Musculoskeletal
A 19-year-old client with multiple fractures of the left leg from an automobile accident has been placed in an external fixation device. Which of the following is a priority nursing diagnosis for this client? a. Disturbed Body Image b. Ineffective Coping c. Risk for Impaired Physical Mobility d. Activity Intolerance
a
A client wearing a right arm cast for a fractured humerus states, "I have not been able to extend my fingers on my right hand since this morning." Which action is the priority for the nurse? a. Evaluate neurovascular status. b. Elevate the right arm on a pillow to reduce edema. c. Encourage the client to take the prescribed analgesics as ordered. d. Ask the client to massage the fingers.
a
A client who had a hip fracture is in the clinic for evaluation a month after surgery. The nurse determines that the client has met outcome goals when the client states which of the following? a. "I went to the grocery store yesterday." b. "I need help getting out of bed." c. "I am having problems with constipation." d. "I am eating and drinking well."
a
A client with a femoral fracture is in Buck's traction and the family asks the nurse if the client's foot should be flush with the footboard of the bed. Which of the following does the nurse teach the family about the client in traction? a. The client should be centered on the bed. b. The client should pull up in bed while someone holds the weights. c. This position maintains countertraction. d. A pillow should be wedged between the footboard and bed.
a
A client with a hip fracture asks the nurse why Buck's traction is being used prior to surgery. The nurse responds with which of the following? a. "Traction reduces muscle spasms." b. "Traction provides rigid immobilization." c. "Traction allows bony healing." d. "Traction lengthens the fractured leg."
a
A client with multiple sclerosis is in the clinic for a follow-up appointment to check progress. The nurse concludes that the plan of care needs goal revisions if which of the following is noted? a. The client is disheveled and unkempt. b. The client attends an MS support group. c. The client performs self-catheterization. d. The client gains 3 pounds.
a
A nursing instructor asks the nursing student to differentiate between osteoporosis and Paget's disease. Which of the following statements, if made by the student, would demonstrate a good understanding of the disorders? a. Although osteoporosis can result from an endocrine disorder or malignancy, it is most often associated with aging. b. Paget's disease occurs in men under the age of 50 in many countries, and is less common in people of Asian, Indian, and Scandinavian descent. c. Paget's disease progresses quickly. d. Osteoporosis progresses quickly.
a
A patient with a family history of osteoarthritis is in the physician's office complaining of left knee pain. The patient states, "I just hope that I have been able to keep from getting osteoarthritis like my mother, since I exercise so much." How should the nurse respond? a. "You might have been able to delay or avoid it by exercising so regularly." b. "As long as you have maintained your ideal body weight, you won't have osteoarthritis." c. "As long as you have taken your calcium supplements, you should be able to avoid it." d. "Since you have a family member with it, you will more than likely have it."
a
Although all of the following nursing diagnoses are important when planning care for the client with osteoporosis, which will the nurse select as most significant in terms of long-term disability? a. Risk for Falls b. Activity Intolerance c. Chronic Pain d. Acute Pain
a
An 87-year-old client has sustained a right hip fracture. The client asks the nurse how long it will take for the fracture to heal. The nurse's response includes consideration of which client factor that influences the rate of bone healing? a. Age of the client b. Weight of the client c. Frequency of physical therapy d. Early ambulation
a
The aged patient fell and dislocated the right shoulder, and was admitted to the hospital overnight. The flow sheet indicated that 10 p.m. neurovascular check of the right upper extremity was within normal limits. The nurse makes rounds at midnight, and gathers the following data: right upper extremity pale; unable to move the lower arm; absent radial and antecubital pulses; and patient's description of "terrible pain" in the right shoulder and arm. What should the nurse do? a. Contact the physician for collaboration on treatment. b. Plan to recheck the findings in 1 hour. c. Reposition the extremity and reapply ice to the shoulder. d. Administer the p.r.n. pain medication according to order.
a
The client with low back pain from a muscle strain asks the nurse if diagnostic testing will include an MRI. The nurse's best response includes which of the following? a. "Conservative treatment for 4 weeks will precede diagnostic testing." b. "An MRI is likely." c. "The doctor will order a CT scan." d. "The doctor will order blood work."
a
The client with newly diagnosed Parkinson's disease states, "I just don't think I can handle having Parkinson's disease." What is the nurse's best first response? a. "You sound overwhelmed. Can you tell me more?" b. "The entire healthcare team will help you manage the disease." c. "I am sure you can. A lot of other people do!" d. "What do you think will be the hardest thing to handle?"
a
The mother of a kindergarten child asks the school nurse why her child has such long arms and legs. The nurse measures the child and finds that the child's height is greater than the 99th percentile. What recommendation should the nurse make? a. "Make an appointment with your health care provider and ask specific questions about height." b. "Come back in 1 week and I will remeasure your child." c. "Here is a pamphlet on growth, development, and growth spurts for you to read." d. "Limit the child's diet to three meals and one bedtime snack each day."
a
The nurse determines that teaching goals have been met for a client with osteoporosis when the client states: a. "I will walk one mile a day." b. "I can smoke half a pack of cigarettes per day." c. "I should do isometric exercises every day." d. "I can stop taking calcium since I am taking fluoride."
a
The nurse finds that the patient has a positive McMurray's test and a negative Phalen's test. What do these findings suggest to the nurse? a. The patient might have had an injury to the meniscus of the knee. b. Carpal tunnel syndrome is present in the patient. c. Osteoarthritis is present in multiple joints. d. Gouty arthritis is present in the knee, but not in the wrist.
a
The nurse is evaluating a client who is being treated for low back pain. The nurse concludes that goals have been met when the client does which of the following? a. Bends at the waist b. Experiences stronger sensations in the affected limb c. Walks in a stiff, flexed gait d. Shows tenderness when the muscle close to the affected disc is palpated
a
The nurse is planning care for a client with Parkinson's disease and selects which of the following priority nursing diagnoses for the client? a. Constipation b. Ineffective Coping c. Acute Confusion d. Anxiety
a
The patient is surprised when the nurse asks about use of herbal or nutritional supplements for treatment of the patient's sore ankle. Why does the nurse ask this question? a. As part of an overall list of any treatment options that are being used b. To find out whether any specific cultural treatments are being used c. As a lead-in to questioning about illegal drug use as a cause/treatment of the pain d. To be able to share with other patients with the same complaint
a
The patient sustained a hip dislocation. The treatment plan is to reduce the dislocation in the Emergency Department. The family asks the nurse why the patient is not being taken to the operating room for the procedure. What is the nurse's best response? a. "By putting the hip back in place as quickly as possible, the probability of damage to the nerves around the area will be reduced." b. "Fixing the hip in this department will save the cost of surgery." c. "This will prevent complications that would be possible due to surgery." d. "Since the hip is not broken, there usually will not be as much pain."
a
Which of the following important points would the nurse include in a teaching program for a young adult with multiple sclerosis? a. Why it is important to avoid extremes of heat and cold b. What can be done to cure the disease c. How pregnancy can improve manifestations d. How to prevent sexually transmitted infections
a
he patient presents to the Emergency Department with a dislocated left shoulder. The patient says that this is the 5th or 6th time the shoulder has been dislocated, but that it "doesn't keep me from playing tennis for more than a week or two." What is the nurse's best response to this patient? a. "Prolonged immobilization for several weeks followed by aggressive therapy can reduce the risk of recurrent dislocation." b. "Wearing a shoulder brace can prevent dislocation." c. "Once a shoulder has been dislocated, there is no effective treatment." d. "Perhaps it's time that you considered participation in a different sport."
a
A patient has been given a preliminary associated diagnosis of osteoporosis following a fall. The nurse is providing education about which tests to expect to confirm the diagnosis. Which test would help to differentiate the diagnosis? (Select all that apply.) a. Serum calcium level b. Bone density examination c. Somatosensory evoked potential d. Fiberoptic endoscopic arthroscopy e. Electromyogram
a, b
A community health nurse is teaching a class on osteoporosis. When members of the class ask what they can do to prevent osteoporosis, which responses would the nurse include? (Select all that apply.) a. Cessation of cigarette smoking b. Limit alcohol intake. c. Increase weight-bearing exercise. d. Have a bone density exam yearly. e. Maintain a high protein diet
a, b, c
The nurse is working with the family of a client with chronic low back pain. The spouse of the client is asking what can be done at home to help the client. The nurse suggests which of the following? (Select all that apply.) a. Suggest ways to reduce stress on the back when working. b. Alert the client when posture is inappropriate. c. Participate with the client in a regular exercise program. d. Let the client do the driving on long trips. e. Remind the client to bend at the back when lifting.
a, b, c
Forty-eight hours ago, an alert and oriented elderly patient had surgery for a left hip replacement. Which assessment findings by the nurse would require immediate intervention? (Select all that apply.) a. Presence of petechiae on upper arms b. Inability to recall reason for being in hospital c. Contusions on upper left thigh d. Crackles in bilateral lung fields upon auscultation e. Strong pedal pulses on affected extremity
a, b, d
A patient was in a motor vehicle accident, and has a fractured nose. The patient is crying loudly about all of the blood all over his face. The nurse must focus on which priority need(s) first? (Select all that apply.) a. Suctioning the blood out of the oropharynx b. Addressing body image concerns c. Monitoring respiratory rate and effort d. Administering intravenous pain medication e. Cleaning up the blood and dressing the wound
a, c
The nurse is caring for a client with osteoarthritis and plans nonpharmacological pain management to include: (Select all that apply.) a. Moderate activity plan b. Ice pack to the most painful area c. Application of moist heat d. NSAIDs e. X-rays
a, c
While in the physician's office, the patient complains of not being able to ride a stationary bicycle for the past 2 weeks because of a "stiff left knee." What other questions should the nurse ask related to this complaint? (Select all that apply.) a. "Tell me about any pain you are experiencing." b. "Is the pain you are experiencing constant?" c. "Have you had any fever in the past few weeks?" d. "Tell me about any injuries you have had in the past few weeks." e. "You have more stiffness in the morning, don't you?"
a, c, d b, e - closed ended questions and assume the patient has pain
A nurse is caring for a patient with Paget's disease. Which complication would be important to monitor for in this patient? (Select all that apply.) a. Osteogenic sarcoma b. Pathologic fractures c. Mental deterioration d. Nerve palsy syndromes e. Compression of the spinal cord
all choices
A 63-year-old client has recently been diagnosed with osteoarthritis (OA) and the nurse is teaching the client about activities to manage the disease. The nurse includes which of the following in the teaching? a. Perform vigorous exercise. b. Do not overuse affected joints. c. Take cod liver oil as a supplement. d. Ice painful joints for 60 minutes.
b
A client complains of "eye problems" and generalized weakness that became markedly worse after visiting a friend and using the hot tub. The client is very wordy about the symptoms. The nurse's best response is which of the following? a. "Please be brief with your answers so I can get you through this." b. "Can you tell me more about the eye problems?" c. "You'll feel better after getting this off your mind." d. "Was the weather the same each time you used the hot tub?"
b
A client with an open fracture is at risk for developing osteomyelitis. Which of the following classic symptoms would the nurse look for to detect development of this complication? a. Acute respiratory distress b. Elevated temperature c. Low bone density d. Shortening of the affected extremity
b
A home health nurse is visiting an elderly client who lives with family members to evaluate the progress of the client's hip pain after a fall. Which of the following would the nurse include when teaching the family about prevention of hip fractures from falls in the home? a. Remove all wall-to-wall carpeting from the home. b. Use lamp shades and frosted bulbs to reduce glare. c. Move items on the stairs to one side. d. Keep bare wood floors well polished.
b
A patient has a compound fracture of the left tibia. It was surgically repaired 4 hours ago, and a long leg cast is present. Which assessment finding by the nurse would require intervention first? a. Patient rates pain as 4 on 0-5 pain scale. b. Patient complains of cast feeling too tight. c. Pedal pulse is palpable, but weaker than it was 2 hours ago. d. Patient is able to move toes only with great effort.
b
A patient has just been medically diagnosed with muscular dystrophy. The nurse is discussing the nursing plan of care with the patient and family. Which of the following nursing problems will be the focus of this plan of care? a. Chronic pain b. Self-care deficit c. Knowledge deficit d. Depression and grief
b
A patient newly diagnosed with gout is admitted to the outpatient unit. The patient reports the following medications as being taken routinely at home. Which medication is of greatest concern to the nurse? a. Oral hypoglycemic agent b. Furosemide (Lasix) c. Insulin d. Ibuprofen (Motrin)
b
A patient who is hospitalized with acute symptoms of Paget's disease asks why it is necessary to get up in the chair and walk three times a day. The patient says moving and walking are painful, and that it would be "better just to stay in bed." What is the nurse's best response to this comment? a. "We need to see how your pain medication is working for when you are active." b. "Making sure you remain active will help you maintain or improve your mobility and prevent complications." c. "Well, it might have been a mistake in your orders. I will have to double-check them." d. "Changing positions frequently will help lessen the duration of this flare-up."
b
A primigravida teenager in the third trimester says to the nurse, "I'm so sway-backed now. Is that because I am pregnant?" What is the nurse's best response? a. "Yes, and it will go away after you deliver." b. "Your back shows 'lordosis' which is an increase in the lumbar curve related to weight shift during pregnancy." c. "You need to see the physician today and tell him about your scoliosis." d. "It's not at all unusual for a young mother to develop kyphosis during pregnancy."
b
A slightly confused elderly patient is in the physician's office complaining of joint pain. During the health assessment questioning, the nurse discovers that the patient was adopted as an infant. Which health assessment question would be the most difficult for this patient to answer? a. "Does your spouse have arthritis?" b. "Does anyone in your family have arthritis?" c. "Were you ever diagnosed with juvenile rheumatoid arthritis as a child?" d. "What childhood immunizations did you receive?"
b
An obese client with degenerative joint disease is being managed pharmacologically with aspirin therapy. The nurse determines that additional teaching is needed when the client makes which of the following statements? a. "I started an exercise program to lose weight." b. "I take my aspirin when I have extreme pain or stiffness." c. "I frequently examine my stools for bleeding." d. "I use heat sometimes to help reduce my pain and stiffness."
b
During a multiple sclerosis exacerbation, the nurse would teach clients that they are at risk for which of the following? a. Constipation b. Injury c. Anorexia d. A sore throat
b
The nurse advises the family of a client with Parkinson's disease that the best approach to helping the client maintain as much functional independence as possible is which of the following? a. Obtain assistive devices that will make activities easier. b. Display an unhurried manner that allows the client to respond. c. Assist the client to take a warm bath every morning. d. Perform passive ROM three times a day.
b
The nurse has volunteered at the local high school to perform physical assessments on students who wish to participate in sports. When the nurse is examining the upper extremities of a 15-year-old girl, the student states that her right elbow aches at night, but her left does not. The nurse notes that the girl has pain and tenderness at the lateral epicondyle. What should be the nurse's next action? a. Tell the student that she is not cleared for sports. b. Ask the student which sport she has been playing. c. Tell the student to apply moist heat to the area. d. Ask the student to return for an examination after the pain and tenderness are gone.
b
The nurse includes which of the following when teaching the client with osteoporosis about preventive measures for complications of osteoporosis? a. Infection b. Fractures c. Contractures d. Blood clots
b
The nurse is caring for a 65-year-old who fell and is in skeletal traction for a right femur fracture. The client is complaining of pain in the leg. The nurse determines that the right foot is pale and without a pedal pulse. The nurse takes which of the following actions? a. Reassures the client that the finding is normal for older adults b. Notifies the physician c. Releases the traction d. Administers half of the pain medication ordered as pain perception may be lower in older adults
b
The nurse is caring for a client with low back pain. The client states that the job requires long hours of sitting and that the doctor suggested a new job. The client is supporting a family and cannot afford to change jobs at this time. The nurse initiates a teaching plan, which includes guidance to: a. Increase fluids. b. Modify the work environment to decrease back stress. c. Take NSAIDs during the day to decrease pain level. d. Lose weight.
b
The nurse is conducting a teaching session regarding osteoarthritis and risk factors for developing the disease. The nurse includes which of the following about primary osteoarthritis risks? a. Joint instability b. Age c. Trauma d. Endocrine disorders
b
The nurse is measuring the degrees of mobility for a 58-year-old female's right wrist, and finds the following: 90-degree flexion, 70-degree extension, 55-degree ulnar deviation, and 20-degree radial deviation. How should the nurse document these findings? a. Normal flexion and extension, abnormal ulnar and radial deviation b. Normal right wrist range-of-motion c. Normal flexion, abnormal extension, normal ulnar deviation, and abnormal radial deviation c. Abnormal flexion, normal extension, abnormal ulnar deviation, and normal radial deviation
b
The nurse on the orthopedic unit receives a client with a broken left tibia who was placed in Buck's traction in the emergency department. Which of the following outcome goals for the client will the nurse evaluate upon admission to the unit? a. Pain medications given in the field have been effective. b. The skin over bony prominences under the traction is intact. c. The pins, wires, and tongs are in place. d. Medications given in the emergency department have been effective.
b
The nurse selects the nursing diagnosis of self-care deficit for a client with osteoarthritis based on which of the following observations? a. The client's hair is combed. b. The client is wearing loafers without socks. c. The client drove to the office. d. The client's shirt is wrinkled.
b
The parent of a 16-year-old patient is upset to learn that her child has a curvature of the spine. She tells the nurse that she does not understand how it happened, since she has always encouraged her child to drink milk with meals to get enough calcium. Which response by the nurse should assist the parent to differentiate the relationship between calcium consumption and the curvature of the spine? a. "Milk at meals might not be a sufficient source of calcium for an adolescent." b. "Curvatures of the spine are often present since birth, but not visible until adolescence." c. "Calcium supplements should be consumed to acquire the amount of calcium needed during adolescence." d. "A lack of exercise in adolescence can result in calcium loss from bones and allow a spinal curvature to occur."
b
The patient has a compound fracture of the arm. What nursing diagnosis/problem has the highest priority? a. Acute Pain b. Potential for Infection c. Alteration in Skin Integrity d. Alteration in Tissue Perfusion
b
The patient suffered a fractured pelvis after being struck by an automobile 2 hours ago. Since admission, the patient's blood pressure has steadily decreased, while the pulse rate has steadily increased. The patient's most recent hemoglobin level has declined 1 gm/dL since admission. The nurse's concern about which of the following potential complications necessitates contacting the patient's physician? a. Post-traumatic stress disorder b. Hypovolemia c. Head injury d. Onset of infection
b
The school nurse is called to the playground, where a 7-year-old has fallen from the top of the slide. The child is lying on the ground face-up and crying. There is an obvious deformity in the child's forearm. Which sequence of action should the nurse follow? a. Align the fracture and walk the child into the nurse's office. b. Reassure the child that she will be helped, and immobilize the arm. c. Sit the patient up and allow her to calm down. d. Pick up the child and carry her to the nurse's office.
b
Which of the following explanations, if given by the patient with generalized multiple sclerosis (MS), would give evidence to the nurse that the patient has understood the nurse's teaching about MS? a. "Multiple sclerosis means that I have a virus that attacks my immune system." b. "With multiple sclerosis, sometimes I'll feel fine, and other times I'll be very tired and have trouble with my vision, have trouble concentrating, and feel depressed." c. "Multiple sclerosis is a problem with my immune system that that leads to increased speed of nerve impulses that causes my legs to feel weak." d. "When my multiple sclerosis symptoms come back, especially being tired, I need to get more rest and sleep, and then I will feel better."
b
Which of the following nursing diagnoses would the nurse choose for a client with multiple sclerosis (MS), regardless of type or severity? a. Impaired Gas Exchange b. Fatigue c. Risk for Aspiration d. Acute Pain
b
While the physician is discussing the need for surgical intervention for a patient's severe osteoarthritis, the patient says, "I want the least invasive surgical treatment possible." The nurse gathers patient education materials that explain which surgical procedure? a. Viscosupplementation b. Arthroscopy c. Osteotomy d. Joint arthroplasty
b
A patient presents at the medical clinic with the following symptoms: flulike symptoms that have been getting worse over the last 3 weeks; a flat, red rash that has gotten bigger, but cleared in the central region; headache; malaise; chills; and stiff neck. The patient presents today because of a facial droop that has never been there previously. What question is most important for the nurse to ask the patient? a. Have you been around any children recently? b. Have you had any tick bites recently? c. Have you changed your diet in any way? d. Have you been under stress in any way?
b (Lyme disease)
Which of the following nursing implications are important when alendronate (Fosamax) and risedronate (Actonel) are prescribed for an older patient? (Select all that apply.) a. Instruct the client to take the medication with meals, highly fluid soups, or cereals. b. Instruct the client to take these drugs on an empty stomach, first thing in the morning, with water. c. Instruct the client to remain upright for 30 minutes and to not eat or drink anything else for 30 minutes. d. Monitor the client for hypertension. e. Monitor daily weight, and observe for signs of weight gain.
b, c
The nurse and a client with suspected Parkinson's disease are discussing the client's symptoms. The client asks what causes the symptoms. The best response by the nurse is that the manifestations are the result of: a. Effects of a neurotoxin. b. Autoimmune response to a viral infection. c. The failure of dopamine to inhibit acetylcholine. d. A genetic defect.
c
A client has undergone a lumbar laminectomy. Which of the following is the priority nursing diagnosis for this client? a. Ineffective Role Performance b. Social Isolation c. Impaired Physical Mobility d. Disturbed Body Image
c
A client has undergone a lumbar laminectomy. Which of the following nursing interventions would be best 4 hours postoperatively? a. Sit the client at the side of the bed. b. Have the client sit in a chair to watch TV. c. Have the client lying in bed in good alignment with the head flat. d. Have the client use the bed rail for support when getting out of bed.
c
A healthy, active 73-year-old patient has suffered a severely sprained right ankle, and is preparing to leave the Emergency Department. Which aid to ambulation would be most appropriate for the patient? a. Wheelchair b. Crutches c. Walker d. Cane
c
A nursing student is attempting to understand the difference between osteoarthritis and rheumatoid arthritis. Which of the following statements, if made by the nursing student, would demonstrate a good understanding of the two disorders? a. Rheumatoid arthritis (RA) is an acute systemic autoimmune disease that causes inflammation of connective tissue, primarily in the joints. b. Osteoarthritis is the least common type of arthritis. c. Rheumatoid arthritis affects three times as many women as men, with an onset date usually between 20 and 40 years of age. d. Women are affected more than men at an earlier age, but the rate of OA in men exceeds that in women by the middle adult years.
c
A patient is brought to the ED with a sports injury-induced "sprain" of the left ankle. The ankle is edematous, with erythema, and is tender to touch. There is no fracture, and the patient is being discharged. What should the nurse include in discharge instructions? a. Follow-up with orthopedic surgeon the following week b. Complete bedrest with left lower leg elevated at all times c. Rest, ice, compression, and elevation for 24-48 hours d. Lower leg immobilizer to be worn while up
c
A truck driver presents to the primary care provider with complaints of persistent back pain. The nurse explains that which client activity documented during the nursing history may contribute to further back injury? a. Providing back support with a pillow when sitting b. Lifting objects close to the body c. Prolonged standing or sitting d. Shifting positions often when sitting for prolonged periods
c
A 67-year-old client asks the nurse about osteoporosis. The nurse responds that osteoporosis can be defined as: a. Increased phagocytic activity. b. Loss of bone matrix. c. New, weaker bone growth. d. Loss of bone density.
d
The nurse is caring for a client who had a fracture one week ago. The client asks why the nurse palpates the casted area when doing the examination. Which of the following is the most appropriate response by the nurse? a. "I am evaluating the strength of the cast." b. "I am making sure the cast is not too tight." c. "I am checking for hot spots that might indicate infection." d. "I am making sure that the cast has dried."
c
The nurse is caring for a confused 86-year-old client who has been admitted to the hospital with a hip fracture. Which of the following data would lead the nurse to conclude that the client is at risk for disturbed thought processes? a. Familiar family in the room b. Hearing aids in place c. Stress induced by the fracture d. Eyeglasses at the bedside
c
The nurse is evaluating the communication abilities of a client with Parkinson's disease and determines that outcomes have been met when the client does which of the following? a. Does not talk because it is frustrating b. Takes 10 minutes to speak the nurse's name c. Brings a slate and chalk to the visit d. Lets a family member speak for the client
c
The nurse is explaining signs and symptoms of complications of Parkinson's disease to a client with Parkinson's disease and the client's family. The nurse includes which of the following as a risk for the client? a. Overhydration b. Hearing deficits c. Oculogyric crisis d. Violence
c
The nurse is planning care for a client with multiple sclerosis and plans to teach about which of the following medications if ordered by the physician? a. Levodopa b. Antihistamines c. Interferon d. Antibiotics
c
The nurse provides teaching to a 50-year-old male Caucasian client with low back pain. The client weighs 200 pounds, drives a fork lift, sits for prolonged periods, and seldom participates in exercise activity. What risk factors should the nurse include in the discussion? a. Age, obesity, lack of exercise, genetic factors b. Degenerative disc disease, gender, race c. Lack of exercise, obesity, sitting for prolonged periods d. Degenerative disc disease, race, inactivity
c
The nurse reinforces teaching for a client after the removal of a short leg cast. The nurse should include which of the following in discussions with the client? a. Vigorously scrub the leg to remove dead skin. b. Wash the skin with undiluted hydrogen peroxide. c. Gently wash and lubricate the leg. d. Avoid touching the leg for 2 weeks.
c
The nurse who is conducting a general health education class for retired adults includes information about walking as a desirable exercise. What is the best rationale for the nurse's choice to include this topic? a. Walking helps to prevent the onset of depression. b. This is a simple activity for anyone. c. Weight-bearing activities are important for older adults. d. The cost for this activity is minimal.
c
The patient is in the Emergency Department for a complaint of left elbow pain. While performing a health examination, the nurse inspects the right elbow in detail as well. The patient gets frustrated with this, and asks the nurse, "Why are you checking the good arm when the left one is the one I am here about?" What is the nurse's best response to this question? a. "I am supposed to do a full examination on admission to the ED." b. "If I only inspect one arm, I would not be doing my job." c. "I am comparing the size, color, and temperature of your injured elbow with that of your uninjured elbow." d. "In many cases, people injure both of their elbows at the same time and don't even realize it."
c
The patient who has suffered a fractured vertebrae at L5 tells the nurse, "I've heard that fractured vertebrae never really heal." What is the nurse's best response to this patient? a. "Your information is accurate." b. "Actually, a fractured vertebra usually heals in 6- 8 weeks." c. "A fractured vertebra will take at least 12 weeks to heal." d. "You should ask your doctor about that."
c
The patient who is 3 days post-total abdominal hysterectomy has been diagnosed with deep vein thromboses in the right peroneal artery. The patient is on strict bedrest, and has an intravenous heparin solution infusing. What is the nurse's best explanation of the purpose of this heparin infusion? a. "Heparin will dissolve the clot in your vein." b. "Heparin is given to improve the circulation." c. "Heparin is given to keep additional clots from forming." d. "Heparin coats the lining of the arteries in your abdomen and lower extremities."
c
The physician prescribes alendronate (Fosamax) and risedronate (Actonel) for a 65-year-old female for which of the following purposes? a. Suppressing inflammation and the normal immune response and enhancing metabolic processes b. Binding bile acids in the gastrointestinal tract to enhance calcium resorption c. Inhibiting osteoclastic activity and decreasing the incidence of vertebral and nonvertebral fractures d. Decreasing spinal fractures and preventing formation of thrombosis
c
This is the sixth Emergency Department visit in 3 months for a patient who asks for medication for relief of generalized pain. The nurse questions the patient in detail about pain manifestations and sleep patterns. Why are these inquiries necessary? a. To assist in deciding which pain medication to administer b. To assist in evaluating the patient for further psychiatric evaluation c. To assist in making a differential diagnosis of fibromyalgia d. To assist in determining whether the patient is exhibiting drug-seeking behavior
c
When teaching care at home for an 87-year-old client with Parkinson's disease, the nurse discusses which of the following priorities of care with the family? a. Preventing an overdose of medications b. Increasing appetite c. Preventing falling d. Avoiding daily baths and showers
c
While assessing a patient's fractured right arm, the nurse notes that the skin is cool and pale, the radial pulse is palpable but weak, and the patient is barely able to extend her fingers. What action should be taken by the nurse? a. Elevate the arm up on two pillows and recheck in 30 minutes. b. Ask the patient whether more pain medication is needed. c. Collaborate with the physician about the findings. d. Remove the splint and rewrap the bandage.
c
Which of the following instructions would the nurse give to a client with multiple sclerosis who is experiencing urinary retention? a. "Run water whenever you experience difficulty initiating urination." b. "Drink caffeinated beverages to promote the ability to form urine." c. "Decrease your fluid intake to decrease urgency." d. "Catheterize your bladder according to the schedule we discussed."
d
While preparing a patient for an electromyogram (EMG), the nurse uses a model of an arm and a safety pin to demonstrate what will be done during the test. The nurse questions the patient about the information presented in order to determine comprehension of the teaching. Which of the following statements by the patient indicates need for further teaching? a. "I know there will be some pain involved in the test, but my doctor really wants the results." b. "It is interesting that the electrical activity of my muscles is able to be measured." c. "I will just need to go out and smoke before the test to calm myself down." d. "Maybe this test will give results that will help with a diagnosis about my muscle weakness."
c
A client with osteoporosis asks the nurse about treatment for osteoporosis. The nurse responds that which of the following are treatments? (Select all that apply) a. NSAIDS b. Gold salts c. Calcium d. Miacalin (calcitonin) e. Fluoride
c, d, e
A nurse is caring for an elderly client whose right hip was pinned after a fracture. Which of the following interventions by the nurse will prevent further injury to the hip? (Select all that apply.) a. TV on at all times b. Vital signs every 4 hours c. Night light in the room at night d. Call bell near the client's hand e. Side rails up
c, d, e
Which of the following is the major mechanism for maintaining calcium balance in the body? a. Appropriate body alignment b. Sarcopenia c. Active and passive exercises d. Bone remodeling
d
A client with Parkinson's disease is taking levodopa to help manage the manifestations of the disease. The client returns to the clinic 2 weeks after starting the medication and states that the medicine is not working because the symptoms are the same as before. The nurse responds with which of the following? a. "You must not be eating enough meat." b. "Perhaps the doctor needs to prescribe a different medication." c. "You must not be taking the correct dose." d. "The medication takes several weeks to months to work."
d
A patient has been diagnosed recently with rheumatoid arthritis. Which medication should the nurse expect to see ordered for this patient? a. Acetaminophen with codeine b. High-dose oral corticosteroids c. Gentamicin d. Intra-articular corticosteroids
d
During assessment of the patient's musculoskeletal system, the nurse perform's Phalen's test. The patient states that she feels numbness and burning in the fingers. What recommendation should the nurse make for this patient? a. "Don't keep your wrist flexed for more than a few seconds at a time." b. "Wear articles of clothing that fit loosely around the arms." c. "Consider taking glucosamine sulfate, an over-the-counter supplement, to increase the synovial fluid in the wrist joint." d. "Let's report the finding to your physician for further evaluation."
d
The nurse collects data from a client with suspected osteoarthritis. The nurse elicits information that will confirm which of the following manifestations of osteoarthritis? a. Elevated sedimentation rate b. Elevated white blood cell count c. Positive rheumatoid factor d. Dull, aching pain in the joints
d
The nurse is caring for a patient with rheumatoid arthritis. Which teaching point should the nurse include in discharge teaching for this patient? a. Pain during exercise means you are working out properly. b. Exercise the weakest joints to avoid misuse. c. Search for activities that require a firm grip. d. Complete activities that can be stopped immediately if needed.
d
The nurse is discussing a test that the physician has ordered with a patient. The patient's right knee is swollen, red, and warm. The nurse explains that a small amount of fluid will be removed from the joint space and evaluated for the presence of infection. The patient says, "I'd sure like to explain that test to my family. What did you call it?" Which response by the nurse would meet these needs in the most effective method? a. "I'll get you a medical reference book so you can look it up." b. "I'll ask the physician to come back in and explain the test to you." c. "When your family gets here, call me, and I will come back and explain it to them." d. "The test is called an 'arthrocentesis.' I'll write that down and draw a picture for you to help you explain it to your family."
d
The nurse is discussing care of a client with multiple sclerosis with the client and family. The client has been placed on diazepam (Valium) to help reduce muscle spasms, and the nurse teaches the family which of the following about the medication? a. Do not suddenly stop the medication. b. The medication can cause diarrhea. c. Take the medication with food. d. The medication can cause respiratory distress.
d
The nurse is preparing to discharge a client with osteoarthritis after a knee replacement. The nurse plans to teach the family and client which priority points of care? a. Fluid requirements for the client b. Nutritional needs of the client c. Administration of IV antibiotics d. Signs and symptoms of infection
d
The nurse is teaching a group of seniors about hip fractures. The nurse explains that the greatest risk for nonunion occurs with which of the following? a. Extracapsular fractures b. Shaft of the femur c. Trochanter region d. Head of the femur
d
The nurse is working with a client with osteoarthritis and is making suggestions about obtaining assistive devices such as shoe horns, zipper grabbers, and long-handled tongs. The nurse is assisting the client to meet which of the following goals? a. Maintain a safe environment. b. Decrease painful stimuli. c. Prevent contractures. d. Prolong independence.
d
The nurse is working with a family who plans to take an elderly family member home after recovery from a hip fracture. The nurse instructs the family about which of the following measures of nonpharmacological pain control for the client? a. Administration of NSAIDs b. Moving the client quickly so pain is minimal c. Vigorous massage of the leg on the affected side d. Deep breathing and relaxation exercises
d
The patient who has been newly diagnosed with Parkinson's disease asks the nurse how Parlodel (bromocriptine) actually works. The nurse's best response is: a. "It is the most commonly prescribed drug for newly diagnosed Parkinson's disease." b. "Your doctor will be arriving soon; I'll put a note on your chart to ask the health care provider to answer your question." c. "I'll set the drug aside and contact the health care provider to be certain that it is the correct medication." d. "Parlodel stops the breakdown of a chemical in the brain called dopamine."
d
The patient who has systemic lupus erythematosus asks the nurse why sun avoidance is necessary, since a family member thought sun exposure might dry up the facial rash. What is the best response by the nurse? a. "We always discourage sun exposure due to the risk of melanoma." b. "The sun is one option of trying to get rid of the facial rash." c. "The only way to get rid of the facial rash is from a tanning bed." d. "The sun exposure will probably make your skin rash worse."
d
The patient with a first relapse of multiple sclerosis is admitted to the Acute Care Unit, and the nurse prepares the patient's plan of care with priority given to: a. Urinary retention. b. Paralysis of lower extremities. c. Difficulty swallowing. d. Visual deficits.
d
The young, healthy patient is preparing to leave the Emergency Department after having a walking cast placed on the left leg for a fractured tibia. The nurse will evaluate discharge teaching as satisfactory when the patient makes which statement? a. "I'll have to use a yardstick to scratch my left lower leg if it itches." b. "I'll cough and deep-breathe every 2 hours." c. "I'll eat a diet high in carbohydrates for energy." d. "I'll call the doctor or return to the Emergency Department if I have trouble breathing, feel anxious, or get a rash on my chest, armpits, or arms."
d