Prep U Exam 6

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The client asks the nurse why she seems to have bone changes since she has gotten older. What is the best response by the nurse? "Bone changes from aging result from a loss of calcium." "Bone changes from aging result from a loss of magnesium." "Bone changes from aging result from a loss of vitamin absorption." "Bone changes from aging result from most medication therapies."

"Bone changes from aging result from a loss of calcium." Explanation: Age-related changes that affect mobility include alterations in bone remodeling and loss of bone calcium, leading to decreased bone density, loss of muscle mass, deterioration of muscle fibers and cell membranes, and degeneration in the function and efficiency of joints. Bone changes do not occur from loss of magnesium, most medications, and loss of vitamin absorption.

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? "CPM prevents injury by limiting flexion of the knee." "CPM increases range of motion of the joint." "CPM strengthens the muscles of the leg." "CPM delivers analgesic agents directly into the joint."

"CPM increases range of motion of the joint." Explanation: CPM increases circulation and range of motion of the knee joint.

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question? "Did you give your child any acetaminophen, such as Tylenol?" "Did you use any medications, like aspirin, for the fever?" "How high did his temperature rise when he was ill?" "What type of fluids did your child take when he had a fever?"

"Did you use any medications, like aspirin, for the fever?" Explanation: Severe and continual vomiting, changes in mental status, lethargy, and irritability are some of the signs and symptoms of Reye syndrome, which can occur as a result of ingesting aspirin or aspirin-containing products during a viral infection. Tylenol (acetaminophen) is allowed for viral infections in the school-age child. The type of fluids consumed during the illness has nothing to do with Reye syndrome. The temperature rise would be important for a much younger child because of the chance of febrile seizures, but not in this age child.

After teaching an older adult about measures to relieve constipation, which statement by the client indicates a need for additional teaching? "I'm going to start walking every day for exercise." "I should use a laxative every other day." "I need to avoid foods that are high in fat." "I'll make sure that I drink plenty of fluids each day."

"I should use a laxative every other day." Explanation: Factors that may cause constipation include prolonged use of laxatives. Therefore, the patient should avoid the regular use of laxatives. To promote gastrointestinal motility, the patient should ensure adequate fluid intake, engage in regular exercise, avoid foods high in fat.

A nurse is educating a patient newly diagnosed with Parkinson's disease. Which description would the nurse offer to describe the disease? "It is an acute disorder." "It is characterized by abnormalities in movement and posture." "It is characterized by abnormalities in behavior." "It is characterized by joint pliancy."

"It is characterized by abnormalities in movement and posture." Explanation: Parkinson's disease is a chronic, progressive, degenerative disorder of the central nervous system characterized by abnormalities in movement and posture (e.g., tremor, bradykinesia, joint and muscular rigidity, postural instability).

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "Keep your right leg elevated above heart level." "A foul smell from the cast is normal." "Cover the cast with a blanket until the cast dries." "Use a knitting needle to scratch itches inside the cast."

"Keep your right leg elevated above heart level." Explanation: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.

An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate? "What concerns you most about Alzheimer disease?" "Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." "Once the underlying cause of the confusion is found and treated, your loved one will be better than ever." "Alzheimer disease can be a great burden on the family. What community resources do you know about?"

"Several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion." Explanation: Delirium is associated with a sudden onset of confusion, not Alzheimer disease. The family needs to be told the correct information, which is that several underlying conditions could be causing the confusion. Once the underlying cause(s) is found and treated, the confusion should subside; however, some clients may not recover from the underlying cause, so telling the family the client will be better than ever is not appropriate. Asking the family about their concerns about Alzheimer disease and what they know about community support related to it is not appropriate because the client is exhibiting symptoms related to delirium.

A nurse is caring for a client with dementia. A family member of the client asks what the most common cause of dementia is. Which response by the nurse is most appropriate? "The most common cause of dementia in the elderly is Alzheimer's disease." "Drug interactions are the most common cause of dementia in the elderly." "Depression may manifest as dementia in elderly clients." "Dementia is a terrible disease of the elderly."

"The most common cause of dementia in the elderly is Alzheimer's disease." Explanation: The nurse should inform the family member that Alzheimer's disease is the most common cause of dementia in elderly clients. Dementia is a clinical manifestation, not a disease process. Although drug interactions and overmedication are causes of dementia, these causes aren't as common as Alzheimer's disease. Depression is common in elderly clients, but it doesn't cause dementia.

A female client's seizure disorder has been successfully controlled by AEDs for years. She and her husband decide that it is time to start a family. She asks the nurse if it is safe for the fetus for her to continue her AEDs as prescribed. What is the nurse's best response? "They are contraindicated during the third trimester." "They are considered teratogenic." "They are safe during pregnancy." "They may interfere with conception."

"They are considered teratogenic." Explanation: Sexually active adolescent girls and women of childbearing potential who require an AED must be evaluated and monitored very closely, because all of the AEDs are considered teratogenic. In general, infants exposed to one AED have a significantly higher risk of birth defects than those who are not exposed, and infants exposed to two or more AEDs have a significantly higher risk than those exposed to one AED.

During an in-service, the charge nurse explains to the licensed vocational nurse (LVN) that there are six categories of anticonvulsants with different mechanisms of action. The LVN demonstrates understanding of the action of the miscellaneous drug, gabapentin, by stating which of the following? "This drug is a gamma-aminobutyric acid (GABA) agonist." "Gabapentin elevates the seizure threshold." "Gabapentin depresses the motor cortex." "This drug acts in the postsynapses in the motor cortex of the brain."

"This drug is a gamma-aminobutyric acid (GABA) agonist." Explanation: Gabapentin is a miscellaneous drug acting as a GABA agonist. Hydantoins stabilize the hyperexcitability postsynaptically in the motor cortex of the brain. Succinimides depress the motor cortex, thus raising the seizure threshold. Benzodiazepines elevate the seizure threshold by decreasing postsynaptic excitation.

A client reports to the nurse that her grandmother with Alzheimer's disease recently moved in with her and her two school-aged children. The client states the grandmother becomes agitated and starts yelling and crying frequently. The woman asks, "What can I do?" The nurse first responds: "Play quiet music that your grandmother may like." "Start rubbing her shoulders and her back." "You need to remain calm during the outbursts." "What precipitates the outbursts?"

"What precipitates the outbursts?" Explanation: A client with Alzheimer's disease may respond to exciting or confusing events with a catastrophic reaction, such as screaming, crying, or becoming abusive. The nurse needs to assess the situation and what precipitates the catastrophic reactions to best address how to prevent these events. Other nursing interventions include telling the client's granddaughter to remain calm and to distract the grandmother with quiet music, stroking, or both.

A client who is receiving phenytoin has a serum drug level drawn. Which result would the nurse interpret as within the therapeutic range? 12 mcg/mL 30 mcg/mL 22 mcg/mL 4 mcg/mL

12 mcg/mL Explanation: The therapeutic serum phenytoin levels range from 10 to 20 mcg/mL. Thus, a level of 12 mcg/mL would fall within this range.

The nurse is monitoring the serum carbamazepine level of a client. Which result would lead the nurse to notify the prescriber that the client most likely needs an increased dosage? 2 mcg/mL 6 mcg/mL 4 mcg/mL 8 mcg/mL

2 mcg/mL Explanation: Therapeutic serum carbamazepine levels range from 4 to 12 mcg/mL. Therefore, a level under 4 mcg/mL would suggest that the drug has not reached therapeutic levels, so the dosage may need to be increased.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time? 14 to 16 weeks 6 to 8 weeks 10 to 12 weeks 2 to 4 weeks

6 to 8 weeks Explanation: Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A total knee replacement An open reduction A fasciotomy A total hip replacement

A fasciotomy Explanation: A treatment option for compartment syndrome is fasciotomy.

A 26 year-old female is resting after a 1-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? An absence seizure A tonic-clonic seizure A complex partial seizure A myoclonic seizure

A tonic-clonic seizure Explanation: A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities. A myoclonic seizure involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities. Absence seizures are nonconvulsive and complex partial seizures are accompanied by automatisms.

Which is a true statement regarding pharmacologic aspects of aging? Aged population tends to be compliant with their medication regimen. Absorption may be affected by changes in gastric pH. Potential for drug-drug reactions decreases with the number of drugs prescribed. Elderly have a decreased percentage of body fat.

Absorption may be affected by changes in gastric pH. Explanation: During the aging process, absorption may be affected by changes in gastric pH. The elderly have an increased percentage of body fat. The potential for drug-drug interaction increases with the number of drugs prescribed. The aged population tends to be less compliant with their medication regimen.

A 6-year-old child with hydrocephalus had a ventriculoperitoneal (VP) shunt placed 6 weeks ago and now has experienced a seizure, vomiting, and loss of appetite. Which intervention will target the child's priority need? Pad and raise the rails on the child's bed. Prepare a menu with the child's favorite foods. Administer intravenous antibiotics as prescribed. Educate the parents about seizure precautions.

Administer intravenous antibiotics as prescribed. Explanation: The major complications associated with shunts are infection and malfunction. When a shunt malfunctions the child experiences vomiting, drowsiness, and headache. When infection has occurred the child experiences increased vital signs, poor feeding, vomiting, decreased responsiveness, seizure activity and signs of local inflammation along the shunt tract. When an infection occurs the priority of care is to treat the infection with IV antibiotics. The seizures and the poor eating will resolve once the infection is cleared. The parents can be taught about seizure precautions and the bed can be padded but these are not the priority of care.

A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action? Administer the medication as prescribed and monitor for therapeutic and adverse effects Contact the provider to question the dose Contact the provider to question the frequency Contact the provider to question the route

Administer the medication as prescribed and monitor for therapeutic and adverse effects Explanation: This prescription is within recommended parameters. The nurse should administer the medication and monitor the client.

A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient? Administer the next drug dose with milk. Observe alterations in blood pressure. Administer the next drug dose with meals. Withhold the next dose of the drug.

Administer the next drug dose with meals. Explanation: The nurse should administer the next drug dose with meals to manage gastrointestinal disturbances in a patient who has been administered antiparkinsonism drugs. Withholding the next dose of the drug, administering the next drug dose with milk, or observing alterations in the patient's blood pressure are not appropriate interventions when caring for a patient who is experiencing GI disturbances with the first dose of antiparkinsonism drugs.

An 18-year-old client has been taking phenytoin for the past 6 months for epileptic seizures. The client's phenytoin levels routinely fall within the therapeutic range. The client contacts the health care provider reporting nausea, headache, and diarrhea. What would be the most appropriate intervention based on the assessment of the client's symptoms and laboratory results? Advise the client to double the dose for 24 hours because the client is experiencing the symptoms of drug withdrawal. Advise the client to decrease the dose because the client is getting too much of the medication. Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Advise the client that these are normal reactions to the medication and he should continue the medication as ordered.

Advise the client to have his blood redrawn today to ensure that it is not at a toxic level. Explanation: Clients may demonstrate adverse effects even if the serum level of phenytoin is "normal"; it is important to adjust the dose to the clinical response of the client, not the serum level.

Which disease includes loss of motor neurons in the anterior horns of the spinal cord and motor nuclei of the lower brain stem? Alzheimer disease Parkinson disease Huntington disease Amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis Explanation: Amyotrophic lateral sclerosis (ALS) is a disease of unknown cause in which there is a loss of motor neurons in the anterior horns of the spinal cord and the motor nuclei of the lower brain stem. Parkinson disease is a slowly progressing neurologic movement disorder that eventually leads to disability. Alzheimer disease is a chronic, progressive, and degenerative brain disorder that is accompanied by profound effects on memory, cognition and ability for self-care. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary choreiform movement and dementia.

The school nurse notes a 6-year-old running across the playground with friends. The child stops in mid-stride, freezing for a few seconds. Then the child resumes his progress across the playground. The school nurse suspects what in this child? A tonic-clonic seizure A complex seizure An absence seizure A partial seizure

An absence seizure Explanation: Absence seizures, formerly referred to as petit mal seizures, are more common in children. They are characterized by a brief loss of consciousness, during which physical activity ceases. The person stares blankly; the eyelids flutter; the lips move; and slight movement of the head, arms, and legs occurs. These seizures typically last for a few seconds, and the person seldom falls to the ground. Because of their brief duration and relative lack of prominent movements, these seizures often go unnoticed. People with absence seizures can have them many times a day. Partial, or focal, seizures begin in a specific area of the cerebral cortex. A generalized seizure involves the whole brain.

What medication teaching should be done for a woman of childbearing age with a seizure disorder? Antiseizure drugs increase the risk for congenital abnormalities. All women of childbearing age should be advised to take a vitamin C supplement. Some antiseizure drugs can interfere with vitamin K metabolism. Antiseizure drugs do not interact with oral contraceptives.

Antiseizure drugs increase the risk for congenital abnormalities. Explanation: For women with epilepsy who become pregnant, antiseizure drugs increase the risk for congenital abnormalities and other perinatal complications. Many of the antiseizure medications interact with oral contraceptives and can interfere with vitamin D metabolism. All women should be advised to take folic acid supplementation.

A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) Apply an emollient lotion to soften the skin. Gradually resume activities and exercise. Use a razor to shave the dead skin off. Control swelling with elastic bandages, as directed. Use friction to remove dead surface skin by rubbing the area with a towel.

Apply an emollient lotion to soften the skin. Control swelling with elastic bandages, as directed. Gradually resume activities and exercise. Explanation: The skin needs to be washed gently and lubricated with an emollient lotion. The patient should be instructed to avoid rubbing and scratching the skin, because doing so can cause damage to newly exposed skin. The nurse and physical therapist educate the patient to resume activities gradually within the prescribed therapeutic regimen. Exercises prescribed to help the patient regain joint motion are explained and demonstrated. Because the muscles are weak from disuse, the body part that has been immobilized cannot withstand normal stresses immediately. In addition, the patient should be instructed to control swelling by elevating the formerly immobilized body part, no higher than the heart, until normal muscle tone and use are reestablished.

Which interventions should a nurse implement as part of initial pain relief for the client with a cast? Select all that apply. Elevate the involved part Provide passive range of motion Apply a new cast Administer analgesics Apply cold packs

Apply cold packs Administer analgesics Elevate the involved part Explanation: Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed, and by administering analgesics. The application of a new cast and providing passive range of motion would not assist in decreasing initial pain for a client with a cast.

A client reports to the nurse that over the past few months the elderly mother has become increasingly angry, responds inappropriately to conversations, and does not respond to calls if her back is turned away. What is the nurse's best response? Tell the client it appears the mother has a hearing loss. Teach the client techniques for coping with the mother's anger. Ask if the mother could come in for a hearing evaluation. Inform the client to ignore the behavior and the mother will stop.

Ask if the mother could come in for a hearing evaluation. Explanation: The client's mother may be experiencing a hearing loss, and the mother should be evaluated for the symptoms the client has described. The other options do not facilitate assessment and, thus, treatment.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Assess for complications. Reposition the client for comfort. Teach relaxation techniques. Assess for previous opioid drug use.

Assess for complications. Explanation: Unrelieved pain can be an indicator of a complication, such as compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the client for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority.

A hospitalized older adult complains of increased coughing and shortness of breath. The nurse assesses the vital signs as temperature 100.2°F oral, respirations 18, pulse 88, and BP 128/80. What action should the nurse do next? Instruct patient to use incentive spirometer. Assess lung sounds and sputum. Administer cough medicine as needed (PRN). Notify the physician.

Assess lung sounds and sputum. Explanation: The older adult's immune system is not as effective, so the older adult may not show typical signs and symptoms of infection. The nurse should assess the lung sounds and sputum for signs and symptoms of infection. A temperature of 100.2°F in an older adult warrants further investigation of infection. The nurse does not have all the required information needed to notify the physician; the nurse needs to listen to lung sounds before notifying the physician. Although the client may need cough medicine PRN, it is not the next action to be taken. The use of an incentive spirometer may help prevent lung issues, but is not the next step to be taken by the nurse.

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. Cut the cast with a cast saw Assess the fingers for color and temperature. Determine the exact site of the pain. Assess for a pressure sore Administer a prescribed analgesic to promote comfort and allay anxiety.

Assess the fingers for color and temperature. Assess for a pressure sore Determine the exact site of the pain. Explanation: Neurovascular assessment includes the assessment of peripheral circulation, motion, and sensation of the affected extremity, assessing the fingers or toes of the affected extremity, and comparing them with those of the opposite extremity. When assessing peripheral circulation, the nurse must check peripheral pulses as well as capillary refill response (within 3 seconds), edema, and the color and temperature of the skin. The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer.

The nurse is preparing an elderly hospitalized client for discharge to home within the hour. What should be the priority for the nurse? Encourage physical activity of 30 minutes following breakfast daily. Administer intravenous morphine for report of postoperative pain. Assess the need for pneumococcal and influenza vaccinations. Instruct the client to receive at least 1 hour of sun exposure each day.

Assess the need for pneumococcal and influenza vaccinations. Explanation: Activities that help elderly people maintain respiratory function include pneumococcal and yearly influenza immunizations. The nurse is to ensure the safety of the client. It is unsafe to administer an intravenous pain medication and then immediately discharge the client. Elderly clients should limit sun exposure to 10 to 15 minutes daily, and avoid heavy activity after eating to prevent indigestion.

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? Evaluating pedal and posterior tibial pulses every 2 hours Assessing movement and sensation in the fingers of the right hand Avoiding handling the cast for 24 hours or until it is dry Keeping the casted arm warm by covering it with a light blanket

Assessing movement and sensation in the fingers of the right hand Explanation: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

An elderly client is contemplating a move to a continuing care retirement community (CCRC). The nurse assesses that the client requires assistance with food preparation and recommends placement in Skilled nursing facility Assisted-living apartment Independent dwelling Acute care facility

Assisted-living apartment Explanation: Continuing care retirement communities have three levels of living arrangements and care. One is independent dwelling, in which people manage their own needs every day. The second is assisted living, in which people require limited assistance with their daily living needs. The third is skilled nursing services, in which continuous nursing assistance is provided. Acute care facility is not part of CCRC.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? Assisting in early ambulation. Using a continuous passive motion (CPM) machine. Encouraging expressions of anxiety. Providing crutches to the client.

Assisting in early ambulation. Explanation: An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

The nurse is teaching about preventing pneumonia and influenza to a group of clients in a senior citizens' wellness class. The nurse includes which of the following topics in the class? Select all options that apply. Participating in regular exercise Ensuring appropriate fluid intake Avoiding all sun exposure Following a high-calcium diet Avoiding environmental smoke

Avoiding environmental smoke Participating in regular exercise Ensuring appropriate fluid intake Explanation: Activities that help elderly clients maintain good respiratory function include avoiding environmental smoke, regularly exercising, and ensuring appropriate fluid intake. Sun exposure and a high-calcium diet are health-promotion strategies for the integumentary and musculoskeletal systems respectively.

The nurse is assessing the genitourinary status of an older adult female patient who is experiencing stress incontinence. What finding is a common gerontologic finding for this population? Urine is more dilute in the older population. All patients develop urinary tract infections. Renal filtration rate increases. Bladder capacity decreases with advanced age.

Bladder capacity decreases with advanced age. Explanation: Certain genitourinary disorders are more common in older adults than in the general population. In the United States, almost 50% of women 80 years of age and older suffer from urinary incontinence (i.e., urine leakage or problems controlling urine flow). This condition should not be mistaken as a normal consequence of aging (Weber & Kelley, 2010). Costly and often embarrassing, it should be evaluated, because in many cases it is reversible or can be treated.

A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient? Ataxia Gingival hyperplasia Urticaria CNS depression

CNS depression Explanation: The nurse should monitor CNS depression in the patient undergoing phenobarbital treatment. Gingival hyperplasia is an adverse reaction in a patient administered ethotoins. Ataxia and urticaria are adverse reactions in patients undergoing anticonvulsant ethosuximide therapy.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for: Swelling and discoloration. Shortening and deformity. Crepitus. Capillary refill.

Capillary refill. Explanation: Assessment for neurovascular impairment includes checking for weak pulses or delayed capillary refill (normal is <2 seconds).

A group of nursing students are preparing for a class presentation to discuss drugs used to treat Parkinson disease. Which drug would the group include when discussing dopaminergic agents? Biperiden Procyclidine Benztropine Carbidopa

Carbidopa Explanation: Carbidopa is classified as a dopaminergic agent that treats parkinsonism by supplementing the amount of dopamine in the brain. Benztropine is classified as a cholinergic blocking drug. Biperiden is classified as a cholinergic blocking drug. Pramipexole is classified as a non-ergot dopamine receptor agonist.

The nurse is working in a long-term care facility. When assessing her patients, what body system dysfunction should the nurse look for as the leading cause of morbidity and mortality in the older adult population? Genitourinary Cardiovascular Respiratory Gastrointestinal

Cardiovascular Explanation: Most deaths in the United States occur in people 65 years of age and older; 48% of these are caused by heart disease and cancer (Kochanek et al., 2011).

Which cleansing solution is the most effective for use in completing pin site care? Alcohol Hydrogen peroxide Chlorhexidine Betadine

Chlorhexidine Explanation: Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? Dislocation of the fingers Extension of the fingers of the right hand Claw-like deformity of the right hand without ability to extend fingers Nodules on the knuckles of the third and fourth finger

Claw-like deformity of the right hand without ability to extend fingers Explanation: A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand. Nodule on the knuckles and dislocation are not indicative of Volkmann's contracture.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? Compound Comminuted Depressed Impacted

Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect? Infection. Compartment syndrome. Chronic venous insufficiency. Phlebitis.

Compartment syndrome. Explanation: Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation.

A nurse is obtaining the health history of a 72-year-old woman who has come to the ambulatory care center for an evaluation. When obtaining information about the woman's sleep patterns, which of the following would the nurse expect to assess? Reports that she falls asleep more quickly Statements that she rarely takes naps during the day Reports that she has trouble waking up from sleeping Complaints about frequently waking up during the night

Complaints about frequently waking up during the night Explanation: Older adults tend to take longer to fall asleep, awaken more frequently and easily, and spend less time in deep sleep. They may experience variations in their normal sleep-wake cycles. Coupled with the lack of quality of sleep at night, napping during the day is a common complaint.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Greenstick Compound

Compound Explanation: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

A client is prescribed lamotrigine for control of partial seizures. What is the most important medication teaching information the nurse should emphasize from the plan of care? Take this medication with food to prevent nausea and vomiting. A mild headache may occur while taking this medication. Seek assistance when walking if dizziness occurs. Contact the health care provider immediately if rash appears.

Contact the health care provider immediately if rash appears. Explanation: GI upset, headache, rash, and dizziness are all adverse reactions of lamotrigine. The most important teaching point to emphasize is to notify the health care provider if a rash appears. A rash can develop into a Stevens-Johnson syndrome rash, a severe and potentially fatal rash.

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? Blood pressure of 140/90 mm Hg Crackles in the lung bases Client complains of pain in the affected rib area when taking a deep breath Heart rate of 94 beats/minute

Crackles in the lung bases Explanation: Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minute is within normal range.

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? Cutting a cast window Removal of the cast Insertion of an external fixator Cutting of a bivalve cast

Cutting a cast window Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? Increased acetylcholine level Increased norepinephrine level Decreased acetylcholine level Decreased norepinephrine level

Decreased acetylcholine level Explanation: A decreased acetylcholine level has been implicated as a cause of cognitive changes in healthy elderly clients and in the severity of dementia. Choline acetyltransferase, an enzyme necessary for acetylcholine synthesis, has been found to be deficient in clients with dementia. Norepinephrine is associated with aggression, sleep-wake patterns, and the regulation of physical responses to emotional stimuli, such as the increased heart and respiratory rates caused by panic.

A nurse is assessing an elderly client with senile dementia. Which neurotransmitter condition is most likely to contribute to this client's cognitive changes? Increased norepinephrine level Decreased acetylcholine level Choline acetyltransferase

The nurse is caring for a 15-year-old male who was involved in a motor vehicle accident and, as a result, sustained a closed head injury. The health care provider ordered phenytoin prophylactically to prevent seizures. The nurse understands that phenytoin works by what mechanism? Decreases the calcium available to the cells responsible for electrical activity in the brain Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Increases the potassium available to the cell to reduce the repolarization of the cell Increases the chloride available to promote depolarization of the cells

Decreases the sodium influx into the cell, thereby preventing the cell from producing a stimulus Explanation: Phenytoin (Dilantin) is the prototype drug that controls seizures by decreasing sodium influx into the cells. Sodium influx produces an action potential, which then causes the neurons to fire.

Regarding the pathophysiology of Parkinson disease, which statement is true? Failure of the cerebral cortex interferes with the use of acetylcholine. Degeneration of the nigrostriatal dopamine neurons occurs. The dopamine receptors increase from an alteration in neuronal basal ganglia. Acetylcholine levels rise and inhibit voluntary movement.

Degeneration of the nigrostriatal dopamine neurons occurs. Explanation: The primary brain abnormality found in all persons diagnosed with Parkinson disease is degeneration of the nigrostriatal dopamine neurons. Acetylcholine has no bearing on Parkinson development. There is a decrease in dopamine rather than an increase.

Which statement best describes the pathophysiology of Parkinson disease? Increase in the number of dopamine receptors by an alternate basal ganglion Rise in acetylcholine levels, causing an inhibition of voluntary movement Degeneration of the nigrostriatal dopamine system Failure of the cerebral cortex, which does not allow the use of acetylcholine

Degeneration of the nigrostriatal dopamine system Explanation: Parkinson disease presents with degenerative changes in the basal ganglia. Dopamine depletion results from degeneration in the nigrostriatal system. The cause of Parkinson disease is still unknown; it is widely believed that most cases are caused by an interaction of environmental and genetic factors.

Which statement best describes the pathophysiology of Parkinson disease? Rise in acetylcholine levels, causing an inhibition of voluntary movement Degeneration of the nigrostriatal dopamine system Increase in the number of dopamine receptors by an alternate basal ganglion Failure of the cerebral cortex, which does not allow the use of acetylcholine

When describing the action of barbiturates and barbiturate-like agents in the control of seizures, what would the nurse include? Promotion of impulse conduction Depression of motor nerve output Stimulation of the cerebral cortex Maintenance of cerebellar function

Depression of motor nerve output Explanation: The barbiturates and barbiturate-like drugs depress motor nerve output, inhibit impulse conduction in the ascending reticular activating system (RAS), depress the cerebral cortex, and alter cerebellar function. They stabilize nerve membranes throughout the CNS directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? Contracture of the hip Avascular necrosis of the hip Dislocation of the hip Re-fracture of the hip

Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? Disseminated intravascular coagulation (DIC) Complex regional pain syndrome (CRPS) Fat embolism syndrome (FES) Avascular necrosis (AVN)

Disseminated intravascular coagulation (DIC) Explanation: DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs.

A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate? Continue taking the vital signs. Distract the client with a familiar object or music. Place the client in a secluded room until calm. Document the inability to assess vital signs due to client's agitation.

Distract the client with a familiar object or music. Explanation: The nurse should try to calm the patient by using distraction with a familiar object or music. Continuing to take the vital signs will cause further agitation and possible harm to the client or nurse. Placing the client in a secluded room may increase agitation and should not be used in this situation. The nurse should document the inability to assess vital signs and the reason why this should be done after the client's basic needs have been met.

A client's recent diagnosis of Parkinson disease has prompted the care provider to promptly begin pharmacologic therapy. The drugs prescribed will likely influence the client's levels of which substance? Serotonin Dopamine Adenosine Acetylcholine

Dopamine Explanation: Although some antiparkinsonian drugs act by reducing the excessive influence of excitatory cholinergic neurons, most act by improving the function of the dopaminergic system. Serotonin and adenosine are not known to participate directly in the pathophysiology of Parkinson disease.

A nurse is providing care to a client with Parkinson's disease. The nurse understands the client's signs and symptoms are related to a depletion of which of the following? Acetylcholine Serotonin Dopamine Norepinephrine

Dopamine Explanation: Parkinson's disease is associated with decreased levels of dopamine resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglion region. The loss of dopamine stores results in more excitatory neurotransmitters (acetylcholine) than inhibitory transmitters (dopamine). Serotonin and norepinephrine are not involved.

A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain? Cerebellum Dopamine nigrostriatal system Serotonergic system Limbic system

Dopamine nigrostriatal system Explanation: The destruction of the dopamine nigrostriatal system upsets the balance of the basal ganglia, resulting in uncontrolled and uncoordinated movement. The cortex is involved in higher processing, serotonin is involved in the limbic system, and the cerebellum is unrelated to Parkinson disease; cerebellar disorders, however, will cause Parkinsonism.

A client with Parkinson disease presents with bradykinesia and an altered gait. These symptoms arise in response to the progressive deterioration of which structure in the brain? Dopamine nigrostriatal system Cerebellum Serotonergic system Limbic system

Which factor should the clinician reassess when combination therapy is ineffective? Drug side effects The patient's age and gender The frequency of the seizures Drug-drug interactions

Drug-drug interactions Explanation: If combination therapy is ineffective, the clinician may need to reassess the patient for type of seizure, medical conditions or drug-drug interactions that aggravate the seizure disorder or decrease the effectiveness of antiseizure drugs, and compliance with the prescribed drug therapy regimen.

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? Clients take an assortment of different drugs. Drugs administered may cause a wide variety of adverse effects. Clients generally do not adhere to the drug regimen. Drugs administered may not cause the requisite therapeutic effect.

Drugs administered may cause a wide variety of adverse effects. Explanation: Drugs administered for Parkinsonism may cause a wide variety of adverse effects, which requires careful observation of the client. Over time, clients may respond less and less to their standard drug therapy and have more frequent "off episodes" of hypomobility. As a result, the nurse should administer the drugs closely to the schedule. Generally, a single drug called levodopa is administered to clients with Parkinson's disease. It is also not true that drugs may not cause the requisite therapeutic effect or such clients do not adhere to the drug regimen.

A client with Parkinson's disease has been receiving levodopa as treatment for the past 7 years. The client comes to the facility for an evaluation and the nurse observes facial grimacing, head bobbing, and smacking movements. The nurse interprets these findings as which of the following? Bradykinesia Dyskinesia Micrographia Dysphonia

Dyskinesia Explanation: Most clients within 5 to 10 years of taking levodopa develop a response to the medication called dyskinesia, manifested as facial grimacing, rhythmic jerking movements of the hands, head bobbing, chewing and smacking movements, and involuntary movements of the trunk and extremities. Bradykinesia refers to an overall slowing of active movement and is a manifestation of the disorder. Micrographia refers to the development of small handwriting as dexterity declines with Parkinson's disease. Dysphonia refers to soft, slurred, low-pitched, and less audible speech that occurs as the disorder progresses.

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? Micrographia Dysphonia Hypokinesia Dysphagia

Dysphonia Explanation: Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.

A client has been prescribed carbamazepine for the prevention of seizures. What action should the nurse perform? Establish intravenous access Teach the client how to self-administer subcutaneous injections Educate the client about taking the medication at the first sign of impending seizure activity Educate the client about the need to take the pills as scheduled

Educate the client about the need to take the pills as scheduled Explanation: Carbamazepine is administered orally on an ongoing basis. It is not an emergency treatment for seizure activity.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Do ROM exercises as indicated. Breathe deeply and cough every 2 hours until ambulation is possible. Elevate the affected extremity and use cold applications. Apply antiembolism stockings as indicated.

Elevate the affected extremity and use cold applications. Explanation: Elevating the affected extremity and using cold applications reduce swelling. Deep breathing and coughing helps with maintenance of effective respiratory rate and depth. ROM exercises maintain full ROM of unaffected joints. Antiembolism stockings help prevent deep vein thrombosis (DVT).

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? Administer prescribed enema to prevent constipation Use frequent dependent positioning to prevent edema Encourage participation in ADLs Promote intake of omega-3 fatty acids

Encourage participation in ADLs Explanation: General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure.

A client has recently brought her elderly mother home to live with her family. The client states that her mother has moderate Alzheimer's disease and asks about appropriate activities for her mother. The nurse tells the client to Ensure that the mother does not have access to car keys or drive an automobile. Allow the mother to smoke cigarettes outside on the porch without supervision. Encourage the mother to take responsibility for cooking and cleaning the house. Turn off lights at night so that the mother differentiates night and day.

Ensure that the mother does not have access to car keys or drive an automobile. Explanation: A person with Alzheimer's disease needs to be provided with a safe environment. Driving is prohibited. Cooking and cleaning may be too much stimulation and place the client in danger. Daily activities must be simplified, short, and achievable. Smoking is allowed only with supervision. The person needs adequate lighting, and nightlights are helpful, particularly if the person has increased confusion at night.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? Remove the cast immediately, notifying the physician. Call for assistance to hold the client in the required position until the cast has dried. Explain that the sensation being felt is normal and will not burn the client. Administer antianxiety and pain medication.

Explain that the sensation being felt is normal and will not burn the client. Explanation: A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

The underlying causative problem in Parkinsonism is: Viral infection Autoimmune disorder Genetic defect Failure of dopamine release

Failure of dopamine release Explanation: Lack of dopamine release is the primary cause of Parkinson disease and associated symptoms.

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient? Spontaneous pneumothorax Fat emboli Pneumonia Cardiac tamponade

Fat emboli Explanation: After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash (NAON, 2007), although not all signs and symptoms manifest at the same time (Tzioupis & Giannoudis, 2011). The typical first manifestations are pulmonary and include hypoxia and tachypnea.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: Delayed union Complex regional pain syndrome Fat embolism syndrome Compartment syndrome

Fat embolism syndrome Explanation: The clinical manifestations described in the scenario are characteristic of fat embolism syndrome.

Which term refers to a fracture in which one side of a bone is broken and the other side is bent? Oblique Greenstick Spiral Avulsion

Greenstick Explanation: A greenstick fracture is a fracture in which one side of a bone is broken and the other side is bent. A spiral fracture is a fracture twisting around the shaft of the bone. An avulsion is when a fragment of bone has been pulled away by a ligament or tendon and its attachment. An oblique is a fracture occurring at an angle across the bone.

The nurse is educating a patient with a seizure disorder. What nutritional approach for seizure management would be beneficial for this patient? Restricts protein to 10% of daily caloric intake Low in fat At least 50% carbohydrate High in protein and low in carbohydrate

High in protein and low in carbohydrate Explanation: A dietary intervention, referred to as the ketogenic diet, may be helpful for control of seizures in some patients. This high-protein, low-carbohydrate, high-fat diet is most effective in children whose seizures have not been controlled with two antiseizure medications, but it is sometimes used for adults who have had poor seizure control (Mosek, Natour, Neufeld, et al., 2009).

A nurse is presenting a safety program to a group of older adults at a continuing care retirement community. The nurse emphasizes measures to reduce the risk of falls based on the understanding that which type of fracture is the most common? Femur Hip Ankle Forearm

Hip Explanation: The most common fracture resulting from falls is hip fracture, which is linked to both osteoporosis and the situation that provoked the fall. Many older adults who fall and sustain a hip fracture cannot regain their prefracture ability.

Which factor inhibits fracture healing? Increased vitamin D and calcium in the diet Age of 35 years History of diabetes Immobilization of the fracture

History of diabetes Explanation: Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection. Factors that enhance fracture healing include proper nutrition, vitamin D and calcium, exercise, maximum bone fragment contact, proper alignment, and immobilization of the fracture.

A nurse is educating a group of middle-aged adults on aging. What information should the nurse include in the teaching? A decline in sexual activity is a normal occurrence as you age. Most older adults reside in a long-term care facility. As an older adult, you will not be able to learn new skills or knowledge. How old you feel will be determined by your physical and cognitive abilities.

How old you feel will be determined by your physical and cognitive abilities. Explanation: The physical health and cognitive abilities of older adults are directly related to quality of life and how "old" one really feels. Older adults can maintain healthy sexual activity and are able to learn new skills and knowledge. Of older adults, 90% live in the community, not in long-term care facilities.

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 42 degree Celsius, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications? Atelectasis Osteomyelitis Urinary retention Hypovolemic shock

Hypovolemic shock Explanation: Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

An older adult client has been prescribed an antiseizure medication and is experiencing central nervous system depression. What is the nurse's most appropriate action? Make a referral to occupational therapy Maintain the client on bed rest Implement falls precautions Monitor vital signs hourly while the client is awake

Implement falls precautions Explanation: CNS depression creates a risk for falls, especially in older clients. There is no need to assess vital signs on an hourly basis and the harm of bed rest exceeds the benefits. Occupational therapy has no direct relationship with treating CNS depression.

An older adult client has been prescribed an antiseizure medication and is experiencing central nervous system depression. What is the nurse's most appropriate action? Implement falls precautions Maintain the client on bed rest Make a referral to occupational therapy Monitor vital signs hourly while the client is awake

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions Preventing demyelization of the efferent cerebellar pathways Increasing the functional ability of the underactive dopaminergic system Preventing axonal degradation of motor neurons

Increasing the functional ability of the underactive dopaminergic system Explanation: Antiparkinson drugs act by increasing the functional ability of the underactive dopaminergic system. The cerebellar pathways, acetylcholine levels and axonal degradation are not components of the etiology of Parkinson disease.

An elderly client exhibits blood pressure of 110/76 while prone, 100/72 sitting, and 92/64 standing. The nurse instructs the client to Use whirlpool baths for relaxation. Take daily hot showers. Ingest five or six small meals each day. Minimize the use of stool softeners.

Ingest five or six small meals each day. Explanation: A client who experiences orthostatic hypotension should eat five or six small meals to minimize hypotension that can occur after large meals. The client should avoid straining when having a bowel movement. A stool softener would be useful. Hot showers and whirlpools should be avoided.

What best reflects the action of barbiturates when used to control seizures? Stimulation of the cerebral cortex Inhibition of impulse conduction Stimulation of motor nerve output Enhancement of cerebellar functioning

Inhibition of impulse conduction Explanation: Barbiturates inhibit impulse conduction in the ascending reticular activating system. Barbiturates depress the cerebral cortex, depress cerebellar functioning, and depress motor nerve output.

An elderly client is hospitalized for treatment related to leukemia. Family members want to visit with a toddler who has a cold. It would be best for the nurse to Inform the family to either wash their hands or use the hand sanitizer. Ask the family to leave the client's room. Instruct the family to remove the toddler from the room for the protection of the client. Allow the toddler to remain in the room if a family member wipes the toddler's nose.

Instruct the family to remove the toddler from the room for the protection of the client. Explanation: Elderly clients, particularly those who may be immunocompromised, need to avoid exposure to those who may have upper respiratory tract infections. The toddler needs to be removed from the client's room, not the whole family. It is appropriate for the family to wash their hands or use the hand sanitizer. However, it does not address the runny nose of the toddler, and it is not the most important action of the nurse.

The nurse is describing hospice services to the family of a patient with end-stage heart failure. Which of the following would the nurse be least likely to include as a major focus of care? Pain control Invasive therapy Emotional support Symptom management

Invasive therapy Explanation: The goal of hospice is to improve the patient's quality of life by focusing on symptom management, pain control, and emotional support.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? Position the client on the affected side. Keep the legs in abduction. Promote elimination with a regular bedpan. Keep the cast clean and dry.

Keep the cast clean and dry. Explanation: Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.

The most effective drug to treat major symptoms associated with Parkinson's is: MAO inhibitors. Apomorphine. Levodopa. Amantadine.

Levodopa. Explanation: Levodopa is the most effective drug available for the treatment of Parkinson's disease. It relieves all major symptoms, especially bradykinesia and rigidity. Levodopa does not alter the underlying disease process, but it may improve a client's quality of life.

What should the nurse include as a possible adverse effect when teaching a client about phenytoin? Diarrhea Physical dependence Increased white blood cell count Liver toxicity

Liver toxicity Explanation: Liver toxicity is a potential adverse effect of phenytoin. Constipation, not diarrhea, is an adverse effect of phenytoin. Bone marrow suppression and leukopenia would be adverse effects of phenytoin. Physical dependence is an adverse effect associated with the use of benzodiazepines and barbiturates.

A client comes to the emergency department experiencing status epilepticus. Which medication would the nurse expect to administer? Methsuximide Levetiracetam Lorazepam Trimethadione

Lorazepam Explanation: Lorazepam is the drug of choice in the treatment of status epilepticus, an emergency characterized by continual seizure activity with no interruptions. Levetiracetam in an anticonvulsant is used as adjunctive therapy to treat partial onset seizures as well as tonic-clonic seizures. Trimethadione is used to treat epilepsy. Methsuximide is used for focal seizures.

A nurse is teaching nursing assistants in an extended-care facility measures to protect the skin of elderly clients. Which of the following measures is the nurse likely to recommend? Encouraging clients to avoid cigarette smoking Taking the clients outside for sun exposure daily Instructing clients to use perfumed skin creams Assisting clients to soak in the bathtub several times each week

Loss of bone density Explanation: Elderly clients experience decreased bone density; they also may experience a loss of bone density from insufficient exercise. For this client, however, additional information indicates that she is taking prednisone, which may induce osteoporosis (loss of bone density). No information indicates that the client is not exercising or has experienced degeneration of bone joints. Degeneration in the efficiency of the bone joints and decreased muscle mass and joint cartilage would have more of an effect on increased pain than on decreased height.

An elderly female client has been taking prednisone for breathing problems for many years. The nurse notes that the client's current height is 64 inches. Two years ago, her height was 66 inches. The nurse assesses this loss in height is most likely the result of Loss of bone density Decreased muscle mass and joint cartilage Degeneration in the efficiency of bone joints The client's failure to exercise

The nurse is collecting data from a child who may have a seizure disorder. Which nursing observations suggest an absence seizure? Muscle tone maintained and child frozen in position Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Brief, sudden contracture of a muscle or muscle group Sudden, momentary loss of muscle tone, with a brief loss of consciousness

Minimal or no alteration in muscle tone, with a brief loss of responsiveness or attention Explanation: Absence seizures are characterized by a brief loss of responsiveness with minimal or no alteration in muscle tone. They may go unrecognized because the child's behavior changes very little. A sudden loss of muscle tone describes atonic seizures. A frozen position describes the appearance of someone having akinetic seizures. A brief, sudden contraction of muscles describes a myoclonic seizure.

Which action would be a priority for a client receiving apomorphine? Checking for skin lesions Monitoring cardiac status Giving the drug with food Palpating the bladder

Monitoring cardiac status Explanation: Apomorphine is associated with a risk for hypotension and a prolonged QT interval. Therefore, the priority would be to monitor the client's cardiac status closely. The drug is given by subcutaneous injection, not oral administration. Checking for skin lesions would be appropriate for a client receiving levodopa due to its association with melanoma. Palpating the bladder would be appropriate for any dopaminergic agent because of the risk for urinary retention. However, this would not be the priority.

Which action would be a priority for a client receiving apomorphine? Palpating the bladder Monitoring cardiac status Checking for skin lesions Giving the drug with food

Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction? Huntington disease Parkinson syndrome Guillain-Barré syndrome Myasthenia gravis

Myasthenia gravis Explanation: Myasthenia gravis is an autoimmune disease caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction. Guillain-Barré syndrome is an acute immune-mediated polyneuropathy characterized by rapidly progressive, ascending symmetrical limb weakness and loss of tendon reflexes. Parkinson disease is a degenerative disorder of basal ganglia function associated with denervation of the nigrostriatal dopamine neurons. Huntington disease is a hereditary disorder which produces localized death of brain cells.

Which disease is thought to be caused by antibody-mediated loss of acetylcholine receptors in the neuromuscular junction? Parkinson syndrome Guillain-Barré syndrome Huntington disease Myasthenia gravis

Which of the following diseases is associated with fewer acetylcholine receptors, resulting in a lower-amplitude endplate potential, muscle weakness, and fatigability? Muscular dystrophy Myasthenia gravis Parkinson disease Guillain-Barré syndrome

Myasthenia gravis Explanation: People with myasthenia gravis have a reduced postsynaptic membrane area and fewer acetylcholine receptors, causing each release of acetylcholine from the presynaptic membrane to result in a lower-amplitude endplate potential.

A client who diagnosed with Parkinson's disease is being treated with levodopa/carbidopa. Which disorder will result in the discontinuation of this drug based on a disease-related contraindication? Narrow-angle glaucoma Human immune deficiency virus Transient ischemic attacks (TIA) Human papillomavirus

Narrow-angle glaucoma Explanation: Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. Levodopa is not contraindicated in clients with human immune deficiency virus, human papillomavirus, or TIAs.

A nurse is caring for a patient prescribed phenobarbital for status epilepticus. What intervention should the nurse perform when the patient has been administered the drug? Observe respirations frequently. Monitor blood glucose levels. Record fluid input and output. Monitor body temperature.

Observe respirations frequently. Explanation: When caring for a patient who has been administered phenobarbital, the nurse should observe respirations frequently. The nurse need not monitor blood glucose levels or body temperature. The nurse need not record fluid input and output. The nurse may need to observe blood glucose levels if the patient is being administered antidiabetic medications along with an anticonvulsant.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Arthrodesis Total joint arthroplasty Joint arthroplasty Open reduction

Open reduction Explanation: An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Open reduction Arthrodesis Joint arthroplasty Total joint arthroplasty

A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson's disease. The nurse would expect to administer this drug by which route? Intravenous Subcutaneous Oral Intramuscular

Oral Explanation: Trihexyphenidyl is available only in an oral form.

Disorders of the pyramidal tracts, such as a stroke, are characterized by which physical finding? Involuntary movements Muscle rigidity Paralysis Hypotonia

Paralysis Explanation: Disorders of the pyramidal tracts (e.g., stroke) are characterized by spasticity and paralysis, whereas those affecting the extrapyramidal tracts (e.g., Parkinson disease) are characterized by involuntary movements, muscle rigidity, and immobility without paralysis. Hypotonia is a condition of less-than-normal muscle tone. Hypertonia or spasticity is a condition of excessive tone. Paralysis refers to a loss of muscle movement. Upper motor neuron (UMN) lesions produce spastic paralysis and lower motor neuron (LMN) lesions flaccid paralysis.

The nurse teaches the client with which disorder that the disease is due to decreased levels of dopamine in the basal ganglia of the brain? Creutzfeldt-Jakob disease Multiple sclerosis Huntington disease Parkinson disease

Parkinson disease Explanation: In some patients, Parkinson disease can be controlled; however, it cannot be cured. Multiple sclerosis is a chronic, degenerative, progressive disease of the central nervous system (CNS) characterized by the occurrence of small patches of demyelination in the brain and spinal cord. Huntington disease is a chronic, progressive, hereditary disease of the nervous system that results in progressive involuntary dancelike movements and dementia. Creutzfeldt-Jakob disease is a rare, transmissible, progressive and fatal disease of the CNS characterized by spongiform degeneration of the gray matter of the brain.

A patient is admitted to the hospital for management of an extrapyramidal disorder. Included in the physician's admitting orders are the medications levodopa, benztropine, and selegiline. The nurse knows that most likely, the client has a diagnosis of: Huntington disease. multiple sclerosis. seizure disorder. Parkinson disease.

Parkinson disease. Explanation: Although antiparkinson drugs are used in some clients with Huntington disease, these drugs are most commonly used in the medical management of Parkinson disease. The listed medications are not used to treat a seizure disorder. The listed medications are not used to treat MS.

A 55-year-old female client presents at the walk-in clinic complaining of feeling like a mask is on her face. While doing the initial assessment, the nurse notes the demonstration of a pill-rolling movement in the right hand and a stooped posture. Physical examination shows bradykinesia and a shuffling gait. What would the nurse suspect is the causative factor for these symptoms? Parkinson's disease Myasthenia gravis Huntington's disease Multiple sclerosis

Parkinson's disease Explanation: Early signs include stiffness, referred to as rigidity, and tremors of one or both hands, described as pill-rolling (a rhythmic motion of the thumb against the fingers). The hand tremor is obvious at rest and typically decreases when movement is voluntary, such as picking up an object. Bradykinesia, slowness in performing spontaneous movements, develops. Clients have a masklike expression, stooped posture, hypophonia (low volume of speech), and difficulty swallowing saliva. Weight loss occurs. A shuffling gait is apparent, and the client has difficulty turning or redirecting forward motion. Arms are rigid while walking. These symptoms are not indicative of MS, Myasthenia gravis, or Huntington's.

Elderly clients who fall are most at risk for which injuries? Humerus fractures Cervical spine fractures Pelvic fractures Wrist fractures

Pelvic fractures Explanation: Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific.

A nurse is providing a fall prevention clinic for a group of older adults. What information should the nurse include? Select all that apply. Use scatter rugs on hard wood surfaces. Place grab bars in the shower and tub Review medications routinely for side effects Wear nonslip shoes or socks when walking Have routine vision and hearing screenings Frequently change the furniture layout in the home

Place grab bars in the shower and tub Have routine vision and hearing screenings Wear nonslip shoes or socks when walking Review medications routinely for side effects Explanation: Grab bars in the shower and tub may decrease the chance of a fall on a slippery surface. Visual and hearing issues may contribute to falls. Medication interaction and side effects may increase the risk for falls, so medications should be reviewed. The older adult should wear proper nonskid footwear or socks when walking to help prevent falls. Changing the layout of the furniture in the home may increase the risk for falls because of items being in unfamiliar locations. Scatter rugs should not be used because they increase the risk for falls.

A client with moderate Alzheimer's disease has been eating poorly, losing weight, and playing with food at meals. The nurse best intervenes by Placing one food at a time in front of the client during meals Converting liquid foods to a gelatin texture Serving hot foods at a warm temperature Cutting the client's food into small pieces

Placing one food at a time in front of the client during meals Explanation: Tasks should be simplified for the client with Alzheimer's disease. All options are steps the nurse can take to promote eating for the client with Alzheimer's disease. Offering one food at a time, however, helps to prevent the client from playing with food.

Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture? Asthma attacks Bronchospasm Pneumonia Confusion

Pneumonia Explanation: Older adults, who are more subject to falls, may fracture one or more ribs and be more susceptible to pneumonia after a rib fracture. Confusion, asthma attacks, and bronchospasm are not conditions that occur after a rib fracture.

An elderly client recovering from a hip repair becomes disoriented and tries to get out of bed frequently. The client states, "I forget I am in the hospital." The best nursing intervention is to Post a sign stating "You are in the hospital" at the client's eye level. Raise the upper and lower side rails of the bed. Place the client in a Posey chest restraint with ties attached to the bed frame. Administer an oral dose of prescribed alprazolam (Xanax).

Post a sign stating "You are in the hospital" at the client's eye level. Explanation: Client confusion increases the risk of falls. Environmental cues include a sign stating, "You are in the hospital." Measures that are not restraining are used first. Raising the lower side rails is considered a restraint. This increases a confused client's risk for falling. Placing a client in a Posey chest restraint is a last resort. Administering an anti-anxiety medication can increase confusion in a client who is already confused.

Which is an age-related change associated with the nervous system? Increased cerebral function Increased nerve impulse conduction Cerebral hypertrophy Postural hypotension

Postural hypotension Explanation: Postural hypotension, cerebral atrophy, decreased cerebral function, and decreased nerve impulse conduction are age-related changes associated with the nervous system.

Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting farther away? Glaucoma Cataract Presbycusis Presbyopia

Presbyopia Explanation: Presbyopia usually begins in the fifth decade of life, when reading glasses are required to magnify objects. Presbycusis refers to age-related hearing loss. Cataract is the development of opacity of the eye lens. Glaucoma is a disease characterized by increased intraocular pressure.

A nurse is caring for a client who has been prescribed diphenhydramine for the treatment of Parkinson disease in an older adult. The client reports diplopia and blurred vision. Which intervention would be appropriate? Provide proper assistance with ambulation. Provide eye protection to the client. Instruct the client to place a cool cloth over eyes. Instruct the client to avoid direct sunlight.

Provide proper assistance with ambulation. Explanation: The nurse should provide proper assistance with ambulation to the client who has developed a visual difficulty. Instructing the client to avoid direct sunlight, providing eye protection to the client, and instructing the client to place a cool cloth over the eyes are not appropriate interventions because they will not help reduce the client's discomfort due to diplopia, nor will they minimize the symptoms.

A nurse is providing care to a patient with delirium. Which interventions would be most appropriate to implement? Select all that apply. Supervising nutritional intake Administering psychoactive drugs Using familiar cues about the environment Providing a calm, quiet environment Keeping the patient awake as much as possible

Providing a calm, quiet environment Supervising nutritional intake Using familiar cues about the environment Explanation: Appropriate interventions when caring for a patient with delirium include maintaining a calm, quiet environment, supervising and monitoring nutritional and fluid intake, and using familiar environmental cues. Psychoactive drugs should be minimized to reduce the possibility of delirium. Keeping the patient awake as much as possible would lead to sleep deprivation, which would increase the patient's risk for delirium.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? Hypovolemia Urinary tract infection Atelectasis Pulmonary embolism

Pulmonary embolism Explanation: Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism.

A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa? Cyanocobalamin (vitamin B12) Ascorbic acid (vitamin C) Pyridoxine (vitamin B6) Phylloquinone (vitamin K1)

Pyridoxine (vitamin B6) Explanation: A nurse should counsel clients receiving levodopa to avoid foods high in pyridoxine (vitamin B6) as it reduces the effect of levodopa. Cyanocobalamin is used to treat pernicious anemia; however, if it is taken with Prilosec, the Prilosec can interfere with the absorption of B12. Phylloquinone (vitamin K1) is well known for being crucial for proper blood clotting and is contraindicated if the client is on anticoagulation therapy. When taking ascorbic acid (vitamin C), the client should tell the health care provider as side effects may be increased.

Which is a factor that contributes to urinary incontinence in older female adults? Relaxed perineal muscle Increased bladder capacity Decreased urinary residual Detrusor stability

Relaxed perineal muscle Explanation: Female older adults typically have relaxed perineal muscle. The relaxed muscle can contribute to urinary incontinence, especially when laughing, coughing, and sneezing. Decreased urinary residual would not be a contributing factor. Most older adults have an increase in urinary residual. Most older adults have a decreased bladder capacity; this contributes to an increase in frequency in urination but not incontinence. Detrusor stability is a normal finding and helps prevent incontinence.

While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client's bedside table and scattered bruising over the client's extremities. What is the nurse's best action? Notify the charge nurse about reporting suspected physical abuse. Tell the client to ask for assistance when ambulating so as to prevent bruising. Report the findings to the primary health care provider immediately. Document the findings and offer the client a soft-bristled toothbrush.

Report the findings to the primary health care provider immediately. Explanation: The client has a history of epilepsy and is likely taking anticonvulsants. Hematologic changes when taking anticonvulsants needs to be reported immediately to the health care provider. Such changes include bleeding gums and easy bruising. Abuse is not the likely cause of the client's bruising given the history of epilepsy. Telling the client to ask for assistance when ambulating and offering a soft toothbrush are appropriate, but the health care provider needs to be notified immediately about the hematologic changes.

A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical? Exercising joints above and below the cast, as ordered Reporting signs of impaired circulation Avoiding walking on a leg cast without the health care provider's permission Using crutches properly

Reporting signs of impaired circulation Explanation: Although all of these points are important, reporting signs of impaired circulation is the most critical. Signs of impaired circulation must be reported to the health care provider immediately to prevent permanent damage. The other options reflect more long-term concerns. The client should learn to use crutches properly to avoid nerve damage. The client may exercise above and below the cast, as the health care provider orders. The client should be told not to walk on the cast without the health care provider's permission.

When assessing an older adult, the nurse anticipates an increase in which component of respiratory status? Cough efficiency Vital capacity Residual lung volume Gas exchange and diffusing capacity

Residual lung volume Explanation: With an increase in residual lung volume the client experiences fatigue and breathlessness with sustained activity. The nurse anticipates decreased vital capacity. The nurse anticipates decreased gas exchange and diffusing capacity resulting in impaired healing of tissues due to decreased oxygenation. The nurse anticipates difficulty coughing up secretions due to decreased cough efficiency.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? Right shoulder slopes downward and droops inward. Client complains of tingling and numbness in the right shoulder. Client complains of pain in the unaffected shoulder. Right shoulder is elevated above the left.

Right shoulder slopes downward and droops inward. Explanation: The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

The nurse is preparing a care plan for a child who has a seizure disorder. The child experiences tonic-clonic seizures. Which nursing diagnosis will the nurse identify as having the highest priority? Risk for self-care deficit: bathing and dressing Risk for injury Risk for ineffective tissue perfusion: cerebral Risk for delayed development

Risk for injury Explanation: A seizure disorder is caused by a disruption in the electrical impulses in the brain. Tonic-clonic seizures are the most dramatic seizure disorder. It is characterized by a loss of consciousness, along with the entire body experiencing tonic contractions followed by rhythmic clonic contractions alternating with relaxation of all muscle groups. Cyanosis may be noted due to apnea, and saliva may collect in the mouth due to an inability to swallow. All of these symptoms would make Risk for injury the highest priority.

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? Heterotopic ossification Epicondylitis Rotator cuff tears Acute compartment syndrome

Rotator cuff tears Explanation: Key assessment findings related to rotator cuff tears include acromioclavicular joint pain, limited range of motion, and muscle weakness. Epicondylitis (tennis elbow) is manifested by pain that usually radiates down the extensor surface of the forearm and generally is relieved with rest and avoidance of the aggravating activity. Heterotopic ossification is the abnormal formation of bone, near bones or in muscle, in response to soft tissue trauma after blunt trauma, fracture, or total joint replacement. Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur.

Following a generalized seizure in a client, which nursing assessment is a priority for detailing the event? Seizure was 1 minute in duration including tonic-clonic activity. Sleeping quietly after the seizure Seizure began at 1300 hours. The client cried out before the seizure began.

Seizure was 1 minute in duration including tonic-clonic activity. Explanation: Describing the length and the progression of the seizure is a priority nursing responsibility. During this time, the client will experience respiratory spasms, and their skin will appear cyanotic, indicating a period of lack of tissue oxygenation. Noting when the seizure began and presence of an aura are also valuable pieces of information. Postictal behavior should be documented along with vital signs, oxygen saturation, and assessment of tongue and oral cavity.

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? Sore and aching A dull, deep, boring ache Sharp and piercing Similar to "muscle cramps"

Sharp and piercing The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place.

Which principle applies to the client in traction? Skeletal traction is never interrupted. Knots in the ropes should touch the pulley. Weights are removed routinely. Weights should rest on the bed.

Skeletal traction is never interrupted. Explanation: Skeletal traction is applied directly to the bone and is never interrupted. To be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait? Hyperactive leg motions like he just can't stand still Difficulty putting weight on soles of feet and tends to walk on tiptoes Slow to start walking and has difficulty when asked to "stop" suddenly Takes large, exaggerated strides and swings arms/hands wildly

Slow to start walking and has difficulty when asked to "stop" suddenly Explanation: The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? Trapeze Continuous passive motion (CPM) device Splint Brace

Splint Explanation: A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.

Which would a nurse identify as least likely to contribute to a decrease in the effectiveness of levodopa? Pyridoxine St. John's wort phenytoin multivitamin supplements

St. John's wort Explanation: St. John's wort can lead to hypertensive crisis if taken with rasagiline, not levodopa. Clients should be cautioned to avoid taking pyridoxine (vitamin B6), phenytoin, and multivitamin supplements if also taking levodopa.

Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse? Diabetic with fasting blood sugar 92; "It is difficult to afford food with all of these medication costs." Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." BMI 24; "My family never gives me my favorite foods." Obvious deformity to right arm; "I tripped on the rug and fell on my arm."

Stage II decubitus ulcer on coccyx; "No one is able to turn or lift me anymore." Explanation: Neglect is the most common form of elder abuse. The inability of an older adult to obtain basic care is considered neglect. If a client is not being turned or repositioned to prevent skin breakdown, then neglect is happening. A BMI of 24 is within the normal range, and the inability of the client to have his or her favorite foods would not be abuse. The client with diabetes has blood sugar within normal ranges, and the client is only expressing concern over the cost of medications; social services may need to be notified to provide help through community resources. The story provided by the older adult with the deformed arm is consistent with the injury.

A client presents at the emergency department with a compound fracture of the right femur. Skeletal traction is applied to align the bones. What type of traction would be used? Buck's traction Thomas splint Steinmann traction Russell traction

Steinmann traction Explanation: Skeletal traction is applied directly to a bone by using a wire (Kirschner), pin (Steinmann), or cranial tongs (Crutchfield). General or local anesthesia may be used when inserting these devices.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? Teach the client how to prevent problems caused by immobility. Assess the client's level of consciousness. Remove the traction at least every 8 hours. Apply the traction straps snugly.

Teach the client how to prevent problems caused by immobility. Explanation: By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

Which statement is accurate regarding care of a plaster cast? The cast must be covered with a blanket to keep it moist during the first 24 hours. A dry plaster cast is dull and gray. The cast can be dented while it is damp. The cast will dry in about 12 hours.

The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.

Which statement is accurate regarding care of a plaster cast? The cast must be covered with a blanket to keep it moist during the first 24 hours. The cast will dry in about 12 hours. A dry plaster cast is dull and gray. The cast can be dented while it is damp.

The nurse is preparing discharge education for the caregivers of a child with a seizure disorder. Which goal of treatment is priority for this client? The child will remain free from injury during a seizure. The family will understand seizure precautions. The child will have an understanding of the disorder. The caregivers will be prepared to care for the child at home.

The child will remain free from injury during a seizure. Explanation: Keeping the child free from injury is the priority goal. The other choices are important, but keeping the child safe is higher than preparing for home care or knowledge deficit concerns. The physical concerns are always priority over the psychological concerns when caring for clients.

An adult client underwent diagnostic testing after experiencing an absence seizure for the first time. What aspect of this client's health history may result in impaired drug excretion? The client takes a beta-blocker for the treatment of hypertension The client has a history of adhering poorly to prescribed treatment The client is morbidly obese The client has recently been diagnosed with diabetic nephropathy

The client has recently been diagnosed with diabetic nephropathy Explanation: Impaired renal function will reduce drug excretion. A lack of adherence must be addressed but this does not affect excretion. Similarly, obesity and the use of a beta-blocker will not inhibit excretion.

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed? The skin may be covered with a yellowish crust that will shed in a few days. The leg strength is enforced by the wearing of the cast. The leg will look as it did prior to the cast being applied. The leg will look moist and will have small bumps that will go away in a few days.

The skin may be covered with a yellowish crust that will shed in a few days. Explanation: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger.

Which statement describes external fixation? The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. The bone is restored to its normal position by external manipulation. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. The bone is surgically exposed and realigned.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. Explanation: In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.

A female client is diagnosed with Parkinson's disease and is having difficulty performing her activities of daily living. Her health care provider orders pramipexole. Pramipexole may be used alone for which purpose? To delay mental impairment related to Parkinson's disease To delay physical impairment related to Parkinson's disease To maintain ability to perform activities of daily living To improve motor performance and improve ability to participate in usual activities of daily living

To improve motor performance and improve ability to participate in usual activities of daily living Explanation: Pramipexole (Mirapex), ropinirole (Requip), and rotigotine-transdermal (Neupro) stimulate dopamine receptors in the brain. They are approved for both beginning and advanced stages of Parkinson's disease. In early stages, one of these drugs can be used alone to improve motor performance, improve ability to participate in usual activities of daily living, and delay levodopa therapy.

A female client is diagnosed with Parkinson's disease and is having difficulty performing her activities of daily living. Her health care provider orders pramipexole. Pramipexole may be used alone for which purpose? To maintain ability to perform activities of daily living To delay mental impairment related to Parkinson's disease To improve motor performance and improve ability to participate in usual activities of daily living To delay physical impairment related to Parkinson's disease

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? Osteotomy Arthrodesis Total arthroplasty Hemiarthroplasty

Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.

The nurse is educating the parents of a 7-year-old girl with epilepsy about managing treatment of the disorder at home. Which intervention is most effective for eliminating breakthrough seizures? Understanding the side effects of medications Treating the child as though she did not have epilepsy Instructing her teacher how to respond to a seizure Placing the child on her side on the floor

Understanding the side effects of medications Explanation: The most common cause of breakthrough seizures is noncompliance with medication administration, which may occur if the parents do not understand what side effects to expect or how to deal with them. Treating the child as though she did not have epilepsy helps improve her self-image and self-esteem. Placing the child on her side on the floor is an intervention to prevent injury during a seizure. Instructing the teacher on how to respond when a seizure occurs will help relieve anxiety and provide a sense of control.

An older adult female patient informs the nurse that she is sexually active but has a problem with vaginal dryness. What can the nurse tell the patient that may help relieve this problem? Use a water-based lubricant with sexual intercourse. Use vaginal douche daily. Use an over-the-counter antifungal cream to treat the fungal infection she probably has. Find other methods of sexual expression.

Use a water-based lubricant with sexual intercourse. Explanation: Changes that occur in the female reproductive system include thinning of the vaginal wall, along with a shortening of the vagina and a loss of elasticity; decreased vaginal secretions, resulting in vaginal dryness, itching, and decreased acidity; involution (atrophy) of the uterus and ovaries; and decreased pubococcygeal muscle tone, resulting in a relaxed vagina and perineum. Without the use of water-soluble lubricants, these changes may contribute to vaginal bleeding and painful intercourse. Use of a vaginal douche daily would not improve vaginal dryness. The vaginal dryness is not associated with a fungal infection. There is no need for the woman to find another method of sexual expression.

Which may occur if a client experiences compartment syndrome in an upper extremity? Callus Whiplash injury Volkmann's contracture Subluxation

Volkmann's contracture Explanation: If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

The reason that federal and state governments carefully regulate the treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement? Vulnerability of older adult patients Patient's inability to make any health care decision Patient's lack of different perspectives Patient's incapacity due to cognitive impairment

Vulnerability of older adult patients Explanation: Because of the vulnerability of older adults, federal and state governments have carefully regulated the treatment given in licensed health care facilities. Cognitive impairment does not automatically constitute incapacity. Older people with fluctuating cognitive status may retain sufficient ability to make some, if not all, their health care decisions. Individuals with different perspectives are required in ethics committees to resolve ethical dilemmas.

A client reports to the nurse that her mother had macular degeneration and is concerned that she, too, may be at risk. What should the nurse tell the client? Vision loss is not hereditary. It is related to diet. This condition is now curable. Wear sunglasses with ultraviolet (UV) protection when outside. Reduce the amount of cigarettes smoked daily from 20 to 10.

Wear sunglasses with ultraviolet (UV) protection when outside. Explanation: A risk factor for macular degeneration is sunlight exposure. Wearing sunglasses provides some protection. Cigarette smoking is another risk factor, and the client must stop smoking to reduce risk. Still another risk factor is heredity, and the client's mother had macular degeneration. Macular degeneration may be treated, but there is no cure.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? Body aligned opposite to line of traction pull Weights hanging and touching the floor Pulleys without evidence of the obstruction Ropes freely moving over pulleys

Weights hanging and touching the floor Explanation: When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.

A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine? With amantadine, catabolism occurs in the kidneys. With amantadine, metabolism occurs in the kidneys. With amantadine, 50% of the drug is excreted via the kidneys. With amantadine, excretion is primarily via the kidneys.

With amantadine, excretion is primarily via the kidneys. Explanation: With amantadine, excretion is primarily via the kidneys, and the drug should be used with caution in clients with renal failure.

Which is not one of the general nursing measures employed when caring for the client with a fracture? cranial nerve assessment assisting with ADLs administering analgesics providing comfort measures

cranial nerve assessment Explanation: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

A nurse is preparing a presentation for a local senior center about the health status of older adults. What trends in health promotion and disease prevention activities would the nurse explain as contributing to declining death rates in the older adult population? Select all that apply. decreased smoking screening for hypertension early detection of elevated cholesterol levels decreased exercise improved nutrition decreased community-based services

decreased smoking improved nutrition screening for hypertension early detection of elevated cholesterol levels Explanation: Most deaths in the United States occur in people 65 years or older, with one-half of these caused by heart disease and cancer. Decreased smoking, improved nutrition, screening for hypertension, and early detection of elevated cholesterol levels are contributing factors to a decreased death rate in older adults. Older adults are encouraged to increase exercise and increase community-based services.

The most common affective or mood disorder of old age is schizophrenia. depression. phobias. anxiety disorder.

depression. Explanation: Depression is the most common affective or mood disorder of old age. Anxiety disorders, schizophrenia, and phobias are not a common affective or mood disorder of old age.

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose? strain dislocation sprain fracture

dislocation Explanation: In joint dislocation, radiographic films show intact yet malpositioned bones. Arthrography or arthroscopy may reveal damage to other structures in the joint capsule. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. Sprains are injuries to the ligaments surrounding a joint. A fracture is a break in the continuity of a bone.

Meniscectomy refers to the incision and diversion of the muscle fascia. excision of damaged joint fibrocartilage. replacement of one of the articular surfaces of a joint. removal of a body part.

excision of damaged joint fibrocartilage. Explanation: The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Amputation refers to the removal of a body part.

The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for: infection. uncontrolled bleeding. falls. excessive sedation.

falls. Explanation: Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls.

What is a common risk for epileptic seizures during late infancy to early childhood? malnutrition medication overdose learning disability fever

fever Explanation: Epilepsy can be classified as idiopathic or attributable to a secondary cause. Secondary causes in infancy include developmental defects, metabolic disease, or birth injury. Fever is a common cause during late infancy and early childhood, and inherited forms usually begin in childhood or adolescence. Learning disability, medication overdose, and malnutrition are not risk factors.

What is the primary medication prescribed to relieve pain associated with shingles? meperidine gabapentin morphine sulfate naproxen sodium

gabapentin Explanation: Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine and morphine sulfate will provide pain relief, but neither are effective in postherpetic neuralgia relief. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia relief.

A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect? mobility. perspiration. involuntary movements. appetite or thirst.

involuntary movements. Explanation: Abnormal and involuntary movements are among the most common and serious adverse effects of carbidopa-levodopa therapy. Increased appetite, thirst, and perspiration are not common adverse effects, and increased mobility is a desired outcome of treatment.

A fracture is considered pathologic when it results in a fragment of bone being pulled away by a ligament or tendon and its attachment. involves damage to the skin or mucous membranes. occurs through an area of diseased bone. presents as one side of the bone being broken and the other side being bent.

occurs through an area of diseased bone. Explanation: Pathologic fractures can occur without the trauma of a fall. An avulsion fracture results in a fragment of bone being pulled away by a ligament or tendon and its attachment. A greenstick fracture presents as one side of the bone being broken and the other side being bent. A compound fracture involves damage to the skin or mucous membranes.

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? hematoma osteomyelitis infection hemorrhage

osteomyelitis Explanation: Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? discontinue use of crutches cold compresses to leg for swelling physical therapy No options are correct.

physical therapy Explanation: For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.

The three major features of Parkinson's include: rigidity, bradykinesia, and tremors. urinary retention, stooped posture, and constipation. slow gait, worsening eyesight, and slowed thought process. masked facies, bradycardia, and hypertension.

rigidity, bradykinesia, and tremors. Explanation: Classic symptoms of Parkinson's disease include resting tremor, bradykinesia, rigidity, and postural instability.

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. wound infection skin breakdown diarrhea pneumonia

skin breakdown wound infection pneumonia Explanation: After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.

What type of seizure activity is characterized by generalized tonic-clonic convulsions lasting for several minutes during which the client does not regain consciousness? status epilepticus febrile akinetic motor

status epilepticus Explanation: Status epilepticus is a life-threatening emergency characterized by generalized tonic-clonic convulsions lasting for several minutes or occurring at close intervals during which the client does not regain consciousness. None of the other options present with this described experience.

To encourage adequate nutritional intake for a client with Alzheimer's disease, a nurse should: fill out the menu for the client. give the client privacy during meals. help the client fill out his menu. stay with the client and encourage him to eat.

stay with the client and encourage him to eat. Explanation: Staying with the client and encouraging him to feed himself will ensure adequate food intake. A client with Alzheimer's disease can forget how to eat. Allowing privacy during meals, filling out the menu, or helping the client to complete the menu doesn't ensure adequate nutritional intake.

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care? traction joint immobilization ice and NSAIDs limited weight bearing

traction Explanation: Joint immobilization, limited weight bearing, ice, and NSAIDs would be included in the initial treatment. Traction is not required because there is no break, and surgery is not required.

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