AH Exam 4 Active Learning Notes/Questions
Pt has compartment syndrome. What do you assess first?
6 P's: pain, pallor, poikilothermia, pulselessness, paresthesia, paralysis
A 22-yr-old patient tells the nurse at the health clinic that he has recently had problems with erectile dysfunction. Which question should the nurse ask to assess for possible etiologic factors in this age group? A. "Do you use recreational drugs or drink alcohol?" B. "Do you experience an unusual amount of stress? C. "Do you have cardiovascular or peripheral vascular disease?" D. "Do you have a history of an erection that lasted for 6 hours or more?"
A. "Do you use recreational drugs or drink alcohol?"
Several patients call the urology clinic requesting appointments with the health care provider as soon as possible. Which patient will the nurse schedule to be seen first? A. A 22-yr-old patient who has noticed a firm, non-tender lump on his scrotum B. A 25-yr-old patient who is concerned that his scrotum "feels like a bag of worms" C. A 40-yr-old patient who has pelvic pain while being treated for chronic prostatitis D. A 70-yr-old patient who is reporting frequent urinary dribbling after a prostatectomy
A. A 22-yr-old patient who has noticed a firm, non-tender lump on his scrotum
Which clients is/are at high risk for chronic low back pain? (Select all that apply.) A. A 63 year old male who is a long-distance truck driver B. A 30 year old nurse who works on an orthopedic unit and smokes C. A 55 year old construction worker who is 62" and weighs 250 lbs. D. A 44 year old female chef with prior compression fracture of the spine E. A 28 year old yoga instructor who is 56" and weighs 130lb
A. A 63 year old male who is a long-distance truck driver B. A 30 year old nurse who works on an orthopedic unit and smokes C. A 55 year old construction worker who is 62" and weighs 250 lbs. D. A 44 year old female chef with prior compression fracture of the spine
A nurse in a clinic is talking with a client who has a new diagnosis of osteoarthritis. The nurse should anticipate that the client will require teaching about which of the following medications? A. Acetaminophen B. Celecoxib C. Cyclobenzaprine D. Ibuprofen
A. Acetaminophen
A client has a severely sprained ankle from a sports injury. What should the nurse teach the client prior to discharge from the urgent care center? A. Alternate cold and heat for 30 minutes each until symptoms are relieved. B. Apply cold for 20 to 30 minutes with breaks of 10 to 15 minutes during the first 2 days. C. Use continuous cold for the first 24 hours and then continuous heat until the symptoms are relieved. D. Apply continuous heat to the ankle for the first 24 hours and then continuous cold until the symptoms are relieved.
A. Alternate cold and heat for 30 minutes each until symptoms are relieved.
The primary nursing intervention that will control swelling while treating a musculoskeletal injury is (SATA): A. Apply cold (moist or dry). B. Immobilize the injured area. C. Elevate the affected area. D. Apply an elastic compression bandage.
A. Apply cold (moist or dry). B. Immobilize the injured area. C. Elevate the affected area. D. Apply an elastic compression bandage.
Which information about continuous bladder irrigation will the nurse teach to a patient who is being admitted for a transurethral resection of the prostate (TURP)? A. Bladder irrigation decreases the risk of postoperative bleeding. B. Hydration and urine output are maintained by bladder irrigation. C. Antibiotics are infused continuously through the bladder irrigation. D. Bladder irrigation prevents obstruction of the catheter after surgery.
A. Bladder irrigation decreases the risk of postoperative bleeding.
A client with a pelvic fracture should be monitored for: A. Change in urine output B. Petechiae on the abdomen C. A palpable lump in the buttock D. Sudden increase in blood pressure
A. Change in urine output
A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan? (Select all that apply) A. Cook food thoroughly before eating. B. Choose low fiber, low residue foods. C. Avoid public transportation such as buses. D. Use rectal suppositories if needed for constipation. E. Talk to the oncologist before having any dental work
A. Cook food thoroughly before eating. B. Choose low fiber, low residue foods. C. Avoid public transportation such as buses. E. Talk to the oncologist before having any dental work
The nurse is caring for a patient who is receiving antiretroviral therapy for treatment of HIV infection. Which assessment best indicates that the patient's condition is improving? A. Decreased viral load B. Increased drug resistance C. Decreased CD4 T cell count D. Increased aminotransferase
A. Decreased viral load
A 51-yr-old patient with a small immobile breast lump is considering having a fine-needle aspiration (FIA) biopsy. What should the nurse explain as an advantage to this procedure? A. FNA is done in the outpatient clinic, and results are available in 1 to 2 days. B. Only a small incision is needed, resulting in minimal breast pain and scarring C. If the biopsy results are negative, no further diagnostic testing will be needed. D. FNA is guided by a mammogram, ensuring that cells are taken from the lesion
A. FNA is done in the outpatient clinic, and results are available in 1 to 2 days.
A client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which nursing interventions would be appropriate for the prophylactic treatment of deep vein thrombosis? Select all that apply. A. Increase fluid intake B. Maintaining antiembolic stockings C. Administering enoxaparin D. Encourage coughing exercises E. Increase fiber intake
A. Increase fluid intake B. Maintaining antiembolic stockings C. Administering enoxaparin
Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma? A. Monitor fluid intake and output. B. Administer calcium supplements C. Assess lymph nodes for enlargement. D. Limit weight bearing and ambulation.
A. Monitor fluid intake and output.
A client is diagnosed with several fractured ribs. after a motor vehicle crash. Which actions will the nurse take when caring for this client? Select all that apply. A. Provide analgesics as prescribed. B. Apply a chest binder as prescribed. C. Instruct on the use of an incentive spirometer. D. Demonstrate the use of a pillow to splint the area. E. Remind to take deep breaths and cough ever hour.
A. Provide analgesics as prescribed. C. Instruct on the use of an incentive spirometer. D. Demonstrate the use of a pillow to splint the area. E. Remind to take deep breaths and cough ever hour.
Which topic will the nurse include in the preoperative teaching for a patient admitted for an abdominal hysterectomy? Select all that apply. A. Purpose of ambulation and leg exercises B. Adverse effects of systemic chemotherapy C. Decrease in vaginal sensation after surgery D. Symptoms caused by the drop in estrogen level
A. Purpose of ambulation and leg exercises D. Symptoms caused by the drop in estrogen level
A nurse plans a community education program related to prevention of cancer with the highest death rates in both women and men. What should the nurse include in the teaching plan? A. Smoking cessation B. Screening with colonoscopy C. Regular examination of reproductive organs D. Use of sunscreen as protection from ultraviolet light
A. Smoking cessation
Which action should the nurse take when caring for a patient who is receiving chemotherapy and reports problems with concentration? A. Suggest use of a daily planner and encourage adequate sleep. B. Teach the patient to rest the brain by avoiding new activities. C. Teach that "chemo-brain" is a short-term effect of chemotherapy. D. Report patient symptoms immediately to the health care provider.
A. Suggest use of a daily planner and encourage adequate sleep.
Which action should the nurse take when a 35-yr-old patient whose repeat cervical Pap test was abnormal? A. Teach the patient about colposcopy. B. Teach the patient about endometrial biopsy. C. Prepare the patient for a dilatation and curettage (D&C) D. Administer 3 doses of human papillomavirus (HPV) vaccine.
A. Teach the patient about colposcopy.
A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor? A. The client has a 30 pack-year smoking history. B. The client's body mass index is 34 (obese). C. The client has primary hypertension. D. The client is 58 years old.
A. The client has a 30 pack-year smoking history.
A patient diagnosed with breast cancer asks the nurse what "triple negative" means. What should an accurate response from the nurse about triple-negative breast cancer include? A. The tumor is not likely to be responsive to hormone therapy. B. Treatment with chemotherapy is not likely to be recommended. C. HER-2 receptor testing was repeated for a total of three samples. D. Estrogen receptor testing identified three hormones causing the cance
A. The tumor is not likely to be responsive to hormone therapy.
A complication of Buck's traction wound be noted by the nurse if: A. Toes of the affected leg become dusky in color B. Redness and purulent drainage appear at the pin site C. Skin over the fracture site was flushed. D. Dorsiflexion developed in the affected foot
A. Toes of the affected leg become dusky in color
A patient is on the surgical unit after a total abdominal hysterectomy. Which finding requires contacting the health care provider? A. Urine output of 125 mL in the first 8 hours after surgery B. Decreased bowel sounds in all four abdominal quadrants C. Report of abdominal pain at the incision site with coughing D. One-inch area of bloody drainage on the abdominal dressing
A. Urine output of 125 mL in the first 8 hours after surgery
A continuous passive motion (CPM machine is used to pror healing and flexibility in the knee and hip joint and increase circulation to the operative area. What is true about the use of CPM? Select all that apply. A. the physician orders the amount of extension and flexion produced by the machine. B. The physician orders the frequency of use of the machine. C. A polar ice unit should not be used at the same time as the PM amount of flexion for clients with hip replacements st exceed 60 degrees in the PM machine D. The amount of flexion for clients with hip replacements should never exceed 60 degrees in the CPM machine
A. the physician orders the amount of extension and flexion produced by the machine. B. The physician orders the frequency of use of the machine.
W.B. is scheduled for a TURP. When you assesses his knowledge of the procedure and its effects, you realize he needs further teaching when he says, A. "It is possible that I'll be sterile following this procedure. B. "It is likely that I will become impotent from this procedure. C. "I understand that some retrograde ejaculation may occur" D. "I will have a catheter for a couple of days to keep my urinary system open
B. "It is likely that I will become impotent from this procedure.
20. A client with osteomyelitis undergoes surgical debridement with implantation of antibiotic beads. When the client asks why the beads are used, the nurse answers. A. "Oral or IV antibiotics are not effective in most cases of bone infection. B. "The beads are an adjunct to debridement and antibiotics for deep infections C. "The beads are used to deliver antibiotics directly to the site of the infection D. "This is the safest method to deliver long term antibiotic therapy for bone infection." E. "Ischemia and bone death related to osteomyelitis are impenetrable to IV antibiotics.
B. "The beads are an adjunct to debridement and antibiotics for deep infections
A widowed mother of 4 school-age children is hospitalized with metastatic ovarian cancer. The patient is crying and tells the nurse that she does not know what will happen to her children when she dies. Which response by the nurse is most appropriate? A. "Don't you have any friends that will raise the children for you?" B. "Would you like to talk about options for the care of your children?" C. "For now you need to concentrate on getting well and not worrying about your children." D. "Many patients with cancer live for a long time, so there is time to plan for your children."
B. "Would you like to talk about options for the care of your children?"
The nurse is assessing a client's upper extremities for strength. The client is able to lift both arms by herself but is unable to hold her arms up when the nurse pushes against her. How would the nurse document this? A. ⅖ B. ⅗ C. ⅘ D. 1/5
B. 3/5
Which assessment finding in a 36-yr-old patient is most indicative of a need for further evaluation? A. Bilateral breast nodules that are tender with palpation. B. A breast nodule that is 1 cm in size, nontender, and fixed. C. A breast lump that increases in size before the menstrual period. D. A breast lump that is small and mobile, with a rubbery consistency
B. A breast nodule that is 1 cm in size, nontender, and fixed.
The nurse informs the patient with a bacterial pneumonia that the most important factor in antibiotic treatment is: A. Antibiotics should have been used to prevent pneumonia B. All of the supplied antibiotics should be taken even when symptoms have stopped C. Stop antibiotics when symptoms stop, even when you have meds left over D. Patients should get antibiotics for any infection to prevent streptococcal diseases
B. All of the supplied antibiotics should be taken even when symptoms have stopped
A 27-yr-old patient who has testicular cancer is being admitted for a unilateral orchiectomy. The patient does not talk to his wife and speaks to the nurse only to answer the admission questions. Which action is appropriate for the nurse to take? A. Teach the patient and the wife that impotence is unlikely after unilateral orchiectomy. B. Ask the patient if he has any questions or concerns about the diagnosis and treatment. C. Inform the patient's wife that concerns about sexual function are common with this diagnosis. D. Document the patient's lack of communication on the health record and continue preoperative care.
B. Ask the patient if he has any questions or concerns about the diagnosis and treatment.
A patient who is being treated for stage IV lung cancer tells the nurse about new-onset back pain. Which action should the nurse take first? A. Give the patient the prescribed PRN opioid. B. Assess for sensation and strength in the legs. C. Notify the health care provider about the symptoms. D. Teach the patient how to use relaxation to reduce pain.
B. Assess for sensation and strength in the legs.
Which action will the nurse include in the plan of care for a patient with right arm lymphedema? A. Avoid isometric exercise on the right arm. B. Assist with application of a compression sleeve. C. Keep the right arm at or below the level of the heart. D. Check blood pressure (BP) on both right and left arms.
B. Assist with application of a compression sleeve.
A routine complete blood count for an active older man indicates possible myelodysplastic syndrome. What should the nurse plan to explain to the patient? A. Blood transfusion B. Bone marrow biopsy C. Filgrastim administration D. Erythropoietin administration
B. Bone marrow biopsy
Which action will the admitting nurse include in the care plan for a patient who has neutropenia? A. Avoid intramuscular injections. B. Check temperature every 4 hours. C. Place a "No Visitors" sign on the door. D. Omit fruits and vegetables from the diet.
B. Check temperature every 4 hours.
A patient with a large stomach tumor attached to the liver is scheduled for a debulking procedure. What should the nurse teach the patient about the outcome of this procedure? A. Pain will be relieved by cutting sensory nerves in the stomach. B. Decreasing the tumor size will improve the effects of other therapy. C. Relieving the pressure in the stomach will promote optimal nutrition. D. Tumor growth will be controlled by removing all the cancerous tissue
B. Decreasing the tumor size will improve the effects of other therapy.
What will the nurse plan to teach the patient who is incontinent of urine following a radical retropubic prostatectomy? A. Restrict oral fluid intake. B. Do pelvic muscle exercises. C. Perform intermittent self-catheterization. D. Use belladonna and opium suppositories.
B. Do pelvic muscle exercises.
To help minimize calcium loss from a hospitalized client's bones, the nurse should: A. Reposition the client every 2 hours. B. Encourage the patient to ambulate in the hall C. Provide the client dairy products at frequent intervals. D. Provide supplemental feedings between meals
B. Encourage the patient to ambulate in the hall
To prevent the debilitating cycle of fatigue-depression-fatigue that can occur in patients with cancer, an appropriate nursing intervention is to: A. Have the patient rest after expending any major energy B. Encourage the patient to implement a daily walking program C. Teach the patient to ignore the fatigue to maintain normal daily activities D. Prevent depression by informing the patient to expect fatigue during cancer treatment
B. Encourage the patient to implement a daily walking program
A patient with leukemia is considering whether to have hematopoietic stem cell transplantation (HSCT). Which information should the nurse include in the patient's teaching plan? A. Donor bone marrow is transplanted through a sternal or hip incision. B. Hospitalization is required for several weeks after the stem cell transplant. C. The transplant procedure takes place in a sterile operating room to decrease the risk for infection. D. Transplant of the donated cells can be very painful because of the nerves in the tissue lining the bone.
B. Hospitalization is required for several weeks after the stem cell transplant.
An 80 year old client has an accidental fall while going to the bathroom without assistance. The leg is deformed and the client is unable to move it. The client is alert and oriented but in pain. What will you do FIRST after confirming the client is safe and stable? A. Apply an ice pack covered with a towel to the site. B. Immobilize the fracture with a splint. C. Administer pain medication. D. Elevate the extremity above heart level.
B. Immobilize the fracture with a splint.
The nurse is screening a client for genetic counseling. What musculoskeletal conditions does the nurse know to have a genetic influence? Select all that apply. A. Osteoarthritis B. Marfan's syndrome C. Stickler's syndrome D. Osteoporosis E. Diabetes Mellitis
B. Marfan's syndrome C. Stickler's syndrome
L.G., a 23-year-old man, is brought to ED following injury to his right arm during a rugby game. He complains of severe 10/10 right shoulder pain, nausea, and numbness and tingling in his right hand fingertips. The nurse's next action is to: A. Administer PRN Morphine as ordered. B. Palpate brachial and radial pulses. C. Prepare the patient for x-ray. D. Assess the client's range of motion.
B. Palpate brachial and radial pulses.
A healthy 24-yr-old patient who has been vaccinated against human papillomavirus (HPV) has a normal Pap test result. Which information will the nurse include in patient teaching when calling the patient with the results of the Pap test? A. You can wait until after age 30 before having another Pap test B. Pap testing is recommended every 3 years for women your age. C. No further Pap testing is needed until you decide to become pregnant. D. Yearly Pap testing is suggested for women with multiple sexual partners.
B. Pap testing is recommended every 3 years for women your age.
What topic should the nurse plan to teach a 26-yr-old patient who has been treated for pelvic inflammatory disease? A. Use of hormone therapy (HT) B. Potential complication of infertility C. Irregularities in the menstrual cycle D. Changes in secondary sex characteristics
B. Potential complication of infertility
The nurse notes bilateral enlargement of the breasts during examination of a 62-yr-old male patient. Which action should the nurse take first? A. Refer the patient for mammography. B. Question the patient about current medications. C. Explain that this is temporary due to hormonal changes. D. Teach the patient how to palpate the breast tissue for lumps.
B. Question the patient about current medications.
Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? A. Patient reports severe back pain. B. Serum calcium level is 15 mg/dL. C. Patient reports no stool for 5 days. D. Urine sample has Bence-Jones protein.
B. Serum calcium level is 15 mg/dL.
After a 48-yr-old patient has had a modified radical mastectomy, the pathology report identifies the tumor as an estrogen-receptor positive adenocarcinoma. What topic should the nurse plan to teach the patient? A. Estradiol B. Tamoxifen C. Raloxifene D. Trastuzumab
B. Tamoxifen
Which information will the nurse plan to include when teaching a young adult who has a family history of testicular cancer about testicular self-examination? A. Testicular self-examination should be done at least weekly. B. Testicular self-examination should be done in a warm room. C. The only structure normally felt in the scrotal sac is the testis. D. Call the health care provider if one testis is larger than the other.
B. Testicular self-examination should be done in a warm room.
In caring for a client after spinal fusion, the nurse would report which finding to the health care provider? A. The client has a single episode of emesis. B. The client is unable to move the lower extremities C. The client is nauseated and has not voided in 4 hours D. The client reports pain at the bone graft donor site
B. The client is unable to move the lower extremities
Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the health care provider? A. Bruises on the patient's back. B. The patient is difficult to arouse. C. Purpura on the patient's oral mucosa. D. The patient's platelet count is 52,000/ML.
B. The patient is difficult to arouse.
A nurse is preparing to transduse a unit of packed RBCs for a client who has sever anemia. The nurse should identify that which of the following interventions will help prevent an acute hemolytic reaction? A. Ensures that the client has a patent IV line B. Verifies with another nurse that the client and blood product match the client's ID band for blood components as well as the blood ID information in their chart C. Takes a complete set of VS before beginning transfusion and periodically during it D. Stays with the client for the first 15-30 minutes minutes of the transfusion
B. Verifies with another nurse that the client and blood product match the client's ID band for blood components as well as the blood ID information in their chart
A 58-yr-old patient is on the medical-surgical unit after undergoing a radical vulvectomy for vulvar carcinoma. What is the greatest risk to the patient at this time? A. Self-care deficit B. Wound infection C. Inadequate nutrition D. Ineffective sexual patternV
B. Wound infection
Alendronate (Fosamax) is prescribed for a patient with osteoporosis. The nurse teaches the patient that: A. The drug must be taken with food to prevent Gl side effects. B. bisphosphonates prevent calcium from being taken from the bones. C. lying down after taking the drug prevents light-headedness and dizziness. D. taking the drug with milk enhances the absorption of calcium from the bowel.
B. bisphosphonates prevent calcium from being taken from the bones
How do you diagnose a person with cancer?
BIOPSY → required for treatment plan and dx
Screenings for cancers?
Breast cancer: mammogram (begin at 40, once a year until they hit 60, more than once a year) Colon: colonoscopy (begin at 40) High risk for colon cancer: modern-day diets, increase in incidence (because of processed foods) Prostate:PSA...can be wrong, DRE is used High risk groups for prostate CA: age, AA, relatives, BRCA + mutation Cervical: pap smear (begin at 21 or when you become sexually active...then do every three years) Risk for cervical cancer decreases as you age Extra estrogen = higher risk for cancer (late menarchy or menopause; no pregnancies; fertility tx) Skin cancer - skin screenings Lung cancer Highest mortality → most found at late stage Low dose CT scans → pts who meet certain requirements can be screened yearly (15 PPD, age, etc.)
Know Buck's Traction and why is it used?
Buck traction is used for: Fracture: Any type of break in a bone. Traction: Traction is the application of a pulling force to an injured part of the body or extremity. Skin traction (bucks traction): Skin traction is applied by strapping the patient's affected lower limb and attaching weights.
The nurse determines that teaching about management of osteoarthritis of the feet and hands has been effective when the client says: A. "I will be careful to avoid crowds and people with infections." B. "I can use heat to relieve the stiffness when I wake up in the morning." C. "I should exercise my hands every day, especially if they are painful and inflamed." D. "I should avoid the use of glucosamine as it has been shown to have no therapeutic value."
C. "I should exercise my hands every day, especially if they are painful and inflamed."
A client is receiving IN antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the client should indicate to the nurse the need for additional teaching related to health maintenance? A. "I'm frustrated with this endless treatment! B. "I will take my oral temperature twice a day." C. "I think my left foot is starting to droop down." D. "I use crutches to avoid weight bearing on the left leg."
C. "I think my left foot is starting to droop down."
A patient who is scheduled for a breast biopsy asks the nurse the difference between a benign tumor and a malignant tumor. Which answer by the nurse is accurate? A. "Benign tumors do not cause damage to other tissues." B. "Benign tumors are likely to recur in the same location." C. "Malignant tumors may spread to other tissues or organs." D. "Malignant cells reproduce more rapidly than normal cells."
C. "Malignant tumors may spread to other tissues or organs."
A 58-yr-old woman tells the nurse, "I understand that I have stage 2 breast cancer and I need to decide on a surgery, but I feel overwhelmed. What do you think I should do?" Which response by the nurse is best? A. "I would have a lumpectomy, but you need to decide what is best for you" B. "It would not be appropriate for me to make a decision about your health." C. "Tell me what you understand about the surgical options that are available." D. "There is no need to make a decision rapidly; you have time to think about this."
C. "Tell me what you understand about the surgical options that are available."
After receiving change-of-shift report for several patients with neutropenia, which patient should the nurse assess first? A. A 23-yr-old who reports severe fatigue B. A 56-yr-old with frequent explosive diarrhea C. A 33-yr-old with a fever of 100.8° F (38.2° C) D. A 66-yr-old who has white pharyngeal lesions
C. A 33-yr-old with a fever of 100.8° F (38.2° C)
Etanercept (Enbrel) is prescribed for a patient with stage ll rheumatoid arthritis. The nurse determines that the medication is effective if what is observed? A. Decreased lymphocyte count B. Absence of Rh factor in the blood C. Decreased C. reactive protein (CRP) (CRP is an inflammatory marker) D. Increased serum immunoglobulin G
C. Decreased C. reactive protein (CRP) (CRP is an inflammatory marker)
The nurse suspects a neurovascular problem based on assessment of: A. Exaggerated strength with movement B. Increased redness and heat below the injury C. Decreased sensation distal to the fracture site D. Purulent drainage at the site of an open fracture
C. Decreased sensation distal to the fracture site
A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client? Select all that apply. A. Systemic infection B. Complex regional pain syndrome C. Deep vein thrombosis D. Fat Embolism E. Compartment syndrome
C. Deep vein thrombosis D. Fat Embolism E. Compartment syndrome
The client is being evaluated for osteoporosis Which diagnostic test is the most accurate when diagnosing osteoporosis? A. X-ray of the femur B. Serum alkaline phosphatase C. Dual-energy x-ray absorptiometry (DEXA) D. Serum bone Gla-protein test
C. Dual-energy x-ray absorptiometry (DEXA)
What will the nurse ask the patient about to determine the severity of benign prostatic hyperplasia (PH) symptoms? A. Blood in the urine B. Lower back or hip pain C. Force of urinary stream → shows if there is a problem evacuating bladder D. Erectile dysfunction (ED)
C. Force of urinary stream → shows if there is a problem evacuating bladder
A nurse is assessing an older adult client who has osteoporosis. Which of the following spinal deformities should the nurse expect to find in this client? A. Lordosis B. Ankylosis C. Kyphosis D. Scoliosis
C. Kyphosis
A client has undergone a lumbar laminectomy and has just returned to the nursing unit. Itis essential for the nurse to perform which of the following activities during this period? A. Assessment of bladder function B. Early ambulation C. Neurovascular checks D. Vital sign checks every half hour
C. Neurovascular checks
A client with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when: A. The patient is unable to tolerate prolonged immobilization B. The client cannot tolerate the surgery for a closed reduction C. Other nonsurgical methods cannot achieve adequate alignment D. A temporary cast would be too unstable to provide normal mobility
C. Other nonsurgical methods cannot achieve adequate alignment
After a change-of-shift report on the oncology unit, which patient should the nurse assess first? A. Patient who has a platelet count of 82,000/L after chemotherapy. B. Patient who has xerostomia after receiving head and neck radiation. C. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C). D. Patient who is worried about getting the prescribed long-acting opioid on time.
C. Patient who is neutropenic and has a temperature of 100.5° F (38.1° C).
Which nursing action should be included in the plan of care for a patient returning to the surgical unit after a left modified radical mastectomy with dissection of axillary lymph nodes? A. Teach the patient to use the ordered patient-controlled analgesia every 10 minutes. B. Obtain a permanent breast prosthesis before the patient is discharged from the hospital. C. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm. D. Insist that the patient examine the surgical incision when the initial dressings are removed.
C. Post a sign at the bedside warning against venipunctures or blood pressures in the left arm.
A nurse is planning an educational session about HIV for newly liscenced nurses. Which of the following info should the nurse include about HIV transmission? A. primarily transmitted through casual contact B. Primarily transmitted through a wound caused by an accident. C. Primarily transmitted through direct contact with infected body fluids D. Primarily transmitted through eating raw meat
C. Primarily transmitted through direct contact with infected body fluids
A client who has been working as a grocery store clerk for a year develops gradual pain, inflammation, and weakness in the left hand and elbow. What would the nurse attribute these symptoms to? A. Muscle spams B. Degenerative arthritis C. Repetitive strain injury D. Meniscus injury
C. Repetitive strain injury
The nurse is caring for a patient with left-sided lung cancer. Which finding would be most important for the nurse to report to the health care provider? A. Hematocrit of 32% B. Pain with deep inspiration C. Serum sodium of 126 mEg/L D. Decreased breath sounds on left side
C. Serum sodium of 126 mEg/L
A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. A. Surgery will not be required. B. Muscle spasms will be relieved. C. The bones of the left leg will be aligned. D. Immobilization of the left leg will be maintained. E. Less pain medication will be required.
C. The bones of the left leg will be aligned. D. Immobilization of the left leg will be maintained.
The nurse is caring for a patient with breast cancer who is receiving chemotherapy with doxorubicin and cyclophosphamide. Which assessment finding is most important to communicate to the health care provider? A. The patient reports fatigue B. The patient eats only 25% of meals C. The patient's apical pulse is irregular D. The patient's white blood cell count is 5000/kL.
C. The patient's apical pulse is irregular
What precautions/testing need to be taken before administering chemotherapy?
CBC and blood chem, pregnancy, thyroid levels, echocardiograms, PFT's
Phalen and Tinel's sign?
Carpal tunnel indicator Press on the nerve - the pt has numbness and tingling in their thumb and index finger
A patient undergoing external radiation has developed a dry desquamation of the skin in the treatment area. The nurse teaches the patient about the management of the skin reaction. Which statement, if made by the patient, indicates the teaching was effective? A. "I can use ice packs to relieve itching. B. "I will scrub the area with warm water. C. "I will expose my skin to a sun lamp each day." D. " I can buy some aloe vera gel to use on my skin."
D. "I can buy some aloe vera gel to use on my skin." *If a pt is receiving radiation therapy, you want to avoid any temperature extremes, tight clothes, or any other things that will irritate the skin
A nurse is teaching a patient about preventing osteoporosis. Which statement lets the nurse know that the pt requires further teaching? A. "I will reduce my intake of sodium." B. "I will decrease my intake of caffeine." C. "I will limit my intake of soft drinks." D. "I will reduce my intake of vitamin K-rich foods."
D. "I will reduce my intake of vitamin K-rich foods."
31. A client with a total hip replacement has developed decreased breath sounds. What is the nurse's best action? A. Put the client on bedrest B. Request an antitussive medication from the health care provider. C. Encourage use of the incentive spirometer. D. Assess for signs and symptoms of systemic infection.
D. Assess for signs and symptoms of systemic infection.
A client is scheduled for a total ankle replacement. The nurse should tell the client that after surgery, he should avoid: A. Lifting heavy objects B. Sleeping on the back C. Abduction exercises of the affected ankle D. Bearing weight on the affected leg for 6 weeks
D. Bearing weight on the affected leg for 6 weeks
A nurse is completing discharge teaching with a client following arthroscopic knee surgery. Which of the following instructions should the nurse include in the teaching? A. Remain on bedrest for the first 24 hours. B. Keep the leg in a dependent position. C. Apply ice to the affected area D. Begin active range of motion.
D. Begin active range of motion.
A nurse is caring for a client who has an increased white blood cell count. Which of the following medications can result in an increased WBC count? A. Diuretics B. Antibiotics C. Histamine 2 blockers D. Corticosteroids
D. Corticosteroids
After 3 weeks of radiation therapy and chemotherapy, H.J. tells you he wants to stop treatment because he wants to have children someday. What is your best response? A. There is no need to worry as the testes are not sensitive to radiation. B. Reproduction is not a priority at this important time in your treatment. C. The combination of radiation and chemotherapy reduce the chances of developing side effects. D. Low sperm counts and loss of motility are often seen with testicular cancer before therapy is begun.
D. Low sperm counts and loss of motility are often seen with testicular cancer before therapy is begun.
Following successful treatment of Hodgkin's lymphoma for a 55-yr-old woman, which topic will the nurse include in patient teaching? A. Potential impact of chemotherapy treatment on fertility B. Application of soothing lotions to treat residual pruritus C. Use of maintenance chemotherapy to maintain remission D. Need for follow-up appointments to screen for malignancy
D. Need for follow-up appointments to screen for malignancy
A diagnosis of AIDS can be made for a patient with HIV with: A. A WBC count less than 3000/mL B. A CD4 T cell count less than 500/mL C. Development of oral candidas (thrust) D. Onset of pneumocystis jirovec/pneumonia
D. Onset of pneumocystis jirovec/pneumonia
When caring for a patient with continuous bladder irrigation after having transurethral resection of the prostate, which action could the nurse delegate to unlicensed assistive personnel (UAP)? A. Teach the patient how to perform Kegel exercises. B. Monitor for increases in bleeding or presence of clots. C. Increase the flowrate of the irrigation if clots are noted. D. Report any patient reports of pain or spasms
D. Report any patient reports of pain or spasms
A patient receiving head and neck radiation for larynx cancer has ulcerations over the oral mucosa and tongue and thick, ropey saliva (xerostomia). Which instructions should the nurse give to this patient? A. Remove food debris from the teeth and oral mucosa with a stiff toothbrush. B. Use cotton-tipped applicators dipped in hydrogen peroxide to clean the teeth. C. Gargle and rinse the mouth several times a day with an antiseptic mouthwash. D. Rinse the mouth before and after each meal and at bedtime with a saline solution.
D. Rinse the mouth before and after each meal and at bedtime with a saline solution.
A patient who has been diagnosed with stage 2 prostate cancer chooses the option of active surveillance. What should the nurse plan to do? A. Vaccinate the patient with sipuleucel-T (Provenge). B. Provide the patient with information about cryotherapy. C. Teach the patient about placement of intraurethral stents. D. Schedule the patient for annual prostate-specific antigen testing.
D. Schedule the patient for annual prostate-specific antigen testing.
A client has bilateral knee pain from osteoarthritis. In addition to taking the prescribed NSAID, the nurse should instruct the client to: A. Avoid foods high in citrus acid B. Keep legs elevated when sitting C. Rest the knees as much as possible to decrease inflammation D. Start a regular exercise program
D. Start a regular exercise program
What will the nurse teach a patient with metastatic breast cancer who has a new prescription for trastuzumab? A. Hot flashes may occur with the medication. B. Serum electrolyte levels will be drawn monthly. C. The patient will need frequent eye examinations. D. The patient should call if she notices ankle swelling
D. The patient should call if she notices ankle swelling
A patient has possible right carpal tunnel syndrome. What symptom should the nurse expect with a positive Tinel's sign? 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. Tingling in the right thumb and index finger
A patient who has a large cystocele was admitted 10 hours ago but has not yet voided. If the patient reports no urge to void, which action should the nurse take first? A. Insert a straight catheter per the PRN order. B. Encourage the patient to increase oral fluids. C. Notify the health care provider of the inability to void. D. Use a bladder scanner to check for urinary retention.
D. Use a bladder scanner to check for urinary retention.
A plaster splint is applied with an elastic bandage to the leg of a patient with a fractured tibia in preparation for open reduction and internal fixation. The patient complains of increasing pain in the affected leg and foot that is not relieved by loosening of the elastic bandage. The most appropriate action by the nurse is to: A. elevate the leg on two pillows. B. apply ice over the fracture site. C. notify the health care provider. D. perform neurovascular assessment of the foot.
D. perform neurovascular assessment of the foot.
How do we treat osteoporosis?
Diet, exercise, medications Once you have it, it is a slow progressive decline - learning how to manage
How do you know if a post surgical joint is infected?
Fever, increase in WBC, swelling, redness, heat at the site/warm to touch
External fixators?
Help heal long bones (like the pelvis)
Oncologic emergencies:
ICP Obstruction → can have an obstruction of anything (ex: gallbladder, bladder, intestine, etc.) Pt will become NPO, NG tube, ostomy Hypercalcemia Myeloma, metastasis to bone Fluids and phosphonates Superior Vena Cava Syndrome Compression of SVC Pt will experience redness superior to the SVC, swelling, blood clots, and possible organ necrosis due to circulation impairment
What are methods of treating cancer?
Immunotherapy, chemotherapy, radiation, surgery, antihormone therapy
What are the SE of radiation? How do these SE vary based on the location of the cancer?
Impaired skin integrity Swelling Side effects are dependent upon where the treatment of cancer is (ex: if you have cancer in the throat, it will affect the airway/swallowing) (ex: if you have rectal cancer, it will affect the ability to use the bathroom) infection** → sepsis (skin breakdown leads to open areas which allow bacteria to enter etc.) More common with rectal/cervical cancer 100.4 temp CA = EMERGENCY → blood cultures and start antibiotics immediately
What are methods of preventing cancer?
Lifestyle changes (diet, cigarette use), exercise, sunscreen, limit alcohol intake, healthy sleep (preventing fatigue)
How do we treat osteomyelitis?
Most likely caused by MRSA Vancomycin in the hospital, Bactrim or doxycycline at home
What are expected side effects of chemotherapy? How do they vary based on methods of administration
N/V Fatigue Bone marrow suppression Alopecia GI problems (ulcerations) Side effects depend on how the medication is administered (ex: If given intrathecally, the pt may not experience as much N&V...b/c of BBB)
Osteoarthritis S/S
Not always symmetrical, not an immune disorder, cartilage degeneration/joint degeneration, Heberdens and Bouchard's nodes found in the nodes
Tumor markers: What is the purpose?
One purpose is to identify whether or not treatment is effective for that tumor See what new treatment needs to be done, shift plans Test for breast cancer tumors to see if it is triple positive: estrogen receptor (ER), progesterone receptor (PR), and a receptor called HER2. Triple pos = all of them Triple neg = none are present, most aggressive with higher incidence Lung cancer to see if it is EJFR positive or negative - what type of treatment the pt needs Does not diagnose Determine treatment plan
What are side effects of immunotherapy or targeted therapy?
Only targeting the bad cells (chemo targets all cells) Flu-like symptoms can occur(think immune system in hyperdrive)
What is ORIF?
Open reduction internal fixation (think plates and screws)
What are our key nursing interventions for vertebral disc surgery?
Pain control Monitor CSF leakage Maintain proper alignment of spine until healed Log roll when changing positions
How do you know if someone has developed a pulmonary embolism?
S/S: SOB, tachycardia, chest pain
What can hinder bone healing?
Smoking Weight bearing too soon Medical conditions - ex: diabetes, vascular disease Some medication such as corticosteroids and other immunosuppressants Severe fractures - possible infection that occurs Advanced age Poor nutrition or impaired metabolism
Rheumatoid Arthritis S/S
Symmetrical presentation, autoimmune, joint inflammation, Sjorgens, myositis, Reynauds, carpal tunnel, morning stiffness that lasts >30 minutes Labs: CRP, RF, anti-CCP, ESR, ANA
TNM staging→
T- size of tumor (4 is the largest) N- nodes (0: not found in any lymph nodes, 1: 1 set of lymph nodes, 2: moved to other sets) M - metastases to solid organ M0→ hasn't metastasized past lymph nodes M1→ stage 4 C; spread outside original origin to another location; very difficult to tx
What TNM staging has the worst prognosis?
T4 N2 M1
What can you tell her about the dx of ovarian cancer?
The older you get, the more at risk for ovarian cancer, never being pregnant is a risk factor (higher exposure to estrogen), usually dx at a late stage
T/F: Staph is the most common cause of post op infections with patients who have "hardware" in them due to surgery
True
What are the warning signs of cancer?
Unexplained weight loss, fatigue, blood in stool/urine, spontaneous bleeds without trauma, abnormal skin growths (moles), lymph nodes (non mobile/ non tender), nagging cough, new "lumps and bumps"
How is log rolling supposed to go?
When log rolling, you need at least 3 people (head/torso/feet) Person in charge is the person at the head Everyone moves in unison
Petechiae is ......
bleeding / blood vessels popping
Saddle paresthesia and incontinence is ....
cauda equine syndrome
Methotrexate and DMARDs .....
given to pts with rheumatoid arthritis
Arthroplasty→
greatest risk for infection (staph)
Dowager's hump is ....
kyphosis (related to osteoperosis)
Alendronate, Risedronate is ....
medication for bone density