Med Surge 1

A client with multiple sclerosis is admitted to the hospital. The client's exacerbations have become more frequent and more severe. One day, the client's partner confides to the nurse, "Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home." After listening to the partner's concerns, which is the best response by the nurse?

"Joining a support group of people who are coping with this problem may be helpful."

A healthcare provider prescribes a diagnostic workup for a client who may have myasthenia gravis. What is the initial nursing objective for the client during the diagnostic phase?

"The client will maintain present muscle strength."

Which structure helps to bend light rays and allow them to fall onto the retina?

Lens

The nurse is providing care to a client with acute arthritis who is on bed rest. The client reports bilateral painful hip and swollen knee joints. What position will help prevent flexion deformities during the acute phase of this client's care?

Prone

Which nursing action is contraindicated when caring for a client with a newly applied long leg cast? a. elevating the cast on a pillow b. drying the cast by using a fan c. leaving the cast exposed to air d. handling the cast with fingertips

d. handling the cast with fingertips

a nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. the client has an order for ambulation with slight weight-bearing on the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. what assistive devise does the nurse expect the provider to order? a. crutches b. quad cane c. straight cane d. standard walker

d. standard walker

what are the diagnostic abnormalities present in a client with fat embolism syndrome, select all that apply

decreased pao2, increased fat cells in urine, decreased hematocrit level

What is the maximum amount of time the nurse should allow an older adult with a cerebrovascular accident (also known as "brain attack") to remain in one position? A. 1 to 2 hours B. 3 to 4 hours C. 15 to 20 minutes D. 30 to 40 minutes

A. 1 to 2 hours

A client newly diagnosed with myasthenia gravis is concerned about fluctuations in physical condition and generalized weakness. When caring for this client it is most important for the nurse to plan which intervention? A. Space activities throughout the day. B. Restrict activities and encourage bed rest. C. Teach the client about limitations imposed by the disorder. D. Have a family member stay at the bedside to give the client support.

A. Space activities throughout the day.

A client with myasthenia gravis experiences dysphagia. What is the priority risk associated with dysphagia that must be considered when planning nursing care?

Aspiration

The nurse is getting a client out of bed to the chair for the first time since surgery 2 days ago. What assessment should the nurse should make first before moving the client? Assessment of appropriate foot wear Assessment of comfort and pain Assessment of wound and skin Assessment of urinary catheter

Assessment of comfort and pain

A client is diagnosed with myasthenia gravis. Which response does the nurse expect the client to demonstrate? A. Partial improvement of muscle strength with mild exercise B. Fluctuating weakness of muscles innervated by the cranial nerves C. Little or no change of muscle strength regardless of therapy initiated D. Dramatic worsening of muscle strength with anticholinesterase drugs

B. Fluctuating weakness of muscles innervated by the cranial nerves

A client with myasthenia gravis experiences generalized weakness. What is most important when planning this client's nursing care? A. Maintaining bed rest B. Providing frequent rest periods C. Reassuring the client that there are many tasks that still can be performed D. Arranging for a relative to be present

B. Providing frequent rest periods

A client who is undergoing treatment for osteomyelitis reports bloody, watery diarrhea. The client also has hives and mouth sores. Which medication will the nurse check for in the client's medication administration record?

Cefazolin

Which condition results in visual distortion? A. Myopia B. Hyperopia C. Presbyopia D. Astigmatism

D. Astigmatism

A nurse is teaching a client with a diagnosis of open-angle glaucoma. The nurse explains that the chief aim of treatment is to meet which goal? A.Rest the eye. B. Dilate the pupil. C. Prevent secondary infections. D. Control the intraocular pressure.

D. Control the intraocular pressure.

A client who has an above-the-knee amputation (AKA) reports phantom limb sensations. What should the nurse do?

Describe the neurologic mechanisms in language that the client understands

A client with osteoarthritis is admitted to the hospital for evaluation of a possible hip replacement. To prevent flexion contractures, the nurse recommends that, when in bed, the client should lie in the supine or prone position. The client voices hesitation, stating that these positions are uncomfortable for the knees and hips. What action should the nurse take?

Encourage the client to maintain extension for specific periods of time

A nurse is interviewing a client with a tentative diagnosis of Parkinson disease. What should the nurse expect the client to report about how the onset of symptoms occurred?

Gradually

The nurse has provided teaching to a client with impaired balance, who uses a walker when ambulating. The nurse observes the client transferring from a sitting to a standing position and using the walker. The nurse evaluates that further teaching is required when the client does what?

Holds both sides of the walker while rising to the standing position

A client is in skin traction while awaiting surgery for repair of a fractured femur. The client reports leg discomfort and asks the nurse to release the traction. Which is the nurse's best initial response?

I can't, because the weights are needed to keep the bone aligned."

A client suffered an injury to the leg as a result of a fall. X-ray films indicate an intertrochanteric fracture of the femur. The client will be placed in Buck traction until surgery is performed. When considering the client's plan of care, the nurse recalls that the primary purpose of Buck traction is to do what?

Immobilize the fracture

A nurse identifies that a client exhibits the characteristic gait associated with Parkinson disease. When recording on the client's record, what term does the nurse use to document this gait?

Shuffling

A client with a femoral fracture associated with osteomyelitis is immobilized for 3 weeks. The nurse assesses for the development of renal calculi. What is the rationale for the nurse's assessment?

Lack of weight-bearing activity promotes bone demineralization.

Where should the nurse place a pillow or sandbag to prevent external rotation of a lower extremity? Lateral to the client's affected hip Under the client's lower affected leg At the ankle of the client's affected leg On the side of the client's affected knee

Lateral to the client's affected hip

To reduce the risk of recurrent painful gout attacks, the nurse teaches the client to avoid which foods? Select all that apply.

Liver Shellfish

Which hearing disorder is most common in women?

Ostosclerosis

A nurse enters the room of a client with myasthenia gravis and identifies that the client is experiencing increased dysphagia. What should the nurse do first?

Raise the head of the bed

A client is admitted to the hospital with a diagnosis of acute Guillain-Barré syndrome. Which assessment is priority?

Respiratory Exchange

An older client with dementia of the Alzheimer type is residing in a nursing home. When in bed, the client consistently is found sleeping in the semi-Fowler position. What area of the client's body does the nurse determine has the most risk for developing a pressure ulcer?

Sacrum

A client diagnosed with Paget's disease is prescribed zoledronic acid. Which assessments should be performed before initiating therapy?

Serum creatinine Dental examination

Which health problem does the nurse identify from an older client's history that increases the client's risk factors for a cerebrovascular accident (CVA, also known as "brain attack")?

TIA

A client is ready to walk with crutches after knee surgery. Which crutch walking technique will the nurse most likely have to reinforce after the client returns from physical therapy

Three Point