Modules 4 & 11 (NCLEX style)

A patient is ordered calcium gluconate for treatment of hypocalcemia. Which statement by the patient indicates a need for further teaching? a. "I will take calcium 1 hour before eating." b. "I will need to avoid eating whole-grain cereals." c. "I should drink a large glass of water each time I take my calcium." d. "I will need to call my healthcare provider if I develop vomiting, constipation, or frequency of urination."

a. "I will take calcium 1 hour before eating." Source: evolve.elsevier.com Ch 75 Dosing of calcium with or after meals, not before, promotes absorption of the medication; therefore, further patient teaching is necessary. Calcium salts should be taken with a large glass of water. Foods to be avoided include spinach, Swiss chard, beets, bran, and whole-grain cereals. Patients should be taught the symptoms of hypercalcemia, such as nausea, vomiting, constipation, urinary frequency, lethargy, and depression, and should promptly notify the healthcare provider if these occur.

A patient with chronic pain has a fentanyl patch applied to his right shoulder. The patient reports that his arm hurts and he requests a warm pack to apply to the area. Which statement by the nurse is correct? a. "Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release." b. "Your arm probably hurts because of the fentanyl patch." c. "I can remove your patch and reapply it after you are done with the warm pack." d. "The fentanyl patch is heat resistant, so I will get you a warm pack."

a. "Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release." evolve.elsevier.com ch 28 Warn patients using fentanyl patches to avoid exposing the patch to direct heat (eg, heating pad, hot tub) because doing so can accelerate fentanyl release. Patches should not be removed and reapplied; use a new patch as ordered if one is removed. Patches should not cause pain, and they are not heat resistant.

A 38 y/o premenopausal woman asks the nurse how much calcium is recommended. The nurse tells the woman to consume: a. 1,000 to 1,200 mg per day b. 1,500 to 2,000 mg per day c. 1,200 to 1,600 mg per day d. 800 to 1,000 mg per day

a. 1,000 to 1,200 mg per day Premenopausal women should consume between 1,000 and 1,200 mg of calcium per day; less than 1,000 mg many not be adequate enough to prevent osteoporosis; more than 1,200 mg may be harmful and is not recommended unless pregnant or lactating

The nurse is administering hydromorphone, 1mg PO, to a pt with moderate abdominal pain. The nurse can expect the pt's pain to improve after: a. 15-30 min b. 15-60 min c. 30-60 min d. 5-10 min

a. 15-30 min When administered orally, the ONSET is 15-30 min, peak is 30-60 min and duration is 2-3 hrs

While caring for a pt with a left arm cast, you assess for signs of infection and should be alert for: (Select all that apply) a. A foul odor b. A hot spot on the cast c. Edema d. Absent radial pulse e. Delayed capillary refill

a. A foul odor b. A hot spot on the cast

Which of the following is an early systemic manifestation of RA? a. Anorexia b. Severe fatigue c. Peripheral neuropathy d. Anemia

a. Anorexia The rest are late systemic manifestations of RA Early systemic manifestations of RA include: Low-grade fever Fatigue Weakness Anorexia

Which of the following is a Nurse-prescribed intervention? a. Assess for signs of dehydration b. Monitor blood sugars c. Monitor serum potassium, phosphate, & sodium levels d. Administer insulin as ordered

a. Assess for signs of dehydration The rest are Provider-prescribed interventions

A nurse teaches a patient who takes raloxifene [Evista] for prevention of postmenopausal osteoporosis to report which finding as an adverse effect of the medication? a. Calf pain and leg swelling b. Fever and fatigue c. Bleeding and bruising d. Hematuria and dysuria

a. Calf pain and leg swelling Source: evolve.elsevier.com Ch 75 Raloxifene preserves bone mineral density and is used to prevent and treat osteoporosis. It increases the risk of deep vein thrombosis (DVT) because of its estrogenic effects in some tissues. Calf pain and leg swelling are symptoms of DVT. Fever and fatigue, bleeding and bruising, and hematuria and dysuria are not adverse effects of raloxifene.

A health care provider writes the following order for an opioidnaive patient who returned from the operating room following a total hip replacement. "Fentanyl patch 100 mcg, change every 3 days." Based on this order, the nurse takes the following action: a. Calls the health care provider, and questions the order b. Applies the patch the third postoperative day c. Applies the patch as soon as the patient reports pain d. Places the patch as close to the hip dressing as possible

a. Calls the health care provider, and questions the order evolve.elsevier.com for Potter and Perry, Ch 43 Fentanyl is 100 times more potent than morphine and not recommended for acute postoperative pain.

The nurse is reviewing the x-ray of a pt with a fractured radius. The x-ray shows splintered bone with multiple fragments. What type of fracture is this? a. Comminuted fracture b. Greenstick fracture c. Closed compound fracture d. Impacted fracture

a. Comminuted fracture

While caring for a pt in Buck's traction, the nurse reduces friction and shear by: a. Elevating the foot of the bed b. Elevating the head of the bed c. Providing a trapeze to promote pt positioning d. Using a footboard to reduce foot drop

a. Elevating the foot of the bed

In addition to local joint pain and limited range of motion, a nurse should recognize which findings as systemic manifestations of rheumatoid arthritis? (Select all that apply.) a. Fatigue b. Hyperglycemia c. Osteoporosis d. Vasculitis e. Corneal ulcers

a. Fatigue d. Vasculitis e. Corneal ulcers Source: evolve.elsevier.com Ch 73 Rheumatoid arthritis is manifested by joint stiffness and pain secondary to an autoimmune disorder in which damaging compounds attack the articular cartilage. In addition, systemic manifestations of fatigue, corneal ulcers, and vasculitis may occur.

Which of the following is NOT a characteristic associated with Rheumatoid Arthritis? a. Infiltration b. Autoimmunity c. Degeneration d. Inflammation

a. Infiltration

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? a. Morphine [Duramorph] b. Pentazocine [Talwin] c. Hydrocodone [Lortab] d. Nalmefene [Revex]

a. Morphine [Duramorph] evolve.elsevier.com ch 28 Morphine is a strong opioid agonist and as such has the highest likelihood of causing respiratory depression. Pentazocine, a partial agonist, and hydrocodone, a moderate to strong agonist, may cause respiratory depression, but they do not do so as often or as seriously as morphine. Nalmefene, an opioid antagonist, would be used to reverse respiratory depression with opioids.

Visceral pain is usually a vague and diffuse pain; it is hard to determine where it is coming from. Which of the following is the visceral pain most likely NOT coming from? Select all that apply: a. Muscle b. Skin c. Stomach d. Bone e. Heart

a. Muscle b. Skin d. Bone Visceral pain usually involves thoracic, abdominal and pelvic organs

Which one of the following instructions is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine? a. Only the patient should push the button. b. Do not use the PCA until the pain is severe. c. The PCA prevents overdoses from occurring. d. Notify the nurse when the button is pushed.

a. Only the patient should push the button. evolve.elsevier.com for Potter and Perry, Ch 43 Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to "push the button" for the patient.

A pt suspected of having a left hip fracture would be expected to show which of the following signs? (Select all that apply) a. The left leg is abducted b. The left leg is adducted c. The left leg is internally rotated d. The left leg is externally rotated e. The left leg is longer than the right f. The left leg is shorter than the right

a. The left leg is abducted d. The left leg is externally rotated f. The left leg is shorter than the right

While caring for a patient with cancer pain, the nurse knows that the World Health Organization (WHO) analgesic ladder recommends: a. Transitioning use of adjuvants with nonsteroidal antiinflammatory drugs (NSAIDs) to opioids. b. Using acetaminophen for refractory pain. c. Limiting the use of opioids because of the likelihood of side effects. d. Avoiding total sedation, regardless of how severe the pain is.

a. Transitioning use of adjuvants with nonsteroidal antiinflammatory drugs (NSAIDs) to opioids. evolve.elsevier.com for Potter and Perry, Ch 43 The WHO analgesic ladder transitions from the use of nonopioids (NSAIDS) with or without adjuvants to opioids with or without adjuvants. Acetaminophen is recommended for lesser levels of pain. Side effects related to the use of opioids may be unavoidable but are treatable. Treatment for severe pain may result in some level of sedation.

Which of the following is an example of a combination opioid? a. Vicodin b. Narcan c. Morphine sulfate d. Oxycodone

a. Vicodin Vicodin is a mixture of hydrocodone and acetaminophen

The normal curvature of the spine is: a. convex through the thoracic portion b. convex through the cervical portion c. concave through the thoracic portion d. concave through the lumbar and thoracic portions

a. convex through the thoracic portion

Which of the following drugs are non-biologic DMARD's? (Select all that apply) a. cyclosporine (Neoral) b. etanercept (Enbrel) c. anakinra (Kineret) d. Leflunomide (Arava)

a. cyclosporine (Neoral) d. Leflunomide (Arava) The rest are Biologic DMARD's

A 4-year old sustains a fall at home and is brought to the emergency room by the mother. After an x-ray examination, the child is determined to have a fractured arm and plaster cast is applied. The nurse provides instructions to the mother regarding care for the child's cast. Which statement by the mother indicates a need for further instructions? a) the cast may feel warm as the cast dries b) I can use lotion or powder around the cast edges to relieve itching c) a small amount of white shoe polish can touch up a soiled white cast d) if the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast

b) I can use lotion or powder around the cast edges to relieve itching

A client is treated in physician's office for a sprained ankle after a fall. Radiographic examination has ruled out a fracture. Before sending the client home, the nurse plans to teach the client to avoid which of the following in the next 24 hours? a) resting the foot b) applying a heating pad c) applying an elastic compression bandage d) elevating the ankle on a pillow while sitting or lying down

b) applying a heating pad Soft tissue injuries such as sprains are treated by RICE (rest, ice, compression, and elevation) for the first 24 hours after the injury. Ice is applied intermittently for 20 to 30 minutes at a time. Heat is not used in the first 24 hours because it could increase venous congestion, which would increase edema and pain.

A client is brought to the emergency room with compound femur fracture. What is the first action the emergency room nurse should do? a) cover the open wound b) check the clients blood pressure c) assess the client's neurologic status d) prepare the client for X-ray

b) check the clients blood pressure

Which of the following complications does the nurse suspect when a client had fracture of the femur and is now experiencing respiratory distress? a) sepsis b) fat embolism c) bleeding d) shock

b) fat embolism Fat embolism is a common complication of fracture of the long bones, like fracture of the femur. Yellow marrow is released into the circulation and reaches the pulmonary circulation. Acute respiratory distress syndrome may occur.

Which of the following is the primary reason for splinting the hands and wrists of client with rheumatoid arthritis? a) to improve the strength of the hands and wrists b) to prevent contractures c) to relieve muscle spasm d) to relieve pain

b) to prevent contractures

Mr. Alcasid asks the nurse, "What is osteoarthritis?" Which response from the nurse is correct? a) your bones are inflamed b) your weight bearing joints are inflamed c) you have inflammation in your joints d) there is shortening of your long bones

b) your weight bearing joints are inflamed

A patient who is postmenopausal is scheduled to begin taking alendronate [Fosamax] to prevent osteoporosis. Which instruction should the nurse give the patient? a. "For the best absorption, take the drug while eating a meal." b. "After taking the medication, sit or stand for 30 minutes." c. "It will be normal to experience some heartburn." d. "Take the medication with orange juice or coffee."

b. "After taking the medication, sit or stand for 30 minutes." Source: evolve.elsevier.com Ch 75 Oral alendronate may result in esophageal ulceration if it fails to pass completely through the esophagus and thus is not administered properly. Sitting or standing for 30 minutes after dosing is recommended to prevent prolonged contact with the esophageal mucosa. Symptoms of esophageal injury are heartburn and pain and should be reported. Because of its poor bioavailability, alendronate must be given before eating or drinking, even orange juice or coffee.

After surgery on a left femur fracture, the pt is ordered partial weight bearing. Which of the following is correct about partial weight bearing? a. The foot may dangle and touch the floor b. 30-50% of weight c. 50-70% of weight d. Weight as tolerated by the pt

b. 30-50% of weight

Compartment syndrome occurs when pressure increases inside a body compartment and impedes blood flow. As a RN, you know that damage is irreversible after: a. 8-12 hours b. 4-6 hours c. 2-4 hours d. 1-3 hours

b. 4-6 hours

Extended release drugs should be given not more often than every: a. 6-10 hours b. 8-12 hours c. 3-12 hours d. 4-8 hours

b. 8-12 hours

A pt is told she is suffering from allodynia. When asked by the pt what this means, the nurse explains that allodynia is: a. A perception of pain that is not there b. A perception of pain by a stimulus that does not normally cause pain c. An increased sensitivity to pain d. A neurological disorder that often responds to adjuvant drugs

b. A perception of pain by a stimulus that does not normally cause pain

Excessive stretching of a muscle or tendon is: a. A sprain b. A strain c. Likely to lead to inflammation d. Can put you at risk for a fracture

b. A strain

A patient with chronic pain was admitted to the hospital. The physician orders morphine PO 5 mg every 4 hours. The patient states that he usually takes his home morphine prescription 10 mg every 4 hours and has been for several months. This patient is at risk for which of the following? a. Physical dependence b. Abstinence syndrome c. Addiction d. Tolerance

b. Abstinence Syndrome evolve.elsevier.com ch 29 The patient is at risk for abstinence syndrome because the order is for half of the pain medication he normally takes at home, a significant decrease in his medication. He is probably already physically dependent on the medication and has developed a tolerance to many of the side effects. With pain, patients are at a low risk for addiction.

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect? a. Immunostimulant b. Antitussive c. Expectorant d. Decongestant

b. Antitussive evolve.elsevier.com ch 28 Codeine provides analgesic and antitussive therapeutic effects.

Rheumatoid Arthritis and Osteoarthritis have many similarities. When comparing the two, you know which of the following to be true of osteoarthritis? (Select all that apply) a. Appears between the ages of 35-45 b. Appears after the age of 60 c. More common in males d. Can be caused by obesity or trauma e. Is an inflammatory disease f. Bouchard's nodes my be present

b. Appears after the age of 60 d. Can be caused by obesity or trauma f. Bouchard's nodes may be present

The nurse is caring for a pt with Dilaudid PCA set at basal rate of 0.1 mg per hour with a 0.1 mg bolus every 10 minutes. The nurse is concerned for opioid toxicity when she notes which of the following findings? (Select all that apply) a. Anxiety b. Bradypnea c. Decreased alertness d. Fever e. The pt is difficult to arouse f. Wheezing

b. Bradypnea c. Decreased alertness e. The pt is difficult to arouse

The nurse is reviewing lab results of a pt with osteoporosis. The nurse would most likely note abnormalities in: a. Calcium and magnesium b. Calcium and phosphorous c. Calcium and potassium d. Magnesium and phosphorus

b. Calcium and phosphorus

The nurse notes that the patient's Foley catheter bag has been empty for 4 hours. The priority action would be to: a. Irrigate the Foley. b. Check for kinks in the tubing. c. Notify the health care provider. d. Assess the patient's intake.

b. Check for kinks in the tubing. evolve.elsevier.com for Potter and Perry, Ch 45 Kinks in tubing prevent flow of urine. To keep the drainage system patent, check for kinks or bends in the tubing.

The nurse is caring for a pt after a closed reduction of a fractured humerus. While monitoring for a fat embolism, the nurse should be alert for which symptoms? (Select all that apply) a. Chest pain that radiates to the left arm b. Confusion and drowsiness c. Diminished pulses and pallor of the affected arm d. Hypoxemia and dyspnea e. Nausea and constipation f. Petechiae on the chest and in the conjunctiva

b. Confusion and drowsiness d. Hypoxemia and dyspnea f. Petechiae on the chest and in the conjunctiva

Which of the following diseases is the most common form of inflammatory arthritis? a. Osteoarthritis b. Gout c. Osteoporosis d. Rheumatoid Arthritis

b. Gout Hinkle and Cheever, 1078

The nurse is planning care for a patient receiving morphine sulfate [Duramorph] by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? a. Administering a cough suppressant b. Inserting a Foley catheter c. Administering an antidiarrheal d. Monitoring liver function tests

b. Inserting a foley catheter evolve.elsevier.com ch 28 Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal, so neither of those types of drugs would be needed to counteract an adverse effect of morphine. Liver toxicity is not a common adverse effect of morphine.

The nurse is assessing an elderly pt with an increased thoracic curve. This condition is called: a. Lordosis b. Kyphosis c. Scoliosis d. Spinosis

b. Kyphosis

What assessment is essential before treatment with hydroxychloroquine [Plaquenil] is started for a patient with rheumatoid arthritis (RA)? a. T3, T4, TSH b. Ophthalmic examination c. PPD and chest x-ray d. BUN and creatinine

b. Opthalmic examination Source: evolve.elsevier.com Ch 73 Patients with RA should have a thorough ophthalmic examination before treatment with hydroxychloroquine is started and also every 6 months thereafter because the drug poses a risk of retinal damage. The medication should be discontinued at the first sign of retinal injury. The remaining options are not indicated before initiating treatment with hydroxychloroquine.

Your pt is experiencing pain she describes as an 8/10. Using the WHO analgesic ladder, which of the following PRN medications would you MOST likely want to give the pt? a. Acetaminophen b. Oxycodone c. Vicodin d. Percocet

b. Oxycodone Mild pain (1/10-3/10) should be treated with a NSAID Moderate pain (4/10-7/10) should be treated with either Vicodin or Percocet ( an opioid combination) Severe pain (8/10-10/10 should be treated with a strong opioid (hydromorphone, morphine sulfate, oxycodone)

A nurse teaches a patient who is to start taking infliximab [Remicade] for rheumatoid arthritis. Which of these cardiac findings should the nurse instruct the patient to report as a complication of the treatment? a. Calf pain b. Pedal edema c. Cool, pale toes d. Clubbed fingernails

b. Pedal edema Source: evolve.elsevier.com Ch 73 Infliximab is a tumor necrosis factor (TNF) blocker used for the treatment of rheumatoid arthritis. It should not be used in patients who have heart failure, and it may cause new-onset heart failure in some individuals. Pedal edema is a sign of heart failure, and the patient should report it to the healthcare provider. Cool, pale toes; calf pain; and clubbed fingers are not symptoms related to heart failure.

The healthcare provider orders celecoxib [Celebrex] 200 mg PO every day for pain in the postoperative patient. The nurse knows that this medication is which classification? a. Opioid analgesic b. Selective COX-2 inhibitor c. Propionic acid derivative d. Salicylate

b. Selective COX-2 inhibitor evolve.elsevier.com ch 29 Celecoxib [Celebrex] is an NSAID. It is a selective COX-2 inhibitor.

A nurse is monitoring a patient who takes etanercept [Enbrel] for rheumatoid arthritis. The nurse should obtain the results of which laboratory test when evaluating for adverse effects? a. Arterial blood gases (ABGs) b. Skin test for tuberculosis c. Electrocardiogram (ECG) d. 24-hour urine collection for creatinine clearance

b. Skin test for tuberculosis Source: evolve.elsevier.com Ch 73 Etanercept increases the risk for serious bacterial and fungal infections, as well as tuberculosis. Patients who develop new infections should be monitored frequently. If tuberculosis develops, it often is extrapulmonary. Patients should be tested for latent tuberculosis, and if the test result is positive, they should be treated for TB before starting etanercept. It is not necessary to obtain ABGs, an ECG, or urine for creatinine clearance when a patient is taking etanercept.

Your pt has a hx of Gout and is currently suffering from Podagra. You know that this is most often seen in which stage of Gout? a. Stage 3 b. Stage 2 c. Stage 5 d. Stage 1

b. Stage 2

A patient is being discharged home on an around-the-clock (ATC) opioid for chronic back pain. Because of this order, the nurse anticipates an order for which class of medication? a. Stool softener b. Stimulant laxative c. H 2 receptor blocker d. Proton pump inhibitor

b. Stimulant laxative evolve.elsevier.com for Potter and Perry, Ch 43 Patients usually become tolerant to the side effects of opioids, with the exception of constipation. Routinely administer stimulant laxatives, not simple stool softeners, to prevent and treat constipation.

In Rheumatoid Arthritis, the autoimmune reaction originates where? a. Distal joints b. Synovial tissue c. Cartilage d. Bone

b. Synovial tissue Hinkle and Cheever, 1062

A new medical resident writes an order for OxyContin SR 10 mg PO q12 hours prn. Which part of the order does the nurse question? a. The drug b. The time interval c. The dose d. The route

b. The time interval evolve.elsevier.com for Potter and Perry, Ch 43 Controlled- or extended-release opioid formulations such as OxyContin are available for administration every 8 to 12 hours ATC. Health care providers should not order these long-acting formulations prn.

The nurse is caring for a client who develops compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. The nurse's response is based on the understanding that: a) A bone fragment has injured the nerve supply in the area b) an injured artery causes impaired arterial perfusion through the compartment c) bleeding and swelling cause increased pressure in an area that cannot expand d) the fascia expands with injury, causing pressure on underlying nerves and muscles

c) bleeding and swelling cause increased pressure in an area that cannot expand Compartment syndrome is caused by bleeding and swelling within a compartment, which is lined by fascia that does not expand. The bleeding and swelling place pressure on the nerves, muscles, and blood vessels in the compartment, triggering the symptoms.

Which non-pharmacologic intervention should the nurse include in the care plan for a patient who has moderate rheumatoid arthritis? a) massaging inflamed joints b) avoiding range of motion c) selecting clothing that have Velcro fasteners d) using assistive devices at meal times

c) selecting clothing that have Velcro fasteners

The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? a. "You will need to change this patch every day, regardless of your pain level." b. "This type of pain medication is not as likely to cause breathing problems." c. "With the first patch, it will take about 24 hours before you feel the full effects." d. "Use your heating pad for the back pain. It will also improve the patch's effectiveness."

c. "With the first patch, it will take about 24 hours before you feel the full effects." evolve.elsevier.com ch 28 Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Fentanyl has the same adverse effects as other opioids, including respiratory depression. Patients should avoid exposing the patch to external heat sources, because this may increase the risk of toxicity.

The nurse directs the NAP to remove a Foley catheter at 1300. The nurse would check if the patient has voided by: a. 1400. b. 1600 c. 1700. d. 2300.

c. 1700 evolve.elsevier.com for Potter and Perry, Ch 45 The patient may experience urinary retention after removal of the catheter. If 4 hours after Foley removal have elapsed without voiding, it may be necessary to reinsert the Foley.

A pts serum uric acid lab test has just come back. Which of the following values would be of MOST concern? a. 5.7mg/dL b. 6.8mg/dL c. 9.2mg/dL d. 1.4mg/dL

c. 9.2mg/dL A serum uric acid level above 6.8 mg/dL can cause urate crystal deposition

The nurse is preparing to ambulate a pt who has recently had TKR. In order to protect the knee, the nurse should: a. Apply an ortho boot b. Apply ice after ambulation c. Apply a knee immobilizer d. Use crutches to minimize weight bearing on the knee

c. Apply a knee immobilizer

The nurse is educating a pt in Buck's traction. The nurse explains to the pt that Buck's traction is: a. A cast used to align the bone b. Attached to the bone using pins c. Attached to the skin and soft tissues d. A belt wrapped around the trunk

c. Attached to the skin and soft tissue Buck's traction uses a boot attached to the skin and soft tissue to decrease spasms and promote alignment and healing.

A pt with Gout would likely be prescribed any of the following medications EXCEPT: a. NSAID b. Colchicine c. Chondroitin d. Corticosteroid

c. Chondroitin This drug is used in pt's suffering from OA

While assessing a pt in skeletal traction, the nurse would expect to note: a. Purulent drainage b. Redness c. Clear drainage d. Swelling

c. Clear drainage

What consequence is associated with pannus? a. Increased forward curvature of thoracic spine b. Crackling sound of the bones as irregular joint surfaces move across one another c. Erosion of bones d. Human leukocyte antigen genes

c. Erosion of bones

The nurse should follow up on which finding if it is identified in a patient receiving periodic intravenous infusions of abatacept [Orencia] for rheumatoid arthritis? a. Itching and hives b. Blurred vision and eye pain c. Fever and malaise d. Jaundice and dark urine

c. Fever and malaise Source: evolve.elsevier.com Ch 73 Abatacept suppresses immune function by reducing T-cell proliferation. Therefore, the patient is at greater risk for serious infections of the upper respiratory, gastrointestinal (GI), and urinary tracts. Fever and malaise are symptoms of infection that should be investigated. Itching and hives, blurred vision and eye pain, and jaundice and dark urine are not adverse effects of abatacept.

A nurse administers naloxone [Narcan] to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? a. Drowsiness b. Tics and tremors c. Increased pain d. Nausea and vomiting

c. Increased pain evolve.elsevier.com ch 28 Naloxone reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of naloxone, the pain will be more acute.

A pt who sustained a fractured fibula has developed compartment syndrome. The nurse explains compartment syndrome to the pt know that: a. Swelling causes blood vessels to hemorrhage b. Swelling caused nerve damage, resulting in numbness c. Is the buildup of pressure from swelling or bleeding in an enclosed space d. Swelling caused the fractured bone to shrink, resulting in atrophy

c. Is the buildup of pressure from swelling or bleeding in an enclosed space Compartment syndrome is when increasing edema or bleeding causes pressure buildup in an enclosed space. This causes compression of arteries, leading to reduced blood flow and tissue ischemia

Which of the following statement regarding Rheumatoid Arthritis is incorrect? a. It affects small joints b. It causes inflammation and joint deformity c. It is localized in the joints d. Pain commonly occurs in the morning

c. It is localized in the joints

The _________ is the outer bony wall of the spinal canal: a. Spinous process b. Foramina c. Lamina d. Transverse process

c. Lamina

Which medication requires screening for tuberculosis before treatment is started? a. Celecoxib [Celebrex] b. Minocycline [Minocin] c. Leflunomide [ARAVA] d. Sulfasalazine [Azulfidine]

c. Leflunomide [ARAVA] Source: evolve.elsevier.com Ch 73 Screening for tuberculosis is necessary before treatment with leflunomide is started, because this medication can increase the risk for severe infection, including tuberculosis. The other medications do not require tuberculosis screening.

A pt c/o unrelieved, persistent, noxious pain. This kind of pain is best described as: a. Visceral pain b. Nociceptive pain c. Neuropathic pain d. Mechanical pain

c. Neuropathic pain

A 55 y/o Hispanic male with a hx of smoking and a BMI of 32 c/o bilateral joint pain. His ESR is 22 mm/h. Based off of these findings and your assessment of the pt, he is most likely to be suffering from: a. Gout b. Osteoporosis c. Osteoarthritis d. Rheumatoid Arthritis

c. Osteoarthritis

Bone resorption is carried out by which of the following cells? a. Chondrocytes b. Osteoblasts c. Osteoclasts d. Osteocytes

c. Osteoclasts

A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? a. Docusate sodium [Colace] b. Ascorbic acid (vitamin C) c. Pantoprazole [Protonix] d. Furosemide [Lasix]

c. Pantoprazole [Protonix] evolve.elsevier.com ch 71 Aspirin inhibits COX-2 and thus suppresses inflammation and reduces moderate pain and fever. It also suppresses COX-1, which increases the risk for gastric ulceration and bleeding. This risk can be reduced through administration of a proton pump inhibitor, such as pantoprazole [Protonix]. It is not necessary for a patient to take vitamin C or docusate sodium while taking aspirin. Although aspirin may cause sodium and water retention in patients who have pre-existing renal dysfunction, it is not necessary for all patients to take furosemide [Lasix] with aspirin.

The nurse reviews the culture results of a pt with osteomyelitis. The nurse would expect which organism to be the likely cause? a. Haemophilus influenzae b. Pseudomonas c. Staphylococcus aureus d. Tuberculosis

c. Staphylococcus aureus

The nurse notices that a patient has received oxycodone/acetaminophen (Percocet) (5/325) two tablets PO every 3 hours for the past 3 days. What concerns the nurse the most? a. The patient's level of pain b. The potential for addiction c. The amount of daily acetaminophen d. The risk for gastrointestinal bleeding

c. The amount of daily acetaminophen evolve.elsevier.com for Potter and Perry, Ch 43 The major adverse effect of acetaminophen is hepatotoxicity. The maximum 24-hour dose is 4 g. It is often combined with opioids (e.g., oxycodone [Percocet]) because it reduces the dose of opioid needed to achieve successful pain control.

Which of the following drugs is a Biologic DMARD that inhibits activation of T-cells? a. golimumab (Simponi) b. tofacitinib (Xeljanz) c. abatacept (Orencia) d. rituximab (Rituxan)

c. abatacept (Orencia)

When a pt has a heart attack and experiences pain in his left arm, what kind of pain is the pt experiencing? a. noxious pain b. hyperalgesia c. referred pain d. localized pain

c. referred pain

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction primarily: a) allows bony healing to begin before surgery b) provides rigid immobilization of the fracture site c) lengthens the fractured leg to prevent severing of blood vessels d) provides comfort by reducing muscle spasms and provides fracture immobilization

d) provides comfort by reducing muscle spasms and provides fracture immobilization Buck's extension traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps immobilize the fracture. Traction does not lengthen the leg for the purpose of preventing blood vessel severance. Traction also does not allow for bony healing to begin.

A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? (Select all that apply.) a. Ibuprofen [Advil] b. Naproxen [Aleve] c. Aspirin [Bayer] d. Acetaminophen [Tylenol] e. Indomethacin [Indocin]

d. Acetaminophen [Tylenol] evolve.elsevier.com ch 71 The use of NSAIDs, which include ibuprofen [Advil], naproxen [Aleve], indomethacin [Indocin], and especially aspirin [Bayer], by children with influenza or chickenpox may precipitate Reye's syndrome. This is a potentially fatal multisystem organ disease. Acetaminophen [Tylenol] may be used safely to reduce fever in children with influenza.

Which laboratory test would best help to evaluate Rheumatoid Arthritis? a. Antinuclear antibody b. Rheumatoid Factor c. C-RP d. Anti-CCP

d. Anti-CCP This test is more specific for RA. If it is positive, it is more likely to indicate RA than all of the other tests

After having received 0.2 mg of naloxone (Narcan) intravenous push (IVP), a patient' s respiratory rate and depth are within normal limits. The nurse now plans to implement the following action: a. Discontinue all ordered opioids b. Close the room door to allow the patient to recover c. Administer the remaining naloxone over 4 minutes d. Assess patient's vital signs every 15 minutes for 2 hours

d. Assess patient's vital signs every 15 minutes for 2 hours evolve.elsevier.com for Potter and Perry, Ch 43 Reassess patients who receive naloxone every 15 minutes for 2 hours following drug administration because the duration of the opioid may be longer than the duration of the naloxone and respiratory depression may return.

Which of the following is an example of a skeletal muscle antispasmodic? a. Calcitonin b. Minocycline c. Ritoximab d. Baclofen

d. Baclofen

Raloxifene [Evista] has been shown to have protective effects against which disorder in women? a. Ovarian cysts b. Polycystic ovary syndrome (PCOS) c. Endometriosis d. Breast cancer

d. Breast cancer Source: evolve.elsevier.com Ch 75 Raloxifene is a selective estrogen receptor modulator, and one of its actions is antiestrogenic effects in some tissues. This offers protection against some types of breast cancer. It has not been shown to reduce the risk of developing ovarian cysts, PCOS, or endometriosis.

All of the following are examples of opioid agonists, EXCEPT: a. Propoxyphene b. Hydrocodone c. Fentanyl d. Buprenorphine

d. Buprenorphine This is an agonist/antagonist drug. It is used as an abuse deterrent

Which of the following is NOT used in managing opioid addiction? a. Dolophine b. Suboxone c. Methadone d. Hysingla

d. Hysingla Hysingla is an extended release hydrocodone

The nurse is assessing a pt who fell from a roof. When assessing for presence of a fracture, the RN asks the pt if the pain: a. Feels like a muscle was overstretched b. Feels like an intense cramp c. Is dull and aching d. Is sharp and continuous

d. Is sharp and continuous

Which of the following statements is true of Osteoarthritis? a. It involves autoimmunity b. Your chances of getting OA are increased if you are male c. Systemic symptoms are present d. It involves narrowing of the joint space

d. It involves narrowing of the joint space

Which prescription would be the most appropriate for treating persistent cancer pain? a. Morphine [Duramorph] 10 mg orally (PO) as needed (PRN) b. Meperidine [Demerol] 100 mg PO every 4 hours c. Pentazocine [Talwin] 75 mg intramuscularly (IM) every 3 to 4 hours PRN d. Morphine [Duramorph] 30 mg every 3 to 4 hours

d. Morphine [Duramorph] 30 mg every 3 to 4 hours evolve.elsevier.com ch 29 For persistent pain, medication should be given on a fixed schedule to prevent opioid levels from becoming subtherapeutic. Meperidine causes accumulation of a toxic metabolite when used on a long-term basis. Pentazocine produces a limited amount of analgesia, and IM injections generally should be avoided. Morphine 30 mg is an appropriate dose and should be given as indicated around the clock.

Your pt is awake and experiencing some adverse side effects from the oxycodone they were given 60 minutes ago. This pt is likely to experience all of the following side effects EXCEPT: a. Sedation b. Orthostatic hypotension c. Constipation d. Respiratory depression

d. Respiratory depression. Awake pt's are NOT in respiratory depression

Phantom pain is associated to which part of the brain? a. Motor cortex b. CNS c. Cerebellum d. Somatosensory cortex

d. Somatosensory cortex

A nurse teaches a patient who is postmenopausal and is scheduled to start taking calcium carbonate as a dietary supplement. The nurse instructs the patient to avoid taking it with which food? a. Milk b. Carrots c. Potatoes d. Spinach

d. Spinach Source: evolve.elsevier.com Ch 75 Oxalic acid, which is found in some foods, such as spinach, rhubarb, Swiss chard, and beets, can suppress the absorption of calcium. Patients should avoid eating a diet rich in these foods when taking calcium carbonate. It is not necessary to avoid milk, carrots, or potatoes when taking calcium carbonate.

A patient is taking methotrexate [Rheumatrex] for rheumatoid arthritis. Which therapeutic action should a nurse expect if the medication is having the desired effect? a. Selective inhibition of cyclooxygenase b. Neutralization of tumor necrosis factor c. Inhibition of T-cell activation d. Suppression of T and B lymphocytes

d. Suppression of T and B lymphocytes Source: evolve.elsevier.com Ch 73 Methotrexate is a nonbiologic DMARD that suppresses the immune system by reducing the activity of B and T lymphocytes. It is highly effective and considered a first-choice medication. Inhibition of cyclooxygenase, neutralization of tumor necrosis factor, and inhibition of T-cell activation are not actions of methotrexate.

A pt is prescribed a high dose of aspirin for osteoarthritis. The nurse should instruct the pt to contact the physician if which of the following symptoms develop? a. Cold extremities b. Constipation c. Diarrhea d. Tinnitus

d. Tinnitus At high doses, aspirin can become ototoxic, causing ringing in the ears (tinnitus)