PCN 102: Test 2

36. Decreasing visual acuity is a sign of .

ANS: normal aging As an individual ages, the crystalline lens of the eye hardens and becomes too large for the eye muscles, thus causing a loss of accommodation, which often results in a need for bifocals or trifocals. REF: Pages 1842-1843, Life Span Considerations box TOP: Normal aging

40. A patient's patellar-femoral cartilage has deteriorated due to arthritis. The medial and lateral cartilage is undamaged. This patient is likely to undergo knee replacement surgery.

ANS: partial unicompartmental Unicompartmental knee arthroplasty is also referred to as partial knee replacement and is performed on patients who have only one of the compartments of the knee affected by arthritis. REF: Pages 1369, 1408 TOP: Partial knee replacement

41. A female patient has been diagnosed with a pelvic fracture that she sustained during a fall. The physician has ordered strict bed rest for this patient. The patient is crying and states, "I'm not used to lying in bed all day. I have many things I need to do at home." An appropriate nursing diagnosis for this patient would be related to decreased mobility.

ANS: powerlessness Strict bed rest can cause a normally active person to feel powerless because she is unable to carry out her daily activities. REF: Page 1382 OBJ: N/A TOP: Nursing diagnosis Step: Planning

38. is a medical term for blurred vision.

ANS: Astigmatism Astigmatism is a defect in the curvature of the eyeball surface, resulting in blurred vision. REF: Page 1847, Table 53-3 TOP: Visual acuity

42. traction is utilized to provide support for the patient with a hip fracture.

ANS: Buck's This traction is frequently used to maintain the reduction of a hip fracture before surgery. REF: Pages 1375, 1392-1393, Figure 44-32 TOP: Buck's traction

39. In gangrene, there is an acute infection to the skeletal muscle. If untreated, will destroy the tissue.

ANS: exotoxins These injuries can produce exotoxins that destroy tissue. The onset is usually sudden and may occur 1 to 14 days after injury. These organisms are anaerobic (grow and function without oxygen) and are spore-formers. REF: Page 1386 OBJ: N/A TOP: Gangrene

43. Among the most common fractures in older women are fractures.

ANS: hip Hip fractures or compression fractures of the spine. Changes in bone mass place older women at risk for hip fractures. REF: Page 1373 TOP: Fractures

19. Which nursing intervention would be appropriate for a patient with rheumatoid arthritis? a. Sleeping at least 8 hours at night and a nap during the day b. Sleeping at 4-hour intervals at night c. No exercise regimen and apply ice to joints as needed d. Jogging at least 20 minutes three days a week

ANS: A Rest is important because fatigue is a major problem. Sleeping 8 to 10 hours a night and taking a 2-hour nap during the day are recommended. REF: Page 1359 TOP: Rheumatoid arthritis

18. A patient, age 76, is partially blind. His physician has diagnosed open-angle glaucoma. The goal of treatment in glaucoma is to a. decrease aqueous humor. b. increase aqueous humor. c. decrease discomfort. d. restore vision.

ANS: A A beta-blocker, such as Betoptic, will reduce intraocular pressure. Miotics such as pilocarpine constrict the pupil and draw the iris away from the cornea, allowing aqueous humor to drain out of the canal of Schlemm. REF: Page 1861, Table 53-5 TOP: Glaucoma Step: Planning

8. The priority nursing responsibility while caring for a patient with vertigo is a. safety. b. comfort. c. hygiene. d. quiet.

ANS: A A nursing diagnosis of Risk for injury related to disturbed sensory perception is the most important diagnosis for a patient with vertigo. REF: Pages 1875-1876, Patient Teaching boxes, NCP 53-2 TOP: Vertigo

1. The movement of an extremity away from the midline of the body is called a. abduction. b. adduction. c. flexion. d. extension.

ANS: A Abduction is movement of an extremity away from the midline of the body. REF: Page 1349, Box 44-2 TOP: Movements

23. The patient is a 20-year-old who has suffered a compound fracture of the femur. The nurse would expect the physician to order intramuscularly. a. tetanus toxoid b. morphine gluconate c. low-molecular-weight heparin d. calcium gluconate

ANS: A Administration of tetanus toxoid is an additional medical measure for compound fracture of the femur. REF: Page 1381 TOP: Fractures

14. The first priority nursing intervention for an impending fat embolism is to administer a. oxygen in a respiratory emergency. b. intravenous fluids in hypovolemic emergency. c. Lasix IV for fluid overload. d. blood therapy in a cardiac emergency.

ANS: A Airway is always the first priority. If hypoxia is present, the physician will order the administration of oxygen. It is important for the nurse to check the liter flow of oxygen and educate patients and their families as to safety precautions necessary when oxygen is administered. REF: Page 1386 TOP: Fat embolism

15. Astigmatism is a medical term meaning which visual disorder? a. Blurred vision b. Inability to detect colors c. Color blindness d. Farsightedness

ANS: A Astigmatism—blurred vision. REF: Page 1847, Table 53-2, Table 53-3 TOP: Visual acuity

8. A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned for her with respect to this diagnostic test? a. Obtain an allergy history before the test. b. Ambulate the patient when she is returned to her room after the test. c. Warn her that paralysis could result from injection of the contrast medium. d. Keep her NPO for 6 to 8 hours after the test.

ANS: A Before the dye is injected, patients must be asked whether they have any allergies, specifically whether they have had any anaphylactic or hypotensive episodes from other dyes. REF: Page 1900 TOP: Diagnostic procedures Step: Planning

34. Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines? a. Brain, liver, kidney b. Lettuce, corn, potatoes c. Beef, pork, chicken d. Fruits and fruit juices

ANS: A Foods high in purines, such as brain, kidney, liver and heart, should be avoided, as well as alcohol. REF: Page 1363 TOP: Gout

29. Otitis media is more frequently seen in children 6 to 36 months because a. eustachian tubes in children are shorter and straighter. b. infection descends via the eustachian tube to the throat. c. children's eustachian tubes are more vertical and longer. d. otitis media is seen equally in both children and adults.

ANS: A Children's shorter and straighter eustachian tubes provide easier access of the organisms from the nasopharynx to travel to the middle ear. REF: Page 1872 TOP: Otitis media Step: Evaluation

14. Rapid onset of decreased vision, halos around lights, and severe eye pain are indications of a. closed-angle glaucoma. b. open-angle glaucoma. c. retinal detachment. d. diabetic retinopathy.

ANS: A Closed-angle glaucoma causes rapid vision loss and dramatic symptoms. Closed-angle (acute) glaucoma produces severe pain, decreased vision, and nausea and vomiting. The patient sees colored halos around lights. REF: Page 1860 TOP: Glaucoma

27. A 28-year-old male patient has a fractured left humerus. He has a cast on his arm. The nurse observes pallor, coolness, and a decrease in capillary refill time to his left hand and fingers. These observations are likely to indicate a. compartment syndrome. b. early infection. c. hemorrhage. d. shock.

ANS: A Collection of objective data involves assessment of the patient's ability to flex the fingers or toes, coolness of the extremity, and absence of pulse in the affected extremity all of which indicate the impaired circulation symptomatic of compartment syndrome. Assessment of skin color for signs of pallor or cyanosis is made. REF: Page 1384, Figure 44-26 TOP: Fractures

10. A patient, age 45, has worked as a basket weaver for the past 10 years. She is being seen at the clinic for symptoms of carpal tunnel syndrome. Collection of subjective data might include a. complaints of burning pain or tingling in the hands. b. edema of the fingers. c. radicular pain. d. complaints of weight loss and fatigue.

ANS: A Collection of subjective data includes the patient's description of discomfort, such as burning pain or tingling in the hands and numbness of thumb, index, and ring fingers. REF: Page 1399, Figure 44-38 TOP: Carpal tunnel syndrome

28. The most common cause of congenital hearing loss from birth or early infancy is: a. Anoxia or trauma b. Tumor c. Infection d. Occasional loud noise

ANS: A Congenital hearing loss is present from birth or early infancy. Anoxia or trauma during delivery may be causes. DIF: Cognitive Level: AnalysisREF: Page 1869, Health Promotion box OBJ: 19 TOP: Hearing loss Step: Evaluation

7. A hearing-impaired patient is having problems communicating with staff members. Which behaviors would continue to hinder communication? a. Overaccentuating words b. Facing the patient when speaking c. Speaking in conversational tones d. Speaking into the affected ear

ANS: A Do not overaccentuate words. Speak in a normal tone; do not shout or raise the pitch of voice. REF: Page 1869, Health Promotion box

10. A patient's neurological status deteriorates over hours, and a craniotomy is performed to evacuate the hematoma. Which nursing intervention is indicated to help decrease the threat of increased intracranial pressure? a. Elevate the head of the bed 30 degrees. b. Cluster nursing interventions to provide uninterrupted periods of rest. c. Teach him to cough and deep breathe to prevent the necessity for suctioning. d. Teach him to hold his breath and bear down while repositioning in bed.

ANS: A Elevate the head of the bed to 30 to 45 degrees to promote venous return. REF: Page 1907 TOP: Hematoma Step: Planning

5. Sjögren's syndrome is associated with which eye disorder? a. Keratoconjunctivitis sicca b. Conjunctivitis c. Blepharitis d. Opaque lens disorder

ANS: A If the patient with keratoconjunctivitis sicca has associated dry mouth, the patient has Sjögren's syndrome (an immunologic disorder characterized by deficient fluid production by the lacrimal, salivary, and other glands, resulting in abnormal dryness of the mouth, eyes, and other mucous membranes). Complaints of dry eye are caused by a variety of ocular disorders characterized by decreased tear secretion or increased tear film evaporation. REF: Pages 1851-1852 TOP: Dry eye disorders

14. Before the patient undergoes computed tomographic (CT) scanning with a contrast medium, the nurse should a. verify that the patient is not allergic to seafood or iodine. b. explain that the patient will have to change position frequently during the procedure. c. maintain a safe distance from the patient to reduce the exposure to radiation. d. verify that the patient has no metal objects such as an implant or a pacemaker.

ANS: A It is important for the nurse to document and report to the physician any history of allergy to iodine and seafood because iodine is present in the contrast medium. REF: Page 1898 TOP: Diagnostic procedures

11. A patient, age 24, had a traumatic amputation of his left foot in a motorcycle accident. He is receiving morphine by a patient-controlled analgesia (PCA) device. He complains of a burning sensation in his left foot. The nurse should explain that a. this is a phantom pain and that its cause is not clearly understood. b. this is not possible because his foot was amputated. c. his regular pain medication will relieve the pain. d. this phantom pain will disappear in about 1 week.

ANS: A Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in the amputated area continued to send a message to the brain (this is normal). REF: Page 1404 TOP: Phantom pain

3. A patient has a head injury and is presenting with signs and symptoms of increased intracranial pressure. Which nursing intervention would be helpful in reducing this pressure? a. Place the neck in a neutral position to promote venous drainage. b. Suction hourly to stimulate the cough reflex. c. Add extra blankets to keep the patient warm. d. Turn the patient frequently to prevent skin impairment.

ANS: A Place the neck in a neutral position (not flexed or extended) to promote venous drainage. REF: Page 1907 TOP: Intracranial pressure (ICP) Step: Planning

22. The patient, age 42, has chronic otitis media. Otoscopic examination reveals a central perforation of the eardrum with purulent drainage into the ear canal. A CT scan confirms the presence of a cholesteatoma in the middle ear, and he is scheduled for a tympanoplasty. Which postoperative activity does the nurse teach him about preoperatively? a. Elevation of head of bed with operative side facing upward b. Enforce bed rest for 72 hours c. Frequent turning, coughing, and deep breathing d. Continuous irrigation of the ear canal with antibiotic solutions

ANS: A Postoperative management for patients who have had a tympanoplasty consists of bed rest until the next morning. The head of the bed is elevated 40 degrees, and the operative side faces upward. REF: Page 1880, Nursing Diagnoses box TOP: Otitis media

31. Rheumatoid arthritis is distinguished from osteoarthritis in that: a. Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints. b. Rheumatoid arthritis is an autoimmune, degenerative disease; osteoarthritis is a systemic inflammatory disease. c. People with osteoarthritis are considered to be genetically predisposed; there is no known genetic component to rheumatoid arthritis. d. Osteoarthritis is often caused by a virus; viruses play no part in the pathogenesis of rheumatoid arthritis.

ANS: A RA is thought to be an autoimmune disorder. Degenerative joint disease is also known as osteoarthritis. REF: Pages 1353-1355, Table 44-4, Figure 44-7 TOP: Rheumatoid arthritis

12. A patient, age 28, has a fractured tibia and fibula. The nurse is performing an assessment of her extremities. The purpose of assessing capillary filling or performing a blanching test is to assess for adequate a. arterial peripheral circulation. b. cardiac output. c. venous peripheral circulation. d. nutritional deficiency.

ANS: A The blanching test measures the rate of capillary refill, which signals circulation status. REF: Pages 1389, 1406 TOP: Fractures

24. A patient, age 72, has a left intertrochanteric fracture as a result of a fall. In planning ways to increase her safety, the nurse realizes it is most important to determine a. preexisting health conditions. b. nutritional status. c. psychosocial history. d. pain level.

ANS: A The patient's medical and surgical history is significant, as well as any family history of bone disease. Although pain level, nutritional status, and psychosocial history are important, they are not the most important. REF: Page 1374 TOP: Fracture of the hip

33. The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk for osteoporosis because her mother has osteoporosis. In teaching her about her osteoporosis, which information does the nurse include? a. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. b. Estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis. c. With a family history of osteoporosis, there is no way to prevent or slow bone reabsorption. d. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

ANS: A To prevent osteoporosis, women are advised to have an adequate daily intake of calcium and vitamin D; exercise regularly; avoid smoking; decrease coffee intake; decrease excess protein in the diet; and engage in regular moderate activity such as walking, bike riding, or swimming at least 3 days a week. A contributing factor may be use of steroids. REF: Pages 1365-1366, Patient Teaching box TOP: Osteoporosis

17. The patient who undergoes total hip replacement may be prescribed prophylactic drugs such as heparin or warfarin (Coumadin). The rationale for this is that it a. decreases the risk of thrombus formation. b. decreases the risk of hemorrhage. c. facilitates the wound-healing process. d. decreases the risk of systemic infection.

ANS: A Treatment will include administration of anticoagulants, such as heparin or warfarin (Coumadin), which decreases the risk of deep vein thrombus. REF: Page 1387 TOP: Medication

4. The term unicompartmental knee arthroplasty is also referred to as a. partial knee replacement. b. removal of the kneecap. c. total knee replacement. d. total knee replacement bilaterally.

ANS: A Unicompartmental knee arthroplasty is also referred to as partial knee replacement. REF: Pages 1369, 1408 TOP: Knee replacement

34. What factors must the nurse consider when assessing readiness to learn when teaching health promotion practices for the visually and hearing impaired? (Select all that apply.) a. Cultural beliefs b. Values c. Habits d. Income e. Occupation

ANS: A, B, C The nurse also assesses readiness to learn and teaches health promotion practices (see Patient Teaching boxes). The nurse must consider the patient's culture, beliefs, values, and habits (Cultural Considerations 13-2), as well as the special needs of the older adult (Older Adult Considerations 13-1). REF: Page 1882 TOP: Health promotion

33. Which may contribute to otitis media? (Select all that apply.) a. Exposure to cigarette smoke b. Allergies c. Upper respiratory infections d. Lower respiratory infections e. Trauma f. Prolonged exposure to loud noise

ANS: A, B, C Otitis media is usually caused by gram-negative bacteria, such as Proteus, Klebsiella, and Pseudomonas. In addition, allergy, exposure to cigarette smoke, mycoplasma, and several viruses may be factors. REF: Page 1872 TOP: Otitis media

44. The main purpose of traction is to (Select all that are correct) a. Align and stabilize a fracture b. Prevent deformities c. Relieve muscle spasms d. Promote bed rest e. Increase circulation to the rest of the body

ANS: A, B, C Skin and skeletal traction provide alignment and stabilize a fracture. This prevents deformities and relieves muscle spasms by putting muscles under tension until they are fatigued. REF: Page 1392 OBJ: N/A TOP: Traction

35. What are the major senses? (Select all that apply.) a. Taste b. Touch c. Smell d. Sight e. Hearing/Balance

ANS: A, B, C, D, E The five major senses are taste, touch, smell, sight, and hearing/balance. REF: Page 1838 TOP: Health promotion

32. Select all the conditions that may cause conductive hearing loss. a. Buildup of cerumen b. Foreign bodies c. Otosclerosis of external auditory canal d. Trauma e. Exposure to ototoxic drugs f. Otitis media with effusion

ANS: A, B, C, F Common causes of conductive hearing loss are buildup of cerumen and otitis media with effusion (escape of effusion). Other conditions that may result in conductive hearing loss are foreign bodies, otosclerosis, and stenosis of the external auditory canal. Sensorineural hearing loss is usually due to trauma, infectious processes, or exposure to ototoxic drugs. REF: Page 1869 TOP: Hearing loss

12. A patient has a family history of cataracts. He asks what symptom would be present if he begins to develop them. The nurse might respond that the first symptom of a cataract is usually a. pain in the eyes. b. blurring of vision. c. loss of peripheral vision. d. dry eyes.

ANS: B Blurring of vision is often the first subjective symptom reported by a patient who has cataracts. REF: Page 1853 TOP: Cataracts

22. A patient, age 44, has chronic osteomyelitis. He should be taught to a. take antibiotics prophylactically. b. avoid trauma to the affected bone. c. decrease activity levels. d. increase dietary intake of calcium and vitamin D.

ANS: B The patient must avoid trauma to the affected bone because pathological fracture is common. REF: Page 1367 TOP: Osteomyelitis

27. A patient, age 23, has been diagnosed with external otitis on return from vacation at the beach. The physician places an ear wick in the external ear canal and prescribes antibiotic otic drops. Before the patient leaves the clinic, the nurse reviews the management of the disorder with her. Which statement by her indicates the need for further instruction? a. "I may use aspirin for the pain." b. "I should remove the wick tomorrow." c. "I should apply the ear drops to the cotton wick placed in my ear canal." d. "I may use warm compresses to the outside of my ear for comfort."

ANS: B A wick is inserted into the ear canal to prevent loss of medication from the canal and to maintain continuous absorption of the medication. REF: Page 1871 TOP: External otitis Step: Evaluation

12. A patient has been diagnosed with organic brain pathology. He is presenting with signs and symptoms of total or partial loss of the ability to recognize familiar objects or people through sensory stimulation. This condition is called a. apraxia. b. agnosia. c. aphasia. d. dysphagia.

ANS: B Agnosia is a total or partial loss of the ability to recognize familiar objects or people through sensory stimuli as a result of organic brain damage. REF: Page 1911 TOP: Organic brain pathology

9. A patient, age 24, is recovering from a fractured tibia. She has been wearing a leg cast for the past month to immobilize the fracture and promote proper alignment. She is being seen at the clinic for follow-up radiographic evaluation of the fracture. The physician tells her that he is hoping for good callus formation to have occurred. When she asks what callus formation is, the nurse tells her it is a. when blood vessels of the bone are compressed. b. a part of the bone healing process after a fracture when new bone is being formed over the fracture site. c. the formation of a clot over the fracture site. d. when the hematoma becomes organized and a fibrin meshwork is formed.

ANS: B Callus formation occurs when the osteoblasts continue to lay the network for bone build-up and osteoclasts destroy dead bone. REF: Page 1380 TOP: Bone healing

32. Which ethnic group is at a highest risk of developing osteoporosis? a. African American women b. Caucasian and Asian women c. African American men d. Latino women

ANS: B Caucasian and Asian women have a higher incidence of osteoporosis than African American women or Hispanic women. REF: Page 1364, Cultural Considerations box TOP: Osteoporosis

8. A patient fell 2 days ago; he has a compound fracture of his left tibia. The physician performed an open reduction with internal fixation (ORIF) to treat the fracture. An important nursing assessment for him would include a. hyperactive bowel sounds. b. elevated temperature and presence of erythema at incision site. c. ecchymosis and edema at incision site. d. complaints of activity intolerance.

ANS: B Collection of objective data includes careful inspection of any wounds. The drainage is assessed for color, amount, and presence of odor. Vital signs are assessed for signs of infection (temperature elevation, tachycardia, and tachypnea). REF: Page 1367 TOP: Compound fracture

30. The office nurse has noted the presence of an increase in lumbar curvature in a 20- year-old female patient. This condition is known as a. scoliosis. b. lordosis. c. kyphosis. d. spondylitis.

ANS: B Common deformities include an increase in the curve at the lumbar space region that throws the shoulder back, making the "lordly or kingly" appearance that is known as lordosis. Scoliosis involves the S curvature of the spine. Kyphosis is the rounding of thoracic spine. REF: Page 1385 TOP: Lordosis

16. A patient, age 18, has multiple soft tissue injuries from a bicycle accident. Primary medical management for soft tissue injuries includes a. rest and heat to control edema. b. elevation and ice to control edema. c. immediate immobilization to halt pain. d. aspiration of excessive fluid.

ANS: B Contusions are the most common soft tissue injury. Most contusions are treated by applying ice bags or cold compresses. REF: Page 1396 TOP: Soft tissue injury Step: Planning

16. Most patients with Ménière's disease are treated with a. surgery. b. diuretics. c. hearing aids. d. analgesics.

ANS: B Fluid restriction, diuretics, and a low-salt diet are prescribed in an attempt to decrease fluid pressure. REF: Page 1877 TOP: Ménière's disease

18. The patient has been diagnosed as having gouty arthritis. He asks the nurse to explain the cause of the inflammation of his great toe. The most appropriate nursing response is a. "You have calcium oxalate deposits that are seen in gouty arthritis." b. "The inflammation is from small accumulations of uric acid crystals which are called tophi." c. "The small nodules are not related to the arthritis condition." d. "You have fat deposits that are common with gouty arthritis."

ANS: B Gout is a metabolic disease resulting from an accumulation of uric acid in the blood. It is an acute inflammatory condition associated with ineffective metabolism of purines. REF: Page 1363 TOP: Gouty arthritis

15. The Glasgow coma scale is a screening tool used to assess level of consciousness in three major areas. They are a. verbal, sensation, motor. b. eye, motor, verbal. c. verbal, pain, reflexes. d. eye, pain, verbal.

ANS: B The Glasgow coma scale was developed in 1974 and consists of three parts of the neurological assessment: eye opening, best motor response, and best verbal response. REF: Page 1695, Table 54-3, Table 54-4 TOP: Glasgow coma scale

38. Prolonged bed rest puts the older adult at risk for a. ankylosing spondylitis. b. pathological fractures. c. osteomyelitis. d. gout.

ANS: B Immobilization results in bone resorption, and the bone tissue becomes less dense. Prolonged bed rest puts the patient at risk for pathological fracture. This is a serious concern for an older adult in terms of regaining mobility. REF: Pages 1353-1355, Table 44-4, Figure 44-7 TOP: Disorders of the musculoskeletal system

4. The patient, age 42, notices that she is having difficulty reading typed print. The nurse would explain that the decreased ability to accommodate for near vision is called a. senility. b. presbyopia. c. myopia. d. refraction.

ANS: B Measurement of visual acuity can determine refractory errors such as presbyopia, the inability to focus on close objects. DIF: Cognitive Level: ApplicationREF: Page 1843, Table 53-2 OBJ: 6 TOP: Vision

9. A patient is prescribed eyedrops that constrict the pupil, permitting aqueous humor to flow. The nurse would reinforce the teaching by referring to the drops as a. mydriatics. b. miotics. c. osmotics. d. inhibitors.

ANS: B Miotics are agents that cause the pupil to contract or constrict. REF: Page 1861 TOP: Medication

7. As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body? a. Agnosia b. Proprioception c. Apraxia d. Sensation

ANS: B Patients may experience a loss of proprioception with a stroke. This may include apraxia and agnosia (a total or partial loss of the ability to recognize familiar objects or people). REF: Page 1911 TOP: Stroke

30. The best prevention of serious complications of ear disorders like infections, mastoiditis and brain abscesses is: a. Strong antibiotics and isolation b. Early detection and treatment c. Surgery and rehabilitation d. Bed rest and early speech reading techniques

ANS: B Prevention of serious complications of ear disorders—such as infections, mastoiditis, and brain abscess—requires early detection and treatment. REF: Page 1883, Key Points TOP: Health promotion

28. A patient, age 45, has had a left intramedullary rod placed into his left femur. He is presenting with signs and symptoms of postoperative shock. The recommended position for a person going into shock is a. semi-Fowler's. b. supine. c. Fowler's d. Trendelenburg.

ANS: B The patient should remain flat in bed. Avoid the Trendelenburg position because it pushes the abdominal organs against the diaphragm, affecting the lung and heart. REF: Page 1385, Figure 44-27 TOP: Fracture of the femur

9. A patient has recently suffered a stroke with left-sided weakness. She has problems with choking, especially when she drinks thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely? a. Having her avoid all liquids b. Instructing her to tuck her chin when swallowing c. Giving her sips of water with each bite d. Having her turn her head to the left

ANS: B The patient should sit at a 90-degree angle with the head up and chin slightly tucked. REF: Page 1910 TOP: Stroke

25. The nurse answers the call light of a newly admitted patient. The patient tells the nurse she is blind and asks the nurse to assist her to the bathroom. Which action by the nurse is most appropriate? a. Take the patient by the arm and lead her slowly to the bathroom. b. Walk slightly ahead of the patient and allow the patient to hold the nurse's elbow. c. Give the patient exact descriptive directions to the bathroom so that she can walk there independently. d. Lead the patient to the bathroom by the hand, describing the location and providing verbal clues.

ANS: B The walking companion should precede the patient by about 1 foot, and the patient's hand should be on the companion's elbow to provide security. REF: Page 1846, Figure 53-5 TOP: Blindness Step: Planning

46. The three vital functions muscles perform when they contract are: (Select all that apply.) a. To allow for accumulation of uric acid in blood b. Maintenance of posture c. Motion d. To serve as a storage area for various minerals e. Production of heat f. To assist in return of venous blood to the left side of the heart

ANS: B, C, E The three vital functions muscles perform when they contract are maintenance of posture, motion and production of 85% of body heat. REF: Page 1346 TOP: Functions of muscular system

45. Which of the significant neurovascular impairment symptoms, following a musculoskeletal trauma, should be reported to the physician? (Select all that apply.) a. Extremity feels warm to touch b. Slow capillary refill c. Diminished or absent pulses, d. Extremity pink in color e. +1 edema of extremity f. Unrelieved pain after administration of pain medication

ANS: B, C, F Assessments of slow capillary refill, diminished or absent pulses, and unrelieved pain after administration of pain medication are complications needing immediate attention. The physician should be notified. The extremity should be warm to touch, pink in color, and may have a slight edema. REF: Pages 1371, 1375 TOP: Fractures

3. Which diagnostic exam is used to find pathological abnormalities of the brain? a. CT scan b. Nuclear medicine scan c. MRI d. Radiograph

ANS: C Magnetic resonance imaging (MRI) is used to detect pathological conditions of the cerebrum and spinal cord. REF: Page 1351 TOP: Diagnostic examination

6. The patient, injured in an automobile accident, is being evaluated in the emergency department for possible head injury. Which test should not be done if there is an indication of increased intracranial pressure? a. CT scan b. MRI scan c. Lumbar puncture d. Electroencephalogram

ANS: C A lumbar puncture is contraindicated in patients who might have increased intracranial pressure, because the withdrawal of fluid may cause the medulla oblongata to herniate downward into the foramen magnum. REF: Pages 1906, 1940 TOP: Trauma

1. A patient visits the physician for a routine physical examination that involves testing distance vision. As she faces the Snellen chart, the nurse is to instruct the patient to a. use both eyes to read the chart. b. read the chart from right to left. c. cover one eye while testing the other. d. use any one eye since they will be the same.

ANS: C A major diagnostic eye test is the Snellen test. While instructing a patient to perform this test, the nurse will have the patient stand or sit 20 feet from the chart and cover one eye to read the letters on the chart. REF: Page 1844, Table 53-2 TOP: Physical examination

37. A 76-year-old female patient is being seen for osteoarthritis of the knee in the clinic. In discussing strengthening exercises, which exercises would you recommend? a. Jogging b. Climbing stairs 2 to 3 times daily c. Bicycling for short distances d. Walking up and down small elevations

ANS: C Bicycling or swimming is recommended for osteoarthritis of the hip or knee. Jogging would put undue stress on knee joints. Climbing stairs should be avoided. Walking should be done on level ground, not up or down elevations. REF: Page 1361, Box 44-3 TOP: Osteoarthritis

3. A patient is cleaning the garage and splashes a chemical in his eyes. The initial priority after the chemical burn is to a. transport to a physician immediately. b. cover the eyes with a sterile gauze. c. irrigate with H2O for 15 minutes or longer. d. irrigate with normal saline solution for 1 to 5 minutes.

ANS: C Burns are medically treated with a prolonged, 15- to 20-minute or longer tap-water flush immediately after burn exposure. REF: Page 1864 TOP: Trauma Step: Planning

19. A male patient brings home a note from the occupational nurse that states, "You have acute bacterial conjunctivitis." This condition is more commonly called a. infection. b. tearing. c. pink eye. d. color blindness.

ANS: C Conjunctivitis is an inflammation of the conjunctiva caused by bacterial or viral infection, allergy, or environmental factors. It is commonly called pink eye. REF: Page 1850 TOP: Conjunctivitis

4. When obtaining a health history from a patient with a neurological problem, the nurse is likely to elicit the most valid response from the patient with which question? a. "Do you have any sensations of pins and needles in your feet?" b. "Does the pain radiate from your back into your legs?" c. "Can you describe the sensations you are having in your head?" d. "Do you ever have any nausea or dizziness?"

ANS: C For patients with suspected neurological conditions, the presence of many symptoms or subjective data may be significant. REF: Page 1893 TOP: Assessment

36. Calcium is a mineral found in many foods that can slow bone loss during the aging process. The following are high in calcium: a. Oranges, yogurt b. Oranges, bananas c. Broccoli, yogurt d. Skim milk, eggs

ANS: C Fresh oranges, bananas, and eggs are not good calcium choices. Broccoli and green vegetables, as well as yogurt, are considered calcium-rich foods. REF: Page 1396 TOP: Osteoporosis

16. When the seriousness of craniocerebral trauma is assessed, it is important to remember that a. heavy scalp bleeding indicates serious trauma. b. open injuries are always more serious than closed injuries. c. signs and symptoms may not occur until several days after the trauma. d. trauma to the frontal lobe is more significant than to any other area.

ANS: C If a patient who has been conscious for several days after head injury loses consciousness or develops neurological signs and symptoms, a subdural hematoma should be suspected. REF: Page 1945 TOP: Trauma

35. The immediate medical management of any fracture is: a. Observe patient for signs of shock. b. Administer analgesics for pain. c. Splint and elevate the involved part. d. Apply heat to control pain.

ANS: C Immediate management includes splinting and elevation of the involved part to prevent edema. After the immediate management, analgesic for pain, application of cold to prevent edema, and observing for signs of shock must be part of the plan of care. REF: Page 1381 TOP: Contact dermatitis Step: Implementation

17. A 32-year-old construction worker has suffered a penetrating wound to his right eye. The best intervention for anyone to perform at the scene while waiting to be transported to the hospital is to a. gently remove the object. b. wipe away the blood and tears. c. cover both eyes with a paper cup and tape. d. do nothing; rush to the hospital.

ANS: C Immediately after a penetrating wound injury, both eyes should be covered while transporting the patient to the hospital because both eyes work in synchrony. A Styrofoam cup provides adequate coverage and is readily available. REF: Page 1865, Safety Alert! TOP: Trauma

25. A patient has undergone a bipolar hip repair (hemiarthroplasty). She should be instructed to a. sit in whatever position is most comfortable. b. sit in a firm, straight-backed chair at a 90-degree angle. c. avoid crossing her legs. d. begin full weight-bearing as soon as tolerated.

ANS: C Instructing the patient not to cross the legs is important because crossing the legs can adduct the affected extremity and dislocate the hip. REF: Page 1375 TOP: Fracture of the hip

23. During a nursing history related to a patient's activity-exercise functional health pattern, the patient comments that he cannot bend over and lift an object without becoming dizzy and that he frequently has to stop physical activities because of dizziness and nausea. Which structure of this patient's ear is most likely to have a dysfunction causing his symptoms? a. Middle ear b. Organ of Corti c. Semicircular canals d. Cochlea

ANS: C Labyrinthitis is an inflammation of the labyrinthine canals of the inner ear. REF: Page 1841 TOP: Aging

31. The aging process can be a factor in the patient's smell and taste. Which may contribute to altered nutrition for the elderly? a. Increase in the receptors in the nasal cavities b. Increase in papillae of the tongue c. Medications d. Myopia

ANS: C Medications often affect the taste of food and can contribute to altered nutrition. A decreased number of receptors in the nasal cavities and papillae of the tongue results in changes in smell and taste. Most affected are the sweet and salty tastes. DIF: Cognitive Level: Knowledge REF: Page 1843, Life Span Considerations box TOP: Health promotion

10. Myopia is a medical term meaning which visual disorder? a. Farsightedness b. Blurred vision c. Nearsightedness d. Halos around lights

ANS: C Myopia—nearsightedness. REF: Pages 1844, 1848, Table 53-3 TOP: Visual acuity

6. A patient, age 79, fell at home and suffered an intracapsular fracture of his left hip. The orthopedic surgeon inserted a prosthetic implant for a bipolar hip replacement. The physician has instructed the nurse to turn him every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs a. together so they don't separate while turning. b. from rubbing together. c. abducted so the prosthesis does not become dislocated. d. abducted to prevent additional pain for the patient with turning.

ANS: C Nursing interventions also involve postoperative maintenance of leg abduction by using an abduction splint for 7 to 10 days to prevent dislocation of the prosthesis. REF: Pages 1375, 1378, Patient Teaching box, Figure 44-15 TOP: Fracture of the hip

13. A patient has been blind for the past 10 years. He is hospitalized with congestive heart failure (CHF). In the care of a long-term blind individual, it is important to a. speak loudly to get the patient's attention. b. schedule a consultation with an occupational therapist to teach activities of daily living. c. announce when you enter and leave the room. d. initiate a referral to the Department of Health and Human Services.

ANS: C The nurse should announce when entering or leaving the room, so that a blind person is not put in the position of talking to someone who is no longer there. REF: Page 1846, Box 53-1 TOP: Blindness Step: Planning

5. A patient, age 89, has had a right below-the-knee amputation. He is progressing well but continues to complain of pain in the toes on his right foot. The physician told him that he is suffering from "phantom pain" in his amputated extremity. He asks the nurse to explain phantom pain. The most appropriate response would be a. "Phantom pain does not exist except in your mind." b. "I can't answer that. You'll have to ask the physician." c. "Phantom pain occurs because the nerve tracts that register pain in the amputated limb continue to send a message to the brain." d. "Phantom pain occurs when you start thinking about your loss. It's best to keep your mind occupied with other things."

ANS: C Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in the amputated area continue to send a message to the brain (this is normal). REF: Pages 1404-1405 TOP: Amputation

13. A patient has sustained a fractured femur in a car accident. The physician has stated concern about the possibility of a fat embolism. The patient's wife asks the nurse about the cause of a fat embolism. The nurse's most appropriate response would be a. "Arterial blood flow is interrupted at the site of injury." b. "Floating fat sometimes causes problems." c. "The break in the bone forces molecules of fat into the bloodstream." d. "We don't know the cause. We just know that it sometimes happens."

ANS: C Pulmonary fat embolism involves the embolization of fat tissue with platelets and circulation of free fatty acids within the pulmonary circulation. REF: Page 1386 TOP: Fat embolism

20. When caring for a patient who is 34 years old and has rheumatoid arthritis, the nurse should remember that a. exercise should be avoided to decrease pain. b. the patient should be discouraged from performing activities of daily living. c. rest and exercise are both important parts of therapy. d. pain is best controlled by use of narcotic analgesics.

ANS: C Rest is important because fatigue is a major problem. Exercise helps prevent the joints from "freezing" and the muscles from weakening. REF: Page 1359 TOP: Rheumatoid arthritis Step: Planning

6. A patient is scheduled for a stapedectomy. Appropriate postoperative teaching should include: a. Hourly changing cotton from external ear canal b. Gently blowing both nares simultaneously c. Teaching patient to open mouth when sneezing or coughing d. Limiting activities for 3 weeks

ANS: C The nurse must include patient teaching about opening the mouth when sneezing or coughing or blowing the nose gently on one side at a time for 1 week. REF: Page 1880, Patient Teaching box TOP: Stapedectomy

26. A patient, age 64, has osteoarthritis of the left hip. He has had a left total hip replacement. The nurse should a. encourage use of the high Fowler's position. b. administer oxygen through a nasal cannula. c. encourage use of an incentive spirometer. d. turn the patient frequently from side to side.

ANS: C The use of incentive spirometers is valuable in assisting the patient to perform adequate respiratory ventilation to prevent pneumonia. REF: Page 1370 TOP: Total hip replacement

21. A 71-year-old patient is manifesting signs and symptoms of gout. When assessing him for signs and symptoms of gout, the nurse should pay particular attention to a. dietary intake of foods high in cholesterol. b. mobility in the hip and knee joints. c. edema or discoloration of the great toe. d. a history of trauma or occupational injury.

ANS: C Tophi (calculi containing sodium urate deposits that develop in periarticular fibrous tissue, typically in patients with gout) result in inflammation of the joint; it is unclear why this occurs. Typically the big toes are involved, but other joints can also be affected. Particular attention should be paid to foods high in purines. REF: Page 1363 TOP: Gout

7. A patient, age 24, has a compartment syndrome after a fracture of his radius and ulna. Nursing assessment will include careful observation for signs and symptoms of a. buccal petechiae. b. thromboembolism. c. Volkmann's contracture. d. fat embolism.

ANS: C Volkmann's contracture is a permanent contracture that can occur as a result of circulatory obstruction secondary to compartment syndrome. REF: Page 1385, Figure 44-27 TOP: Compartment syndrome

11. A patient has a history of tonic-clonic seizures. She was admitted to the neurological unit after having had three tonic-clonic seizures in the past 2 days. Her husband reported that she had been sleeping for long periods after each seizure. The nurse explains to him that this rest period after a tonic-clonic seizure is called a a. convalescent period. b. post-status epilepticus period. c. post-tonic-clonic period. d. postictal period.

ANS: D Seizures are followed by a rest period of variable length, called a postictal period. REF: Page 1912 TOP: Seizures

2. The patient tells the nurse that he is legally blind. This information provides the nurse with which information to use in planning care? a. No vision enhancement techniques would be appropriate for this patient, because he is totally blind. b. This patient probably has some light perception, but no usable vision. c. This patient has some usable vision, which enables him to function at an acceptable level. d. Further questioning is needed to determine how this patient's visual impairment affects his normal functioning.

ANS: D "Legal blindness" refers to individuals with a maximum visual acuity of 20/200 with corrective eyewear and/or visual field sight capacity reduced by 20 degrees. Categories have been established to help determine the exact extent of the vision loss and what assistive measures are appropriate for the individual. The nurse will need more information as to the exact extent of the vision loss for this patient. REF: Page 1845 TOP: Blindness Step: Planning

11. A patient has an infectious/inflammatory process of the eyelid. The primary goal of nursing intervention is a. administering antibiotics. b. flushing the eye with sterile ophthalmic solution. c. maintaining bed rest. d. preventing further infection.

ANS: D A primary objective of nursing care for the patient with an infectious or inflammatory process of the eyelids is prevention of the spread of infection. Hand hygiene is essential before contact with the eye. REF: Page 1850 TOP: Infectious/inflammatory disorders Step: Planning

21. When the eye adjusts to seeing objects at various distances, it is called a. PERRLA. b. refraction. c. focusing. d. accommodation.

ANS: D Accommodation: The eye is able to focus on objects at various distances. REF: Page 1840 TOP: Aging

15. A patient, age 68, has suffered an intertrochanteric fracture of the right hip. Before surgery, to provide support and comfort, an immobilizing device is applied. This is called a a. Thomas splint. b. Bryant's traction. c. Russell's traction d. Buck's traction.

ANS: D Buck's traction is a form of traction used as a temporary measure to provide support and comfort to a fractured extremity until a more definite treatment is initiated. REF: Page 1375, Figure 44-32 TOP: Fractures

5. A patient has been injured in a motorcycle accident and is presenting with signs and symptoms of increased intracranial pressure. What is the most significant sign or symptom of increased intracranial pressure? a. Pupil changes b. Ipsilateral paralysis c. Vomiting d. Decrease in the level of consciousness

ANS: D Collection of objective data includes a change in level of consciousness. A change in the level of consciousness is the earliest sign of increased intracranial pressure. REF: Pages 1897, 1905 TOP: Intracranial pressure (ICP)

24. During examination of his external ear, the patient tells the nurse that his ear is very painful when touched. The nurse recognizes that this finding is commonly associated with a. a ruptured tympanic membrane. b. a blocked eustachian tube. c. infection of the mastoid bone. d. inflammation of the ear canal.

ANS: D The acute inflammatory or infectious process produces pain with movement of the auricle or chewing, and often the entire side of the headaches. REF: Page 1871 TOP: Infectious/inflammatory disorders

20. The patient, age 71, has severe vertigo. A nursing action to help him reduce the symptoms is: a. Avoid sudden movements until the vertigo lessens. b. Avoid noises until the vertigo lessens. c. Encourage fluid intake. d. Lie immobile and hold the head in one position until the vertigo lessens.

ANS: D Lie immobile and hold the head in one position until the vertigo lessens. REF: Page 1876, Patient Teaching box TOP: Vertigo Step: Planning

13. A patient has been complaining of headaches. If the headaches are migraine, the nurse would expect to assess that the headaches: a. They are observed during times of stress. b. They become worse toward evening. c. They have their onset when the person is in his or her twenties or thirties. d. They may cause unusual smells or sounds for the patient before the pain begins.

ANS: D Migraine headaches are unusual in that there are prodromal (early signs and symptoms of a developing condition or disease) signs and symptoms that occur before the acute attack. REF: Page 1901 TOP: Headache

2. The large, fan-shaped muscle that covers the anterior chest from the sternum to the proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, and rotate is a. serratus anterior. b. intercostal. c. transversus abdominis. d. pectoralis major.

ANS: D Pectoralis major is the large, fan-shaped muscle that covers the anterior chest and is an adductor muscle, which will cause the shoulder to flex. REF: Page 1348, Table 44-1, Figure 44- 5 TOP: Muscle functions

26. The patient, age 62, has had insulin-dependent diabetes mellitus for 20 years and has symptoms of proliferate diabetic retinopathy. He is scheduled for his first panretinal photocoagulation treatment. The nurse explains to him that the purpose of this procedure is to a. destroy the retina, which is not getting enough blood supply. b. reduce edema in the macula of the eye. c. vaporize fatty deposits that appear in the retina. d. destroy new blood vessels, seal leaking vessels, and help prevent retinal edema.

ANS: D Photocoagulation is useful in diabetic retinopathy to cauterize hemorrhaging vessels. REF: Page 1856 TOP: Diabetic retinopathy

29. When caring for the patient who is in shock, the nurse should provide a. adequate oral fluids to replace blood loss. b. external heat to combat shivering. c. sedatives to decrease anxiety and apprehension. d. oxygen to support respiratory function.

ANS: D Respiratory assistance may be given by administering oxygen. IV fluids are required for rapid access to blood volume. Shock causes altered level of consciousness and does not require medication to decrease anxiety or apprehension. REF: Page 1385

1. The name of this area of the brain means "bridge." It is the origin of cranial nerves V through VIII and is responsible for sending impulses to the structures inferior and superior to it. It also contains a respiratory center that complements the part of the brain stem located inferior to it. It is called the a. medulla oblongata. b. diencephalon. c. cerebellum. d. pons.

ANS: D The pons connects the midbrain to the medulla oblongata. The word pons means "bridge." It is the origin of cranial nerves V and VIII. REF: Page 1890 TOP: Anatomy and physiology

2. The cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions is the a. somatic motor nerve. b. visceral sensory nerve. c. abducens nerve. d. vagus nerve.

ANS: D The vagus nerve extends from the throat, larynx, and organs in the thoracic and abdominal cavities. It is responsible for sensations and will accelerate peristalsis when stimulated. REF: Page 1891, Table 54-1 TOP: Anatomy and physiology

37. Schiötz tonometry is a diagnostic test for .

ANS: glaucoma REF: Page 1860, Figure 53-11 TOP: Diagnostic tests