Chapter 20 exam3

A client who has had total hip replacement surgery asks the nurse when she will be able to use a regular-height toilet seat again. What is the nurse's best response? a. "As soon as you are able to walk without a limp." b. "As soon as the staples are removed from the incision." c. "When you are off pain medication and warfarin (Coumadin)." d. "When you can hold your leg 6 inches off the bed for 5 full minutes."

A. As soon as you are able to walk without a limp

The nurse is caring for a post operative client on the med surg unit following a total left hip replacement the previous day. During the assessment, the nurse notes that the client's left leg is cool, with weak pedal pulses. What is the nurse's first action? a. Assess circulatory status of the right leg. b. Notify the surgeon immediately. c. Measure leg circumference at the calf. d. Check for bilateral Homans' signs.

A. Assess circulatory status of the right leg.

The nurse is caring for a client who has had hip replacement surgery 2 days before. The client reports severe pain at the surgical site despite having received 2 Vicodin tablets 2 hours previously. The client is requesting IV pain medication. What is the nurse's primary intervention? a. Assess the surgical site for signs of infection. b. Administer 2 more Vicodin tablets. c. Apply a large ice bag to the operative site. d. Reassure the client that the Vicodin will work soon.

A. Assess the surgical site for signs of infection

The school nurse removes a tick embedded in a student's scalp by the hairline. Which follow-up instruction is the nurse sure to provide to the mother? a. "Call your pediatrician right away if a fever or a red rash develops at the bite." b. "If your child does not have symptoms within 2 weeks, you can relax." c. "Call your pediatrician tomorrow to get antibiotics to prevent Lyme disease." d. "Keep the site clean, but you don't have to worry about further problems."

A. Call your pediatrician right away if a fever or a red rash develops at the bite.

The nurse is working a t a clinic, where several clients are waiting to be seen. Which client does the nurse assess first? a. Client with temporal arteritis with new onset of blurry double vision b. Client with polymyalgia rheumatica with low-grade fever and fatigue c. Client with polymyositis reporting generalized rash and joint pain d. Client with ankylosing spondylitis who presents with back pain and weight loss

A. Client with temporal arteritis with new onset of blurry double vision

The nurse is caring for a client who has dysphagia caused by systemic sclerosis. What is the best intervention for the nurse to implement for this client? a. Encourage frequent, high-protein, easy to swallow foods. b. Teach the client to lie flat after meals to prevent reflux. c. Thicken liquids to a nectar or honey consistency. d. Have the client hyperextend his or her neck while swallowing.

A. Encourage frequent, high protein, easy to swallow foods.

The nurse is caring for a female client who has a history of chronic fatigue syndrome. Which finding is the nurse surprised to see in the client's record? a. Hemoglobin, 7.2 g/dL b. Serum creatinine, 0.9 mg/dL c. Multiple tender lymph nodes d. Newly red, swollen, warm knee

A. Hemoglobin, 7.2 g/dL

An older adult client is scheduled for knee replacement surgery. Which statement by the client indicates a need for further preoperative instruction? a. "I need to keep my leg positioned away from my body." b. "I may have a continuous passive motion machine for a few days." c. "I may need more pain medicine than I did with my hip replacement." d. "I probably can get back to work within 2 to 3 weeks."

A. I need to keep my leg positioned away from my body.

The nurse is teaching a community health class about health promotion techniques. Which statement by a student indicates a strategy to help prevent the development of osteoarthritis? a. "I will keep my BMI under 24." b. "I will switch to low-tar cigarettes." c. "I will start jogging twice a week." d. "I will have a family tree done."

A. I will keep my BMI under 24

(Select All) After hip replacement surgery, a client receives two doses of enoxaprain (Lovenox) during the day shift. What orders does the nurse anticipate for the client? a. Laboratory draw for platelet count b. Laboratory draw for prothrombin time (PTT) c. Laboratory draw for international normalized ratio (INR) d. Order for protamine sulfate e. Order for vitamin K

A. Laboratory draw for platelet count D. Order for protamine sulfate

A client with rheumatoid arthritis had abdominal surgery and has returned to the postoperative nursing unit. The client is unable to use the incentive spiromter correctly, demonstrating limited lung volume and fatiguing easily. What action by the nurse takes priority? a. Notify the physician immediately. b. Have respiratory therapy re-instruct the client. c. Assess for pain and medicate if necessary. d. Let the client rest for a few hours.

A. Notify the physician immediately

A client had a total knee replacement this morning and has a continuous passive motion machine. What activity related to the CPM does the RN delegate to the unlicensed assistive personnel? a. Placing controls out of the reach of confused clients b. Assessing the client's response to the CPM c. Teaching the client's family the rationale for the CPM d. Assessing neurovascular status of the leg in the CPM

A. Placing controls out of the reach of confused clients

The nurse is caring for a client who is 1 day post total hip replacement. The nurse is instructing the client about how to perform quadriceps-setting exercises correctly. Which direction does the nurse provide to the client? a. "Straighten your legs and push the back of your knees into the mattress." b. "Straighten your legs and bring each leg separately off the mattress 6 inches." c. "Raise each leg 10 inches off the bed, keep it straight, and make ankle circles." d. "Bend each knee, and rapidly point your toes downward and then upward."

A. Straighten your legs and push the back of your knees into the mattress

A client with a history of rheumatoid arthritis will be starting drug therapy with etanercept (Enbrel). What is most important for the nurse to teach the client a. The correct technique for subcutaneous injections b. How to self-monitor blood glucose levels c. How to set up and prime the IV tubing d. How to calculate the dosage based on symptoms

A. The correct technique for subcutaneous injections

A client with chronic gout take probenecid (Benemid) and comes to the clinic reporting frequent severe headaches and a new gout flare. The client is frustrated because the gout had been under good control Which question by the nurse is most helpful? a. "What do you take for your headaches?" b. "Do you know what triggers your gout?" c. "Have you been following your diet?" d. "Did you switch from wine to beer lately?"

A. What do you take for your headaches?

A client presents with painful, inflamed fingers with small, hard, yellow nodules that have a sandy yellow drainage. Which medication does the nurse prepare to administer to the client? a. Colchicine (Colasalide) b. Allopurinol (Zyloprim) c. Methotrexate (Rheumatrex) d. Aspirin

B. Allopurinol (Zyloprim)

A client had a total knee replacement earlier in the day and has a continuous femoral nerve blockade. When entering the room to assess the client, the nurse notes that the television volume is quite loud. The client explains that it is hard to hear with "all the ringing in my ears." What action by the nurse takes priority? a. Perform a neurovascular assessment on the operative extremity. b. Call another nurse to notify the anesthesiologist immediately. c. Take a full set of vital signs and discontinue the CFNB. d. Pad the siderails and instituting other seizure precautions.

B. Call another nurse to notify the anesthesiologist immediately.

A client is admitted for a total hip replacement. Past medical history includes diabetes mellitus type2, a heart attack 5 years ago, and allergies to sulfa drugs. The client currently takes insulin on a sliding scale and celecoxib (Celebrex). Before administering the client's medications, which action by the nurse is most appropriate? a. Take the client's blood pressure in both arms. b. Call the physician to clarify the orders. c. Schedule a preoperative electrocardiogram. d. Review the client's laboratory values.

B. Call the physician to clarify the order

The nurse is working in a clinic when a young male client presents with reports of pain and urination. The client wants testing for sexually transmitted diseases. The nurse notes that the client's eyes are red and inflamed. What question by the nurse is most important? a. "Do you have more than one sexual partner?" b. "Do you have any new joint pain?" c. "What eyedrops have you used for your red eyes?" d. "Are you allergic to any antibiotics?"

B. Do you have any new joint pain

The nurse is working in a primary care clinic and sees a young male client. The client is athletic and is well over 6 feet tall, with size 14 shoes. What diagnostic test does the nurse facilitate for the client? a. Coagulation studies b. Echocardiography c. Electromyelography d. Genetic testing

B. Echocardiography

(Select All) What interventions does the nurse recommend for a client who is to be discharged home following total hip replacement surgery? a. Continuous passive motion machine b. Elevated toilet seat c. Walker d. Crutches e. TED hose f. Heating pad

B. Elevated toilet seat C. Walker E. TED hose

(Select All) The nurse is teaching a client with rheumatoid arthritis about joint protection principles. What information does the nurse include? a. Use smaller joints to rest the larger ones. b. Hold objects with two hands, not one. c. Sit most often in a reclining chair. d. Use assistive-adaptive devices. e. Bend at your knees to lift objects.

B. Hold objects with two hands, not one D. Use assistive adaptive devices E. Bend at your knees to lift objects

The nurse is instructing a client about the management of systemic sclerosis. Which statement indicates that the client requires additional teaching? a. "I will let my doctor know right away if I develop a fever." b. "Ice packs will help relieve the aching pain in my hips and knees." c. "I will wear mittens when I am in the freezer section of the grocery store." d. "I will apply a rich moisturizer to my skin every morning after my shower."

B. Ice packs will help relieve the aching pain in my hips and knees.

The nurse is caring for an older adult client who will be discharged home to live with an adult daughter. The client will be given prescriptions for four new medications for rheumatoid arthritis. How does the nurse ensure that the client will be able to take the medications correctly at home? a. Monitor the client self-administering medications while in the hospital. b. Include the client's daughter when teaching the client about the medications. c. Provide the client with pamphlets and information about all the medications. d. Make a chart showing which medications the client should take at different times.

B. Include the clint's daughter when teaching the client about the medications.

A client is reeiving warfarin (Coumadin) daily following toal hip replacement surgery. Which laboratory value requires intervention by the nurse? a. Potassium (K+), 4.2 mEq/L b. International normalized ratio (INR), 5.1 c. Prothrombin time (PT), 13.4 seconds d. Hemoglobin (Hg), 16 g/dL

B. International normalized ratio (INR), 5.1

The nurse is working with a client who has severe rheumatoid arthritis in their hands. The client states that she is frustrated at mealtime because it is difficult for her to manage cups and silverware. What is the nurse's best response? a. "I'll have the nursing assistants set up your meal trays while you are in the hospital." b. "Let's see if the occupational therapist can provide you with some utensils that are easier for you to use." c. "I'll arrange for a home nursing assistant to help you with your meals after you are discharged from the hospital." d. "Let's see if the physical therapist can suggest some muscle strengthening exercises for you."

B. Let's see if the occupational therapist can provide you with some utensils that are easier for you to use.

A female client with rheumatoid arthritis has taken Rheumatrex (methotrexate) for the past year to control her symptoms. The client comes to the clinic and tells the nurse that a home pregnancy test was positive. What is the nurse's best response? a. "You need to schedule a prenatal appointment with your obstetrician right away." b. "Stop taking Rheumatrex immediately. I'll tell the physician you are pregnant." c. "Continue taking the Rheumatrex, and increase the dose if you have a flare." d. "See a genetic counselor to determine whether your baby will have rheumatoid arthritis."

B. Stop taking Rheumatrex immediately. I'll tell the physician you are pregnant.

The nurse is working with a client who will be taking 20 mg of prednisone daily for rheumatoid arthritis. Which precautions does the nurse give the client about taking this medication? a. "Take this medication at bedtime because it will make you sleepy." b. "Take calcium and vitamin D supplements daily." c. "Eat a high-fiber diet with lots of lean meats." d. "Wash your face twice a day with an antibacterial soap."

B. Take calcium and vitamin D supplements daily

The nurse is caring for an older adult client who has had a hip replacement 2 days previously. Which assessment finding is the best indicator that the client does not need pain medication at this time? a. The client received 2 pain pills 2 hours ago. b. The client states that she has no pain. c. The client is sleeping quietly. d. The client's vital signs are stable.

B. The client states that she has no pain

A client who has had bilateral total knee replacements is prescribed enoxaprin sodium (Lovenox) injections twice daily for the next 3 weeks. The client asks the nurse why she has to have the medication. What is the nurse's best response? a. "To prevent swelling within your new knee joints." b. "To prevent the formation of blood clots in your legs." c. "To prevent arthritis from developing in your new knee joints." d. "To prevent an infection from developing in your new knee joints."

B. To prevent the formation of blood clots in your legs.

The nurse is caring for a client who had right total knee replacement surgery 3 days ago. During the assessment, the nurse notes that the client's right lower leg is twice the size of the left. What is the nurse's priority intervention? a. Elevate the client's right leg. b. Apply antiembolism stockings. c. Assess the client's respiratory status. d. Check the client's pedal pulses.

C. Assess the client's respiratory status.

The nurse has taught a client with lupus about skin protection in the clinic. Later, the nurse sees the client at an outdoor music festival. Which observation by the nurse indicates that the client requires further instruction? a. Client is wearing a thin, long-sleeved shirt. b. Client is wearing a hat with a full brim. c. Client is discussing her new perm. d. Client is seen applying sunscreen twice.

C. Client is discussing her new perm.

The nurse is caring for a pregnant client who is taking umbra (adalimumab) to control symptoms of rheumatoid arthritis. The client mentions the pain and inconvenience of the subcutaneous injections and asks, "While I'm pregnant, can I take this drug by mouth instead?" What is the nurse's best response? a. "I will ask the physician to write a prescription for you today." b. "Humira takes much longer to work when it is given orally." c. "Humira can be given only by subcutaneous injection." d. "You can switch from Humira to oral leflunomide (Arava)."

C. Humira can be given only by subcutaneous injection.

The nurse provides discharge teaching for a client to prevent a new attack of gout. Which statement by the client indicates that additional teaching is required? a. "I will keep a food and symptom diary for a few weeks." b. "If I get a headache, I will take Tylenol instead of aspirin." c. "I hate to start limiting my fluid intake so much!" d. "Citrus juices and milk may keep me from having kidney stones."

C. I hate to start limiting my fluid intake so much!

A client returns to the medical-surgical unit after a total hip replacement with a large wedge-shaped pillow between his legs. The client's daughter asks the nurse why the pillow is in place. What is the nurse's best response? a. "It will help prevent bedsores from developing." b. "It will help prevent nerve damage and foot drop." c. "It will keep the new hip from becoming dislocated." d. "It will prevent climbing out of bed if he becomes confused."

C. It will keep the new hip from becoming dislocated

The nurse is caring for an older adult client who has fallen and fractured her hop. The client will have hip replacement surgery followed by extensive rehabilitation. The client confides in the nurse, "I feel like I don't have any control over anything anymore now that I am old." What is the nurse's best response? a. "I'll make sure that the physical and occupational therapists see you after surgery to help get your strength back." b. "It's normal to feel this way, but hopefully you will be back on your feet after a stay in rehab." c. "It's important to control what you can right now, like making out your menu every day and working with the therapists." d. "I sense that you are feeling depressed about the situation. I will ask the doctor to prescribe an antidepressant for you."

C. It's important to control what you can right now, like making out your menu every day and working with the therapists.

Which statement by a client indicates that additional teaching is needed in the management of fibromyalgia? a. "I will switch to decaffeinated coffee in the mornings." b. "Water aerobics classes will be a good form of exercise." c. "Limiting my physical activity will reduce my fatigue." d. "I will take my sertraline (Zoloft) right before I go to bed.

C. Limiting my physical activity will reduce my fatigue

The nurse is teaching a client how to reduce the pain that she often experiences with fibromyalgia. Which statement does the nurse include in the teaching? a. "Wear gloves outdoors in cooler temperatures." b. "Avoid exercising when your muscles are sore." c. "Make sure that you get enough sleep every night." d. "Stay out of the sun as much as possible."

C. Make sure that you get enough sleep every night

The school nurse is working with a group of high school students who will be going on a field trip to a nature center. Which student is at highest risk for a tick bite? a. Male student with a beard and a baseball cap b. Female student with long hair pulled back in a ponytail c. Male student wearing a long-sleeved shirt and shorts d. Female student who is wearing scented hand lotion

C. Male student wearing a long-sleeved shirt and shorts.

The home care nurse is making a follow-up visit to a client who had total hip replacement surgery 2 weeks ago. Which client statement indicates a need for clarification regarding postoperative routine? a. "My daughter helps me put on my elastic TED (thromboembolic deterrent) hose every day." b. "I take 200 mg of Motrin (ibuprofen) at bedtime so that I can sleep." c. "Now that my hip doesn't hurt, I can cross my legs like a lady again." d. "Each day, I try to increase my walking time by at least 10 minutes."

C. Now that my hip doesn't hurt, I can cross my legs like a lady again.

A client with diagnosed osteoarthritis comes to the clinic reporting a low-grade fever, fatigue, and bilateral joint pain. What action by the nurse is most appropriate? a. Assess the client for a systemic infection. b. Discuss increasing the dose of anti-arthritis drugs. c. Prepare the client for a laboratory draw for rheumatoid factor. d. Teach the client joint protection activities.

C. Prepare the client for a laboratory draw for rheumatoid factor

The nurse is caring for a client who has a history of severe rheumatoid arthritis. The client becomes combative and abusive to the staff when she is unable to perform personal care independently. What is the best statement the nurse can make to the client at this time a. "I will have to restrain your hands if you cannot keep them to yourself." b. "I will ask your doctor for a psychiatrist to talk to you about anger management." c. "You seem frustrated. Would you like to try to dress again in a few minutes?" d. "Would you like me to get an order for medication to help you settle down?"

C. You seem frustrated. Would you like to try to dress again in a few minutes?

A nurse is caring for a client who has had rheumatoid arthritis for 5 years. Which laboratory value requires the most immediate intervention by the nurse? a. White blood cell count (WBC), 3800/mm3 b. Hemoglobin (Hg), 10.6 g/dL c. Blood urea nitrogen (BUN), 16 mg/dL d. Creatinine, 3.2 mg/dL

D. Creatinine, 3.2 mg/dL

The nurse is teaching a client who has osteoarthritis ways to slow progression of the disease. Which statement indicates that the client understands the nurse's instruction? a. "I will eat more vegetables and less meat." b. "I will avoid exercising to minimize wear on my joints." c. "I will take calcium with vitamin D every day." d. "I will start swimming twice a week."

D. I will start swimming twice a week.

The nurse is caring for an older adult client who will be discharged after being hospitalized for a total hip replacement. Which statement indicates that arrangements may have to be made to have the client's medications supervised at home? a. "I will take my Coumadin pill every day just before the evening news." b. "My wife takes iron too, so we will take our pills together every morning." c. "I prepare all my pills for the week and will place them in a labeled medi-set." d. "If my legs get swollen, I will take an extra Coumadin pill that day."

D. If my legs get swollen, I will take an extra Coumadin pill that day.

A client is suspected to have rheumatoid arthritis. Which manifestations does the nurse assess this client carefully for? a. Crepitus when the client moves the shoulders b. Numbness and tingling in the client's fingers c. Client has cool feet, with weak pedal pulses d. Low-grade fever, fatigue, anorexia with weight loss

D. Low-grade fever, fatigue, anorexia with weight loss

The nurse is instructing a client about management of discoid lupus erythematosus. Which statement indicates that the client requires additional teaching? a. "I will be sure to apply sunscreen whenever I am outside." b. "I will apply small amounts of the steroid cream to my face twice a day." c. "I will take Plaquenil (hydroxychloroquine sulfate) with breakfast each morning." d. "Steroids weaken the immune system, so I will wash my hands frequently."

D. Steroids weaken the immune system, so I will wash my hands frequently.