Exam 3 Study Set

The nurse recommends that, when in bed, a client who has osteoarthritis should lie in the supine or prone position. The client states that these positions are uncomfortable for the knees and hips. Which action would the nurse take? a. Encourage the client to maintain extension for specific periods of time b. Urge the client to lie in whatever position is most comfortable c. Insert a pillow under the client's knees to relieve discomfort d. Place the client in the semi-Fowler position most of the time

Encourage the client to maintain extension for specific periods of time

Osteoarthritis

Joint pain, stiffness, Heberden & Bosuchard nodes

Opioid + NSAID + Muscle Relaxer

Multimodal pain management

Calcium

The best "medicine" for osteoporosis is

Benzodiazepines

This drug family will help you SLEEP, but you might become ADDICTED

Nalaxone

Your pt is on a PCA & scores a 4 on POSS (OD)

Which factors contribute to development of osteoporosis in female clients? Select all that apply a. Cigarette smoking b. Moderate exercise c. Use of street drugs d. Familial predisposition e. Inadequate intake of dietary calcium

a. Cigarette smoking d. Familial predisposition e. Inadequate intake of dietary calcium

Which question would the nurse ask to determine a client's potential for injury because of sleep deprivation? Select all that apply a. Do you operate heavy machinery at work? b. What activities do you do in your spare time? c. Do you feel the need to take naps during the day? d. Does sleepiness affect your performance at work? e. How many hours of sleep do you get every night?

a. Do you operate heavy machinery at work? d. Does sleepiness affect your performance at work?

A client dies during surgery, and the family members ask that the hospital not conduct autopsy examinations. Which religion might the nurse expect this family to practice? a. Islam b. Hinduism c. Buddhism d. Christianity

a. Islam

which medication is derived from a natural source and may be prescribed for the treatment of OP? a. calcitonin b. raloxifene c. clomiphene d. bisphosphonates

a. calcitonin

What is sleep hygiene?

best practices for getting good rest

A client who is to have a total hip arthroplasty with an uncemented prosthesis asks, "When will I be able to get up and walk?" Which information would the nurse include in a response? a. Full weight bearing is permitted after 2 weeks b. Partial weight bearing begins the day after surgery c. Full weight bearing may begin the day after surgery d. Partial weight bearing progresses to full weight bearing in 2 weeks

c. Full weight bearing may begin the day after surgery

Which action would the nurse take for an older client with Alzheimer disease who sleeps very little and becomes more disoriented from sleep deprivation? a. Shut the client's door during the night b. Apply a vest restraint when the client is in bed c. Leave a dim light on in the client's room at night d. Administer the client's prescribed as-needed sedative medication

c. Leave a dim light on in the client's room at night

What is insomnia?

recurring problems in falling or staying asleep

What is sleep apnea?

temporary cessations of breathing during sleep and repeated momentary awakenings

Standard dose of acetaminophen

650 MG

BEST person to help communicate in foreign language?

CERTIFIED translator

SHELL-fish allergy

Caution For pt taking glucosamine (coast)

Zolpidem (Ambien)

Don't take me unless you can sleep at night- i will put you out or make you sleep walk

Worst side effect of NSAIDS

GI bleed

Best side to get OOB after hip replacement?

UNaffected side

c. Moderate abduction

Which position would the nurse use for placement of the affected extremity of a client who is recovering from an open reduction and internal fixation (ORIF) of a fractured hip? a. External rotation b. Slight hip flexion c. Moderate abduction d. Anatomic body alignment

Pre-medicate the patient

Your ortho pt is still having pain & is about to have PT

which action by a 70 yo female client would best limit further progression of OP? a. taking supplemental calcium and vitamin d b. increasing the consumption of eggs and cheese c. taking supplemental magnesium and vitamin e d. increasing the consumption of milk products

a. taking supplemental calcium and vitamin d

Which PRIORITY nursing intervention would the nurse include in the plan of care for an older adult who sustained a right hip fracture? a. oxygen therapy b. cardiac monitoring c. nutrition supplements d. venous thromboembolism (VTE) prevention

d. venous thromboembolism (VTE) prevention

healthcare disparities

differences in access to or availability of facilities and services

The nurse starts a new job and recognizes that the patient population is very diverse. What action will help the nurse to provide culturally competent care? a. Read about all of the cultural groups in the local population. b. Treat all of the patients the same, regardless of their cultural background. c. Increase self-awareness of cultural identity, cultural knowledge, and potential biases. d. Attempt to remain culturally neutral while treating patients of a different culture.

Increase self-awareness of cultural identity, cultural knowledge, and potential biases.

A client says, "none of these medications will work on me because I am away from my holy land." Which course of action would the nurse need to take to comply with teamwork and collaboration competency according to the quality and the safety education for nurses (QSEN)? a. Provide care to the client with respect to diversity, values, and beliefs b. Approach the agency chaplain to discuss the spiritual needs of the client c. Conduct thorough research on the effect of emotional distress on the client's health d. Use the flow chart data to provide the best care and monitor the outcome of the care processes

Approach the agency chaplain to discuss the spiritual needs of the client

Opioids help with pain, but don't help with what?

Constipation

impaired perfusion

In a hip fx, pt with POOR pedal pulses

Cluster Care

Pt is naving hard time sleeping in nospital, but doesn't want sleep mods

when taking the history for a client who is being treated for OSA, which findings would the nurse expect? select all that apply a. daytime hypoxemia b. chronic fatigue c. enlarged tonsils d. subcutaneous emphysema e. poor concentration

b. chronic fatigue c. enlarged tonsils e. poor concentration

a client with OP is encouraged to drink milk. the client refuses the milk, explaining that it causes gas and bloating. which calcium-rich food would the nurse suggest for clients who do not tolerate milk? a. oats b. yogurt c. potatoes d. applesauce

b. yogurt

Which scenario would contribute to health disparities? a. An English-speaking critical care nurse assesses a Hispanic client in a coma b. an English-speaking nurse plans the nursing procedures for a black Latino client c. an English-speaking nurse provides discharge instructions to an English-speaking client who is hard of hearing d. an English-speaking nurse conducts an admission interview of a Puerto Rican immigrant with limited knowledge of English

d. an English-speaking nurse conducts an admission interview of a Puerto Rican immigrant with limited knowledge of English

a client has a large, open abdominal wound. the HCP prescription states to cleanse the wound with NS, pack it with damp gauze, cover with abdominal pads, and secure with Montgomery straps 2x a day. which step would the nurse take to maintain sterility when changing the dressing? a. use 2 square gauze pads to cleanse the wound, one for each half of the wound b. apply new Montgomery straps each time the dressing is changed c. hold the wet gauze with the tips of the forceps higher than the wrist d. cleanse the wound with wet, sterile gauze from the center of the wound outward

d. cleanse the wound with wet, sterile gauze from the center of the wound outward

Complete Pain Assessment

Your pt says their pain is out of control; there is an available PRN med

Which type of response is being demonstrated in a client with insomnia who takes a new medication to promote sleep and two hours later is wide awake and feeling more energized than before the medication was taken? a. Allergic b. Synergistic c. Paradoxical d. Idiosyncratic

c. Paradoxical

Which client is MOST at risk for OP? a. Nonsmoking 60 yo, BMI 27.1 b. 66 yo white woman, BMI 18, who is a retired paralegal c. 68 yo black woman, BMI 23.3, who is a retired receptionist d. 62 yo woman, BMI 23.2, who takes calcium carbonate daily

b. 66 yo white woman, BMI 18, who is a retired paralegal

The nurse is managing care for a client who has had a total hip arthroplasty. Which action by the UAP will require the nurse to intervene? a. The client's heels are kept off of the bed b. The UAP elevates the client's affected leg on a pillow c. The UAP uses a pillow to keep the client's legs abducted d. The client uses a walker when ambulating with the UAP

b. The UAP elevates the client's affected leg on a pillow

a client who has degenerative joint disease of the vertebral column is taught to turn from the back to the side, while keeping the spine straight. in addition to crossing an arm over the chest, which action would the nurse instruct the client to take? a. pull yourself to one side by using the night table b. bend your top knee to the side to which you will turn c. turn with both legs straight while your ankles are crossed d. flex your bottom knee to the side to which you wish to turn

b. bend your top knee to the side to which you will turn

a client who has been taking the prescribed dose of zolpidem for 5 days returns to the clinic for a follow-up visit. which statement by the client indicates the medication has been effective? a. i have less pain b. i have been sleeping better c. my blood glucose is under control d. my blood pressure is coming down

b. i have been sleeping better

which statement indicates understanding of the instructions when a client who had a total hip replacement is taught wound care by the nurse in preparation for discharge? a. i will sit in a chair for several hours daily b. i will inspect the incision for healing when i change the dressing c. i will check to see whether the staples have dissolved within a few days d. i will call the HCC if i see any clear drainage coming from the incision

b. i will inspect the incision for healing when i change the dressing

The spouse of a comatose client who has severe internal bleeding refuses to allow transfusions of whole blood because they are Jehovah's Witnesses. The client does not have a Durable Power of Attorney for Healthcare. What action should the nurse take? 1. Institute the prescribed blood transfusion because the client's survival depends on volume replacement. 2.Clarify the reason why the transfusion is necessary and explain the implications if there is no transfusion. 3.Phone the health care provider for an administrative prescription to give the transfusion under these circumstances. 4. Give the spouse a treatment refusal form to sign and notify the health care provider that a court order now can be sought

Give the spouse a treatment refusal form to sign and notify the health care provider that a court order now can be sought

the nurse is completing an assessment on an older adult who fell and fractured the left hip. Which clinical indicator would the nurse identify as typical with fractured left hip? a. left hip is ecchymotic b. left leg is noticeably shorter than the right. c. left leg is internally rotated d. left hip is tender when touched

b. left leg is noticeably shorter than the right

A nurse hired to work in a metropolitan hospital provides services for a culturally diverse population. One of the nurses on the unit says it is the nurses' responsibility to discourage "these people" from bringing all that "home medicine stuff" to their family members. Which response by the recently hired nurse is most appropriate? a. "Hospital policies should put a stop to this." b. "Everyone should conform to the prevailing culture." c. "Nontraditional approaches to health care can be beneficial." d. "You are right because they may have a negative impact on people's health."

Nontraditional approaches to health care can be beneficial

Which finding on the first postoperative day after a client has an open reduction and internal fixation of a fractured hip will be most important to report to the HCP a. Client report of level 8 incisional pain (0-10) b. 50 mL of deep red drainage in wound drainage device c. Swelling and redness in the calf of the operative leg d. Client oral temperature elevation to 100.2F

Swelling and redness in the calf of the operative leg

A female client asks the nurse whether she should be tested for osteoporosis. Which statements reflect current advice regarding the prevention for OP? Select all that apply a. A bone mineral density test is the only way to diagnose OP b. Everyone with OP should be treated with bisphosphonates c. All adults need 1000mg of calcium and 400-800 IU of Vitamin D each day d. Women should be evaluated clinically for risk of OP annually after 70 e. Postmenopausal women and all adults over the age of 65 should be tested for OP

a. A bone mineral density test is the only way to diagnose OP e. Postmenopausal women and all adults over 65 should be tested for OP

Which mechanism of action explains why naloxone is administered for a heroin overdose? a. Competition with opioids for occupancy of opioid receptors b. Blunts severity of withdrawal symptoms as heroin wears off c. Accelerated metabolism of heroin and stimulation of respiratory centers d. Stimulation of cortical sites that control consciousness and cardiovascular function

a. Competition with opioids for occupancy of opioid receptors

Which physiologic symptom would the nurse associate with a client's sleep deprivation? Select all that apply a. Ptosis and blurred vision b. Agitation and hyperactivity c. Confusion and disorientation d. Increased sensitivity to pain e. Decreased auditory alertness

a. Ptosis and blurred vision e. Decreased auditory alertness

which findings from the client's history would be symptoms of insomnia disorder? select all that apply a. fatigue b. panic attacks c. acute pain d. early morning awakenings e. reduced concentration f. irritability

a. fatigue d. early morning awakenings e. reduced concentration f. irritability

the nurse understands which anesthetic medication is commonly used for short procedures on pediatric patients? a. fentanyl b. morphine c. meperidine d. hydromorphone

a. fentanyl

the nurse is completing the health history of a client admitted to the hospital with OA. which joint would the nurse expect the client to report as having been involved first? select all that apply a. hips b. knees c. ankles d. shoulders e. metacarpals

a. hips b. knees

which statement by the adolescent indicats a need for further teaching about the importance of sleep? a. i need 7 hours of sleep each night b. not getting enough sleep can affect my grades c. sleep deprivation can affect my physical health d. i should leave my phone in the other room to improve my sleep

a. i need 7 hours of sleep each night

which client statement indicates understanding of the precautions taken during bisphosphonate therapy? a. i should take the medication with a large glass of water b. i should take the medication with a noon meal c. i will not need to taper off this medication d. i should lie down after taking the medication

a. i should take the medication with a large glass of water

Osteoporosis

loss of height & KYPHOSIS

which action indicates the need for additional teaching when the nurse is educating a client on the use of heat and cold for OA pain? a. places ice pack on skin b. uses ice pack for 20 mins c. applies lightweight heating pad d. tests water before getting into shower

a. places ice pack on skin

which assessment would the nurse complete after a client has an open reduction internal fixation of a fractured hip? a. asses femoral pulse b. asses toes for mobility c. check condition of the pin d. monitor ROM of the knee

a. places ice pack on skin

which medication class includes amitriptyline? a. tricyclics b. monoamine oxidase inhibitors c. selective serotonin reuptake inhibitors d. serotonin-norepinephrine reuptake inhibitors

a. tricyclics

which intervention would the nurse include in the plan of care for a client after a total hip replacement? select all that apply a. maintain the affected hip in the adduction position when moving the client b. regularly scheduled analgesics and as needed medications for pain control c. the client should sit in the chair at the height to encourage flexion of the hip joint d. frequent neurovascular assessment should be done and compared to the unaffected side e. when turning. the client should log roll to prevent the leg from falling forward or backwards

b. regularly scheduled analgesics and as needed medications for pain control d. frequent neurovascular assessment should be done and compared to the unaffected side e. when turning. the client should log roll to prevent the leg from falling forward or backwards

Before beginning administration of morphine via patient-controlled analgesia (PCA), which assessment would the nurse perform first? a. Temperature b. Blood Pressure c. Respirations d. Urinary output

c. Respiration

Which population-level action would the nurse use to support tertiary prevention for clients with OP? a. Develop an educational campaign to support early identification of OP b. Provide routine screening for OP at local heath fairs and community sites c. Support development of low-impact physical activity options for those diagnoses with OP d. Encourage local providers to include discussion of strategies that reduce OP risk during annual wellness visits

c. Support development of low-impact physical activity options for those diagnosed with OP

Which part of the client's body would the nurse assess to identify osteoporotic changes? a. Long bones b. Facial bones c. Vertebral column d. Joints of the hands

c. Vertebral column

which sedative-hypnotics would the nurse identify as being used to treat insomnia associated with a panic disorder? select all that apply a. phenelzine b. paroxetine c. alprazolam d. imipramine e. clonazepam

c. alprazolam e. clonazepam

What is sleep deprivation?

fatigue, irritability, distractibility & altered thought process

What is somatic pain?

pain from skin, muscles, and joints

which activity would the nurse recommend to a client who asks for advice about insomnia? select all that apply a. drink a glass of wine b. engage in vigorous exercise before bedtime c. eat foods containing lysine d. follow same bedtime ritual each night e. perform deep-breathing exercises

d. follow same bedtime ritual each night e. perform deep-breathing exercises

Which nursing intervention would the nurse include in the plan of care for an older adult client with decreased bone density? a. Teaching the client isometric exercises b. Advising the client to take a warm shower c. Providing supportive armchairs to the client d. Demonstrating weight-bearing exercises to the client

d. Demonstrating weight-bearing exercises to the client

When assessing a 75 yo client, which finding by the nurse would be MOST important to report to the HCP? a. Decreased lung sounds at bases b. Kyphosis with barrel-shaped chest c. Oxygen saturation at rest 93% d. Expiratory wheezes bilaterally

d. Expiratory wheezes bilaterally

a client with OA reports experiencing painful back muscle spasms. which medication would the nurse administer? a. tramadol b. hyaluronate c. diclofenac epolamine patch d. cyclobenzaprine hydrochloride

d. cyclobenzaprine hydrochloride

when providing care for several clients on a med surg unit, which task would the nurse appropriatly delegate to the UAP? a. ask a client about their new report of chest pain b. turn a bed-bound client to prevent pressure injuries c. change a surgical dressing for a client who is 7 days post surgery d. administer acetaminophen to a client who reports having a headache

b. turn a bed-bound client to prevent pressure injuries

which strategies would the nurse teach a client who say, "i have been having trouble sleeping and feel wide awake as soon as i get into bed?" select all that apply a. eating a heavy snack near bedtime b. reading in bed before shutting out the light c. leaving the bedroom when unable to sleep d. drinking a cup of warm coffee with milk at bedtime e. exercising in the afternoon rather than the evening f. drinking at least 1 glass of wine or other alcoholic beverage at bedtime

c. leaving the bedroom when unable to sleep e. exercising in the afternoon rather than the evening

which scenario explained by the RN teaching about factors that influence sleep is an example of a lifestyle factor? a. a client reports trouble falling asleep because of thinking about stress at work b. a client in the ICU has not slept properly because of noises and disturbances c. a client who has been taking antidepressants reports drowsiness and lack of sleep d. a client who works rotating overnight shifts reports fatigue and difficulty sleeping through the night

d. a client who works rotating overnight shifts reports fatigue and difficulty sleeping through the night

which action would the nurse perform immediately after applying capsaicin to a client with diabetic neuropathy? a. monitor for skin irritation b. perform a painful procedure c. notify the HCP d. remove gloves and wash hands

d. remove gloves and wash hands