Acute and Chronic End Of Chapter Questions!

24. In a patient with a stable vertebral fracture, what should the nurse teach the patient to do? a. Remain on bed rest until the pain is gone. b. Logroll to keep the spine straight when turning. c. How to use bone cement to correct the problem. d. Take as much analgesic as needed to relieve the pain.

. b. The spine should be kept straight by turning the shoulders and hips together (logrolling). This keeps the spine in good alignment until union has been accomplished. Bed rest may be required for a short time but not until the pain is gone. Analgesics should be taken only as ordered. If they do not relieve the pain, the health care provider should be notified. Bone cement is used by the surgeon to stabilize vertebral compression fractures.

What should be included in the management during the first 48 hours after an acute soft tissue injury of the ankle (select all that apply)? a. Use of elastic wrap b. Initial immobilization and rest c. Elevation of ankle above the heart d. Alternating the use of heat and cold e. Administration of antiinflammatory drugs

8. a, b, c, e. Consider the principle of RICE. Rest: movement should be restricted. Ice: cold should be used to promote vasoconstriction and to reduce edema. C: compression helps to decrease swelling. E: elevate the extremity above the level of the heart. Mild nonsteroidal antiinflammatory drugs (NSAIDs) may be needed to manage pain. Warm, moist compresses may be used after 48 hours for 20 to 30 minutes at a time to reduce swelling and provide comfort.

The nurse is admitting a patient to the clinical unit from surgery. Being alert to potential fluid volume alterations, what assessment data will be important for the nurse to monitor to identify early changes in the patient's postoperative fluid volume (select all that apply)? a. Intake and output b. Skin turgor c. Lung sounds d. Respiratory rate e. Level of consciousness

All of the above!

18. Which effects contribute to making nitrates the first-line therapy for the treatment of angina (select all that apply)? a. Decrease heart rate (HR) d. Dilate coronary arteries b. Decrease preload e. Prevent thrombosis of plaques c. Decrease afterload f. Decrease myocardial contractility

b, c, d. Nitrates decrease preload and afterload to decrease the coronary workload and dilate coronary arteries to increase coronary blood supply. The other options are not attributed to nitrates.

Which condition is transmitted through wound contamination, causes painful tonic spasms or seizures, and can be prevented by immunization?

Tetanus is transmitted through wound contamination, causes painful tonic spasms or seizures, and can be prevented with immunization.

10. The x-ray shows that the patient's fracture is at the remodeling stage. What characteristics of the fracture healing process are happening at this stage (select all that apply)? 1. Radiologic union 2. Absorption of excess cells 3. Return to preinjury strength and shape 4. Semisolid blood clot at the ends of fragments 5. Deposition and absorption of bone in response to stress 6. Unorganized network of bone woven around fracture parts

a, b, c, e. When the remodeling stage of healing occurs, radiologic union is present. Excess callus is reabsorbed, trabecular bone is laid, and the bone returns to its preinjury structure strength and shape. The osteoblasts and osteoclasts function normally in response to stress. The fracture hematoma stage is when the hematoma at the ends of the fragments becomes a semisolid blood clot. There is an unorganized network of bone composed of cartilage, osteoblasts, calcium, and phosphorus woven around fracture parts in the callus formation stage.

9. During a routine health examination, a 48-year-old patient is found to have a total cholesterol level of 224 mg/dL (5.8 mmol/L) and an LDL level of 140 mg/dL (3.6 mmol/L). What does the nurse teach the patient based on the Therapeutic Lifestyle Changes diet (select all that apply)? a. Use fat-free milk d. Eliminate intake of simple sugars b. Abstain from alcohol use e. Avoid egg yolks and foods prepared with whole eggs c. Reduce red meat in the diet

a, c, e. Therapeutic Lifestyle Changes diet recommendations emphasize reduction in saturated fat and cholesterol intake. Red meats, whole milk products, and eggs as well as butter, stick margarine, lard, and solid shortening should be reduced or eliminated from diets. If triglyceride levels are high, alcohol and simple sugars should be reduced.

23. What emergency considerations must be included with facial fractures (select all that apply)? a. Airway patency d. Cranial nerve assessment b. Oral examination e. Immobilization of the jaw c. Cervical spine injury

a, c. Airway patency and cervical spinal cord injury are the emergency considerations with facial fractures. Oral examination and cranial nerve assessment will be done after the patient is stabilized. Immobilization of the jaw is done surgically for a mandibular fracture.

Which statements about fluid in the human body are true (select all that apply)? a. The primary hypothalamic mechanism of water intake is thirst. b. Third spacing refers to the abnormal movement of fluid into interstitial spaces. c. A cell surrounded by hypoosmolar fluid will shrink and die as water moves out of the cell. d. A cell surrounded by hyperosmolar fluid will shrink and die as water moves out of the cell. e. Concentrations of Na+ and K+ in interstitial and intracellular fluids are maintained by the sodium-potassium pump.

a, d, e

20. When instructing the patient with angina about taking sublingual nitroglycerin tablets, what should the nurse teach the patient? a. To lie or sit and place one tablet under the tongue when chest pain occurs b. To take the tablet with a large amount of water so it will dissolve right away c. That if one tablet does not relieve the pain in 15 minutes, the patient should go to the hospital d. That if the tablet causes dizziness and a headache, stop the medication and call the doctor or go to the hospital

a. A common complication of nitrates is dizziness caused by orthostatic hypotension, so the patient should sit or lie down and place the tablet under the tongue. The tablet should be allowed to dissolve under the tongue. To prevent the tablet from being swallowed, water should not be taken with it. The recommended dose for the patient for whom nitroglycerin (NTG) has been prescribed is one tablet taken sublingually (SL) or one metered spray for symptoms of angina. If symptoms are unchanged or worse after 5 minutes, the patient should contact the emergency medical services (EMS) system before taking additional NTG. If symptoms are significantly improved by one dose of NTG, instruct the patient or caregiver to repeat NTG every 5 minutes for a maximum of three doses and contact EMS if symptoms have not resolved completely. Headache is also a common complication of nitrates but usually resolves with continued use of nitrates and may be controlled with mild analgesics.

27. Which kind of hip fracture is usually repaired with a hip prosthesis? a. Intracapsular c. Subtrochanteric b. Extracapsular d. Intertrochanteric

a. A hip prosthesis is usually used for intracapsular fractures. The other options are all extracapsular fractures.

12. A patient with a fractured femur experiences the complication of malunion. The nurse recognizes that what happens with this complication? a. The fracture heals in an unsatisfactory position. b. The fracture fails to heal properly despite treatment. c. Fracture healing progresses more slowly than expected. d. Loss of bone substances occurs as a result of immobilization.

a. A malunion occurs when the bone heals in the expected time but in an unsatisfactory position, possibly resulting in deformity or dysfunction. Nonunion occurs when the fracture fails to heal properly despite treatment and delayed union is healing of the fracture at a slower rate than expected. In posttraumatic osteoporosis, the loss of bone substances occurs as a result of immobilization.

35. Priority Decision: An immediate prosthetic fitting during surgery is used for a patient with a traumatic below-the- knee amputation. During the immediate postoperative period, what is a priority nursing intervention? a. Monitor the patient's vital signs. b. Assess the incision for hemorrhage. c. Elevate the residual limb on pillows. d. Have the patient flex and extend the knee every hour.

a. Because the device covers the residual limb, the surgical site cannot be directly seen and postoperative hemorrhage is not apparent on dressings, requiring vigilant assessment of vital signs for signs of bleeding. Elevation of the residual limb with an immediate prosthetic fitting is not necessary because the device itself prevents edema formation. Exercises to the leg are not performed in the immediate postoperative period to avoid disruption of ligatures and the suture line.

It is especially important for the nurse to assess for which clinical manifestation(s) in a patient who has just undergone a total thyroidectomy (select all that apply)? a. Confusion b. Weight gain c. Depressed reflexes d. Circumoral numbness e. Positive Chvostek's sign

a. Confusion d. Circumoral numbness e. Positive Chvostek's sign

When obtaining information about the patient's use of medications, the nurse recognizes that both bone and muscle function may be impaired when the patient reports taking what type of drug? a. Corticosteroids c. Potassium-depleting diuretics b. Oral hypoglycemic agents d. Nonsteroidal antiinflammatory drugs (NSAIDs)

a. Corticosteroids cause protein catabolism with skeletal muscle wasting and increased osteoclast activity with loss of bone mass, which can have a marked detrimental effect on mobility and activity. Potassium-depleting diuretics may cause hypokalemia, which is associated with muscle weakness and cramps. Oral hypoglycemic drugs and nonsteroidal antiinflammatory drugs (NSAIDs) are not known to affect the musculoskeletal system.

To provide free water and intracellular fluid hydration for a patient with acute gastroenteritis who is NPO, the nurse would expect administration of which infusion? a. Dextrose 5% in water b. Dextrose 10% in water c. Lactated Ringer's solution d. Dextrose 5% in normal saline (0.9%)

a. Dextrose 5% in water

How is urinary function maintained during the acute phase of spinal cord injury? a. An indwelling catheter b. Intermittent catheterization c. Insertion of a suprapubic catheter d. Use of incontinent pads to protect the skin

a. During the acute phase of spinal cord injury, the bladder is hypotonic, causing urinary retention with the risk for reflux into the kidney or rupture of the bladder. An indwelling catheter is used to keep the bladder empty and to monitor urinary output. Intermittent catheterization or other urinary drainage methods may be used in long- term bladder management. Use of incontinent pads is inappropriate because they do not help the bladder to empty.

36. Why does a nurse position a patient with an above-the-knee amputation with a delayed prosthetic fitting prone several times a day? a. To prevent flexion contractures c. To reduce edema in the residual limb b. To assess the posterior skin flap d. To relieve pressure on the incision site

a. Flexion contractures, especially of the hip, may be debilitating and delay rehabilitation of the patient with a leg amputation. To prevent hip flexion, the patient should avoid sitting in a chair with the hips flexed or having pillows under the surgical extremity for prolonged periods and the patient should lie on the abdomen for 30 minutes three to four times a day to extend the hip.

8. The nurse is encouraging a sedentary patient with major risks for CAD to perform physical exercise on a regular basis. In addition to decreasing the risk factor of physical inactivity, the nurse tells the patient that exercise will also directly contribute to reducing which risk factors? a. Hyperlipidemia and obesity b. Diabetes mellitus and hypertension c. Elevated serum lipids and stressful lifestyle d. Hypertension and elevated serum homocysteine

a. Increased exercise without an increase in caloric intake will result in weight loss, reducing the risk associated with obesity. Exercise increases lipid metabolism and increases HDL, thus reducing CAD risk. Exercise may also indirectly reduce the risk of CAD by controlling hypertension, promoting glucose metabolism in diabetes, and reducing stress. Although research is needed to determine whether a decline in homocysteine can reduce the risk of heart disease, it appears that dietary modifications are indicated for risk reduction.

25. When is a fat embolism most likely to occur? a. 24 to 48 hours following a fractured tibia c. 4 to 5 days following a fractured femur b. 36 to 72 hours following a skull fracture d. 5 to 6 days following a pelvic fracture

a. Initial manifestations of fat embolism usually occur 24 to 48 hours after injury and are associated with fractures of long bones and multiple fractures related to pelvic injuries, including fractures of the femur, tibia, ribs, and pelvis.

23. The nurse suspects stable angina rather than MI pain in the patient who reports that his chest pain a. is relieved by nitroglycerin. b. is a sensation of tightness or squeezing. c. does not radiate to the neck, back, or arms. d. is precipitated by physical or emotional exertion.

a. One of the primary differences between the pain of angina and the pain of an MI is that angina pain is usually relieved by rest or nitroglycerin, which reduces the oxygen demand of the heart, whereas MI pain is not. Both angina and MI pain can cause a pressure or squeezing sensation; may or may not radiate to the neck, back, arms, fingers, and jaw; and may be precipitated by exertion.

13. What is a disadvantage of open reduction and internal fixation of a fracture compared to closed reduction? a. Infection b. Skin irritation c. Nerve impairment d. Complications of immobility

a. Open reduction uses a surgical incision to correct bone alignment but infection is the main disadvantage, as well as anesthesia complications or the effect of preexisting medical conditions. Skin irritation and nerve impairment is most likely with skin traction. Prolonged immobility is possible with skeletal traction.

21. When teaching an older adult with CAD how to manage the treatment program for angina, which guidelines does the nurse use to teach the patient? a. To sit for 2 to 5 minutes before standing when getting out of bed b. To exercise only twice a week to avoid unnecessary strain on the heart c. That lifestyle changes are not as necessary as they would be in a younger person d. That aspirin therapy is contraindicated in older adults because of the risk for bleeding

a. Orthostatic hypotension may cause dizziness and falls in older adults taking antianginal agents that decrease preload. Patients should be cautioned to change positions slowly. Daily exercise programs are indicated for older adults and may increase performance, endurance, and ability to tolerate stress. A change in lifestyle behaviors may increase the quality of life and reduce the risks of CAD, even in the older adult. Aspirin is commonly used in these patients and is not contraindicated.

The patient had a fracture. At 3 weeks to 6 months there is clinical union, and this is the first stage of healing that is sufficient to prevent movement of the fracture site when the bones are gently stressed. How is this stage of fracture healing documented? a. Ossification c. Consolidation b. Remodeling d. Callus formation

a. Ossification is the stage of fracture healing when there is clinical union and enough strength to prevent movement at the fracture site. Remodeling is the normal function of the bone. Consolidation is when the distance between bone fragments eventually closes and radiologic union first occurs. The callus formation stage appears by the end of the second week of injury when minerals and new bone matrix are deposited in the osteoid that is produced in the granulation tissue stage.

37. A patient who had a below-the-knee amputation is to be fitted with a temporary prosthesis. It is most important for the nurse to teach the patient to do what? a. Inspect the residual limb daily for irritation. b. Apply an elastic shrinker before applying the prosthesis. c. Perform range-of-motion (ROM) exercises to the affected leg four times a day. d. Apply alcohol to the residual limb every morning and evening to toughen the skin.

a. Skin breakdown on the residual limb can prevent the use of a prosthesis so the limb should be inspected every day for signs of irritation or pressure areas. No substances except water and mild soap should be used on the residual limb and range-of-motion (ROM) exercises are not necessary when the patient is using a prosthesis. A residual limb shrinker is an elastic stocking that is used to mold the limb in preparation for prosthesis use but a cotton residual limb sock is worn with the prosthesis.

20. What surgical treatment will the nurse prepare the patient for in the presence of compartment syndrome? a. Fasciotomy b. Amputation c. Internal fixation d. Release of tendons

a. Soft tissue edema in the area of the injury may cause an increase of pressure within the closed spaces of the tissue compartments formed by the nonelastic fascia, creating compartment syndrome. If symptoms occur, it may be necessary to incise the fascia surgically, a procedure known as a fasciotomy. Amputation is usually necessary only if the limb becomes septic because of untreated compartment syndrome.

10. To which patients should the nurse teach the Therapeutic Lifestyle Changes diet to reduce the risk of coronary artery disease (CAD)? a. All patients to reduce CAD risk b. Patients who have experienced an MI c. Individuals with two or more risk factors for CAD d. Individuals with a cholesterol level >200 mg/dL (5.2 mmol/L)

a. The Therapeutic Lifestyle Changes diet includes recommendations for all people, not just those with risk factors, to decrease the risk for CAD.

What is the function of a tendon? a. Attaches muscle to bone b. Connects bone to bone at the joint c. Connects cartilage to muscle in joints d. Attaches synovium to the joint capsule

a. The function of the tendon is to attach muscle to bone. The ligament attaches bone to bone at the joint. Fascia encloses individual muscles but does not connect cartilage to muscle in joints. The bursae are lined with a synovial membrane and are located in joints to relieve pressure and decrease friction between moving parts.

The nursing care for a patient with hyponatremia includes a. fluid restriction. b. administration of hypotonic IV fluids. c. administration of a cation-exchange resin. d. increased water intake for patients on nasogastric suction

a. fluid restriction.

The lungs act as an acid-base buffer by a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load. c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. d. decreasing respiratory rate and depth

a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.

During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is a. osmosis. b. diffusion. c. active transport. d. facilitated diffusion

a. osmosis.

An older woman was admitted to the medical unit with dehydration. Clinical indications of this problem are (select all that apply) a. weight loss. b. dry oral mucosa. c. full bounding pulse. d. engorged neck veins. e. decreased central venous pressure.

a. weight loss. b. dry oral mucosa. e. decreased central venous pressure.

5. Which characteristics are associated with LDLs (select all that apply)? a. Increases with exercise b. Contains the most cholesterol c. Has an affinity for arterial walls d. Carries lipids away from arteries to liver e. High levels correlate most closely with CAD f. The higher the level, the lower the risk for CAD

b, c, e. LDLs contain more cholesterol than the other lipoproteins, have an attraction for arterial walls, and correlate most closely with increased incidence of atherosclerosis and CAD. HDLs increase with exercise and carry lipids away from arteries to the liver for metabolism. A high HDL level is associated with a lower risk of CAD.

16. Which characteristics describe unstable angina (select all that apply)? a. Usually precipitated by exertion b. Unpredictable and unrelieved by rest c. Characterized by progressive severity d. Occurs only when the person is recumbent e. Usually occurs in response to coronary artery spasm

b, c. Unstable angina is unpredictable and unrelieved by rest and has progressively increasing severity. Chronic stable angina is usually precipitated by exertion. Angina decubitus occurs when the person is recumbent. Prinzmetal's angina is frequently caused by a coronary artery spasm.

13. Myocardial ischemia occurs as a result of increased oxygen demand and decreased oxygen supply. What factors and disorders result in increased oxygen demand (select all that apply)? a. Hypovolemia or anemia b. Increased cardiac workload with aortic stenosis c. Narrowed coronary arteries from atherosclerosis d. Angina in the patient with atherosclerotic coronary arteries e. Left ventricular hypertrophy caused by chronic hypertension f. Sympathetic nervous system stimulation by drugs, emotions, or exertion

b, d, e, f. Increased oxygen demand is caused by increasing the workload of the heart, including left ventricular hypertrophy with hypertension, sympathetic nervous stimulation, and anything precipitating angina. Hypovolemia, anemia, and narrowed coronary arteries contribute to decreased oxygen supply.

18. A patient is discharged from the outpatient clinic following application of a synthetic fiberglass long arm cast for a fractured ulna. Before discharge, the nurse instructs the patient to do what? a. Never get the cast wet. b. Move the shoulder and fingers frequently. c. Place tape petals around the edges of the cast when it is dry. d. Use a sling to support the arm at waist level for the first 48 hours.

b. A patient with any type of cast should exercise the joints above and below the cast frequently and moving the fingers frequently will improve circulation and help to prevent edema. Unlike plaster casts, thermoplastic resin or fiberglass casts are relatively waterproof and, if they become wet, can be dried with a hair dryer on low setting. Tape petals are used on plaster casts to protect the edges from breaking and crumbling but are not necessary for synthetic casts. After the cast is applied, the extremity should be elevated at about the level of the heart to promote venous return and ice may be used to prevent edema.

The patient asks, "What does the doctor mean when he says that I have an avulsion fracture in my leg? I thought I had a sprain!" What is the best response by the nurse? a. "It is a fracture with more than two fragments." b. "It means that a ligament pulled a bone fragment loose." c. "The line of the fracture is twisted along the shaft of the bone." d. "The line of the fracture is at right angles to the longitudinal axis of the bone."

b. An avulsion fracture occurs when a ligament pulls a bone fragment loose, with pain similar to a sprain. A fracture with two or more fragments is a comminuted fracture. It is a spiral fracture when it is twisted around a bone shaft. It is a transverse fracture when the line of fracture is at right angles to the longitudinal axis.

24. A patient admitted to the hospital for evaluation of chest pain has no abnormal serum cardiac markers 4 hours after the onset of pain. What noninvasive diagnostic test can be used to differentiate angina from other types of chest pain? a. 12-lead ECG b. Exercise stress test c. Coronary angiogram d. Transesophageal echocardiogram

b. An exercise stress test will reveal ECG changes that indicate impaired coronary circulation when the oxygen demand of the heart is increased. A single ECG is not conclusive for CAD and negative findings do not rule out CAD. Coronary angiography can detect narrowing of coronary arteries but is an invasive procedure. Echocardiograms of various types may identify abnormalities of myocardial wall motion under stress but are indirect measures of CAD.

Application of RICE (rest, ice, compression, and elevation) is indicated for initial management of which type of injury? a. Muscle spasms b. Sprains and strains c. Repetitive strain injury d. Dislocations and subluxations

b. Application of cold, compression, and elevation are indicated to prevent edema resulting from sprain and some strain injuries. Muscle spasms are usually treated with heat applications and massage and repetitive strain injuries require cessation of the precipitating activity and physical therapy. Dislocations or subluxations require immediate reduction and immobilization to prevent vascular impairment and bone cell death.

The patient is told by the health care provider that the size of the patient's muscle has decreased. How should the nurse document this occurrence? a. Hyaline c. Isometric b. Atrophy d. Hypertrophy

b. Atrophy is when the muscle size decreases. Hyaline is the most common type of cartilage tissue. Isometric is a muscle contraction that produces hypertrophy. Hypertrophy is the increase in the size of cells causing an increase in the organ.

19. The patient has used sublingual nitroglycerin and various long-acting nitrates but now has an ejection fraction of 38% and is considered at a high risk for a cardiac event. Which medication would first be added for vasodilation and to reduce ventricular remodeling? a. Clopidogrel (Plavix) c. Diltiazem (Cardizem) b. Captopril (Capoten) d. Metoprolol (Lopressor)

b. Captopril (Capoten) would be added. It is an angiotensin- converting enzyme (ACE) inhibitor that vasodilates and decreases endothelial dysfunction and may prevent ventricular remodeling. Clopidogrel (Plavix) is an antiplatelet agent used as an alternative for a patient unable to use aspirin. Diltiazem (Cardizem), a calcium channel blocker, may be used to decrease vasospasm but is not known to prevent ventricular remodeling. Metoprolol (Lopressor) is a β-adrenergic blocker that inhibits sympathetic nervous stimulation of the heart.

The nurse identifies the presence of a fracture based on what cardinal sign of fracture? a. Muscle spasms b. Obvious deformity c. Edema and swelling d. Pain and tenderness

b. Deformity is the cardinal sign of fracture but may not be apparent in all fractures. Other supporting signs include edema and swelling, localized pain and tenderness, muscle spasm, ecchymosis, loss of function, crepitation, and an inability to bear weight.

6. Which serum lipid elevation, along with elevated LDL, is strongly associated with CAD? a. Apolipoproteins b. Fasting triglycerides c. Total serum cholesterol d. High-density lipoprotein (HDL)

b. Elevated fasting triglyceride levels are associated with cardiovascular disease and diabetes. Apolipoproteins are found in varying amounts on the HDLs and activate enzyme or receptor sites that promote removal of fat from plasma, which is protective. The apolipoprotein A and apolipropotein B ratio must be done to predict CAD. Elevated HDLs are associated with a lower risk of CAD. Elevated total serum cholesterol must be calculated with HDL for a ratio over time to determine an increased risk of CAD.

28. During the assessment, the nurse identifies crackles in the lungs and an S3 heart sound. Which complication of MI should the nurse suspect and further investigate? a. Pericarditis b. Heart failure c. Ventricular aneurysm d. Papillary muscle dysfunction

b. Heart failure, which can escalate to cardiogenic shock, initially occurs with mild dyspnea, restlessness, agitation, pulmonary congestion with crackles, S3 or S4 heart sounds, and jugular vein distention. Pericarditis is a common complication identified with chest pain that is aggravated by inspiration, coughing, and moving the upper body. Ventricular aneurysm is manifested with heart failure, dysrhythmias, and angina. Papillary muscle dysfunction is suspected with a new systolic apical murmur.

While caring for an 84-year-old patient, the nurse monitors the patient's fluid and electrolyte balance, recognizing what as a normal change of aging? a. Hyperkalemia b. Hyponatremia c. Decreased insensible fluid loss d. Increased plasma oncotic pressures

b. Hyponatremia

15. A patient is admitted with an open fracture of the tibia following a bicycle accident. During assessment of the patient, what specifically should the nurse question the patient about? a. Any previous injuries to the leg b. The status of tetanus immunization c. The use of antibiotics in the last month d. Whether the injury was exposed to dirt or gravel

b. Infection is the greatest risk with an open fracture and all open fractures are considered contaminated. Tetanus prevention is always indicated if the patient has not been immunized or does not have current boosters. Prophylactic antibiotics are often used in management of open fractures but recent antibiotic therapy is not relevant, nor is previous injury to the site.

A patient with paraplegia has developed an irritable bladder with reflex emptying. What will be most helpful for the nurse to teach the patient? a. Hygiene care for an indwelling urinary catheter b. How to perform intermittent self-catheterization c. To empty the bladder with manual pelvic pressure in coordination with reflex voiding patterns d. That a urinary diversion, such as an ileal conduit, is the easiest way to handle urinary elimination

b. Intermittent self-catheterization five to six times a day is the recommended method of bladder management for the patient with a spinal cord injury and reflexic neurogenic bladder because it more closely mimics normal emptying and has less potential for infection. The patient and family should be taught the procedure using clean technique and if the patient has use of the arms, self-catheterization should be performed. Indwelling catheterization is used during the acute phase to prevent overdistention of the bladder and surgical urinary diversions are used if urinary complications occur.

What is hyperkalemia frequently associated with? a. Hypoglycemia b. Metabolic acidosis c. Respiratory alkalosis d. Decreased urine potassium levels

b. Metabolic acidosis

17. To assess for neurologic status in a patient with a fractured humerus, what should the nurse ask the patient to do? a. Evert, invert, dorsiflex, and plantar flex the foot. b. Abduct, adduct, and oppose the fingers and pronate and supinate the hand. c. Assess the location, quality, and intensity of pain below the site of the injury. d. Assess the color, temperature, capillary refill, peripheral pulses, and presence of edema in the extremity.

b. Neurologic assessment includes evaluation of motor and sensory function and, in the upper extremity, includes abduction and adduction of the fingers, opposition of the fingers, and supination and pronation of the hands. It also includes sensory perception in the fingers. Evaluation of the feet would occur in lower extremity injuries. Assessment of color, temperature, capillary refill, peripheral pulses, and edema evaluates vascular status.

34. A patient complains of pain in the foot of a leg that was recently amputated. What should the nurse recognize about this pain? a. It is caused by swelling at the incision. b. It should be treated with ordered analgesics. c. It will become worse with the use of a prosthesis. d. It can be managed with diversion because it is psychologic.

b. Phantom sensation or phantom pain may occur following amputation, especially if pain was present in the affected limb preoperatively. The pain is a real sensation to the patient and will first be treated with analgesics and other pain interventions (i.e., tricyclic antidepressants, antiseizure drugs, transcutaneous electrical nerve stimulation [TENS], mirror therapy, acupuncture). As recovery and ambulation progress, phantom limb sensation usually subsides.

The nurse is reviewing a patient's morning laboratory results. Which result is of greatest concern? a. Serum Na+ of 150 mEq/L b. Serum Mg2+ of 1.1 mEq/L c. Serum PO43- of 4.5 mg/dL d. Serum Ca2+ (total) of 8.6 mg/dL

b. Serum Mg2+ of 1.1 mEq/L

15. What types of angina can occur in the absence of CAD (select all that apply)? a. Silent ischemia b. Nocturnal angina c. Prinzmetal's angina d. Microvascular angina e. Chronic stable angina

c, d. Prinzmetal's angina and microvascular angina may occur in the absence of CAD but with arterial spasm in Prinzmetal's angina or abnormalities of the coronary microcirculation. Silent ischemia is prevalent in persons with diabetes mellitus and contributes to asymptomatic myocardial ischemia. Nocturnal angina occurs only at night. Chronic stable angina refers to chest pain that occurs with the same pattern of onset, duration, and intensity intermittently over a long period of time.

2. What accurately describes the pathophysiology of CAD? a. Partial or total occlusion of the coronary artery occurs during the stage of raised fibrous plaque b. Endothelial alteration may be caused by chemical irritants such as hyperlipidemia or by tobacco use c. Collateral circulation in the coronary circulation is more likely to be present in the young patient with CAD d. The leading theory of atherogenesis proposes that infection and fatty dietary intake are the basic underlying causes of atherosclerosis

b. The etiology of CAD includes atherosclerosis as the major cause. The pathophysiology of atherosclerosis development is related to endothelial chemical injury and inflammation, which can be the result of tobacco use, hyperlipidemia, hypertension, toxins, diabetes mellitus, hyperhomocysteinemia, and infection causing a local inflammatory response in the inner lining of the vessel walls. Partial or total occlusion occurs in the complicated lesion stage. Extra collateral circulation occurs in the presence of chronic ischemia. Therefore it is more likely to occur in an older patient.

3. While obtaining patient histories, which patient does the nurse identify as having the highest risk for CAD? a. A white man, age 54, who is a smoker and has a stressful lifestyle b. A white woman, age 68, with a BP of 172/100 mm Hg and who is physically inactive c. An Asian woman, age 45, with a cholesterol level of 240 mg/dL and a BP of 130/74 mm Hg d. An obese African American man, age 65, with a cholesterol level of 195 mg/dL and a BP of 128/76 mm Hg

b. This white woman has one unmodifiable risk factor (age) and two major modifiable risk factors (hypertension and physical inactivity). Her gender risk is as high as a man's because she is over 65 years of age. The white man has one unmodifiable risk factor (gender), one major modifiable risk factor (smoking), and one minor modifiable risk factor (stressful lifestyle). The Asian woman has only one major modifiable risk factor (hyperlipidemia) and Asians in the United States have fewer myocardial infarctions (MIs) than do whites. The African American man has an unmodifiable risk factor related to age and one major modifiable risk factor (obesity).

Two days following a spinal cord injury, a patient asks continually about the extent of impairment that will result from the injury. What is the best response by the nurse? a. "You will have more normal function when spinal shock resolves and the reflex arc returns." b. "The extent of your injury cannot be determined until the secondary injury to the cord is resolved." c. "When your condition is more stable, MRI will be done to reveal the extent of the cord damage." d. "Because long-term rehabilitation can affect the return of function, it will be years before we can tell what the complete effect will be."

b. Until the edema and necrosis at the site of the injury are resolved in 72 hours to 1 week after the injury, it is not possible to determine how much cord damage is present from the initial injury, how much secondary injury occurred, or how much the cord was damaged by edema that extended above the level of the original injury. The return of reflexes signals only the end of spinal shock and the reflexes may be inappropriate and excessive, causing spasms that complicate rehabilitation.

The nurse anticipates that treatment of the patient with hyperphosphatemia secondary to renal failure will include a. fluid restriction. b. calcium supplements. c. loop diuretic therapy. d. magnesium supplements

b. calcium supplements.

Which serologic tests would be done to evaluate rheumatoid arthritis (select all that apply)? a. Uric acid d. Antinuclear antibody (ANA) b. Anti-DNA antibody e. Erythrocyte sedimentation rate (ESR) c. Rheumatoid factor (RF)

c, d, e. Increases in rheumatoid factor (RF), antinuclear antibody (ANA), and erythrocyte sedimentation rate (ESR) as well as depletion of complement, total hemolytic, and presence of human leukocyte antigen (HLA)-B27 may occur in rheumatoid arthritis. Uric acid may be elevated in gout. Anti-DNA antibody is the most specific test for systemic lupus erythematosus.

12. What are manifestations of acute coronary syndrome (ACS) (select all that apply)? a. Dysrhythmia b. Stable angina c. Unstable angina d. ST-segment-elevation myocardial infarction (STEMI) e. Non-ST-segment-elevation myocardial infarction (NSTEMI)

c, d, e. Unstable angina, ST-segment-elevation myocardial infarction (STEMI), and non-ST-segment-elevation myocardial infarction (NSTEMI) are conditions that are manifestations of acute coronary syndrome (ACS). The other options are not manifestations of ACS.

Which patient would be at greatest risk for the potential development of hypermagnesemia? a. 83-year-old man with lung cancer and hypertension b. 65-year-old woman with hypertension taking β-adrenergic blockers c. 42-year-old woman with systemic lupus erythematosus and renal failure d. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection

c. 42-year-old woman with systemic lupus erythematosus and renal failure

22. The woman with osteoporosis slipped on the ice and now her wrist hurts. If there is a fracture, what type of fracture is expected? a. Dislocation c. Colles' fracture b. Open fracture d. Incomplete fracture

c. A Colles' fracture most often occurs in patients over 50 years of age with osteoporosis and frequently when the patient attempts to break a fall with an outstretched arm and hand. Dislocation is the complete separation of articular surfaces of the joint caused by a ligament injury. Open fracture is when there is communication with the external environment. A fracture is incomplete if only part of the bone shaft is fractured and the bone is still in one piece.

In report, the nurse is told that the patient has a contracture of the right arm. What does the nurse know this means? a. A fluid-filled cyst c. Shortening of a muscle or ligament b. Generalized muscle pain d. Grating sensation between bones with movement

c. A contracture is shortening of a muscle or ligament that causes resistance of movement. A fluid-filled cyst is a ganglion cyst. Generalized muscle pain is myalgia. Crepitation is a grating sensation between bones with movement.

The patient with osteoporosis had a spontaneous hip fracture. How should the nurse document this before the x-ray results return? a. Open fracture c. Pathologic fracture b. Oblique fracture d. Greenstick fracture

c. A pathologic fracture is a spontaneous fracture at the site of bone disease, such as osteoporosis. An open fracture is when there is communication with the external environment. The oblique fracture has a slanted fracture line. A greenstick fracture is splintered on one side and the other side is bent.

What is the most common diagnostic test used to assess musculoskeletal disorders? a. Myelogram c. Standard x-ray b. Arthroscopy d. Magnetic resonance imaging (MRI)

c. A standard x-ray evaluates structural or functional changes of bones and joints and can determine density of bone. Myelogram is a sensitive test for nerve impingement and can detect very subtle lesions and injuries. Arthroscopy is used to visualize, diagnose, or repair joint problems. Magnetic resonance imaging (MRI) is used to view soft tissue.

26. At what point in the healing process of the myocardium following an infarct does early scar tissue result in an unstable heart wall? a. 2 to 3 days after MI b. 4 to 10 days after MI c. 10 to 14 days after MI d. 6 weeks after MI

c. At 10 to 14 days after MI, the myocardium is considered especially vulnerable to increased stress because of the unstable state of healing at this point, as well as the increasing physical activity of the patient. At 2 to 3 days, removal of necrotic tissue is taking place by phagocytic cells. By 4 to 10 days, the necrotic tissue has been cleared and a collagen matrix for scar tissue has been deposited. Healing with scar-tissue replacement of the necrotic area is usually complete by 6 weeks.

The athlete comes to the clinic with bursitis. What does the nurse know happens to the tissue to cause pain when bursitis occurs? a. Tearing of a ligament b. Stretching of muscle and fascia sheath c. Inflammation of synovial membrane sac at friction sites d. Incomplete separation of articular surfaces of joint caused by ligament injury

c. Bursitis is inflammation of synovial membrane sac at friction sites. Tearing of a ligament is a sprain. Stretching of muscle and fascia sheath is a strain. Incomplete separation of articular surfaces of joints caused by ligament injury is subluxation.

11. A 62-year-old woman has prehypertension (BP 142/90 mm Hg) and smokes a pack of cigarettes per day. She has no symptoms of CAD but a recent LDL level was 154 mg/dL (3.98 mmol/L). Based on these findings, the nurse would expect that which treatment plan would be used first for this patient? a. Diet and drug therapy c. Diet therapy and smoking cessation b. Exercise instruction only d. Drug therapy and smoking cessation

c. Diet therapy and smoking cessation are indicated for a patient without CAD who has prehypertension and an LDL level ≥130 mg/dL. When the patient's LDL level is ≥160 mg/dL, drug therapy would be added to diet therapy. Because tobacco use is related to increased BP and LDL level, the benefit of smoking cessation is almost immediate. Exercise is indicated to reduce risk factors throughout treatment.

A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication? a. Seizures b. Paralysis c. Dysrhythmias d. Acute kidney injury

c. Dysrhythmias

A patient with chronic kidney disease has hyperphosphatemia. What is a commonly associated electrolyte imbalance? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypomagnesemia

c. Hypocalcemia

What is an example of an IV solution that would be appropriate to treat an extracellular fluid volume deficit? a. D5W b. 3% saline c. Lactated Ringer's solution d. D5W in normal saline (0.45%)

c. Lactated Ringer's solution

Which type of bone cell is responsible for the formation of bone? a. Osteocyte c. Osteoblast b. Osteoclast d. Sarcomere

c. Osteoblasts form bone. Osteocytes are mature bone cells. Osteoclasts are responsible for the resorption of bone. A sarcomere is the contractile unit of myofibrils.

19. A patient with a fractured tibia accompanied by extensive soft tissue damage initially has a splint applied and held in place with an elastic bandage. What early sign should alert the nurse that the patient is developing compartment syndrome? a. Paralysis of the toes b. Absence of peripheral pulses c. Distal pain unrelieved by opioid analgesics d. Skin over the injury site is blanched when the bandage is removed

c. Pain that is distal to the injury and is unrelieved by opioid analgesics is the earliest sign of compartment syndrome. Paralysis and absence of peripheral pulses will eventually occur if it is not treated but these are late signs that often appear after permanent damage has occurred. The overlying skin may appear normal because the surface vessels are not occluded.

26. The nurse suspects a fat embolism rather than a pulmonary embolism from a venous thrombosis when the patient with a fracture develops what? a. Tachycardia and dyspnea b. A sudden onset of chest pain c. Petechiae around the neck and upper chest d. Electrocardiographic (ECG) changes and decreased PaO2

c. Patients with fractures are at risk for both fat embolism and pulmonary embolism from venous thromboembolism but there is a difference in the time of occurrence, with fat embolism occurring shortly after the injury and thrombotic embolism occurring several days after immobilization. They both may cause pulmonary symptoms of chest pain, tachypnea, dyspnea, apprehension, tachycardia, and cyanosis. However, fat embolism may cause petechiae located around the neck, anterior chest wall, axilla, buccal membrane of the mouth, and conjunctiva of the eye, which differentiates it from thrombotic embolism.

33. Priority Decision: Twenty-four hours after a below-the-knee amputation, a patient uses the call system to tell the nurse that his dressing (a compression bandage) has fallen off. What is the first action that the nurse should take? a. Apply ice to the site. b. Cover the incision with dry gauze. c. Reapply the compression dressing. d. Elevate the extremity on a couple of pillows.

c. The compression dressing or bandage supports the soft tissues, reduces edema, hastens healing, minimizes pain, and promotes residual limb shrinkage. If the dressing is left off, edema will form quickly and may delay rehabilitation. Elevation and ice will not be as effective at preventing the edema that will form. Dressing the incision with dry gauze will not provide the benefits of a compression dressing.

Without surgical stabilization, what method of immobilization for the patient with a cervical spinal cord injury should the nurse expect to be used? a. Kinetic beds b. Hard cervical collar c. Skeletal traction with skull tongs d. Sternal-occipital-mandibular immobilizer brace

c. The development of better surgical stabilization has made surgery the more frequent treatment of cervical injuries. However, when surgery cannot be done, skeletal traction with the use of Crutchfield, Vinke, or other types of skull tongs is required to immobilize the cervical vertebrae, even if a fracture has not occurred. Hard cervical collars or a sternal-occipital- mandibular immobilizer brace may be used after cervical stabilization surgery or for minor injuries or stabilization during emergency transport of the patient. Sandbags may also be used temporarily to stabilize the neck during insertion of tongs or during diagnostic testing immediately following the injury. Special turning or kinetic beds may be used to turn and mobilize patients who are in cervical traction.

1. Which patient is most likely to be in the fibrous stage of development of coronary artery disease (CAD)? a. Age 40, thrombus adhered to the coronary artery wall b. Age 50, rapid onset of disease with hypercholesterolemia c. Age 32, thickened coronary arterial walls with narrowed vessel lumen d. Age 19, elevated low-density lipoprotein (LDL) cholesterol, lipid-filled smooth muscle cells

c. The fibrous plaque stage has progressive changes that can be seen by age 30. Collagen covers the fatty streak and forms a fibrous plaque in the artery. The thrombus adheres to the arterial wall in the complicated lesion stage. Rapid onset of coronary artery disease (CAD) with hypercholesterolemia may be related to familial hypercholesterolemia, not a stage of CAD development. The fatty streak stage is the earliest stage of atherosclerosis and can be seen by age 15.

27. To detect and treat the most common complication of MI, what should the nurse do? a. Measure hourly urine output. b. Auscultate the chest for crackles. c. Use continuous cardiac monitoring. d. Take vital signs every 2 hours for the first 8 hours

c. The most common complication of MI is cardiac dysrhythmias. Continuous cardiac monitoring allows identification and treatment of dysrhythmias that may cause further deterioration of the cardiovascular status or death. Measurement of hourly urine output and vital signs is indicated to detect symptoms of the complication of cardiogenic shock. Crackles, dyspnea, and tachycardia may indicate the onset of heart failure.

22. When a patient reports chest pain, why must unstable angina be identified and rapidly treated? a. The pain may be severe and disabling. b. ECG changes and dysrhythmias may occur during an attack. c. Atherosclerotic plaque deterioration may cause complete thrombus of the vessel lumen. d. Spasm of a major coronary artery may cause total occlusion of the vessel with progression to MI.

c. Unstable angina is associated with the rupture of a once-stable atherosclerotic plaque, exposing the intima to blood and stimulating platelet aggregation and local vasoconstriction with thrombus formation. Patients with unstable angina require immediate hospitalization and monitoring because the lesion is at increased risk of complete thrombosis of the lumen with progression to MI. Any type of angina may be associated with severe pain, ECG changes, and dysrhythmias. Prinzmetal's angina is characterized by coronary artery spasm.

The nurse teaches individuals that one of the best ways to prevent musculoskeletal injuries during physical exercise is by doing what? a. Increase muscle strength with daily isometric exercise. b. Avoid exercising on concrete or hard pavement surfaces. c. Perform stretching and warm-up exercises before exercise. d. Wrap susceptible joints with elastic bandages or adhesive tape before exercise.

c. Warm-up exercises "prelengthen" potentially strained tissues by avoiding the quick stretch often encountered in sports and also increase the temperature of muscle, resulting in increased speed of cell metabolism, increased speed of nerve impulses, and improved oxygenation of muscle fibers. Stretching is also thought to improve kinesthetic awareness, lessening the chance of uncoordinated movement. Muscle strength is not a key factor in soft tissue injuries and taping or wrapping joints may actually predispose a person to injury by weakening the joint, unless a previous injury is being treated.

The nurse should be alert for which manifestations in a patient receiving a loop diuretic? a. Restlessness and agitation b. Paresthesias and irritability c. Weak, irregular pulse and poor muscle tone d. Increased blood pressure and muscle spasms

c. Weak, irregular pulse and poor muscle tone

14. What causes the pain that occurs with myocardial ischemia? a. Death of myocardial tissue b. Dysrhythmias caused by cellular irritability c. Lactic acid accumulation during anaerobic metabolism d. Elevated pressure in the ventricles and pulmonary vessels

c. When the coronary arteries are occluded, contractility ceases after several minutes, depriving the myocardial cells of glucose and oxygen for aerobic metabolism. Anaerobic metabolism begins and lactic acid accumulates, irritating myocardial nerve fibers that then transmit a pain message to the cardiac nerves and upper thoracic posterior roots. The other factors may occur during vessel occlusion but are not the source of pain.

The typical fluid replacement for the patient with a fluid volume deficit is a. dextran. b. 0.45% saline. c. lactated Ringer's. d. 5% dextrose in 0.45% saline.

c. lactated Ringer's.

7. The laboratory tests for four patients show the following results. Which patient should the nurse teach first about preventing CAD because the patient is at the greatest risk for CAD even without other risk factors? a. Total cholesterol: 152 mg/dL, triglycerides: 148 mg/dL, LDL: 148 mg/dL, HDL: 52 mg/dL b. Total cholesterol: 160 mg/dL, triglycerides: 102 mg/dL, LDL: 138 mg/dL, HDL: 56 mg/dL c. Total cholesterol: 200 mg/dL, triglycerides: 150 mg/dL, LDL: 160 mg/dL, HDL: 48 mg/dL d. Total cholesterol: 250 mg/dL, triglycerides: 164 mg/dL, LDL: 172 mg/dL, HDL: 32 mg/dL

d. All of this patient's results are abnormal. The patient in option c is close to being at risk, as all of that patient's results are at or near the cutoff for being acceptable. If this patient is a woman, the HDL is too low. The other patients' results are at acceptable levels.

A 72-year-old man tells the nurse that he cannot perform most of the physical activities he could do 5 years ago because of overall joint aches and pains. What can the nurse do to assist the patient to prevent further deconditioning and decrease the risk for developing musculoskeletal problems? a. Limit weight-bearing exercise to prevent stress on fragile bones and possible hip fractures. b. Advise the patient to avoid the use of canes and walkers because they increase dependence on ambulation aids. c. Advise the patient to increase his activity by more frequently climbing stairs in buildings and other environments with steps. d. Discuss use of over-the-counter (OTC) medications to decrease inflammation and pain so that exercise can be maintained.

d. Almost all older adults have some degree of decreased muscle strength, joint stiffness, and pain with motion. The use of mild antiinflammatory agents decreases inflammation and pain and can help the patient to maintain activity and prevent further deconditioning but other prescribed drugs and potential abdominal problems must be considered by the patient. Musculoskeletal problems in the older adult can be prevented with appropriate strategies, especially exercise. Stair walking can create enough stress on fragile bones to cause a hip fracture and use of ramps may help to prevent falls. Walkers and canes should be used as necessary to decrease stress on joints so that activity can be maintained.

17. Tachycardia that is a response of the sympathetic nervous system to the pain of ischemia is detrimental because it increases oxygen demand and a. increases cardiac output. b. causes reflex hypotension. c. may lead to atrial dysrhythmias. d. impairs perfusion of the coronary arteries.

d. An increased heart rate (HR) decreases the time the heart spends in diastole, which is the time of greatest coronary blood flow. Unlike other arteries, coronary arteries are perfused when the myocardium relaxes and blood backflows from the aorta into the sinuses of Valsalva, which have openings to the right and left coronary arteries. Thus the heart has a decreased oxygen supply at a time when there is an increased oxygen demand. Tachycardia may also lead to ventricular dysrhythmia. The other options are incorrect.

4. Priority Decision: While teaching women about the risks and incidence of CAD, what does the nurse emphasize? a. Smoking is not as significant a risk factor for CAD in women as it is in men. b. Women seek treatment sooner than men when they have symptoms of CAD. c. Estrogen replacement therapy in postmenopausal women decreases the risk for CAD. d. CAD is the leading cause of death in women, with a higher mortality rate after MI than in men.

d. CAD is the number-one killer of American women and women have a much higher mortality rate within 1 year following MI than do men. Smoking carries specific problems for women because smoking has been linked to a decrease in estrogen levels and to early menopause and it has been identified as the most powerful contributor to CAD in women under the age of 50. Fewer women than men present with classic manifestations and women delay seeking care longer than men. Recent research indicates that estrogen replacement does not reduce the risk for CAD, even though estrogen lowers low-density lipoprotein (LDL) and raises high-density lipoprotein (HDL) cholesterol.

In a patient with a positive Chvostek's sign, the nurse would anticipate the IV administration of which medication? a. Calcitonin b. Vitamin D c. Loop diuretics d. Calcium gluconate

d. Calcium gluconate

The patient works on a computer 8 hours each day. What kind of repetitive strain injury would be expected in this patient? a. Meniscus injury c. Radial-ulnar fracture b. Rotator cuff injury d. Carpal tunnel syndrome

d. Carpal tunnel syndrome would be expected related to the continuous wrist movements. Injuries of the menisci, which are fibrocartilage in the knee, are common with athletes. Radial-ulnar fractures are seen with great force such as a car accident or a fall. Rotator cuff injuries occur with sudden adduction forces applied to the cuff while the arm is held in abduction. They are commonly seen with repetitive overhead motions.

In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system? a. Kidneys b. Cardiovascular system c. Musculoskeletal system d. Central nervous system

d. Central nervous system

14. A young patient with a fractured femur has a hip spica cast applied. While the cast is drying, what should the nurse do? a. Elevate the legs above the level of the heart for 24 hours. b. Turn the patient to both sides and prone to supine every 2 hours. c. Cover the cast with a light blanket to avoid chilling from evaporation. d. Assess the patient frequently for abdominal pain, nausea, and vomiting.

d. Complaints of abdominal pain or pressure, nausea, and vomiting are signs of cast syndrome that occur when hip spica casts or body jacket braces are applied too tightly, causing compression of the superior mesenteric artery against the duodenum. The cast may need to be split or removed and the health care provider should be notified. Elevation is not indicated for a spica cast and the patient with a spica cast should not be placed in the prone position during the initial drying stage because the cast is so large and heavy it may break. A cast should never be covered with a blanket because heat builds up in the cast and may increase edema.

29. In the patient with chest pain, which results can differentiate unstable angina from an MI? a. ECG changes present at the onset of the pain b. A chest x-ray indicating left ventricular hypertrophy c. Appearance of troponin in the blood 48 hours after the infarct d. Creatine kinase (CK)-MB enzyme elevations that peak 18 hours after the infarct

d. Creatine kinase-muscle and brain subunits band (CK- MB) is a tissue enzyme that is specific to cardiac muscle and is released into the blood when myocardial cells die. CK-MB levels begin to rise about 6 hours after an acute MI, peak in about 18 hours, and return to normal within 24 to 36 hours. This increase can identify the presence of and quantify myocardiac damage. Cardiac troponin T and troponin I are released with myocardial damage, rise as quickly as CK-MB does, and remain elevated for 2 weeks. ECG changes are often not apparent immediately after infarct and may be normal when the patient seeks medical attention. An enlarged heart, determined by x-ray, indicates cardiac stress but is not diagnostic of acute MI.

What stimulates aldosterone secretion from the adrenal cortex? a. Excessive water intake b. Increased serum osmolality c. Decreased serum potassium d. Decreased sodium and water

d. Decreased sodium and water

What test provides fast, precise measurement of the bone mass of the spine, forearm, and total body to evaluate osteoporosis? a. Bone scan c. Quantitative ultrasound (QUS) b. Diskogram d. Dual energy x-ray absorptiometry (DXA)

d. Dual energy x-ray absorptiometry (DXA) measures bone mass of spine, femur, forearm, and total body and is used to diagnose and monitor changes in bone density with treatment. Bone scan is done with the injection of a radioisotope that is taken up by the bone to identify osteomyelitis, osteoporosis, and primary and metastatic malignant lesions. A diskogram is an x-ray with contrast media to evaluate intervertebral disc abnormalities. Quantitative ultrasound (QUS) evaluates density, elasticity, and strength of bone, which is commonly assessed at the calcaneus (heel).

Which patient is at risk for hypernatremia? a. Has a deficiency of aldosterone b. Has prolonged vomiting and diarrhea c. Receives excessive IV 5% dextrose solution d. Has impaired consciousness and decreased thirst sensitivity

d. Has impaired consciousness and decreased thirst sensitivity

A patient is taking diuretic drugs that cause sodium loss from the kidney. Which fluid or electrolyte imbalance is most likely to occur in this patient? a. Hyperkalemia b. Hyponatremia c. Hypocalcemia d. Hypotonic fluid loss

d. Hypotonic fluid loss

What is the best description of the periosteum? a. Lining of a joint capsule b. A characteristic of skeletal muscle c. Most common type of cartilage tissue d. Fibrous connective tissue covering bone

d. Periosteum is the fibrous connective tissue covering bone. Synovium is the lining of a joint capsule. Striated is a characteristic of skeletal muscle. Hyaline is the most common type of cartilage.

16. Priority Decision: A patient has fallen in the bathroom of the hospital room and reports pain in the upper right arm and elbow. Before splinting the injury, the nurse knows that the priority management of a possible fracture should include which action? a. Elevation of the arm b. Application of ice to the site c. Notification of the health care provider d. Neurovascular checks below the site of the injury

d. Pulses, sensation, and motor function distal to the injury should be checked before and after splinting to assess for nerve or vascular damage and documented to avoid doubts about whether a problem discovered later was missed during the original examination or was caused by the treatment. Elevation of the limb and application of ice should be instituted after the extremity is splinted.

25. A 52-year-old man is admitted to the emergency department with severe chest pain. On what basis would the nurse suspect an MI? a. He has pale, cool, clammy skin. b. He reports nausea and vomited once at home. c. He says he is anxious and has a feeling of impending doom. d. He reports he has had no relief of the pain with rest or position change.

d. The subjective report of the pain from an MI is usually severe. It usually is unrelieved by nitroglycerin, rest, or position change and usually lasts more than the 15 or 20 minutes typical of angina pain. All of the other symptoms may occur with angina as well as with an MI.

The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to a. apply warm moist compresses to the insertion site. b. attempt to force 10 mL of normal saline into the device. c. place the patient on the left side with head-down position. d. instruct the patient to change positions, raise arm, and cough.

d. instruct the patient to change positions, raise arm, and cough.

. A patient has the following arterial blood gas results: pH 7.52; PaCO2 30 mm Hg; HCO3− 24 mEq/L. The nurse determines that these results indicate a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis

d. respiratory alkalosis

During the postoperative care of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because a. older adults have an impaired thirst mechanism and need reminding to drink fluids. b. water accounts for a greater percentage of body weight in the older adult than in younger adults. c. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures. d. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults.

d. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults.