M3 Quiz

Which assessment finding would the nurse expect in a client diagnosed with Paget's disease? 1. Severe back pain 2. Walking with a limp 3. Upper extremity grip weakness 4. A shuffled gait 5. Bow legged

1., 2. & 5. Correct: Paget's disease is a chronic skeletal bone disorder in which there is excessive bone resorption followed by the marrow being replaced by fibrous connective tissue. The new bone is larger, disorganized, and weak. These clients have severe pain, may walk with a limp, and may become bow legged. 3. Incorrect: Muscle weakness is not a symptom. 4. Incorrect: This is a manifestation of Parkinson's disease which is related to brain and nerve signals. It is not related to Paget's disease.

A nurse is caring for a client with a suspected myocardial infarction (MI). What lab work or diagnostics should the nurse anticipate the primary healthcare provider prescribing to specifically confirm the diagnosis? 1. ECG 2. Troponin Level 3. PTT 4. Metabolic Panel 5. CPK-MB 6. CPK-BB Rationale

1., 2., & 5. Correct: Yes, when a client is suspected of having an MI, the client needs an ECG, Troponin, and CPK-MB levels. Remember Troponin is our favorite, because Troponin will confirm an MI even when the client delays seeking care. CPK-MB is right because CPK-MB is cardiac specific. 3.Incorrect: No, PTT looks at clotting factors and does not tell you if the client is having an MI. 4 Incorrect: No, but what if you just don't know about this answer? Look at it; a metabolic panel will tell you about metabolism and that is not what I am concerned with here. 6.Incorrect: No, CPK-BB is used to assess for brain damage, not cardiac damage.

Which interventions would the nurse initiate to lessen acid reflux in a client diagnosed with gastric esophageal reflux disease (GERD)? 1. Provide small, frequent meals. 2. Avoid carbonated beverages. 3. Administer omeprazole as prescribed. 4. Assist with smoking cessation. 5. Place in right lateral position after eating.

1., 2., 3., & 4. Correct: Gastroesophageal reflux disease is a disorder that results from stomach acid moving backward from the stomach into the esophagus. GERD usually happens because the lower esophageal sphincter (LES) — the muscular valve where the esophagus joins the stomach — opens at the wrong time or does not close properly. All of these actions are correct to help alleviate GERD. 5. Incorrect: It is best for the client to sit upright for 3 hours after a meal and to not eat 2 to 3 hours before going to bed.

The nurse is assessing a pregnant client who thinks she is in labor. Which statement by the client would alert the nurse that the client is likely experiencing true labor? 1. "The pain is in my back, and comes around to my abdomen." 2. "The contractions seem to increase when I begin walking around." 3. "The pain is in my lower abdomen and groin." 4. "My contractions are coming every 5 minutes." 5. "Changing my position does not help with the pain intensity."

1., 2., 4., & 5. Correct: All of these are signs of true labor. 3. Incorrect: The pain from true labor is in the back and comes around to the abdomen.

A petite female client presents to the clinic with symptoms of back pain and states, "I think I am getting shorter." Which information would be appropriate for the nurse to provide? 1. Spend time in the sunlight. 2. Wear low heeled, nonslip sole shoes. 3. Walk at least 30 minutes most days. 4. Include yogurt and cheese in diet. 5. Take regularly scheduled prescribed corticosteroids.

1., 2.,3. & 4. Correct: The client with osteoporosis is usually female, and small framed. Back pain from collapsed vertebrae and shortening are symptoms. Exposure to light converts vitamin D stores in the skin. Low-heeled, nonslip soled shoes are a safety issue to prevent loss of balance and falls. Weight bearing exercises like walking will promote bone density. Yogurt and cheese are high in calcium. 5 Incorrect: This individual should not be taking corticosteroids as these drugs will promote the loss of calcium from the bones.

An elderly client with dementia is being admitted to a long-term care facility. When orienting the client to the environment, what is the most important action for the nurse to take? 1. Provide nurse's name upon entering client's room. 2. Show client how to use the call bell in the room. 3. Provide a tour of the facility and grounds. 4. Instruct client on the location of emergency exits. RationaleStrategies

2. CORRECT: Changes can be very overwhelming for an elderly client, particularly in the presence of dementia. The most important issue is to be sure the client understands how to summon staff at any point. Demonstrating the use of the call bell and allowing the client to provide a return demonstration is the most important action. 1. INCORRECT: This client has dementia and therefore may not be able to process or remember names. This is an appropriate action, but remember safety first. 3. INCORRECT: Though orientation to a new environment would be important, this client's mental status can be easily overwhelmed with too much information. The focus should be restricted to the most basic safety information that the client needs to know. 4. INCORRECT: While emergency exits are critical information, a client with dementia has a limited ability to comprehend a large volume of new information all at once. Multiple exits, depending on the client's location in the facility, is too much complex information initially.

The nurse has a prescription to calculate a client's body mass index (BMI). The client weighs 150 kgs and is 1.8 m tall. Determine the BMI to the whole number.

The client has a BMI of 46 BMI = weight in kilograms / height in meters squared First we multiply the client's height by itself: 1.8 x 1.8 = 3.24 ² Next we divide the client's weight by the height in meters ²: 150 / 3.24 = 46.3

What information should a nurse include when preparing discharge education for a client diagnosed with gastroesophageal reflux disease (GERD)? 1. Foods that may trigger an attack include apple juice, cream cheese, and oatmeal. 2. Lose weight slowly at a rate of 1 kilogram per week. 3. Only eat three small meals per day. 4. Avoid tight-fitting clothing. 5. Wait at least 1 hour after eating to lie down.

2., & 4. Correct: Excess pounds (kg) put pressure on the abdomen, pushing up the stomach and causing acid to back up into the esophagus. Work to slowly lose weight, no more than 1-2 pounds (0.5-1 kg) per week. Avoid tight-fitting clothing. Clothes that fit tightly around the waist put pressure on the abdomen and the lower esophageal sphincter. 1. Incorrect: These foods are safe for the client with GERD to eat. Common triggers include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine. 3. Incorrect: Eat 6 small meals per day. Avoid eating 3 large meals. 5. Incorrect: Don't lie down immediately after a meal. Wait at least 3 hours after eating. Gastric acid is more likely to go up into the esophagus if the client lies down immediately.

The nurse is preparing a seminar for a group of clients diagnosed with irritable bowel syndrome. Which point should the nurse include? 1. Teach about a low fiber diet. 2. Schedule meals at regular times. 3. Fluid should be taken with meals. 4. Become active in yoga classes. 5. Keep a food diary for 2 weeks.

2., 4. & 5. Correct: Eating at regular intervals and chewing foods slowly and thoroughly will help to manage symptoms. Additional strategies include maintaining good dietary habits with avoidance of food triggers. Stress management via relaxation techniques, yoga, or exercise are recommended. Identify irritating foods by keeping a food diary for 1-2 weeks. 1. Incorrect: This client needs a high soluble fiber diet to help control diarrhea and constipation. Dietary fiber and bulk help the client by establishing regular bowel elimination patterns with soft, bulky stools. 3. Incorrect: Although adequate fluid intake is necessary, fluid should not be taken with meals because this results in abdominal distention.

A client at 28 weeks gestation reports swollen hands and feet during her prenatal visit. Which additional signs/symptoms would be of concern to the nurse? 1. Decreased deep tendon reflexes 2. Blurred vision 3. Blood glucose 120mg/dL (6.7 mmol/L) 4. Muscle spasms 5. Headache

2., 4., & 5 Correct: Muscle spasms indicating nerve/muscle irritation. Headache and blurred vision are indicators of increasing blood pressure. This client is going into preeclampsia. 1. Incorrect: No, the deep tendon reflexes will be hyperactive (increased) with preeclampsia. 3. Incorrect: Mild blood sugar elevation is not related to preeclampsia.

Which postpartum client should the nurse assign to the last private room in the Women's Health Center? 1. Placenta abruption during delivery 22 hours ago 2. Boggy fundus five hours post-delivery 3. Pre-eclamptic prior to delivery 30 hours ago 4. WBC count is 12,000/mm3 (12 x 10^9​/L) at 24 hours postpartum

3. Correct: This pre-eclamptic client delivered 30 hours ago. They are trying to make you think that everything is OKAY because they say AFTER delivery... the client must have a private room because any stimulus can still precipitate a seizure. 1. Incorrect: People who are at risk for bleeding and shock do not require private rooms. 2. Incorrect: Boggy fundus....doesn't have anything to do with a private room. 4. Incorrect: This is the one most people jump on.... Most postpartum clients have elevated white counts post-delivery. Normal white count is 5,000-10,000/ mm3 or 5-10 x 109/L

Post epidural anesthesia, a laboring client's blood pressure drops to 92/42. Which intervention by the nurse takes priority? 1. Elevate the head of the bed 2. Administer oxygen by face mask 3. Position client side-lying 4. Begin dopamine 5 mcg/kg/min

3. Correct: When you turn them on their side, this relieves pressure on the vena cava and the BP will go UP. 1. Incorrect: This will drop the pressure more. 2. Incorrect: O2 doesn't bring up the BP. 4. Incorrect: Stay away from drugs as long as you can

A client is preparing to be discharged after a total hip replacement. Which client statement would indicate teaching has been successful regarding prevention of hip prosthesis dislocation? 1. "I should not cross my affected leg over my other leg." 2. "I should not bend at the waist more than 90 degrees." 3. "While lying in bed, I should not turn my affected leg inward." 4. "It is necessary to keep my knees together at all times." 5. "When I sleep, I should keep a pillow between my legs."

1., 2., 3. & 5. Correct: These are appropriate actions to prevent hip prosthesis dislocation. Until the hip prosthesis stabilizes it is necessary to follow these instructions for proper positioning to avoid dislocation. 4. Incorrect: The knees should be kept apart to prevent dislocation.

A case manager is assessing an unresponsive client diagnosed with terminal hepatic encephalopathy for equipment needs upon discharge home for hospice care. Which equipment should the case manager obtain for this client? 1. Alternating pressure mattress 2. Hospital bed 3. Walker 4. Suction equipment 5. Oxygen

1., 2., 4., & 5. Correct: An alternating pressure mattress will help to prevent pressure ulcers. A hospital bed is needed so that the head of the client's bed can be elevated to 30 degrees to ease respirations and decrease the work of breathing. The client with hepatic encephalopathy is unresponsive and may need suctioning if unable to clear secretions from the oropharynx. The client at the end stages of liver disease will be hypoxemic, so oxygen therapy is provided. 3. Incorrect: The unresponsive client will not need a walker.

Which teaching points would the nurse include in a client's nutritional teaching plan to accomplish the goal of a gluten free diet? 1. Gluten is a protein found in wheat. 2. The main starchy foods that a person can eat are made with barley. 3. Fruits can be eaten on a gluten free diet. 4. Pure, non-contaminated oats are an acceptable grain food that the client can consume. 5. Accidentally eating food with gluten may result in abdominal pain and diarrhea.

1., 3., 4., & 5. Correct: A gluten-free diet is used in the treatment of celiac disease. Gluten is a protein found in barley, rye, and wheat. All products containing these grains are to be avoided. Rice and corn may be used. In addition, pure oats that have not been cross-contaminated with wheat, barley and/or rye can be safely consumed by most individuals with celiac disease or other gluten sensitivity. A reduction in the fiber content of the diet is also frequently recommended. Fruits, vegetables, nuts, diary products and meats not prepared with gluten containing ingredients can be eaten. Accidentally ingesting food with gluten may result in abdominal pain and diarrhea. Some people do not experience signs and symptoms, but this does not mean it is not damaging their small intestines. Even trace amounts of gluten may be damaging. 2. Incorrect: The main starchy foods that a person can eat are made with rice, corn, potatoes, quinoa, and Tapioca.

The house supervisor has sent an LPN to assist on a busy medical-surgical unit. Which client could the charge nurse assign to the LPN? 1. Being discharged with a new Hickman port. 2. With a deep vein thrombosis (DVT) on a heparin infusion. 3. Two-days post gastric bypass taking clear liquids. 4. With Alzheimer's disease awaiting transfer to nursing home. 5. New transfer from post-anesthesia care unit (PACU) following a mastectomy.

3 and 4. CORRECT: An LPN should be assigned stable clients who do not require initial teaching or frequent assessments. The client who is two days post gastric bypass has already advanced to clear liquids and would be appropriate for an LPN. Also, a client who has Alzheimer's disease awaiting transfer would have needs that could be addressed by an LPN, and therefore is a suitable assignment. 1. INCORRECT: This client has a new Hickman port which is an implanted access device used for chemotherapy or medications given long term. There is a great deal of teaching necessary regarding the care of this port. This client should be assigned to an RN. 2. INCORRECT: This client will need frequent assessment of circulation in the area of the DVT and monitoring for evidence of bleeding complications. Additionally, PTT levels will be drawn every 6 hours that may require the nurse to adjust the heparin infusion rate. This client is not appropriate for an LPN. 5. INCORRECT: This fresh post-op client will require frequent vitals and assessment of the surgical dressing following this surgery. This client would be assigned to an RN.

A child with a radial fracture reports itching below the casted area. What is the appropriate nursing action to relieve itching? 1. Allow the child to use a Q-tip to scratch the area. 2. Assess the fingers and areas above the cast to identify areas of irritation. 3. Apply an ice pack for 10-15 minutes. 4. Raise the cast above the level of the heart to reduce itching sensation.

3. Correct: This will change the sensation. Normally the answer is use a cool blow dryer, but they wanted to see if you would be flexible with what you know. Use an ice pack that will not get the cast wet. 1. Incorrect: A Q-tip is soft, trying to make you feel like this is okay to put into a cast. But objects should never be placed under the cast. 2. Incorrect: How does assessing the fingers decrease itching? It doesn't. 4. Incorrect: Raising the cast above the level of the heart will help reduce swelling under the cast in the first 24 to 72 hours after a cast is applied, but it does not help with itching.

A client who is 34 weeks pregnant is admitted to the ob/gyn unit with a diagnosis of pregnancy induced hypertension. During the admission process, the client suddenly reports continuous abdominal pain and the nurse notes abdominal firmness. What interventions should the nurse implement? 1. Reassure client that the baby will be fine. 2. Evaluate fetal heart tones. 3. Monitor amount of vaginal bleeding. 4. Notify primary healthcare provider. 5. Prepare for vaginal delivery.

2., 3., & 4. Correct: The client's symptoms indicate that she is experiencing abruptio placentae. The nurse must evaluate the mother's wellbeing by assessing vital signs, and monitoring blood loss. The nurse must also evaluate the fetal wellbeing by auscultating fetal heart tones. A cesarean delivery is indicated if the fetus and/or mom is in distress, so the primary healthcare provider must be notified immediately. 1. Incorrect: Do not give false assurance. The baby may or may not be fine. 5. Incorrect: A cesarean delivery is indicated for this client.

An occupational health nurse is planning to teach a group of manufacturing workers how to prevent back injuries. What teaching points should the nurse plan to include? 1. When sitting, keep knees slightly lower than the hips. 2. Avoid movements that require spinal flexion with straight legs. 3. Squarely face the direction of anticipated movement. 4. Pivot to turn while holding an object. 5. Wear comfortable, low-heeled shoes.

2., 3., 4., & 5. Correct: Flexion of the spine with the legs straight (toe-touches, sit-ups) can injure the back. Avoid twisting of the back by squarely facing the direction of movement. Move toward or away from your center of gravity. Pivoting is a technique in which the body is turned in a way that avoids twisting of the spine. Comfortable, low heeled shoes provide good foot support and reduce the risk of slipping, stumbling, or turning your ankle. 1. When sitting, keep knees slightly higher than the hips.

Question: A client has been admitted with advanced Cirrhosis. The nurse's assessment reveals an abdominal girth increase of 5 inches (12.7 cm) and a weight increase of 6 lbs.(2.71 kg) since yesterday's measurements. What further assessment findings would the nurse expect? 1. Hypotension 2. Cool extremities 3. Bradycardia 4. CVP readng of 8 mm/Hg 5. Radial pulses 4+/4+

1. & 2. Correct: These are signs and symptoms of FVD due to 3rd spacing and shock is what you are afraid of. 3. Incorrect: We would expect the heart rate to increase in FVD in an effort to move what little volume you have left through the system. 4. Incorrect: This is a high CVP, and with FVD you would expect it to be low. 5. Incorrect: Pulses are evaluated on a 4 point scale, so 4 would be a bounding pulse which would indicate fluid volume excess.

Which statement made by a client diagnosed with Addison's disease indicates to the nurse that the client needs further teaching about fludrocortisone therapy? 1. "Taking my medicine at night will help me sleep." 2. "It is important to wear a medical alert bracelet all of the time." 3. "My medication dose may change based on my daily weight." 4. "I may need more medication if I feel weak or dizzy."

1. Correct: Steroids can cause insomnia so the client does not need to take the medication prior to going to bed. 2. Incorrect: This is a correct statement of understanding by the client. Wearing a medical alert bracelet is an excellent way of informing healthcare providers of a life threatening condition if the client is unable to verbalize that information. 3. Incorrect: Another correct statement. Steroid therapy is adjusted according to the client's weight and signs of fluid volume status. 4. Incorrect: This statement indicates that the client understands therapy. Signs of being undermedicated include weakness, fatigue, and dizziness. The client will need to report these symptoms so more medication can be given to the client.

What interventions can an occupational health nurse discuss with a client in an effort to improve lateral epicondylitis (tennis elbow) pain? 1. Avoid activities that make the pain worse. 2. An oral, nonsteroidal, anti-inflammatory drug may be prescribed. 3. Immediately start stretching and exercising the muscle and tendon. 4. If pain persists, a cortisone injection into the inflamed area may be recommended. 5. Apply ice for 45 minutes, six times a day.

1., 2., & 4. Correct: General activities that make the pain worse should be avoided or at least cut back. While continued activity in the presence of mild discomfort is not harmful, activities that cause severe pain will only prolong the necessary recovery time and should be avoided. Oral, nonsteroidal, anti-inflammatory drugs are very helpful in controlling the pain and inflammation of tennis elbow. The medicine is taken daily for at least four to six weeks when treating severe cases. For less severe cases, these medicines may be taken only when needed. Cortisone injections are considered when the other measures have not worked and the pain is severe. The cortisone is injected into the area of the inflamed tendons in order to decrease the inflammation. 3. Incorrect: Stretching and exercising of the involved muscle and tendon unit is one of the mainstays of treatment for this condition once pain and inflammation have subsided, but not during the acute phase. A gentle stretching program is started through a range of motion at the elbow and wrist. This is combined with a program of muscle strengthening. 5. Incorrect: It is recommended to apply ice to the area two to three times a day, for 20 to 30 minutes each time.

The nurse recognizes that Rho(D) immune globulin would be indicated for which Rh negative client? 1. Elective abortion at sixteen weeks gestation 2. Involved in a major car accident 3. Requires amniocentesis 4. Diagnosed with an ectopic pregnancy 5. Forty-eight hours post delivery of term Rh positive baby 6. Twenty weeks gestatation

1., 2., 3., 4. & 5. Correct: All of these clients may need to receive the Rho(D) immune globulin because they could have some bleeding and therefore develop antibodies against a Rh positive fetus. 6. Incorrect: An optional Rho(D) immune globulin dose may have been given during pregnancy by the practitioner, but it is 28 weeks, not 20 weeks.

The nurse cares for a client after a gastroscopy examination. Which nursing interventions are appropriate post-procedure? 1. Maintain NPO status until the gag reflex returns. 2. Observe for hematemesis. 3. Monitor intake and output. 4. Assess bowel elimination. 5. Monitor respirations. 6. Connect to oxygen saturation monitor.

1., 2., 5, & 6. Correct: A gastroscopy examination uses a flexible fiber-optic tube to visualize the esophagus and/or stomach. The throat is numbed before the procedure to inhibit the gag reflex and to allow the scope to pass freely. Therefore, it is important to maintain NPO status until the gag reflex returns. The nurse should monitor for hematemesis, respirations, and oxygen saturation to ensure the scope did not damage any structures like the esophagus or lungs. 3. Incorrect: Because the kidneys are not affected during this procedure, monitoring intake and output is not an important intervention. 4. Incorrect: Because the bowels are not affected during this procedure, this is not an important intervention.

A client has been admitted with advanced cirrhosis. The nurse's assessment reveals an abdominal girth increase of 5 inches (12.7 cm) and a weight increase of 6 lbs. (2.72 kg) since yesterday's measurements. Based on this data, what would be the nurse's priority assessment? 1. Stool for occult blood 2. Ammonia blood level 3. Blood pressure 4. Level of consciousness

3. Correct: In ascites, the client is in FVD and we worry about shock. If my blood pressure drops, I will have decreased perfusion of my vital organs. Poor perfusion leads to organ damage and failure. 1. Incorrect: We are worried about bleeding because the liver is sick, but this is not the first priority in this case. Third spacing (ascites) has increased placing the clietn at risk for FVD and shock. 2. Incorrect: Ammonia level would indicate a worsening liver condition, but this is not a priority here. 4. Incorrect: LOC is a good indicator of perfusion, but it may be affected by other factors, such as the ammonia level, as well. The BP will tell us the most about shock, and that is what I am worried about here