MED SURG EXAM

c

12. When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a: a. Trochanter roll by the knee b. Sandbag to the lateral calf c. Trochanter roll to the thigh d. Footboard

b

13. A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to: a. Leave the pillow as his stump is elevated b. Remove the pillow and elevate the foot of the bed c. Leave the pillow and elevate the foot of the bed d. Check with the physician and clarify the orders

c

14. A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to: a. Protect the skin with lotion b. Keep the client pulled up in bed c. Pad the top of the splint with washcloths d. Provide a footplate in the bed

b

15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to: a. Reduce fever b. Reduce the inflammation of the joints c. Assist the client's range of motion activities without pain d. Prevent extension of the disease process

a

16. Following an amputation, the advantage to the client for an immediate prosthesis fitting is: a. Ability to ambulate sooner b. Less change of phantom limb sensation c. Dressing changes are not necessary d. Better fit of the prosthesis

d

17. One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to: a. Cough and deep breathe b. Turn himself in bed c. Perform biceps exercise d. Wiggle his toes

d

18. The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to: a. Get the client up in a chair after dangling at the bedside. b. Use a walker for balance when getting the client out of bed c. Have the client put minimal weight on the affected side when getting up d. Practice getting the client out of bed by having her slightly flex her hips

b

19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to: a. Anchor the traction b. Prevent footdrop c. Keep the client from sliding down in bed d. Prevent pressure areas on the foot

d

2. A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make? a. Observe the color of the fingers b. Palpate the radial pulse under the cast c. Check the cast for odor and drainage d. Evaluate the response to analgesics

b

21. When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by: a. Elevating the foot of the bed b. Elevating the head of the bed c. Application of the pelvic girdle d. Lowering the head of the bed

b

24. A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has a. Headaches b. Tarry stools c. Blurred vision d. Decreased appetite

c

25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to a. Read a story and act out the part b. Watch a puppet show c. Watch television d. Listen to the radio

d

29. After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching? a. "I will take my vitamins while I am on this drug" b. "I must not drink any alcohol while I'm taking this drug" c. I should brush my teeth after every meal" d. "I will continue taking my birth control pills"

a

3. After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for: a. An anaphylactic reaction to the dye b. Inflammation from the extravasation of fluid during injection. c. Fluid overload from the volume of the infusions d. A normal reaction to the stress of the diagnostic procedure.

c

30. When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess? a. Anemia c. Weight loss b. Osteoporosis d. Local joint pain

c

31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? a. At bedtime b. On arising c. Immediately after meal d. On an empty stomach

c

32. When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following? a. Hepatotoxicity b. Renal toxicity c. Gastrointestinal bleeding d. Nausea and vomiting

c

33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following? a. A developing infection b. Bleeding in the operative site c. Joint dislocation d. Glue seepage into soft tissue

c

34. Which of the following would the nurse assess in a client with an intracapsular hip fracture? a. Internal rotation c. Shortening of the affected leg b. Muscle flaccidity d. Absence of pain the fracture area

d

35. Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc? a. Informing the client that the procedure is painless b. Taking a thorough history of past surgeries c. Checking for previous complaints of claustrophobia d. Starting an intravenous line at keep-open rate

d

36. Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site? a. Elevate the stump b. Reinforcing the dressing c. Calling the surgeon d. Drawing a mark around the site

d

4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician? a. Moderate pain, as reported by the client b. Report, by client, the heat is being felt under the cast c. Presence of slight edema of the toes of the casted foot d. Onset of paralysis in the toes of the casted foot

a

40. Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following? a. Hemorrhage b. Infection c. Deformity d. Shock

a

42. A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following? a. Expected common side effects b. Hypersensitivity reactions c. Possible habituating effects d. Hemorrhage from GI irritation

c

43. When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first? a. The area proximal to the fracture b. The actual fracture site c. The area distal to the fracture d. The opposite extremity for baseline comparison

a

46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following? a. Pulmonary emboli b. Osteomyelitis c. Fat emboli d. Urinary tract infection

b

47. When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely? a. Formation of scar tissue interfering with absorption b. Development of pus leading to ischemia c. Production of bacterial growth by avascular tissue d. Antibiotics not being instilled directly into the bone

c

48. Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury? a. Homan's sign c. Tenderness b. Pain d. Leg girth

a

49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority? a. Allergy to iodine or shellfish b. Ability of the client to remain still during the procedure c. Whether the client has any remaining questions about the procedure d. Whether the client wishes to void before the procedure

b

5. Which of these nursing actions will best promote independence for the client in skeletal traction? a. Instruct the client to call for an analgesic before pain becomes severe. b. Provide an overhead trapeze for client use c. Encourage leg exercise within the limits of traction d. Provide skin care to prevent skin breakdown.

a

50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client? a. Divertional activity deficit b. Powerlessness c. Self care deficit d. Impaired physical mobility

a

51. The nurse is teaching the client who is to have a gallium scan about the procedure. The nurse includes which of the following items as part of the instructions? a. The gallium will be injected intravenously 2 to 3 hours before the procedure b. The procedure takes about 15 minutes to perform c. The client must stand erect during the filming d. The client should remain on bed rest for the remainder of the day after the scan

b

52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection? a. Coolness and pallor of the extremity b. Presence of a "hot spot" on the cast c. Diminished distal pulse d. Dependent edema

c

53. The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device? a. Massage the skin of the right leg with lotion every 8 hours b. Give pin care once a shift c. Inspect the skin on the right leg at least once every 8 hours d. Release the weights on the right leg for range of motion exercises daily

c

54. The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the: a. Left leg and right crutch then right leg and left crutch b. Crutches and then both legs simultaneously c. Crutches and the right leg then advance the left leg d. Crutches and the left leg then advance the right leg

a

55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the: a. Left hand and placing the cane in front of the left foot b. Right hand and placing the cane in front of the right foot c. Left hand and 6 inches lateral to the left foot d. Right hand and 6 inches lateral to the left foot

a

56. The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a: a. Pillow to keep the right leg abducted during turning b. Pillow to keep the right leg adducted during turning c. Trochanter roll to prevent external rotation while turning d. Trochanter roll to prevent abduction while turning

b

57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint: a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting b. Apply an Ace wrap around the dressing and put ice on the knee while sitting c. Lift the client to the bedside change leaving the CPM machine in place d. Obtain a walker to minimize weight bearing by the client on the affected leg

b

58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately: a. Calls the physician b. Rewrap the stump with an elastic compression bandage c. Applies ice to the site d. Applies a dry sterile dressing and elevates it on a pillow

d

59. The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to: a. Wear a clean nylon stump sock daily b. Toughen the skin of the stump by rubbing it with alcohol c. Prevent cracking of the skin of the stump by applying lotion daily d. Using a mirror to inspect all areas of the stump each day

c

6. A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis. a. The client reports pain in the affected leg b. A large hematoma is visible in the affected extremity c. The affected extremity is shortenend, adducted, and extremely rotated d. The affected extremity is edematous.

a Normal Uric acid levels are 2.4-6.0 mg/dL (female) and 3.4-7.0 mg/dL (male). Normal values will vary from laboratory to laboratory. Also important to blood uric acid levels are purines.

60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to note in the client? a. Uric acid level of 8 mg/dl b. Calcium level of 9 mg/dl c. Phosphorus level of 3 mg/dl d. Uric acid level of 5 mg/dl

c

7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan? a. Order a trapeze to increase the client's ambulation b. Maintain the client in a flat, supine position at all times. c. Provide pin care at least every hour d. Remove traction weights for 20 minutes every two hours.

d

8. To prevent foot drop in a client with Buck's traction, the nurse should: a. Place pillows under the client's heels. b. Tuck the sheets into the foot of the bed c. Teach the client isometric exercises d. Ensure proper body positioning.

a

9. Which nursing intervention is appropriate for a client with skeletal traction? a. Pin care b. Prone positioning c. Intermittent weights d. 5lb weight limit

a

45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus? a. Acute respiratory distress syndrome b. Migraine like headaches c. Numbness in the right leg d. Muscle spasms in the right thigh

c

26. On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses: a. Limited motion of joints b. Deformed joints of the hands c. Early morning stiffness d. Rheumatoid nodules

b

22. After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for: a. Increase in the temperature b. Change in color c. Edema d. Movement

b

1. A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position? a. Supine b. Semi Fowler's c. Orthopneic d. Trendelenburg

a

10. In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position? a. Supine b. Prone c. Sim's d. Lithotomy

c

11. An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is: a. It will be very painful for the client b. The soft tissue around the site will be damaged c. Displacement can occur with flexion d. It will pull the hip out of alignment

b

20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the: a. Client's position b. Rope/pulley system c. Amount of weight d. Point of friction

b

23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for: a. Urinary retention b. Bladder distention c. Weight gain d. Bower evacuation

c

27. After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching? a. History of Epstein-Barr virus infection b. Female gender c. Adults between the ages 60 to 75 years d. Positive testing for human leukocyte antigen (HLA) DR4 allele

d

28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods? a. Proper body alignment b. Elevating the part c. Prone lying positions d. Positions of flexion

d

44. A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure? a. Rales b. Jaundice c. Generalized edema d. Dark, scanty urine

d

37. A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first? a. Tell the client it is impossible to feel the pain b. Show the client that the toes are not there c. Explain to the client that the pain is real d. Give the client the prescribed narcotic analgesic

d

38. The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches? a. Abdominal exercises b. Isometric shoulder exercises c. Quadriceps setting exercises d. Triceps stretching exercises

d

39. The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas? a. Axillae b. Elbows c. Upper arms d. Hands

c

41. The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect? a. Killing of microorganisms b. Reduction in itching c. Relief of muscle spasms d. Decrease in nervousness

B Complex intra-articular fractures are repairedwith external fixators because they have a better long-term outcome than those treated withcasting. This is especially true in a young client.The incidence of complications, such as pin tractinfections and neuritis, is 20% to 60%. Clientsmust be taught how to do pin care and assessfor development of neurovascular complications.

A 49-yer-old client was admitted for surgicalrepair of a Colles' fracture. An external fixator was placed during surgery. The surgeonexplains that this method of repair: A. has very low complication rate B. maintains reduction and overall hand function C. is less bothersome than a cast D. is best for older people

ANS: A Verbalizing the observed behavior is atherapeutic communication technique in whichthe nurse acknowledges what the client isfeeling. Offering to listen to the client expressher anger can help the nurse and the clientunderstand its cause and begin to deal with it.Although stress can exacerbate the symptomsof SLE, telling the client to calm down doesn'tacknowledge her feelings. Offering to get thenursing supervisor also doesn't acknowledge theclient's feelings. Ignoring the client's feelingssuggest that the nurse has no interest in whatthe client has said

A client is admitted to the hospital with anexacerbation of her chronic systemic lupuserythematosus (SLE). She gets angry when her call bell isn't answered immediately. The mostappropriate response to her would be: A. "You seem angry. Would you like to talkabout it?" B. "Calm down. You know that stress will makeyour symptoms worse." C. "Would you like to talk about the problem withthe nursing supervisor?" D. "I can see you're angry. I'll come back whenyou've calmed down.

a a herniated disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg.

A client seeks care for low back pain of 2 weeks durations. Which assessment finding suggests a herniated intervertebral disk? a pain radiating down the posterior thigh b back pain when the knees are flexed c atrophy of the lower leg muscles d woman's sign

a

A nurse is teaching a client wit osteomalacia how to take prescribed vitamin d supplements. The nurse stresses the importance of taking only the prescribed amount because high doses of vitamin D can be toxic. Early signs and symptoms of vitamin D toxicity include: a GI upset and metallic taste b dry skin, hair loss, and inflamed mucous membranes c flushing and orthostatic hypotension d sensory neuropathy and difficulty maintaining balance

ANS: A In osteoarthritis, stiffness is common in large,weight bearing joints such as the hips. This jointstiffness alters functional ability and range of motion, placing the client at risk for falling andinjury. Therefore, client safety is in jeopardy.Osteoporosis doesn't affect urinary elimination,breathing, or nutrition.

Which nursing diagnosis is most appropriatefor an elderly client with osteoarthritis? A. Risk for injury B. Impaired urinary elimination C. Ineffective breathing pattern D. Imbalanced nutrition: less than bodyrequirements