3130 EXAM #4 SET 2

12. The patient recently diagnosed with systemic lupus erythematosus (SLE) asks the nurse, "What is SLE and how did I get it?" Which statement best explains the scientific rationale for the nurse's response? A. "There is no known identifiable reason for a patient to develop SLE." B. "SLE occurs after a viral illness as a result of damage to the endocrine system." C. "SLE is thought to occur because the kidneys do not filter antibodies from the blood." D. "SLE occurs because of an abnormal immune response which may have a genetic or hormonal component."

D. "SLE occurs because of an abnormal immune response which may have a genetic or hormonal component."

14. A patient with systemic lupus erythematosus (SLE) who has a facial flush and alopecia tells the nurse, "I hate the way I look! I never go anyplace except to the health clinic." Which of the following would be an appropriate nursing diagnosis for this patient? A. Activity intolerance related to fatigue and inactivity. B. Impaired social interaction related to lack of social skills. C. Impaired skin integrity related to itching and skin sloughing. D. Social isolation related to embarrassment about the effects of SLE.

D. Social isolation related to embarrassment about the effects of SLE.

A client is brought to the emergency department with reports of a bad headache and an increase in blood pressure. The blood pressure reading obtained by the nurse is 260/180 mm Hg. What is the therapeutic goal for reduction of the mean blood pressure? Reduce the blood pressure by 20% to 25% within the first hour of treatment. Reduce the blood pressure to about 140/80 mm Hg. Rapidly reduce the blood pressure so the client will not suffer a stroke. Reduce the blood pressure by 50% within the first hour of treatment.

Reduce the blood pressure by 20% to 25% within the first hour of treatment.

Which finding indicates that hypertension is progressing to target organ damage? Retinal blood vessel damage Urine output of 60 mL over 2 hours Blood urea nitrogen concentration of 12 mg/dL Chest x-ray showing pneumonia

Retinal blood vessel damage

Which term describes high blood pressure from an identified cause, such as renal disease? Primary hypertension Secondary hypertension Rebound hypertension Hypertensive emergency

Secondary hypertension

A nurse providing education about hypertension to a community group is discussing the high risk for cardiovascular complications. What are risk factors for cardiovascular problems in clients with hypertension? Select all that apply. Gallbladder disease Smoking Diabetes mellitus Physical inactivity Frequent upper respiratory infections

Smoking Diabetes mellitus Physical inactivity

Which of the following procedures involves a surgical fusion of the joint? a) Osteotomy b) Arthrodesis c) Synovectomy d) Tenorrhaphy

b) Arthrodesis

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication? a) Prednisone (Deltasone) b) Allopurinol (Zyloprim) c) Colchicine d) Propoxyphene hydrochloride (Darvon)

c) Colchicine

11. The nurse teaching a support group of women with rheumatoid arthritis (RA) about how to manage activities of daily living suggests that they a. stand rather than sit when performing household and yard chores. b. strengthen small hand muscles by wringing sponges or washcloths. c. protect the knee joints by sleeping with a small pillow under the knees. d. avoid activities that require repetitive use of the same muscles and joints.

d. avoid activities that require repetitive use of the same muscles and joints.

Priority nursing actions when caring for a hospitalized patient with a new onset temperature of 102.2 degrees F (39 degrees C) and severe neutropenia include (select all that apply) A. administering the prescribed antibiotic STAT. B. taking a full set of vital signs and notifying the physician immediately. C. drawing peripheral and central line blood cultures. D. administering transfusions of WBCs treated to decrease immunogenicity. E. ongoing monitoring of the patient's vital signs for septic shock.

Answer Key: A, B, C, E Feedback: See Evolve for Rationale

The nurse is caring for a client with Parkinson's disease. Which finding about gait should the nurse expect to note in the client? A. Walking on the toes B. Unsteady and staggering C. Shuffling and propulsive D. Broad-based and waddling

Answer Key: C

A patient suffers an injury to the shoulder while playing football. To identify abnormalities of cartilage and soft tissue surrounding the joint, the nurse would expect the patient to be evaluated with a. radioisotope bone scanning. b. arthroscopy. c. standard x-rays. d. magnetic resonance imaging (MRI).

Answer: D Rationale: MRI is most useful in assessing for soft tissue injuries. Bone scanning and standard radiographs are used to assess for injures or lesions of bone. Arthroscopy is used for visualizing the joints. Cognitive Level: Comprehension Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity

The nurse is providing care for a client with a diagnosis of hypertension. The nurse should consequently assess the client for signs and symptoms of which other health problem? Migraines Atrial-septal defect Atherosclerosis Thrombocytopenia

Atherosclerosis

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? a) Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. b) Assist the patient up in the chair for meals to avoid complications associated with immobility. c) Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d) Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

C Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line.

When assessing a patient diagnosed with multiple sclerosis (MS), which of the following would require immediate action by the healthcare provider? A. Paresthesia and tremor B.Nystagmus and diplopia C. Dysphagia and congested cough D. Fatigue and depression

C. Dysphagia and congested cough

Which of these assessment findings should the healthcare provider expect to identify as an early clinical characteristic of multiple sclerosis (MS)? A.Muscle atrophy B.Dementia C.Changes in Vision D.Clonus

C.Changes in Vision

According to the DASH diet, how many servings of vegetables should a person consume each day? a. 2 or fewer b. 2 or 3 c. 4 or 5 d. 7 or 8

c Four or five servings of vegetables are recommended in the DASH diet. The diet recommends two or fewer servings of lean meat, fish, and poultry; two or three servings of low-fat or fat-free dairy foods; and seven or eight servings of grains and grain products.

Which of the following symptoms do you as the nurse expect to see in the patient with primary progressive multiple sclerosis? (Select All that Apply): A. Blurred double vision B. Fatigue C. Diarrhea D. Intention tremors E. Paralytic ileus

A. Blurred double vision B. Fatigue D. Intention tremors

Which assessment data should the nurse assess in the client diagnosed with Guillain-Barré syndrome? A. An exaggerated startle reflex and memory changes. B. Cogwheel rigidity and inability to initiate voluntary movement. C. Sudden severe unilateral facial pain and inability to chew. D. Progressive ascending paralysis of the lower extremities and numbness.

D. Progressive ascending paralysis of the lower extremities and numbness.

C. presence of a hot spot on the cast

The nurse is checking the casted extremity of a client. The nurse should check for which sign indicative of infection? A. dependent edema B. diminished distal pulse C. presence of a hot spot on the cast D. coolness and pallor of extremity

Much information can be gained from comparing blood pressure measurements. What does a blood pressure reading indicate? a. All of the options are correct. b. arterial ability to stretch and fill with blood c. pumping efficacy of the heart d. circulating blood volume

a The measured BP reflects the ability of the arteries to stretch and fill with blood, the efficiency of the heart as a pump, and the volume of circulating blood.

A nurse is assisting with with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? a. A 16-year-old girl b. A 40-year-old African-American man c. A 50-year-old Caucasian woman d. An Asian adult man

b Prevalence of hypertension varies by ethnicity, with African Americans having the highest prevalence.

Which of the following maybe the first and only physical sign of symptomatic osteoarthritis (OA)? a) Limb shortening b) Limited passive movement c) Joint instability d) Joint enlargement

b) Limited passive movement

The nurse is seeing a client for the first time and has just checked the client's blood pressure. The nurse would consider the client prehypertensive if: a. diastolic BP is between 70 and 79 mm Hg. b. diastolic BP is 100 mm Hg. c. systolic BP is between 120 and 139 mm Hg. d. systolic BP is above 180 mm Hg.

c Once the systolic BP goes above 120 mm Hg, the patient is considered prehypertensive, according to the National Heart, Lung, and Blood Institute's (2015) definition.

An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically: a) Scanty in volume. b) Clear and pale. c) Milky, cloudy, and dark yellow. d) Straw-colored.

c) Milky, cloudy, and dark yellow.

Nursing assessment for tinnitus, gastric intolerance, and bleeding is important for patient who take which class of medications for a rheumatic disease? a) COX-2 inhibitors b) Antimalarials c) Salicylates d) Immunosuppressive

c) Salicylates

The nurse is caring for a client diagnosed with Guillain-Barré syndrome. Which assessment findings require nursing action? Select all that apply. A. Blood pressure of 80/42 B. Respiratory rate of 24 C. Shallow breathing pattern D. Peripheral oxygen saturation (SpO2) of 85% E. Diminished breath sounds in all lung fields

A. Blood pressure of 80/42 C. Shallow breathing pattern D. Peripheral oxygen saturation (SpO2) of 85% E. Diminished breath sounds in all lung fields

3. The nurse expects to find which characteristic clinical manifestation in a patient with early stage osteoarthritis? A. Joint pain relieved by rest. B. Joint stiffness that is worse with activity. C. Pain that improves with humidity and low barometric pressure. D. Significant loss of function from Bouchard's and Heberden's nodes.

A. Joint pain relieved by rest.

15. The nurse is teaching a patient with newly diagnosed ankylosing spondylitis about the management of the condition? Which of the following should the nurse include in the teaching plan? A. Local moist heat applications. B. Exercise by taking long walks. C. Sleep on the side with hips flexed. D. Take frequent naps during the day.

A. Local moist heat applications.

A client with a history of seizures is placed on seizure precautions. Which emergency equipment will the nurse provide at the bedside? Select all that apply. A. Oropharyngeal airway B. Oxygen C. Nasogastric tube D. Suction setup E. Padded tongue blade

A. Oropharyngeal airway B. Oxygen D. Suction setup

A 57-year-old postmenopausal woman is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement, if made by the patient to the nurse, indicates understanding of the procedure? A. "The bone density in my heel will be measured." B. "This procedure will not cause any pain or discomfort." C. "I will not be exposed to any radiation during the procedure." D. "I will need to remove my hearing aids before the procedure."

B. "This procedure will not cause any pain or discomfort." Dual-energy x-ray absorptiometry (DXA) is painless and measures the bone mass of spine, femur, forearm, and total body with minimal radiation exposure. A quantitative ultrasound (QUS) evaluates density, elasticity, and strength of bone using ultrasound of the calcaneus (heel). Magnetic resonance imaging would require removal of objects such as hearing aids that have metal parts.

The nurse is caring for a patient treated with alteplase following a stroke. Which assessment finding is the highest priority for the nurse? A. Client's blood pressure is 144/90. B. Client is having epistaxis. C. Client ate only half of the last meal. D. Client continues to be drowsy.

B. Client is having epistaxis.

The nurse assesses an older adult with a diagnosis of severe, late-stage Alzheimer's disease. Which assessment findings would the nurse expect for this client? Select all that apply. A. Acute confusion B. Hallucinations C. Wandering D. Urinary incontinence E. Difficulty eating

B. Hallucinations D. Urinary incontinence E. Difficulty eating

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid (select all that apply): A. Rest B. Infection C. Overexertion D. High caffeine intake

B. Infection C. Overexertion D. High caffeine intake

To prevent autonomic hyperreflexia, which nursing action will the home health nurse include in the plan of care for a patient who has paraplegia at the T4 level ? A. Support selection of a high-protein diet. B. Discuss options for sexuality and fertility. C. Assist in planning a prescribed bowel program. D. Use quad coughing to strengthen cough efforts.

C. Assist in planning a prescribed bowel program.

Certain transdermal patches must be removed before an MRI is performed because they can cause burns. True False

True. Rationale: Transdermal patches (eg, NicoDerm, Transderm Nitro, Transderm Scopolamine, and Catapres-TTS) that have a thin layer of aluminized backing must be removed before an MRI because they can cause burns

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? a) Scoliosis b) Degenerative joint disease c) Muscular dystrophy d) Paget's disease

b) Degenerative joint disease

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process? a) Inflammation b) Gout c) Infection d) Degeneration

b) Gout

What intervention is a priority for a patient diagnosed with osteoarthritis? a) Colchicine b) Allopurinol (Zyloprim) c) Physical therapy and exercise d) Hydrotherapy

c) Physical therapy and exercise

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)? a) The patient should continue taking the medication if fever occurs. b) The medication is administered IM. c) The medication is given at room temperature. d) It is important to monitor for injection site reactions.

d) It is important to monitor for injection site reactions.

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? Select all that apply. a) Support joints with splints and pillows. b) Provide opportunities for the client to verbalize feelings. c) Assist the client to develop a sleep routine. d) Provide diversional activities. e) Provide assistive devices for self-feeding.

• Support joints with splints and pillows. • Provide diversional activities. • Provide opportunities for the client to verbalize feelings.

The nurse cares for the client being evaluated for Guillain-Barre Syndrome. Which sign is most suggestive of Guillain-Barre Syndrome? A. Ascending paralysis B. Numbness and tingling of the fingers C. Hyperactive reflexes D. Tinnitus

A. Ascending paralysis

When the nurse is planning care for a hospitalized patient who is experiencing an acute episode of trigeminal neuralgia, an appropriate action to include is a. Teach facial and jaw relaxation techniques b. Assess intake and output and dietary intake c. Apply ice packs for no more than 20 minutes d.Spend time at the bedside talking with the patient

B) Assess intake and output and dietary intake

The nurse is admitting a patient who has a neck fracture at the C6 level to the intensive care unit. Which assessment findings indicate neurogenic shock? A. Hyperactive reflexes below the injury B. Hypotension and warm extremities C. Lack of sensation or movement below the injury D. Involuntary and spastic movement

B. Hypotension and warm extremities

The nurse will assess a 67-year-old patient who is experiencing a cluster headache for A. nuchal rigidity. B. unilateral ptosis. C. projectile vomiting. D. throbbing, bilateral facial pain.

B. unilateral ptosis.

A family member asks the nurse about whether there would be any long-term psychological effects from a client's mild traumatic brain injury. What is the nurse's best response? A. "You need to talk with the client's primary health care provider." B. "Usually any effects last for only a few weeks or months." C. "Each person's reaction to brain injury is different." D. "You should expect a change in the client's personality.

C. "Each person's reaction to brain injury is different."

The RN is caring for a PT with increased ICP. Which nursing action should be avoided? A. Reposition the patient every two hours. B. Position the patient with the head elevated 30 degrees. C. Suction the airway every two hours per standing orders. D. Provide continuous oxygen as ordered.

C. Suction the airway every two hours per standing orders.

11. The nurse is planning care for a patient with an acute episode of gout who has a red, swollen, and painful right great toe. Which nursing action should be included in the plan of care? A. Gently palpate the toe to assess swelling. B. Limit fluids to no greater than 2,000 mL per day. C. Use a foot cradle to hold bedding away from the toe. D. Teach patient to avoid use of nonsteroidal anti-inflammatory drugs.

C. Use a foot cradle to hold bedding away from the toe.

When analyzing the cerebrospinal fluid of a pt diagnosed with MS, which of the following results would the healthcare provider anticipate? A. Cloudy with increased turbidity B. Clear with decreased white blood cells C. clear with increased proteins D. pinkish with increased red blood cells.

C. clear with increased proteins.

2. Bell's palsy is associated with infection by which of the following pathogens? A)Herpes simplex 1 B) Herpes zoster C) Epstein Barr virus D) All of these are correct

D) All of these are correct

Most back pain is self-limited and resolves within __ weeks with analgesics, rest, stress reduction, and relaxation. A. 1 B. 2 C. 3 D. 4

D. 4 Rationale: Most back pain is self-limited and resolves within 4 weeks with analgesics, rest, stress reduction, and relaxation.

6. A patient with rheumatoid arthritis reports receiving the following dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce? A. Wheat germ and yeast. B. Yogurt and blackstrap molasses. C. Multiple vitamin supplements in large doses. D. A balanced diet including a variety of different food groups.

D. A balanced diet including a variety of different food groups.

The DASH (Dietary Approaches to Stop Hypertension) diet has been recommended to a 58-year-old woman with a recent diagnosis of primary hypertension. What dietary component will the woman consume most if she adheres to this diet? a. Grains and grain products b. Fruits c. Vegetables d. Low-fat dairy products

a The DASH diet recommends 7 to 8 daily servings of grain products, 4 to 5 servings each of fruits and vegetables, and 2 to 3 servings of low-fat dairy products.

A 56-year-old male client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response? "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." "You have no need to worry. Your pressure is probably elevated because you are being tested."

"A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made."

Which intervention should the nurse take with the client recently diagnosed with ALS? A. Discuss a percutaneous gastrostomy tube. B. Explain how a fistula is accessed. C. Provide an advance directive. D. Refer to a PT for leg braces.

Answer Key: C Feedback: It is never too early to discuss advance directives with a client diagnosed with a terminal illness

A patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find? A. Hyperactive left-sided tendon reflexes B. Right-sided neglect C. Impulsive behavior D. Difficulty comprehending instructions

Answer Key: D

The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching? A. "I can sit down to put on my pants and shoes." B. "I try to exercise every day and rest when I'm tired." C. "My son removed all loose rugs from my bedroom." D. "I don't need to use my walker to get to the bathroom."

Answer Key: D

Which assessment data should the nurse assess in the client diagnosed with Guillain-Barré syndrome? A. An exaggerated startle reflex and memory changes. B. Cogwheel rigidity and inability to initiate voluntary movement. C. Sudden severe unilateral facial pain and inability to chew. D. Progressive ascending paralysis of the lower extremities and numbness.

Answer Key: D

Alendronate (Fosamax) is ordered for a patient with osteoporosis. Which information should the nurse teach the patient about the medication? A. Acts as a selective estrogen receptor modulator B. Reduces risk of invasive breast cancer C. May be obtained as a nasal spray D. Inhibits bone resorption

Alendronate (Fosamax), a bisphosphonate, is a potent inhibitor of bone resorption that preserves bone mass and increases bone density. Raloxifene (Evista) is an example of a selective estrogen receptor modulator that is used to treat osteoporosis, and which also reduces the risk of invasive breast cancer. Calcitonin (Miacalcin) is dispensed as a nasal spray.

The nurse assessing a patient with newly diagnosed trigeminal neuralgia will ask the patient about A. triggers leading to facial discomfort. B. weakness on the affected side of the face. C. visual problems caused by ptosis. D. poor appetite caused by loss of taste.

Answer Key: A Feedback: The major clinical manifestation of trigeminal neuralgia is severe facial pain triggered by cutaneous stimulation of the nerve. Ptosis, loss of taste, and facial weakness are not characteristics of trigeminal neuralgia.

Which nursing diagnosis is a priority in the care of a patient with myasthenia gravis (MG)? A. Acute confusion B. Bowel incontinence C. Activity intolerance D. Disturbed sleep pattern

C. Activity intolerance

The nurse is caring for a client with expressive (Broca's) aphasia. Which nursing intervention is appropriate for communicating with the client? A. Refer the client to the speech-language pathologist. B. Speak loudly to help the client interpret what is being said. C. Provide pictures to help the client communicate. D. Ask the client to read messages on a white board.

C. Provide pictures to help the client communicate.

When caring for a client diagnosed with Guillain-Barre syndrome, which does the nurse identify as the MOST serious complication of this syndrome?A. Urinary retention B. Immobility C. Respiratory failure D. Loss of communication

C. Respiratory failure

The nurse observes a certified nursing assistant (CNA) obtaining a blood pressure reading with a cuff that is too small for the patient. The nurse informs the CNA that using a cuff that is too small can affect the reading results in what way? The results will be falsely decreased. The results will be falsely elevated. It will give an accurate reading. It will be significantly different with each reading.

The results will be falsely elevated.

A patient has come to the clinic for a follow-up assessment. Before taking the blood pressure, the nurse should determine if the patient has: Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Been NPO for at least 2 hours Avoided drinking coffee for 12 hours before the visit

Tried to rest quietly for 5 minutes before the reading is taken

A client is scheduled for a bone biopsy. What action by the nurse takes priority? a. Administering the preoperative medications b. Answering any questions about the procedure c. Ensuring that informed consent is on the chart d. Showing the clients family where to wait

c. Ensuring that informed consent is on the chart The priority is to ensure that informed consent is on the chart. The preoperative medications should not be administered until the nurse is confident the procedure will occur and the client has already signed the consent, if the medications include anxiolytics or sedatives or opioids. The provider should answer questions about the procedure. The nurse does show the family where to wait, but this is not the priority and could be delegated.

A client has a metastatic bone tumor. What action by the nurse takes priority? a. Administer pain medication as prescribed. b. Elevate the extremity and apply moist heat. c. Handle the affected extremity with caution. d. Place the client on protective precautions.

c. Handle the affected extremity with caution. Bones invaded by tumors are very fragile and fracture easily. For client safety, the nurse handles the affected extremity with great care. Pain medication should be given to control pain. Elevation and heat may or may not be helpful. Protective precautions are not needed for this client.

A nurse educator is providing information to a small group of clients about hypertension without comorbities. What does the nurse explain about the target goals of the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8)? a. 135/80 or lower b. 135/85 or lower c. 140/90 or lower d. 150/90 or lower

d The goal of hypertension treatment is to prevent complications and death by achieving and maintaining the arterial blood pressure at 150/90 or lower. The JNC8 specifies a lower goal pressure of 140/90 for people with diabetes mellitus or chronic kidney disease.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to: a) wear protective devices when exercising. b) wear worn, comfortable shoes. c) get help when lifting objects. d) install safety devices in the home.

d) install safety devices in the home.

A patient, with a history of peptic ulcer disease is diagnosed with RA. The nurse practitioner prescribes an anti-inflammatory drug that also protects the stomach lining. Which of the following is that medication? a) c. DMARD (Rheumatrex) b) a. NSAID (ibuprofen) c) d. Biologic agent (Enbrel) d) b. COX-2 inhibitor (Celebrex)

d). COX-2 inhibitor (Celebrex)

The nurse is caring for a client using a continuous passive motion (CPM) machine and has delegated some tasks to the unlicensed assistive personnel (UAP). What action by the UAP warrants intervention by the nurse? a. Checking to see if the machine is working b. Keeping controls in a secure place on the bed c. Placing padding in the machine per request d. Storing the CPM machine under the bed after removal

d. Storing the CPM machine under the bed after removal For infection control (and to avoid tripping on it), the CPM machine is never placed on the floor. The other actions are appropriate.

Which of the following is the most common joint affected in gout? a) Metatarsophalangeal b) Knee c) Ankle d) Tarsal area

a) Metatarsophalangeal

An arthrocentesis is done to remove synovial fluid from a joint. Synovial fluid from an inflamed joint is characteristically: a) Milky, cloudy, and dark yellow. b) Clear and pale. c) Straw-colored. d) Scanty in volume

a) Milky, cloudy, and dark yellow.

Which diagnostic study is decreased in patient diagnosed with rheumatoid arthritis? a) Red blood cell count b) ESR c) Uric acid d) Creatinine

a) Red blood cell count

A nurse working in the clinic is seeing a client who has just been prescribed a new medication for hypertension. The client asks why hypertension is sometimes called the "silent killer." What is the best response by the nurse? "Hypertension often causes no symptoms." "Hypertension often kills early in the disease process." "Hypertension often causes no pain." "Hypertension is difficult to diagnose."

"Hypertension often causes no symptoms."

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? 145/95 or lower 130/80 or lower 150/95 or lower 125/85 or lower

130/80 or lower

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit? 1. "I can use heat and cold as often as I want." 2. "With heat, I should apply it for no longer than 20 minutes at a time." 3. "Heat-producing liniments can be used with other heat devices." 4. "Ten to 15 minutes per application is the maximum time for cold applications."

3. Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold.

How long does a patient taking bisphosphonates need to stay upright after administration? A. 10 minutes B. 20 minutes C. 30 minutes D. 120 minutes

30 minutes Bisphosphonates are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes.

According to the DASH diet, how many servings of vegetables should a person consume each day? 2 or fewer 2 or 3 4 or 5 7 or 8

4 or 5

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

Which priority client problem is the highest priority for the client diagnosed with Guillain Barre Syndrome? 1. High risk for injury. 2. Fear and anxiety. 3. Altered nutrition. 4. Ineffective breathing pattern.

4. Ineffective breathing pattern.

A client has had hypertension for 20 years. The nurse should asses the client for? a) renal insufficiency and failure b) valvular heart disease c) Endocarditis d) peptic ulcer disease

A Renal disease, including renal insufficiency and failure, is a complication of hypertension. Effective treatment of hypertension assists in preventing this complication.

A. I need to avoid getting the cast wet

A client is being discharged home after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client makes which statement? A. i need to avoid getting the cast wet B. I will use my fingertips to lift and move the leg C. I need to cover the casted leg with warm blankets D. I can use a padded coat hanger end to scratch under the cast

A patient is diagnosed with hypertension and nadolol (Corgard) is prescribed. The nurse should consult with the health care provider before giving this medication upon finding a history of a. asthma. b. peptic ulcer disease. c. alcohol dependency. d. myocardial infarction (MI).

ANS: A Nonselective β-blockers block β1- and β2-adrenergic receptors and can cause bronchospasm, especially in patients with a history of asthma. β-blockers will have no effect on the patient's peptic ulcer disease or alcohol dependency. β-blocker therapy is recommended after MI.

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? Renal failure Right ventricular hypertrophy Glaucoma Anemia

Renal failure

A patient with a history of hypertension treated with a diuretic and an angiotensin-converting enzyme (ACE) inhibitor arrives in the emergency department complaining of a severe headache and has a BP of 240/118 mm Hg. Which question should the nurse ask first? a. Did you take any acetaminophen (Tylenol) today? b. Do you have any recent stressful events in your life? c. Have you been consistently taking your medications? d. Have you recently taken any antihistamine medications?

ANS: C Sudden withdrawal of antihypertensive medications can cause rebound hypertension and hypertensive crisis. Although many over-the-counter medications can cause hypertension, antihistamines and acetaminophen do not increase BP. Stressful events will increase BP but not usually to the level seen in this patient.

Which of the following findings is most typical of a client with a fractured hip? A. Pain in the hip and affected leg B. Diminished sensation in the affected leg C. Absence of pedal and femoral pulses in the affected extremity D. Misalignment of the affected extremity

Answer D is correct. The most typical sign of a fractured hip is misalignment. Pain, paresthesia, and pulselessness are characteristics associated with all fractures, so answers A,B,C, are wrong.

While horseback riding a patient fell from the hose sustaining a pelvic fracture. What complications should the nurse know to monitor for that are common to pelvic fractures? A. Paresthesia and ischemia B. Hemorrhage and shock C. Paralytic ileus and a lacerated urethra D. Thrombophlebitis and infection

Answer B

A client has been diagnosed as experiencing "white-coat hypertension." This refers to: anxiety insomnia depression loss of consciousness

Anxiety

A 38 year old woman has newly diagnosed Multiple Sclerosis (MS) and asks the nurse what is going to happen to her. The best response by the nurse is: A. " You need to plan for continuous loss of movement, sensory functions and mental capabilities" B. " Most people with MS have periods of attacks and remission, with progressively more nerve damage over time" C. " You will most likely have a steady course of chronic progressive nerve damage that will change your personality" D. " It is common for people with MS to have an acute attack of weakness and then a reversal of MS."

B. " Most people with MS have periods of attacks and remission, with progressively more nerve damage over time"

1. The occupational health nurse is teaching a class on the risk factors for developing osteoarthritis (OA). Which is a modifiable risk factor for developing OA? A. Increasing age. B. Being overweight. C. Genetic susceptibility. D. Previous joint damage

B. Being overweight.

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia? a) Widespread chronic pain b) Butterfly facial rash c) Heberden nodes d) Jaw locking

a) Widespread chronic pain

The nurse is developing a nursing care plan for a client who is being treated for hypertension. What is a measurable client outcome that the nurse should include? Client will reduce Na+ intake to no more than 2.4 g daily. Client will have a stable BUN and serum creatinine levels. Client will abstain from fat intake and reduce calorie intake. Client will maintain a normal body weight.

Client will reduce Na+ intake to no more than 2.4 g daily.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a) a BP recheck should be scheduled in a few weeks b) the dietary sodium and fat content should be decreased c) there is an immediate danger of a stroke and hospitalization will be required d) more diagnostic testing may be needed to determine the cause of the hypertension

D A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need rapid treatment and ongoing monitoring.

A client who sustained a recent cervical spinal cord injury reports feeling flushed. The client's blood pressure is 180/100. What is the nurse's best action at this time? A. Perform a bladder assessment. B. Insert an indwelling urinary catheter. C. Turn on a fan to cool the patient. D. Place the patient in a sitting position.

D. Place the patient in a sitting position.

A. It has a high risk of infection.

The nurse is preparing to care for a patient who requires skeletal traction. The nurse knows which statement is true regarding skeletal traction? A. It has a high risk of infection. B. It is used for only fractures of the lower extremity bones. C. It uses a series of removable pins, ropes, and weights to realign bones. D. It requires nurses to frequently assess and modify the amount of weight applied

C. Swelling and pain in the big toe or other joint

When assigned to care for a patient who has gout, the LPN/LVN should assess for which condition? A. Evidence of unilateral joint deformity B. Decreased range-of-motion of most joints C. Swelling and pain in the big toe or other joint D. Signs of compression of the spine from collapsed vertebrae

13. A 37-year-old patient with 2 school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that home life is very stressful. Which response by the nurse is most appropriate? a. "Tell me more about situations that are causing you stress." b. "You need to see a family therapist for some help with stress." c. "Your family should understand the impact of your rheumatoid arthritis." d. "Perhaps it would be helpful for your family to be involved in a support group."

a. "Tell me more about situations that are causing you stress."

The nurse is working with clients who have connective tissue diseases. Which disorders are correctly paired with their manifestations? (Select all that apply.) a. Dry, scaly skin rash Systemic lupus erythematosus (SLE) b. Esophageal dysmotility Systemic sclerosis c. Excess uric acid excretion Gout d. Footdrop and paresthesias Osteoarthritis e. Vasculitis causing organ damage Rheumatoid arthritis

a. Dry, scaly skin rash Systemic lupus erythematosus (SLE) b. Esophageal dysmotility Systemic sclerosis e. Vasculitis causing organ damage Rheumatoid arthritis A dry, scaly skin rash is the most frequent dermatologic manifestation of SLE. Systemic sclerosis can lead to esophageal motility problems. Vasculitis leads to organ damage in rheumatoid arthritis. Gout is caused by hyperuricemia; the production of uric acid exceeds the excretion capability of the kidneys. Footdrop and paresthesias occur in rheumatoid arthritis.

A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best? a. Your feet have less blood flow, so healing is slower. b. The bones in your feet are hard to operate on. c. The surrounding bones and tissue are damaged. d. Your feet bear weight so they never really heal.

a. Your feet have less blood flow, so healing is slower. The feet are the most distal to the heart and receive less blood flow than other organs and tissues, prolonging the healing time after surgery. The other explanations are not correct.

9. Which action will the nurse include in the plan of care for a 33-year-old patient with a new diagnosis of rheumatoid arthritis? a. Instruct the patient to purchase a soft mattress. b. Suggest that the patient take a nap in the afternoon. c. Teach the patient to use lukewarm water when bathing. d. Suggest exercise with light weights several times daily.

b. Suggest that the patient take a nap in the afternoon. More rest for the patient

6. The patient developed a flare up of chronic gout while hospitalized for a heart attack. When doing discharge teaching for this patient who takes aspirin for its antiplatelet effect, what should the nurse include about preventing future attacks of gout? a. Limit fluid intake. b. Administration of probenecid (Benemid) c. Administration of allopurinol (Zyloprim) d. Administration of nonsteroidal antiinflammatory drugs (NSAIDs)

c. Administration of allopurinol (Zyloprim) Because of how the drugs interact with each other

A client has a continuous passive motion (CPM) device after a total knee replacement. What action does the nurse delegate to the unlicensed assistive personnel (UAP) after the affected leg is placed in the machine while the client is in bed? a. Assess the distal circulation in 30 minutes. b. Change the settings based on range of motion. c. Raise the lower siderail on the affected side. d. Remind the client to do quad-setting exercises.

c. Raise the lower siderail on the affected side. Because the clients leg is strapped into the CPM, if it falls off the bed due to movement, the clients leg (and new joint) can be injured. The nurse should instruct the UAP to raise the siderail to prevent this from occurring. Assessment is a nursing responsibility. Only the surgeon, physical therapist, or specially trained technician adjusts the CPM settings. Quad-setting exercises are not related to the CPM machine.

14. The nurse is planning care for a patient with hypertension and gout who has a red and painful right great toe. Which nursing action will be included in the plan of care? (Build up of uric acid is gout) (Painful) a. Gently palpate the toe to assess swelling. b. Use pillows to keep the right foot elevated. c. Use a footboard to hold bedding away from the toe. d. Teach patient to avoid use of acetaminophen (Tylenol).

c. Use a footboard to hold bedding away from the toe. Intense pain from gout

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? a. "Your blood pressure is fine. Just keep doing what you're doing." b. "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." c. "The lower the better. Blood pressure of 120/80 mm Hg is best for everyone." d. "Clients with diabetes should have a lower blood pressure goal. You should strive for 130/80 mm Hg."

d An individual with diabetes mellitus should strive for blood pressure of 130/80 mm Hg or less. An individual without diabetes should strive for blood pressure of 140/90 mm Hg or less.

patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand about the action of this compound? a) Inhibits DNA synthesis b) Inhibits platelet aggregation c) Inhibits lysosomal enzymes d) Inhibits T- and B-cell activity

d) Inhibits T- and B-cell activity

18. After the nurse assesses a 78-year-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management, which information is most important to report to the health care provider? (Naproxen's main side effect is acute kidney failure) a. Knee crepitation is noted with normal knee range of motion. b. Patient reports embarrassment about having Heberden's nodes. c. Patient's knee pain while golfing has increased over the last year. d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

d. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

5. The health care provider prescribes the disease modifying anti-rheumatic drug, leflunomide (Arava), for a 28-year-old woman with stage II moderate rheumatoid arthritis (RA). When providing teaching to the patient regarding this medication it is most important to include which information? A. Report any blurring of vision. B. Use a reliable method of birth control. C. Start taking a mega dose of vitamin B12 daily. D. Do not eat within 4 hours of taking the medication.

B. Use a reliable method of birth control.

The nurse teaches a client, who has recently been diagnosed with hypertension, about dietary restrictions: a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client's needs? a) mixed green salad with blue cheese dressing, crackers, and cold cuts b) ham sandwich on rye bread and an orange c) baked chicken, an apple, and slice of white bread d) hot dogs, baked beans, and celery and carrot sticks

C Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in both fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically asymptomatic.

9. Uricosuric agents such as probenecid (Benemid) may be prescribed for chronic gout for which primary purpose? A. Decrease the pain. B. Metabolize purines. C. Decrease concentration of uric acid in the blood. D. Increase renal perfusion and elimination of sodium

C. Decrease concentration of uric acid in the blood

7. The nurse should include which intervention to help decrease stiffness and prevent deformities of the knee in a patient with rheumatoid arthritis? A. Maintain a knee brace on the leg. B. Keep the patient on a regimen of bedrest. C. Stay active and encourage motion of the joint. D. Immobilize the joint with pillows until pain subsides.

C. Stay active and encourage motion of the joint.

C. Quadriceps setting exercises

The nurse is caring for a patient who has had a knee replacement. Within 2 to 3 days, the LPN/LVN can likely anticipate which change in the plan of care? A. Walker training B. Enemas until clear C. Quadriceps setting exercises D. Cessation of pain medication

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? a) Reports increased fatigue b) Reports ability to perform ADLs c) Reports decreased joint pain d) Shows a weight gain of 2 pounds

a) Reports increased fatigue

The community health nurse is preparing a program geared toward primary prevention of hypertension. When preparing the program, what activities will aid the nurse in meeting the goals of primary prevention? a) providing dietary counseling for clients with hypertension b) offering free blood pressure screenings to participants c) having a contest for participants to win an automatic blood pressure cuff for home use d) providing literature to discuss modifiable risk factors

D Primary prevention activities seek to reduce the incidence of disease. These are risk factors associated with hypertension. Change in modifiable risk factors may result in the reduction of disease incidence. Secondary prevention is the reducing of risks and complications to the client who already has a disorder. Ex- providing dietary counseling, free blood pressure screenings, and a contest for a free BP cuff

C. check the clients alignment in bed

The nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first? A. provide pin care B. call the health care provider C. check the clients alignment in bed D. medicate the client with an analgesic

The nurse is reinforcing patient teaching with a newly diagnosed patient with Huntington's Disease. Which statement would be appropriate to include in the teaching? a)"This is a reversible disease, so staying compliant with your drug therapy will help you not lose any cognitive function" b)"Even though the symptoms you are experiencing are severe, there is no cure but drug therapy can help manage symptoms." c) HD etiology is unknown but it could originate from exposure to toxins and viruses"

b)"Even though the symptoms you are experiencing are severe, there is no cure but drug therapy can help manage symptoms."

A patient is flying overseas for 1 week for business and packed antihypertensive medications in a suitcase. After arriving at the intended destination, the patient found that the luggage had been stolen. If the patient cannot take the medication, what condition becomes a concern? a. Isolated systolic hypertension b. Rebound hypertension c. Angina d. Left ventricular hypertrophy

b Patients need to be informed that rebound hypertension can occur if antihypertensive medications are suddenly stopped. Thus, patients should be advised to have an adequate supply of medication, particularly when traveling and in case of emergencies such as natural disasters. If traveling by airplane, patients should pack the medication in their carry-on luggage.

17. Which laboratory data is important to communicate to the health care provider for a patient who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis? (Methotrexate is an immune suppressor) a. The blood glucose is 90 mg/dL. b. The rheumatoid factor is positive. c. The white blood cell (WBC) count is 1500/µL. 5000-10000. d. The erythrocyte sedimentation rate is elevated.

c. The white blood cell (WBC) count is 1500/µL. 5000-10000.

The bone cells that function in the resorption of bone tissue are called a.osteoids b.osteocytes c.osteoclasts d.osteoblasts

c.osteoclasts Osteoclasts participate in bone remodeling by assisting in the breakdown of bone tissue.

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) a) Dysphagia owing to hardening of the esophagus b) Decreased ventilation owing to lung scarring c) Dyspnea owing to fibrotic cardiac tissue d) Productive cough e) Butterfly-shaped rash on the face

• Decreased ventilation owing to lung scarring • Dysphagia owing to hardening of the esophagus • Dyspnea owing to fibrotic cardiac tissue

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a. Low dietary fiber intake b. No regular aerobic exercise c. Weight 5 pounds above ideal weight d. Drinks wine with dinner once a week

ANS: B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? Furosemide Spironolactone Chlorothiazide Chlorthalidone

Spironolactone

Which client is most likely to develop systemic lupus erythematosus (SLE)? a) A 27-year-old black female b) A 35-year-old Hispanic male c) A 25-year-old Jewish female d) A 25-year-old white male

a) A 27-year-old black female

A 30 year old patient is admitted with a diagnosis of myasthenia gravis and worsening of symptoms. In taking a history, which of the following complaints would the nurse consider most typical? A. stooped posture, dysphagia, tremor B. numbness, dysphagia, spasticity C. fading voice, dysphagia, exercise intolerance D. Spasticity, incontinence of bladder, auditory problems

Answer Key: C

When caring for a client with hypocalcemia, the nurse should assess for: A. A decreased level of consciousness B. Tetany C. Bradycardia D. Respiratory Depression

Answer B is correct. The most common complication of hypocalcemia is overstimulation of the nerves and muscles. Tetany, which can progress to convulsions, indicated that the patient's condition is worsening. Answer A is incorrect because a decreased level of consciousness is not associated with hypocalcemia. Tachycardia, not bradycardia, is associated with hypocalcemia, making answer C incorrect. Answer D is incorrect because respiratory depression is not directly related to hypocalcemia.

During assessment of the patient with trigeminal neuralgia, the nurse should (select all that apply) A. inspect all aspects of the mouth and teeth. B. assess the gag reflex and respiratory rate and depth. C. lightly palpate the affected side of the face for edema. D. test for temperature and sensation perception on the face. E. ask the patient to describe factors that initiate an episode.

Answer Key: A, D, E

The physician orders Rocephin 2g in 100ml to infuse over 45 mins for a post-op total hip patient. The IV is to infuse via a macro drip (10 gtts per ml). The nurse should set the IV rate at: A. 12 gtts/min B. 22 gtts/min C. 32 gtts/min D. 42 gtts/min

Rationale: Answer B is correct. The total to be infused (100ml) divided by the total time in minutes (45 minutes) times the drip factor (10gtt) equals 22 gtts per minute. The other answers are mathematically incorrect.

Which of the following instructions should be included for the patient taking calcium supplements? A.The patient should take her calcium with meals B.The patient should take all her daily calcium supplements at one time C.The patient should take her calcium supplement after meals to prevent stomach upset D.The patient can use calcium- based antacids for supplement.

Rationale: Answer D is correct. Many people prefer to supplement their calcium intake with calcium- based antacids. If calcium supplements are used, they should be administered 30 minutes before meals to maximize absorption, so answer A is wrong. Calcium absorption is better if it is administered throughout the day rather than in a single dose, making answer B wrong. Calcium supplements do not cause stomach upset, so answer C is wrong.

A client comes to the walk-in clinic complaining of frequent headaches. While assessing the client's vital signs, the nurse notes the BP is 161/101 mm Hg. How would this client's BP be defined? Elevated Normal Stage 1 hypertensive Stage 2 hypertensive

Stage 2 hypertensive

B. Smoking increases the risk of developing osteoporosis.

The nurse is assessing injuries on a patient admitted to the unit who had fallen at home several hours ago. When looking at the patient's history, the nurse notices that he has smoked at least four packs of cigarettes per day for the past 60 years. What impact does smoking have on the musculoskeletal health of a patient? A. Smoking increases the risk of more falls in the elderly. B. Smoking increases the risk of developing osteoporosis. C. Smoking decreases the risk of developing osteoporosis. D. Smoking decreases the risk of a hip fracture as you age

Which of the following would be consistent with the diagnosis of rheumatoid arthritis? a) Cloudy synovial fluid b) Increased C4 complement component c) Increased red blood cell count d) Decreased ESR

a) Cloudy synovial fluid

Which of the following refers to fixation of a joint? a) Ankylosis b) Pannus c) Articulations d) Synovitis

a) Ankylosis

While performing passive range of motion for a patient, the nurse puts the ankle 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. b.inversion and eversion. Common movements that occur at the ankle include inversion, eversion, flexion, and extension.

The nurse working in the rheumatology clinic is seeing clients with rheumatoid arthritis (RA). What assessment would be most important for the client whose chart contains the diagnosis of Sjogrens syndrome? a. Abdominal assessment b. Oxygen saturation c. Renal function studies d. Visual acuity

d. Visual acuity Sjogrens syndrome is seen in clients with RA and manifests with dryness of the eyes, mouth, and vagina in females. Visual disturbances can occur. The other assessments are not related to RA and Sjogrens syndrome.

What risk factors would cause the nurse to become concerned that the client may have atherosclerotic heart disease? Select all that apply. hypertension diabetes obesity lowered triglyceride levels active lifestyle family history of early cardiovascular events

hypertension diabetes obesity family history of early cardiovascular events

A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary and secondary hypertension is what? Secondary hypertension has a specific cause. Secondary hypertension has a more gradual onset than primary hypertension. Secondary hypertension does not cause target organ damage. Secondary hypertension does not respond to antihypertensive drug therapy.

Secondary hypertension has a specific cause.

Which of the following is characterized by an increased forward curvature of the thoracic spine? A. Lordosis B. Kyphosis C. Scoliosis D. Crepitus

Kyphosis Rationale: Common deformities of the spine include kyphosis, which is an increased forward curvature of the thoracic spine.

The nurse is reviewing the diet of a client who has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine because caffeine: increases the heart rate and causes vasoconstriction. reduces the heart rate and leads to a coronary artery disease. reduces the heart rate and causes low blood pressure. increases the heart rate and causes angina.

increases the heart rate and causes vasoconstriction.

A client is taking amiloride and lisinopril for the treatment of hypertension. What laboratory studies should the nurse monitor while the client is taking these two medications together? Magnesium level Potassium level Calcium level Sodium level

Potassium level

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? "A glass of red wine each day will lower my blood pressure." "I should eliminate caffeine from my diet to lower my blood pressure." "If I include less fat in my diet, I'll lower my blood pressure." "Limiting my salt intake to 2 grams per day will improve my blood pressure."

"Limiting my salt intake to 2 grams per day will improve my blood pressure."

High blood pressure is highly prevalent in the United States. Approximately how many people have high blood pressure in the United States? 1 in 3 adults 1 in 6 adults 1 in 7 adults 1 in 10 adults

1 in 3 adults

1) The nurse is assessing a postmenopausal client. Which question should the nurse ask to assess for signs of osteoporosis? A) "Have you experienced any palpitations?" B) "Are you having any low back pain?" C) "Are you having problems with swelling in your feet?" D) "Is constipation a problem for you?"

Answer: B Explanation: A client with osteoporosis will often present with low back pain as well as a decrease in height. Palpitations, constipation, and swelling are not early signs of osteoporosis. Page Ref: 857

A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of her left eye. Correct interpretation of this assessment finding indicates which of the following? 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.

2. Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine (Plaquenil) in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals. Although cataracts may develop in young adults, they are less likely, and damage from the hydroxychloroquine is the most obvious at-risk factor. Eyesight is not affected by the disease process of rheumatoid arthritis.

The nurse is developing a care plan with an older adult and is instructing the client that hypertension can be a silent killer. The nurse should instruct the client to be aware of signs and symptoms of other system failures and encourage the client to report signs of which of the following diseases that are often a result of undeteced high blood pressure? a) cerebrovascular accidents (CVAs) b) Liver disease c) Myocardial Infarction d) Pulmonary disease

A Hypertension is referred to as the silent killer for adults, because until the adult has significant damage to other systems, the hypertension may go undetected. CVAs can be related to long-term hypertension. Liver or pulmonary disease is not generally associated with hypertension. Myocardial infarction is generally related to coronary artery disease.

An industrial health nurse at a larger printing plant finds a male employee's BP to be elevated on two occasions 1 month apart and refers him to his private physician. The employee is about 25 lbs overweight and has smoked a pack of cigarettes daily for more than 20 years. The client was prescribed Atenolol (Tenormin) for the hypertension. The nurse should instruct the client to: a) avoid sudden discontinuation of the drug b) monitor the blood pressure annually c) follow a 2 g sodium diet d) discontinue the medication if severe headaches develop

A Sudden discontinuation of this drug is dangerous because it may exacerbate symptoms. This medication should not be discontinued without a physicians order.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: a) Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. b) Increases norepinephrine secretion and thus decreases blood pressure and heart rate. c) Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. d) Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

A Propranolol is a beta-adrenergic blocking agent. Actions of propranolol include reducing heart rate, decreasing myocardial contractility, and slowing conduction.

When developing a presentation for a local community group on hypertension, the nurse integrates information about the importance of blood pressure control. Which of the following would the nurse include? SATA a) HTN increases the buildup of atherosclerotic plaque b) HTN increases risk of stroke c) HTN increases risk fo colorectal carcinoma d) HTN increases risk fo liver disease e) HTN increases the workload of the heart

A B E Hypertension is serious, because is causes the heart to work too hard and contributes to atherosclerosis. HTN also increases the risk of heart disease, heart failure (HF), kidney disease, blindness, and stroke.

C. impaired tissue perfusion

A client has sustained a closed fracture and has just has a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by what condition? A. Infection under the cast B. the anxiety of the client C. impaired tissue perfusion D. the newness of the fracture

The nurse provides instructions to a 30-year-old female office worker who has low back pain. Which statement by the patient requires an intervention by the nurse? A. "Acupuncture to the lower back would cause irreparable nerve damage." B. "Smoking may aggravate back pain by decreasing blood flow to the spine." C. "Sleeping on my side with knees and hips bent reduces stress on my back." D. "Switching between hot and cold packs provides relief of pain and stiffness."

A. "Acupuncture to the lower back would cause irreparable nerve damage." Acupuncture is a safe therapy when the practitioner has been appropriately trained. Very fine needles are inserted into the skin to stimulate specific anatomic points in the body for therapeutic purposes.

The nurse is teaching a client about what to expect during a cerebral angiographic examination. Which statement by the client indicates a need for further teaching? A. "I can't have this test because I am allergic to shellfish." B. "My head will be strapped in place so I don't move." C. "I'll have to keep my leg very still after the procedure." D. "I'll have a temporary dressing on my groin."

A. "I can't have this test because I am allergic to shellfish."

The nurse admits a 55-year-old female with multiple sclerosis to a long-term care facility. Which finding is of most immediate concern to the nurse? A. Ataxic gait B. Radicular pain C. Severe fatigue D. Urinary retention

A. Ataxis gait An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in individuals with gait instability or visual or cognitive impairments. The other signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also occur in the patient with multiple sclerosis and need to be managed, but are not the priority.

A retired 66- year- old female patient is being evaluated for osteoporosis as part of a yearly physical exam. The patient states that she is a smoker, watches television for most of the day, and has been hospitalized twice with fractures within the last year. Based on this information, the nurse suspects which condition? A.Low bone mass leading to increased bone fragility B.Degeneration of the articular cartilage C.Recurrent attacks of acute arthritis D.Personality changes caused by chronic nature of illness

A. Low bone mass leading to increased bone fragility ' Low bone mass, structural deterioration of bone tissue leading to bone fragility, and increased susceptibility to fractures are seen with osteoporosis. The patient also has risk factors associated with osteoporosis: smoking, sedentary lifestyle, and being female and menopausal. Degenerative changes are associated with frequent exacerbations of arthritis. There is no indication of personality change in this patient.

The nurse is performing a musculoskeletal assessment of an 81-year-old female patient whose mobility has been progressively decreasing in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg? A. Observe the patient's unassisted ROM in the affected leg. B. Perform passive ROM, asking the patient to report any pain. C. Ask the patient to lift progressive weights with the affected leg. D. Move both of the patient's legs from a supine position to full flexion.

A. Observe the patient's unassisted ROM in the affected leg. Passive ROM should be performed with extreme caution and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safe than asking the patient to lift weights with her legs.

The nurse assessing a patient with newly diagnosed trigeminal neuralgia will ask the patient about A. triggers leading to facial discomfort. B. weakness on the affected side of the face. C. visual problems caused by ptosis. D. poor appetite caused by loss of taste.

A. triggers leading to facial discomfort.

Which BP finding by the nurse indicates that no changes in therapy are needed for a patient with stage 1 hypertension who has a history of heart failure? a. 108/64 mm Hg b. 128/76 mm Hg c. 140/90 mm Hg d. 136/ 82 mm Hg

ANS: B The goal for antihypertensive therapy for a patient with hypertension and heart failure is a BP of <130/80 mm Hg. The BP of 108/64 may indicate overtreatment of the hypertension and an increased risk for adverse drug effects. The other two blood pressures indicate a need for modifications in the patient's treatment.

The nurse in the emergency department received change-of-shift report on four patients with hypertension. Which patient should the nurse assess first? a. 52-year-old with a BP of 212/90 who has intermittent claudication b. 43-year-old with a BP of 190/102 who is complaining of chest pain c. 50-year-old with a BP of 210/110 who has a creatinine of 1.5 mg/dL d. 48-year-old with a BP of 200/98 whose urine shows microalbuminuria

ANS: B The patient with chest pain may be experiencing acute myocardial infarction and rapid assessment and intervention is needed. The symptoms of the other patients also show target organ damage, but are not indicative of acute processes.

The nurse is assessing a patient who has been admitted to the intensive care unit (ICU) with a hypertensive emergency. Which finding is most important to report to the health care provider? a. Urine output over 8 hours is 200 mL less than the fluid intake. b. The patient is unable to move the left arm and leg when asked to do so. c. Tremors are noted in the fingers when the patient extends the arms. d. The patient complains of a severe headache with pain at level 8/10 (0 to 10 scale).

ANS: B The patient's inability to move the left arm and leg indicates that a hemorrhagic stroke may be occurring and will require immediate action to prevent further neurologic damage. The other clinical manifestations also likely are caused by the hypertension and will require rapid nursing actions, but they do not require action as urgently as the neurologic changes.

A patient has been diagnosed with possible white coat hypertension. Which action will the nurse plan to take next? a. Schedule the patient for frequent BP checks in the clinic. b. Instruct the patient about the need to decrease stress levels. c. Tell the patient how to self-monitor and record BPs at home. d. Teach the patient about ambulatory blood pressure monitoring.

ANS: C Having the patient self-monitor BPs at home will provide a reliable indication about whether the patient has hypertension. Frequent BP checks in the clinic are likely to be high in a patient with white coat hypertension. Ambulatory blood pressure monitoring may be used if the data from self-monitoring is unclear. Although elevated stress levels may contribute to hypertension, instructing the patient about this is unlikely to reduce BP.

Which information should the nurse include when teaching a patient with newly diagnosed hypertension? a. Dietary sodium restriction will control BP for most patients. b. Most patients are able to control BP through lifestyle changes. c. Hypertension is usually asymptomatic until significant organ damage occurs. d. Annual BP checks are needed to monitor treatment effectiveness.

ANS: C Hypertension is usually asymptomatic until target organ damage has occurred. Lifestyle changes and sodium restriction are used to help manage blood pressure, but drugs are needed for most patients. BP should be checked by the health care provider every 3 to 6 months.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a. Encourage oral fluids to prevent dry mouth or dehydration. b. Instruct the patient to ask for help if heart palpitations occur. c. Ask the patient to request assistance when getting out of bed. d. Teach the patient that headaches may occur with this medication.

ANS: C Labetalol decreases sympathetic nervous system activity by blocking both α- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension. Heart palpitations, dehydration, and headaches are possible side effects of other antihypertensives.

The charge nurse observes a new RN doing discharge teaching for a hypertensive patient who has a new prescription for enalapril (Vasotec). The charge nurse will need to intervene if the new RN tells the patient to a. check the BP with a home BP monitor every day. b. move slowly when moving from lying to standing. c. increase the dietary intake of high-potassium foods. d. make an appointment with the dietitian for teaching.

ANS: C The ACE inhibitors cause retention of potassium by the kidney, so hyperkalemia is a possible adverse effect. The other teaching by the new RN is appropriate for a patient with newly diagnosed hypertension who has just started therapy with enalapril.

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a. "The medication may not work as well if I take any aspirin." b. "The doctor may order a blood potassium level occasionally." c. "I will call the doctor if I notice that I have a frequent cough." d. "I won't worry if I have a little swelling around my lips and face."

ANS: D Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

A 38 year old woman has newly diagnosed Multiple Sclerosis (MS) and asks the nurse what is going to happen to her. The best response by the nurse is: A. " You need to plan for continuous loss of movement, sensory functions and mental capabilities" B. " Most people with MS have periods of attacks and remission, with progressively more nerve damage over time" C. " You will most likely have a steady course of chronic progressive nerve damage that will change your personality" D. " It is common for people with MS to have an acute attack of weakness and then a reversal of MS."

Answer Key: B

When a patient with hypertension who has a new prescription for atenolol (Tenormin) returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first? a. Provide information about the use of multiple drugs to treat hypertension. b. Teach the patient about the reasons for a possible change in drug therapy. c. Remind the patient that lifestyle changes also are important in BP control. d. Question the patient about whether the medication is actually being taken.

ANS: D Since noncompliance with antihypertensive therapy is common, the nurse's initial action should be to determine whether the patient is taking the atenolol as prescribed. The other actions also may be implemented, but these would be done after assessing patient compliance with the prescribed therapy.

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a. The patient avoids eating nuts or nut butters. b. The patient restricts intake of dietary protein. c. The patient has only one cup of coffee in the morning. d. The patient has a glass of low-fat milk with each meal.

ANS: D The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing what health problem? Acute kidney injury Right ventricular hypertrophy Glaucoma Anemia

Acute kidney injury

A community health nurse is planning an educational campaign addressing hypertension. The nurse should anticipate that the incidence and prevalence of hypertension are likely to be highest among members of what ethnic group? Pacific Islanders African-Americans Asians Hispanics

African-Americans

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? Age Obesity Inactivity Dyslipidemia

Age

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________. A. metabotropic; muscle weakness B. nicotinic acetylcholine; muscle weakness C. dopaminergic adrenergic; muscle contraction D. nicotinic adrenergic; muscle contraction

Answer Key: B

6) An adult client who resides in a long-term care facility is diagnosed with osteoporosis. The client has a history of falls and dementia. Which nursing intervention will best aid in meeting an outcome goal of injury prevention for this client? A) Using furniture as obstacles to keep the client in the bed B) Keeping the bed in the lowest position C) Keeping a nightlight on in the hallway D) The use of wrist restraints

Answer: B Explanation: A) Keeping the bed in the lowest position will reduce the incidence of injury should the client attempt to get up. The use of restraints could increase the incidence of injury. Using the furniture as an obstacle could cause injury if the client is able to get up. In a long-term care facility, a nightlight should be provided in the room so the client can see to use the restroom.

2) A nurse is conducting a health history on an older adult client. Which assessment finding indicates the client is at risk for osteoporosis? A) Having a body mass index (BMI) that indicates obesity B) Using glucocorticoids for 10 years because of a chronic lung disorder C) Eating three to five servings of shrimp and liver per week D) Drinking three glasses of skim milk daily

Answer: B Explanation: A) Long-time use of corticosteroids is a risk factor for developing osteoporosis. Obesity is not a risk factor for osteoporosis. Skim milk is a good source of calcium and vitamin D, which prevents or slows osteoporosis. A diet rich in shellfish and organ meats is high in purine, which may predispose the client to gout.

An important question to ask a patient with low back pain is: A. "How does your back pain affect your activities of daily living?" B. "Tell me about your pain and what interventions are helpful in managing your pain." C. "How long have you had back pain?" D. "Have you ever had magnetic resonance imaging to find a cause for your back pain?"

Answer: B Rationale: The primary concern for patients with back pain is continuous pain. Obtaining a thorough assessment of the patient's pain level and effective interventions to treat pain is an important element of the nursing assessment.

3) The nurse is planning care for a female adult client who is high-risk for developing osteoporosis. Which interventions will decrease the client's risk of developing this health problem? Select all that apply. A) Increasing the intake of alcoholic beverages B) Isometric exercise for at least 30 minutes three times per week C) Weight-bearing exercises such as walking D) Having a yearly dual-energy x-ray absorptiometry (DEXA) test E) A diet with adequate amounts of calcium and vitamin D

Answer: C, E Explanation: A) Interventions that may decrease this client's risk of developing osteoporosis include regular weight-bearing exercise, such as walking, as this activity slows bone loss. Other intervention include encouraging clients to consume adequate amounts of calcium and vitamin D in their diets to prevent osteoporotic fracture. A DEXA test measures bone density, but it does not decrease the client's risk for developing osteoporosis. Measures to prevent or treat osteoporosis include limiting the intake of beverages containing alcohol, caffeine, and phosphorus. Isometric exercises are not effective against osteoporosis.

4) The nurse identifies the nursing diagnosis Imbalanced Nutrition: Less Than Body Requirements as appropriate for a client with osteoporosis. Which client statement indicated to the nurse that this nursing diagnosis was appropriate? A) "I like to remove all of the fat from the meat I eat." B) "I am trying to eat a low-carb diet." C) "I plan to start eating out less." D) "I am allergic to dairy products."

Answer: D Explanation: A) The client who is allergic to dairy products may not take in much calcium, which increases the risk of osteoporosis, so focusing on diet would be a priority for this client. The statements about removing fat, eating a low-carb diet, and eating out less are healthy changes for many individuals that help reduce calorie intake, but they would not address one of the root causes of osteoporosis, deficient calcium intake.

A patient has a new order for open magnetic resonance imaging (MRI) to evaluate for right femur osteomyelitis. Which information obtained by the nurse indicates that the nurse should consult with the health care provider before scheduling an MRI? a. The patient is claustrophobic. b. The patient wears a hearing aid. c. The patient is allergic to shellfish. d. The patient has a pacemaker.

Answer: D Rationale: Patients with permanent pacemakers cannot have MRI. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Contrast medium will not be used, so shellfish allergy is not a contraindication to MRI. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity

Which diagnostic test is used to confirm ALS? A. Electromyelogram (EMG) B. Muscle biopsy C. Serum creatinine D. Pulmonary function test

B. Muscle biopsy

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells? A. Osteoclasts add canaliculi. B. Osteoblasts deposit new bone. C. Osteocytes are mature bone cells. D. Osteons create a dense bone structure.

B. Osteoblasts deposit new bone. Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian systems create a dense bone structure, but these are not involved with bone remodeling.

A patient taking metoprolol (Lopressor) for hypertension reports all of the following side effects. Fo which side effect will you notify the prescriber? a) increased urination during the daytime b) Heart rate of 68/min c) chest pain during exercise d) decreased sexual ability

C

Essential hypertension would be diagnosed in a 40-year-old male whose blood pressure readings were consistently at or above which of the following? a) 120/90 mmHg b) 130/85 mmHg c) 140/90 mmHg d) 160/80 mmHg

C American Heart Association standards define hypertension as a consistent systolic blood pressure level greater than 140 mm Hg and a consistent diastolic blood pressure level greater than 90 mm Hg.

After giving a patient the initial dose of oral labetalol (Normodyne) for treatment of hypertension, which action should the nurse take? a) encourage oral fluids to prevent dry mouth or dehydration b) instruct the patient to ask for help if heart palpitations occur c) ask the patient to request assistance when getting out of bed d) teach the patient that headaches may occur with this medication

C Labetalol decreases sympathetic nervous system activity by blocking both α- and β-adrenergic receptors, leading to vasodilation and a decrease in heart rate, which can cause severe orthostatic hypotension.

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? a) the patients most recent BP reading is 156/94 mmHg b) the patient pulse has dropped from 64 to 58 beats/min c) the patient has developed wheezes throughout the lung fields d) the patient complains that the fingers and toes feel quite cold

C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with β-receptor blockade but do not require any change in therapy.

The client with experiencing status epilepticus is admitted to the intensive care unitWhich collaborative intervention should the nurse anticipate? A. Assess the client's neurological status every hour. B. Monitor the client's heart rhythm via telemetry. C. Administer an anticonvulsant medication by IV. D. Prepare to administer a glucocorticosteroid orally.

C. Administer an anticonvulsant medication by IV.

Which intervention should the nurse take with the client recently diagnosed with ALS? A. Discuss a percutaneous gastrostomy tube. B. Explain how a fistula is accessed. C. Provide an advance directive. D. Refer to a PT for leg braces.

C. Provide an advance directive.

The nurse is caring for a client with Parkinson's disease. Which finding about gait should the nurse expect to note in the client? A. Walking on the toes B. Unsteady and staggering C. Shuffling and propulsive D. Broad-based and waddling

C. Shuffling and propulsive

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. An appropriate action by the nurse is to a. administer prescribed opioids to relieve the pain. b. explain the reasons for phantom limb pain. c. loosen the compression bandage to decrease incisional pressure. d. remind the patient that this phantom pain will diminish over time.

Correct Answer: A Rationale: Phantom limb pain is treated like any other type of postoperative pain would be treated. Explanations of the reason for the pain may be given, but the nurse should still medicate the patient. The compression bandage is left in place except during physical therapy or bathing. Although the pain may decrease over time, it still requires treatment now. Cognitive Level: Comprehension Text Reference: pp. 1660-1661 Nursing Process: Implementation NCLEX: Physiological Integrity

The health care provider initially orders bed rest for a patient with an open-book pelvic fracture. Which assessment data obtained by the nurse are most important to report to the health care provider? a. The bowel tones are absent. b. There is an unusual amount of pelvic movement. c. The patient complains of level 4 abdominal pain on a 10-point pain scale. d. There is bruising of the abdomen.

Correct Answer: A Rationale: Absent bowel tones may be due to complications of pelvic fractures such as paralytic ileus, hemorrhage, or trauma to the bladder, urethra, or colon. Unusual pelvic movement, abdominal pain, and abdominal bruising would be expected with this type of injury.

A patient is to be discharged from the hospital 4 days after undergoing a total hip arthroplasty. A statement by the patient that indicates a need for additional discharge instructions is a. "I should not cross my legs while sitting." b. "I can sleep in any position that is comfortable for me." c. "I will use a toilet elevator on the toilet seat." d. "I will have someone else put on my shoes and socks."

Correct Answer: B Rationale: The patient needs to sleep in a position that allows excessive internal rotation or flexion of the hip. The other patient statements indicate that the patient has understood the teaching. Cognitive Level: Application Text Reference: p. 1654 Nursing Process: Evaluation NCLEX: Physiological Integrity

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles.

Decreases the production of neurotransmitters that constrict peripheral arterioles.

Which stroke risk factor for a 48-yr-old male patient in the clinic is most important for the nurse to address? A. The patient works at a desk and relaxes by watching television. B. The patient is 25 lb above the ideal weight. C. The patient drinks a glass of red wine with dinner daily. D. The patient's usual blood pressure (BP) is 170/94 mm Hg.

D. The patient's usual blood pressure (BP) is 170/94 mm Hg.

Choose the statements that correctly match the hypertensive medication with its side effect. Select all that apply. With ACE inhibitors, assess for bradycardia. Beta-blockers may cause sedation. Direct vasodilators may cause headache and tachycardia. Cough is a common side effect of adrenergic inhibitors. With thiazide diuretics, monitor serum potassium concentration.

Direct vasodilators may cause headache and tachycardia. With thiazide diuretics, monitor serum potassium concentration.

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? dizziness persistent cough blurred vision tremor

Dizziness

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? The BP is always higher in a hypertensive emergency. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. Hypertensive urgency is treated with rest and benzodiazepines to lower BP. Hypertensive emergencies are associated with evidence of target organ damage.

Hypertensive emergencies are associated with evidence of target organ damage

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? Hypertensive emergency Hypertensive urgency Primary hypertension Secondary hypertension

Hypertensive emergency

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? Postural hypertension and resulting injury Rebound hypertension Sexual dysfunction Postural hypotension and resulting injury

Postural hypertension and resulting injury

The primary defect in osteomalacia is a deficiency in which vitamin? A. B12 B. D C. E D. C

b. D Rationale: The primary defect in osteomalacia is a deficiency of activated vitamin D, which promotes calcium absorption from the GI tract and facilitates mineralization of bone.

D. Secure the abduction wedge between the legs until the surgeon requests removal.

The LPN/LVN is caring for a patient who has had a total hip replacement. Which intervention should be implemented for this patient to help prevent dislocation? A. Adjust the patient's chair so that the hips are flexed in a normal position. B. Ensure the surgical bone cement remains firmly bonded with the prosthesis. C. Assist the patient to bear weight on the operative side within the first 24 hours. D. Secure the abduction wedge between the legs until the surgeon requests removal.

A. 1 week

The nurse is caring for a patient who has experienced a stroke. The nurse has implemented range-of-motion exercises. The nurse recognizes that contractures may begin within what time period? A. 1 week B. 1 month C. 2 weeks D. 24 hours

C. 5-second nail bed capillary refill

The patient in the outpatient surgery center has just returned from surgery to decompress the medial nerve as treatment for carpal tunnel syndrome. Which assessment finding immediately after surgery would alert the nurse to a possible complication? A. Nail beds that are pink B. Numbness of the fingertips C. 5-second nail bed capillary refill D. Fingertips that are warm to the touch

Papilledema is a fairly common symptom of elevated blood pressure. The best way to detect this condition is through: a. ophthalmic examination. b. using a sphygmomanometer. c. laboratory tests. d. an MRI.

a Papilledema is an edema of the optic nerves, and thus needs an ophthalmic examination for detection.

Which of the following terms refers to fixation or immobility of a joint? a) Ankylosis b) Arthroplasty c) Hemarthrosis d) Diarthrodial

a) Ankylosis

12. The nurse suggests that a patient recently diagnosed with rheumatoid arthritis (RA) plan to start each day with a. a warm bath followed by a short rest. b. a short routine of isometric exercises. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness.

a. a warm bath followed by a short rest.

A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic treatment does the nurse apply? a. Heating pad b. Ice packs c. Splints d. Wax dip

b. Ice packs Ice is best for acute inflammation. Heat often helps with joint stiffness. Splinting helps preserve joint function. A wax dip is used to provide warmth to the joint which is more appropriate for chronic pain and stiffness.

3. The nurse is assessing a 65-year-old female patient with newly diagnosed trigeminal neuralgia will ask the patient about a. Visual problems caused by ptosis. b. Triggers leading to facial discomfort. c. Poor appetite caused by loss of taste. d. Weakness on the affected side of the face.

b. Triggers leading to facial discomfort.

The nurse is providing nutrition teaching to a patient with Parkinson's. Which statement made by the patient would indicate the need for further instruction by the nurse? a."I should increase my fiber intake" b."I'm going to make sure I get enough fish and beef to ensure I get adequate amounts of Vitamin B6." c."I may need to work with a speech therapist as my disease progresses." d."I will eat 6 small meals a day."

b."I'm going to make sure I get enough fish and beef to ensure I get adequate amounts of Vitamin B6."

You are teaching a patient with osteopenia. What is important to include in the teaching plan? a.Lose weight. b.Stop smoking. c.Eat a high-protein diet. d.Start swimming for exercise

b.Stop smoking. Patients with osteopenia should be instructed to quit smoking in order to decrease loss of bone mass.

Ms. Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of teaching plan for her condition? a) Encouraging the client to eat a healthy diet b) Avoiding caffeine and alcohol c) Applications of ice d) Regular exercise and stress reduction

c) Applications of ice

2. A nurse is assessing the recent health history of a 63-year-old patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which activity pattern? a. Bed rest with bathroom privileges b. Daily high-impact aerobic exercise c. Regular exercise program of walking d. Frequent rest periods with minimal exercise

c. Regular exercise program of walking

An older adult client has newly diagnosed stage 2 hypertension. The health care provider has prescribed Chlorothiazide and Benazepril. What will the nurse monitor this client for? a. Postural hypertension and resulting injury b. Rebound hypertension c. Sexual dysfunction d. Postural hypotension and resulting injury

d Antihypertensive medication can cause hypotension, especially postural hypotension that may result in injury. Rebound hypertension occurs when antihypertensive medication is stopped abruptly. Sexual dysfunction may occur, especially with beta blockers, but other medications are available should this problem ensue. This is not immediately a priority concern. Antihypertensive medications do not usually cause postural hypertension.

A blood pressure (BP) of 140/90 mm Hg is considered to be normal. prehypertension. hypertension. a hypertensive emergency.

hypertension

A nurse is caring for a client who has hypertension and diabetes mellitus. The client's blood pressure this morning was 150/92 mm Hg. When the client asks the nurse what his or her blood pressure should be, what is the nurse's most appropriate response? "Your blood pressure is fine. Just keep doing what you're doing." "The current recommendation is for everyone to have blood pressure of 140/90 mm Hg or lower." "The lower the better. Blood pressure of 130/80 mm Hg is best for everyone." "Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

"Clients with diabetes should have a lower blood pressure goal. You should strive for 120/80 mm Hg."

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client? "Take this medication before going to bed." "Increase the amount of fruits and vegetables you eat." "You may develop nasal congestion or depression while taking this medication." "You may drink alcohol while taking this medication."

"Increase the amount of fruits and vegetables you eat."

A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? "Eat a banana every day because this medication causes moderate hyperkalemia." "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium." "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." "This medication increases sodium levels in your blood, so cut down on your salt."

"This medication can cause low blood pressure and dizziness, especially when you get up suddenly."

A client with newly diagnosed hypertension has come to the clinic for a follow-up visit. The client asks the nurse why she has to come in so often. What would be the nurse's best response? "We do this so we can identify any of the early symptoms of a stroke." "We do this to determine how your blood pressure changes throughout the day." "We do this to see how often you should change your medication dose." "We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."

"We do this to make sure your health is stable. We'll then monitor it at routinely scheduled intervals."

2. A client with rheumatoid arthritis states, "I can't do my household chores without becoming tired. My knees hurt whenever I walk." Which nursing diagnosis would be most appropriate? 1. Activity intolerance related to fatigue and pain. 2. Self-care deficit related to increasing joint pain. 3. Ineffective coping related to chronic pain. 4. Disturbed body image related to fatigue and joint pain.

1. Based on the client's complaints, the most appropriate nursing diagnosis would be Activity intolerance related to fatigue and pain. Nursing interventions would focus on helping the client conserve energy and decrease episodes of fatigue. Although the client may develop a self-care deficit related to the activity intolerance and increasing joint pain, the client is voicing concerns about household chores and difficulty around the house and yard, not self-care issues. Over time, the client may develop ineffective coping or body image disturbance as the disorder becomes chronic with increasing pain and fatigue.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3. Initially, most clients with early symptoms of rheumatoid arthritis complain of early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3. Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks. Pain relief is a high priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures.

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which of the following, if stated by the client, would indicate the need for additional teaching? 1. Pushing with palms when rising from a chair. 2. Holding packages close to the body. 3. Sliding objects. 4. Carrying a laundry basket with clinched fingers and fists.

4. Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

A nurse is assisting with checking blood pressures at a local health care fair. To which client would the nurse pay particular attention? A 16-year-old girl A 40-year-old African-American man A 50-year-old Caucasian woman An Asian adult man

A 40-year-old African-American man

A nurse is teaching a larger female client about alcohol intake and how it affects hypertension. The client asks if drinking two beers at night is an acceptable intake. What answer by the nurse is best? a) no, women should only have one beer a day as a general rule b) no, you should not drink any alcohol with hypertension c) yes, since you are larger, you can have more alcohol d) yes, two beers per day is acceptable amount of alcohol

A Alcohol intake should be limited to 2 drink per day for men and 1 drink per day for women. A "drink" is classified as one beer, 1.5 ox of har liquor, or 5 ounces of wine. Limited alcohol intake is acceptable with hypertension. The women's size does not matter.

Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is: a) decrease in heart rate b) lessening of fatigue c) improvement in blood sugar levels d) increase in urine output

A The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output.

A nurse is educating a group of older adults on the impact of lifestyle changes on hypertension. The nurse includes which of the following in the education? (SATA) a) learn how to read and interpret food labels b) the sodium content of commonly consumed foods c) techniques to incorporate more physical activity into the daily routine d) the actions of calcium channel blocker medications on hypertension e) the importance of adhering to pharmacological regimens for treatment of hypertension

A B C Options A and B address dietary interventions to control hypertension. Option C addresses physical activity. These all involve lifestyle changes to control hypertension. Options D and E are related to pharmacological treatment of hypertension.

A client is taking clonidine (Catapres) for treatment of hypertension. The nurse should teach the client about which of the following common adverse effects of this drug? SATA a) Dry Mouth b) Hyperkalemia c) Impotence d) Pancreatitis e) Sleep disturbance

A C E Clonidine (Catapres) is a central-acting adrenergic antagonist. It reduces sympathetic outflow from the central nervous system. Dry mouth, impotence, and sleep disturbances are possible adverse effects.

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a client with hypertension, the nurse learns that the client has a family history of hypertension and she herself has high cholesterol and lipid levels. The client says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk factor for hypertension? Hyperlipidemia Excessive alcohol intake A family history of hypertension Closer adherence to medical regimen

A family history of hypertension

B. petaling the cast edges with adhesive tape

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which intervention? A. massaging the skin at the rim of the cast B. petaling the cast edges with adhesive tape C. using a rough file to smooth the cast edges D. applying lotion to the skin at the rim of the cast

A. "I should hold the muscle in contraction for at least a minute."

A patient on bed rest has been instructed on performing quadriceps setting exercises. What statement by the patient indicates the need for further instruction? A. "I should hold the muscle in contraction for at least a minute." B. "I should release the muscle and count to five before contracting again." C."The exercises will benefit me most if I perform them three to four times a day." D. "These exercises are good to recondition my muscles in preparation for getting out of bed."

he nurse is teaching a client about taking a new prescription for pyridostigmine. Which statements by the nurse indicate correct information about this drug? Select all that apply. A. "Avoid opioids and other sedating drugs when taking this medication." B. "Report increased mucous secretions and sweating immediately to the primary health care provider." C. "Take the prescribed medication after meals to increase intestinal absorption." D. "Avoid taking antibiotics, especially neomycin, while on this medication." E. "Maintain the exact same dose of this medication every day."

A. "Avoid opioids and other sedating drugs when taking this medication." B. "Report increased mucous secretions and sweating immediately to the primary health care provider." D. "Avoid taking antibiotics, especially neomycin, while on this medication."

The nurse provides health teaching for a client beginning glatiramer acetate therapy. Which statement by the client indicates a need for additional teaching? A. "I'll take this drug with food every morning." B. "I'll look for signs of skin reaction at the injection site." C. "I'll stay away from kids who have colds." D. "I'll avoid large crowds so I don't get sick."

A. "I'll take this drug with food every morning."

A 54-year-old patient with acute osteomyelitis asks the nurse how this problem will be treated. Which response by the nurse is most appropriate? A. "IV antibiotics are usually required for several weeks." B. "Oral antibiotics are often required for several months." C. "Surgery is almost always necessary to remove the dead tissue that is likely to be present." D. "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."

A. "IV antibiotics are usually required for several weeks." The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. Surgery may be used for chronic osteomyelitis, which may include debridement of the devitalized and infected tissue and irrigation of the affected bone with antibiotics.

Which of the following interventions will the healthcare provider put in place when caring for a patient who has been diagnosed with Huntington's Disease (HD)? Select all that apply. A. Auscultate the patient's lung sounds B. Advise the patient to make position changes slowly C. Advocate for a diet that consists of broths and liquids that help prevent aspiration D. Educate the patient that Isocarboxazid (Marplan) and tetrabenazine (Xenazine) should be taken together 2 hours before bedtime to help alleviate insomnia

A. Auscultate the patient's lung sounds B. Advise the patient to make position changes slowly

A 50-year-old patient is reporting a sore shoulder after raking the yard. The nurse should suspect which problem? A. Bursitis B. Fasciitis C. Sprained ligament D. Achilles tendonitis

A. Bursitis Bursitis is common in adults over age 40 and with repetitive motion, such as raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone, not the shoulder, and causes pain with walking or running. A sprained ligament occurs when a ligament is stretched or torn from a direct injury or sudden twisting of the joint, not repetitive motion.

Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy? A. Corticosteroids B. β-Adrenergic blockers C. Antiplatelet aggregators D. Calcium-channel blockers

A. Corticosteroids Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly associated with damage to the musculoskeletal system.

What findings can be identified with the use of radiography of the spine? A. Fracture, dislocation, infection, osteoarthritis, or scoliosis B. Infections, tumors, and bone marrow abnormalities C. Soft tissue lesions adjacent to the vertebral column D. Spinal nerve root disorders

A. Fracture, dislocation, infection, osteoarthritis, or scoliosis Radiography of the spine may demonstrate a fracture, dislocation, infection, osteoarthritis, or scoliosis. Bone scan and blood studies may disclose infections, tumors, and bone marrow abnormalities. Computed tomography is useful in identifying soft tissue lesions adjacent to the vertebral column. An electromyogram is used to evaluate spinal nerve root disorders.

10. The clinic nurse is providing dietary instructions to a patient diagnosed with gout. The nurse will instruct the patient to avoid which foods high in purine? SELECT ALL THAT APPLY. A. Goose. B. Carrots. C. Chicken. D. Sardines. E. Beef liver.

A. Goose. D. Sardines. E. Beef liver.

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in this group of joints? (Select all that apply.) A. Hinge joint of the knee B. Ligaments joining the vertebrae C. Fibrous connective tissue of the skull D. Ball and socket joint of the shoulder or hip E. Cartilaginous connective tissue of the pubis joint

A. Hinge joint of the knee D. Ball and socket joint of the shoulder or hip The diarthrodial joints include the hinge joint of the knee and elbow, the ball and socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are synarthrotic joints.

18. The nurse would expect the patient with fibromyalgia to report which manifestations? SELECT ALL THAT APPLY. A. Sleep disturbances. B. Multiple tender points. C. Cardiac palpitations and dizziness. D. Multijoint pain with inflammation and swelling. E. Widespread bilateral, burning musculoskeletal pain.

A. Sleep disturbances. B. Multiple tender points. E. Widespread bilateral, burning musculoskeletal pain.

During assessment of the patient with trigeminal neuralgia, the nurse should (select all that apply) A. inspect all aspects of the mouth and teeth. B. assess the gag reflex and respiratory rate and depth. C. lightly palpate the affected side of the face for edema. D. test for temperature and sensation perception on the face. E. ask the patient to describe factors that initiate an episode.

A. inspect all aspects of the mouth and teeth. D. test for temperature and sensation perception on the face. E. ask the patient to describe factors that initiate an episode.

After a patient experienced a brief episode of tinnitus, diplopia, and dysarthria with no residual effects, the nurse anticipates teaching the patient about A. oral low-dose aspirin therapy. B. heparin intravenous infusion. C. cerebral aneurysm clipping. D. tissue plasminogen activator (tPA).

A. oral low-dose aspirin therapy.

The nurse is caring for a client diagnosed with Guillain Barre Syndrome. Which assessment finding requires nursing action? Select all that apply A.Blood pressure of 80/42 B.A respiratory rate of 24 C.A peripheral oxygen saturation of 85% D. Diminished breath sounds in all lung fields

A.Blood pressure of 80/42 C.A peripheral oxygen saturation of 85% D. Diminished breath sounds in all lung fields

The nurse is reviewing the laboratory tests for a patient who has recently been diagnosed with hypertension. Which result is most important to communicate to the health care provider? a. Serum creatinine of 2.6 mg/dL b. Serum potassium of 3.8 mEq/L c. Serum hemoglobin of 14.7 g/dL d. Blood glucose level of 98 mg/dL

ANS: A The elevated creatinine indicates renal damage caused by the hypertension. The other laboratory results are normal.

Which nursing action should the nurse take first in order to assist a patient with newly diagnosed stage 1 hypertension in making needed dietary changes? a. Have the patient record dietary intake for 3 days. b. Give the patient a detailed list of low-sodium foods. c. Teach the patient about foods that are high in sodium. d. Help the patient make an appointment with a dietitian.

ANS: A The initial nursing action should be assessment of the patient's baseline dietary intake through a 3-day food diary. The other actions may be appropriate, but assessment of the patient's baseline should occur first.

Which assessment finding for a patient who is receiving furosemide (Lasix) to treat stage 2 hypertension is most important to report to the health care provider? a. Blood glucose level of 180 mg/dL b. Blood potassium level of 3.0 mEq/L c. Early morning BP reading of 164/96 mm Hg d. Orthostatic systolic BP decrease of 12 mm Hg

ANS: B Hypokalemia is a frequent adverse effect of the loop diuretics and can cause life-threatening dysrhythmias. The health care provider should be notified of the potassium level immediately and administration of potassium supplements initiated. The elevated blood glucose and BP also indicate a need for collaborative interventions but will not require action as urgently as the hypokalemia. An orthostatic drop of 12 mm Hg is common and will require intervention only if the patient is symptomatic.

Which action will be included in the plan of care when the nurse is caring for a patient who is receiving sodium nitroprusside (Nipride) to treat a hypertensive emergency? a. Organize nursing activities so that the patient has undisturbed sleep for 6 to 8 hours at night. b. Assist the patient up in the chair for meals to avoid complications associated with immobility. c. Use an automated noninvasive blood pressure machine to obtain frequent BP measurements. d. Place the patient on NPO status to prevent aspiration caused by nausea and the associated vomiting.

ANS: C Frequent monitoring of BP is needed when the patient is receiving rapid-acting IV antihypertensive medications. This can be most easily accomplished with an automated BP machine or arterial line. The patient will require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep is not appropriate. When patients are receiving IV vasodilators, bed rest is maintained to prevent decreased cerebral perfusion and fainting. There is no indication that this patient is nauseated or at risk for aspiration, so an NPO status is unnecessary.

The RN is caring for a patient with a hypertensive crisis who is receiving sodium nitroprusside (Nipride). Which of the following nursing actions can the nurse delegate to an experienced LPN/LVN? a. Titrate nitroprusside to maintain BP at 160/100 mm Hg. b. Evaluate effectiveness of nitroprusside therapy on BP. c. Set up the automatic blood pressure machine to take BP every 15 minutes. d. Assess the patient's environment for adverse stimuli that might increase BP.

ANS: C LPN/LVN education and scope of practice include correct use of common equipment such as automatic blood pressure machines. The other actions require more nursing judgment and education and should be done by RNs.

The nurse cares for the client being evaluated for Guillain-Barre Syndrome. Which sign is most suggestive of Guillain-Barre Syndrome? A. Ascending paralysis B. Numbness and tingling of the fingers C. Hyperactive reflexes D. Tinnitus

Answer Key: A

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a. Obtain a BP reading in each arm and average the results. b. Deflate the BP cuff at a rate of 5 to 10 mm Hg per second. c. Have the patient sit in a chair with the feet flat on the floor. d. Assist the patient to the supine position for BP measurements.

ANS: C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

When caring for a client diagnosed with Guillain-Barre syndrome, which does the nurse identify as the MOST serious complication of this syndrome? A. Urinary retention B. Immobility C. Respiratory failure D. Loss of communication

Answer Key: C

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a. Check BP daily before taking the medication. b. Increase fluid intake if dryness of the mouth is a problem. c. Include high-potassium foods such as bananas in the diet. d. Change position slowly to help prevent dizziness and falls.

ANS: D The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of the medication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

Which findings indicates a need for further assessment of the patient scheduled for a magnetic resonance imaging (MRI)? A. The patient is an insulin- dependent diabetic B. The patient refuses a corner bed C. The patient is allergic to shellfish D. The patient has a history of asthma

An MRI requires the patient to be confined in a small enclosure for a period of time. The patient's refusal to accept the corner bed could indicate claustrophobia, so the patient needs further assessment. An MRI is not contraindicated for patients with diabetes or asthma; therefore, answers A and D are incorrect. Answer C is incorrect because no contrast medium is used.

The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? A. A 42-yr-old patient with multiple sclerosis who was admitted with sepsis. B. A 72-yr-old patient with Parkinson's disease who has aspiration pneumonia C. A 38-yr-old patient with myasthenia gravis who declined prescribed medications D. A 45-yr-old patient with amyotrophic lateral sclerosis who refuses enteral feedings

Answer Key: C Feedback: Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will experience myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.

Which nursing diagnosis is a priority in the care of a patient with myasthenia gravis (MG)? A. Acute confusion B. Bowel incontinence C. Activity intolerance D. Disturbed sleep pattern

Answer Key: C Feedback: The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG. Although sleep disturbance is likely, activity intolerance is of primary concern.

A 63-yr-old patient who began experiencing right arm and leg weakness is admitted to the emergency department. In which order will the nurse implement these actions included in the stroke protocol? a. Obtain CT scan without contrast. b. Infuse tissue plasminogen activator (tPA). c. Administer oxygen to keep O2 saturation >95%. d. Use National Institute of Health Stroke Scale to assess patient. A. A, B, C, D. B. B, C, A, D. C. D, C, A, B. D. C, D, A, B.

Answer Key: D

12) What is the primary cause of loss of height in individuals with osteoporosis? A) Collapse of vertebral bodies B) Decrease in length of long bones C) Flexion of the knees and hips D) Cervical lordosis

Answer: A Explanation: A) The loss of height in individuals with osteoporosis occurs primarily as a result of vertebral body collapse. Osteoporosis also contributes to cervical lordosis, and the knees and hips flex to help maintain the center of gravity; however, these do not contribute to overall loss of height. Osteoporosis does not cause a decrease in the length of long bones.

When taking a patient history during assessment of the musculoskeletal system, the nurse identifies an increased risk for the patient who reports a. that a parent became much shorter with aging. b. a sprained ankle 2 years previously. c. a family history of tuberculosis. d. taking over-the-counter (OTC) ibuprofen (Advil) for occasional aches.

Answer: A Rationale: A family history of height loss with aging may indicate osteoporosis, and the patient may need to consider preventative actions, such as calcium supplements. A sprained ankle 2 years previously will not cause any current or future musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk. Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

Based on the nurse's understanding of the physiology of bone and cartilage, the injury that the nurse would expect to heal most rapidly is a a. fracture of the midhumerus. b. torn knee cruciate ligament. c. fractured nose. d. severely sprained ankle.

Answer: A Rationale: Bone is dynamic tissue that is continually growing. Nasal fracture, sprains, and ligament tears injure cartilage, tendons, and ligaments, which are slower to heal. Cognitive Level: Application Text Reference: p. 1615 Nursing Process: Assessment NCLEX: Physiological Integrity

Which information obtained during the nurse's assessment of the patient's nutritional-metabolic pattern may indicate the risk for musculoskeletal problems? a. The patient is 5 ft 2 in and weighs 180 lb. b. The patient prefers whole milk to nonfat milk. c. The patient dislikes fruits and vegetables. d. The patient takes a multivitamin daily.

Answer: A Rationale: The patient's height and weight indicate obesity, which places stress on weight-bearing joints. The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems. Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

The patient who has completed radiation therapy treatments for a form of cancer is at high risk for developing: A. Osteomalacia B. Osteosarcoma C. Paget's disease of the bone D. Osteochondroma

Answer: B Rationale: Patients who have received radiation for other forms of cancer are at high risk for developing osteosarcoma. Osteomalacia is caused by a vitamin D deficiency. Paget's disease is a metabolic disorder of bone remodeling. Osteochondroma is a benign bone tumor that has its onset in childhood

5) A client who is at risk for developing osteoporosis asks what can be done to decrease the risk of actually developing the disease. Which intervention would be the most beneficial for this client? A) Decreasing the amount of calcium in the client's diet B) Providing the client with assisted range of motion exercising twice daily C) Increasing regular weight-bearing activities D) Protecting the client's bones with strict bedrest

Answer: C Explanation: A) A standard intervention for those attempting to prevent osteoporosis is beginning an exercise plan that includes weight-bearing activities. Strict bedrest, decreasing calcium intake, and assisted range of motion exercises may make the osteoporosis worse.

When the nurse is assessing a new patient in the clinic, which information about the patient's medications will be of most concern? a. The patient takes hormone replacement therapy (HRT) to prevent "hot flashes." b. The patient takes a daily multivitamin and calcium supplement. c. The patient has severe asthma and requires frequent therapy with steroids. d. The patient has migraine headaches which are treated with NSAIDs.

Answer: C Rationale: Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems. Cognitive Level: Application Text Reference: p. 1619 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

A patient with kyphosis is scheduled for dual-energy x-ray absorptiometry (DEXA) testing. The nurse will plan to a. start an intravenous line. b. screen the patient for shellfish allergies. c. teach the patient that DEXA is noninvasive. d. give an oral sedative.

Answer: C Rationale: DEXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Implementation NCLEX: Physiological Integrity

The patient who is taking alendronate (Fosamax) is at high risk for developing which disorder? A. Cardiovascular disease B. Breast cancer C. Inflammation of the esophagus D. Stroke

Answer: C Rationale: Esophagitis and esophageal ulcers have been reported with use of all of the bisphosphonates. The other answer selections apply to hormone replacement therapy.

During assessment of the musculoskeletal system of a 74-year-old woman, the nurse notes that the patient has lost 1 inch in height since the previous visit two years ago. The nurse will plan to teach the patient about a. diskography studies. b. magnetic resonance imaging (MRI). c. dual-energy x-ray absorptiometry (DEXA). d. myelographic testing.

Answer: C Rationale: The decreased height and the patient's age suggest that the patient may have osteoporosis and that bone density testing is needed. Diskography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic test for osteoporosis. Cognitive Level: Application Text Reference: pp. 1619, 1625 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

10) A nurse is educating a group of adults about the risks for osteoporosis. Which statements will the nurse include when discussing the use of alcohol and cigarettes? Select all that apply. A) "Smoking decreases nerve supply to the bones." B) "Nicotine increases calcium absorption, leading to decreased bone density." C) "Moderate alcohol consumption in postmenopausal women actually may increase bone mineral content." D) "Alcohol has a direct toxic effect on osteoclast activity, suppressing bone formation." E) "Heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis."

Answer: C, E Explanation:A) Both cigarette smoking and excess alcohol intake are risk factors for osteoporosis. Smoking decreases the blood supply to bones, and nicotine slows the production of osteoblasts and impairs the absorption of calcium, contributing to decreased bone density. Alcohol has a direct toxic effect on osteoblast activity, suppressing bone formation during periods of alcohol intoxication. In addition, heavy alcohol use may be associated with nutritional deficiencies that contribute to osteoporosis. Interestingly, moderate alcohol consumption in postmenopausal women actually may increase bone mineral content, possibly by increasing levels of estrogen and calcitonin

11) Which change in bone structure contributes to osteoporosis? A) The diaphysis of the bone becomes longer. B) Trabeculae are increased in cancellous bone. C) The outer cortex of the bone becomes thicker. D) The diameter of the bone increases.

Answer: D Explanation: A) In osteoporosis, the diameter of the bone increases, thinning the outer supporting cortex. Trabeculae are lost from cancellous bone. Osteoporosis does not affect the length of the bone.

A client treated for hypertension with furosemide (Lasix), atenolol (Tenormin), and ramipril (Altace) develops a second degree heart block Mobitz type 1. Which of the following actions should the nurse take? a) administer a 250 mL fluid bolus b) withhold the atenolol c) prepare for cardioversion d) set up for an arterial line

B The client may be asymptomatic and the underlying cause should be assessed. Drugs that block the AV node should be avoided, such as beta blockers (Atenolol), calcium channel blockers, digoxin, and amiodarone. Symptomatic clients are treated with atropine and transcutaneous pacing. There is no indication for a fluid bolus, cardioversion, or arterial line.

A client with early dementia asks the nurse to find her mother, who is deceased. What is the nurse's most appropriate response? A. "We can call her in a little while if you want." B. " Your mother died over 20 years ago." C. "What did your mother look like?" D. "I'll ask your father to find her when he visits."

B. " Your mother died over 20 years ago."

Which statements about stroke prevention indicate a client's understanding of health teaching by the nurse? Select all that apply. A. "I will take aspirin every day." B. "I have decided to stop smoking." C. "I will try to walk at least 30 minutes most days of the week." D. "I need to cut down a lot on my drinking." E. "I'm going to decrease salt in my diet."

B. "I have decided to stop smoking." C. "I will try to walk at least 30 minutes most days of the week." D. "I need to cut down a lot on my drinking." E. "I'm going to decrease salt in my diet."

The nurse is assessing a client who opens both eyes when spoken to, obeys commands, and seems confused during conversation. Which Glasgow Coma Score (GCS) will the nurse document? A. 15 B. 14 C. 11 D. 9

B. 14

During a health screening event which assessment finding would alert the nurse to the possible presence of osteoporosis in a white 61-year-old female? A. The presence of bowed legs B. A measurable loss of height C. Poor appetite and aversion to dairy products D. Development of unstable, wide-gait ambulation

B. A measurable loss of height A gradual but measurable loss of height and the development of kyphosis or "dowager's hump" are indicative of the presence of osteoporosis in which the rate of bone resorption is greater than bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis but are not indicative it is present. A wide gait is used to support balance and does not indicate osteoporosis.

The nurse performs an initial assessment on an older client. Which assessment findings would the nurse expect to be the result of normal physiologic aging? Select all that apply. A. Confusion B. Hearing loss C. Decerebrate positioning D. Slurred speech E. Constipation F. Urinary incontinence

B. Hearing loss E. Constipation

The client diagnosed with Guillain Barre Syndrome is on a ventilator. Which intervention will assist the client to communicate with the nursing staff? A. Provide an erase slate board for the client to write on B. Instruct the client to blink once for "no" and twice for "yes." C. Refer to a speech therapist to help with communication. D. Leave the call light within easy reach of the client.

B. Instruct the client to blink once for "no" and twice for "yes.

A client returns from the postanesthesia care unit (PACU) after a surgical removal of a brainstem tumor. In what position will the nurse place the client at this time? A. Turn the patient from side to side to prevent aspiration. B. Keep the client flat in bed or up 10 degrees and reposition from side to side. C. Elevate the head of the bed to at least 30 degrees at all times. D. Keep the client in a sitting position in bed at all times.

B. Keep the client flat in bed or up 10 degrees and reposition from side to side.

During a client's neurologic assessment, the nurse finds that the client continues to be drowsy but is easily awakened. How does the nurse document this client's level of consciousness? A. Stuporous B. Lethargic C. Comatose D. Alert

B. Lethargic

The nurse is caring for a patient admitted to the nursing unit with osteomyelitis of the tibia. Which symptom will the nurse most likely find on physical examination of the patient? A. Nausea and vomiting B. Localized pain and warmth C. Paresthesia in the affected extremity D. Generalized bone pain throughout the leg

B. Localized pain and warmth Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or spread from another part of the body. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and warmth. Nausea and vomiting and paresthesia of the extremity are not expected to occur. Pain occurs, but it is localized, not generalized throughout the leg.

The home care nurse visits an 84-year-old woman with pneumonia after her discharge from the hospital. Which assessment finding would the nurse expect because of age-related changes in the musculoskeletal system? A. Positive straight-leg-raising test B. Muscle strength is scale grade 3/5 C. Lateral S-shaped curvature of the spine D. Fingers drift to the ulnar side of the forearm

B. Muscle strength is scale grade 3/5 Decreased muscle strength is an age-related change of the musculoskeletal system caused by decreased number and size of the muscle cells. The other assessment findings indicate musculoskeletal abnormalities. A positive straight-leg-raising test indicates nerve root irritation from intervertebral disk prolapse and herniation. An ulnar deviation or drift indicates rheumatoid arthritis due to tendon contracture. Scoliosis is a lateral curvature of the spine.

A nurse is caring for a client who has a hard cervical collar for a complete cervical spinal cord injury. Which assessment finding will the nurse report to the primary health care provider? A. Purulent drainage from the pin sites on the client's forehead B. Painful pressure injury under the collar C. Inability to move legs or feet D. Oxygen saturation of 95% on room air

B. Painful pressure injury under the collar

A patient you are caring for has just been told that he has ALS. You know that he has a sedentary lifestyle, was a cigarette smoker for 10 years, and has a high stress job. He asks you what he could have done to prevent this disease. Your best response is: A. Smoking and an inactive lifestyle greatly contribute to the disease ALS. B. There is nothing that you could have done to prevent the ALS disease. C. Consistent high stress has been linked to the ALS diagnosis. D. Because your grandfather had ALS, you were likely to get it too.

B. There is nothing that you could have done to prevent the ALS disease.

The nurse is preparing to administer Sinemet to a client whose highest blood pressure is 88/50 while lying in bed. What is the nurse's priority action at this time? A. Instruct the client to get out of bed slowly. B. Withhold the drug until contacting the primary health care provider. C. Ask the client about the presence of hallucinations. D. Take the client's apical pulse and temperature.

B. Withhold the drug until contacting the primary health care provider.

Myasthenia gravis occurs when antibodies attack the __________ receptors at the neuromuscular junction leading to ____________. A. metabotropic; muscle weakness B. nicotinic acetylcholine; muscle weakness C. dopaminergic adrenergic; muscle contraction D. nicotinic adrenergic; muscle contraction

B. nicotinic acetylcholine; muscle weakness

A patient with a left-brain stroke suddenly bursts into tears when family members visit. The nurse should A. explain to the family that depression is normal following a stroke. B. teach the family that emotional outbursts are common after strokes. C. use a calm voice to ask the patient to stop the crying behavior. D. have the family members leave the patient alone for a few minutes.

B. teach the family that emotional outbursts are common after strokes.

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? C-reactive protein (CRP) levels Sodium, chloride, and potassium levels Arterial blood gas (ABG) results Blood urea nitrogen (BUN) and creatinine levels

Blood urea nitrogen (BUN) and creatinine levels

Which action will the nurse in the hypertension clinic take in order to obtain an accurate baseline blood pressure (BP) for a new patient? a) obtain a BP reading in each arm and average the result b) deflate the BP cuff at a rate of 5 - 10 mmHg per second c) have the patient sit in a chair with the feet flat on the floor d) assist the patient to the supine position for BP measurements

C The patient should be seated with the feet flat on the floor. The BP is obtained in both arms, but the results of the two arms are not averaged. The patient does not need to be in the supine position. The cuff should be deflated at 2 to 3 mm Hg per second.

A patient shows signs of fatigue, muscle weakness, dysphagia, as well as stiff and clumsy gait. Which diagnostic test(s) will be used to confirm the diagnosis of ALS? Select all that apply. a. EED b. Serum Creatine Kinase c.MRI d. Pulmonary function test e. Electromyography(EMG)

C) MRI E) EMG

The nurse determines that teaching about management of migraine headaches has been effective when the patient says which of the following? A. "I can take the (Topamax) as soon as a headache starts." B. A glass of wine might help me relax and prevent a headache." C. "I will lie down someplace dark and quiet when the headaches begin." D. "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."

C. "I will lie down someplace dark and quiet when the headaches begin."

A 54-year-old patient admitted with cellulitis and probable osteomyelitis received an injection of radioisotope at 9:00 AM before a bone scan. The nurse should plan to send the patient for the bone scan at what time? A. 9:30 PM B. 10:00 AM C. 11:00 AM D. 1:00 PM

C. 11:00 AM A technician usually administers a calculated dose of a radioisotope 2 hours before a bone scan. If the patient was injected at 9:00 AM, the procedure should be done at 11:00 AM. 10:00 AM would be too early; 1:00 PM and 9:30 PM would be too late.

The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? A. A 42-yr-old patient with multiple sclerosis who was admitted with sepsis. B. A 72-yr-old patient with Parkinson's disease who has aspiration pneumonia C. A 38-yr-old patient with myasthenia gravis who declined prescribed medications D. A 45-yr-old patient with amyotrophic lateral sclerosis who refuses enteral feedings

C. A 38-yr-old patient with myasthenia gravis who declined prescribed medications

19. Which information will the nurse include when teaching a patient with newly diagnosed systemic exertion intolerance disease (SEID) {formally called chronic fatigue syndrome} about selfmanagement? A. Avoid use of over-the-counter antihistamines or decongestants. B. A low-residue, low-fiber diet will reduce any abdominal distention. C. A gradual increase in your daily exercise may help decrease fatigue. D. Systemic exertion intolerance disease usually progresses as patients become older.

C. A gradual increase in your daily exercise may help decrease fatigue.

The nurse is caring for a client with chronic confusion who often yells and screams when touched. Which nursing intervention is most appropriate when caring for this client? A. Provide a large clock and calendar for the patient to read. B. Use removable restraints such as a roll-waist belt to prevent wandering. C. Approach the patient so the nurse can be seen clearly. D. Place the patient in a room close to the nurses' station for frequent observation.

C. Approach the patient so the nurse can be seen clearly.

A 63-year-old woman has been taking prednisone (Deltasone) daily for several years after a kidney transplant to prevent organ rejection. What is most important for the nurse to assess? A. Staggering gait B. Ruptured tendon C. Back or neck pain D. Tardive dyskinesia

C. Back or neck pain Osteoporosis with resultant fractures is a frequent and serious complication of systemic corticosteroid therapy. The ribs and vertebrae are affected the most, and patients should be observed for signs of compression fractures (back and neck pain). Phenytoin (Dilantin) is an antiseizure medication. An adverse effect of phenytoin is an ataxic (or staggering) gait. A rare adverse effect of ciprofloxacin (Cipro) and other fluoroquinolones is tendon rupture, usually of the Achilles tendon. The highest risk is in people age 60 and older and in people taking corticosteroids. Antipsychotics and antidepressants may cause tardive dyskinesia, which is characterized by involuntary movements of the tongue and face.

A patient with a T4 spinal cord injury asks the nurse if he will be able to be sexually active. Which initial response by the nurse is best? A. Reflex erections frequently occur, but orgasm may not be possible. B. Sildenafil (Viagra) is used by many patients with spinal cord injury. C. Multiple options are available to maintain sexuality after spinal cord injury. D. Penile injection, prostheses, or vacuum suction devices are possible options.

C. Multiple options are available to maintain sexuality after spinal cord injury.

16. The nurse is caring for a patient with newly diagnosed ankylosing spondylitis. Which information will the nurse include when teaching the patient about the management of this condition? A. Maintain bedrest during a flare. B. Sleep with the head on two pillows. C. Perform back and breathing exercises. D. Avoid non-steroidal anti-inflammatory drugs (NSAIDS).

C. Perform back and breathing exercises.

8. Anakinra (Kineret), an interleukin-1 receptor agonist, is prescribed for a patient who has moderately severe rheumatoid arthritis. When teaching the patient about this drug, the nurse will include information about which of the following? A. Avoiding concurrently taking aspirin. B. Symptoms of gastrointestinal (GI) bleeding. C. Self-administration of subcutaneous injections. D. Taking the medication with at least 8 ounces of fluid.

C. Self-administration of subcutaneous injections.

A 30 year old patient is admitted with a diagnosis of myasthenia gravis and worsening of symptoms. In taking a history, which of the following complaints would the nurse consider most typical? A. stooped posture, dysphagia, tremor B. numbness, dysphagia, spasticity C. fading voice, dysphagia, exercise intolerance D. Spasticity, incontinence of bladder, auditory problems

C. fading voice, dysphagia, exercise intolerance

A 65-yr-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is A. searching the Internet for educational videos. B. evaluating the home for environmental safety. C. promoting physical exercise and a well-balanced diet. D. designing an exercise program to strengthen and stretch specific muscles.

C. promoting physical exercise and a well-balanced diet.

A patient has been prescribed antihypertensives. After assessment and analysis, the nurse has identified a nursing diagnosis of risk for ineffective health maintenance related to nonadherence to therapeutic regimen. When planning this client's care, what desired outcome should the nurse identify? Client takes medication as prescribed and reports any adverse effects. Client's BP remains consistently below 140/90 mm Hg. Client denies signs and symptoms of hypertensive urgency. Client is able to describe modifiable risk factors for hypertension.

Client takes medication as prescribed and reports any adverse effects.

9. A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone a. is strong enough to stand mild stress. b. union is complete on the x-ray. c. fragments are fully fused. d. healing has started.

Correct Answer: A Rationale: The cast may be removed when callus ossification has occurred. It is not necessary to wait until radiologic union or complete bone fusion occurs. Bone healing starts immediately after the injury, but the cast will need to be worn at least 3 weeks.

A patient with severe ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the right hand and fingers. The nurse determines that the patient has realistic expectations of the outcome of surgery when the patient says, a. "I will be able to use my fingers to grasp objects better." b. "My fingers will appear normal in size and shape after this surgery." c. "This procedure will prevent further deformity in my hands and fingers." d. "I will not have to do as many hand exercises after the surgery."

Correct Answer: A Rationale: The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Cognitive Level: Application Text Reference: p. 1664 Nursing Process: Evaluation NCLEX: Physiological Integrity

A patient who has severe peripheral arterial disease and ischemic foot ulcers is upset with the health care provider's recommendation to have an above-the-knee amputation. The patient tells the nurse, "If they want to cut off my leg, they should just shoot me instead." The most appropriate response to the patient's statement is, a. "Let's talk about how you feel this surgery will affect you." b. "If you do not want the surgery, you do not have to have it." c. "I understand why you are upset, but there really is no choice because your leg is so badly diseased." d. "Many people are able to function normally with a prosthesis after amputation, and you can too."

Correct Answer: A Rationale: The initial nursing action should be to assess how the patient feels about the amputation and what the patient knows about the procedure and rehabilitation process. Discussion about the patient's option to not have the procedure, the reason the procedure is needed, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient's current level of knowledge and emotional state. Cognitive Level: Application Text Reference: p. 1659 Nursing Process: Implementation NCLEX: Psychosocial Integrity

10. A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should a. have the patient lift the buttocks by bending and pushing with the left leg. b. turn the patient partially to each side with the assistance of another nurse. c. place a pillow between the patient's legs and turn gently to each side. d. loosen the traction and have the patient turn onto the unaffected side.

Correct Answer: A Rationale: The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.

31. When preparing a patient to ambulate the day after an ORIF for a hip fracture, which action is most important for the nurse to take? a. Administering the ordered oral opioid pain medication b. Instructing the patient about the benefits of ambulation c. Ensuring that the incisional drain has been discontinued d. Changing the hip dressing and document the appearance of the site

Correct Answer: A Rationale: The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient's willingness to ambulate, but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not impact on ambulation. Cognitive Level: Application Text Reference: pp. 1654, 1647 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine a. whether there is bruising at the shoulder area. b. whether the right arm is shorter than the left. c. the amount of pain the patient is experiencing. d. how much range of motion (ROM) is present.

Correct Answer: B Rationale: A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. The nurse will expect bruising and pain at the area, even without an injury that requires surgery. The shoulder should be immobilized until it is evaluated by the health care provider.

13. Following the application of a hip spica cast for a patient with a fracture of the proximal third of the left femur, an appropriate nursing intervention is to a. use the cast support bar to reposition the patient every 2 to 3 hours. b. ask the patient about any abdominal discomfort or nausea. c. discuss the reasons for remaining on bed rest for several weeks. d. promote drying of the cast by placing the patient in a prone position every 4 hours.

Correct Answer: B Rationale: Assessment of bowel tones, abdominal pain, and nausea and vomiting will detect the development of cast syndrome. To avoid breakage, the support bar should not be used for repositioning. After the cast dries, the patient can begin ambulating with the assistance of physical therapy personnel. The patient should not be placed in the prone position until the cast has dried to avoid breaking the cast. Cognitive Level: Application Text Reference: p. 1640 Nursing Process: Implementation NCLEX: Physiological Integrity

35. When giving home-care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include? a. Keep the hand immobile to prevent soft tissue swelling. b. Call the health care provider for increased swelling or numbness. c. Keep the right shoulder elevated on a pillow or cushion. d. Avoid the use of NSAIDs for the first 48 hours after the injury.

Correct Answer: B Rationale: Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat pain after a fracture. Cognitive Level: Application Text Reference: p. 1646 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse observes a patient doing all these activities after having a hip-replacement surgery. Which patient action requires that the nurse intervene immediately? a. The patient sits straight up on the edge of the bed. b. The patient leans over to pull shoes and socks on. c. The patient bends over the sink while brushing the teeth. d. The patient uses crutches with a swing-to gait.

Correct Answer: B Rationale: Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation. The other patient actions are appropriate and do not require any immediate action by the nurse to protect the patient. Cognitive Level: Application Text Reference: p. 1654 Nursing Process: Assessment NCLEX: Physiological Integrity

When getting a patient from the bed into the chair for the first time since having an ORIF of a hip fracture, the nurse should a. use a mechanical lift to transfer the patient from the bed to the chair. b. assist the patient to use a walker with partial weight bearing to assist in transfer to the chair. c. have the patient use crutches with a swing-through gait to transfer. d. ask a nursing assistant to help the patient to stand at the bedside and pivot to the chair.

Correct Answer: B Rationale: The patient will use an assistive device such as a walker to help with the initial transfers and ambulation. A mechanical lift is not needed. Crutch walking is taught before discharge but would not be used for the initial transfer. The RN, not a nursing assistant, should supervise the patient during the initial transfer to evaluate how well the patient is able to accomplish this skill.

A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with replacement of the total knee joint with a plastic prosthesis. Postoperatively, the nurse expects care of the leg to include a. bed rest for 3 days with the left leg immobilized in an extended position. b. use of a compression bandage to hold the left knee in a flexed position. c. progressive leg exercises to obtain 90-degree flexion. d. early ambulation with full weight bearing on the left leg.

Correct Answer: C Rationale: After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The patient is ambulated the first postoperative day. A compression bandage is used to hold the knee in an extended position after surgery. Full weight bearing is expected before discharge, but it is not started early after surgery. Cognitive Level: Application Text Reference: p. 1664 Nursing Process: Planning NCLEX: Physiological Integrity

A patient with an intracapsular fracture of the left femur is placed in Buck's traction before surgery for a hip replacement. The patient asks why traction is necessary when surgery is planned. The nurse's response to the patient is based on the knowledge that traction a. will help prevent flexion contractures of the affected hip. b. is necessary to prevent displacement of the fracture. c. will decrease the incidence of painful muscle spasms d. is used to maintain the leg in the external rotation position.

Correct Answer: C Rationale: Buck's traction keeps the leg immobilized and reduces muscle spasm. Flexion contractures are not likely to occur during the short time before surgery. Displacement of the hip is prevented by keeping the patient on bed rest before surgery. The leg is externally rotated because of the hip fracture, not because of traction. Cognitive Level: Comprehension Text Reference: p. 1653 Nursing Process: Implementation NCLEX: Physiological Integrity

Following x-rays of an injured wrist, the patient is informed that it is badly sprained. In teaching the patient to care for the injury, the nurse tells the patient to a. apply a heating pad to reduce muscle spasms. b. wear an elastic compression bandage continuously. c. use pillows to keep the arm elevated above the heart. d. gently exercise the joint to prevent muscle shortening.

Correct Answer: C Rationale: Elevation of the arm will reduce the amount of swelling and pain. For the first 24 to 48 hours, cold packs are used to reduce swelling. Compression bandages are not left on continuously. The wrist should be rested and kept immobile to prevent further swelling or injury.

22. After falling at home, a patient is admitted to the emergency department, where x-rays confirm the presence of an extracapsular fracture of the femur. When assessing the patient, the nurse would expect to find a. bruising of the left hip and thigh. b. numbness in the left leg and hip. c. outward pointing toes on the left leg. d. weak or nonpalpable left leg pulses.

Correct Answer: C Rationale: External rotation of the leg is a classic sign associated with a hip fracture. Bruising does not always appear rapidly, and bruising extending to the thigh might indicate hemorrhage. Numbness and decreased pulses are not typical of a hip fracture unless there is associated tissue swelling and trauma to blood vessels.

A patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast, and a sling is admitted to the medical-surgical unit. Which nursing intervention will be included in the plan of care? a. Use surgical net dressing to hang the arm from an IV pole. b. Immobilize the fingers on the left hand with gauze dressings. c. Assess the left axilla and change absorbent dressings as needed. d. Assist the patient in passive range of motion (ROM) for the right arm.

Correct Answer: C Rationale: The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. A patient with a sling would not have traction applied by hanging. The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active ROM on the uninjured side. Cognitive Level: Application Text Reference: p. 1640 Nursing Process: Planning NCLEX: Physiological Integrity

A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity. The initial action by the nurse should be to a. splint the lower leg. b. elevate the left leg. c. check the popliteal, dorsalis pedis, and posterior tibial pulses. d. obtain information about the patient's tetanus immunization status.

Correct Answer: C Rationale: The initial nursing action should be assessment of the neurovascular status of the injured leg. After assessment, the nurse may need to splint and elevate the leg, based on the assessment data. Information about tetanus immunizations should be done if there is an open wound. Cognitive Level: Application Text Reference: p. 1642 Nursing Process: Assessment NCLEX: Physiological Integrity

When counseling an older patient about ways to prevent fractures, which information will the nurse include? a. Tacking down scatter rugs in the home is recommended. b. Occasional weight-bearing exercise will improve muscle and bone strength. c. Most falls happen outside the home. d. Buying shoes that provide good support and are comfortable to wear is recommended.

Correct Answer: D Rationale: Comfortable shoes with good support will help to decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Regular weight-bearing exercise will improve strength, but occasional exercise is not helpful in improving strength. Falls inside the home are responsible for many injuries. Cognitive Level: Application Text Reference: p. 1630 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

A patient with lower-leg fractures has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching? a. "You will need to remain on bed rest until bone healing is complete." b. "The external fixator can be removed during the bath or shower." c. "Prophylactic antibiotics are needed until the external fixator is removed." d. "You will need to assess and clean the pin insertion sites daily."

Correct Answer: D Rationale: Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given when an external fixator is used. Cognitive Level: Application Text Reference: p. 1641 Nursing Process: Implementation NCLEX: Physiological Integrity

12. Following a motor-vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. Which action will the nurse take first? a. Elevate the leg on pillows. b. Apply a compression bandage. c. Place ice packs on the lower leg. d. Check leg pulses and sensation.

Correct Answer: D Rationale: The initial action by the nurse will be to assess the circulation to the leg and to observe for any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.

A patient with a fractured pelvis is initially treated with bed rest with no turning from side to side permitted. The second day after admission, the patient develops chest pain, tachypnea, and tachycardia. The nurse determines that the patient's symptoms are most likely related to fat embolism when assessment of the patient reveals a. a blood pressure of 100/65 mm Hg. b. anxiety, restlessness, and confusion. c. warm, reddened areas in the calf. d. pinpoint red areas on the upper chest.

Correct Answer: D Rationale: The presence of petechiae helps distinguish fat embolism from other problems. The other symptoms might occur with fat embolism but could also occur with other postoperative complications such as bleeding, myocardial infarction, venous thrombosis, or hypoxemia.

Which precaution is most important for you to teach a patient who has been prescribed a beta blocker drug for hypertension? a) avoid alcoholic beverage while taking this drug b) weigh yourself daily at the same time every morning c) wear gloves and other warm clothing during col weather d) do not suddenly stop taking this drug without notifying your prescriber

D

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? a) "The medication may not work as well if I take any aspirin." b) "The doctor may order a blood potassium level occasionally." c) "I will call the doctor if I notice that I have a frequent cough." d) "I won't worry if I have a little swelling around my lips and face."

D Angioedema occurring with angiotensin-converting enzyme (ACE) inhibitor therapy is an indication that the ACE inhibitor should be discontinued. The patient should be taught that if any swelling of the face or oral mucosa occurs, the health care provider should be immediately notified because this could be life threatening. The other patient statements indicate that the patient has an accurate understanding of ACE inhibitor therapy.

An exercise program is prescribed for the client with hypertension. Which intervention would be most likely to assist the client in maintaining an exercise program? a) giving the client a written exercise program b) explaining the exercise program tot eh client's spouse c) reassuring the client that he or she can do the exercise program d) tailoring a program to the client's needs and abilities

D Tailoring or individualizing a program to the client's lifestyle has been shown to be an effective strategy for changing health behaviors. Providing a written program, explaining the program to the client's spouse, and reassuring the client that he or she can do the program may be helpful but are not as likely to promote adherence as individualizing the program.

A patient has just been diagnosed with hypertension and has a new prescription for captopril (Capoten). Which information is important to include when teaching the patient? a) check BP daily before taking the medication b) increase fluid intake if dryness of the mouth is a problem c) include high-potassium foods such as bananas in the diet d) change position slowly to help prevent dizziness and falls

D The angiotensin-converting enzyme (ACE) inhibitors frequently cause orthostatic hypotension, and patients should be taught to change position slowly to allow the vascular system time to compensate for the position change. Increasing fluid intake may counteract the effect of themedication, and the patient is taught to use gum or hard candy to relieve dry mouth. The BP does not need to be checked at home by the patient before taking the medication. Because ACE inhibitors cause potassium retention, increased intake of high-potassium foods is inappropriate.

A 63-yr-old patient who began experiencing right arm and leg weakness is admitted to the emergency department. In which order will the nurse implement these actions included in the stroke protocol? a. Obtain CT scan without contrast. b. Infuse tissue plasminogen activator (tPA). c. Administer oxygen to keep O2 saturation >95%. d. Use National Institute of Health Stroke Scale to assess patient. A. A, B, C, D. B. B, C, A, D. C. D, C, A, B. D. C, D, A, B.

D) C, D, A, B.

All of the following are risk factors for Huntington's Disease EXCEPT: A)Dominant inheritance B)Having a parent with HD C)Being 30-50 years of age D)Being of Caucasian descent

D)Being of Caucasian descent

Which nursing action has the highest priority for a patient who was admitted 16 hours earlier with a C5 spinal cord injury? A. Application of pneumatic compression devices to legs B. Cardiac monitoring for bradycardia C. Administration of low-molecular-weight heparin D. Assessment of respiratory rate and effort

D. Assessment of respiratory rate and effort

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations? A. "You should go on a diet and exercise more to feel better about yourself." B. "Something must be wrong with you because you should not have these problems." C. "You have arthritis and need to go on nonsteroidal antiinflammatory drugs (NSAIDs)." D. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging."

D. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging." The musculoskeletal system's normal changes of aging include decreased muscle mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees; decreased fine motor dexterity; and slowed reaction times. Going on a diet and exercising will help but not stop these changes. Telling the patient "Something must be wrong with you..." will not be helpful to the patient's frustrations.

The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching? A. "I can sit down to put on my pants and shoes." B. "I try to exercise every day and rest when I'm tired." C. "My son removed all loose rugs from my bedroom." D. "I don't need to use my walker to get to the bathroom."

D. "I don't need to use my walker to get to the bathroom."

The nurse is reinforcing teaching with a newly diagnosed patient with amyotrophic lateralsclerosis. Which statement would be appropriate to include in the teaching? A. "ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication." B. "Even though the symptoms you are experiencing are severe, most people recover with treatment." C. "You need to consider advance directives now, since you will lose cognitive function as the disease progresses." D. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

D. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first?A. 12-Lead electrocardiogram (ECG) B. Chest radiograph (chest x-ray) C. Complete blood count (CBC) D. Computed tomography (CT) scan

D. Computed tomography (CT) scan

A patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find? A. Hyperactive left-sided tendon reflexes B. Right-sided neglect C. Impulsive behavior D. Difficulty comprehending instructions

D. Difficulty comprehending instructions

The nurse is reinforcing health teaching about osteoporosis with a 72-year-old patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient? A. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. B. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. C. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements and/or foods high in calcium and engages in regular weight-bearing exercise. Corticosteroids interfere with bone metabolism. Estrogen therapy is no longer used to prevent osteoporosis because of the associated increased risk of heart disease and breast and uterine cancer.

The nurse is caring for a client with trigeminal neuralgia. Which patient problem is the priority for the nurse? A. Facial twitching B. Problems with communication C. Ptosis and diplopia D. Severe facial pain

D. Severe facial pain

A 54-year-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information? A. Two additional follow-up scans will be required. B. There will be only mild pain associated with the procedure. C. The procedure takes approximately 15 to 30 minutes to complete. D. The patient will be asked to drink increased fluids after the procedure.

D. The patient will be asked to drink increased fluids after the procedure. Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans and no pain are associated with bone scans that take 1 hour of lying supine.

The nurse will explain to the patient who has a T2 spinal cord transection injury that A. tachycardia is common with this type of injury. B. use of the shoulders will be limited. C. total loss of respiratory function may occur. D. function of both arms should be retained.

D. function of both arms should be retained.

A patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously, and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for A. transluminal angioplasty. B. intravenous heparin drip administration. C. surgical endarterectomy. D. tissue plasminogen activator (tPA) infusion.

D. tissue plasminogen activator (tPA) infusion.

A client has been diagnosed as being prehypertensive. What should the nurse encourage this client to do to aid in preventing a progression to a hypertensive state? Avoid excessive potassium intake. Exercise on a regular basis. Eat less protein and more vegetables. Limit morning activity.

Exercise on a regular basis.

D. The extent of the patient's disability or paralysis

For the patient who needs the support of a crutch while walking, the type of crutch selected will depend on which assessment? A. The gait the patient will use B. What is most comfortable for the patient C.The availability of insurance reimbursement D. The extent of the patient's disability or paralysis

The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching? Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

A client with secondary hypertension has come into the clinic for a routine check-up. When comparing this client's diagnosis to primary hypertension, the nurse recognizes that secondary hypertension: has a specific cause. has a more gradual onset than primary hypertension. does not normally cause target organ damage. does not normally respond to antihypertensive drug therapy. TAKE ANOTHER QUIZ

Has a specific cause

The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? Screen the client for visual disturbances regularly. Have the client participate in monitoring his or her own BP. Emphasize the dire health outcomes associated with inadequate BP control. Encourage the client to lose weight and exercise regularly.

Have the client participate in monitoring her or her own BP.

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) Heart rate Respiratory rate Heart rhythm Character of apical and peripheral pulses Lung sounds

Heart rate Heart rhythm Character of apical and peripheral pulses

A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? Drowsiness or lethargy Increased urine output Decreased heart rate Mild agitation

Increased urine output

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. decreases circulating blood volume.

Increases the heart rate, constricts arterioles, and reduces the heart's ability t eject blood.

A client diagnosed with hypertension informs the nurse that they are not taking prescribed antihypertensive medications due to an absence of symptoms. What is the most appropriate response by the nurse? Inform the client that this is why hypertension is known as "the silent killer." Inform the client that remaining unmedicated is all right in conjunction with routine follow-up. Suggest that the client try an herbal supplement instead. Inform the client there should be no problems as long as she a low sodium diet is maintained.

Inform the client that this is why hypertension is known as "the silent killer."

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? Administer I.V. fluids as ordered. Administer an isosorbide as ordered. Insert an indwelling urinary catheter as ordered. Instruct the client to sit for several minutes before standing.

Instruct the client to sit for several minutes before standing.

C. Weight-bearing exercises

LPNs/LVNs can do much to decrease the incidence of osteoporosis by teaching all female patients that preventive measures include sufficient calcium intake and which other intervention? A. Sufficient fluid intake B. Supplemental B vitamins C. Weight-bearing exercises D. Total avoidance of alcohol

The nurse is assessing a client new to the clinic. Records brought to the clinic show that the client's hypertension has not improved. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? Progressive target organ damage Possibility of medication interactions Lack of adherence to prescribed drug therapy Possible heavy alcohol use or use of recreational drugs

Lack of adherence to prescribed drug therapy

The nurse is screening a number of adults for hypertension. What range of blood pressure is considered normal? Less than 140/90 mm Hg Less than 130/90 mm Hg Less than 129/89 mm Hg Less than 120/80 mm Hg

Less than 120/80 mm Hg

The nurse is developing a teaching plan for a client diagnosed with hypertension. What would be important for the nurse to emphasize as part of the plan of care? Limiting sodium intake in the diet Limiting cigarette smoking to 1 pack a week Limiting alcohol to a can of beer to four times a day to thin the blood Limiting activity to prevent over exertion

Limiting sodium intake in the diet

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? Lowering and controlling the blood pressure without adverse effects and without undue cost Making sure that the patient adheres to the therapeutic medication regimen Instructing the patient to enter a weight loss program and begin an exercise regimen Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

Lowering and controlling the blood pressure without adverse effects and without undue cost

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. What should the nurse integrate into the management of this client's hypertension? Ensure that the client receives a larger initial dose of antihypertensive medication due to impaired absorption. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. Recognize that an older adult is less likely to adhere to the medication regimen than a younger client. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion.

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? Hypertensive Normal Slightly hypertensive Prehypertensive

Prehypertensive

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? Purchasing a self-monitoring BP cuff Discussing methods for stress reduction Advising smoking cessation Administering glycemic control

Purchasing a self-monitoring BP cuff

An elderly patient with a fractured hip is placed in Buck's traction. The primary purpose for Buck's traction for the patient is: A. To decrease muscle spasm B. To prevent the need for surgery C. To alleviate the pain associated with the fracture D. To prevent bleeding associated with the hip fractures

Rationale: Answer A is correct. Buck's traction is a skin traction used to decrease muscle spasms. Buck's traction will not prevent the need for surgery, making answer B wrong. It also will not alleviate the pain associated with the fracture or prevent bleeding, so answers C and D are wrong.

The nurse is performing a post-op assessment of an elderly patient with a total hip repair. Although he has not requested medication for pain, the nurse suspects that the patient's discomfort is severe and prepares to administer pain medication. Which of the following signs would not support the nurse's assessment of acute post- op pain? A. Increased blood pressure B. Inability to concentrate C. Dilated pupils D. Decreased heart rate

Rationale: Answer D is correct. The patient in acute pain experiences physiological arousal similar to the fight or flight response- for example, an increased (not decreased) heart rate, an increased BP, and dilated pupils. Answers A,B, and C are wrong because increased BP, inability to concentrate, and dilated pupils are reactions to pain. The question asks which does not support as assessment of post-op pain, so answer D is correct.

B. Fat embolism

The appearance of a petechial rash and respiratory distress 2 to 3 days after a fracture should be reported promptly because they may be symptomatic of which life-threatening complication? A. Infection B. Fat embolism C. Nerve damage D. Vitamin deficiency

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. The incidence and prevalence of hypertension increase with age. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

The incidence and prevalence of hypertension increase with age.

D. preforming active range of motion to the right ankle and knee

The nurse has provided instructions regarding specific leg exercises for the client immobilized in the right skeletal lower leg traction. The nurse determines that the client needs further teaching if the nurse observes the client doing what activity? A. pulling up on the trapeze B. flexing and extending the feet C. doing quadriceps-setting and gluteal-setting exercises D. preforming active range of motion to the right ankle and knee

D. elevate the leg on pillows continuously for 24-48 hours

The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should preform which intervention? A. keep the leg in a level position B. elevate the leg for 3 hours, and put it flat for 1 hour C. keep the leg level for 3 hours, and elevate it for one hour D. elevate the leg on pillows continuously for 24-48 hours

A. Pain D. Difficulty providing own hygiene E. Difficulty moving about the house and/or work setting(s)

The nurse is participating in a patient care conference to plan the care for a patient with osteoporosis. Which issues should be discussed for inclusion in this patient's care plan? (Select all that apply.) A. Pain B. Difficulty breathing C. Potential for excessive fluid D. Difficulty providing own hygiene E. Difficulty moving about the house and/or work setting(s)

B. 8 inchess to the front and side of the clients toes

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions the nurse should plan to tell the client to place the crutches in which position? A. 3 inches to the front and side of the clients toes B. 8 inches to the front and side of the clients toes C. 15 inches to the front and side of the clients toes D. 20 inches to the front and side of the clients toes

A. keep the cast and extremity elevated B. the cast needs to be kept clean and dry C. allow the wet cast 24 to 72 hours to dry

The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list? (select all that apply) A. keep the cast and extremity elevated B. the cast needs to be kept clean and dry C. allow the wet cast 24 to 72 hours to dry D. expect tingling and numbness in the extremity E. use a hair dryer set on a warm to hot setting to dry the cast F. use a soft padded object that will fit under the cast to scratch the skin under the cast

C. immobilize the leg before moving the client

The nurse witnesses a client sustain a fall and suspects that the clients leg may be fractured. Which action is the priority? A. take a set of vital signs B. call the radiology department C. immobilize the leg before moving the client D. reassure the client that everything will be fine

A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less To stop smoking and increase physical activity to 30 minutes/day most days of the week To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less

A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the primary rationale behind that advice to the client? Quitting smoking will cause the client's hypertension to resolve. Tobacco use increases the client's concurrent risk of heart disease. Tobacco use is associated with a sedentary lifestyle. Tobacco use causes ventricular hypertrophy.

Tobacco use increases the client's concurrent risk of heart disease.

A client has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the client has done which of the following? Tried to rest quietly for 5 minutes before the reading is taken Refrained from smoking for at least 8 hours Drank adequate fluids during the day prior Avoided drinking coffee for 12 hours before the visit

Tried o rest quietly for 5 minutes before the reading is taken

Is the following statement True or False? Testing for crepitus can produce further tissue damage and should be avoided.

True Testing for crepitus can produce further tissue damage and should be avoided.

Is the following statement true or false? The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs.

True The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. Removal of the weights completely defeats their purpose and may result in injury to the patient.

The prevalence of osteoporosis in women aged more than 80 years is 50%. True False

True. Rationale: The prevalence of osteoporosis in women aged more than 80 years is 50%.

D. Assess temperature trends and sniff around the cast for signs of foul odor.

Which nursing action is most appropriate for monitoring a patient with a casted lower extremity for infection? A. Assess vital signs every hour while the patient is awake. B. Remove the cast weekly to check the wound for signs of infection. C. Remove the cast bi-weekly to check the wound for signs of infection. D. Assess temperature trends and sniff around the cast for signs of foul odor.

A client has a history of osteoarthritis. Which signs and symptoms should the nurse expect to find on physical assessment? a) Joint pain, crepitus, Heberden's nodes b) Tophi, enlarged joints, Bouchard's nodes c) Swelling, joint pain, and tenderness on palpation d) Hot, inflamed joints; crepitus; joint pain

a) Joint pain, crepitus, Heberden's nodes

A client who is newly diagnosed with hypertension is going to be starting antihypertensive medicine. What is one of the main things the client and the client's spouse should watch for? a. dizziness b. persistent cough c. blurred vision d. tremor

a A common adverse effect of all antihypertensive drugs is postural hypotension, which can lead to falls. The client and the client's spouse should be alerted to this possibility and provided with some tips for managing dizziness.

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? a. Renal failure b. Right ventricular hypertrophy c. Glaucoma d. Anemia

a When uncontrolled hypertension is prolonged, it can result in renal failure, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not associated with hypertension.

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Nonsteroidal anti-inflammatory drugs (NSAIDs) b) Disease-modifying antirheumatic drugs (DMARDS) c) Glucocorticoids d) Tumor necrosis factor (TNF) blockers

a) Nonsteroidal anti-inflammatory drugs (NSAIDs)

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? a) "It will get better and worse again." b) "When it clears up, it will never come back." c) "It will never get any better than it is right now." d) "I'll definitely need surgery for this."

a) "It will get better and worse again."

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client? a) Fatigue b) Ineffective airway clearance c) Self-care deficit: Bathing d) Risk for infection

a) Fatigue

A nurse in the family clinic is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which medication does the nurse plan primary teaching? a. Acetaminophen (Tylenol) b. Cyclobenzaprine hydrochloride (Flexeril) c. Hyaluronate (Hyalgan) d. Ibuprofen (Motrin)

a. Acetaminophen (Tylenol) All of the drugs are appropriate to treat OA. However, the first-line drug is acetaminophen. Cyclobenzaprine is a muscle relaxant given to treat muscle spasms. Hyaluronate is a synthetic joint fluid implant. Ibuprofen is a nonsteroidal anti-inflammatory drug.

A client has been diagnosed with fibromyalgia syndrome but does not want to take the prescribed medications. What nonpharmacologic measures can the nurse suggest to help manage this condition? (Select all that apply.) a. Acupuncture b. Stretching c. Supplements d. Tai chi e. Vigorous aerobics

a. Acupuncture b. Stretching d. Tai chi There are many nonpharmacologic means for controlling the symptoms of fibromyalgia, including acupuncture, stretching, tai chi, low-impact aerobics, swimming, biking, strengthening, massage, stress management, and hypnosis. Dietary supplements and vigorous aerobics are not recommended.

A nurse is teaching a client with psoriatic arthritis about the medication golimumab (Simponi). What information is most important to include? a. Avoid large crowds or people who are ill. b. Stay upright for 1 hour after taking this drug. c. This drug may cause your hair to fall out. d. You may double the dose if pain is severe.

a. Avoid large crowds or people who are ill. This drug has a Food and Drug Administration black box warning about opportunistic or other serious infections. Teach the client to avoid large crowds and people who are ill. The other instructions do not pertain to golimumab.

A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best? a. Ensure the client gets 15 minutes of sun exposure daily. b. Give the client daily vitamin D injections. c. Hide vitamin D supplements in favorite foods. d. Plan to serve foods naturally high in vitamin D.

a. Ensure the client gets 15 minutes of sun exposure daily. Sunlight is a good source of vitamin D, and the nursing staff can ensure some sun exposure each day. Vitamin D is not given by injection. Hiding the supplement in food is unethical. Very few foods are naturally high in vitamin D, but some are supplemented.

What information does the nurse teach a women's group about osteoporosis? a. For 5 years after menopause you lose 2% of bone mass yearly. b. Men actually have higher rates of the disease but are underdiagnosed.c. There is no way to prevent or slow osteoporosis after menopause. d. Women and men have an equal chance of getting osteoporosis.

a. For 5 years after menopause you lose 2% of bone mass yearly. For the first 5 years after menopause, women lose about 2% of their bone mass each year. Men have a slower loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after menopause.

A patient with osteomyelitis is treated with surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse answers (select all that apply) a."The beads are used to directly deliver antibiotics to the site of the infection." b."There are no effective oral or IV antibiotics to treat most cases of bone infection." c."This is the safest method of delivering long-term antibiotic therapy for a bone infection." d."The beads are an adjunct to debridement and oral and IV antibiotics for deep infections." e."The ischemia and bone death that occur with osteomyelitis are impenetrable to IV antibiotics."

a."The beads are used to directly deliver antibiotics to the site of the infection." d."The beads are an adjunct to debridement and oral and IV antibiotics for deep infections." Treatment of chronic osteomyelitis includes surgical removal of the poorly vascularized tissue and dead bone and the extended use of IV and oral antibiotics. Antibiotic-impregnated polymethylmethacrylate bead chains may be implanted during surgery to aid in combating the infection.

A normal assessment finding of the musculoskeletal system is a.no deformity or crepitation. b.muscle and bone strength of 4. c.ulnar deviation and subluxation. d.angulation of bone toward midline.

a.no deformity or crepitation Normal physical assessment findings of the musculoskeletal system include normal spinal curvatures; no muscle atrophy or asymmetry; no joint swelling, deformity, or crepitation; no tenderness on palpation of muscles and joints; full range of motion of all joints without pain or laxity; and muscle strength score of 5.

The nurse is caring for a patient with systolic blood pressure of 135 mm Hg. This finding would be classified as a. normal. b. prehypertension. c. stage 1 hypertension. d. stage 2 hypertension.

b A systolic blood pressure of 135 mm Hg is classified as prehypertension. A systolic BP less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is stage I hypertension. A systolic BP greater than or equal to 160 is classified as stage II hypertension.

Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except? a) Avoid sunlight and ultraviolet radiation. b) If you have problems with a medication, you may stop it until your next physician visit. c) Pace activities. d) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing

b) If you have problems with a medication, you may stop it until your next physician visit.

A nursing student asks the instructor how to identify rheumatoid nodules in a client with rheumatoid arthritis. Which of the following characteristics would the instructor include? a) Reddened b) Located over bony prominence c) Nonmovable d) Tender to touch

b) Located over bony prominence

5. When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which statement? a. "I should take the Naprosyn as prescribed to help control the pain." b. "I should try to stay standing all day to keep my joints from becoming stiff." c. "I can use a cane if I find it helpful in relieving the pressure on my back and hip." d. "A warm shower in the morning will help relieve the stiffness I have when I get up."

b. "I should try to stay standing all day to keep my joints from becoming stiff."

7. After the nurse has finished teaching a 68-year-old patient with osteoarthritis (OA) of the right hip about how to manage the OA, which patient statement indicates a need for more teaching? a. "I can take glucosamine to help decrease my knee pain." b. "I will take 1 g of acetaminophen (Tylenol) every 4 hours." c. "I will take a shower in the morning to help relieve stiffness." d. "I can use a cane to decrease the pressure and pain in my hip."

b. "I will take 1 g of acetaminophen (Tylenol) every 4 hours."

A nurse works in the rheumatology clinic and sees clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client who reports jaw pain when eating b. Client with a red, hot, swollen right wrist c. Client who has a puffy-looking area behind the knee d. Client with a worse joint deformity since the last visit

b. Client with a red, hot, swollen right wrist All of the options are possible manifestations of RA. However, the presence of one joint that is much redder, hotter, or more swollen that the other joints may indicate infection. The nurse needs to see this client first.

A nurse works with several clients who have gout. Which types of gout and their drug treatments are correctly matched? (Select all that apply.) a. Allopurinol (Zyloprim) Acute gout b. Colchicine (Colcrys) Acute gout c. Febuxostat (Uloric) Chronic gout d. Indomethacin (Indocin) Acute gout e. Probenecid (Benemid) Chronic gout

b. Colchicine (Colcrys) Acute gout c. Febuxostat (Uloric) Chronic gout d. Indomethacin (Indocin) Acute gout e. Probenecid (Benemid) Chronic gout Acute gout can be treated with colchicine and indomethacin. Chronic gout can be treated with febuxostat and probenecid. Allopurinol is used for chronic gout.

The clinic nurse assesses a client with diabetes during a checkup. The client also has osteoarthritis (OA). The nurse notes the clients blood glucose readings have been elevated. What question by the nurse is most appropriate? a. Are you compliant with following the diabetic diet? b. Have you been taking glucosamine supplements? c. How much exercise do you really get each week? d. You're still taking your diabetic medication, right?

b. Have you been taking glucosamine supplements? All of the topics are appropriate for a client whose blood glucose readings have been higher than usual. However, since this client also has OA, and glucosamine can increase blood glucose levels, the nurse should ask about its use. The other questions all have an element of nontherapeutic communication in them. Compliant is a word associated with negative images, and the client may deny being noncompliant. Asking how much exercise the client really gets is accusatory. Asking if the client takes his or her medications right? is patronizing.

The nurse advises a patient with myasthenia gravis to: a. Protect the extremities from injury due to poor sensory perception b. Perform physically demanding activities early in the day c. Do frequent weight-bearing exercise to prevent muscle atrophy d. Anticipate the need for weekly plasmapheresis treatments

b. Perform physically demanding activities early in the day

15. Which assessment information obtained by the nurse indicates that a patient with an exacerbation of rheumatoid arthritis (RA) is experiencing a side effect of prednisone (Deltasone)? (Steroid) (Hyperglycemia can be done by anything other than insulin) a. The patient has joint pain and stiffness. b. The patient's blood glucose is 165 mg/dL. c. The patient has experienced a recent 5-pound weight loss. d. The patient's erythrocyte sedimentation rate (ESR) has increased.

b. The patient's blood glucose is 165 mg/dL.

A patient is scheduled for an electromyogram (EMG). 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.

b.insertion of small needles into certain muscles Electromyography (EMG) is an evaluation of electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles and attached to leads that record electrical activity of muscle. Results provide information related to lower motor neuron dysfunction and primary muscle disease

The nurse is assessing a client new to the clinic. Records brought to the clinic show that the client's hypertension has not improved. What contributing factor should the nurse first explore in an effort to identify the cause of the client's inadequate BP control? a. Progressive target organ damage b. Possibility of medication interactions c. Lack of adherence to prescribed drug therapy d. Possible heavy alcohol use or use of recreational drugs

c Deviation from the therapeutic program is a significant problem for people with hypertension and other chronic conditions requiring lifetime management. An estimated 50% of clients discontinue their medications within 1 year of beginning to take them. Consequently, this is a more likely problem than substance use, organ damage, or adverse drug interactions.

A blood pressure (BP) of 140/90 mm Hg is considered to be a. normal. b. prehypertension. c. hypertension. d. a hypertensive emergency.

c A BP of 140/90 mm Hg or higher is hypertension. A blood pressure less than 120/80 mm Hg is considered normal. A BP of 120 to 139/80 to 89 mm Hg is prehypertension. Hypertensive emergency is a situation in which BP is severely elevated and there is evidence of actual or probable target organ damage.

A diastolic blood pressure of 90 mm Hg is classified as a. normal. b. prehypertension. c. stage 1 hypertension. d. stage 2 hypertension.

c A diastolic BP of 80 to 80 mm Hg is classified as prehypertension. A diastolic BP less than 80 mm Hg is normal. A diastolic BP of 90 to 99 mm Hg is stage I hypertension. A diastolic BP of 100 mm Hg or above is classified as stage 2 hypertension.

A nurse practitioner is managing the care of a patient who has gout. Choose the medication that she would prescribe as the drug of choice to prevent tophi formation and promote tophi regression. a) Anturane b) Uloric c) Zyloprim d) Benemid

c) Zyloprim

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? a) Computed tomography (CT) b) Magnetic resonance imaging (MRI) c) Muscle biopsy d) Bone scan

c) Muscle biopsy

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)? a) Glucocorticoids b) Tumor necrosis factor (TNF) blockers c) Nonsteroidal anti-inflammatory drugs (NSAIDs) d) Disease-modifying antirheumatic drugs (DMARDS)

c) Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which of the following is the leading cause of disability and pain in the elderly? a) Scleroderma b) Rheumatoid arthritis (RA) c) Osteoarthritis d) SLE

c) Osteoarthritis

A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication? a) Take the medication on an empty stomach in order to increase effectiveness. b) Since the medication is able to be obtained over the counter, it has few side effects. c) Take the medication with food to avoid stomach upset. d) Inform the physician if there is ringing in the ears.

c) Take the medication with food to avoid stomach upset.

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage? a) Pannus b) Joint effusion c) Tophi d) Subchondral bone

c) Tophi

8. A patient with rheumatoid arthritis being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? a. Draw blood for rheumatoid factor analysis. b. Teach the patient about injections for the nodules. c. Assess the nodules for skin breakdown or infection. d. Discuss the need for surgical removal of the nodules.

c. Assess the nodules for skin breakdown or infection. (Assessment comes first)

A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first? a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago b. Client taking ibandronate (Boniva) who cannot remember when the last dose was c. Client taking raloxifene (Evista) who reports unilateral calf swelling d. Client taking risedronate (Actonel) who reports occasional dyspepsia

c. Client taking raloxifene (Evista) who reports unilateral calf swelling The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is an adverse effect of raloxifene. The client with flank pain may have had a kidney stone but is not acutely ill now. The client who cannot remember taking the last dose of ibandronate can be seen last. The client on risedronate may need to change medications.

A hospitalized client is being treated for Ewings sarcoma. What action by the nurse is most important? a. Assessing and treating the client for pain as needed b. Educating the client on the disease and its treatment c. Handling and disposing of chemotherapeutic agents per policy d. Providing emotional support for the client and family

c. Handling and disposing of chemotherapeutic agents per policy All actions are appropriate for this client. However, for safety, the nurse should place priority on proper handling and disposal of chemotherapeutic agents.

A client has newly diagnosed systemic lupus erythematosus (SLE). What instruction by the nurse is most important? a. Be sure you get enough sleep at night. b. Eat plenty of high-protein, high-iron foods. c. Notify your provider at once if you get a fever. d. Weigh yourself every day on the same scale.

c. Notify your provider at once if you get a fever. Fever is the classic sign of a lupus flare and should be reported immediately. Rest and nutrition are important but do not take priority over teaching the client what to do if he or she develops an elevated temperature. Daily weights may or may not be important depending on renal involvement.

The nurse working in the orthopedic clinic knows that a client with which factor has an absolute contraindication for having a total joint replacement? a. Needs multiple dental fillings b. Over age 85 c. Severe osteoporosis d. Urinary tract infection

c. Severe osteoporosis Osteoporosis is a contraindication to joint replacement because the bones have a high risk of shattering as the new prosthesis is implanted. The client who needs fillings should have them done prior to the surgery. Age greater than 85 is not an absolute contraindication. A urinary tract infection can be treated prior to surgery.

A client has fibromyalgia and is prescribed duloxetine hydrochloride (Cymbalta). The client calls the clinic and asks the nurse why an antidepressant drug has been prescribed. What response by the nurse is best? a. A little sedation will help you get some rest. b. Depression often accompanies fibromyalgia. c. This drug works in the brain to decrease pain. d. You will have more energy after taking this drug.

c. This drug works in the brain to decrease pain. Duloxetine works to increase the release of the neurotransmitters serotonin and norepinephrine, which reduces the pain from fibromyalgia. The other answers are inaccurate.

The nurse receives report about a patient diagnosed with Parkinson's Disease. The nurse remembers that the disease is caused by... a.Accumulation of amyloid plaques in brain b.Autoimmune destruction of myelin sheaths in the CNS c.Loss of dopaminergic neurons in the CNS d.Antibody attachment acetylcholine receptors at neuromuscular junction of skeletal muscles

c.Loss of dopaminergic neurons in the CNS

42 year old female presents to the ER with worsening bilateral facial droop,muscle weakness and fatigue. You believe the patient has MG. What complication is MOST important to monitor for? a. Hypotension b. Bradycardia c.Respiratory depression d.Vasoconstriction

c.Respiratory depression

Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis? a) Provide an analgesic after exercise. b) Assess for the gastrointestinal complications associated with COX-2 inhibitors. c) Avoid the use of topical analgesics. d) Encourage weight loss and an increase in aerobic activity.

d) Encourage weight loss and an increase in aerobic activity.

The nurse in the rheumatology clinic is assessing clients with rheumatoid arthritis (RA). Which client should the nurse see first? a. Client taking celecoxib (Celebrex) and ranitidine (Zantac) b. Client taking etanercept (Enbrel) with a red injection site c. Client with a blood glucose of 190 mg/dL who is taking steroids d. Client with a fever and cough who is taking tofacitinib (Xeljanz)

d. Client with a fever and cough who is taking tofacitinib (Xeljanz) Tofacitinib carries a Food and Drug Administration black box warning about opportunistic infections, tuberculosis, and cancer. Fever and cough may indicate tuberculosis. Ranitidine is often taken with celecoxib, which can cause gastrointestinal distress. Redness and itchy rashes are frequently seen with etanercept injections. Steroids are known to raise blood glucose levels.

A client with rheumatoid arthritis (RA) is on the postoperative nursing unit after having elective surgery. The client reports that one arm feels like pins and needles and that the neck is very painful since returning from surgery. What action by the nurse is best? a. Assist the client to change positions. b. Document the findings in the clients chart. c. Encourage range of motion of the neck. d. Notify the provider immediately.

d. Notify the provider immediately. Clients with RA can have cervical joint involvement. This can lead to an emergent situation in which the phrenic nerve is compressed, causing respiratory insufficiency. The client can also suffer a permanent spinal cord injury. The nurse needs to notify the provider immediately. Changing positions and doing range of motion may actually worsen the situation. The nurse should document findings after notifying the provider.

A client is admitted with a large draining wound on the leg. What action does the nurse take first? a. Administer ordered antibiotics. b. Insert an intravenous line. c. Give pain medications if needed. d. Obtain cultures of the leg wound.

d. Obtain cultures of the leg wound. The nurse first obtains wound cultures prior to administering broad-spectrum antibiotics. The nurse would need to start the IV prior to giving the antibiotics as they will most likely be parenteral. Pain should be treated but that is not the priority.

A nurse is discharging a client to a short-term rehabilitation center after a joint replacement. Which action by the nurse is most important? a. Administering pain medication before transport b. Answering any last-minute questions by the client c. Ensuring the family has directions to the facility d. Providing a verbal hand-off report to the facility

d. Providing a verbal hand-off report to the facility As required by The Joint Commission and other accrediting agencies, a hand-off report must be given to the new provider to prevent error. The other options are valid responses but do not take priority.

An older client has returned to the surgical unit after a total hip replacement. The client is confused and restless. What intervention by the nurse is most important to prevent injury? a. Administer mild sedation. b. Keep all four side rails up. c. Restrain the clients hands. d. Use an abduction pillow.

d. Use an abduction pillow. Older clients often have trouble metabolizing anesthetics and pain medication, leading to confusion or restlessness postoperatively. To prevent the hip from dislocating, the nurse should use an abduction pillow since the client cannot follow directions at this time. Sedation may worsen the clients mental status and should be avoided. Using all four siderails may be considered a restraint. Hand restraints are not necessary in this situation.

A nurse is caring for a client after joint replacement surgery. What action by the nurse is most important to prevent wound infection? a. Assess the clients white blood cell count. b. Culture any drainage from the wound. c. Monitor the clients temperature every 4 hours. d. Use aseptic technique for dressing changes.

d. Use aseptic technique for dressing changes. Preventing surgical wound infection is a primary responsibility of the nurse, who must use aseptic technique to change dressings or empty drains. The other actions do not prevent infection but can lead to early detection of an infection that is already present.

When grading muscle strength, the nurse records a score of 3, 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 Muscle strength score of 3 indicates active movement only against gravity and not against resistance

A patient is receiving the anti-parkinson medication Levadopa in the hospital. The nursing instructor would have to intervene if the student nurse caring for the patient did which of the following? a.Takes the patient's blood pressure before administering medication b.Assists the patient from lying down to sitting before standing c.Monitors the patient for any hallucinations d.Gives medication with meals to increase absorption across the blood brain barrier.

d.Gives medication with meals to increase absorption across the blood brain barrier.

Which of the following classifications are considered antiarthritic drugs? Select all that apply. a) Anti-inflammatory b) Glucocorticoids c) Disease-modifying antirheumatics (DMARDs) d) Diuretics e) Muscle relaxants

• Anti-inflammatory • Disease-modifying antirheumatics (DMARDs) • Glucocorticoids

Which diagnostic test is used to confirm ALS? A. Electromyelogram (EMG) B. Muscle biopsy C. Serum creatinine D. Pulmonary function test

Answer Key: B

he nurse is caring for a patient who has been diagnosed with "rheumatic disease." What nursing diagnoses will most likely apply to this patient's care? Select all that apply a) Pain b) Alteration in self-concept c) Fatigue d) Fluid volume deficit e) Fluid and electrolyte imbalance

• Fatigue • Pain • Alteration in self-concept • Fluid and electrolyte imbalance

20. The nurse determines additional instruction is needed when a patient diagnosed with scleroderma says which of the following? A. "Paraffin baths can be used to help my hands." B. "I should lie down for an hour after each meal." C. "Lotions will help if I rub them in for a long time." D. "I should perform routine stretching exercises including yawing with an open mouth."

B. "I should lie down for an hour after each meal."

While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take? A. Insert an oral airway during the seizure to maintain a patent airway. B. Restrain the patient's arms and legs to prevent injury during the seizure. C. Consider time and observe and record the details of the seizure and postictal state. D. Avoid touching the patient to prevent further nervous system stimulation.

C. Consider time and observe and record the details of the seizure and postictal state.

The nurse is preparing a teaching plan for a client with migraine headaches. Which of these foods or food additives that may trigger a migraine will the nurse include in the teaching? Select all that apply. A. Sugar B. Salt C. Monosodium glutamate (MSG) D. Caffeine E. Wine F. Tyramine

C. Monosodium glutamate (MSG) D. Caffeine E. Wine F. Tyramine

13. The nurse is performing an assessment on a patient who reports fatigue, weakness, malaise, muscle and joint pain at multiple sites, anorexia, and photosensitivity. Systemic lupus erythematosus (SLE) is suspected. The nurse further assesses for which sign that is also indicative of SLE? A. Ascites. B. Weight gain. C. Two hemoglobin S genes. D. Butterfly rash on cheeks and bridge of nose.

D. Butterfly rash on cheeks and bridge of nose.

The nurse is preparing a teaching plan for a patient who is being discharged following a total hip replacement. The nurse would include which part of the following content as a part of the teaching plan? Select all that apply A. Avoid low, cushioned chairs B. Use a device that raises toilet seat C. Avoid bending greater than 90 degrees D. Turn at the waist to reach objects E. Do not cross the legs

Rationale: A,B,C,E are correct. Following a total hip replacement, the patient must be instructed to avoid activities such as sitting in low, cushioned chairs; crossing legs; and using a standard- height toilet. These activities cause adduction of the less or greater than 90 degrees' flexion at the hip, leading to possible dislocation. Turning at the waist violates principles of general body mechanics.

A patient has been diagnosised with osteomalacia. What symptoms does the nurse recognize that correlate with the diagnosis? A. Bone fractures and kyphosis B. Bone pain and tenderness C. Muscle Weakness and spasms D. Softened and compressed vertebrae

Rationale: Answer B is correct.

Which activity is most appropriate for a three- year old with a cast? A. Barbie doll and accessories B. Toy telephone C. Coloring book and crayons D. Puzzles

Rationale: Answer B is correct. The toy telephone is large enough that it cannot be placed beneath the cast, and it promotes social and language development. Answers A,C, and D contain small pieces that can be placed beneath the cast, so they are incorrect.

A patient is admitted for an MRI, a CT scan, and a myelogram. Which of the following medication orders should be questioned for the patient who is to have a myelogram? A. Ampicillin 250mg PO q6H B. Motrin 400mg PO q4h PRN for headache C. Seconal 50mg HS PRN sleep D. Darvon 65mg PO q4h for pain

Rationale: Answer C is correct. Seconal is a barbiturate, and CNS depressants and stimulants, as well as phenothiazines, should not be given for 48 hours prior to a mylegram because they decrease the sizure threshold. Ampicillin is an antibiotic, Motrin is an NSAID, and Darvon is an analgesic, so they can all be given, making answers A,B, and D wrong.

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults that are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1, 2, 4. Rheumatoid arthritis (RA) affects women three times more often than men, between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing rheumatoid arthritis.

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate (Rheumatrex), which of the following statements indicates the need for further teaching? 1. "I will take my vitamins while I'm on this drug." 2. "I must not drink any alcohol while I'm taking this drug." 3. "I should brush my teeth after every meal." 4. "I will continue taking my birth control pills."

1. Because some over-the-counter vitamin supplements contain folic acid, the client should avoid self-medication with vitamins while taking methotrexate, a folic acid antagonist. Because methotrexate is hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for infection. Therefore, meticulous mouth care is essential to minimize the risk of infection. Contraception should be used during methotrexate therapy and for 8 weeks after the therapy has been discontinued because of its effect on mitosis. Methotrexate is considered teratogenic.

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate? 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?" Which of the following responses by the nurse would be most appropriate? 1. "It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation." 2. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3. "That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it." 4. "Every person is different. What works for one client may not always be effective for another."

4. The nurse's most appropriate response is one that is therapeutic. The basic principle of therapeutic communication and a therapeutic relationship is honesty. Therefore, the nurse needs to explain truthfully that each client is different and that there are various forms of arthritis and arthritis treatment. To state that it is the physician's prerogative to decide how to treat the client implies that the client is not a member of his or her own health care team and is not a participant in his or her care. The statement also is defensive, which serves to block any further communication or questions from the client about the physician. Asking the client to tell more about the friend presumes that the client knows correct and complete information, which is not a valid assumption to make. The nurse does not know about the client's friend and should not make statements about another client's condition. Stating that the drug is for cases that are worse than the client's demonstrates that the nurse is making assumptions that are not necessarily valid or appropriate. Also, telling the client not to worry ignores the underlying emotions associated with the question, totally discounting the client's feelings.

D. provides comfort by reducing muscle spasms and provides fracture immobilization

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension fraction has which primary function? A. allows bony healing to being before surgery B. provides rigid immobilization of the fracture site C. lengthens the fractured leg to prevent severing of the blood vessels D. provides comfort by reducing muscle spasms and provides fracture immobilization

A nurse is discussing with a nursing student how to accurately measure blood pressure. What statement by the student indicates an understanding of the education? A cuff that is too small will give a false high blood pressure. A cuff that is too small will give a false low blood pressure. A cuff that is too large will give a false high blood pressure. The size of the cuff does not matter as long as it fits snugly around the arm.

A cuff that is too small will give a false high blood pressure.

The nurse is teaching a client about self-management measures to help prevent low back pain. Which teaching should be included? Select all that apply. A. "Losing weight can decrease strain on your back." B. "Avoid twisting at your waist." C. "Exercise on a regular basis, including walking." D. "Don't bend at your waist when lifting a heavy object." E. "Eat foods high in calcium and vitamin D to prevent bone loss."

A. "Losing weight can decrease strain on your back." B. "Avoid twisting at your waist." C. "Exercise on a regular basis, including walking." D. "Don't bend at your waist when lifting a heavy object." E. "Eat foods high in calcium and vitamin D to prevent bone loss."

17. A patient with fibromyalgia was prescribed the antiseizure medication pregabalin (Lyrica) for relief of the clinical manifestations of fibromyalgia. The nurse is assessing the effectiveness of the medication. Which of the following statements by the patient indicates the medication is having the most desired effects? A. "The widespread pain I have has lessened." B. "I haven't noticed any changes in my depression or pain." C. "My restorative sleep has increased but so has my fatigue." D. "My depression has decreased but I have decreased sleep time."

A. "The widespread pain I have has lessened."

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ may be present in the fluid if MS is present. A. increase in IgG B. high amounts of RBC C. low amounts of WBC D. oblong red blood cells and glucose

A. increase in IgG

A 27-year-old patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room (select all that apply)? A. Side-rail pads B. Tongue blade C. Oxygen mask D. Suction tubing E. Urinary catheter F. Nasogastric tube

A. side-rail pads C. Oxygen mask D. Suction tubing

During change-of-shift report, the nurse obtains this information about a hypertensive patient who received the first dose of propranolol (Inderal) during the previous shift. Which information indicates that the patient needs immediate intervention? a. The patient's most recent BP reading is 156/94 mm Hg. b. The patient's pulse has dropped from 64 to 58 beats/minute. c. The patient has developed wheezes throughout the lung fields. d. The patient complains that the fingers and toes feel quite cold.

ANS: C The most urgent concern for this patient is the wheezes, which indicate that bronchospasm (a common adverse effect of the noncardioselective β-blockers) is occurring. The nurse should immediately obtain an oxygen saturation measurement, apply supplemental oxygen, and notify the health care provider. The mild decrease in heart rate and complaint of cold fingers and toes are associated with β-receptor blockade but do not require any change in therapy. The BP reading may indicate that a change in medication type or dose may be indicated; however, this is not as urgently needed as addressing the bronchospasm.

A 52-year-old patient who has no previous history of hypertension or other health problems suddenly develops a BP of 188/106 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that a. a BP recheck should be scheduled in a few weeks. b. the dietary sodium and fat content should be decreased. c. there is an immediate danger of a stroke and hospitalization will be required. d. more diagnostic testing may be needed to determine the cause of the hypertension.

ANS: D A sudden increase in BP in a patient over age 50 with no previous hypertension history or risk factors indicates that the hypertension may be secondary to some other problem. The BP will need rapid treatment and ongoing monitoring. If the patient has no other risk factors, a stroke in the immediate future is unlikely. There is no indication that dietary salt or fat intake have contributed to this sudden increase in BP, and reducing intake of salt and fat alone will not be adequate to reduce this BP to an acceptable level.

A patient with osteoporosis has been advised to increase the amount of calcium in her diet. Which food provides the most calcium? An 8- oz glass of milk An ounce of cheddar cheese A half cup of raw broccoli A 4- ounce salmon croquette

Answer A is correct. An 8-ounce glass of milk contains 290mg of calcium. Answers B, C, and D contain lesser amounts; therefore, they are incorrect. (Note: An ounce of cheddar cheese contains 205 mg of calcium; half a cup of raw broccoli contains 175mg of calcium; and 4 ounces of salmon croquette contains 165 mg of calcium).

A patient with a total knee replacement returns from surgery. Which findings require immediate nursing intervention? A. The is 30ml bloody drainage from the surgical drain B. The continuous passive motion machine is set on 90-degree flexion C. The patient is unable to ambulate to the bathroom D. The patient is complaining of muscle spasm

Answer B is correct. The CPM machine should not be set at 90-degree flexion until the fifth postoperative day. Answers A, C, and D are expected findings and do not require immediate nursing intervention, so they are incorrect

The primary purpose for using a continuous passive movement (CPM) apparatus for a patient with a total knee repair is to help: A. Prevent contractures B. Promote flexion of the artificial joint C. Decrease the pain associated with early ambulation D. Alleviate lactic acid production in the leg muscles

Answer B is correct. The primary purpose of the continuous passive motion machine is to promote flexion of the artificial joint. Answers A,C, and D do not describe the purpose of the CPM machine; therefore, they are incorrect.

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? A. "I will lie down prone with my legs slightly elevated." B. "I will bend at the waist when I am lifting objects from the floor." C. "I will avoid prolonged sitting or walking." D. "Instead of turning around to grasp an object, I will twist at the waist."

Answer C

A patient with an open reduction and internal fixation for a fractured hip is to being ambulation. The hip was repaired using a compression plate and screws. The patient will most likely begin ambulation with: A. Full weight bearing on the affected leg B. Nonweight bearing on the affected leg C. Toe touch weight bearing on the affected leg D. Weight bearing as tolerated on the affected leg

Answer C is correct. The patient with ORIF of a fractured hip will begin ambulation with toe touch weight bearing on the affected leg. Answer A is incorrect because it places to much weight on the newly repaired hip. Answer B is incorrect because the patient allowed to bear minimal weight on the affected leg. Answer D is incorrect because it can place too much or too little pressure on the newly repaired hip.

The nurse determines that a 55- year-old female patient is experiencing menopause and is also at risk for osteoporosis. What foods other than milk can the nurse suggest to this patient to increase calcium intake? A. Seafood, wheat, corn, green vegetables B. Chicken vegetables, green vegetables, pasta, broccoli C. Green vegetables, sardines, salmon with bone, molasses D. Fresh fruits, English muffins, black beans, asparagus

Answer C is correct. Women of menopausal age are at risk for osteoporosis, and foods high in calcium should be encouraged. A diet with green vegetables, sardines, salmon with bone, and molasses provides high- quality calcium and is recommended for a patient experiencing menopause in order to decrease the risk of osteoporosis. A diet with seafood, wheat, corn, and green vegetables is more concentrated in carbohydrates than proteins containing more calcium. A diet with chicken, green vegetables, sardines, and broccoli contains some calcium but is lower than the other option. Foods such as fresh fruits, English muffins, black beans, and asparagus are inadequate in calcium.

Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ may be present in the fluid if MS is present. A. increase in IgG B. high amounts of RBC C. low amounts of WBC D. oblong red blood cells and glucose

Answer Key: A Feedback: Your patient is scheduled for a lumbar puncture to help diagnose multiple sclerosis. The patient wants clarification about what will be found in the cerebrospinal fluid during the lumbar puncture to confirm the diagnosis of MS. You explain that ____________ may be present in the fluid if MS is present.

Which of the following symptoms do you as the nurse expect to see in the patient with primary progressive multiple sclerosis? (Select All that Apply): A. Blurred double vision B. Fatigue C. Diarrhea D. Intention tremors E. Paralytic ileus

Answer Key: A, B, D

A 27-year-old patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room (select all that apply)? A. Side-rail pads B. Tongue blade C. Oxygen mask D. Suction tubing E. Urinary catheter F. Nasogastric tube

Answer Key: A, C, D Feedback: The patient is at risk for further seizures, and oxygen and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The bed's side rails should be padded to minimize the risk for patient injury during a seizure. Use of tongue blades during a seizure is contraindicated. Insertion of a nasogastric (NG) tube is not indicated because the airway problem is not caused by vomiting or abdominal distention. A urinary catheter is not required unless there is urinary retention.

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect? A. Yellow-tinged sclerae B. Numbness of the extremities C. Gum bleeding and tenderness D. Shiny, smooth tongue

Answer Key: B

The nurse is admitting a patient who has a neck fracture at the C6 level to the intensive care unit. Which assessment findings indicate neurogenic shock? A. Hyperactive reflexes below the injury B. Hypotension and warm extremities C. Lack of sensation or movement below the injury D. Involuntary and spastic movement

Answer Key: B Feedback: Neurogenic shock is characterized by hypotension, bradycardia, and vasodilation leading to warm skin temperature. Spasticity and hyperactive reflexes do not occur at this stage of spinal cord injury. Lack of movement and sensation indicate spinal cord injury but not neurogenic shock.

A patient with a left-brain stroke suddenly bursts into tears when family members visit. The nurse should A. explain to the family that depression is normal following a stroke. B. teach the family that emotional outbursts are common after strokes. C. use a calm voice to ask the patient to stop the crying behavior. D. have the family members leave the patient alone for a few minutes.

Answer Key: B Feedback: Patients who have left-sided brain stroke are prone to emotional outbursts that are not necessarily related to the emotional state of the patient. Depression after a stroke is common, but the suddenness of the patient's outburst suggests that depression is not the major cause of the behavior. The family should stay with the patient. The crying is not within the patient's control, and asking the patient to stop will lead to embarrassment.

The nurse will assess a 67-year-old patient who is experiencing a cluster headache for A. nuchal rigidity. B. unilateral ptosis. C. projectile vomiting. D. throbbing, bilateral facial pain.

Answer Key: B Feedback: Unilateral eye edema, tearing, and ptosis are characteristic of cluster headaches. Nuchal rigidity suggests meningeal irritation, such as occurs with meningitis. Although nausea and vomiting may occur with migraine headaches, projectile vomiting is more consistent with increased intracranial pressure (ICP). Unilateral sharp, stabbing pain, rather than throbbing pain, is characteristic of cluster headaches.

A patient you are caring for has just been told that he has ALS. You know that he has a sedentary lifestyle, was a cigarette smoker for 10 years, and has a high stress job. He asks you what he could have done to prevent this disease. Your best response is: A. Smoking and an inactive lifestyle greatly contribute to the disease ALS. B. There is nothing that you could have done to prevent the ALS disease. C. Consistent high stress has been linked to the ALS diagnosis. D. Because your grandfather had ALS, you were likely to get it too.

Answer Key: B Feedback: the most common cause of ALS remains unknown and is currently under study. There is not currently any one known predictor or cause of disease

During your discharge teaching to a patient with multiple sclerosis, you educate the patient on how to avoid increasing symptoms and relapses. You tell the patient to avoid (select all that apply): A. Rest B. Infection C. Overexertion D. High caffeine intake

Answer Key: B, C, D

A 65-yr-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is A. searching the Internet for educational videos. B. evaluating the home for environmental safety. C. promoting physical exercise and a well-balanced diet. D. designing an exercise program to strengthen and stretch specific muscles.

Answer Key: C

The RN is caring for a PT with increased ICP. Which nursing action should be avoided? A. Reposition the patient every two hours. B. Position the patient with the head elevated 30 degrees. C. Suction the airway every two hours per standing orders. D. Provide continuous oxygen as ordered.

Answer Key: C

The client with experiencing status epilepticus is admitted to the intensive care unit Which collaborative intervention should the nurse anticipate? A. Assess the client's neurological status every hour. B. Monitor the client's heart rhythm via telemetry. C. Administer an anticonvulsant medication by IV. D. Prepare to administer a glucocorticosteroid orally.

Answer Key: C

The nurse determines that teaching about management of migraine headaches has been effective when the patient says which of the following? A. "I can take the (Topamax) as soon as a headache starts." B. A glass of wine might help me relax and prevent a headache." C. "I will lie down someplace dark and quiet when the headaches begin." D. "I should avoid taking aspirin and sumatriptan (Imitrex) at the same time."

Answer Key: C

While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take? A. Insert an oral airway during the seizure to maintain a patent airway. B. Restrain the patient's arms and legs to prevent injury during the seizure. C. Consider time and observe and record the details of the seizure and postictal state. D. Avoid touching the patient to prevent further nervous system stimulation.

Answer Key: C

A patient with left-sided weakness that started 60 minutes earlier is admitted to the emergency department and diagnostic tests are ordered. Which test should be done first? A. 12-Lead electrocardiogram (ECG) B. Chest radiograph (chest x-ray) C. Complete blood count (CBC) D. Computed tomography (CT) scan

Answer Key: D

Which stroke risk factor for a 48-yr-old male patient in the clinic is most important for the nurse to address? A. The patient works at a desk and relaxes by watching television. B. The patient is 25 lb above the ideal weight. C. The patient drinks a glass of red wine with dinner daily. D. The patient's usual blood pressure (BP) is 170/94 mm Hg.

Answer Key: D Feedback: Hypertension is the single most important modifiable risk factor. People who drink more than 1 (for women) or 2 (for men) alcoholic beverages a day may increase their risk for hypertension. Physical inactivity and obesity contribute to stroke risk but not as much as hypertension.

The nurse is reinforcing teaching with a newly diagnosed patient with amyotrophic lateral sclerosis. Which statement would be appropriate to include in the teaching? A. "ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication." B. "Even though the symptoms you are experiencing are severe, most people recover with treatment." C. "You need to consider advance directives now, since you will lose cognitive function as the disease progresses." D. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

Answer Key: D Feedback: The disease results in destruction of the motor neurons in the brainstem and spinal cord, causing gradual paralysis. Cognitive function is maintained. Because no cure exists for amyotrophic lateral sclerosis (ALS), interprofessional care is palliative and based on symptom relief. Death often occurs within 2 to 5 years after diagnosis

A patient arrives in the emergency department with hemiparesis and dysarthria that started 2 hours previously, and health records show a history of several transient ischemic attacks (TIAs). The nurse anticipates preparing the patient for A. transluminal angioplasty. B. intravenous heparin drip administration. C. surgical endarterectomy. D. tissue plasminogen activator (tPA) infusion.

Answer Key: D Feedback: The patient's history and clinical manifestations suggest an acute ischemic stroke, and a patient who is seen within 4.5 hours of stroke onset is likely to receive tPA (after screening with a CT scan). Heparin administration in the emergency phase is not indicated. Emergent carotid transluminal angioplasty or endarterectomy is not indicated for the patient who is having an acute ischemic stroke.

A patient is seen at the urgent care center following a blunt injury to the left knee. The knee is grossly swollen and very painful, but the skin is intact. During an arthrocentesis on the patient's knee, the nurse would expect the aspirated fluid to appear a. sanguineous. b. purulent and thick. c. straw colored. d. white, thick, and ropelike.

Answer: A Rationale: The patient's clinical manifestations suggest hemarthrosis, and the appearance of blood in the synovial fluid is expected. Purulent fluid occurs when there is a joint infection. Straw-colored fluid is normal and will not be expected when the knee is swollen and painful. Thick fluid suggests infection. Cognitive Level: Comprehension Text Reference: p. 1628 Nursing Process: Assessment NCLEX: Physiological Integrity

9) The nurse is caring for an older adult client who is taking calcium for the treatment of osteoporosis. Which statements will the nurse include when educating the client about this medication? Select all that apply. A) "The most common adverse effect is hypercalcemia caused by taking too much of the supplement." B) "Oral calcium supplements are best taken on an empty stomach." C) "Adults 50 years of age and over should obtain at least 500 to 750 mg per day of elemental calcium." D) "If you have a condition called ventricular fibrillation, this medication might help." E) "Report symptoms of weakness, increased urination, and thirst."

Answer: A, E Explanation: A) Calcium gluconate and other calcium compounds are used to treat and prevent osteoporosis. Oral calcium supplements are best taken with meals or within 1 hour following meals. It is recommended that adults 50 years of age and over obtain at least 1000 to 1200 mg per day of elemental calcium. The most common adverse effect is hypercalcemia caused by taking too much of the supplement. Symptoms include lethargy, drowsiness, weakness, headache, anorexia, nausea and vomiting, increased urination, and thirst. Calcium supplementation is contraindicated in clients with ventricular fibrillation.

13) The nurse is caring for an 8-year-old client with cerebral palsy and limited walking ability. The parents are very protective and perform most activities for the child. Which intervention is essential in promoting bone growth and reducing the risk of osteoporosis? A) Provide client teaching related to using restraints to prevent falls. B) Provide client teaching related to assistive devices to encourage walking. C) Refer the client to a dietitian to increase calcium and vitamin D intake. D) Refer the client to an occupational therapist to increase limb movement

Answer: B Explanation: A) The most effective way to prevent osteoporosis is to perform weight-bearing activities and exercise. The client has limited walking ability rather than complete paralysis, so with practice, help from parents, and the appropriate use of assistive devices, the child could learn to walk independently. This would help stimulate bone growth. The nurse can inform the client and parents about the importance of calcium and vitamin D in the diet without referral to a dietitian. The nurse may need to refer the client to a physical therapist, not an occupational therapist, to help teach the client to walk independently. Appropriate restraints may be required to prevent falls for clients with cerebral palsy who do not have adequate body control. However, use of restraints will not increase bone growth in these clients.

When the health care provider tells a patient that the pain in the patient's knee is caused by bursitis, the patient asks the nurse to explain just what bursitis is. The nurse's best response would be to tell the patient bursitis is an inflammation of a. the fibrocartilage that acts as a shock absorber in the knee joint. b. a small, fluid-filled sac found at many joints. c. any connective tissue that is found supporting the joints of the body. d. the synovial membrane that lines the area between two bones of a joint.

Answer: B Rationale: Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa. Cognitive Level: Comprehension Text Reference: p. 1618 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse is assessing the passive range of motion of a patient's shoulder. The patient complains of pain during circumduction when the nurse moves the arm behind the patient. Which question should the nurse ask? a. "Do you ever have trouble making it to the toilet?" b. "Do you have difficulty in putting on a jacket?" c. "Are you able to feed yourself without difficulty?" d. "How well are you able to sleep at night?"

Answer: B Rationale: The patient's pain will make it more difficult to accomplish tasks like putting on a shirt or jacket. This pain should not impact the patient's ability to feed himself or herself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping. Cognitive Level: Application Text Reference: pp. 1620-1622 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

The nurse is caring for a patient with osteoporosis who is being discharged on alendronate (Fosamax). Which statement would indicate effective teaching? A. "I should take the medication immediately before bed" B. "I should remain in an upright position for 30 minutes after taking the medication" C. "The medication is more effective if I take it with milk or dairy products" D. If I skip a dose, I can take two tablets the next time"

Answer: B- Rationale should remain upright for 30 mins.

14) The nurse is caring for a woman who is at 14 weeks' gestation with her first child. The woman asks the nurse, "Am I at risk for osteoporosis since my baby takes calcium from my body?" What response by the nurse is correct? A) "You may lose small amounts of bone mass with each pregnancy, but if you only have one child, the bone loss should not be significant enough to cause osteoporosis." B) "When bone mass is lost during pregnancy, it is very difficult to restore, and you may be at increased risk for osteoporosis later in life. You should take a calcium supplement to prevent this." C) "If you eat a diet that is rich in calcium, any bone mass that is lost during pregnancy and breastfeeding will be restored within several months of weaning the child." D) "The baby won't require enough calcium during development to affect your bone mass or cause osteoporosis."

Answer: C C) During pregnancy, the growing fetus requires calcium to develop the skeleton. Calcium is also required for milk production. If the mother does not eat a diet rich in calcium, the baby draws what it needs from the mother's bones, causing a decrease in bone mass. Any bone mass that is lost during pregnancy or breastfeeding is typically easily restored several months after the infant is weaned from the breast. Studies indicate that the more times women are pregnant, the greater the mother's bone density.

7) The nurse is providing teaching to a young adult who is at risk for early-onset osteoporosis. Which intervention should the nurse suggest? A) The client should stop all physical activity. B) The client should reduce the intake of dairy in the diet. C) The client should increase intake of calcium and vitamin D. D) The client should start estrogen replacement therapy.

Answer: C Explanation: A) An appropriate goal for this client is a diet rich in calcium and vitamin D. Walking and weight-bearing exercise help prevent osteoporosis, so the client should not stop all physical activity. Dairy is rich in calcium, so reducing intake of dairy is not recommended. Due to the client's age, it is not likely that the client needs estrogen replacement therapy at this time.

8) A postmenopausal adult client is concerned about the development of osteoporosis and wants to begin preventative activities. Which statement by the nurse is appropriate? A) "You should first determine if you are at risk for the development of osteoporosis." B) "After menopause, the decline is too rapid to begin preventative interventions." C) "Weight-bearing exercise and calcium supplements are helpful in the prevention of osteoporosis." D) "Hormone replacement therapy should be initiated as soon as possible."

Answer: C Explanation: A) Osteoporosis risk factors increase after menopause. Preventative activities include implementing weight-bearing exercise and beginning calcium supplements. It is not too late to begin prevention activities. Without additional information, it is not possible to determine if the client is a candidate for hormone replacement therapy. The client in the scenario has two risk factors presented. Although a full analysis would be beneficial, it does not answer the client's request for information.

While testing the patient's muscle strength, the nurse finds that the patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should documents the patient's muscle strength as level a. 1. b. 2. c. 3. d. 4.

Answer: C Rationale: A level 3 indicates that the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.

An expected outcome of an older patient with acute osteomyelitis is: A. Pain B. Fatigue C. Low-grade fever D. Elevated leukocyte count

Answer: C Rationale: Common presenting symptoms of osteomyelitis are pain, fever, edema, elevated leukocyte count, fatigue, and general malaise. However, older adults may not have an extreme temperature elevation because of lower core body temperature and compromised immune system that occur with normal aging.

When assessing the musculoskeletal system, the nurse's initial action will usually be to a. have the patient move the extremities against resistance. b. feel for the presence of crepitus during joint movement. c. observe the patient's body build and muscle configuration. d. check active and passive range of motion for the extremities.

Answer: C Rationale: The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of abnormal areas. The other assessments are also included in the assessment but are usually done after inspection. Cognitive Level: Comprehension Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

The nurse teaches a client about lifestyle modifications to help manage hypertension. Which client statement indicates teaching has been effective? a) I won't be able to run in marathons anymore b) I know i need to give up my cigarettes and alcohol c) i need to get started on my medications right away d) my father had hypertension, did nothing, and lived to be 90 years old

B Limiting intake of alcohol and discontinuing tobacco products are important nonpharmacological methods for controlling hypertension. Implementing lifestyle modifications may eliminate the need for pharmacotherapy, so the client may not have to take medication right away. Increasing physical activity is an important lifestyle modification for controlling hypertension. The fact that the client's father had hypertension and lived to be 90 years old does not mean that the client will have the same experience; the client is in denial.

The nurse obtains this information from a patient with prehypertension. Which finding is most important to address with the patient? a) low dietary fiber intake b) no regular aerobic exercise c) weight 5 pounds above ideal weight d) drinks wine with dinner once a week

B The recommendations for preventing hypertension include exercising aerobically for 30 minutes most days of the week. A weight that is 5 pounds over the ideal body weight is not a risk factor for hypertension. The Dietary Approaches to Stop Hypertension (DASH) diet is high in fiber, but increasing fiber alone will not prevent hypertension from developing. The patient's alcohol intake will not increase the hypertension risk.

In teaching the hypertensive client to avoid orthostatic hypotension, the nurse should emphasize which of the following instructions? SATA a) plan regular times for taking medications b) rise slowly form bed c) avoid standing still for long periods d) avoid excessive alcohol intake e) avoid hot baths

B C Changing positions slowly and avoiding long periods of standing may limit the occurrence of orthostatic hypotension. Scheduling regular medication times is important for blood pressure management but this aspect is not related to the development of orthostatic hypotension.

2. After the nurse has finished teaching a patient with moderate osteoarthritis (OA) of the right knee about how to manage the OA, which patient statement indicates a need for more teaching? A. "I can take glucosamine to help decrease my knee pain." B. "I will take 1 g of acetaminophen (Tylenol) every 4 hours." C. "I can use a cane to decrease the pressure and pain in my knee." D. "I will use heat therapy such as warm whirlpool baths to help relieve stiffness."

B. "I will take 1 g of acetaminophen (Tylenol) every 4 hours."

A 42-year-old man who is scheduled for an arthrocentesis arrives at the outpatient surgery unit and states, "I do not want this procedure done today." Which response by the nurse is most appropriate? A. "When would you like to reschedule the procedure?" B. "Tell me what your concerns are about this procedure." C. "The procedure is safe, so why should you be worried?" D. "The procedure is not painful because an anesthetic is used."

B. "Tell me what your concerns are about this procedure." The nurse should use therapeutic communication to determine the patient's concern about the procedure. The nurse should not provide false reassurance. It is not appropriate for the nurse to assume the patient is concerned about pain or to assume the patient is asking to reschedule the procedure.

A female patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in her right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem? A. Atrophy B. Ankylosis C. Crepitation D. Contracture

B. Ankylosis Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement.

The client realizes the importance of quitting smoking, and the nurse develops a plan to help the client achieve this goal. Which of the following nursing interventions should be the initial step in this plan? a) review the negative effects of smoking on the body b) discuss the effects of passive smoking on environmental pollution c) establish the client's daily smoking pattern d) explain how smoking worsens high blood pressure

C A plan to reduce or stop smoking begins with establishing the client's personal daily smoking pattern and activities associated with smoking. It is important that the client understands the associated health and environmental risks, but this knowledge has not been shown to help clients change their smoking behavior.

The most important long-term goal for a client with hypertension would be to: a) learn how to avoid stress b) explore a job change or early retirement c) make a commitment to long-term therapy d) lose weight

C Compliance is the most critical element of hypertension therapy. In most cases, hypertensive clients require lifelong treatment and their hypertension cannot be managed successfully without drug therapy. Stress management is an important component of hypertension therapy, but the priority goal is related to compliance. It is not necessary for the client to change jobs or retire, but rather to learn to manage stress if the job is stressful. Losing weight may be necessary and will contribute to lower blood pressure, but the client must first accept the need for a lifelong management plan to control the hypertension.

The nurse is caring for patients in a primary care clinic. Which individual is most at risk to develop osteomyelitis caused by Staphylococcus aureus? A. 22-year-old female with gonorrhea who is an IV drug user B. 48-year-old male with muscular dystrophy and acute bronchitis C. 32-year-old male with type 1 diabetes mellitus and a stage IV pressure ulcer D. 68-year-old female with hypertension who had a knee arthroplasty 3 years ago

C. 32-year-old male with type 1 diabetes mellitus and a stage IV pressure ulcer Osteomyelitis caused by Staphylococcus aureus is usually associated with a pressure ulcer or vascular insufficiency related to diabetes mellitus. Osteomyelitis caused by Staphylococcus epidermidis is usually associated with indwelling prosthetic devices such as joint replacements. Osteomyelitis caused by Neisseria gonorrhoeae is usually associated with gonorrhea. Osteomyelitis caused by Pseudomonas is usually associated with IV drug use. Muscular dystrophy is not associated with osteomyelitis.

The nurse determines that dietary teaching for a 75-year-old patient with osteoporosis has been successful when the patient selects which highest-calcium meal? A. Chicken stir-fry with 1 cup each onions and green peas, and 1 cup of steamed rice B. Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk D. A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit

C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk The highest calcium content is present in the lunch containing milk and milk products (yogurt) and small fish with bones (sardines). Chicken, onions, green peas, rice, ham, whole wheat bread, broccoli, apple, eggs, and grapefruit each have less than 75 mg of calcium per 100 g of food. Swiss cheese and American cheese have more calcium, but not as much as the sardines, yogurt, and milk.

A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? a. "You have an appointment with a physical therapist for tomorrow." b. "Leave the shoulder immobilizer on for the first few days to minimize pain." c. "The doctor will use the drop-arm test to determine the success of the procedure." d. "You should try to find a different position to play on the baseball team."

Correct Answer: A Rationale: Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder." A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of ROM. The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.

11. A patient in the emergency department is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for a. conscious sedation. b. a knee immobilizer. c. gentle knee flexion. d. cast application.

Correct Answer: A Rationale: The first goal of collaborative management is realignment of the knee to its original anatomic position, which will require anesthesia or conscious sedation. Immobilization of the joint will be done after realignment. Later, gentle ROM exercises may be started if the joint is stable. Casting is not usually required for dislocations. Cognitive Level: Application Text Reference: p. 1632 Nursing Process: Implementation NCLEX: Physiological Integrity

All these medications are ordered at 9:00 AM for a patient who has had a right-hip replacement the previous day and is scheduled to ambulate with the physical therapist for the first time at 9:45. Which medication should be given first? a. Oxycodone (Roxicodone) 5 mg PO b. Ceftriaxone (Rocephin) 500 mg IV c. Enoxaparin (Lovenox) 30 mg SC d. Psyllium (Metamucil) 1 tsp PO

Correct Answer: A Rationale: The pain medication should be given so that it has time to take effect before the patient is ambulated. The other medications will not affect whether the patient can ambulate or not, although the antibiotic and anticoagulant medications should be given as soon as possible in order to maintain therapeutic blood levels. Cognitive Level: Application Text Reference: p. 1647 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient with comminuted fractures of the tibia and fibula is treated with open reduction and application of an external fixator. The next day, the patient complains of severe pain in the leg, which is unrelieved by ordered analgesics. The patient's toes are pink, but the patient complains of numbness and tingling. The most appropriate action by the nurse is to a. notify the patient's health care provider. b. check the patient's blood pressure. c. assess the external fixator pins for redness or drainage. d. elevate the extremity and apply ice over the wound site.

Correct Answer: A Rationale: The patient's clinical manifestations point to compartment syndrome and delay in diagnosis, and treatment may lead to severe functional impairment. There is no reason to suspect that patient's symptoms are caused by hypotension or hypertension or by infection at the pin sites. Elevation of or ice application to the leg will decrease arterial flow and further reduce perfusion. Cognitive Level: Application Text Reference: pp. 1650-1651 Nursing Process: Implementation NCLEX: Physiological Integrity

7. A 22-year-old patient started an exercise regimen 2 months ago that includes running 3 to 4 miles a day. The patient tells the nurse, "I enjoy my daily runs, but now I have shin splints." Which response by the nurse is appropriate? a. "You may be increasing your running time too quickly and need to cut back a little bit." b. "You need to have x-rays of your lower legs to be sure you do not have stress fractures." c. "You should expect some leg pain while running." d. "You should try speed-walking rather than running."

Correct Answer: A Rationale: The patient's information about running 3 to 4 miles daily after starting an exercise program only 2 months previously suggests that the shin splints are caused by overuse. Radiographs are not indicated for the type of injury described by the patient. Shin splints are not a normal or expected response to running. Because the patient expresses enjoyment of running, it would not be appropriate for the nurse to suggest a different sport. Cognitive Level: Application Text Reference: p. 1630 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the health care provider. Which one will the nurse act on first? a. Administer naproxen (Naprosyn) 500 mg PO. b. Wrap the ankle and apply an ice pack. c. Give acetaminophen with codeine (Tylenol #3). d. Take the patient to the radiology department for x-rays.

Correct Answer: B Rationale: Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied. Cognitive Level: Application Text Reference: p. 1631 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient who has been hospitalized for 3 days with a hip fracture and Buck's traction has sudden onset shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? a. Stay with the patient and offer reassurance. b. Administer oxygen at 4 L/min by a nasal cannula. c. Notify the health care provider about the patient's symptoms. d. Check the patient's legs for swelling or tenderness.

Correct Answer: B Rationale: The patient's clinical manifestations and history are consistent with a pulmonary embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiologic need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for deep vein thrombosis (DVT) are obtained. Cognitive Level: Application Text Reference: p. 1646 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient undergoes a right below-the-knee amputation with an immediate prosthetic fitting. When the patient is returned to the nursing unit, the nurse should a. check the surgical site for hemorrhage. b. take the patient's vital signs frequently. c. keep the residual leg elevated on a pillow. d. place the patient in a prone position.

Correct Answer: B Rationale: The vital signs should be monitored frequently to assess for hemorrhage because the nurse will not be able to visualize the surgical site. Flexion contracture of the hip would be encouraged by elevating the residual limb on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period. Cognitive Level: Application Text Reference: p. 1660 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient hospitalized with multiple fractures has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should a. keep the left arm in a dependent position. b. handle the cast with the palms of the hands. c. place gauze around the cast edge to pad any roughness. d. cover the cast with a small blanket to absorb the dampness.

Correct Answer: B Rationale: Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent creating areas inside the cast that could place pressure on the arm. The left arm should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.

In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is a. risk for constipation related to prolonged bed rest. b. activity intolerance related to deconditioning. c. risk for infection related to disruption of skin integrity. d. risk for impaired skin integrity related to immobility.

Correct Answer: C Rationale: A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis. After an ORIF, patients typically are mobilized starting the first postoperative day, so problems caused by immobility are not as likely. Cognitive Level: Application Text Reference: p. 1638 Nursing Process: Diagnosis NCLEX: Physiological Integrity

A patient has a short-arm plaster cast applied at the outpatient center for a wrist fracture. An understanding of discharge teaching is apparent when the patient says, a. "I can get the cast wet as long as I dry it right away with a hair dryer." b. "I should avoid moving my fingers and elbow until the cast is removed." c. "I will apply an ice pack to the cast over the fracture site for the next 24 hours." d. "I can rub lotion on any itching areas under the cast with a cotton-tipped applicator."

Correct Answer: C Rationale: Ice application for the first 24 hours after a fracture will help to reduce swelling and can be placed over the cast. Plaster casts should not get wet. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.

A patient is admitted with facial injuries after a bicycle accident and has a repair of a fractured mandible. When doing postoperative teaching, the nurse will include information about a. the use of sterile technique for dressing changes. b. the importance of including high-fiber foods in the diet. c. when the patient may need to cut the immobilizing wires. d. self-administration of nasogastric tube feedings.

Correct Answer: C Rationale: The jaw will be wired for stabilization, and the patient should know what emergency situations require that the wires be cut to protect the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high-fiber foods. Initially, the patient may receive nasogastric tube feedings, but by discharge the patient will swallow liquid through a straw. Cognitive Level: Application Text Reference: p. 1657 Nursing Process: Implementation NCLEX: Physiological Integrity

3. A checkout clerk in a grocery store has muscle and tendon tears that have become inflamed, causing pain and weakness in the left hand and elbow. The nurse identifies these symptoms as related to a. muscle spasms. b. meniscus injury. c. repetitive strain injury. d. carpal tunnel syndrome.

Correct Answer: C Rationale: The patient's occupation and the inflammation, pain, and weakness in the elbow and hand suggest a repetitive strain injury. Muscle spasms would be characterized by a palpable, firm muscle mass during the spasm. Meniscus injury would affect the knee. Carpal tunnel syndrome is characterized by weakness and numbness of the hand.

When evaluating the crutch-walking technique of a patient with a right-leg long-leg cast and no weight bearing on the right leg, the nurse determines that the patient is prepared to ambulate independently with the crutches on observing that the patient a. uses the bedside chair to assist in balance as needed when ambulating in the room. b. keeps the padded area of the crutch firmly in the axillary area when ambulating. c. advances the right leg and both crutches together and then advances the left leg. d. moves the left crutch with the left leg and then the right crutch with the right leg.

Correct Answer: C Rationale: When using crutches, patients are usually taught to move the assistive device and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg. Cognitive Level: Application Text Reference: p. 1648 Nursing Process: Evaluation NCLEX: Safe and Effective Care Environment

4. When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to a. do stretching and warm-up exercises before starting work. b. wrap the wrists with a compression bandage every morning. c. use acetaminophen (Tylenol) instead of NSAIDs for wrist pain. d. obtain a keyboard pad to support the wrist while word processing.

Correct Answer: D Rationale: Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by the use of a pad that will keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease swelling. Cognitive Level: Application Text Reference: p. 1633 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

The nurse provides discharge instructions to a patient with an above-the-knee amputation who will be fitted with a prosthesis when healing is complete and the residual limb is well molded. The nurse determines that teaching has been effective when the patient says, a. "I should change the limb sock when it becomes soiled or stretched out." b. "I should use lotion on the stump to prevent drying and cracking of the skin." c. "I should elevate my residual limb on a pillow 2 or 3 times a day." d. "I should lay on my abdomen for 30 minutes 3 or 4 times a day."

Correct Answer: D Rationale: The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limp sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage flexion contracture. Cognitive Level: Application Text Reference: p. 1661 Nursing Process: Evaluation NCLEX: Physiological Integrity

After the nurse teaches the patient with stage 1 hypertension about diet modifications that should be implemented, which diet choice indicates that the teaching has been effective? a) the patient avoids eating nuts or nut butters b) the patient restricts intake of dietary protein c) the patient has only one cup of coffee in the morning d) the patient has a glass of low fat milk with each meal

D The Dietary Approaches to Stop Hypertension (DASH) recommendations for prevention of hypertension include increasing the intake of calcium-rich foods. Caffeine restriction and decreased protein intake are not included in the recommendations. Nuts are high in beneficial nutrients and 4 to 5 servings weekly are recommended in the DASH diet.

A client's job involves working in a warm, dry room, frequently bending and crouching to check the underside of a high-speed press, and wearing eye guards. Given this information, the nurse should assess the client for which of the following? a) muscle aches b) thirst c) lethargy d) orthostatic hypotension

D Possible dizziness from orthostatic hypotension when rising from a crouched or bent position increases the client's risk of being injured by the equipment. The nurse should assess the client's blood pressure in all three positions (lying, sitting, and standing) at all routine visits. The client may experience muscle aches, or thirst from working in a warm, dry room, but these are not as potentially dangerous as orthostatic hypotension. The client should not be experiencing lethargy.

A 67-year-old patient hospitalized with osteomyelitis has an order for bed rest with bathroom privileges with the affected foot elevated on two pillows. The nurse would place highest priority on which intervention? A. Ambulate the patient to the bathroom every 2 hours. B. Ask the patient about preferred activities to relieve boredom. C. Allow the patient to dangle legs at the bedside every 2 to 4 hours. D. Perform frequent position changes and range-of-motion exercises.

D. Perform frequent position changes and range-of-motion exercises. The patient is at risk for atelectasis of the lungs and for contractures because of prescribed bed rest. For this reason, the nurse should place the priority on changing the patient's position frequently to promote lung expansion and performing range-of-motion (ROM) exercises to prevent contractures. Assisting the patient to the bathroom will keep the patient safe as the patient is in pain, but it may not be needed every 2 hours. Providing activities to relieve boredom will assist the patient to cope with the bed rest, and dangling the legs every 2 to 4 hours may be too painful. The priority is position changes and ROM exercises.

The nurse observes that an 18- year- old female patient has asymmetry of the shoulders and hips, and the hem of her dress is uneven. The nurse suspects that the patient may be presenting with which disorder? A. Congenital hip dislocation B. Scoliosis C. Fractured tibia D. Degenerative disc disease

Rationale: Answer B is correct. A classic sign of scoliosis is asymmetrical dress or skirt hem caused by unevenness of affected shoulder and hip, due to a lateral curvature of the spine. The spinal deformity causes the asymmetry. Congenital hip dislocation is diagnosed during infancy. Signs of a fractured tibia would include painful ambulation, not unevenness of the shoulder and hip. Degenerative disc disease is typically experienced by older adults and causes a uniform decline in height.

The nurse at an orthopedic joint clinic is preparing pre-operative teaching for a patient scheduled for total hip replacement surgery. Which would be included in the teaching plan? A. Avoid sitting in a chair B. Make sure that commode seats are at low levels C. Avoid crossing the legs when sitting D. Physical Therapy will assist with adduction exercises

Rationale: Answer C is correct. The patient with joint hip replacement should avoid adduction of the legs and flexion of the hips greater than 90 degrees to ensure continued placement of the prosthetic joint. It is recommended for these patients to use recliners for seating instead of straight chairs., therefore A is incorrect. Commode seats will have to be raised and abduction of the legs is required, making B and D incorrect choices.

The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine What does the nurse understand this common finding is known as? A.Lordosis B.Scoliosis C.Osteoporosis D.Kyphosis

Rationale: Answer D is correct.

A patient complains of tingling and numbness in his right leg following application of a long leg cast. The patient's discomfort is most likely the result of: A. Reduced venous return B. Bone healing C. Arterial insufficiency D. Nerve compression

Rationale: Answer D is correct. Numbness and tingling in a n extremity immobilized by a cast are most likely the result of nerve compression. Answer A is incorrect because reduced venous return results in swelling in the extremity. Answer B is incorrect because numbness and tingling are not associated with bone healing. Answer C is incorrect because arterial insufficiency results in diminished or absent pulses in the extremity.

To prevent dislocation of a hip prosthesis following a total hip replacement, the nurse should: A. Maintain the patient's affected leg in an adducted position B. Maintain the patient's affected hip in a flexed position C. Tell the patient to remain in supine position D. Place an abduction pillow between the patient's leg

Rationale: Answer D is correct. The patient's leg should be maintained in an abducted position to prevent dislocation of the prosthesis. This is accomplished by the use of an abduction pillow. Answers A and B will increase the likelihood of dislocation of the prosthesis; therefore, they are incorrect. Answer C is unnecessary; therefore, it is incorrect.

An elderly female is admitted with a fractured right femoral neck. Which assessment finding is expected? A. Free movement of the right leg B. Abduction of the right leg C. Internal rotation of the right hip D. Shortening of the right leg

Rationale: Answer D is correct. The symptoms of this fracture include shortened, adducted, and external rotation. Answer A is incorrect because the patient usually is unable to move the leg due to pain. Answer B is incorrect because the symptom is adduction, not abduction. Answer C is wrong because it's external rotation, not internal rotation.

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? Select all that apply. A.Checking the urine for hematuria B.Palpating peripheral pulses in both lower extremities C.Testing the stool for occult blood D.Assessing level of consciousness E.Assessing pupillary response

Rationale: Correct answer is A,B, and C

D. stay with the person and encourage the person to remain still

The nurse is one of several people who witnesses a vehicle hit pedestrian at a fairly low speed on a small street. The individual is dazed and tired to get up and the leg appears fractured. The nurse should plan to preform which action ? A. Try to manually reduce the fracture B. assist the person to get up and walk to the sidewalk C. leave the person for a few moments to call an ambulance D. stay with the person and encourage the person to remain still

A. Loss of bone mass B. Decrease in height D. Decreased muscle mass

The nurse is providing education to a middle-aged female about her changing health needs. The nurse should be sure to include information on which age-related changes? (Select all that apply.) A. Loss of bone mass B. Decrease in height C. Increased circulation D. Decreased muscle mass E. Increased mineral exchange

C. The patient initially advances the left crutch.

The nurse is assisting the patient to use the 4-point gait with crutches. Which behavior by the patient demonstrates understanding? A. The patient initially advances the left foot. B.The patient initially advances the right foot. C. The patient initially advances the left crutch. D. The patient initially advances the right crutch.

A. elevating the limb and applying ice to the affected leg

The nurse is caring for a client with fresh application of a plaster leg cast. The nurse should plan to prevent the development of compartment syndrome by which action? A. elevating the limb and applying ice to the affected leg B. elevating the limb and covering the limb with bath blankets C. keeping the leg horizontal and applying ice to the affected leg D. placing the leg in a slightly depended position and applying ice

C. 1 cup low-fat yogurt

The nurse is educating the patient with osteoporosis on the best diet choices to improve bone density. The patient would demonstrate an understanding of the teaching by selecting which food choice that has the highest calcium content? A. 1 cup spinach B. 1 cup chopped kale C. 1 cup low-fat yogurt D. 1 ounce sliced carrots

B. moves the cane when the right leg is moved

The nurse is evaluating the clients use of a cane for left-sided weakness. The nurse should intervene and correct the client if the nurse observes that the client preformed which action? A. holds the cane on the right side B. moves the cane when the right leg is moved C. leans on the cane when the right leg swings through D. keeps the cane 6 inches out to the side of the right foot

B. serous drainage

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be atleast concerned with which finding? A. inflammation B. serious drainage C. pain at pin site D. purulent drainage

A. "Rest your ankle as much as possible." B. "Prop your ankle on pillows while resting." C. "You should wrap your ankle with an elastic bandage."

The patient presents to the clinic after falling from her bike and is diagnosed with a Grade II ankle sprain. The nurse should make which statements to the patient regarding the treatment of her sprained ankle? (Select all that apply.) A. "Rest your ankle as much as possible." B. "Prop your ankle on pillows while resting." C. "You should wrap your ankle with an elastic bandage." D. "Take stimulant laxatives with your narcotic pain medication." E. "Place an ice pack on your ankle for 30 minutes every 4 hours." F. "Begin walking on your injured ankle after 24 hours, and increase your ambulation as tolerated."

B. Tetanus booster D. Intravenous (IV) morphine E. IV antibiotics

The patient presents to the clinic with a compound fracture of the right leg. The nurse anticipates the administration of which classes of medications? (Select all that apply.) A. Aspirin B. Tetanus booster C. Hepatitis B vaccine D. Intravenous (IV) morphine E. IV antibiotics

C. Bone density

The patient presents to the clinic with symptoms indicative of osteoporosis. The nurse anticipates which study will be performed in order to confirm the diagnosis? A. Chest x-ray B. Nuclear scan C. Bone density D. Computed tomography (CT) scan

D. Torn anterior cruciate ligament injury

The patient presents to the emergency department after a soccer game. The patient reports that she made a sharp turn and heard and felt a large pop from her knee. The patient reports, "Now, when I'm walking, it feels like my knee just gives out, and I almost fall. Plus, it's twice the size of my other knee, and I can't straighten it all the way." The nurse recognizes that these symptoms correspond with which injury? A. Torn meniscus B. Dislocated patella C. Torn quadriceps muscle D. Torn anterior cruciate ligament injury

An older adult is newly diagnosed with primary hypertension and has just been started on a beta-blocker. What should the nurse include in health education? Increasing fluids to avoid extracellular volume depletion from the diuretic effect of the beta-blocker Maintaining a diet high in dairy to increase protein necessary to prevent organ damage Use of strategies to prevent falls stemming from postural hypotension Limiting exercise to avoid injury that can be caused by increased intracranial pressure

Use of strategies to prevent falls stemming from postural hypotension

A client is being seen at the clinic on a monthly basis for assessment of blood pressure. The client has been checking blood pressure at home as well and has reported a systolic pressure of 158 and a diastolic pressure of 64. What does the nurse suspect this client is experiencing? a. Isolated systolic hypertension b. Secondary hypertension c. Primary hypertension d. Hypertensive urgency

a As a result of changes that occur with aging, the aorta and large arteries are less able to accommodate the volume of blood pumped out by the heart (stroke volume), and the energy that would have stretched the vessels instead elevates the systolic blood pressure, resulting in an elevated systolic pressure without a change in diastolic pressure. This condition, known as isolated systolic hypertension, is more common in older adults and is associated with significant cardiovascular and cerebrovascular morbidity and mortality (Chobanian et al., 2003).

Which describes a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage? a. Hypertensive emergency b. Hypertensive urgency c. Primary hypertension d. Secondary hypertension

a A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage. Hypertensive urgency is a situation in which blood pressure is severely elevated but there is no evidence of actual or probable target organ damage. Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure from an unidentified source.

The nurse is completing a cardiac assessment on a client. The patient has a blood pressure (BP) reading of 126/80. What would the nurse would identify this blood pressure reading as? a. Prehypertension b. Normal c. Stage 1 hypertension d. Stage 2 hypertension

a A systolic BP of 128 mm Hg is classified as prehypertension. A systolic BP of less than 120 mm Hg is normal. A systolic BP of 140 to 159 mm Hg is Stage I hypertension. A systolic BP of greater than or equal to 160 is classified as Stage 2 hypertension.

Officially, hypertension is diagnosed when the client demonstrates a systolic blood pressure greater than ______ mm Hg and a diastolic blood pressure greater than _____ mm Hg over a sustained period. a. 140, 90 b. 130, 80 c. 110, 60 d. 120, 70

a According to the categories of blood pressure levels established by the JNC VI, stage 1 hypertension is demonstrated by a systolic pressure of 140 to 159, or a diastolic pressure of 90 to 99. Pressure of 130 systolic and 80 diastolic falls within the prehypertension classification range for an adult. Pressures of 110 systolic and 60 diastolic, and of 120 systolic and 70 diastolic, fall within the normal range for an adult.

A client with newly diagnosed hypertension asks what to do to decrease the risk for related cardiovascular problems. Which risk factor is not modifiable by the client? a. Age b. Obesity c. Inactivity d. Dyslipidemia

a Age and family history for cardiovascular disease are risk factors that cannot be changed. Obesity, inactivity, and disylipidemia are risk factors that can be improved by the client through dietary changes, exercise, and other healthy lifestyle choices.

High blood pressure is highly prevalent in the United States. Approximately how many people have high blood pressure in the United States? a. 1 in 3 adults b. 1 in 6 adults c. 1 in 7 adults d. 1 in 10 adults

a Approximately 68 million people, or 1 in 3 adults, in the United States have high blood pressure. (Centers for Disease Control and Prevention, 2016).

A 35-year-old client has been diagnosed with hypertension. The client is a stock broker, smokes daily, and has diabetes. During a follow-up appointment, the client states that regular visits to the doctor just to check blood pressure (BP) are cumbersome and time consuming. As the nurse, which aspect of client teaching would you recommend? a. Purchasing a self-monitoring BP cuff b. Discussing methods for stress reduction c. Advising smoking cessation d. Administering glycemic control

a Because this client finds visiting the doctor time-consuming just for a BP reading, as the nurse, you can suggest the use of an automatic cuff at a local pharmacy, or purchasing a self-monitoring cuff. Discussing methods to reduce stress, advising smoking cessation, and achieving glycemic control would constitute client education in managing hypertension.

A client who has just been diagnosed with hypertension has been instructed to take a daily blood pressure measurement. The systolic blood pressure reading measures the volume of blood ejected from the: a. left ventricle. b. right ventricle. c. left atrium. d. right atrium.

a Systolic blood pressure is determined by the force and volume of blood that the left ventricle ejects during systole and the ability of the arterial system to distend at the time of ventricular contraction.

A client with primary hypertension comes to the clinic reporting a gradual onset of blurry vision and decreased visual acuity over the past several weeks. The nurse is aware that these symptoms could be indicative of what? a. Retinal blood vessel damage b. Glaucoma c. Cranial nerve damage d. Hypertensive emergency

a Blurred vision, spots in front of the eyes, and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system as a result of hypertension. Glaucoma and cranial nerve damage do not normally cause these symptoms. A hypertensive emergency would have a more rapid onset.

A client with primary hypertension reports dizziness with ambulation when taking the prescribed alpha-adrenergic blocker. When teaching this client, what should the nurse emphasize? a. Rising slowly from a lying or sitting position b. Increasing fluids to maintain BP c. Stopping medication if dizziness persists d. Taking medication first thing in the morning

a Clients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. It is not necessary to teach these clients about increasing fluids or taking medication in the morning (this would increase the effects of dizziness). Clients should not be taught to stop the medication if dizziness persists because this is unsafe and beyond the nurse's scope of practice.

A client has severe coronary artery disease (CAD) and hypertension. Which medication order should the nurse consult with the health care provider about that is contraindicated for a client with severe CAD? a. Clonidine b. Amiloride c. Bumetanide d. Methyldopa

a Clonidine (Catapres) is contraindicated for clients with severe coronary artery disease.

The nurse is developing a nursing care plan for a client who is being treated for hypertension. What is a measurable client outcome that the nurse should include? a. Client will reduce Na+ intake to no more than 2.4 g daily. b. Client will have a stable BUN and serum creatinine levels. c. Client will abstain from fat intake and reduce calorie intake. d. Client will maintain a normal body weight.

a Dietary sodium intake of no more than 2.4 g daily is recommended as a dietary lifestyle modification to prevent and manage hypertension. Giving a specific amount of allowable sodium intake makes this a measurable goal. None of the other listed goals is quantifiable and measurable.

The nurse is teaching a client who is experiencing dizziness to rise slowly from a sitting or lying position. What is the rationale for the teaching? a. Gradual changes in position provide time for the heart to increase rate of contraction to resupply oxygen to the brain. b. Gradual changes in position help reduce the blood pressure to resupply oxygen to the brain. c. Gradual changes in position help reduce the heart's work to resupply oxygen to the brain. d. Gradual changes in position provide time for the heart to reduce its rate of contraction to resupply oxygen to the brain.

a It is important for the nurse to encourage the patient to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain. Blood pressure and heart rate do not affect this process.

A client who is newly diagnosed with high blood pressure has a 20-pack-year tobacco history. The nurse recommends smoking cessation for this client because nicotine: a. raises heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b. decreases heart rate, constricts arterioles, and reduces the heart's ability to eject blood. c. increases heart rate, constricts arterioles, and increases the heart's ability to eject blood. d. decreases circulating blood volume.

a Nurses recommend smoking cessation for clients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood.

A client has come to the clinic for a follow-up assessment that will include a BP reading. To ensure an accurate reading, the nurse should confirm that the client has done which of the following? a. Tried to rest quietly for 5 minutes before the reading is taken b. Refrained from smoking for at least 8 hours c. Drank adequate fluids during the day prior d. Avoided drinking coffee for 12 hours before the visit

a Prior to the nurse assessing the client's BP, the client should try to rest quietly for 5 minutes. The forearm should be positioned at heart level. Caffeine products and cigarette smoking should be avoided for at least 30 minutes prior to the visit. Recent fluid intake is not normally relevant.

A nurse is teaching a client with severe hypertension about the damage this condition can cause to the body. What system/organs will the nurse note are particularly targeted for damage due to severe hypertension? a. Sensory b. Musculoskeletal c. Gastrointestinal d. Integumentary

a Prolonged elevated blood pressure eventually damages blood vessels throughout the body, particularly in target organs such as the heart, kidneys, brain, and eyes. The usual consequences of prolonged, uncontrolled hypertension are myocardial infarction, heart failure, renal failure, strokes, and impaired vision.

A client with secondary hypertension has come into the clinic for a routine check-up. When comparing this client's diagnosis to primary hypertension, the nurse recognizes that secondary hypertension: a. has a specific cause. b. has a more gradual onset than primary hypertension. c. does not normally cause target organ damage. d. does not normally respond to antihypertensive drug therapy.

a Secondary hypertension has a specific identified cause. A cause could include narrowing of the renal arteries, renal parenchymal disease, hyperaldosteronism, certain medications, pregnancy, and coarctation of the aorta. Secondary hypertension does respond to antihypertensive drug therapy and can cause target organ damage if left untreated.

Which finding indicates that hypertension is progressing to target organ damage? a. Retinal blood vessel damage b. Urine output of 60 mL over 2 hours c. Blood urea nitrogen concentration of 12 mg/dL d. Chest x-ray showing pneumonia

a Symptoms suggesting that hypertension is progressing to the extent that target organ damage is occurring must be detected early so that appropriate treatment can be initiated. All body systems must be assessed to detect any evidence of vascular damage. An eye examination with an ophthalmoscope is important because retinal blood vessel damage indicates similar damage elsewhere in the vascular system. The client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed. A BUN concentration of 12 mg/dL and urine output of 60 mL over 2 hours are normal findings. The presence of pneumonia does not indicate target organ damage.

A client with a history of hypertension is receiving client education about structures that regulate arterial pressure. Which structure is a component of that process? a. kidneys b. parasympathetic nervous system c. limbic system d. lungs

a The autonomic nervous system, the kidneys, and various endocrine glands regulate arterial pressure.

A client in a clinic setting has just been diagnosed with hypertension. When the client asks what the end goal is for treatment, what is the nurse's best response? a. To prevent complications/death by achieving and maintaining a blood pressure of 140/90 or less b. To prevent complications/death by achieving and maintaining a blood pressure of 145/95 or less c. To stop smoking and increase physical activity to 30 minutes/day most days of the week d. To lose weight, achieve a body mass index of 24 or less, and to eat a diet rich in fruits and vegetables

a The end goal of hypertension treatment is to prevent complications and death by achieving and maintaining arterial blood pressure at 140/90 or lower for most people. To achieve this end goal, the client is taught to make the following lifestyle changes (these are not end goals; they are ways to reach the end goal listed above): (1) maintaining a normal body mass index (about 24; greater than 25 is considered overweight); maintaining a waist circumference of less than 40 inches for men and 35 inches for women; limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day; engaging in aerobic activity at least 30 minuetes per day most days of the week.

The nurse is reviewing the diet of a client who has been diagnosed with hypertension. The nurse recommends reducing or avoiding caffeine because caffeine: a. increases the heart rate and causes vasoconstriction. b. reduces the heart rate and leads to a coronary artery disease. c. reduces the heart rate and causes low blood pressure. d. increases the heart rate and causes angina.

a The nurse recommends reducing or avoiding caffeine for clients with hypertension because caffeine increases the heart rate and causes vasoconstriction. Angina and coronary artery disease are the result of arteries becoming blocked by a substance called plaque.

It is appropriate for the nurse to recommend smoking cessation for clients with hypertension because nicotine a. increases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. b. decreases the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. c. increases the heart rate, constricts arterioles, and increases the heart's ability to eject blood. d. decreases circulating blood volume.

a The nurse recommends smoking cessation for clients with hypertension because nicotine raises the heart rate, constricts arterioles, and reduces the heart's ability to eject blood. Reduced oral fluids decrease the circulating blood volume.

The nurse is planning the care of a patient admitted to the hospital with hypertension. What objective will help to meet the needs of this patient? a. Lowering and controlling the blood pressure without adverse effects and without undue cost b. Making sure that the patient adheres to the therapeutic medication regimen c. Instructing the patient to enter a weight loss program and begin an exercise regimen d. Scheduling the patient for all follow-up visits and making phone calls to the home to ensure adherence

a The objective of nursing care for patients with hypertension focuses on lowering and controlling the blood pressure without adverse effects and without undue cost.

A client newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a client with prolonged, uncontrolled hypertension is at risk for developing what health problem? a. Acute kidney injury b. Right ventricular hypertrophy c. Glaucoma d. Anemia

a When uncontrolled hypertension is prolonged, it can result in acute kidney injury, myocardial infarction, stroke, impaired vision, left ventricular hypertrophy, and cardiac failure. Glaucoma and anemia are not directly associated with hypertension.

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? a) "Pace yourself and rest frequently, especially after activities." b) "Do all your chores in the morning, when pain and stiffness are least pronounced." c) "Do all your chores in the evening, when pain and stiffness are least pronounced." d) "Do all your chores after performing morning exercises to loosen up."

a) "Pace yourself and rest frequently, especially after activities."

Which patient has the highest priority? a.A 50-year old man recently diagnosed with ALS who presents crackles upon auscultation. b.A 40-year old woman with ALS who has been on Riluzole (Rilutek) and is experiencing yellowing of the skin. c.A 29 year old admitted a day ago for a 30 feet fall while intoxicated, landing on his buttocks, with a comminuted 3 column burst fracture of the L4 vertebral body. He is scheduled for a Helial CT scan through the upper sacrum w/out contrast. d.A 70 year old patient who has sacral pressure ulcer type II.

a) A 50-year old man recently diagnosed with ALS who presents crackles upon auscultation

client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Administering ordered analgesics and monitoring their effects b) Performing meticulous skin care c) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes d) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware

a) Administering ordered analgesics and monitoring their effects

Which of the following clinical manifestations would the nurse expect to find in a client with osteoarthritis? a) Early morning stiffness b) Subcutaneous nodules c) Small joint involvement d) Joint pain that diminishes with rest

a) Early morning stiffness

Which nursing diagnosis is least appropriate for the client with rheumatoid arthritis? a) Imbalanced nutrition: greater than body requirements b) Impaired physical mobility c) Deficient knowledge: symptom management d) Chronic pain

a) Imbalanced nutrition: greater than body requirements

Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis? a) Low back pain b) Patchy hair loss on the scalp c) Red, butterfly-shaped facial rash d) Increased urine output

a) Low back pain

A nurse should advise a patient with gout to avoid which of the following foods? a) Organ meats and scallops b) Nuts and peanut butter c) Fruits and juices d) Bread and cereal

a) Organ meats and scallops

A nurse is providing education about hypertension to a community group. What are possible consequences of untreated hypertension? Select all that apply. a. Coronary artery disease b. Myocardial infarction c. Pancreatitis d. Tension pneumothorax e. Stroke

a, b, e People with hypertension may remain asymptomatic for many years. When specific signs and symptoms appear, however, they usually indicate vascular damage. Coronary artery disease with angina and myocardial infarction are common consequences of hypertension. Cerebrovascular involvement may lead to a stroke. Tension pneumothorax and pancreatitis are not directly related to hypertension.

Which condition(s) indicates target organ damage from untreated/undertreated hypertension? Select all that apply. a. Heart failure b. Retinal damage c. Diabetes d. Hyperlipidemia e. Stroke

a, b, e Target organs include the heart, kidney, brain, and eyes. Hyperlipidemia and diabetes are risk factors for development of hypertension.

Which statements are true when the nurse is measuring blood pressure (BP)? Select all that apply. a. Using a BP cuff that is too small will give a higher BP measurement. b. The client's arm should be positioned at the level of the heart. c. Using a BP cuff that is too large will give a higher BP measurement. d. The client's BP should be measured 1 hour before consuming alcohol. e. The client should sit quietly while BP is being measured.

a, b, e These statements are all true when measuring a BP. When using a BP cuff that is too large, the reading will be lower than the actual BP. The client should avoid smoking cigarettes or drinking caffeine for 30 minutes before BP is measured.

The nurse is performing an assessment on a patient to determine the effects of hypertension on the heart and blood vessels. What specific assessment data will assist in determining this complication? (Select all that apply.) a. Heart rate b. Respiratory rate c. Heart rhythm d. Character of apical and peripheral pulses e. Lung sounds

a, c, d During the physical examination, the nurse must also pay specific attention to the rate, rhythm, and character of the apical and peripheral pulses to detect the effects of hypertension on the heart and blood vessels.

What action by the perioperative nursing staff is most important to prevent surgical wound infection in a client having a total joint replacement? a. Administer preoperative antibiotic as ordered. b. Assess the clients white blood cell count. c. Instruct the client to shower the night before. d. Monitor the clients temperature postoperatively.

a. Administer preoperative antibiotic as ordered. To prevent surgical wound infection, antibiotics are given preoperatively within an hour of surgery. Simply taking a shower will not help prevent infection unless the client is told to use special antimicrobial soap. The other options are processes to monitor for infection, not prevent it.

A client with fibromyalgia is in the hospital for an unrelated issue. The client reports that sleep, which is always difficult, is even harder now. What actions by the nurse are most appropriate? (Select all that apply.) a. Allow the client uninterrupted rest time. b. Assess the clients usual bedtime routine. c. Limit environmental noise as much as possible. d. Offer a massage or warm shower at night. e. Request an order for a strong sleeping pill.

a. Allow the client uninterrupted rest time. b. Assess the clients usual bedtime routine. c. Limit environmental noise as much as possible. d. Offer a massage or warm shower at night. Clients with fibromyalgia often have sleep disturbances, which can be exacerbated by the stress, noise, and unfamiliar environment of the hospital. Allowing uninterrupted rest time, adhering to the clients usual bedtime routine as much as possible, limiting noise and light, and offering massages or warm showers can help. The client does not need a strong sleeping pill unless all other options fail and the client requests something for sleep. At that point a mild sleeping agent can be tried.

An older client returning to the postoperative nursing unit after a hip replacement is disoriented and restless. What actions does the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Apply an abduction pillow to the clients legs. b. Assess the skin under the abduction pillow straps. c. Place pillows under the heels to keep them off the bed. d. Monitor cognition to determine when the client can get up. e. Take and record vital signs per unit/facility policy.

a. Apply an abduction pillow to the clients legs. c. Place pillows under the heels to keep them off the bed. e. Take and record vital signs per unit/facility policy. The UAP can apply an abduction pillow, elevate the heels on a pillow, and take/record vital signs. Assessing skin is the nurses responsibility, although if the UAP notices abnormalities, he or she should report them. Determining when the client is able to get out of bed is also a nursing responsibility.

A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best? a. Arrange a home safety evaluation. b. Ensure the client has a walker at home. c. Help the client look into assisted living. d. Refer the client to Meals on Wheels.

a. Arrange a home safety evaluation. This client has several risk factors that place him or her at a high risk for falling. The nurse should consult social work or home health care to conduct a home safety evaluation. The other options may or may not be needed based upon the clients condition at discharge.

A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best? a. Ask the client about fear of falling. b. Instruct the client to increase calcium. c. Suggest other exercises the client can do. d. Tell the client to try weight lifting.

a. Ask the client about fear of falling. Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight lifting.

A client who has had systemic lupus erythematosus (SLE) for many years is in the clinic reporting hip pain with ambulation. Which action by the nurse is best? a. Assess medication records for steroid use. b. Facilitate a consultation with physical therapy. c. Measure the range of motion in both hips. d. Notify the health care provider immediately.

a. Assess medication records for steroid use. Chronic steroid use is seen in clients with SLE and can lead to osteonecrosis (bone necrosis). The nurse should determine if the client has been taking a steroid. Physical therapy may be beneficial, but there is not enough information about the client yet. Measuring range of motion is best done by the physical therapist. Notifying the provider immediately is not warranted.

The nurse on the postoperative inpatient unit assesses a client after a total hip replacement. The clients surgical leg is visibly shorter than the other one and the client reports extreme pain. While a co-worker calls the surgeon, what action by the nurse is best? a. Assess neurovascular status in both legs. b. Elevate the affected leg and apply ice. c. Prepare to administer pain medication. d. Try to place the affected leg in abduction.

a. Assess neurovascular status in both legs. This client has manifestations of hip dislocation, a critical complication of this surgery. Hip dislocation can cause neurovascular compromise. The nurse should assess neurovascular status, comparing both legs. The nurse should not try to move the extremity to elevate or abduct it. Pain medication may be administered if possible, but first the nurse should thoroughly assess the client.

A client is in the internal medicine clinic reporting bone pain. The clients alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate? a. Assess the client for leg bowing. b. Facilitate an oncology workup. c. Instruct the client on fluid restrictions. d. Teach the client about ibuprofen (Motrin).

a. Assess the client for leg bowing. This client has manifestations of Pagets disease. The nurse should assess for other manifestations such as bowing of the legs. Other care measures can be instituted once the client has a confirmed diagnosis.

A client comes to the family medicine clinic and reports joint pain and stiffness. The nurse is asked to assess the client for Heberdens nodules. What assessment technique is correct? a. Inspect the clients distal finger joints. b. Palpate the clients abdomen for tenderness. c. Palpate the clients upper body lymph nodes. d. Perform range of motion on the clients wrists.

a. Inspect the clients distal finger joints. Herberdens nodules are seen in osteoarthritis and are bony nodules at the distal interphalangeal joints. To assess for this finding, the nurse inspects the clients distal fingertips. These nodules are not found in the abdomen, lymph nodes, or wrists.

A client in the orthopedic clinic has a self-reported history of osteoarthritis. The client reports a low-grade fever that started when the weather changed and several joints started acting up, especially both hips and knees. What action by the nurse is best? a. Assess the client for the presence of subcutaneous nodules or Bakers cysts. b. Inspect the clients feet and hands for podagra and tophi on fingers and toes. c. Prepare to teach the client about an acetaminophen (Tylenol) regimen. d. Reassure the client that the problems will fade as the weather changes again.

a. Assess the client for the presence of subcutaneous nodules or Bakers cysts. Osteoarthritis is not a systemic disease, nor does it present bilaterally. These are manifestations of rheumatoid arthritis. The nurse should assess for other manifestations of this disorder, including subcutaneous nodules and Bakers cysts. Podagra and tophi are seen in gout. Acetaminophen is not used for rheumatoid arthritis. Telling the client that the symptoms will fade with weather changes is not accurate.

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the clients psychosocial needs? a. Assess the clients coping skills and support systems. b. Explain that the surgery leads to a longer life expectancy. c. Refer the client to the social worker or hospital chaplain. d. Reinforce physical therapy to aid with ambulating normally.

a. Assess the clients coping skills and support systems. The first step in the nursing process is assessment. The nurse should assess coping skills and possible support systems that will be helpful in this clients treatment. Explaining that a limb salvage procedure will extend life does not address the clients psychosocial needs. Referrals may be necessary, but the nurse should assess first. Reinforcing physical therapy is also helpful but again does not address the psychosocial needs of the client.

A client has been diagnosed with rheumatoid arthritis. The client has experienced increased fatigue and worsening physical status and is finding it difficult to maintain the role of elder in his cultural community. The elder is expected to attend social events and make community decisions. Stress seems to exacerbate the condition. What action by the nurse is best? a. Assess the clients culture more thoroughly. b. Discuss options for performing duties. c. See if the client will call a community meeting. d. Suggest the client give up the role of elder.

a. Assess the clients culture more thoroughly. The nurse needs a more thorough understanding of the clients culture, including the meaning of illness and the ramifications of the elder not being able to perform traditional duties. This must be done prior to offering any possible solutions. If the nurse does not understand the consequences of what is suggested, the client may simply be unwilling to listen or participate in problem solving. The other options may be reasonable depending on the outcome of a better cultural understanding.

The nurse is working with a client who has rheumatoid arthritis (RA). The nurse has identified the priority problem of poor body image for the client. What finding by the nurse indicates goals for this client problem are being met? a. Attends meetings of a book club b. Has a positive outlook on life c. Takes medication as directed d. Uses assistive devices to protect joints

a. Attends meetings of a book club All of the activities are appropriate for a client with RA. Clients who have a poor body image are often reluctant to appear in public, so attending public book club meetings indicates that goals for this client problem are being met.

A nurse is teaching a female client with rheumatoid arthritis (RA) about taking methotrexate (MTX) (Rheumatrex) for disease control. What information does the nurse include? (Select all that apply.) a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. c. Pregnancy and breast-feeding are not affected by MTX. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects.

a. Avoid acetaminophen in over-the-counter medications. b. It may take several weeks to become effective on pain. d. Stay away from large crowds and people who are ill. e. You may find that folic acid, a B vitamin, reduces side effects. MTX is a disease-modifying antirheumatic drug and is used as a first-line drug for RA. MTX can cause liver toxicity, so the client should be advised to avoid medications that contain acetaminophen. It may take 4 to 6 weeks for effectiveness. MTX can cause immunosuppression, so avoiding sick people and crowds is important. Folic acid helps reduce side effects for some people. Pregnancy and breast-feeding are contraindicated while on this drug.

A home health care nurse is visiting a client discharged home after a hip replacement. The client is still on partial weight bearing and using a walker. What safety precautions can the nurse recommend to the client? (Select all that apply.) a. Buy and install an elevated toilet seat. b. Install grab bars in the shower and by the toilet. c. Step into the bathtub with the affected leg first. d. Remove all throw rugs throughout the house. e. Use a shower chair while taking a shower.

a. Buy and install an elevated toilet seat. b. Install grab bars in the shower and by the toilet. d. Remove all throw rugs throughout the house. e. Use a shower chair while taking a shower. Buying and installing an elevated toilet seat, installing grab bars, removing throw rugs, and using a shower chair will all promote safety for this client. The client is still on partial weight bearing, so he or she cannot step into the bathtub leading with the operative side. Stepping into a bathtub may also require the client to bend the hip more than the allowed 90 degrees.

A client takes celecoxib (Celebrex) for chronic osteoarthritis in multiple joints. After a knee replacement, the health care provider has prescribed morphine sulfate for postoperative pain relief. The client also requests the celecoxib in addition to the morphine. What action by the nurse is best? a. Consult with the health care provider about administering both drugs to the client. b. Inform the client that the celecoxib will be started when he or she goes home. c. Teach the client that, since morphine is stronger, celecoxib is not needed. d. Tell the client he or she should not take both drugs at the same time.

a. Consult with the health care provider about administering both drugs to the client. Despite getting an opioid analgesic for postoperative pain, the nurse should be aware that the client may be on other medications for arthritis in other joints. The nonsteroidal anti-inflammatory drug celecoxib will also help with the postoperative pain. The nurse should consult the provider about continuing the celecoxib while the client is in the hospital. The other responses are not warranted, as the client should be restarted on this medication postoperatively.

A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best? a. Consult with the provider about an x-ray. b. Encourage the client to use ibuprofen (Motrin). c. Have the client perform hip range of motion. d. Place the client in a rigid cervical collar.

a. Consult with the provider about an x-ray. Back pain with tenderness is indicative of a spinal compression fracture, which is the most common type of osteoporotic fracture. The nurse should consult the provider about an x-ray. Motrin may be indicated but not until there is a diagnosis. Range of motion of the hips is not related, although limited spinal range of motion may be found with a vertebral compression fracture. Since the defect is in the thoracic spine, a cervical collar is not needed.

The nurse on an inpatient rheumatology unit receives a hand-off report on a client with an acute exacerbation of systemic lupus erythematosus (SLE). Which reported laboratory value requires the nurse to assess the client further? a. Creatinine: 3.9 mg/dL b. Platelet count: 210,000/mm3 c. Red blood cell count: 5.2/mm3 d. White blood cell count: 4400/mm3

a. Creatinine: 3.9 mg/dL Lupus nephritis is the leading cause of death in clients with SLE. The creatinine level is very high and the nurse needs to perform further assessments related to this finding. The other laboratory values are normal.

A nurse is caring for a client with systemic sclerosis. The clients facial skin is very taut, limiting the clients ability to open the mouth. After consulting with a registered dietitian for appropriate nutrition, what other consultation should the nurse facilitate? a. Dentist b. Massage therapist c. Occupational therapy d. Physical therapy

a. Dentist With limited ability to open the mouth, dental hygiene may be lacking. The nurse should encourage the client to see a dentist. The other referrals are not related to the mouth.

The nurse is teaching a client with gout dietary strategies to prevent exacerbations or other problems. Which statement by the nurse is most appropriate? a. Drink 1 to 2 liters of water each day. b. Have 10 to 12 ounces of juice a day. c. Liver is a good source of iron. d. Never eat hard cheeses or sardines.

a. Drink 1 to 2 liters of water each day. Kidney stones are common in clients with gout, so drinking plenty of water will help prevent this from occurring. Citrus juice is high in ash, which can help prevent the formation of stones, but the value of this recommendation is not clear. Clients with gout should not eat organ meats or fish with bones, such as sardines.

A client is started on etanercept (Enbrel). What teaching by the nurse is most appropriate? a. Giving subcutaneous injections b. Having a chest x-ray once a year c. Taking the medication with food d. Using heat on the injection site

a. Giving subcutaneous injections Etanercept is given as a subcutaneous injection twice a week. The nurse should teach the client how to self- administer the medication. The other options are not appropriate for etanercept.

A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.) a. Grab bars to reach high items b. Long-handled bath scrub brush c. Soft rocker-recliner chair d. Toothbrush with built-up handle e. Wheelchair cushion for comfort

a. Grab bars to reach high items b. Long-handled bath scrub brush d. Toothbrush with built-up handle Grab bars, long-handled bath brushes, and toothbrushes with built-up handles all provide modifications for daily activities, making it easier for the client with RA to complete ADLs independently. The rocker-recliner and wheelchair cushion are comfort measures but do not help increase independence.

A client is getting out of bed into the chair for the first time after an uncemented hip replacement. What action by the nurse is most important? a. Have adequate help to transfer the client. b. Provide socks so the client can slide easier. c. Tell the client full weight bearing is allowed. d. Use a footstool to elevate the clients leg.

a. Have adequate help to transfer the client. The client with an uncemented hip will be on toe-touch only right after surgery. The nurse should ensure there is adequate help to transfer the client while preventing falls. Slippery socks will encourage a fall. Elevating the leg greater than 90 degrees is not allowed.

A client recently diagnosed with systemic lupus erythematosus (SLE) is in the clinic for a follow-up visit. The nurse evaluates that the client practices good self-care when the client makes which statement? a. I always wear long sleeves, pants, and a hat when outdoors. b. I try not to use cosmetics that contain any type of sunblock. c. Since I tend to sweat a lot, I use a lot of baby powder. d. Since I cant be exposed to the sun, I have been using a tanning bed.

a. I always wear long sleeves, pants, and a hat when outdoors. Good self-management of the skin in SLE includes protecting the skin from sun exposure, using sunblock, avoiding drying agents such as powder, and avoiding tanning beds.

The increased risk for falls in the older adult is most likely due to a.changes in balance. b.decrease in bone mass. c.loss of ligament elasticity. d.erosion of articular cartilage.

a.changes in balance Aging can cause changes in a person's sense of balance, making the person unsteady, and proprioception may be altered. The risk for falls also increases in older adults partly because of a loss of strength.

A patient with tendonitis asks what the tendon does. The nurse's response is based on the knowledge that tendons a.connect bone to muscle. b.provide strength to muscle. c.lubricate joints with synovial fluid. d.relieve friction between moving parts.

a.connect bone to muscle Tendons are composed of dense, fibrous connective tissue that contains bundles of closely packed collagen fibers arranged in the same plane for additional strength. They connect the muscle sheath to adjacent bone.

Before discharge from the same-day surgery unit, instruct the patient who has had a surgical correction of bilateral hallux valgus to a.rest frequently with the feet elevated. b.soak the feet in warm water several times a day. c.expect the feet to be numb for the next few days. d.expect continued pain in the feet, since this is not uncommon.

a.rest frequently with the feet elevated. After surgical correction of bilateral hallux valgus, the feet should be elevated with the heel off the bed to help reduce discomfort and prevent edema.

The nurse is providing care for a client with a new diagnosis of hypertension. How can the nurse best promote the client's adherence to the prescribed therapeutic regimen? a. Screen the client for visual disturbances regularly. b. Have the client participate in monitoring his or her own BP. c. Emphasize the dire health outcomes associated with inadequate BP control. d. Encourage the client to lose weight and exercise regularly.

b Adherence to the therapeutic regimen increases when clients actively participate in self-care, including self-monitoring of BP and diet. Dire warnings may motivate some clients, but for many clients this is not an appropriate or effective strategy. Screening for vision changes and promoting healthy lifestyle are appropriate nursing actions, but do not necessarily promote adherence to a therapeutic regimen.

A patient has been diagnosed with prehypertension and has been encouraged to exercise regularly and begin a weight loss program. What other healthcare professional may be helpful for the client to see? a. Occupational therapist b. Dietician c. Pharmacist d. Social worker

b Clients with prehypertension and a need to lose weight will benefit from a dietician for food selections and menu planning. An occupational therapist works with clients for meaning activites for daily tasks. The pharmacist deals with medications and the social worker will help with dealing with problems to improve life.

The nurse is caring for an older adult with a diagnosis of hypertension who is being treated with a diuretic and beta-blocker. What should the nurse integrate into the management of this client's hypertension? a. Ensure that the client receives a larger initial dose of antihypertensive medication due to impaired absorption. b. Pay close attention to hydration status because of increased sensitivity to extracellular volume depletion. c. Recognize that an older adult is less likely to adhere to the medication regimen than a younger client. d. Carefully assess for weight loss because of impaired kidney function resulting from normal aging.

b Older adults have impaired cardiovascular reflexes and thus are more sensitive to extracellular volume depletion caused by diuretics. The nurse needs to assess hydration status, low BP, and postural hypotension carefully. Older adults may have impaired absorption, but they do not need a higher initial dose of an antihypertensive than a younger person. Adherence to treatment is not necessarily linked to age. Kidney function and absorption decline with age; less, rather than more antihypertensive medication is prescribed. Weight gain is not necessarily indicative of kidney function decline.

During an adult client's last two office visits, the nurse obtained BP readings of 122/84 mm Hg and 130/88 mm Hg, respectively. How would this client's BP be categorized? a. Normal b. Prehypertensive c. Stage 1 hypertensive d. Stage 2 hypertensive

b Prehypertension is defined systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg.

A nurse is teaching about lifestyle modifications to a group of clients with known hypertension. Which statement would the nurse include in the education session? a. Maintain a body mass index between 30 and 35. b. Engage in aerobic activity at least 30 minutes/day most days of the week. c. Maintain a waist circumference of 45 inches (114 cm) (men) and 40 inches (102 cm) (women) or less. d. Limit alcohol consumption to no more that 3 drinks per day.

b Recommmended lifestye modifications to prevent and manage hypertension include maintaining a normal body mass index (about 24; greater than 25 is considered overweight), maintaining a waist circumference of less than 40 inches for men and 35 inches for women, limiting alcohol intake to no more than 2 drinks for men and 1 drink for women per day, and engaging in aerobic activity at least 30 minutes per day most days of the week.

Which term describes high blood pressure from an identified cause, such as renal disease? a. Primary hypertension b. Secondary hypertension c. Rebound hypertension d. Hypertensive emergency

b Secondary hypertension is high blood pressure from an identified cause, such as renal disease. Primary hypertension denotes high blood pressure form an unidentified source. Rebound hypertension is pressure that is controlled with therapy and becomes uncontrolled (abnormally high) when that therapy is discontinued. A hypertensive emergency is a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage.

A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient? a. Smoking directly causes high blood pressure. b. Smoking increases the risk of heart disease. c. Smoking causes obesity, which exacerbates hypertension. d. Smoking increases cardiac output.

b Smoking does not cause high blood pressure, but it does increase the risk for heart disease. A patient with hypertension is already at an increased risk of heart disease. Smoking does not directly cause obesity and it does not increase cardiac output.

A client newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the client and advises that the client should avoid tobacco use. What is the primary rationale behind that advice to the client? a. Quitting smoking will cause the client's hypertension to resolve. b. Tobacco use increases the client's concurrent risk of heart disease. c. Tobacco use is associated with a sedentary lifestyle. d. Tobacco use causes ventricular hypertrophy.

b Smoking increases the risk for heart disease, for which a client with hypertension is already at an increased risk. Quitting will not necessarily cause hypertension to resolve and smoking does not directly cause ventricular hypertrophy. The association with a sedentary lifestyle is true, but this is not the main rationale for the nurse's advice; the association with heart disease is more salient.

The nurse is caring for a client who is prescribed medication for the treatment of hypertension. The nurse recognizes that which medication conserves potassium? a. Furosemide b. Spironolactone c. Chlorothiazide d. Chlorthalidone

b Spironolactone is known as a potassium-sparing diuretic. Furosemide causes loss of potassium from the body. Chlorothiazide and chlorthalidone cause mild hypokalemia.

A nurse is teaching a client who is newly diagnosed with hypertension and diabetes mellitus. What will the nurse specify about this client's target blood pressure? a. 145/95 or lower b. 130/80 or lower c. 150/95 or lower d. 125/85 or lower

b The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) specifies a lower goal pressure of 130/80 for people with diabetes mellitus.

A client is placed on a low-sodium (500 mg/day) diet. Which client statement indicates that the nurse's nutrition teaching plan has been effective? a. "I can still eat a ham-and-cheese sandwich with potato chips for lunch." b. "I chose broiled chicken with a baked potato for dinner." c. "I chose a tossed salad with sardines and oil and vinegar dressing for lunch." d. "I'm glad I can still have chicken bouillon."

b The client's choice of a baked potato with broiled chicken indicates effective nutrition teaching because potatoes and chicken are relatively low in sodium. Ham, sardines, and bouillon are extremely high in sodium and shouldn't be included in a low-sodium diet.

Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension? a. The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults. b. The incidence and prevalence of hypertension increase with age. c. Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults. d. Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

b The prevalence of hypertension increases with aging. Aging causes structural and functional changes in the heart and blood vessels, including atherosclerosis and decreased elasticity of the major blood vessels. The diagnostic criteria between older and younger adults do not differ. Older adults are not more immune to the damaging effects of high blood pressure.

The nurse is caring for a client who has had 25 mg of oral hydrochlorothiazide added to the medication regimen for the treatment of hypertension. Which instruction should the nurse give the client? a. "Take this medication before going to bed." b. "Increase the amount of fruits and vegetables you eat." c. "You may develop dry mouth or nasal congestion while taking this medication." d. "You may drink alcohol while taking this medication."

b Thiazide diuretics cause loss of sodium, potassium, and magnesium. The client should be encouraged to eat fruits and vegetables that are high in potassium. Diuretics cause increased urination; the client should not take the medication before going to bed. Thiazide diuretics to not cause dry mouth or nasal congestion. Postural hypotension (side effect) may be potentiated by alcohol.

A client's medication regimen for the treatment of hypertension includes hydrochlorothiazide. Following administration of this medication, the nurse should anticipate what effect? a. Drowsiness or lethargy b. Increased urine output c. Decreased heart rate d. Mild agitation

b Thiazide diuretics lower BP by reducing circulating blood volume; this results in a short-term increase in urine output. These drugs do not cause bradycardia, agitation, or drowsiness.

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find? a) Increased C4 complement b) Elevated erythrocyte sedimentation rate c) Increased albumin levels d) Increased red blood cell count

b) Elevated erythrocyte sedimentation rate

A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response? a) It's impossible to determine at the time of diagnosis how the disease will progress. b) Hand and finger deformities are associated with the development of rheumatoid arthritis. c) He should discuss this concern with his physician. d) A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities.

b) Hand and finger deformities are associated with the development of rheumatoid arthritis.

The nurse knows that a patient who presents with the symptom of "blanching of his fingers on exposure to cold" would be assessed for the rheumatic disease known as: a) Sjögren's syndrome. b) Raynaud's phenomenon. c) Ankylosing spondylitis. d) Reiter's syndrome.

b) Raynaud's phenomenon.

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues? a) Systemic lupus erythematosus b) Scleroderma c) Rheumatoid arthritis d) Polymyalgia rheumatic

b) Scleroderma

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? a) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." b) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." c) "OA is more common in women. RA is more common in men." d) "OA affects joints on both sides of the body. RA is usually unilateral."

b) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"? a) "You are not immune to the disease causing the symptoms." b) "Your symptoms are a result of your body attacking itself." c) "You have inherited your parent's immunity to the disease." d) "You have antigens to the disease, but it they do not prevent the disease."

b) "Your symptoms are a result of your body attacking itself."

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? a) Acupuncture b) An exercise routine that includes range-of-motion (ROM) exercises c) Cold therapy d) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs)

b) An exercise routine that includes range-of-motion (ROM) exercises

A nurse should expect to administer which medication to a client with gout? a) Aspirin b) Colchicine c) Furosemide (Lasix) d) Calcium gluconate (Kalcinate)

b) Colchicine

Nursing care for the patient with fibromyalgia should be guided by what assumption? a) Patients with fibromyalgia will eventually lose their ability to walk. b) Patients with fibromyalgia may feel as if their symptoms are not taken seriously. c) All patients with fibromyalgia have the same type of symptoms. d) Patients with fibromyalgia rarely respond to treatment.

b) Patients with fibromyalgia may feel as if their symptoms are not taken seriously.

In teaching clients with osteoarthritis about their condition, it would be important for the nurse to focus on: a) Prevention of joint deformity b) Strategies for remaining active c) DMARDs therapy d) Detection of systemic complications

b) Strategies for remaining active

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as? a) Boutonnière deformity b) Swan neck deformity c) Ulnar deviation d) Rheumatoid nodules

b) Swan neck deformity

Which of the following disorders is characterized by an increased autoantibody production? a) Polymyalgia rheumatic b) Systemic lupus erythematosus (SLE) c) Scleroderma d) Rheumatoid arthritis (RA)

b) Systemic lupus erythematosus (SLE)

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include: a) administration of opioids for pain control. b) administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program. c) administration of monthly intra-articular injections of corticosteroids. d) vigorous physical therapy for the joints.

b) administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout? a) methotrexate b) colchicine c) prednisone d) penicillamine

b) colchicine

The nurse is reviewing the medication administration record of a client who takes a variety of medications for the treatment of hypertension. What potential therapeutic benefits of antihypertensives should the nurse identify? Select all that apply. a. Increased venous return b. Decreased peripheral resistance c. Decreased blood volume d. Decreased strength and rate of myocardial contractions e. Decreased blood viscosity

b, c, d The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction. Antihypertensive medications do not increase venous return or decrease blood viscosity.

One of your patients with a diagnosis of MG has a scheduled dose of Pyridostigmine (Mestion) at 0900. It is now 0800 and breakfast is served at 0930. When should you administer the Mestion to your patient? a.Now b.0830 c.1030 d.0930

b. 0830

The nursing student studying rheumatoid arthritis (RA) learns which facts about the disease? (Select all that apply.) a. It affects single joints only. b. Antibodies lead to inflammation. c. It consists of an autoimmune process. d. Morning stiffness is rare. e. Permanent damage is inevitable.

b. Antibodies lead to inflammation. c. It consists of an autoimmune process. RA is a chronic autoimmune systemic inflammatory disorder leading to arthritis-type symptoms in the joints and other symptoms that can be seen outside the joints. Antibodies are created that lead to inflammation. Clients often report morning stiffness. Permanent damage can be avoided with aggressive, early treatment.

10. Which information will the nurse include when preparing teaching materials for patients with exacerbations of rheumatoid arthritis? a. Affected joints should not be exercised when pain is present. b. Application of cold packs before exercise may decrease joint pain. B because it lessen pain. c. Exercises should be performed passively by someone other than the patient. d. Walking may substitute for range-of-motion (ROM) exercises on some days.

b. Application of cold packs before exercise may decrease joint pain.

A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority? a. Allow the client to rest in a position of comfort. b. Assess the clients cardiac and respiratory systems. c. Assist the client with ambulating and position changes. d. Position the client on one side propped with pillows.

b. Assess the clients cardiac and respiratory systems. This degree of curvature of the spine affects cardiac and respiratory function. The nurses priority is to assess those systems. Positioning is up to the client. The client may or may not need assistance with movement.

1. A nurse is working with a 73-year-old patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient uses which description of the condition? a. Joint destruction caused by an autoimmune process b. Degeneration of articular cartilage in synovial joints c. Overproduction of synovial fluid resulting in joint destruction d. Breakdown of tissue in non-weight-bearing joints by enzymes

b. Degeneration of articular cartilage in synovial joints

A client is scheduled to have a hip replacement. Preoperatively, the client is found to be mildly anemic and the surgeon states the client may need a blood transfusion during or after the surgery. What action by the preoperative nurse is most important? a. Administer preoperative medications as prescribed. b. Ensure that a consent for transfusion is on the chart. c. Explain to the client how anemia affects healing. d. Teach the client about foods high in protein and iron.

b. Ensure that a consent for transfusion is on the chart. The preoperative nurse should ensure that all valid consents are on the chart, including one for blood transfusions if this may be needed. Administering preoperative medications is important for all preoperative clients and is not specific to this client. Teaching in the preoperative area should focus on immediate concerns.

The nurse working in the rheumatology clinic assesses clients with rheumatoid arthritis (RA) for late manifestations. Which signs/symptoms are considered late manifestations of RA? (Select all that apply.) a. Anorexia b. Feltys syndrome c. Joint deformity d. Low-grade fever e. Weight loss

b. Feltys syndrome c. Joint deformity e. Weight loss Late manifestations of RA include Feltys syndrome, joint deformity, weight loss, organ involvement, osteoporosis, extreme fatigue, and anemia, among others. Anorexia and low-grade fever are both seen early in the course of the disease.

A client with systemic lupus erythematosus (SLE) was recently discharged from the hospital after an acute exacerbation. The client is in the clinic for a follow-up visit and is distraught about the possibility of another hospitalization disrupting the family. What action by the nurse is best? a. Explain to the client that SLE is an unpredictable disease. b. Help the client create backup plans to minimize disruption. c. Offer to talk to the family and educate them about SLE. d. Tell the client to remain compliant with treatment plans.

b. Help the client create backup plans to minimize disruption. SLE is an unpredictable disease and acute exacerbations can occur without warning, creating chaos in the family. Helping the client make backup plans for this event not only will decrease the disruption but will give the client a sense of having more control. Explaining facts about the disease is helpful as well but does not engage the client in problem solving. The family may need education, but again this does not help the client to problem-solve. Remaining compliant may help decrease exacerbations, but is not as powerful an intervention as helping the client plan for such events.

A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate? a. Drink at least 8 ounces of water with it. b. Make appointments to come get your shot. c. Sit upright for 30 to 60 minutes after taking it. d. Take the drug on an empty stomach.

b. Make appointments to come get your shot. Denosumab is given by subcutaneous injection twice a year. The client does not need to drink 8 ounces of water with this medication as it is not taken orally. The client does not need to remain upright for 30 to 60 minutes after taking this medication, nor does the client need to take the drug on an empty stomach.

A client has a bone density score of -2.8. What action by the nurse is best? a. Asking the client to complete a food diary b. Planning to teach about bisphosphonates c. Scheduling another scan in 2 years d. Scheduling another scan in 6 months

b. Planning to teach about bisphosphonates A T-score from a bone density scan at or lower than -2.5 indicates osteoporosis. The nurse should plan to teach about medications used to treat this disease. One class of such medications is bisphosphonates. A food diary is helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will not prevent the disease. Simply scheduling another scan will not help treat the disease either.

An older client is scheduled to have hip replacement in 2 months and has the following laboratory values: white blood cell count: 8900/mm3, red blood cell count: 3.2/mm3, hemoglobin: 9 g/dL, hematocrit: 32%. What intervention by the nurse is most appropriate? a. Instruct the client to avoid large crowds. b. Prepare to administer epoetin alfa (Epogen). c. Teach the client about foods high in iron. d. Tell the client that all laboratory results are normal.

b. Prepare to administer epoetin alfa (Epogen). This client is anemic, which needs correction prior to surgery. While eating iron-rich foods is helpful, to increase the clients red blood cells, hemoglobin, and hematocrit within 2 months, epoetin alfa is needed. This colony-stimulating factor will encourage the production of red cells. The clients white blood cell count is normal, so avoiding infection is not the priority.

A 56-year-old male client at a screening event has a blood pressure reading of 146/96 mm Hg. Upon hearing the reading, the client states, "My pressure has never been this high. Do you think my doctor will prescribe medication to reduce it?" What is the nurse's best response? a. "Yes. Hypertension is prevalent among men; it is fortunate we caught this during your routine examination." b. "We will need to reevaluate your blood pressure because your age places you at high risk for hypertension." c. "A single elevated blood pressure does not confirm hypertension. You will need to have your blood pressure reassessed several times before a diagnosis can be made." d. "You have no need to worry. Your pressure is probably elevated because you are being tested."

c Hypertension is confirmed by two or more readings with systolic pressure of at least 140 mm Hg and diastolic pressure of at least 90 mm Hg. An age of 56 does not constitute a risk factor in and of itself. The nurse should not tell the student that there is no need to worry.

A 56-year-old man visits his primary care provider infrequently but has now presented with complaints of transient visual disturbances. Assessment of the patient has yielded few remarkable findings with the exception of blood pressure (BP) of 169/106 mm Hg. When do signs and symptoms of hypertension typically appear? a. Once the patient's average BP crosses the threshold of 140/90 mm Hg b. During the prehypertension stage of the disease c. After target organ damage has occurred d. After hypertension becomes an irreversible condition

c Hypertension may be asymptomatic and remain so for many years; however, when signs and symptoms appear, vascular damage related to the organs served by the involved vessels has occurred. This fact underlies the need for screening and early intervention.

A client in a hypertensive emergency is admitted to the ICU. The nurse anticipates that the client will be treated with IV vasodilators, and that the primary goal of treatment is what? a. Lower the BP to reduce onset of neurologic symptoms, such as headache and vision changes. b. Decrease the BP to a normal level based on the client's age. c. Decrease the mean arterial pressure between 20% and 25% in the first hour of treatment. d. Reduce the BP to ≤ 120/75 mm Hg as quickly as possible.

c Initially, the treatment goal in hypertensive emergencies is to reduce the mean arterial pressure by 25% in the first hour of treatment, with further reduction over the next 24 hours. Lowering the BP too fast may cause hypotension in a client whose body has adjusted to hypertension and could cause a stroke, MI, or visual changes. Neurologic symptoms should be addressed, but this is not the primary focus of treatment planning.

It is important for the nurse to encourage the cltient diagnosed with hypertension to rise slowly from a sitting or lying position because gradual changes in position a. help reduce the blood pressure to resupply oxygen to the brain. b. help reduce the work required by the heart to resupply oxygen to the brain. c. provide time for the heart to increase the rate of contraction to resupply oxygen to the brain. d. provide time for the heart to reduce the rate of contraction to resupply oxygen to the brain.

c It is important for the nurse to encourage the client to rise slowly from a sitting or lying position because gradual changes in position provide time for the heart to increase its rate of contraction to resupply oxygen to the brain, not blood pressure or heart rate.

Hypertension that can be attributed to an underlying cause is termed a. primary hypertension. b. essential hypertension. c. secondary hypertension. d. isolated systolic hypertension.

c Secondary hypertension may be caused by a tumor of the adrenal gland (e.g., pheochromocytoma). Primary, or essential, hypertension has no known underlying cause. Isolated systolic hypertension is demonstrated by readings in which the systolic pressure exceeds 140 mm Hg and the diastolic measurement is normal or near normal (less than 90 mm Hg).

The nurse is providing health education to an older adult client. What should the nurse teach the client about the relationship between hypertension and age? a. "Because of reduced smooth muscle tone in blood vessels, blood pressure tends to go down with age, not up." b. "Decreases in the strength of arteries and the presence of venous insufficiency cause hypertension in the elderly." c. "Structural and functional changes in the cardiovascular system that occur with age contribute to an increase in blood pressure." d. "The neurologic system of older adults is less efficient at monitoring and regulating blood pressure."

c Structural and functional changes in the heart and blood vessels contribute to an increase in BP that occurs with aging. Venous insufficiency does not cause hypertension, however. Increased BP is not primarily a result of neurologic changes.

A newly diagnosed client with hypertension is prescribed a thiazide diuretic. What client education should the nurse provide to this client? a. "Eat a banana every day because this medication causes moderate hyperkalemia." b. "Take over-the-counter potassium pills because this medication causes your kidneys to lose potassium." c. "This medication can cause low blood pressure and dizziness, especially when you get up suddenly." d. "This medication increases sodium levels in your blood, so cut down on your salt."

c Thiazide diuretics can cause postural hypotension, which may be potentiated by alcohol, barbiturates, opioids, or hot weather. Thiazide diuretics do not cause either moderate hyperkalemia or severe hypokalemia and they do not result in hypernatremia.

A nurse is performing blood pressure screenings at a local health fair. While obtaining subjective assessment data from a client with hypertension, the nurse learns that the client has a family history of hypertension and she herself has high cholesterol and lipid levels. The client says she smokes one pack of cigarettes daily and drinks "about a pack of beer" every day. The nurse notes what nonmodifiable risk factor for hypertension? a. Hyperlipidemia b. Excessive alcohol intake c. A family history of hypertension d. Closer adherence to medical regimen

c Unlike cholesterol levels, alcohol intake, and adherence to treatment, family history is not modifiable.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? a) Infliximab (Remicade) b) Etanercept (Enbrel) c) Methotrexate (Rheumatrex) d) Methylprednisolone (Medrol)

c) Methotrexate (Rheumatrex)

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? a) "I have pain in my hands." b) "I have trouble with my balance." c) "My finger joints are oddly shaped." d) "My legs feel weak."

c) "My finger joints are oddly shaped."

A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are? a) Bouchard's nodes b) Rheumatoid nodules c) Heberden's nodes d) Tophi

c) Heberden's nodes

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about? a) Azathioprine (Imuran) b) Aurothioglucose (Solganal) c) Hydroxychloroquine (Plaquenil) d) Diclofenac (Voltaren)

c) Hydroxychloroquine (Plaquenil

A client is recovering from an attack of gout. Client teaching should include the need to lose weight because: a) weight loss will increase uric acid levels and reduce stress on joints. b) weight loss will reduce inflammation. c) weight loss will reduce uric acid levels and reduce stress on joints. d) weight loss will reduce purine levels.

c) weight loss will reduce uric acid levels and reduce stress on joints.

4. The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to do what? a. Use a wheelchair to avoid walking as much as possible. b. Sit in chairs that cause the hips to be lower than the knees. c. Eat a well-balanced diet to maintain a healthy body weight. d. Use a walker for ambulation to relieve the pressure on the hips.

c. Eat a well-balanced diet to maintain a healthy body weight.

A nurse is discharging a client after a total hip replacement. What statement by the client indicates good potential for self-management? a. I can bend down to pick something up. b. I no longer need to do my exercises. c. I will not sit with my legs crossed. d. I wont wash my incision to keep it dry.

c. I will not sit with my legs crossed. There are many precautions clients need to take after hip replacement surgery, including not bending more than 90 degrees at the hips, continuing prescribed exercises, not crossing the legs, and washing the incision daily and patting it dry.

The nurse is caring for a client with systemic sclerosis (SSc). What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Collaborate with a registered dietitian for appropriate foods. b. Inspect the skin and note any areas of ulceration. c. Keep the room at a comfortably warm temperature. d. Place a foot cradle at the end of the bed to lift sheets. e. Remind the client to elevate the head of the bed after eating.

c. Keep the room at a comfortably warm temperature. d. Place a foot cradle at the end of the bed to lift sheets. e. Remind the client to elevate the head of the bed after eating. The client with SSc should avoid cold temperatures, which may lead to vasospasms and Raynauds phenomenon. The UAP can adjust the room temperature for the clients comfort. Keeping the sheets off the feet will help prevent injury; the UAP can apply a foot cradle to the bed to hold the sheets up. Because of esophageal problems, the client should remain in an upright position for 1 to 2 hours after meals. The UAP can remind the client of this once he or she has been taught. The other actions are performed by the registered nurse.

A nurse is working with a community group promoting healthy aging. What recommendation is best to help prevent osteoarthritis (OA)? a. Avoid contact sports. b. Get plenty of calcium. c. Lose weight if needed. d. Engage in weight-bearing exercise.

c. Lose weight if needed. Obesity can lead to OA, and if the client is overweight, losing weight can help prevent OA or reduce symptoms once it occurs. Arthritis can be caused by contact sports, but this is less common than obesity. Calcium and weight-bearing exercise are both important for osteoporosis.

After a total knee replacement, a client is on the postoperative nursing unit with a continuous femoral nerve blockade. On assessment, the nurse notes the clients pulses are 2+/4+ bilaterally; the skin is pale pink, warm, and dry; and the client is unable to dorsiflex or plantarflex the affected foot. What action does the nurse perform next? a. Document the findings and monitor as prescribed. b. Increase the frequency of monitoring the client. c. Notify the surgeon or anesthesia provider immediately. d. Palpate the clients bladder or perform a bladder scan.

c. Notify the surgeon or anesthesia provider immediately. With the femoral nerve block, the client should still be able to dorsiflex and plantarflex the affected foot. Since this client has an abnormal finding, the nurse should notify either the surgeon or the anesthesia provider immediately. Documentation is the last priority. Increasing the frequency of assessment may be a good idea, but first the nurse must notify the appropriate person. Palpating the bladder is not related.

An older client with diabetes is admitted with a heavily draining leg wound. The clients white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first? a. Administer acetaminophen (Tylenol). b. Educate the client on amputation. c. Place the client on contact isolation. d. Refer the client to the wound care nurse.

c. Place the client on contact isolation. In the presence of a heavily draining wound, the nurse should place the client on contact isolation. If the client has discomfort, acetaminophen can be used, but this client has not reported pain and is afebrile. The client may or may not need an amputation in the future. The wound care nurse may be consulted, but not as the first action.

A nurse is caring for four clients. After the hand-off report, which client does the nurse see first? a. Client with osteoporosis and a white blood cell count of 27,000/mm3 b. Client with osteoporosis and a bone fracture who requests pain medication c. Post-microvascular bone transfer client whose distal leg is cool and pale d. Client with suspected bone tumor who just returned from having a spinal CT

c. Post-microvascular bone transfer client whose distal leg is cool and pale This client is the priority because the assessment findings indicate a critical lack of perfusion. A high white blood cell count is an expected finding for the client with osteoporosis. The client requesting pain medication should be seen second. The client who just returned from a CT scan is stable and needs no specific postprocedure care.

3. The nurse is admitting a patient who is scheduled for knee arthroscopy (go in and look at the joint) related to osteoarthritis (OA). Which finding should the nurse expect to be present on examination of the patient's knees? a. Ulnar drift b. Pain with joint movement c. Reddened, swollen affected joints d. Stiffness that increases with movement

c. Reddened, swollen affected joints

16. A patient with a chronic attack of gout in the right great toe has a new prescription for probenecid (Benemid). Which information about the patient's home routine indicates a need for teaching regarding gout management? a. The patient sleeps about 8 to 10 hours every night. b. The patient usually eats beef once or twice a week. c. The patient takes one aspirin a day to prevent angina. d. The patient usually drinks about 3 quarts water daily.

c. The patient takes one aspirin a day to prevent angina.

A client has rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is best? a. Lets ask the provider about increasing your pain pills. b. Hold ice bags against your hands before quilting. c. Try a paraffin wax dip 20 minutes before you quilt. d. You need to stop quilting before it destroys your fingers.

c. Try a paraffin wax dip 20 minutes before you quilt. Paraffin wax dips are beneficial for decreasing pain in arthritic hands and lead to increased mobility. The nurse can suggest this comfort measure. Increasing pain pills will not help with movement. Ice has limited use unless the client has a hot or exacerbated joint. The client wants to finish her project, so the nurse should not negate its importance by telling the client it is destroying her joints.

While obtaining subjective assessment data related to the musculoskeletal system, it is particularly important to ask a patient about other medical problems such as a.hypertension. b.thyroid problems. c.diabetes mellitus. d.chronic bronchitis.

c.diabetes mellitus The nurse should question the patient about past medical problems because certain illnesses are known to affect the musculoskeletal system directly or indirectly. These diseases include tuberculosis, poliomyelitis, diabetes mellitus, parathyroid problems, hemophilia, rickets, soft tissue infection, and neuromuscular disabilities.

A patient who has had gout for a number of years visits his health care provider for his quarterly evaluation. He reports less-frequent episodes of pain and inflammation. The nurse documents that the patient was in which phase/stage of the process? a) . Asymptomatic b) Acute gouty arthritis c) Intercritical d) Chronic tophaceous

d) Chronic tophaceous

A nurse on a busy medical unit is aware of the importance of accurate blood pressure (BP) measurement. To ensure accuracy when assessing patients' blood pressures, the nurse should always: a. Use a manual, rather than automated, sphygmomanometer b. Alternate blood pressure readings between patients' right and left arms c. Take serial blood pressure readings on each patient d. Ensure that the correct cuff size is used for each patient

d Correct cuff size is essential to obtaining accurate BP readings. Repeated readings are not necessarily required to obtain accurate blood pressure. As well, it is not always necessary to alternate arms or to use a manual sphygmomanometer.

The nurse teaches the client which guidelines regarding lifestyle modifications for hypertension? a. Reduce smoking to no more than four cigarettes per day b. Limit aerobic physical activity to 15 minutes, three times per week c. Stop alcohol intake d. Maintain adequate dietary intake of fruits and vegetables

d Guidelines include adopting the Dietary Approaches to Stop Hypertension (DASH) eating plan: consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced amounts of saturated and total fat; reduce dietary sodium intake to no more than 100 mmol/day (2.4 g sodium or 6 g sodium chloride); engage in regular aerobic physical activity such as brisk walking (at least 30 min/day, most days of the week); moderate alcohol consumption, limiting consumption to no more than two drinks (eg, 24 oz beer, 10 oz wine, or 3 oz 80-proof whiskey) per day in most men and to no more than one drink per day in women and lighter-weight people. Tobacco should be avoided because anyone with high blood pressure is already at increased risk for heart disease, and smoking amplifies this risk.

The staff educator is teaching ED nurses about hypertensive crisis. The nurse educator should explain that hypertensive urgency differs from hypertensive emergency in what way? a. The BP is always higher in a hypertensive emergency. b. Vigilant hemodynamic monitoring is required during treatment of hypertensive emergencies. c. Hypertensive urgency is treated with rest and benzodiazepines to lower BP. d. Hypertensive emergencies are associated with evidence of target organ damage.

d Hypertensive emergencies are acute, life-threatening BP elevations that require prompt treatment in an intensive care setting because of the serious target organ damage that may occur. Blood pressures are extremely elevated in both urgency and emergencies, but there is no evidence of target organ damage in hypertensive urgency. Extremely close hemodynamic monitoring of the client's BP is required in both situations. The medications of choice in hypertensive emergencies are those with an immediate effect, such as IV vasodilators. Oral doses of fast-acting agents, such as beta-adrenergic blocking agents, angiotensin-converting enzyme inhibitors, or alpha-agonists, are recommended for the treatment of hypertensive urgencies.

A patient arrives at the clinic for a follow-up visit for treatment of hypertension. The nurse obtains a blood pressure reading of 180/110 but finds no evidence of impending or progressive organ damage when performing the assessment on the patient. What situation does the nurse understand this patient is experiencing? a. Hypertensive emergency b. Primary hypertension c. Secondary hypertension d. Hypertensive urgency

d Hypertensive urgency describes a situation in which blood pressure is very elevated but there is no evidence of impending or progressive target organ damage (Chobanian et al., 2003). Elevated blood pressures associated with severe headaches, nosebleeds, or anxiety are classified as urgencies. In these situations, oral agents can be administered with the goal of normalizing blood pressure within 24 to 48 hours (Rodriguez et al., 2010).

A client in hypertensive emergency is being cared for in the ICU. The client has become hypovolemic secondary to natriuresis. What is the nurse's most appropriate action? a. Add sodium to the client's IV fluid, as prescribed. b. Administer a vasoconstrictor, as prescribed. c. Promptly cease antihypertensive therapy. d. Administer normal saline IV, as prescribed.

d If there is volume depletion secondary to natriuresis caused by the elevated BP, then volume replacement with normal saline can prevent large, sudden drops in BP when antihypertensive medications are given. Sodium administration, cessation of antihypertensive therapy, and administration of vasoconstrictors are not normally indicated.

A patient comes to the walk-in clinic. While assessing the patient's vital signs, the nurse assesses the patient's blood pressure at 128/89 mm Hg. According to JNC7, how would this patient's blood pressure be classified? a. Hypertensive b. Normal c. Slightly hypertensive d. Prehypertensive

d JNC7 defines a blood pressure of less than 120/80 mm Hg diastolic as normal, 120 to 129/80 to 89 mm Hg as prehypertension, and 140/90 mm Hg or higher as hypertensive.

A client's recently elevated BP has prompted the primary care provider to prescribe furosemide. The nurse should closely monitor which of the following? a. The client's oxygen saturation level b. The client's red blood cells, hematocrit, and hemoglobin c. The client's level of consciousness d. The client's potassium level

d Loop diuretics can cause potassium depletion. They do not normally affect level of consciousness, erythrocytes, or oxygen saturation.

An adult patient's blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient's nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage? a. C-reactive protein (CRP) levels b. Sodium, chloride, and potassium levels c. Arterial blood gas (ABG) results d. Blood urea nitrogen (BUN) and creatinine levels

d Nephropathy is a common consequence of hypertension; this problem would be manifested by increased BUN and creatinine levels. Electrolyte levels are also assessed, but these are less sensitive and specific to target organ damage. Abnormal ABGs and CRP levels are not common indicators of target organ damage.

The nurse is assessing a patient with severe hypertension. When performing a focused assessment of the eyes, what does the nurse understand may be observed related to the hypertension? a. Cataracts b. Glaucoma c. Retinal detachment d. Papilledema

d Physical examination may reveal no abnormalities other than elevated blood pressure. Occasionally, retinal changes such as hemorrhages, exudates (fluid accumulation), arteriolar narrowing, and cotton-wool spots (small infarctions) occur. In severe hypertension, papilledema (swelling of the optic disc) may be seen.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress a. increases the production of neurotransmitters that constrict peripheral arterioles. b. increases the resistance that the heart must overcome to eject blood. c. increases blood volume and improves the potential for greater cardiac output. d. decreases the production of neurotransmitters that constrict peripheral arterioles.

d Reduced stress decreases the production of neurotransmitters that constrict peripheral arterioles. Reduced stress may assist in reducing blood volume and resistance to the heart.

The home health nurse is caring for a client who has a diagnosis of hypertension. What assessment question most directly addresses the possibility of worsening hypertension? a. "Are you eating less salt in your diet?" b. "How is your energy level these days?" c. "Do you ever get chest pain when you exercise?" d. "Do you ever see spots in front of your eyes?"

d To identify complications or worsening hypertension, the client is questioned about blurred vision, spots in front of the eyes, and diminished visual acuity. The heart, nervous system, and kidneys are also carefully assessed, but angina pain and decreased energy are not normally suggestive of worsening hypertension. Sodium limitation is a beneficial lifestyle modification, but nonadherence to this is not necessarily a direct sign of worsening symptoms.

Which client statement indicates a good understanding of the nutritional modifications needed to manage hypertension? a. "A glass of red wine each day will lower my blood pressure." b. "I should eliminate caffeine from my diet to lower my blood pressure." c. "If I include less fat in my diet, I'll lower my blood pressure." d. "Limiting my salt intake to 2 grams per day will improve my blood pressure."

d To lower blood pressure, a client should limit daily salt intake to 2 g or less. Alcohol intake is associated with a higher incidence of hypertension, poor compliance with treatment, and refractory hypertension. Chronic, moderate caffeine intake and fat intake don't affect blood pressure

A client experiences orthostatic hypotension while receiving furosemide to treat hypertension. How will the nurse intervene? a. Administer I.V. fluids as ordered. b. Administer an isosorbide as ordered. c. Insert an indwelling urinary catheter as ordered. d. Instruct the client to sit for several minutes before standing.

d To minimize the effects of orthostatic hypotension, the nurse should instruct the client to rise slowly, such as by sitting for several minutes before standing. Administering I.V. fluids would be inappropriate (unless the client were dehydrated) because doing so would counteract the effects of furosemide and could cause fluid imbalance. Administering a vasodilator, isosorbide, would further reduce the client's blood pressure, worsening orthostatic hypotension. Inserting an indwelling urinary catheter would make it easier to monitor urine output, but wouldn't minimize the effects of orthostatic hypotension.

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis? a) "I have pain in my hands." b) "My legs feel weak." c) "I have trouble with my balance." d) "My finger joints are oddly shaped."

d) "My finger joints are oddly shaped."

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? a) Performing meticulous skin care b) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes c) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware d) Administering ordered analgesics and monitoring their effects

d) Administering ordered analgesics and monitoring their effects

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient? a) Ice packs b) Opioid therapy c) Surgery d) Nonsteroidal anti-inflammatory drugs (NSAIDs)

d) Nonsteroidal anti-inflammatory drugs (NSAIDs)

What should the nurse teach the patient about the diagnosis of osteoarthritis? a) "It affects young males." b) "It affects the cartilaginous joints of the spine and surrounding tissues." c) "It requires early treatment because most of the damage appears to occur early in the course of the disease." d) "It is the most common and frequently disabling of joint disorders."

d) "It is the most common and frequently disabling of joint disorders."

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? a) "Exposure to sunlight will help control skin rashes." b) "Corticosteroids may be stopped when symptoms are relieved." c) "There are no activity limitations between flare-ups." d) "Monitor your body temperature."

d) "Monitor your body temperature."

What is the priority intervention for a patient who has been admitted repeatedly with attacks of gout? a) Increase fluids b) Place patient on bed rest c) Insert a foley catheter d) Assess dietary diet and activity at home

d) Assess dietary diet and activity at home

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find? a) Increased albumin levels b) Increased C4 complement c) Increased red blood cell count d) Elevated erythrocyte sedimentation rate

d) Elevated erythrocyte sedimentation rate elevated ESR shows inflammation associated with RA

A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout? a) Elevated white blood count b) Increased AST and ALT c) Decreased hemoglobin and hematocrit d) Elevated uric acid levels

d) Elevated uric acid levels

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? a) Exercising in the evening before going to bed is beneficial. b) The time of day when exercise is performed isn't important. c) Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. d) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

d) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a) Weight gain, hypervigilance, hypothermia, and edema of the legs b) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers c) Hypothermia, weight gain, lethargy, and edema of the arms d) Facial erythema, pericarditis, pleuritis, fever, and weight loss

d) Facial erythema, pericarditis, pleuritis, fever, and weight loss

Which of the following suggests to the nurse that the client with systemic lupus erythematous is having renal involvement? a) Behavioral changes b) Decreased cognitive ability c) Chest pain d) Hypertension

d) Hypertension

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority? a) Risk for constipation b) Imbalanced nutrition: More than body requirements c) Impaired gas exchange d) Impaired skin integrity

d) Impaired skin integrity

Fibromyalgia is a common condition that a) Involves generalized muscle aching, mood swings, and loss of balance b) Involves pain, viral infection, and tremors c) Involves diminished vision, chronic fatigue, and reduced appetite d) Involves chronic fatigue, generalized muscle aching, and stiffness

d) Involves chronic fatigue, generalized muscle aching, and stiffness

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? a) Infliximab (Remicade) b) Etanercept (Enbrel) c) Methylprednisolone (Medrol) d) Methotrexate (Rheumatrex)

d) Methotrexate (Rheumatrex)

Which of the following is the most common cause for a patient to seek medical attention for arthritis? a) Joint swelling b) Stiffness c) Weakness d) Pain

d) Pain

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease? a) Ankylosing spondylitis b) Reiter's syndrome c) Sjögren's syndrome d) Raynaud's phenomenon

d) Raynaud's phenomenon

Scleroderma typically starts with which type of organ involvement? a) Kidney b) Lung c) Brain d) Skin

d) Skin

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following? a) The symptoms are primarily localized to the skin but may involve the joints. b) It has very specific manifestations that make diagnosis relatively easy. c) This disorder is more common in men in their thirties and forties than in women. d) The belief is that it is an autoimmune disorder with an unknown trigger.

d) The belief is that it is an autoimmune disorder with an unknown trigger.

A nurse practitioner is managing the care of a patient who has gout. Choose the medication that she would prescribe as the drug of choice to prevent tophi formation and promote tophi regression. a) Uloric b) Benemid c) Anturane d) Zyloprim

d) Zyloprim

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to: a) prevent infection. b) prevent platelet aggregation. c) promote diuresis. d) combat inflammation.

d) combat inflammation.

The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option? a. Client with diabetes who has a serum creatinine of 0.8 mg/dL b. Client who recently fell and has vertebral compression fractures c. Hypertensive client who takes calcium channel blockers d. Client with a spinal cord injury who cannot tolerate sitting up

d. Client with a spinal cord injury who cannot tolerate sitting up Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes clients bad candidates for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and hypertension are not related unless the client also has renal disease. The client who recently fell and sustained fractures is a good candidate for this drug if the fractures are related to osteoporosis.

A client has a possible connective tissue disease and the nurse is reviewing the clients laboratory values. Which laboratory values and their related connective tissue diseases (CTDs) are correctly matched? (Select all that apply.) a. Elevated antinuclear antibody (ANA) Normal value; no connective tissue disease b. Elevated sedimentation rate Rheumatoid arthritis c. Lowered albumin Indicative only of nutritional deficit d. Positive human leukocyte antigen B27 (HLA-B27) Reiters syndrome or ankylosing spondylitis e. Positive rheumatoid factor Possible kidney disease

d. Positive human leukocyte antigen B27 (HLA-B27) Reiters syndrome or ankylosing spondylitis e. Positive rheumatoid factor Possible kidney disease The HLA-B27 is diagnostic for Reiters syndrome or ankylosing spondylitis. A positive rheumatoid factor can be seen in autoimmune CTDs, kidney and liver disease, or leukemia. An elevated ANA is indicative of inflammatory CTDs, although a small minority of healthy adults also have this finding. An elevated sedimentation rate indicates inflammation, whether from an infection, an injury, or an autoimmune CTD. Lowered albumin is seen in nutritional deficiencies but also in chronic infection or inflammation.

The nurse is reinforcing teaching with a newly diagnosed patient with amyotrophic lateral sclerosis. Which statement would be appropriate to include in the teaching? a."ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication." b."Even though the symptoms you are experiencing are severe, most people recover with treatment." c."You need to consider advance directives now, since you will lose cognitive function as the disease progresses." d."This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

d."This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function."

To prevent muscle atrophy, the nurse teaches the patient with a leg immobilized in traction to perform (select all that apply) a.flexion contractions. b.tetanic contractions. c.isotonic contractions. d.isometric contractions. e.extension contractions.

d.isometric contractions Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger. Muscular atrophy (i.e., decrease in size) occurs with the absence of contraction that results from immobility.

Nurses should implement measures to relieve emotional stress for clients with hypertension because the reduction of stress increases the production of neurotransmitters that constrict peripheral arterioles. increases the resistance that the heart must overcome to eject blood. increases blood volume and improves the potential for greater cardiac output. decreases the production of neurotransmitters that constrict peripheral arterioles.

decreases the production of neurotransmitters that constrict peripheral arterioles.