Hesi EAQ

An 80-year-old patient suffering from severe pain in the lower jaw is diagnosed with acute osteomyelitis. Which symptom may be least likely to be found? 1 Severe throbbing pain 2 Body temperature of 102°F 3 Swelling of the affected region 4 Erythema of the affected region

Correct 2 Older adults may not have an extreme temperature elevation because of lower core body temperature and a compromised immune system that occurs with normal aging. Acute osteomyelitis is characterized by severe throbbing pain, swelling, and erythema of the affected region.

An 80-year-old patient with uncontrolled hypertension reports pain in the right foot and is diagnosed with a hallux valgus deformity. What is the most appropriate treatment? 1 Bunionectomy 2 Custom-made shoes 3 Osteotomy of the bunion 4 Stabilization of bone using screws

Correct 2 Patients with advanced age, uncontrolled hypertension, uncontrolled diabetes mellitus, and other medical conditions are not good candidates for surgery. Thus, custom-made shoes that fit the deformed feet are suggested to provide comfort and support. For patients who are medically fit for surgery, a bunionectomy (removal of bony overgrowth and bursa), osteotomy (excision of bony overgrowth), and stabilization of the bone with screws can be performed.

The nurse is teaching a patient who underwent surgery for mandibular fracture with inner maxillary fixation about self-care upon discharge. Which statement regarding self-management made by the patient indicates effective learning? 1 "I will cut the wires if I vomit." 2 "I will not use an irrigating device." 3 "I will consume a semi-liquid only diet." 4 "I will do the rewiring as soon as possible."

Correct 1 With inner maxillary fixation, bones are realigned and then wired in place with the closed bite. If the patient vomits after an inner maxillary fixation, the patient should immediately cut the wires to prevent aspiration. Irrigating devices are important for maintaining oral health because a patient cannot brush after surgery until completely healed. The patient should consume only a liquid diet, because chewing is not possible after surgery. Rewiring should be done only by the licensed practitioner.

The nursing instructor is teaching a group of nursing students about emergency care for extremity fractures. What statement made by a participant indicates a need for further teaching? 1 "I should not apply direct pressure on the affected area." 2 "I should not remove the patient's shoes." 3 "I should cut the clothing over the affected area." 4 "I should apply a splint above and below the fracture."

Correct 1 During emergency care for an extremity fracture, direct pressure should be applied on the affected area to prevent bleeding. The patient's shoes must not be taken off as it can increase the trauma. The clothing over the affected area is cut or removed to inspect the area for the extent of damage and to check for bleeding. The upper and lower end of the injury should be supported and splinted to immobilize the extremity.

The nurse is caring for the following patients. Which patient should the nurse assess first? 1 A patient diagnosed with idiopathic pulmonary fibrosis on parenteral morphine 2 A patient diagnosed with sarcoidosis who just received a second dose of IV corticosteroids 3 A patient diagnosed with bronchiolitis obliterans organizing pneumonia (BOOP) who returned from a biopsy 2 hours ago 4 A patent being evaluated for latency (allergic) asthma who received an inhaled corticosteroid 1 hour ago

Correct 1 The patient with idiopathic pulmonary fibrosis receiving parenteral morphine is in the later stage of the disease and likely will have hypoxemia even with high levels of oxygen. The patient with sarcoidosis has had the necessary treatment and is not the priority. The patient with BOOP has had a biopsy and is not the priority. The patient with latency asthma has no current exposure and has received treatment; this patient is not the priority.

What will the nurse teach a patient with diabetes mellitus with nephropathy and the patient's family about this condition? 1 "The severity of this condition depends on your average blood glucose level." 2 "This condition generally only occurs in patients with type 1 diabetes mellitus." 3 "This condition generally only occurs in patients with type 2 diabetes mellitus." 4 "The severity of this condition depends on how long you have had diabetes mellitus."

Correct 1 The severity of diabetic kidney disease is directly related to the average blood glucose level. Diabetic kidney disease may occur in either type 1 or type 2 diabetes mellitus. The severity of diabetic kidney disease is not correlated with the length of time a patient has had diabetes.

A postoperative patient is receiving epidural analgesia and reports itching. What does the nurse do next? 1 Reduces the analgesic dose 2 Gives diphenhydramine 3 Gives an antiemetic 4 Calls the surgeon

Correct 1 Pruritus (itching) is a common side effect of epidural opioids and is first treated by reducing the analgesic dose. Because epidural-induced pruritus does not appear to be caused by histamine release, diphenhydramine may not be effective in relieving itching and may work only via its sedating effects. Antiemetics are given to relieve nausea and vomiting. If a health care provider needs to be called, it would be the anesthesiologist, not the surgeon.

A patient who has recently been diagnosed with renovascular disease asks the nurse, "What is the cause of this disease?" What is the nurse's best response? Select all that apply. 1 "A blood clot in your vessels may cause this disease." 2 "A buildup of plaque in your vessels may cause this disease." 3 "The narrowing of your renal vessels may cause this disease." 4 "This disease is most likely caused by a genetic malformation." 5 "This disease is most likely caused by excess hormone secretion."

Correct 1, 2, 3 Renovascular disease may be caused by thrombosis, atherosclerosis, or stenosis. A blood clot in the vessels best describes thrombosis. A buildup of plaque in the vessels best describes atherosclerosis. Narrowing of the vessels best describes stenosis. Renovascular disease is often not caused by a genetic malformation and is not caused by excess hormone secretion.

The nurse is completing the rehabilitation center admission assessment of a patient recovering from a stroke. What assessments does the nurse conduct for this patient? Select all that apply. 1 History of present condition 2 Interruptions in skin integrity 3 Sensory perceptual changes 4 Communication abilities 5 Fine motor skills

Correct 1, 2, 3, 4 At the time of admission to the rehabilitation center, the nurse obtains the history of the patient's present condition, interruptions in skin integrity, sensory perceptual changes, and communication abilities for the patient who is recovering from stroke. An occupational therapist assesses the fine motor skills of the patient.

In which newly admitted patient situations does the nurse initiate a conversation about advance directives? Select all that apply. 1 A patient with a non-life-threatening illness 2 A person who currently has advance directives 3 The patient with end-stage kidney disease 4 The comatose patient who was injured in an automobile crash 5 The laboring mother expecting her first child

Correct 1, 2, 3, 5 All patients who are hospitalized need to be asked about advance directives by the nurse when they are admitted to a hospital. This is a requirement of the Patient Self-Determination Act. Many nurses feel uncomfortable discussing advance directives with "healthy" patients, but the circumstances of admission do not relieve the nurse of this responsibility. The patient with preexisting advance directives still needs to be questioned; it is possible that the patient's wishes have changed since the documents were established. Patients who have potentially life-threatening diseases or conditions should establish advance directives while they are able to do so. The comatose patient is not considered capable of making decisions about his or her wishes concerning advance directives.

The nurse is conducting a literature search to answer a quantitative question. To collect the top level of evidence, what resources does the nurse search? Select all that apply. 1 Systematic reviews 2 Clinical practice guidelines 3 Original single studies 4 Randomized clinical trials 5 Narrative literature reviews

Correct 1, 2, 4 To collect top level evidence for a quantitative question, the nurse searches systematic reviews, clinical practice guidelines, and randomized or multi-site clinical trials. This saves a lot of time compared to searching original single studies; reviewing, critiquing, and synthesizing every original single study is time-consuming. Narrative literature reviews are not top level evidence; they come under level V evidence.

What interventions does the nurse include when planning care for a patient diagnosed with thrombocytopenia? Select all that apply. 1 Avoid venipuncture 2 Floss between teeth daily 3 Apply ice to areas of trauma 4 Use the smallest gauge needle possible 5 Measure abdominal girth three times daily

Correct 1, 3, 4 Avoiding venipuncture, applying ice to areas of trauma, and using the smallest gauge needle possible are appropriate actions when caring for a patient with thrombocytopenia. Patients with thrombocytopenia should avoid flossing their teeth. Abdominal girth should be measured once daily.

The nurse is assessing a patient with scoliosis. What does the degree of curvature of the spine in scoliosis signify? Select all that apply. 1 The spine is unstable if the curvature is over 50 degrees. 2 In adults, there is a progressive deviation of the spine by 5 degrees each year. 3 Cardiopulmonary function is compromised if curvature is more than 60 degrees. 4 Patients are prescribed exercises if curvature is less than 50 degrees. 5 Surgical intervention is preferred if curvature is less than 50 degrees.

Correct 1, 3, 4 Scoliosis presents as a lateral curvature of the vertebral spine. If the lateral curvature is greater than 50 degrees, it may result in an unstable spine and cardiopulmonary function is compromised. If the curvature is less than 50 degrees, the condition can be managed conservatively by encouraging exercises and the application of moist heat. In adults, this disorder is progressive and may result in deviation of the spine by one degree each year. Surgical intervention is preferred if the curvature is greater than 50 degrees to prevent osteoarthritis, shortness of breath, and fatigue.

A patient has had reconstructive surgery for scoliosis. What postoperative interventions does the nurse perform? Select all that apply. 1 Assess respiratory status and encourage the use of incentive spirometry. 2 Provide pain medication as needed. 3 Encourage stretching exercises to improve mobility. 4 Teach the patient to log roll. 5 Collaborate with the case manager for continued patient care.

Correct 1, 4, 5 The nurse should assess the respiratory status of the patient and encourage the use of incentive spirometry to prevent atelectasis. The patient should be taught to log roll while keeping the body in alignment. The patient will require home care nursing and physical therapy after discharge from the hospital; the nurse should collaborate with the case manager for continued patient care. After surgery, the patient will experience severe pain and anxiety, so the nurse should teach the patient to use IV patient-controlled analgesia. The patient is not asked to perform stretching exercises; the physical therapist will collaborate with the patient to improve mobility and ambulation.

Which questions can be considered foreground questions in evidence-based practice (EBP)? Select all that apply. 1 "Is jogging better than walking to cut down the fat?" 2 "What are the common symptoms of patients with anorexia?" 3 "What are the frequent causes for one-sided headache?" 4 "Which is the effective treatment for cancer in older patients?" 5 "Is homeopathy better than allopathy to treat diseases?"

Correct 1, 4, 5 The questions, "Is jogging better than walking to cut down the fat?", "Is homeopathy better than allopathy to treat diseases?", and "Which is the effective treatment for cancer in older patients?" are all foreground questions. A foreground question usually asks about a relationship and the question may be controversial. Questions such as "What are the common symptoms of patients with anorexia?" and "What are the frequent causes for one-sided headache?" are background questions. A background question usually asks for a fact or a statement on which most authorities would agree, the answer to the question can be found in a textbook, and the question is not controversial.

What type of foot disorder appears as a bump on the side of the big toe? 1 Hammertoe 2 Hallux valgus 3 Plantar fasciitis 4 Morton's neuroma

Correct 2 A bunion (also referred to as hallux valgus or hallux abducto valgus) is often described as a bump on the side of the big toe. A hammertoe occurs due to the pressure of poorly fitting shoes; the metatarsophalangeal (MTP) joint becomes disfigured and permanently bends to the side. Plantar fasciitis is one of the most common causes of heel pain; it involves pain and inflammation of a thick band of tissue, called the plantar fascia, which runs along the bottom of the foot and connects the heel bone to the toes. Morton's neuroma is an injury to the nerve between the toes, which causes pain. The injury happens due to the growth of a small tumor in the digital nerve of the foot.

The nurse is reviewing the reports of a patient suffering from septic shock. The investigation data is given below. What would the nurse conclude based on these findings? -serum creatinine 2.5 mg/dl -Blood Urea Nitrogen 35 mg/dl -serum calcuim 7 mg/dl 1 Intrinsic acute kidney injury 2 Prerenal acute kidney injury 3 Intrarenal acute kidney injury 4 Postrenal acute kidney injury

Correct 2 An acute kidney injury (AKI) that results from decreased blood perfusion is called prerenal AKI. Signs of this condition include increased serum creatinine and blood urea nitrogen levels and decreased serum calcium levels. Intrinsic or intrarenal acute kidney injury and postrenal acute kidney injury occur due to an injury to glomeruli, nephrons, or tubules and not septic shock.

The nurse must obtain the height of a patient with a hip contracture. How does the nurse obtain this assessment? 1 Measures the patient's height in millimeters for accuracy 2 Uses a sliding-blade knee height caliper 3 Uses the stick of a weight scale 4 Asks the patient to stand erect and look straight ahead

Correct 2 The height of a patient with a hip contracture is measured using a sliding-blade knee height caliper, which uses the distance between the patient's heel and patella to estimate the height. Height is measured in inches or centimeters. The stick of a weight scale is used to determine the height of a patient who can stand, which this patient cannot do.

A nurse is caring for a male patient with renal cell carcinoma. What statement made by the patient is consistent with his diagnosis? Select all that apply. 1 My urine is cloudy all the time." 2 "I feel like my sex drive is decreased." 3 "I look more feminine than I used to." 4 "My blood pressure is high all the time." 5 "I feel cold all the time, even in summer."

Correct 2 , 3, 4, 5 The hormones released by the renal cell carcinoma tumor may decrease the patient's sex drive and change the patient's sexual characteristics. Hypertension occurs with this type of cancer due to the systemic effects from the tumor. Patients with renal cell carcinoma usually do not have cloudy urine and do not feel cold.

The nurse is conducting a health history interview for a patient who is scheduled for dermabrasion. Which notations in the medical record support the need for this surgery? Select all that apply. 1 Sagging of facial skin 2 Moderate acne scarring 3 Multiple actinic keratoses 4 Posttraumatic nasal deformity 5 Difficulty breathing through the nose

Correct 2, 3 A patient with documented moderate acne scarring and multiple actinic keratosis is a candidate for dermabrasion. Sagging of facial skin supports the need for rhytidectomy, or facelift. Posttraumatic nasal deformity and difficulty breathing support the need for rhinoplasty.

What postoperative complications are associated with pain and fever in a patient recovering from breast augmentation surgery? Select all that apply. 1 Breast edema 2 Implant leakage 3 Wound infection 4Nipple discharge 5 Swollen axillary nodes

Correct 2, 3 The postoperative complications of pain and fever after breast augmentation surgery are caused by infection and implant leakage. Breast edema, nipple discharge, and swollen axillary nodes are not postoperative complications after breast augmentation surgery.

A 67-year-old patient is diagnosed with plantar fasciitis. What conservative management does the nurse suggest? Select all that apply. 1 Avoid prolonged rest. 2 Apply an ice pack to the site. 3 Perform weight-bearing exercises. 4 Strap the affected foot. 5 Wear shoes with good support. 6 Avoid cortisone medications.

Correct 2, 4, 5 Plantar fasciitis is an inflammation of the plantar fascia presenting as severe pain in the arch of the foot. The patient should be instructed to apply an ice pack to the site to reduce inflammation. The patient should also strap the affected foot to maintain the arch and wear shoes that provide good support and comfort. The patient should provide rest to the area and perform stretching exercises to relax the muscles of the feet. Cortisone and nonsteroidal anti-inflammatory drugs (NSAIDs) are used to control pain and inflammation.

What would be the most appropriate surgical intervention for a patient with a nasoethmoid complex fracture? 1 Resorbable devices 2 Inner maxillary fixation 3 Microplating surgical systems 4 Open reduction with internal fixation

Correct 3 A nasoethmoid complex fracture affects the central upper midface. In microplating surgical systems, the plates are made up of synthetic, inorganic, or biologically organic combinations to fix the bone defect. These plates help in holding bone fragments until new bones are developed. The plates can be removed or placed permanently. Resorbable devices are ineffective for nasoethmoid complex fractures because they are made of plastic that begins to biodegrade after 8 weeks. Inner maxillary fixation is also ineffective for nasoethmoid complex fracture because it is used only for realignment of bones, and then wiring is done to keep the bones in place. Open reduction with internal fixation is mostly used in extensive jaw fractures.

A nurse notices the lateral drift of the greater toe at the first metatarsophalangeal joint. What would be the expected diagnosis by the primary health care provider? 1 Hammertoe 2 Hallux varus 3 Hallux valgus 4 Plantar fasciitis

Correct 3 Hallus valgus is a deformity characterized by medial deviation of the first metatarsal and lateral deviation of the hallux. Hammertoe is the dorsiflexion of the metatarsophalangeal joint with plantar flexion of the proximal interphalangeal joint next to it. Deformity of the great toe joint where the hallux is deviated medially away from the first metatarsal bone is called hallux varus. An inflammation of plantar fascia on the arch of the foot is called plantar fasciitis.

If sterile gauze falls to the ground and hits the front of the surgeon's gown on the way down, what does the nurse do to ensure proper infection control? 1 Helps the surgeon change the gown 2 Picks the gauze up with a pair of sterile gloves 3 Picks the gauze up without touching the surgeon 4 Sprays an antimicrobial on the surgeon's gown

Correct 3 The surgeon is sterile, but the gauze is now nonsterile and must be removed and counted. A sterile gauze touching a sterile gown does not require a gown change. Sterile gloves are not needed to pick the gauze up. An antimicrobial spray is inappropriate in this situation.

What specialized precautions should the nurse include in the plan of care when caring for a patient with the Ebola virus? Select all that apply. 1 Provide care and comfort measures 2 Assess for unexplained blood clotting 3 Isolate patient with Ebola in a single room 4 Use dedicated or disposable medical equipment and supplies

Correct 3, 4 The patient with the Ebola virus is highly contagious so the nurse should isolate the patient in a single room. The nurse should also use dedicated or disposable medical equipment and supplies to prevent cross contamination of the virus with other patients. Care and comfort measures are patient-centered collaborative care and should be provided to all patients no matter what the diagnosis is. The nurse should assess for unexplained hemorrhage, not unexplained blood clotting.

Which statement is true regarding a ganglion cyst? Select all that apply. 1 Ganglion cysts have malignant potential. 2 Ganglion cysts cause severe pain on palpation. 3 Ganglion cysts can rapidly disappear and recur. 4 Treatment includes the aspiration of cystic fluid with a fine needle. 5 Ganglion cysts form due to the degeneration of synovium surrounding the tendon.

Correct 3, 4, 5 A ganglion is a round, benign cyst usually found on a wrist, foot joint, or tendon. These cysts may rapidly disappear and then recur. The fluid within the cyst can be aspirated through a small needle, and the ganglion can be relieved. The cyst is formed due to the degeneration of synovium surrounding the tendon. These cysts are benign and painless on palpation.

In what type of sarcoma does the patient experience dull pain and swelling for a long period? 1 Fibrosarcoma 2 Osteosarcoma 3 Ewing's sarcoma 4 Chondrosarcoma

Correct 4 A chondrosarcoma is one of the most common bone sarcomas seen in adulthood. It is usually associated with dull pain and swelling for a long period. A fibrosarcoma is a malignant (cancerous) tumor that originates in the connective fibrous tissue found at the ends of the bones of the arm or legs before spreading to other surrounding soft tissues. Pain or soreness is caused by suppressed nerves and muscles. Osteosarcomas are the most common type of primary malignant bone tumors. The tumor is relatively large, causing acute pain and swelling. Ewing's sarcoma is not as common as other tumors; it is the most malignant. Like other primary tumors, it causes pain and swelling but also leucocytosis and a low-grade fever.

A patient with congestive heart failure developed symptoms such as difficulty breathing, sweating, and hemoptysis. The primary health care provider prescribed furosemide. Which route would be the most effective for the administration of the drug? 1 Oral route 2 Intramuscular route 3 Subcutaneous route 4 Intravenous direct route

Correct 4 Difficulty breathing, sweating, and hemoptysis are symptoms of pulmonary edema, which is a complication of congestive heart failure. Pulmonary edema is an emergency condition and the patient should be treated immediately. So, furosemide should be administered through the intravenous direct/push route. Furosemide can be administered through the oral, intramuscular, or subcutaneous route to reduce vascular congestion and the workload of the heart.

The patient complains to the nurse of acute pain in the 3rd and 4th toes and a burning sensation in the web space between these toes. Which condition would the nurse anticipate in the patient? 1 Hammertoe 2 Hallus valgus 3 Plantar fasciitis 4 Plantar digital neuritis

Correct 4 Plantar digital neuritis or Morton's neuroma occurs due to small tumor growth in the digital nerve of the foot. The patient usually experiences acute pain and a burning sensation in the web space. The pain involves the entire surface of the 3rd and 4th toes. A hammertoe is the dorsiflexion of the metatarsophalangeal joint with plantar flexion of the proximal interphalangeal joint next to it. A deformity of the great toe joint where the hallux is deviated medially away from the first metatarsal bone is called hallux valgus. Plantar fasciitis is an inflammation of plantar fascia located in the arch of the foot.

What teaching should be provided to a patient scheduled for a percutaneous stereotactic rhizotomy for trigeminal neuralgia? Select all that apply. 1 Local anesthesia will be used. 2 Glycerol is injected to coat the nerve. 3 A balloon is inserted to cushion the nerve. 4 It is performed as an outpatient procedure. 5 A heating current destroys some of the nerve fibers.

Correct 4, 5 A percutaneous stereotactic rhizotomy is performed as an ambulatory care (outpatient) procedure. A hollow needle is passed into the trigeminal nerve fibers, where a heating current is used to destroy some of the nerve fibers. General, not local, anesthesia is used. A glycerol injection is a separate procedure, as is balloon microcompression.