical activities that involve spinal flexion.

A

*Which action will the nurse take in order to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur?* a. Assess for hip pain. b. Assess for contractures. c. Check peripheral pulses. d. Monitor for hip dislocation.

A

*Which action will the nurse take when caring for a patient with osteomalacia?* a. Teach about the use of vitamin D supplements. b. Educate about the need for weight-bearing exercise. c. Discuss the use of medications such as bisphosphonates. d. Emphasize the importance of sunscreen use when outside.

A

*Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication?* a. Blurred vision b. Joint tenderness c. Abdominal cramping d. Elevated blood pressure

A

*Which nursing action for a patient who has had right hip arthroplasty can the nurse delegate to experienced unlicensed assistive personnel (UAP)?* a. Reposition the patient every 1 to 2 hours. b. Assess for skin irritation on the patient's back. c. Teach the patient quadriceps-setting exercises. d. Determine the patient's pain intensity and tolerance.

A

*Which nursing action is correct when performing the straight-leg raising test for an ambulatory patient with back pain?* a. Lift the patient's leg to a 60-degree angle from the bed. b. Place the patient in the prone position on the exam table. c. Ask the patient to dangle both legs over the edge of the exam table. d. Instruct the patient to elevate the legs and tense the abdominal muscles.

A

Which finding from analysis of fluid from a patient's right knee arthrocentesis will be of concern to the nurse? a. Cloudy fluid b. Scant thin fluid c. Pale yellow fluid d. Straw-colored fluid

A

A young adult client with a new diagnosis of rheumatoid arthritis states, "The pain in my joints is just a temporary thing. If I keep eating right and exercising, it'll go away." The nurse should identify the client is exhibiting which of the following defense mechanisms?

Denial

A nurse is teaching a client who has rheumatoid arthritis about taking methotrexate. Which of the following information should the nurse include?

Drink 2-3L of water per day

A nurse is assessing a client who is 24 hours postoperative following an open reduction and internal fixation to repair a fracture of the femur. Which of the following assessment findings is an early manifestation of fat embolism syndrome (FES)?

Dyspnea

A nurse is caring for an older adult client who has rheumatoid arthritis and is taking aspirin 650mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of the medication?

Erythrocyte sedimentation rate (ESR)

A nurse is assessing a client who is in skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin site?

Fever

A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen?

I will limit my alcohol intake

A nurse is assessing a client who has a fracture of the femur. The nurse obtains vital signs on admission and again in 2 hours. Which of the following changes in assessment should indicate to the nurse that the client could be developing a serious complication?

Increased respiratory rate of 18 to 44

A nurse is assessing an older adult client who has experienced some loss of bone density. The nurse observes a "hunchback" curvature of the client's spine. The nurse should expect the provider to document which of the following disorders?

Kyphosis

A nurse is assessing a client who has a puncture wound on his foot. Which of the following findings is a manifestation of acute osteomyelitis?

Localized erythema

A nurse is teaching a group of clients about osteoarthritis. Which of the following recommendations should the nurse include in the teaching?

Maintain a recommended body weight

A nurse is planning care for a client who is postoperative following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan of care?

Prevent hip flexion of the affected extremity

A nurse is assessing a client who has Paget's disease of the bone. Which of the following findings should the nurse expect

cranial enlargement skeletal pain Waddling gait

A nurse is teaching a client who has a new diagnosis of gout about managing the disorder. Which of the following instructions should the nurse include in the teaching?

eat less/avoid- liver, sardines, shrimp, red meats, beef, lamb, pork

A nurse is caring for a client who is postoperative following a total hip arthroplasty. The nurse assists the client into a supine position. Which of the following actions is appropriate to prevent dislocation of the hip?

maintain foam wedge between legs

A nurse is caring for a client who has acute osteomyelitis. Which of the following interventions is the nurse's priority?

Administer antibiotics to the client

A nurse is preparing a presentation at a community center about osteoarthritis. The nurse should plan to include which of the following information

Affects weight-bearing joints Crepitus can occur in affected joints Causes joint stiffness Causes joint pain

A nurse is teaching a client about risk factors for osteoarthritis. Which of the following factors should the nurse include in the teaching?

Aging, obesity, smoking

A nurse is caring for a client who has developed gout. Which of the following medications should the nurse prepare to administer?

Allopurinol

A nurse is caring for a client following a right total hip arthroplasty. Postoperatively the nurse should maintain the right leg in which of the following positions?

Abduction

*A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery?* a. "This procedure will correct the deformities in my fingers." b. "I will not have to do as many hand exercises after the surgery." c. "I will be able to use my fingers with more flexibility to grasp things." d. "My fingers will appear more normal in size and shape after this surgery."

C

*A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review?* a. Rheumatoid factor (RF) b. Antinuclear antibody (ANA) c. Anti-Smith antibody (Anti-Sm) d. Lupus erythematosus (LE) cell prep

C

*A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding is most important for the nurse to communicate to the health care provider?* a. There is bruising at the shoulder area. b. The patient reports arm and shoulder pain. c. The right arm appears shorter than the left. d. There is decreased shoulder range of motion.

C

*A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take?* a. Draw blood for rheumatoid factor analysis. b. Teach the patient about injections for the nodules. c. Assess the nodules for skin breakdown or infection. d. Discuss the need for surgical removal of the nodules.

C

*A patient hospitalized with a fever and red, hot, painful knees is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient* a. had several knee injuries as a teenager. b. recently returned from South America. c. is sexually active with multiple partners. d. has a parent who has rheumatoid arthritis.

C

*A patient is admitted to the emergency department with a left femur fracture. Which information obtained by the nurse is most important to report to the health care provider?* a. Ecchymosis of the left thigh b. Complaints of severe thigh pain c. Slow capillary refill of the left foot d. Outward pointing toes on the left foot

C

*A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse identifies a need for additional teaching related to health maintenance when the nurse finds that the patient* a. is frustrated with the length of treatment required. b. takes and records the oral temperature twice a day. c. is unable to plantar flex the foot on the affected side. d. uses crutches to avoid weight bearing on the affected leg.

C

*A patient who arrives at the emergency department experiencing severe left knee pain is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for* a. a knee immobilizer. b. gentle knee flexion. c. monitored anesthesia care. d. physical activity restrictions.

C

*A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a long-arm cast and a sling. Which nursing intervention will be included in the plan of care?* a. Use surgical net dressing to hang the arm from an IV pole. b. Immobilize the fingers of the left hand with gauze dressings. c. Assess the left axilla and change absorbent dressings as needed. d. Assist the patient in passive range of motion (ROM) for the right arm.

C

*A patient with a fracture of the left femoral neck has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should* a. loosen the traction and help the patient turn onto the unaffected side. b. place a pillow between the patient's legs and turn gently to each side. c. have the patient lift the buttocks slightly by using a trapeze over the bed. d. turn the patient partially to each side with the assistance of another nurse.

C

*A patient with an acute attack of gout in the right great toe has a new prescription for probenecid. Which information about the patient's home routine indicates a need for teaching regarding gout management?* a. The patient sleeps 8-10 hours each night. b. The patient usually eats beef once a week. c. The patient takes one aspirin a day to prevent angina. d. The patient usually drinks about 3 quarts water each day.

C

*A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is appropriate?* a. Ask the HCP about discontinuing methotrexate b. Remind the patient that RA is a chronic health condition. c. Suggest the patient use over-the-counter (OTC) artificial tears. d. Teach the patient about adverse effects of the RA medications.

C

*A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. The initial action by the nurse should be to* a. elevate the right leg. b. splint the lower leg. c. assess the pedal pulses. d. verify tetanus immunization.

C

*After a motorcycle accident, a patient arrives in the emergency department with severe swelling of the left lower leg. Which action will the nurse take first?* a. Elevate the leg on 2 pillows. b. Apply a compression bandage. c. Assess leg pulses and sensation. d. Place ice packs on the lower leg.

C

*After completing the health history, the nurse assessing the musculoskeletal system will begin by* a. having the patient move the extremities against resistance. b. feeling for the presence of crepitus during joint movement. c. observing the patient's body build and muscle configuration. d. checking active and passive range of motion for the extremities.

C

A nurse is teaching a client who is to begin long-term therapy with prednisone to treat rheumatoid arthritis. The nurse should instruct the client to take which of the following supplements while taking this medication?

Calcium and Vitamin D

A nurse is planning care for a newly admitted client who has skeletal traction for a fractured femur. Which of the following interventions should the nurse include in the plan?

Monitor the clients pedal pulses every hour

A nurse is completing a physical assessment of a client who has early osteoarthritis. Which of the following manifestations should the nurse expect?

Pain worsens with activity

A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period?

Perform neurovascular checks of the extremities.

A nurse is teaching a client who has a fractured femur about fat emboli syndrome. Which of the following findings should the nurse include as a manifestation of a fat embolism?

Petechiae on the chest

A nurse is teaching a client who has gout about medications. The nurse should teach the client to avoid the use of which of the following types of medication?

Salicylates, such as aspirin, and diuretics can trigger gout attacks.

*When reviewing the health record for a new patient with rheumatoid arthritis, the nurse reads that the patient has swan neck deformities. Which deformity will the nurse expect to observe when assessing the patient?*

Swan neck deformity involves distal interphalangeal joint hyperflexion and proximal interphalangeal joint hyperextension of the hands. The other deformities are also associated with rheumatoid arthritis: ulnar drift, boutonniere deformity, and hallux vagus.

A nurse is teaching a client who has a pelvic fracture about manifestations of fat embolism syndrome. The nurse should include which of the following findings as an early manifestation?

Tachypnea

A nurse is caring for a client who sustained a femur fracture in an automobile accident and is placed into skeletal traction. The nurse may remove the weights from the traction device if which of the following occurs?

The client develops a life-threatening situation