Practice Questions

The nurse is assessing a client who had a left hip replacement 36 hours ago. Which of the follow- ing indicates the prosthesis is dislocated? Select all that apply.1 1 The client reported a "popping" sensation in the hip. 2 The left leg is shorter than the right leg. 3 The client has sharp pain in the groin. 4 The client cannot move his right leg. 5 The client cannot wiggle the toes on the left leg.

1, 2, 3,

The nurse is assessing a client's left leg for neurovascular changes following a total left knee replacement. Which of the following are expected normal findings? Select all that apply. ■ 1. Reduced edema of the left knee. ■ 2. Skin warm to touch. ■ 3. Capillary refill response. ■ 4. Moves toes. ■ 5. Pain absent. ■ 6. Pulse on left leg weaker than right leg

1, 2, 3, 4

A nurse should teach a client, following a diagnostic arthroscopy, to: SELECT ALL THAT APPLY. 1 elevate the involved extremity for 24 to 48 hours. 2 apply ice continually for 24 hours. 3 report severe joint pain immediately to the physician. 4 resume usual activities to help reduce swelling. 5 treat pain with a mild analgesic such as acetaminophen (Tylenol)

1, 3, 5

At what time of day should the nurse encour- age a client with Parkinson's disease to schedule the most demanding physical activities to minimize the effects of hypokinesia? 1Early in the morning, when the client's energy level is high. 2To coincide with the peak action of drug therapy. 3Immediately after a rest period. 4When family members will be available.

2

A client returned from surgery with a debri- ded open tibial fracture and has a three-way drain- age system. The nurse should first: ■ 1. Review the results of culture and sensitivity testing of the wound. ■ 2. Look for the presence of a pressure dressing over the wound. ■ 3. Determine if the client has increased pain from exposed nerve endings. ■ 4. Check the client's blood pressure for hypoten- sion resulting from additional vessel bleeding.

1

Because a client has a Thomas splint, the nurse should assess the client regularly for which of the following? ■ 1. Signs of skin pressure in the groin area. ■ 2. Evidence of decreased breath sounds. ■ 3. Skin breakdown behind the heel. ■ 4. Urine retention.

1

The client diagnosed with osteoarthritis states, "My friend takes steroid pills for her rheu- matoid arthritis. Why don't I take steroids for my osteoarthritis?" Which of the following is the best explanation? 1 Intra-articular corticosteroid injections are used to treat osteoarthritis. 2 Oral corticosteroids can be used in osteoar- thritis. 3 A systemic effect is needed in osteoarthritis. 4 Rheumatoid arthritis and osteoarthritis are two similar diseases.

1

A client is to have a total hip replacement. The preoperative plan should include which of the following? Select all that apply. ■ 1. Administer antibiotics as prescribed to ensure therapeutic blood levels. ■ 2. Apply leg compression device. ■ 3. Request a trapeze be added to the bed. ■ 4. Teach isometric exercises of quadriceps and gluteal muscles. ■ 5. Demonstrate crutch walking with a 3-point gait. ■ 6. Place Buck's traction on the bed.

1, 3, 4

A client is being switched from levodopa (L-dopa) to carbidopa-levodopa (Sinemet). The nurse should monitor for which of the following possible complications during medication changes and dos- age adjustment? 1 Euphoria. 2. Jaundice. 3. Vital sign fluctuation. 4. Signs and symptoms of diabetes

3

After teaching a group of clients with osteoarthritis about using regular exercise, which of the following client statements indicates effective teaching? 1 "Performing range-of-motion exercises will increase my joint mobility." 2 "Exercise helps to drive synovial fluid through the cartilage." 3 "Joint swelling should determine when to stop exercising." 4 "Exercising in the outdoors year-round pro- motes joint relaxation."

2

he nurse is assessing a client for neurologic impairment after a total hip replacement. Which of the following would indicate impairment in the affected extremity? ■ 1. Decreased distal pulse. ■ 2. Inability to move. ■ 3. Diminished capillary refill. ■ 4. Coolness to the touch.

2

. A client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should first?1 Stabilize the leg with Buck's traction. 2 Apply an ice pack to the affected hip. 3 Position the client toward the opposite side of the hip. 4 Notify the orthopedic surgeon.

4

A client with a fractured right femur has not had any immunizations since childhood. Which of the following biologic products should the nurse administer to provide the client with passive immu- nity for tetanus? ■ 1. Tetanus toxoid. ■ 2. Tetanus antigen. ■ 3. Tetanus vaccine. ■ 4. Tetanus antitoxin.

4

A client with multiple sclerosis (MS) is expe- riencing bowel incontinence and is starting a bowel retraining program. Which strategy is inappropriate? 1. Eating a diet high in fiber. ■ 2. Setting a regular time for elimination. ■ 3. Using an elevated toilet seat. ■ 4. Limiting fluid intake to 1,000 mL/day.

4

Prior to surgery, the nurse is instructing a cli- ent who will have a total hip replacement tomorrow. Which of the following information is most impor- tant to include in the teaching plan at this time? 1Teaching how to prevent hip flexion. 2 Demonstrating coughing and deep-breathing techniques. 3 Showing the client what an actual hip pros- thesis looks like. 4 Assessing the client's fears about the procedure.

4

The nurse is developing the plan of care for an older adult client with a hip fracture. Which of the following chronic health problems would the nurse be least likely to assess in the client? 1 Hypertension. ■ 2. Cardiac decompensation. ■ 3. Pulmonary disease. ■ 4. Multiple sclerosis.

4

A nurse is assessing an elderly client in Buck's trac- tion to temporally immobilize a fracture of the proxi- mal femur prior to surgery. Which finding requires the nurse to intervene immediately? 1. Reddened area on the sacrum 2. Voiding concentrated urine, 50 mL/hr 3. Capillary refill 3 seconds, dorsiflexion and sensation intact, pedal pulses palpable 4. Lower leg secure in traction boot and ropes and pulleys and 5 lb weight hanging freely

1

The nurse is teaching the client to administer enoxaparin (Lovenox) following a total hip arthro- plasty? The nurse should instruct the client about which of the following? Select all that apply. 1 Report promptly any difficulty breathing, rash, or itching. 2 Notify the health care provider of unusual bruising. 3 Avoid all aspirin-containing medications. 4 Wear or carry medical identification. 5 Expel the air bubble from the syringe before the injection. 6 Remove needle immediately after medication is injected.

1, 2, 3, 4

Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? Select all that apply. 1 Avoid turning the toes or knee outward. 2 Use an abduction pillow between the legs when in bed. 3 Use an elevated toilet seat and shower chair. 4 Do not extend the operative leg backwards. 5 Restrict motion for 2 weeks after surgery.

1, 3, 4

A clinic nurse suspects that a client may have devel- oped osteomyelitis 3 months following a left shoulder arthroplasty. Which findings on assessment prompted the nurse's conclusion? SELECT ALL THAT APPLY. 1. Sudden onset of chills 2. Temperature 103°F (39.4°C) 3. Bradycardia 4. Report by the client of a pulsating pain in the area that intensifies with movement 5. Painful, swollen area on the left shoulder

1,2, 4, 5

A client had a posterolateral total hip replacement 2 days ago. What should the nurse include in the client's plan of care? Select all that apply. 1 When using a walker, encourage the client to point the toes inward. 2 Position a pillow between the legs to main- tain abduction. 3 Allow the client to be in the supine position or in the lateral position on the unoperated side. 4 Do not allow the client to bend down to tie or slip on shoes. 5 Place ice on the incision after physical therapy.

2, 3, 4, 5

The nurse is teaching a client with bladder dys- function from multiple sclerosis (MS) about bladder training at home. Which instructions should the nurse include in the teaching plan? Select all that apply. 1 Restrict fluids to 1,000 mL/24 hours. 2 Drink 400 to 500 mL with each meal. 3 Drink fluids midmorning, midafternoon, and late afternoon. 4 Attempt to void at least every 2 hours. 5 Use intermittent catheterization as needed.

2, 3, 4, 5

A client who had a total hip replacement 4 days ago is worried about dislocation of the pros- thesis. The nurse should respond by saying which of the following? 1"Don't worry. Your new hip is very strong." 2 "Use of a cushioned toilet seat helps to pre- vent dislocation." 3 "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them." 4 "Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation."

3

After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse cor- rectly interprets these findings as indicating which of the following? ■ 1. A developing infection. ■ 2. Bleeding in the operative site. ■ 3. Joint dislocation. ■ 4. Glue seepage into soft tissue.

3

A health care provider has ordered carbi- dopa-levodopa (Sinemet) four times per day for a client with Parkinson's disease. The client states that he wants "to end it all now that the Parkinson's disease has progressed." What should the nurse do? Select all that apply. 1 Explain that the new prescription for Sinemet will treat his depression. 2 Encourage the client to discuss his feelings as the Sinemet is being administered. 3Contact the health care provider before administering the Sinemet. 4Determine if the client is on antidepressants or monoamine oxidase (MAO) inhibitors. 5Determine if the client is at risk for suicide.

3, 4, and 5

A postmenopausal client is scheduled for a bone-density scan. To plan for the client's test, what should the nurse communicate to the client? 1 Request that the client remove all metal objects on the day of the scan. 2 Instruct the client to consume foods and bev- erages with a high content of calcium for 2 days before the test. 3 Inform the client that she will need to ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4 Tell the client that she should report any sig- nificant pain to her physician at least 2 days before the test.

1

A client with osteoporosis needs education about diet and ways to increase bone density. Which of the following should be included in the teaching plan? Select all that apply. 1 Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2 Choose good calcium sources, such as figs, broccoli, and almonds. 3 Use alcohol in moderation because a moder- ate intake has no known negative effects. 4 Try swimming as a good exercise to maintain bone mass. 5 Avoid the use of high-fat foods, such as avo- cados, salad dressings, and fried foods.

1, 2, 3

A client with osteoarthritis will undergo an arthrocentesis on his painful edematous knee. What should be included in the nursing plan of care? Select all that apply. 1 Explain the procedure. 2 Administer preoperative medication 1 hour before 3 surgery. 4 Instruct the client to immobilize the knee for 2 days after the surgery. 5 Assess the site for bleeding. 6 Offer pain medication.

1, 4, 5

The nurse observes that a client's upper arm tremors disappear as he unbuttons his shirt. Which statement best guides the nurse's analysis of this observation about the client's tremors? 1The tremors are probably psychological and can be controlled at will. 2The tremors sometimes disappear with pur- poseful and voluntary movements. 3The tremors disappear when the client's attention is diverted by some activity. 4There is no explanation for the observation; it is probably a chance occurrence.

2

The nurse prepares a teaching plan for a client about crutch walking using a two-point gait pattern. Which of the following should the nurse include? 1 Advance a crutch on one side and then advance the opposite foot; repeat on the opposite side. 2 Advance a crutch on one side and simultane- ously advance and bear weight on the oppo- site foot; repeat on the opposite side. 3 Advance both crutches together and then follow by lifting both lower extremities to the level of the crutches. 4 Advance both crutches together and then fol- low by lifting both lower extremities past the level of the crutches.

2

A client is in balanced suspension traction using a half-ring Thomas splint with a Pearson attachment that suspends the lower extremity and applies direct skeletal traction for a hip fracture. Which of the following nursing assessments would not be appropriate? ■ 1. Greater trochanter skin checks. ■ 2. Pin site inspection. ■ 3. Neurovascular checks proximal to the splint. ■ 4. Foot movement evaluation.

3

A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mm Hg, a pulse rate of 115 bpm, and respirations of 8 breaths/minute and shal- low. The nurse interprets these findings as indicat- ing which of the following? ■ 1. Expected common adverse effects. ■ 2. Hypersensitivity reaction. ■ 3. Possible habituating effect. ■ 4. Hemorrhage from gastrointestinal irritation.

3

A new medication regimen is ordered for a client with Parkinson's disease. At which time should the nurse make certain that the medication is taken? 1. At bedtime. ■ 2. All at one time. ■ 3. Two hours before mealtime. ■ 4. At the time scheduled.

4

fter teaching the client with a femoral fracture about the purpose of treatment with skeletal traction, which of the following, if stated by the cli- ent, would indicate the need for additional teaching? ■ 1. To align injured bones. ■ 2. To provide long-term pull. ■ 3. To apply 25 lb of traction. ■ 4. To pull weight with a boot.

4

he nurse is planning care for the client with a femoral fracture who is in balanced suspension traction. Which of the following would the nurse be least likely to include in the plan of care?1. 1Use of a fracture bedpan. 2Checks for redness over the ischial tuberosity. 3Elevation of the head of bed no more than 25 degrees. 4 Personal hygiene with a complete bed bath.

4