Exam 5 Lessons Med-Surg

A patient with low back pain is beginning chiropractic therapy. The provider prescribes cyclobenzaprine, 10 mg every eight hours as needed, for muscle stiffness or pain. The medication is available in 5-mg tablets. The patient asks the nurse, "How many of these pills can I take each day?"

6

A child is admitted to the hospital for surgical resection of an osteosarcoma and will require chemotherapy. The child is fearful of the hospital admission. Which action should the nurse take? A. Encourage the family to stay with the child. B. Encourage the child to play with other children. C. Administer a mild anti-anxiety medication as ordered. D. Coordinate with a child counselor to communicate with child and family.

A

A child is admitted with a diagnosis of osteochondroma and is crying inconsolably because of pain. Which action should the nurse take first? A. Assess the location and severity of pain B. Administer prescribed pain medication C. Ask for assistance from parent to console the child D. Continue taking the history and report the crying to the health care provider

A

A nurse is reviewing the medical history of a patient with a pathologic fracture of the hip. Which condition may be a cause for the fracture of this patient? A. Breast cancer B. Lactose intolerance C. Rheumatoid arthritis D. Systemic lupus erythematosus (SLE)

A

A patient asks the nurse about the development of a benign bone tumor. Which information should the nurse provide? A. Benign tumors will not spread to other body parts. B. Benign bone tumors are likely to be fatal for the patient. C. Benign bone tumors start in the middle portion of the long bones. D. Benign bone tumors are small and will not compress healthy bone tissue.

A

A patient with an upper arm fracture is diagnosed with compartment syndrome. After the health care provider cuts the cast, the nurse notes continued swelling, absent radial pulse, pallor, and cool skin. Which initial action should the nurse take? A. Begin preoperative checklist B. Raise the fractured arm above the head C. Obtain samples for urinalysis and serum creatinine D. Continue doing the neurovascular examination until patient is stable

A

A patient with swelling, pain, and ulcers of the right leg reports numbness and tingling of the toes. For which diagnostic study would the nurse expect to prepare this patient? A. Venography B. Blood culture C. Arteriography D. White blood cell count

A

The nurse is caring for a patient who reports having severe pain and decreased movement after an ankle dislocation. After verifying the prescription and patient allergies, which medication would the nurse safely administer to this patient? A. Morphine B. Cyclobenzaprine C. Acetaminophen/codeine D. Oxycodone/acetaminophen

A

The nurse is caring for a patient with a right leg deformity who reports numbness of the toes and plantar aspect of the foot. On further assessment, the nurse notes no pedal pulse and cool skin. Which action should the nurse take next after notifying the provider? A. Prepare for reduction and splint B. Start IV infusion with normal saline C. Prepare the patient for a STAT X-ray D. Elevate the right leg and apply ice pack

A

The nurse would most likely expect to see vertebral discs break down in which region of the spine? A. Lumbar B. Sacral C. Thoracic D. Cervical

A

The patient is admitted to the hospital with a chondrosarcoma. In which part of the body would the nurse expect to find this bone tumor? A. Cartilage in the arm, leg, or pelvis B. Cavity of a single hand or foot bone C. Medullary cavity of pelvis, femur, or humerus D. Metaphyseal portion of long bones, pelvis, and scapula

A

The patient with acute low back pain tells that nurse that a new job requires stocking shelves with boxes of equipment. Which information about proper body mechanics should the nurse give the patient? A. "Do not lift boxes past the elbows." B. "Wear a back brace while lifting the boxes." C. "Do not lift boxes beyond the level of the shoulders." D. "Avoid lifting boxes that weigh more than 10 pounds."

A

When caring for a patient with a right leg fracture, the patient reports pain not relieved by analgesic and tingling of the toes. The nurse also notes diminished pedal pulses and swelling above the dressing. Which action should the nurse take? A. Loosen the dressing B. Maintain the traction weight C. Prepare for emergency decompression D. Immediately inform the health care provider

A

While caring for a patient after a third-degree ankle sprain, the nurse notes the patient can bear weight on the affected foot without discomfort. Which actions would the nurse consider? Select all that apply. A. Teach strengthening exercises for the ankle B. Assess neurovascular status of affected extremity C. Teach patient to continue applying ice packs at home D. Check X-ray finding with the patient to see if there is no fracture E. Perform passive range-of-motion (ROM) exercises on the affected foot

A,B

A nurse is caring for an older adult patient and suspects the patient may have a herniated disc. Which signs/symptoms are indicative of a herniated disc? Select all that apply. A. Pain B. Numbness C. Leg weakness D. Cold sensation E. Swelling of the arm

A,B,C

A patient presents with bilateral leg pain, abdominal pain, and difficulty breathing after a motor vehicle accident. The nurse notes obvious deformities to the bilateral lower legs, bruising to the chest, and abrasions on the chest, abdomen, and arms. Which actions should the nurse perform while assessing the severity of the patient's injuries? Select all that apply. A. Auscultate lung sounds B. Assess peripheral pulses C. Assess capillary refill time D. Start intravenous (IV) infusion with dextrose in 5% water E. Prepare patient for computed tomography (CT) scan

A,B,C

The nurse is caring for a patient whose malignant tumor is not operable. Which procedures would the nurse expect the health care provider to recommend for this patient? Select all that apply. A. Radiation B. Chemotherapy C. Pain management D. Regular screenings E. Computed tomography (CT)-guided biopsy

A,B,C,D

A patient with osteoarthritis (OA) reports doing a lot of walking and is now experiencing increased knee pain. Which actions should the nurse recommend to this patient? Select all that apply. A. Use a whirlpool on a daily basis. B. Alternate application of ice and heat to the knee. C. Incorporate more exercise into your daily routine. D. Take frequent rest periods with the knee elevated. E. Take the biological response modifiers as prescribed.

A,B,D

The nurse is caring for a patient who underwent an open hip fracture reduction. The patient reports having pain that radiates down the leg. Which actions should the nurse take? Select all that apply. A. Assess for muscle spasm B. Administer pain medication C. Massage the surrounding muscles D. Assess vital signs and capillary refill E. Report symptoms immediately to health care provider

A,B,D

Which questions should the nurse ask a patient with osteoarthritis (OA) to determine comfort? Select all that apply. A. "When your pain occurs, how long does it last?" B. "How would you rate your pain on a scale of 0 to 10?" C. "How many hours of sleep do you average per night?" D. "What medications do you take to alleviate your arthritic pain?" E. "Does the arthritis prevent you from doing activities you enjoy?"

A,B,D,E

The nurse is preparing a 68-year-old patient for left above-knee amputation. The patient has a history of stroke, diabetes, and hypertension. Which actions are important to take preoperatively? Select all that apply. A. Monitor blood sugar levels B. Assess the patient for hemorrhage C. Teach about upper body strength exercises D. Use mirror therapy to prepare for loss of limb E. Discuss type of prosthetic to be placed during surgery

A,C

A patient with osteoarthritis (OA) who is working as an office assistant asks the nurse what can be done to perform the job while managing their symptoms of OA. Which responses from the nurse would benefit the patient? Select all that apply. A. "Use a computer instead of writing by hand." B. "Try standing up instead of sitting down for long periods." C. "Use a voice or video recorder and transcribe when necessary." D. "Sit up straight and make sure you have your office chair in a comfortable position." E. "Repeat joint exercises throughout the day so that your hands can better adapt to writing and typing."

A,C,D

Which patients are at risk for amputation? Select all that apply. A. Active duty soldier B. Teenager with a pelvic fracture C. Older adult with arteriosclerosis D. Young adult with peripheral artery disease E. Child with second-degree sunburn on the legs

A,C,D

A female patient with rheumatoid arthritis (RA) states that she has been treated for years with different medications but is frustrated that she still hasn't achieved relief. Which responses from the nurse are appropriate? Select all that apply. A. "Maybe you should try yoga or Tai Chi." B. "Try adding some herbal supplements to the medication regimen." C. "You should ask your health care provider about joint replacement." D. "Symptoms of RA can be alleviated with weight loss and some adjustments to activities." E. "You can speak to your health care provider about transcutaneous electrical nerve stimulation (TENS)."

A,C,E

A patient with a pelvic fracture is non-weight bearing and is unable to ambulate. Which dietary modifications should the nurse anticipate for this patient? Select all that apply. A. Increase dietary fiber B. Limit oral fluid intake C. Increase iron-rich foods D. Increase calcium-rich foods E. Decrease protein-rich foods

A,D

After a motor vehicle accident, a patient presents with a deformity to the leg with decreased pedal pulses. The fibula protrudes from the lateral aspect of the leg. How should the nurse classify the fracture? Select all that apply. A. Open B. Spiral C. Closed D. Displaced E. Incomplete

A,D

The nurse is caring for a patient who is being considered for a limb salvage of the right lower extremity. Which elements are priority for the nurse to assess before the procedure? Select all that apply. A. Pulse B. Airway C. Breathing D. Movement E. Circulation F. Degree of pain

A,D,E

The nurse is caring for a patient who underwent right arm amputation secondary to a crush injury. The patient does not talk much about the surgery but does indicate that he is nervous about using the prosthesis and asks for guidance. Which responses by the nurse are appropriate? Select all that apply. A. "When I change your dressing, let's look at the surgical site together." B. "I will get your primary health care provider so you can discuss your concerns." C. "It is important to not think of this as a loss, but a different way to approach life." D. "I will provide a list of therapists that you can use to help you use your prosthesis." E. "You are moving in the right direction by thinking ahead to how you will use your prosthesis."

A,D,E

The nurse is caring for a patient with a short leg cast who reports itching and burning inside the cast. Which actions would the nurse perform? Select all that apply. A. Assess capillary refill of the toes B. Apply ice on the affected leg for 2 days C. Immobilize joints above and below the cast D. Report the symptoms to the health care provider E. Teach the patient to use cool setting of hair dryer for itching

A,D,E

A health care provider has ordered a computed tomography (CT) scan of the leg of a patient with suspected osteochondroma. Which question should the nurse ask the patient first before the procedure? A. "What did you eat or drink in the last 8 hours?" B. "Do you have allergies to shrimp or other seafood?" C. "Are you claustrophobic or afraid of small confined places?" D. "Do you have any metal clips or other prosthetics in your body?"

B

A nurse is reviewing a list of patients in the outpatient unit. Which condition is a risk factor for amputation? A. Benign cyst on the right foot B. Gangrene secondary to diabetes C. Subcutaneous cyst on the right lower leg D. Newly diagnosed peripheral vascular disease (PVD)

B

A patient is undergoing a noninvasive electrical bone growth stimulation on a nonunion fracture of the spine after a spinal fusion surgery that was performed 6 months ago. Which action should the nurse take? A. Check if the electrode is implanted in the bone fragment. B. Ensure that treatment is administered while patient is sleeping. C. Assist patient in walking while in treatment for at least three times for 15 minutes. D. Check if the external power supply is inserted properly through the skin and bone.

B

A patient who fractured the humerus 5 weeks prior presents for a follow-up X-ray. Which result should the nurse expect to find on the X-ray? A. Soft tissue damage B. Fracture still evident C. Joint union complete D. Distance between bone fragments decreasing

B

A patient with chronic low back pain is complaining of difficulty sleeping. Which medication would be an appropriate treatment for the patient's complaint? A. Ibuprofen B. Duloxetine C. Prednisone D. Gabapentin

B

The medical-surgical charge nurse receives a patient in the postanesthetic care unit after successful completion of spinal fusion. The patient is still sedated and is assigned to a staff nurse. The unit charge nurse intervenes when the staff nurse prepares to give which prescription to the patient? A. Morphine, 2 mg, intravenously (IV) B. Diazepam, 2.5 mg, by mouth C. Morphine via patient-controlled analgesia pump D. Hydromorphone, 1 mg, intravenously

B

The nurse is caring for a patient after an open reduction of a hip fracture that requires immobilization. Which form of immobilization would the nurse anticipate? A. Skin traction B. Skeletal traction C. Internal fixation D. External fixation

B

The nurse is providing health education to a patient who is scheduled for disc replacement. Which information should the nurse include in the teaching plan about the procedure? A. Disc replacement will permanently resolve pain. B. Disc replacement will reduce, but not eliminate, pain. C. Pain from the procedure should be resolved within five days. D. Disc replacement will allow the patient to regain hyperextension ability.

B

Which teaching should the nurse provide to a patient with rheumatoid arthritis (RA) who has just started taking azathioprine? A. Increase oral fluid intake B. Avoid people who are sick C. Adhere to a weekly blood test D. Refrain from being out in the sun

B

The nurse is caring for a patient who has undergone cervical spine surgery. Which findings should prompt the nurse to implement immediate life-saving measures? Select all that apply. A. Cough B. Dyspnea C. Nasal flaring D. Vesicular breath sounds E. Diminished breath sounds

B,C

The nurse is caring for a patient with acute low back pain. Which topics would be included when teaching the patient about management techniques? Select all that apply. A. Encouraging one week of bed rest B. Safe use of oral opioid medications C. Attending physical therapy sessions D. Information on complementary therapy E. Consulting with a surgeon regarding surgical options

B,C,D

Which findings would the nurse expect to note when assessing the lower extremities of a patient with low back pain? Select all that apply. A. Pale, cool skin B. Tense muscle tone C. Hyperactive reflexes D. Guarding of the area E. Decreased pain with movement

B,C,D

The nurse is caring for a patient with an open arm fracture after a horse riding accident. Which actions are important for the nurse to take? Select all that apply. A. Splint the arm B. Administer IV antibiotics C. Assess capillary refill of fingers D. Assess airway and cervical spine E. Administer antitetanus as prescribed F. Apply heating pads on the affected areas

B,C,D,E

A patient diagnosed with osteoarthritis (OA) would have which manifestations? Select all that apply. A. Low-grade fever B. Joint pain and stiffness C. Generalized body malaise D. Grating sensation with movement E. Nodes at the proximal interphalangeal joints

B,D,E

The nurse is developing a plan of care for a patient admitted to the hospital with chronic back pain. Which interventions should be included in the plan? Select all that apply. A. Encourage bed rest B. Assess patient's pain level C. Provide a light, soft mattress D. Offer hot and cold compresses E. Provide pillows while the patient is sleeping

B,D,E

Which signs and symptoms would the nurse find in a patient with compartment syndrome? Select all that apply. A. Erythema B. 1+ pulses C. Warmth at the affected site D. Pain not relieved by morphine E. Tingling sensation of the fingers

B,D,E

The nurse is caring for a 55-year-old patient with a history of hypertension and skin cancer. The nurse notes discoloration and diminished pulses on a patient's left foot. The patient reports prolonged exposure to cold, decreased sensation, and tingling in the area. Which factors likely contributed to the patient's risk for amputation? Select all that apply. A. Patient's age B. Exposure to cold C. History of skin cancer D. History of hypertension E. Decreased tissue perfusion

B,E

A nurse is evaluating a list of patients and identifies which patient as having the highest risk for bone cancer? A. A 15-year-old boy with a mass on his face B. A 30-year-old man with a mass on his face C. A 10-year-old boy with a hard mass on his shoulder D. A 50-year-old man with a hard mass on his shoulder

C

A patient with a right leg amputation reports hip pain and muscle tightness. Which recommendation should the nurse make? A. Use mirror therapy B. Sit upright for 2 hours daily C. Lie prone for 30 minutes 3 to 4 times per day D. Wear compression bandage 24 hours per day

C

An image of the hand of a patient with osteoarthritis (OA) is provided. Which label (A, B, C, or D) in the image points to a Bouchard's node?

C

The nurse is assessing the dressing of patient after completion of lumbar spine surgery and notes yellow-tinged drainage. After further examination, the nurse documents that the patient has a headache with a rating of seven on a pain scale of one to 10. Which action is most appropriate action for the nurse to take next? A. Administer morphine intravenously B. Test the drainage for the presence of glucose C. Notify the health care provider immediately D. Remove the dressing and apply a pressure bandage

C

The nurse is caring for an older adult patient immediately after a closed right above-knee amputation with a skin flap. Which order by the health care provider should the nurse implement? A. Adjust prosthesis B. Administer antibiotics C. Apply wound vacuum device D. Prepare the patient for arteriography

C

The nurse is preparing a patient for surgery after a crush injury to the right ankle. The patient's leg and knee were not damaged. For which type of amputation would the nurse anticipate preparing this patient? A. Ray amputation B. Hip disarticulation C. Syme's amputation D. Above-knee amputation

C

The nurse is providing orientation to a new graduate who is caring for a patient with a herniated disc. The graduate asks, "What is a disc herniation?" Which is the appropriate response by the nurse? A. "The annulus fibrosus is deteriorating." B. "The annulus fibrosus has penetrated the nucleus pulposus." C. "The nucleus pulposus has bulged out through an opening in the annulus fibrosus." D. "The nucleus pulposus is inflamed and causing irritation to the surrounding nerves."

C

The nurse is reviewing the intake forms for a patient with acute low back pain. Which finding is most likely related to the cause of the pain? A. Went swimming the previous day B. History of degenerative disc disease (DDD) C. Twisted funny while playing volleyball D. Smokes a half pack of cigarettes per week

C

The student nurse asks the instructor, "Why are nurses at such great risk for developing low back pain?" Which response by the instructor is correct? A. "Nurses spend a lot of time standing." B. "Nurses often do not have time to take breaks and rest." C. "Nurses often perform a lot of heavy lifting and bending." D. "Nurses sometimes use poor posture while sitting down during documentation."

C

When preparing to care for a patient with intervertebral disc disease, what should the nurse plan to tell the patient to do in order to maintain proper body mechanics? A. Use a backless chair B. Stand with feet close together C. Sit upright while seated at a desk D. Use a soft, airy mattress for sleep

C

Which patient statement indicates correct understanding about the management of rheumatoid arthritis (RA)? A. "I like to knit to keep my joints active." B. "I only use ice packs to try to relieve pain." C. "I have started taking a yoga class weekly." D. "I wear my hand splints except when gardening."

C

Which injuries are susceptible to compartment syndrome? Select all that apply. A. Fractured rib B. Orbital fracture C. Upper arm fracture D. Basilar skull fracture E. Third-degree ankle strain

C,E

A nurse is caring for a patient who has a 20-pack-year (one pack a day for 20 years) history of smoking. The patient reports shortness of breath and back pain when taking a deep breath. Initial testing has revealed a mass in the spine. Which diagnostic workup would the nurse anticipate this patient to undergo next? A. X-ray B. Radionuclide bone scan C. Magnetic resonance imaging (MRI) D. Computed tomography (CT)-guided biopsy

D

A patient being prepared for a laminectomy tells the nurse, "I only took six days off from work to recover. Will that be enough time?" Which response by the nurse is appropriate? A. "You should have at least 10 days off from work to recover." B. "You should speak to the surgeon about how much recovery time is needed." C. "As long as you will only be sitting down and not moving around much, you should be fine." D. "It may take a few weeks to fully recover from the surgery. Six days may not be enough time."

D

The nurse walks into the room of a patient with low back pain. The patient is packing belongings and preparing for discharge. The nurse notes the patient is leaning forward with the legs straight, picking up shoes off the floor. Which action should the nurse take? A. Ask a physical therapist to evaluate the patient's body mechanics. B. Call the unlicensed assistive personnel (UAP) to help the patient pack. C. Praise the patient for good understanding and using good body mechanics. D. Correct the patient by reminding him or her to bend the knees when leaning forward.

D

Which manifestation can be seen in a patient with a third-degree back strain? A. Mild edema B. Pain and pallor C. Active bleeding D. Complete loss of function

D

Which manifestations would indicate that a patient is in the late stage of rheumatoid arthritis (RA)? Select all that apply. A. Weakness B. Paresthesias C. Low-grade fever D. Gel phenomenon E. Peripheral neuropathy

D,E

Place the clinical progression of rheumatoid arthritis in order of occurrence in the disease process.

Synovial inflammation and lymphocytes increase. Articular cartilage destruction causes growth of vascular granulation tissue. Inflamed pannus destroys bone and bone edges. Joint deformities occur.

The nurse is coordinating the care of a patient with a metastatic tumor to the hip who is scheduled for chemotherapy infusion in the morning. Prioritize the steps in the care of this patient.

Take patient's blood pressure Clean and access port Begin chemotherapy infusion Provide patient education