Lewis 12th edition end of chapter questions: 66,67,68,69,12,15,56,26

15.5 Which factors place the patient at increased risk for severe COVID-19? (select all that apply) a. Obesity b. Thyroid disease c. Cigarette smoking d. Pernicious anemia e. Chronic kidney disease

a. Obesity c. Cigarette smoking e. Chronic kidney disease

12.1 A patient 1 day postoperative after abdominal surgery has incisional pain, 99.5F temperature, slight redness at the incision margins, and 30 mL serosanguinous drainage in the Jackson-Pratt drain. Based on this assessment, what conclusion would the nurse make? a. The patient has a normal inflammatory response. b. The abdominal incision shows signs of an infection. c. The abdominal incision shows signs of impending dehiscence. d. The patient's health care provider must be notified about their condition.

a. The patient has a normal inflammatory response.

56.7 A patient with breast cancer who underwent mastectomy is asking about reconstructive surgery. Which information would the nurse provide? a. It can restore lactation. b. Nipple sensation may not return. c. The triceps muscle is used as a tissue flap for breast reconstruction. d. Patients must wait 3 months after mastectomy before reconstruction can begin.

b. Nipple sensation may not return.

67.6 The nurse would monitor a patient with a pelvic fracture for a. changes in urine output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden increase in blood pressure.

a. changes in urine output.

67.7 The nurse teaches the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contracture. b. clot formation at the incision. c. skin irritation and breakdown. d. increased risk for wound dehiscence.

a. hip flexion contracture.

12.5 Which patient has the greatest risk for delayed wound healing? a. A 65-year-old woman with stress incontinence b. A 52-year-old obese woman with type 2 diabetes c. A 78-year-old man who has a history of hypertension d. A 30-year-old man who drinks 2 alcoholic beverages per day

b. A 52-year-old obese woman with type 2 diabetes

12.9 An 82-year-old man is being cared for at home by his family. A pressure injury on his right buttock measures 1 x 2 x 0.8 cm, and pink subcutaneous tissue is completely visible on the wound bed. Which stage would the nurse document on the wound assessment form? a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

c. Stage 3

15.4 When working with a patient who has suspected tuberculosis, the nurse would a. wear a cloth mask. b. only use standard precautions. c. place the patient on airborne precautions. d. wear a new gown each time they enter the room.

c. place the patient on airborne precautions.

67.9 A patient is scheduled for total ankle replacement. The nurse should tell the patient 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

26.10 A patient is recovering from second- and third-degree burns over 30% of his body, and the burn care team is planning for discharge. The first action the nurse would take when meeting with the patient would be to a. arrange a return-to-clinic appointment and prescription for pain medications. b. give the patient written information and websites resources for burn survivors. c. teach the patient and the caregiver proper wound care to be performed at home. d. review the patient's current health care status and readiness for discharge to home.

d. review the patient's current health care status and readiness for discharge to home.

69.5 In teaching a patient with systemic lupus erythematosus about the disorder, the nurse knows the pathophysiology includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG. b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer. c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles. d. the production of a variety of autoantibodies directed against components of the cell nucleus.

d. the production of a variety of autoantibodies directed against components of the cell nucleus.

67.1 The nurse in urgent care suspects an ankle sprain when a patient describes a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track. c. dropping a 10-lb weight on his lower leg at the health club. d. twisting his ankle while running bases during a baseball game.

d. twisting his ankle while running bases during a baseball game.

56.3 Which are considered risk factors for breast cancer in women? (select all that apply) a. Having menarche at age 17 b. Being a woman over age 60 c. Previous history of ovarian cancer d. Having a brother with breast cancer e. Stopping oral contraceptives 15 years ago

b. Being a woman over age 60 c. Previous history of ovarian cancer d. Having a brother with breast cancer

69.6 Which drug would the nurse plan to administer to the patient with Sjögren syndrome with the goal of improving symptoms of dry eyes? a. Etanercept (Enbrel) b. Pilocarpine (Salagen) c. Cyclosporine (Restasis) d. Cyclobenzaprine (Flexeril)

c. Cyclosporine (Restasis)

15.8 Opportunistic diseases in HIV infection a. are usually benign. b. are slow to develop and progress. c. occur in the presence of immunosuppression. d. are curable with appropriate drug interventions.

c. occur in the presence of immunosuppression.

6. When grading muscle strength, the nurse records a score of 3/5, which indicates a. no detection of muscular contraction. b. a barely detectable flicker of contraction. c. active movement against full resistance without fatigue. d. active movement against gravity but not against resistance.

d. active movement against gravity but not against resistance.

26.3 Estimate the total body surface area burn injury using the rule of 9's. Burns involve the entire right arm and upper back. _____%

18%

12.6 Which order should a nurse question in the plan of care for an older adult, immobile stroke patient with a pink, clean stage 3 pressure injury? a. Pack the wound with foam dressing. b. Turn and position the patient every hour. c. Clean the wound daily with a cytotoxic solution. d. Assess for pain and medicate before dressing change.

c. Clean the wound daily with a cytotoxic solution.

68.7 A patient with osteoporosis shows an understanding of appropriate self-care when they state a. "I should remove trip hazards such as throw rugs in my house to make it safer." b. "I am not using the cane my HCP recommended. I don't want to look that old!" c. "I can continue to go downhill skiing as long as I'm careful and don't ever fall." d. "I need to take up running to help strengthen my bones. Walking is just not enough."

a. "I should remove trip hazards such as throw rugs in my house to make it safer."

68.4 Which persons are at high risk for chronic low back pain? (select all that apply) a. A 63-year-old man 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 6 ft, 2 in and weighs 250 lb d. A 44-year-old female chef with prior compression fracture of the spine e. A 28-year-old female yoga instructor who is 5 ft, 6 in and weighs 130 lb

a. A 63-year-old man 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 6 ft, 2 in and weighs 250 lb d. A 44-year-old female chef with prior compression fracture of the spine

12.8 Which patients are at most risk for pressure injuries? (select all that apply) a. A patient with right sided-paralysis and fecal incontinence b. An older adult who is alert and needs assistance to ambulate c. A young adult patient with paraplegia after a gunshot wound d. A morbidly obese patient who has an open abdominal wound e. An ambulatory patient who has occasional stress incontinence f. A young adult with a tibial fracture from a motor vehicle accident

a. A patient with right sided-paralysis and fecal incontinence c. A young adult patient with paraplegia after a gunshot wound d. A morbidly obese patient who has an open abdominal wound

56.2 Which intervention would the nurse include in the plan of care for a young woman with preductal mastitis? a. Administer antibiotics as ordered. b. Teach the woman about a breast biopsy. c. Counsel her on the need for genetic breast cancer screening. d. Explain the role of radiation therapy as a treatment alternative.

a. Administer antibiotics as ordered.

26.9 What intervention prevents hypertrophic scarring during the rehabilitation phase of burn recovery? a. Applying pressure garments b. Repositioning the patient every 2 hours c. Performing active ROM at least every 4 hours d. Applying a water-based moisturizer to healed skin

a. Applying pressure garments

69.3 Which drug would the nurse prepare to administer to the patient with acute gout? a. Colchicine b. Allopurinol c. Sulfasalazine d. Cyclosporine

a. Colchicine

66.5 The nurse obtained a health history of a patient with a fracture. Which problem, if reported by the patient, would most concern the nurse? a. Diabetes b. Hypertension c. Chronic bronchitis d. Nephrotic syndrome

a. Diabetes

26.6 What nutrition intervention may promote wound healing for a patient with a 10% burn injury? a. Eat a high-protein, high-carbohydrate diet b. Increase normal caloric intake by about 4 times c. Eat at least 1500 calories/day in small, frequent meals d. Eat a lactose-free diet to reduce the potential for diarrhea

a. Eat a high-protein, high-carbohydrate diet

26.5 Which lab result supports the need for additional IV fluid to treat burn shock? a. Hematocrit 52% b. Sodium 137 mEq/L c. WBC 12.5 x 10^9/L d. Potassium 3.4 mmol/L

a. Hematocrit 52%

12.7 An 85-year-old patient has a score of 16 on the Braden Scale. What should the nurse include in the plan of care? a. Implementing a 1-hour turning schedule with skin assessment. b. Elevating the head of the bed 90 degrees when the patient is supine. c. Continuing with weekly skin assessments with no special precautions. d. Placing a silicone foam dressing on the patient's sacrum to prevent breakdown.

a. Implementing a 1-hour turning schedule with skin assessment.

68.1 A patient with acute osteomyelitis is being discharged on antibiotic therapy. What would the nurse include in the teaching plan? (select all that apply) a. It is important to finish all the antibiotics even if you feel better. b. You will need to schedule periodic through bone scans and ESR testing. c. If the infection comes back, you must contact the HCP to schedule surgery. d. Signs such as fever and night sweats may be present but are usually not severe. e. Contact the HCP if signs of infection such as pain and swelling at the site occur.

a. It is important to finish all the antibiotics even if you feel better. b. You will need to schedule periodic through bone scans and ESR testing. d. Signs such as fever and night sweats may be present but are usually not severe. e. Contact the HCP if signs of infection such as pain and swelling at the site occur.

26.4 A patient is hospitalized with burns to his head, neck, and anterior and posterior chest after an explosion in his garage. The respiratory therapist applied a non-rebreather mask. On assessment, the nurse auscultates wheezes throughout the lung fields. On reassessment, the wheezes are gone, and the breath sounds are greatly decreased. Respiratory rate is 6/min. Oxygen saturation decreases to 88%. The patient is unresponsive. What is the priority nursing intervention? a. Notify the HCP and get ready for intubation. b. Encourage the patient to cough and auscultate the lungs again. c. Obtain vital signs, oxygen saturation, and a STAT arterial blood gas. d. Document the findings and continue to monitor the patient's breathing.

a. Notify the HCP and get ready for intubation.

69.7 Teach the patient with fibromyalgia the importance of limiting intake of which foods? (select all that apply) a. Sugar b. Gluten c. Alcohol d. Caffeine e. Red meat

a. Sugar c. Alcohol d. Caffeine

26.8 What nursing interventions can be used to manage burn pain? (select all that apply) a. Suggest pain management options. b. Use a pain-rating tool to monitor the patient's level of pain. c. Delay painful dressing changes until the patient's pain is completely relieved. d. Use a multimodal approach (e.g., sustained-release and short-acting opioids, NSAIDs, adjuvant analgesics). e. Provide nonpharmacologic therapies (e.g., music therapy, distraction) to replace opioids in the acute phase of a burn injury.

a. Suggest pain management options. b. Use a pain-rating tool to monitor the patient's level of pain. d. Use a multimodal approach (e.g., sustained-release and short-acting opioids, NSAIDs, adjuvant analgesics).

56.5 The nurse teaches a patient starting immune based therapy for breast cancer that this treatment works by a. blocking HER-2 receptors. b. increasing estrogen production. c. increasing the number of macrophages. d. preventing the production of aromatase.

a. blocking HER-2 receptors.

66.4 The increased risk for falls in the older adult is likely due to (select all that apply) a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. d. erosion of articular cartilage. e. decrease in muscle mass and strength.

a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. e. decrease in muscle mass and strength.

66.3 A patient with a torn ligament in the knee asks what the ligament does. The nurse would respond that ligaments a. connect bone to bone. b. provide strength to muscle. c. lubricate joints with synovial fluid. d. relieve friction between moving parts.

a. connect bone to bone.

66.2 When performing passive range of motion for a patient, the nurse puts the elbow joint through the movements of (select all that apply) a. flexion and extension. b. inversion and eversion. c. pronation and supination. d. flexion, extension, abduction, and adduction. e. pronation, supination, rotation, and circumduction.

a. flexion and extension. c. pronation and supination

15.3 Interventions to prevent health care-associated infections include (select all that apply) a. following hand-washing protocols. b. limiting visitors to persons over age 18. c. giving all patients prophylactic antibiotics. d. placing all patients on contact precautions. e. decontaminating equipment used for patient care.

a. following hand-washing protocols. e. decontaminating equipment used for patient care.

67.2 A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by a. formation of callus. b. complete bony union. c. hematoma at the fracture site. d. presence of granulation tissue.

a. formation of callus.

15.2 Factors associated with an increase in reemerging infections include (select all that apply) a. international travel. b. poor immunization rates. c. poor sanitation standards. d. not completing a full course of antibiotics. e. correct use of personal protective equipment.

a. international travel. b. poor immunization rates. c. poor sanitation standards. d. not completing a full course of antibiotics.

15.6 The patient asks the nurse why they need viral load testing. The nurse responds that an undetectable HIV viral load (select all that apply) a. is the goal of HIV therapy. b. occurs with drug resistance. c. is a sign of disease progression. d. means that person is cured of HIV. e. means that someone is unable to sexually transmit HIV.

a. is the goal of HIV therapy. e. means that someone is unable to sexually transmit HIV.

56.4 A patient with breast cancer has a lumpectomy with sentinel lymph node biopsy that is positive for cancer. You explain that, of the other tests done to determine the risk for cancer recurrence or spread, the results that support the more favorable prognosis are (select all that apply) a. well-differentiated tumor. b. estrogen receptor-positive tumor. c. overexpression of HER-2 cell marker. d. involvement of 2 to 4 axillary nodes. e. aneuploidy status from cell proliferation studies.

a. well-differentiated tumor. b. estrogen receptor-positive tumor.

68.2 A patient with history of colon cancer is diagnosed with rib fractures, and the HCP orders a bone scan. The nurse determines the patient understands teaching about the purpose of the procedure when they state a. "The bone scan will cure my rib fractures." b. "The bone scan will see if my colon cancer may have spread." c. "My colon cancer was cured so I really don't think this is necessary." d. "The results of the bone scan will only just confirm that I have a rib fracture."

b. "The bone scan will see if my colon cancer may have spread."

12.3 A patient in the unit has a 103.7F temperature. Which intervention would be most effective in restoring normal body temperature? a. Using a cooling blanket while the patient is febrile b. Giving antipyretics on an around-the-clock schedule c. Providing increased fluids and have the AP give sponge baths d. Giving prescribed antibiotics and placing warm blankets for comfort

b. Giving antipyretics on an around-the-clock schedule

26.2 Which wound description indicates a need for excision and grafting? (select all that apply) a. Red, painful blisters b. Leathery, brown, exposed tendon c. Pearly white color, insensitive to pain, dry d. Charred eschar, visible thrombosed blood vessels e. Large, fluid-filled vesicles, moderate edema, moist, red

b. Leathery, brown, exposed tendon c. Pearly white color, insensitive to pain, dry d. Charred eschar, visible thrombosed blood vessels

15.1 A surgical unit's quality improvement committee notes the number of new catheter-associated urinary tract infections (CAUTIs) increased over the past 6 months. The nurse understands that this means: a. There is CAUTI pandemic on the unit. b. There is a need to review unit practices. c. Droplet precautions are needed to prevent CAUTIs. d. The prevalence of antibiotic resistant CAUTI infections is decreasing.

b. There is a need to review unit practices.

12.2 The nurse assessing a patient with a chronic leg wound finds redness and edema. The patient reports pain at the wound site. What would the nurse expect to be ordered to assess the patient's systemic response? a. Serum protein analysis b. WBC count and differential c. Punch biopsy of the center of the wound d. Culture and sensitivity of the wound

b. WBC count and differential

69.1 In assessing the joints of a patient with osteoarthritis, the nurse understands that Heberden nodes a. are often red, swollen, and tender. b. indicate osteophyte formation at the DIP joints. c. are the result of pannus formation at the PIP joints. d. occur from deterioration of cartilage caused by proteolytic enzymes.

b. indicate osteophyte formation at the DIP joints.

69.2 Assessment findings that the nurse would expect in a patient with rheumatoid arthritis who has articular involvement include (select all that apply) a. bamboo-shaped fingers b. metatarsal head dislocation in feet c. noninflammatory pain in large joints d. asymmetric involvement of small joints e. morning stiffness lasting 60 minutes or more

b. metatarsal head dislocation in feet e. morning stiffness lasting 60 minutes or more

69.4The nurse should teach the patient with ankylosing spondylitis the importance of a. avoiding extremes in environmental temperatures. b. regularly exercising and maintaining proper posture. c. maintaining the patient's usual physical activity during flares. d. applying hot and cool compresses for relief of local symptoms.

b. regularly exercising and maintaining proper posture.

67.8 A patient with osteoarthritis is scheduled for total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply) a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint.

b. replace the joint. d. improve or maintain ROM

68.6 A patient who ran his first marathon had heel pain that would not resolve and was diagnosed with calcaneus stress fracture. The nurse will teach the patient to (select all that apply) a. resume running in 1 week. b. rest and refrain from running. c. wear a shoe heel pad when ambulating. d. walk barefoot to decrease pressure on the heel. e. apply ice to the heel and take NSAIDs as directed by HCP.

b. rest and refrain from running. c. wear a shoe heel pad when ambulating. e. apply ice to the heel and take NSAIDs as directed by HCP.

66.7 An abnormal assessment finding of the musculoskeletal system is a. equal leg length bilaterally. b. ulnar deviation and subluxation. c. full range of motion in all joints. d. muscle strength of 5/5 in all muscles.

b. ulnar deviation and subluxation.

15.7 A basic principle to consider when planning treatment for HIV is a. stimulating the immune system to increase viral load. b. using a combination of drugs from more than one class. c. suppressing the replication of virus by decreasing the CD4+ count. d. encouraging patients to use natural supplements, such as St. John's Wort.

b. using a combination of drugs from more than one class.

26.1 Which instruction would the nurse provide to prevent burn injuries? a. Set hot water temperature at 140ÅãF. b. Use only hardwired smoke detectors. c. Encourage regular home fire exit drills. d. Do not allow older adults to cook unattended.

c. Encourage regular home fire exit drills.

12.4 A nurse is caring for a patient who has a pressure injury that is treated with debridement, irrigations, and moist gauze dressings. How would the nurse expect healing to occur? a. Cell regeneration b. Tertiary intention c. Secondary intention d. Remodeling of tissues

c. Secondary intention

56.1A nurse planning a community program on breast cancer screening guideline would include which recommendation about screening in average risk women? a. Women over age 55 should discontinue screening. b. Women 40 to 45 should receive a clinical breast exam. c. Women aged 45 to 54 years should get annual mammograms. d. Women should have the option of beginning annual screening at age 35.

c. Women aged 45 to 54 years should get annual mammograms.

66.8 A patient is scheduled for a bone scan. The nurse explains that this diagnostic test involves a. incision or puncture of the joint capsule. b. insertion of small needles into certain muscles. c. administration of a radioisotope before the procedure. d. placement of skin electrodes to record muscle activity.

c. administration of a radioisotope before the procedure.

67.4 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.

67.3 A patient 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 cannot tolerate prolonged immobilization. b. the patient 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.

15.10 What is the most appropriate nursing intervention to help patients with HIV adhere to their treatment plan? a. Set up a drug pillbox for the patient every week. b. Give the patient a video and a brochure to view and read at home. c. Tell the patient that side effects of ART are bad but that they go away. d. Assess the patient's routines and find adherence cues that fit into their life circumstances.

d. Assess the patient's routines and find adherence cues that fit into their life circumstances.

26.7 A patient has 25% TBSA burn from a car fire. His wounds have been debrided and covered with a silver-impregnated dressing. What is the most important nursing intervention following surgery? a. Wash the wound with soap and water 3 times a day. b. Medicate for pain relief in between dressing changes. c. Reapply a new dressing without disturbing the wound bed. d. Assess the wound for signs of infection during dressing changes.

d. Assess the wound for signs of infection during dressing changes.

68.5 When caring for a patient after lumbar spinal surgery, the nurse would immediately report which finding to the HCP? a. The patient reports mild low back pain. b. The patient has a single episode of emesis. c. The patient is nauseated and has not voided in 4 hours. d. The patient has loss of sensation to the perineum, buttocks, inner thighs, and back of the legs.

d. The patient has loss of sensation to the perineum, buttocks, inner thighs, and back of the legs.

15.9 The nurse caring for a patient with HIV who has been on ART for many years plans care with the knowledge that the patient a. will inevitably develop drug resistance. b. is less likely to develop problems such as hyperlipidemia. c. is more likely to require treatment of opportunistic infections. d. can develop other chronic conditions at an earlier age than someone without HIV.

d. can develop other chronic conditions at an earlier age than someone without HIV.

56.6 A priority in providing care for a patient who underwent mastectomy includes a. teaching the patient to shower with cool water. b. measuring blood pressures in both upper extremities. c. instructing the patient to limit movement to promote healing. d. encouraging exercises to restore arm function on the affected side.

d. encouraging exercises to restore arm function on the affected side.

68.3 The nurse provides counseling to a family of a patient with Duchenne muscular dystrophy with the knowledge that a. patients are usually female. b. all daughters of a carrier will be carriers. c. genetic testing can help determine treatment. d. only males can pass the gene to their offspring.

d. only males can pass the gene to their offspring.

66.1 The bone cells that function in the formation of new bone tissue after a patient sustains a fracture are called a. osteoids. b. osteocytes. c. osteoclasts. d. osteoblasts.

d. osteoblasts.

67.5 A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects early compartment syndrome when the patient has a. increasing edema of the limb. b. muscle spasms of the lower arm. c. bounding pulse at the fracture site. d. pain when passively extending the fingers.

d. pain when passively extending the fingers.