exam 1 -med surg

The emergency department nurse is caring for an adult client who was in a motor vehicle accident. Radiography reveals an ulnar fracture. Which type of pain is the nurse addressing with this client?

Acute

An occupational health nurse overhears an employee talking to a manager about a 65-year-old coworker. Which phenomenon should the nurse identify when hearing the employee state to the coworker, "You should just retire and make way for some new blood"?

Ageism

A nurse provides care on a bone marrow transplant unit and is preparing a client for a hematopoietic stem cell transplantation (HSCT) the following day. Which information should the nurse emphasize to the client's family and friends?

"Do not visit if you've had a recent infection."

The clinic nurse is caring for an adult oncology client who reports extreme fatigue and weakness after the first week of radiation therapy. Which response by the nurse would best reassure this client?

"These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory studies and test results."

An adult client with leukemia will soon begin chemotherapy. What would the nurse do to combat the most common adverse effects of chemotherapy?

Administer an antiemetic.

The hospice nurse has just admitted a new client to the program. What principle guides hospice care?

Care addresses the needs of the client as well as the needs of the family.

When discussing with a client factors that distinguish malignant cells from benign cells of the same tissue type, which characteristic should the nurse mention?

Different proteins in the cell membrane

A client with terminal small-cell lung cancer has been given a six-month prognosis and wants to die at home. The health care team believes the condition warrants inpatient care. The nurse might suggest which compromise?

Discuss a referral for hospice care.

The nurse manager is orienting a new nurse to the oncology unit. When reviewing the safe administration of antineoplastic agents, which action should the nurse manager emphasize?

Dispose of the antineoplastic wastes in the hazardous waste receptacle.

The nurse is admitting an oncology client to the unit prior to surgery. The nurse reads in the electronic health record that the client has just finished radiation therapy. With knowledge of the consequent health risks, the nurse should prioritize assessments related to what health problem?

Impaired wound healing

A client is hospitalized because a large abdominal tumor was seen on the computed tomography scan. A biopsy is ordered, and the client wants to know if "this will cause a big scar." Which type of biopsy will this client likely experience?

Incisional

A client was diagnosed with rheumatoid arthritis 1 year ago, but has achieved adequate symptom control with celecoxib, a COX-2 selective NSAID. The nurse should recognize that this drug, like other NSAIDs, influences what aspect of the pathophysiology of nociceptive pain?

Inhibiting transduction by blocking the formation of prostaglandins in the periphery

A client with a diagnosis of prostate cancer is scheduled to have an interstitial implant for high-dose radiation (HDR). What safety measure should the nurse include in this client's plan of care?

Limit the time that visitors spend at the client's bedside

A nurse who works in an oncology clinic is assessing a client who has arrived for a 2-month follow-up appointment following chemotherapy. The nurse notes that the client's skin appears yellow. Which blood tests should be done to further explore this clinical sign?

Liver function tests (LFTs)

The nurse is admitting a client to the rehabilitation unit who has a diagnosis of persistent, severe pain. According to the client's history, the client's pain has not responded to conventional approaches to pain management. What treatment should the nurse expect will be tried with this client?

Long-term intrathecal or epidural catheter

A client's intractable neuropathic pain is being treated using a multimodal approach to analgesia. After administering a recently increased dose of IV morphine to the client, the nurse has returned to assess the client and finds the client unresponsive to verbal and physical stimulation with a respiratory rate of five breaths per minute. The nurse has called a code blue and should anticipate the administration of what drug?

Naloxone

A client newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?

Nausea and vomiting

Which nursing action best demonstrates primary cancer prevention?

Promoting and providing vaccines

The nurse is describing some of the major characteristics of cancer to a client who has recently received a diagnosis of malignant melanoma. When differentiating between benign and malignant cancer cells, the nurse should explain differences in which of the following aspects? Select all that apply.

Rate of growth Ability to cause death Ability to spread

The nurse is caring for a client whose diagnosis of bone cancer is causing severe and increasing pain. Before introducing nonpharmacologic pain control interventions into the client's plan of care, the nurse should teach the client which of the following?

Reducing the use of analgesics is not the purpose of these interventions

A 16-year-old female client has post-chemotherapy alopecia. This prompts the nursing diagnoses of Disturbed Body Image and Situational Low Self-Esteem. Which response by the client would best indicate improved coping related to these diagnoses?

Requests that her family bring her makeup and a wig

The nurse on a bone marrow transplant unit is caring for a client with cancer who has just begun hematopoietic stem cell transplantation (HSCT). What is the priority nursing diagnosis for this client?

Risk for infection related to altered immunologic response

A public health nurse has formed an interdisciplinary team that is developing an educational program entitled Cancer: The Risks and What You Can Do About Them. Participants will receive information, but the major focus will be screening for relevant cancers. This program is an example of what type of health promotion activity?

Secondary prevention

A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The client has asked if they will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this client most likely undergo?

Sentinel node biopsy

The nurse is caring for a client with an advanced stage of breast cancer and the client has recently learned that the cancer has metastasized. The nurse enters the room and finds the client struggling to breathe, and the nurse's rapid assessment reveals that the client's jugular veins are distended. The nurse should suspect the development of what oncologic emergency?

Superior vena cava syndrome (SVCS)

A client receiving an intravenous (IV) opioid following surgery is being switched to an oral form of the drug. To provide safe care for the client, which concept of equianalgesia should the nurse follow? Select all that apply

There is a difference in potency between oral and IV doses of morphine. Equianalgesic conversion prevents giving the client an opioid overdose The dose and frequency of the opioid conversion is guided by the client's individual response to the drug

The home health nurse is performing a home visit for an oncology client discharged three days ago after completing chemotherapy treatment for non-Hodgkin lymphoma. The nurse's priority assessment should include examination for the signs and symptoms of which complication?

Tumor lysis syndrome (TLS)

The admissions department at a local hospital is registering a 78-year-old client for an outpatient diagnostic test. The admissions nurse asks if the client has an advance directive. The client reports not wanting to complete an advance directive because they do not want anyone controlling their finances. What would be appropriate information for the nurse to share with this client?

"Advance directives are limited only to health care instructions and directives."

The nurse is planning an educational event for the nurses on a subacute medical unit on the topic of normal, age-related physiologic changes. What phenomenon should the nurse address?

A decrease in muscle mass and bone density

During the care conference for a client who has multiple chronic conditions, the case manager has alluded to the principles of the interface model of disability. What statement is most characteristic of this model?

"This client can be empowered and doesn't have to be dependent."

A 19-year-old client with a diagnosis of Down syndrome is being admitted to the unit for the treatment of community-acquired pneumonia. When planning this client's care, the nurse recognizes that this client's disability is categorized as what type?

A developmental disability

An unlicensed assistive personnel (UAP) reports to the nurse that a postsurgical client has pain rated as 8 on a 0-to-10-point scale. The UAP tells the nurse that the client is exaggerating and does not need pain medication. What is the nurse's best response?

"Unless there is strong evidence to the contrary, we should take the client's report at face value."

A client who is legally blind is being admitted to the hospital. The client informs the nurse that they need to have their guide dog present during hospitalization. What is the nurse's best response to the client?

"Arrangements can be made for your guide dog to be at the hospital with you during your stay."

The nurse is caring for a 25-year-old client with a traumatic brain injury and severe disabilities caused by a motor vehicle accident. The client asks the nurse for education about sex in regards to their condition. How should the nurse respond?

"Do you have specific questions first? I can bring additional resources into the discussion as needed.

While on spring break, a 22-year-old client was taken to the hospital for heat stroke and alcohol poisoning. The client is worried and states that a biopsy was taken and showed "some kind of benign condition." Which response by the nurse would be best?

"I understand that you are worried. Benign conditions are noncancerous, but let's look at your chart to see your results."

The nurse is reviewing the importance of preventive health care with a client who has a disability. The client describes intense financial pressures associated with being disabled. What is the nurse's best response?

"I'll look into federal assistance programs that provide financial assistance for health-related expenses for people with disabling conditions."

A client tells the nurse that the doctor just told the client that a new diagnosis of rheumatoid arthritis is considered to be a "chronic condition." The client asks the nurse what "chronic condition" means. What would be the nurse's best response?

"It is a health problem that require managements of several months or longer."

During a routine mammogram, a client asks the nurse whether breast cancer causes the most deaths. Which type of cancer is the leading cause of death in the United States?

Lung

A client is receiving postoperative morphine through a client-controlled analgesia (PCA) pump and the client's prescriptions specify an initial bolus dose. What is the nurse's priority assessment?

Assessment for respiratory depression

The nurse is conducting a health education about cancer prevention to a group of adults. What menu best demonstrates dietary choices for potentially reducing the risks of cancer?

Baked apricot chicken and steamed broccoli

A 37-year-old client with multiple sclerosis is married and has three children. The nurse has worked extensively with the client and family to plan appropriate care. What is the nurse's most important role with this client?

Help the client develop strategies to implement treatment regimens

A client has been hospitalized for a wedge resection of the left lower lung lobe after a routine chest x-ray showed carcinoma. The client reports feeling anxious and asks to smoke. Which statement by the nurse would be most therapeutic?

"You are anxious about the surgery. Do you see smoking as helping?"

The nurse is caring for a 91-year-old client who reports urge incontinence and sometimes falling when trying to get to the bathroom at home. The nurse identifies the nursing diagnosis of Risk for Falls related to impaired mobility and urinary incontinence. This client's risk for falls is considered to be which of the following?

A geriatric syndrome

A gerontologic nurse is aware of the demographic changes that affect the provision of health care. Which demographic change has the biggest impact?

A growing number of people live to a very old age.

A nurse is caring for an 81-year-old client who has become increasingly frail and unsteady when standing. During the assessment, the client reports having fallen three times in the month, though the client did not suffer any injury. The nurse should take action in the knowledge that this client is at a high risk for which type of injury?

A hip fracture

A client uses a wheelchair. The client wants to attend a church-sponsored support group for parents of children diagnosed with autism spectrum disorder. The client arrives at the church and realizes there are no ramps or elevators to the basement. What type of barrier did this client encounter?

A structural barrier

A home health nurse makes a home visit to a 90-year-old client who has cardiovascular disease. During the visit the nurse observes that the client has begun exhibiting subtle and unprecedented signs of confusion and agitation. What should the home health nurse do?

Arrange for the client to see their primary care provider.

The nurse is assessing an 86-year-old postoperative client who has an unexpressive, stoic demeanor. The client is curled into the fetal position and diaphoretic, and the vital signs are elevated. On a 10-point scale, the client indicates a pain level of "3 or so." How should the nurse treat this client's pain?

Believe what the client says, reinforce education, and reassess often

The nurse is performing an initial assessment of a 75-year-old client who has just relocated to the long-term care facility. During the nurse's interview with the client, the client admits drinking around 600 mL (20 oz) of vodka every evening. What types of cancer does this put the client at risk for? Select all that apply

Breast cancer Esophageal cancer Liver cancer

A medical nurse is appraising the effectiveness of a client's current pain control regimen. The nurse is aware that if an intervention is deemed ineffective, goals need to be reassessed and other measures need to be considered. What is the role of the nurse in obtaining additional pain relief for the client?

Client advocate

The nurse is caring for a young adult client with a diagnosis of cerebral palsy who has been admitted for the relief of painful contractures in the lower extremities. When creating a nursing care plan for this client, what variables should the nurse consider? Select all that apply.

Client's comorbid conditions Type of procedure to be performed Changes in neurologic function that may result from the procedure Prior effectiveness in relieving the pain

Which intervention should the nurse teach a client who is at risk for hypercalcemia?

Consume 2 to 4 L of fluid daily

The nurse caring for an older adult client with osteoarthritis is reviewing the client's chart. This client is on a variety of medications prescribed by different care providers in the community. In light of the QSEN competency of safety, what is the nurse most concerned about with this client?

Drug interactions

A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in clients at risk for thrombocytopenia?

Epistaxis

The nurse is caring for a client admitted to the medical-surgical unit after an injury. The client states, "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the client's care, which variables should the nurse consider? Select all that apply.

How the presence of pain affects clients and families Resources that can assist the client with pain management The advantages and disadvantages of available pain relief strategies

The nurse is caring for a client who is to begin receiving external radiation for a malignant tumor of the neck. While providing client education, what potential adverse effects should the nurse discuss with the client?

Impaired nutritional status

A client's most recent diagnostic imaging has revealed that lung cancer has metastasized to the bones and liver. What is the most likely mechanism by which the client's cancer cells spread?

Lymphatic circulation

An oncology nurse educator is providing health education to a client who has been diagnosed with skin cancer. The client's wife has asked about the differences between normal cells and cancer cells. What characteristic of a cancer cell should the educator cite?

Malignant cells contain proteins called tumor-associated antigens

The nurse is assuming the care of an adult client who has been experiencing severe and intractable pain. When reviewing the client's medication administration record, the nurse notes the presence of gabapentin. The nurse is justified in suspecting which phenomenon in the etiology of the client's pain?

Neuropathy

The nurse is caring for a client who has just been told that the client's stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer?

Palliative

A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical clients' pain. What principle should guide the nurse's use of placebos in pain management?

Placebos are never recommended in the treatment of pain

A woman with a family history of breast cancer received a positive result on a breast tumor marking test and is requesting a bilateral mastectomy. This surgery is an example of which type of oncologic surgery?

Prophylactic surgery

A client was diagnosed with cancer several weeks ago and family members describe the client as "utterly distraught." The client has fully withdrawn from social and family contact. What is the nurse's best action?

Refer the client to the appropriate mental health provider.

The public health nurse is presenting a health promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?

Smoking cessation

While a client is receiving intravenous (IV) doxorubicin hydrochloride for the treatment of cancer, the nurse observes swelling and pain at the IV site. The nurse should prioritize which action?

Stopping the administration of the drug immediately

The nurse is caring for a young mother who has a longstanding diagnosis of multiple sclerosis (MS). The parent was admitted with a postpartum infection 3 days ago, and the plan is to discharge the client home when the client has finished 5 days of IV antibiotic therapy. What information would be most useful for the nurse to provide at discharge?

The same information you would provide to a client without a chronic condition

The home health nurse is making an initial home visit to a 71-year-old client who is widowed. The client reports having begun taking some herbal remedies. Which should the nurse be sure to include in the client's education?

There is a need to inform the primary care provider and pharmacist about the herbal remedies.

The nurse is creating a nursing care plan for a client with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of clients who live with chronic pain should be integrated into care planning?

They can experience acute pain in addition to chronic pain.

A client is asking for a breakthrough dose of analgesia. The pain-medication prescriptions are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner?

To achieve better pain control than with one medication alone

A client with cancer expresses concern to the nurse that increasingly higher doses of opioids are needed to control pain and the client is concerned about opioid overdose and addiction. Which concept of pain management should guide the nurse's response to this client?

Tolerance develops when higher doses are needed to control pain.

A client is experiencing severe pain after suffering an electrical burn in a workplace accident. The nurse is applying knowledge of the pathophysiology of pain when planning this client's nursing care. What is the physiologic process by which noxious stimuli, such as burns, activate nociceptors?

Transduction

A new client has been admitted with a diagnosis of stage IV breast cancer. The client has a comorbidity of myasthenia gravis. During the initial assessment, the client states that they felt the lump in the breast about 9 months ago. The nurse asks the client why they did not see the health care provider when first finding the lump in breast. What would be a factor that is known to influence the client in seeking health care services?

Unfavorable interactions with health care providers

The nurse is caring for a postsurgical client who minimally speaks the dominant language. How should the nurse most accurately assess this client's pain?

Use a chart with the dominant language on one side of the page and the client's native language on the other so the client can rate their pain.

The home health nurse is developing a plan of care for a client who will be managing chronic pain at home with NSAID analgesics. Which pain management interventions should the nurse teach the client? Select all that apply

Use a pain assessment tool to monitor pain levels and response to interventions Monitor for adverse analgesic effects and notify the health care provider if they occur. Discuss the use of nonpharmacologic measures of pain control.

The nurse is caring for a client with back pain. The nurse reviews the medications and sees that an NSAID (ibuprofen) is prescribed every 6 hours as needed. How should the nurse best implement preventive pain measures?

Use a pain scale to assess client's pain and offer ibuprofen every 6 hours.

The nurse is caring for a client with sickle cell disease who lives in the community. Over the years, there has been joint damage, and the client is in chronic pain. The client has developed a tolerance to the usual pain medication. When does the tolerance to pain medication become the most significant problem?

When it results in inadequate relief from pain

A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Which age-related change should the nurse be aware of when planning the appropriate administration of this drug? An older adult client has:

less subcutaneous tissue and less muscle mass than a younger client.

Gerontologic nursing is a specialty area of nursing that provides care for older adults in our population. Which goal of care should a gerontologic nurse prioritize when working with this population? Helping older adults

use their strengths to optimize independence.

A 45-year-old client was diagnosed with schizophrenia at the age of 20. The client is having trouble finding community-based services to help increase their quality of life. Which program would most benefit the client?

Medicaid

When the nurse observes physical indicators of illness in the older population, that nurse should be aware of which of the following principles?

Indicators that are useful and reliable in younger populations cannot be relied on as

Many individuals with disabilities are employed. What has research shown about this employed population?

People with disabilities earn less money than people without disabilities.

A couple who are in their early 80s have provided constant care for their 44-year-old child who has Down syndrome. When planning this family's care, the nurse should be aware that the parents most likely have concerns around what question?

"Who will care for our child once we're unable?"

A client with osteoarthritis of the hip for a number of years reports a dull, aching pain with ambulation and pain shooting down the leg at night while sleeping. The nurse recognizes that the client is experiencing which type of pain?

Chronic pain

A client's spouse is concerned because the client is requiring increasingly high doses of analgesia. The spouse reports that the client, "was in pain long before the cancer diagnosis because of a broken back about 20 years ago. For that problem, though, the pain medicine wasn't just raised and raised." What would be the nurse's best response?

"Much cancer pain is caused by tumor involvement and needs to be treated in a way that brings the client relief."

The nurse is caring for a client with metastatic bone cancer. The client asks the nurse, "Why am I getting larger doses of this pain medication? It does not seem to be affecting me." What is the nurse's best response?

"Over time you become more tolerant of the drug."

The nurse on a rehabilitation unit receives a report about a new client who has fibromyalgia and has difficulty with ADLs. The off-going nurse also reports that the client is withdrawn, refusing visitors, and has been vacillating between tears and anger all afternoon. What aspect of chronic pain syndromes could account for this client's behavior?

Chronic pain can cause intense emotional responses.

A gerontologic nurse is overseeing the care in a large, long-term care facility. The nurse is educating staff about the significant threat posed by influenza in older, frail adults. What action should the nurse prioritize to reduce the incidence and prevalence of influenza in the facility?

Ensure that residents receive influenza vaccinations in the fall of each year.

Which age-related physiologic change contributes to heart disease being the leading cause of death in older adults?

Heart muscle and arteries lose their elasticity.

The nurse is caring for a 25-year-old client who has Down syndrome and who has just been diagnosed with type 2 diabetes. What consideration should the nurse prioritize when planning this client's nursing care?

How the developmental disability influences the client's health management

The nurse is admitting a client with an abdominal tumor who is experiencing increasing unrelieved pain over the last three days despite taking opioids, as prescribed. Which sign—a manifestation of unrelieved pain—should the nurse expect to assess in this client?

Hyperglycemia

The interface model of disability is being used to plan the care of a client who is living with the effects of a stroke. Why should the nurse prioritize this model?

It promotes the idea that clients are capable and responsible.

A major cause of health-related problems is the increase in the incidence of chronic conditions. Which factor has contributed to the increased incidence of chronic diseases in developing countries?

Adoption of a more sedentary lifestyle, which is increasing obesity

A 62-year-old woman started experiencing urinary incontinence six months ago and now wears disposable incontinent panties. The client does not drink any fluids after 5 pm and considers this problem part of aging. What priority modifications and advice should be given to this client?

"Urinary incontinence is not part of the aging process. You should see your HCP and increase your water intake."

The nurse is caring for clients in the urology clinic. A new, 73-year-old client presents with reports of urinary incontinence and is prescribed an anticholinergic. Why might this type of medication be an inappropriate choice in the older adult population?

. Confusion can be an adverse effect of this medication.

A client who had abdominal surgery reports extreme pain when the bed sheet touches the abdomen. Which concept does the nurse use to explain this phenomenon to the client?

Allodynia

An international nurse has noted that a trend in emerging countries is a decrease in mortality from some acute conditions. What has contributed to this decrease in mortality from some acute conditions

Improved nutrition

As a case manager, the nurse oversees the multidisciplinary care of several clients living with chronic conditions. Two of the nurse's clients are living with spina bifida. The center of care for these two clients will typically exist where?

In the home

Nurses and members of other health disciplines at a state's public health division are planning programs for the next 5 years. The group has made the decision to focus on diseases that are experiencing the sharpest increases in their contributions to the overall death rate in the state. This team should plan health promotion and disease prevention activities to address what health problem?

Alzheimer disease

A 65-year-old client has come to the clinic for a yearly physical. The client reports enjoying good health, but also reports having occasional episodes of constipation over the past 6 months. What intervention should the nurse first suggest?

Increase daily intake of water.

The nurse is caring for a 77-year-old client who was recently admitted to the geriatric medical unit. Since admission, the client has spoken frequently of becoming a burden to their children and the challenge of "staying afloat" financially. When planning this client's care, the nurse should recognize a heightened risk of what nursing diagnosis?

Anxiety

A gerontologic nurse is making an effort to address some of the misconceptions about older adults that exist among health care providers. The nurse has made the point that most people aged 75 years and over remain functionally independent. The nurse should attribute this trend to what factor?

Application of health-promotion and disease-prevention activities

A 69-year-old client is readmitted with heart failure. The client reports taking all medications as prescribed. The client's grandchild usually helps to set up a weekly organizer pill container but is away at college. What should the nurse first do with this information?

Complete a comprehensive assessment reviewing the client's medication history, including over-the-counter medications

A client who uses a wheelchair was unable to enter a health care clinic because the pavement was too high. The client filed a formal complaint stating that reasonable accommodations were not met. What is an example of a reasonable accommodation under the 1990 American Disabilities Act (ADA)?

Accessible facilities and equipment

A client who has recently been diagnosed with chronic heart failure is being taught by the nurse how to live successfully with the chronic condition. The client's ability to meet this goal will primarily depend on the client's ability to do which of the following?

Adapt a lifestyle to accommodate the client's symptoms.

The community nurse is caring for a client who has paraplegia following a farm accident when they were an adolescent. This client is now 64 years old and has just been diagnosed with congestive heart failure. The client states, "I'm so afraid about what is going to happen to me." What would be the best nursing intervention for this client?

Assist the client in making suitable plans for care.

The nurse is caring for a client with dementia who has a fractured femur secondary to a fall. Which approach should the nurse take in regard to pain management with this client?

Assume that a fracture is painful and the client is in pain

Two clients have recently returned to the postsurgical unit after knee arthroplasty. One client is reporting pain of 8 to 9 on a 0-to-10 pain scale, whereas the other client is reporting a pain level of 3 to 4 on the same pain scale. What is the nurse's most plausible rationale for understanding the clients' different perceptions of pain?

Awareness and emotions affect the perception of pain.

An 80-year-old client is being admitted for dehydration and syncope. The client is found to be hypotensive, and intravenous fluids are ordered. What are some teaching strategies that the nurse should review with this client?

Before ambulation the client should rise slowly and take mini breaks between lying, sitting, and standing.

A client is receiving care on the oncology unit for breast cancer that has metastasized to the lungs and liver. When addressing the client's pain in the plan of nursing care, the nurse should consider which characteristic of cancer pain?

Cancer pain can be acute or chronic and typically requires comparatively high doses of pain medications

A nurse knows that clients with "invisible" disabilities like chronic pain often feel that their chronic conditions are more challenging to deal with than more visible disabilities. Why would they feel this way?

Despite appearances, invisible disabilities can be as disabling as visible disabilities

A 55-year-old client is preparing to retire in the next five years. The client has made both financial and social plans to make a successful transition. What are some examples of social change that the client could plan?

Developing routines and friends not associated with work

A gerontologic nurse is basing the therapeutic programs at a long-term care facility on Miller's Functional Consequences Theory. To put this theory into practice, the nurse should prioritize which task?

Differentiating between age-related changes and modifiable risk factors

An 80-year-old client has been admitted to the hospital for hypertension and now requires oxygen. The client asks the nurse why oxygen is needed because they have never smoked and feel fine. The client requires oxygen in the hospital because of which respiratory changes or requirements?

Diminished respiratory efficiency and declining aerobic capacity

The case manager is working with an 84-year-old client newly admitted to a rehabilitation facility. When developing a care plan for this client, which factors should the nurse identify as positive attributes that enhance coping in this age group? Select all that apply.

Effective adaptation skills Increased life experience Resilience during change

A 59-year-old client has come to the health care provider's office for an annual physical and is being assessed by the office nurse. The nurse who is performing routine health screening for this client should be aware that one of the first physical signs of aging is what?

Failing eyesight, especially close vision

A client has recently been diagnosed with type 2 diabetes. The client is clinically obese and has a sedentary lifestyle. How can the nurse best begin to help the client increase their activity level?

Identify barriers with the client that inhibit lifestyle changes

The nurse is caring for a 78-year-old client with cardiovascular disease. The client comes to the clinic with a suspected respiratory infection and is diagnosed with pneumonia. What should the nurse recognize about the altered responses of older adults?

Increased and closer monitoring of older adults' body systems must occur to identify possible systemic complications

A 43-year-old female client with epilepsy is admitted to the hospital. The client has been on seizure medications most of their adult life. What would be an appropriate care plan for this client?

Increased fall risk related to medication regimen

A nurse is aware that the number of people in the United States who are living with disabilities is expected to continue increasing. What is considered to be one of the factors contributing to this increase?

Increased survival rates among people who experience trauma

The nurse is providing education to a client with early-stage Alzheimer disease (AD) and the family members. The client has been prescribed donepezil hydrochloride. What should the nurse explain to the client and family about this drug?

It slows the progression of AD

A nurse is planning discharge education for an 81-year-old client with mild short-term memory loss. The discharge education will include how to perform basic wound care for the venous ulcer on the client's lower leg. When planning the necessary health education for this client, the nurse should take which action?

Keep teaching periods short.

The presence of a gerontologic advanced practice nurse in a long-term care facility has benefited both the clients and the larger community in which they live. Nurses in this advanced practice role have been shown to cause which outcome?

Less deterioration takes place in the overall health of clients

The nurse is providing care for an 82-year-old client whose signs and symptoms of Parkinson disease have worsened over the past several months. The client reports no longer being able to do as many things as in the past. Based on this statement, what issue is of most concern to the client?

Loss of independence

When implementing a comprehensive plan to reduce the incidence of falls on a gerontologic unit, what risk factors should the nurse identify? Select all that apply.

Medication effects Poor lighting Sensory impairment

The nurse, who is a member of the palliative care team, is assessing a client. The client reports saving client-controlled analgesics (PCA) until the pain is intense because pain control has been inadequate. What client education should the nurse give this client?

Medication should be taken when pain levels are low so the pain is easier to reduce.

The nurse is caring for a 71-year-old client who experienced a humeral fracture in a fall. The client is receiving an opioid for pain control. Which principle of pain management for an older adult should the nurse apply?

Monitor for signs of drug toxicity.

A 76-year-old client is in the emergency department with reports of nausea, dyspnea, and shoulder pain. The spouse stated the client woke up confused, slightly unsteady, and pale. Which problem or condition is most likely occurring?

Myocardial ischemia

A 55-year-old woman with multiple sclerosis is deficient in completing health screening and health promotion tests. Based on the information provided, and statistical data, what is the most likely test that the client missed?

Pelvic examination

The home health nurse is caring for a homebound client who is terminally ill and is delivering a client-controlled analgesia (PCA) pump at today's visit. The family members will be taking care of the client. What would the nurse's priority interventions be for this visit?

Provide client and family teaching regarding the operation of the pump, monitoring the IV site, and knowing the side effects of the medication.

The nurse in a pain clinic is caring for a client who has long-term, intractable pain. The pain team feels that first-line pharmacologic methods of pain relief have been ineffective. Which recommendation should guide this client's subsequent care?

The client may benefit from a multimodal approach to pain management

A home care nurse is making an initial visit to a 68-year-old client. The nurse finds the client tearful and emotionally withdrawn. Even though the client lives alone and has no family, the client has been managing well at home until now. What would be the most appropriate action for the nurse to take?

Reassess the client's psychosocial status and make the necessary referrals.

A client who is recovering from a stroke expresses frustration about their care to the nurse, stating, "It seems like everyone sees me as just a problem that needs fixing." This client's statement is suggestive of what model of disability?

Rehabilitation model

The nurse is assessing a client's pain while the client awaits a cholecystectomy. The client is tearful, hesitant to move, and grimacing, but reports feeling pain as a 2 at this time on a 0-to-10 pain scale. How should the nurse best respond to this assessment finding?

Reinforce education about the pain scale number system.

A medical-surgical nurse is teaching a client about the health implications of the client's recently diagnosed type 2 diabetes. The nurse should teach the client to be proactive with glycemic control to reduce the risk of what health problem?

Renal failure

A client has just returned from the postanesthesia care unit (PACU) following left tibia open reduction internal fixation. The client is reporting pain, and the nurse is preparing to administer intravenous hydromorphone. Prior to administering the drug, the nurse should prioritize which assessment?

Respiratory status

After a sudden decline in cognition, a 77-year-old client who has been diagnosed with vascular dementia is receiving care at home. To reduce this client's risk of future infarcts, which action should the nurse most strongly encourage?

Rigorous control of the client's blood pressure and serum lipid levels

A 72-year-old client has returned to the community following knee replacement surgery. The client takes nine different medications and has experienced dizziness since discharge. The nurse should identify which nursing diagnosis?

Risk for falls related to polypharmacy and impaired balance

A nurse is taking an Advanced Cardiovascular Life Support class. The nurse has dyslexia and is given an extra hour to complete the exam. What type of disability best defines the nurse's condition?

Sensory disability

A community health nurse has drafted a program that will address the health promotion needs of members of the community who live with one or more disabilities. Which area of health promotion education is known to be neglected among adults with disabilities?

Sexual health

A 54-year-old female client visiting her gynecologist is postmenopausal and reports painful intercourse. What is a physical change that is occurring to the client's reproductive system to account for this problem?

Shortening of the vagina

The nurse is caring for a male client with a history of chronic angina. The client states that after breakfast he usually takes a shower and shaves. It is at this time, the client says, that he tends to experience chest pain. What should the nurse counsel the client to do to decrease the likelihood of angina in the morning?

Shower in the evening and shave before breakfast

A 76-year-old client with Parkinson disease has been admitted with aspiration pneumonia and constipation. Which nursing intervention would help both diagnoses?

Sitting upright for meals

For several years, a community health nurse has been working with a 78-year-old man who requires a wheelchair for mobility. The nurse is aware that the interactions between disabilities and aging are not yet clearly understood. This interaction varies depending on what variable?

Socioeconomics

A 75-year-old client has been admitted to the rehabilitation facility after falling and fracturing the left hip. The client has not regained functional ability and may have to be readmitted to an acute-care facility. When planning this client's care, what should the nurse know about the negative effects of the stress associated with pain?

Stress is particularly harmful in older adults who have been injured or who are ill.

A 39-year-old client with paraplegia has been admitted to the hospital for the treatment of a sacral pressure injury. The nurse is aware that the client normally lives alone in an apartment and manages their ADLs independently. Before creating the client's plan of care, how should the nurse best identify the level of assistance that the client will require in the hospital?

Talk with the client about the type and level of assistance that the client desires

A client with a spinal cord injury is being assessed by the nurse prior to being discharged from the rehabilitation facility. The nurse is planning care through the lens of the interface model of disability. Within this model, the nurse will plan care based on what belief?

The client has the potential to function effectively despite the disability.

An initiative has been launched in a large hospital to promote the use of "people-first" language in formal and informal communication. What is the significance to the client when the nurse uses

The client is of more importance to the nurse than the disability.

The nurse is caring for a client with a fractured pelvis and a ruptured bladder resulting from a motor vehicle accident. The nurse's aide (NA) reports concern to the nurse because the client's resting heart rate is 110 beats per minute, respirations are 24 breaths per minute, temperature is 37.3°C (99.1°F) axillary, and the blood pressure is 125/85 mm Hg. What other information is most important as the nurse assesses this client's physiologic status?

The client's rating of their pain