Module 4 mus

Which system must be protected to minimize injury to the nurse and patient? A. Respiratory B. Musculoskeletal C. Cardiovascular D. Gastrointestinal

Musculoskeletal

intramuscular injection

ventrogluteal, vastus lateralis of the thigh, and the deltoid muscle

Fast fibers are also called _____________ because they have a low red myoglobin content.

"white fibers"

Fried's Rule (Infants yonger than 2 years old)

(age in months/150) x adult dose

8. Keratin is found in which layer of the skin? A. Dermis B. Epidermis C. Subcutaneous D. Serous

B. Epidermis

45. The longest bone in the body is the: A. tibia B. fibula C. femur D. humerus

C. femur

What helps reduce muscle atrophy?

-ROM (movement of the body that involves the muscles and joints in natural directional movements) exercises. -Passive ROM is done by caregivers -Active ROM is done by patients

Insulin (Syringes, Needles, and Uses)

-Site: Abdomen, lateral and posterior areas of upper arm or thigh, scapular area, upper ventro-dorsal gluteal areas-Maximum Volume: 1 mL-Syringe: Insulin- calibrated on 100-unit scale-Needle Size: Non-removable 3/8 in. 29 gauge-Needle Angle: 45 or 90 degrees

69. Dorsiflexion refers to: A. hand movements B. eye movements C. foot movements D. head movements

C. foot movements

(CPM)continuous passive motion

-machines flex and extend joints for passive mobilization with out the strain of active exercise. -Therapy is frequently used immediately after total knee replacement surgery, but can also be used in outpatient or home physical therapy programs.

Complications of immobility include:

-muscle atrophy -contractures -pressure ulcers -reduced peristalsis -postural hypotension

17. The nurse is trying to give all of his patients the 9:00 am medications. An older Hispanic woman needs 15 medications every morning but is consistently preoccupied whenever the nurse enters the room. What should the nurse do? (101) 1. Administer the medications to other patients first and then help this patient. 2. Give the patient a 15-minute warning and then stick to the promised time. 3. Try to find out why the woman is so consistently preoccupied. 4. Start giving this patient the medications at 8:00 am so there is extra time

1. Administer the medications to other patients first and then help this patient.

62. The nurse is observing the patient self-administer medication with a metered-dose inhaler (MDI). What action by the patient re-quires correction and further instruction? (462) 1. Shakes canister to determine how much is left 2. Inhales one puff with one inspiration 3. Inhales medication slowly and deeply 4. Waits 2-5 minutes between puffs

1. Shakes canister to determine how much is left

2. Which position would be most comfortable for the patient and provide the best access for the nurse to insert a rectal suppository? (165) 1. Sims 2. Lithotomy 3. Trendelenberg 4. Orthopneic

1. Sims

The range of motion (ROM) that can be safely performed on the neck includes: (select all that apply) 1. flexion 2. supination 3. lateral flexion 4. rotation 5. hyperextension

1, 3, and 4

The nursing student is trying to explain the importance of taking blood pressure medication every day to an older patient who is on a fixed income. Which question from the patient is the best indication that his perception of time tends to be present-oriented? (101) 1. "Can I save the medication on the days when I feel okay?" 2. "What should I do if I am running out of medication and have no money?" 3. "My wife takes blood pressure medication too. Can I share her pills?" 4. "Would you take this medication if you were in my position?"

1. "Can I save the medication on the days when I feel okay?"

A patient who is Muslim dies during the night. To respect the patient's religious beliefs, what should the nurse do first? (103) 1. Contact the family before giving any post-mortem care. 2. Stay with the deceased until a family member arrives. 3. Wait at least 30 minutes before giving post-mortem care. 4. Contact the organ transplant team because the donation is likely.

1. Contact the family before giving any postmortem care.

63. What types of medications cannot be crushed for ease of administration? Select all that apply. (443) 1. Extended-release capsules 2. Tablets 3. Sublingual tablets 4. Enteric-coated tablets 5. Sustained-release capsules

1. Extended-release capsules 3. Sublingual tablets 4. Enteric-coated tablets 5. Sustained-release capsules

Medication Error Causes

1. Failure to follow 6 Rights 2. Lack of knowledge about medication 3. Calculation errors 4. Documentation errors 5. Look alike/Sound alike meds 6. Abbreviations

8. The patient experienced a stroke that left her with severe left-sided paralysis and very limited mobility. Which device would prevent plantar flexion? (169) 1. Footboard 2. Bedboard 3. Trapeze bar 4. Trochanter roll

1. Footboard

Functions of The Skin

1. Protection 2. Temperature Regulation 3. Sense Organ Activity 4. Excretion 5. Synthesis of Vitamin D

74. The nurse is supervising a nursing student who must give several medications. The nurse would intervene if the student performed which action? (444) 1. Puts a suppository in a uniform pocket 2. Used aseptic technique to handle pills 3. Looked at the meniscus when pouring a liquid 4. Read the label of the bottle as she took it off the shelf

1. Puts a suppository in a uniform pocket

A nurse is caring for a male neonate born to observant Orthodox Jewish parents. Who will the nurse anticipate will circumcise the neonate? a. A bishop b. A mohel c. His father d. His physician

A mohel

64. The nurse identifies that a patient is having an idiosyncratic reaction to a medication. Which patient's report is consistent with the nurse's analysis? (433) 1. Hypnotic medication causes him to be awake most of the night. 2. Antianxiety medication seems to make the pain medication more effective. 3. Previous dosage of pain medication does not seem to be working like it used to. 4. Antibiotic medication seems to cause an uncomfortable, itchy rash.

1. Hypnotic medication causes him to be awake most of the night.

65. Which route of drug administration will achieve the fastest onset of action? (434) 1. Intravenous 2. Buccal 3. Rectal 4. Oral

1. Intravenous

4. The nurse is working with a patient who has poor balance to move from the bed to the chair. What is included in the correct technique for assisting the patient to stand and pivot to the chair? (163) 1. Keep the knees slightly bent. 2. Maintain a narrow base with the feet. 3. Keep the stomach muscles loose. 4. Stand at arm's length from the patient.

1. Keep the knees slightly bent.

State the principles of body mechanics

1. Maintain appropriate body alignment 2. Maintain wide base of support 3. Bend knees and hips 4. Do not bend from waist

15. Which situation is the best example of proper ergonomic principles? (160) 1. Nurse A raises the head of the bed, supports the patient's shoulders, and helps to swing the legs around and off the bed using a pivoting motion. 2. Nurse B rolls the patient onto his/her side. The nurse then stoops, and when standing, brings the patient along with the nurse. 3. Nurse C gradually lowers the patient into the chair; the nurse bends her hips and knees as the patient leans slightly forward and sits down. 4. Nurse D assesses for equipment such as IV lines, urinary catheters, or tubes and positions them to avoid tension during the transfer.

1. Nurse A raises the head of the bed, sup-ports the patient's shoulders, and helps to swing the legs around and off the bed us-ing a pivoting motion.

11. The nurse is from a small town in the United States and is starting a new job in a large urban area with a diverse population. What strategies can the nurse use to develop cultural competence? Select all that apply. (96) 1. Perform a self-assessment of beliefs and practices. 2. Adapt personal beliefs to match those of individual patients. 3. Keep an open mind about cultural differences. 4. Treat everyone equally and act the same toward all patients. 5. Ignore the differences and focus on exhibit-ing kindness and care. 6. Understand own values, preferences, and cultural heritage.

1. Perform a self-assessment of beliefs and practices. 3. Keep an open mind about cultural differences. 6. Understand own values, preferences, and cultural heritage.

isotonic contraction

A muscle contraction that pulls on the bones and produces movement of body parts.

Based on Joint Commission requirements, under what circumstances must the nurse perform medication reconciliation? Select all that apply. (438) 1. The patient has just been admitted to the medical-surgical unit. 2. The provider has just made morning rounds and several new medications are prescribed. 3. The patient's daughter is taking her father home after a prolonged hospitalization. 4. The patient is being transferred to a rehabilitation unit after having hip surgery. 5. The patient has just finished a complete course of prescribed antibiotics.

1. The patient has just been admitted to the medical-surgical unit. 3. The patient's daughter is taking her father home after a prolonged hospitalization. 4. The patient is being transferred to a rehabilitation unit after having hip surgery.

76. Which factor would be the most important in the nurse's decision to choose an 18-gauge needle? (467) 1. Viscosity of solution 2. Age of patient 3. Length of needle 4. Weight of patient

1. Viscosity of solution

Bone repair

1. hematoma formation 2. callus formation 3. callus ossification 4. bone remodeling

83. Which patient is the most likely candidate for the use of a Morgan lens to flush the eye? (455) 1. Patient has allergic conjunctivitis in both eyes. 2. Patient was sprayed in the eyes with pepper spray. 3. Patient needs frequent eye irrigations at home. 4. Patient has pain after prolonged use of contact lenses.

2. Patient was sprayed in the eyes with pep-per spray.

Tendon

Connects muscle to bone

5. The patient had a surgical procedure and is getting up to ambulate for the first time. While ambulating down the hallway, the patient says, "I'm going to faint." What should the nurse do first? (168) 1. Call out for someone to obtain a wheel-chair. 2. Pull the patient close and lower him gently to the floor. 3. Lean the patient against the wall until the episode passes. 4. Support the patient and move quickly back to the room.

2. Pull the patient close and lower him gently to the floor.

What is the minimal number of hours of daily activity necessary to prevent the complications of immobility?

2 hrs/24 hr period

9. When assessing the neurovascular status of a patient, what is an expected finding? (170) 1. Capillary refill after 8 seconds 2. Pulses strong and easily palpated 3. Loss of sensation to an affected area 4. Mild localized discomfort

2. Pulses strong and easily palpated

80. An older patient is receiving a medication that is potentially nephrotoxic. Which assessment is the most relevant to potential nephrotoxicity? (479) 1. Change of mental status 2. Reduced urinary output 3. Nausea and vomiting 4. Increased blood pressure

2. Reduced urinary output

12. The nurse is caring for a patient who is dying. What does evidence-based practice indicate about cultural beliefs and rituals that surround death? (97) 1. The family should be encouraged to pray at the bedside. 2. Respect and protection of the dying person's soul are important. 3. Lack of religious preference increases problems with coping. 4. Rituals and ceremonies to delay or ward off death should be discouraged.

2. Respect and protection of the dying per-son's soul are important.

66. The nurse has five stable patients and each needs many medications. All of the medications are scheduled to be administered at 9:00 am. What should the nurse do first? (438) 1. Inform the RN that some of the medications were given late, despite best efforts. 2. Start at 08:30 am and give medications to the most cooperative patients first. 3. Administer as many medications at 9:00 am as possible and then write an incident report. 4. Ask the RN to change patient assignments so that medications are given on time.

2. Start at 08:30 am and give medications to the most cooperative patients first.

The nurse is assessing a patient who is receiving IV fluid and medication. Which finding is the most serious? (478) 1. The patient complains of pain at the insertion site. 2. The patient is dyspneic and has a weak, thready pulse. 3. The patient's arm is swollen and the skin is cool to the touch. 4. The patient is very scared and upset be-cause the IV bag is empty.

2. The patient is dyspneic and has a weak, thready pulse.

21. The nurse is assessing a patient who reports, "It feels like there is something inside me that wants to come out." Which questions would the nurse ask to assess the patient's belief system? Select all that apply. (97) 1. "When did you first notice the feeling?" 2. "Why do you think this is happening right now?" 3. "What do you think is causing the problem?" 4. "Why do you think this is happening to you?" 5. "What do you think will help clear up the problem?" 6. "How long does the feeling last?"

2. "Why do you think this is happening right now?" 3. "What do you think is causing the problem?" 4. "Why do you think this is happening to you?" 5. "What do you think will help clear up the problem?"

67. An IV of 1000 mL 5% dextrose and 45% saline is to infuse over 8 hours. The IV fluid is started at 0800 hours. At 1400 hours, how much IV flu-id has the patient received if the nurse correctly set the flow rate? (477) 1. 1000 mL 2. 750 mL 3. 625 mL 4. 500 mL

2. 750 mL

60. A tuberculin test will be given to the patient. What site would the nurse select for this intra-dermal injection? (475) 1. Upper outer aspect of the arm 2. Anterior aspect of the forearm 3. Middle third of the anterior thigh 4. A 2-inch diameter around the umbilicus

2. Anterior aspect of the forearm

A patient needs a PRN dose of pain medication. The provider's prescription reads 2 mg oral MS PRN for severe pain. The pharmacy sends magnesium sulfate. What should the nurse do first? (439) 1. Ask the patient if he has ever taken magnesium sulfate for relief of pain. 2. Call the provider and ask for clarification of the prescription. 3. Use a drug reference and see if magnesium sulfate is a pain medication. 4. Call the pharmacy and ask for clarification of what was sent.

2. Call the provider and ask for clarification of the prescription.

56. Upon getting the assignment for the evening, the nurse notices that two patients on the unit have the same last name. What is the best way to prevent medication errors for these two patients? (439) 1. Ask the patients their names. 2. Check the patients' identification bands. 3. Ask another nurse about their identities. 4. Verify their names with the family mem-bers.

2. Check the patients' identification bands.

75. The patient has an order for a medication that is to be delivered via an MDI. Which chronic health condition is the patient most likely to have? (458) 1. Hypertension 2. Chronic bronchitis 3. Diabetes mellitus 4. Arteriosclerotic heart disease

2. Chronic bronchitis

15. The nurse is a happy and outgoing person, and comes from a family where hugging, touching, patting, or playfully punching are part of normal everyday interaction. What is the best strategy for the nurse to combine her personal style with giving culturally appropriate care? (96) 1. Assess her own behaviors and try to understand the origin of her personal style. 2. Consider different patient care settings and observe interactions. 3. Learn which cultures can accept touch by health care personnel. 4. Request to care for patients who are from her own culture.

2. Consider different patient care settings and observe interactions.

9. The surgeon informs the patient that there is a risk of blood loss during the planned surgical procedure, but the patient is a Jehovah's Witness, so she refuses to sign the consent form. Which nursing action is in the best interest of the patient? (104) 1. Support the patient's decision to refuse the procedure. 2. Discuss realistic alternatives to blood transfusion with the surgeon. 3. Document the patient's decision in the medical record. 4. Contact the risk manager for advice about convincing the patient.

2. Discuss realistic alternatives to blood trans-fusion with the surgeon.

81. Upon assessment of the IV insertion site, the nurse suspects that the patient has phlebitis. Which assessment finding supports the nurse's analysis? (478) 1. Edema at the site 2. Erythema along the vein 3. Cool skin around site 4. Sluggish flow of IV fluid

2. Erythema along the vein

73. Two nurses are standing in the medication area. Nurse A is preparing medication but hears an alarm indicating that an unstable patient needs help right away. She hands the prepared medication to Nurse B and asks her to give it to the correct patient. What should Nurse B do first? (438) 1. Go ahead and give it because she witnessed all of the preparations that Nurse A made. 2. Inform the charge nurse that Nurse A needs assistance because of a critical patient. 3. Give the medication, but later indicate to Nurse A that she should do the documentation. 4. Discard the prepared medication and prepare another dose and give it to the patient.

2. Inform the charge nurse that Nurse A needs assistance because of a critical patient.

51. The nurse is assigned to give routine immunizations to infants who are seen in the well-baby clinic. In addition to standard medication documentation, what must be recorded when giving immunizations? (439) 1. Duration and course of postinjection observation time 2. Lot number of vial, manufacturer, and expiration date of vaccine 3. Age of the child at time of any previous immunizations or vaccinations 4. Informed consent with signatures from both parents or any guardians

2. Lot number of vial, manufacturer, and expiration date of vaccine

16. Which patient behavior should be corrected to reduce the risk of thrombophlebitis? (167) 1. The patient gets out of bed and forgets to put on slippers. 2. The patient sits in a chair and crosses their legs while reading a book. 3. The patient forgets to rise slowly when getting out of bed. 4. The patient sits in a slouched position on a soft couch.

2. The patient sits in chair and crosses legs while reading a book.

8. What cultural difference(s) does the nurse need to be aware of when caring for an older adult? Select all that apply. (98) 1. They are usually more tolerant of other cultures. 2. They may say hurtful things if cognitive impairment is present. 3. They are more likely to be rigid in their practices. 4. They are less likely to use home remedies. 5. They rely more on traditional religious practices. 6. They are less likely to be well-educated.

2. They may say hurtful things if cognitive impairment is present. 3. They are more likely to be rigid in their practices. 5. They rely more on traditional religious practices.

55. The nurse determines the location for an injection by identifying the greater trochanter of the femur, the anterosuperior iliac spine, and the iliac crest. Which injection site has the nurse located? (471) 1. Rectus femoris 2. Ventrogluteal 3. Dorsogluteal 4. Vastus lateralis

2. Ventrogluteal

How is a sitz bath done? How long should it last? What temp?

20-30 min @98-102

70. The nurse is giving a patient the morning medications. The patient says, "I don't recognize this pill." What should the nurse say? (438) 1. "The medications that you will get in the hospital may be different than the ones you take at home." 2. "Medications are made by different manufacturers. They can be chemically identical but have a different appearance." 3. "Let me review the list of your home medications and I'll find out if anything new was prescribed for you." 4. "I carefully checked all of your medications against the provider's prescriptions and these are correct."

3. "Let me review the list of your home medications and I'll find out if anything new was prescribed for you."

7. Patients who are immobilized in health care facilities require that their psychosocial needs be met along with their physiologic needs. Which statement by the nurse acknowledges these needs? (167) 1. "Visiting hours will be limited so you can rest." 2. "We will help you do everything so you don't have to worry." 3. "Let's talk about what you used to do at home during the day." 4. "A private room can be arranged for you."

3. "Let's talk about what you used to do at home during the day."

54. An IV of 500 mL D5 W is to infuse over 4 hours. The administration set is 15 gtt/mL. What is the correct number of gtt/min? (477) 1. 19 gtt/min 2. 24 gtt/min 3. 31 gtt/min 4. 42 gtt/min

3. 31 gtt/min

52. The nurse is reviewing the prescriptions that the provider wrote for several patients. Which one will the nurse attend to first? (433) 1. A prescription for a PRN stool softener 2. A dose of antipyretic medication now 3. A stat dose of IV epinephrine 4. A one-time only dose of an anxiolytic

3. A stat dose of IV epinephrine

49. A new nurse is working in a small rural long-term care facility. An older provider routinely directs the care of the residents and he prefers to handwrite his notes and orders, rather than use a computer. What should the new nurse do first if the provider's handwriting is illegible? (442) 1. Consult the director of nursing services about the provider's behavior. 2. Call the provider for clarification whenever it is necessary. 3. Ask the charge nurse for assistance in interpreting the handwriting. 4. Gently offer to help the provider learn how to use the computer.

3. Ask the charge nurse for assistance in interpreting the handwriting.

77. The nurse is assessing an existing IV that seems to have stopped infusing. What should the nurse do first? (468) 1. Recalculate the drip rate and then count the number of drops per minute. 2. Discontinue the IV and inform the RN or provider. 3. Check for infiltration and ask the patient about pain or discomfort. 4. Try repositioning the patient's extremity or adjusting the height of the IV bag.

3. Check for infiltration and ask the patient about pain or discomfort.

69. The provider prescribes two medications and suggests to the nurse that they could be mixed together in the same syringe to prevent the patient from having to get two separate injections. The nurse mixes the drugs, but a precipitate forms in the syringe. What should the nurse do? (433) 1. Ask the provider to verify the request to mix the drugs. 2. Gently rotate the syringe between the palms of the hands to mix the solution. 3. Discard the syringe and call the pharmacy for information about compatibilities. 4. Administer the medications as prescribed and document the injection site.

3. Discard the syringe and call the pharmacy for information about compatibilities.

82. The nurse is at home and her husband accidentally gets a caustic chemical splash in his eyes. What should the nurse do first? (449) 1. Drive him to the hospital and flush his eyes with sterile normal saline. 2. Call Poison Control and ask for advice about the specific chemical. 3. Gently flush his eyes with tap water for at least 15 minutes. 4. Assess him for burning, changes in visual acuity, or pain.

3. Gently flush his eyes with tap water for at least 15 minutes.

19. The nurse is discussing the parents' beliefs and use of folk medicine, which they would like to use to treat their child's respiratory infection. Which health care practice is the cause for the greatest concern? (107) 1. Placing a religious medal on the bedside table 2. Having a folk healer come to heal with touch and faith 3. Giving the child an herbal tea that gives strength and health 4. Bathing at night instead of in the morning

3. Giving the child an herbal tea that gives strength and health

What does passive-ROM mean? A. A nurse or other person performs exercises to a patient's extremities B. A patient moves extremities minimally without exertion C. The patient moves the extremities in an extreme manner D. The patient does not perform exercises to his/her full ability

A nurse or other person performs exercises to a patient's extremities

The patient reports having an anaphylactic reaction to an IV medication but cannot remember the name. The nurse informs the provider and the provider tells the nurse to go ahead and administer the prescribed medication. What should the nurse do? (478) 1. Refuse to administer the medication because the allergy history is not clarified. 2. Take baseline vital signs and recheck the patient frequently during the infusion. 3. Inform the charge nurse or RN about the potential for an adverse reaction. 4. Call the pharmacy and see if they have any records of the patient's allergies.

3. Inform the charge nurse or RN about the potential for an adverse reaction.

3. Which medications are most likely to contribute to orthostatic hypotension? (162) 1. Medications used to treat osteoporosis 2. Medications used to prevent thrombophlebitis 3. Medications used to reduce high blood pressure 4. Medications used to treat arthritis pain

3. Medications used to reduce high blood pressure

16. The nurse is working in an assisted-living facility and most residents take their meals in a common dining area. What is the best method for seating the residents? (99) 1. Assign seating so that each resident has a consistent place at mealtimes. 2. Encourage the residents to continuously sit with someone new for stimulation. 3. Observe how self-mobile and ambulatory residents seat and group themselves. 4. Ask each resident where he/she would like to sit at the beginning of each meal.

3. Observe how self-mobile and ambulatory residents seat and group themselves.

13. The patient, who is in no apparent distress, is accompanied to the clinic by several family members who cluster around. All are attempt-ing to talk to each other and the nurse at the same time. The nurse can hear a mixture of English and another language being spoken. What should the nurse do first? (101) 1. Try to determine who speaks the best Eng-lish. 2. Take only the patient to an examination room and shut the door. 3. Project calm energy and try to identify the leader of the family. 4. Physically assess the patient and take vital signs to ascertain stability.

3. Project calm energy and try to identify the leader of the family.

14. A male patient says to the nurse regarding the UAP, "That young Asian woman who helped me with my bath was really nice, but she seemed scared and never looked up; just kept her head down. Did I do something to scare or offend her?" What should the nurse do first? (96) 1. Find the UAP and ask her to explain her behavior to the patient. 2. Reassure him that he did nothing wrong and that the UAP's behavior is cultural. 3. Tell the patient that you will check with the UAP and then get back to him. 4. Apologize to the patient and give then give feedback to the UAP.

3. Tell the patient that you will check with the UAP and then get back to him.

59. When would the nurse use the Z-track technique? (470) 1. The patient is extremely obese. 2. The child is younger than 5 years old. 3. The prescribed medication can irritate tissue. 4. The prescribed dose of medication is very large.

3. The prescribed medication can irritate tissue.

78. The nurse is performing an intradermal injection for an allergy test. He does not aspirate for this type of injection. What is the best rationale for the nurse's technique? (472) 1. This is a standard procedure and he is following the procedure manual. 2. Aspirating can cause bruising and the patient will receive many allergy tests. 3. There are no major veins or arteries in the intradermal tissues. 4. The needle is so fine and short that it is unlikely to cause tissue damage.

3. There are no major veins or arteries in the intradermal tissues.

20. On visiting the patient at home, the nurse finds that the patient is not following the dietary instructions. The nurse discovers that the wife, who shops and cooks, believes that her husband needs "nutritious home-cooked meals from his native country." What should the nurse do first? (107) 1. Change the dietary plan to meet the patient's and family's cultural preferences. 2. Consult a nutritionist for ways to adapt the wife's cooking to the dietary plan. 3. Revise the patient's nutritional goal to incorporate the cultural dietary patterns. 4. Ask the wife to describe a typical 24-hour day of meal preparation and snacks.

4. Ask the wife to describe a typical 24-hour day of meal preparation and snacks.

How does the nurse determine what the drip factor is for an IV set? (477) 1. Ask the charge nurse. 2. Calculate the IV rate. 3. Look in a reference book. 4. Check the IV tubing box.

4. Check the IV tubing box.

What temp is tepid bath?

98.6, to lower body temp and relieve tension

53. A prescription for codeine gr 1⁄2 is written for the patient. The medication is supplied in mg. What should the nurse administer? (424) 1. 3 g 2. 30 g 3. 3 mg 4. 30 mg

4. 30 mg

84. Which patient is most likely to need an ear irrigation? (455) 1. A child who inserted a dried pinto bean into the ear canal 2. A toddler who has a severe ear infection with exudate 3. A teenager who has bleeding from the ear after a fight 4. An older patient who reports a crackling noise in ear

4. An older patient who reports a crackling noise in ear

Skin Cancer, warning signs

A Asymmetry B Border irregular C Color is mottled D Diameter is large E Elevation almost always E Enlargement

72. The nurse has performed a medication calculation and has determined that to give the prescribed dose, 15 tablets would have to be administered to the patient. The nurse has asked two other nurses to recheck the calculations and the answer is always 15. What should the nurse do first? (438) 1. Give the 15 tablets because the calculations have been checked and rechecked. 2. Call the pharmacy and ask if the medication comes in different strength. 3. Call the provider and ask for verification of the prescription. 4. Consult a reliable drug reference to see if the prescribed dose is within safe range.

4. Consult a reliable drug reference to see if the prescribed dose is within safe range.

6. The patient will be immobilized for an extended period due to extensive injuries. Which intervention will the nurse use to prevent respiratory complications? (168) 1. Suction the airway every hour. 2. Change the patient's position every 4-8 hours. 3. Use oxygen and nebulizer treatments regularly. 4. Encourage deep-breathing and coughing every hour.

4. Encourage deep-breathing and coughing every hour.

58. When preparing an opioid medication, the nurse drops the pill on the floor. What should the nurse do? (437) 1. Discard the medication in the biohazard container. 2. Notify the pharmacy of a replacement dose. 3. Wipe off the medication and administer it. 4. Have another nurse witness the disposal of the pill.

4. Have another nurse witness the disposal of the pill.

1. A nurse walks into the patient's room and notices that the patient is having trouble breathing. Which position will the nurse use to help relieve the patient's respiratory distress? (165) 1. Lower the head of the bed and place the patient in a supine anatomical position. 2. Position the patient on the side with knee and thigh drawn up toward the chest. 3. Lower the patient's head and place the body and legs on a slightly inclined plane. 4. Raise the head of the bed to 90 degrees and have the patient lean forward on the over-bed table.

4. Raise the head of the bed to 90 degrees and have the patient lean forward on the over-bed table.

68. The nurse hears in the report that 1000 mL of normal saline was started at 3:00 am to infuse at 125 mL per hour. At 7:30 am, the nurse evaluates the patient and the IV infusion, which is running by gravity; the IV fluid bag shows that approximately 200 mL has been infused. What should the nurse do first? (477) 1. Calculate the amount of fluid that should have infused and then give it. 2. Report the error to the charge nurse and write an incident report. 3. Document the amount of fluid infused and the appearance of the site. 4. Recalculate the drops/minute and reset the rate of flow to 125 mL/hour.

4. Recalculate the drops/minute and reset the rate of flow to 125 mL/hour.

A patient has been immobilized for 5 days because of extensive abdominal surgery. When this patient is helped out of bed for the first time, which nurses diagnosis related to safety applies to this patient? 1. Pain 2. Impaired skin integrity 3. Altered tissue perfusion 4. Risk for activity intolerance

4. Risk for activity intolerance

12. What is the most likely complication when an older adult patient gets pulled across the bed when changing wet linens? (162) 1. Dislocation of a joint 2. Increased stress to the joints 3. Abnormal hyperextension of a joint 4. Shearing or tearing of the skin

4. Shearing or tearing of the skin

57. The nurse is working in the newborn nursery and will be giving vitamin K injections to the babies. What is the preferred site for these injections? (470) 1. Deltoid 2. Dorsogluteal 3. Ventrogluteal 4. Vastus lateralis

4. Vastus lateralis

Burn degree layers

4th degree- (full thickness) below subcutaneous tissue to muscle or bone

rigor mortis

A fixed muscular contraction after death

33. Which of the following is not correct? A. A baby is born with a straight spine B. In the adult, the sacral and thoracic curves are convex C. The normal curves of the adult spine provide greater strength than a straight spine D. A curved structure has more strength than a straight one of the same size and materials

A. A baby is born with a straight spine

2. What is the movement of a part away from the midline of the body called? A. Abduction B. Adduction C. Pronation D. Plantar flexion

A. Abduction

3. Which of the following statements about hair follicles is true? A. Arrector pili muscles are associated with them B. Sudoriferous glands empty into them C. They arise directly from the epidermis layer of skin D. All of the above are true

A. Arrector pili muscles are associated with them

3. Of what is yellow bone marrow primarily made? A. Fatty tissue B. Blood cells C. Epithelial tissue D. Fibrous tissue

A. Fatty tissue

8. Which of the following statements about muscle atrophy is true? A. It decreases the size of a muscle B. It increases the size of a muscle C. It has no effect on muscle size D. None of the above is true

A. It decreases the size of a muscle

41. When a baby learns to walk, which area of the spine becomes concave? A. Lumbar B. Thoracic C. Cervical D. Coccyx

A. Lumbar

9. Which of the following occurs during isometric exercises? A. Muscle length remains the same B. Muscle tension remains the same C. Muscle length shortens D. None of the above occurs

A. Muscle length remains the same

31. Which of the following is/are not a part of the axial skeleton? A. Scapula B. Cranial bones C. Vertebra D. Ribs E. Sternum

A. Scapula

48. In most cases, isotonic contraction of muscle produces movement at a/an: A. insertion B. beginning C. joint D. bursa

C. joint

10. What are the joints between the cranial bones called? A. Synarthroses B. Diarthroses C. Amphiarthroses D. All of the above

A. Synarthroses

Which of the following statements concerning the ribs is true? A. The first seven pairs attach to the sternum by cartilage B. The last four pairs are called floating ribs because they are free in the front C. The eighth, ninth, and tenth pairs do not move because they are not attached to the sternum D. All of the above statements concerning the ribs are true

A. The first seven pairs attach to the sternum by cartilage

1. What type of serous membrane that covers organs is found in all body cavities? A. Visceral B. Pleural C. Parietal D. Synovial

A. Visceral

39. The heel bone is known as the: A. calcaneus B. talus C. metatarsal D. phalanges

A. calcaneus

46. Distally, the ___________ articulates with the patella. A. femur B. fibula C. tibia D. humerus

A. femur

43. The skin is the ____________________ line of defense against microbes that invade the body's internal environment. A. first B. second C. third D. fourth

A. first

64. A movement that makes the angle between two bones smaller is: A. flexion B. extension C. abduction D. adduction

A. flexion

46. Twitch contractions easily can be seen: A. in isolated muscles prepared for research B. in a great deal of normal muscle activity C. during resting periods D. none of the above

A. in isolated muscles prepared for research

41. When a muscle contracts and no movement results, the contraction is: A. isometric B. isotonic C. twitch D. tetanic

A. isometric

40. Any measurable variation from the normal structure of tissue is known as a/an: A. lesion B. burn C. blister D. erythema

A. lesion

67. When you move your head from side to side as in shaking your head "no," you are ______________ a muscle group. A. rotating B. pronating C. supinating D. abducting

A. rotating

46. The most common type of skin cancer is: A. squamous cell B. basal cell C. melanoma D. Kaposi sarcoma

A. squamous cell

The nurse is caring for a postpartum patient who requests to dry and bury the umbilical cord near an object or in a place that symbolizes what the parents want for the child's future. Which cultural beliefs does the nurse recognize this patient adhering to? a. American Indian b. African American c. Chinese American d. Mexican American

ANS: A After delivery, American Indians practice taking the umbilical cord from the newborn, drying and burying it near an object or place that symbolizes what the parents want for the child's future.

Which statement about the biomedical health belief system is true? a. Life processes can be manipulated by human beings by mechanical interventions. b. Life processes cannot be manipulated by human beings by mechanical interventions. c. Disease has a nonspecific cause, onset, course, and treatment. d. Disease is only caused by failure of body parts and chemical imbalances.

ANS: A Characteristic of the biomedical health belief system include the beliefs that life is regulated by biomedical and physical processes. Life processes can be manipulated by human beings by mechanical interventions. Health is the absence of disease or signs and symptoms of disease. Disease is an alteration of the structure and function of the body. Disease has a specific cause, onset, course, and treatment. It is caused by trauma, pathogens, chemical imbalances, or failure of body parts. Treatment focuses on the use of physical and chemical treatments.

35. The bone that runs along the lateral side of your forearm is the: A. humerus B. ulna C. radius D. tibia

C. radius

The nurse is caring for a Muslim patient. What dietary selection should the nurse serve to this patient? a. Bacon, eggs, and toast b. Pork fried rice c. Ham and cheese sandwich d. Chicken and rice

ANS: D Muslims practice avoidance of foods that include pork products. Bacon, pork, and ham are all pork products. Only the chicken and rice meal does not include a pork product.

Which health belief system focuses on restoring balance with physical, social, and metaphysical worlds? a. Folk health belief system b. Holistic health belief system c. Biomedical health belief system d. Alternative/complementary belief system

ANS: B The treatment based on the holistic health belief system is designed to restore balance with physical, social, and metaphysical worlds.

A nurse is preparing a meal tray for a patient who is a Latter-Day Saint. What beverage should the nurse prepare? a. Tea with all meals b. Coffee each morning c. Cola beverages d. Fruit juice

ANS: D For observant Latter-Day Saints, beverages with caffeine such as cola, coffee, and tea; alcohol; and other substances are considered injurious.

Nasal sprays

Absorbed quickly Less medication is used and wasted when you administer them in this manner For individual use only

Which of the following is a true benefit of nasal sprays? a. Absorbed quickly, less medication is used and wasted b. Absorption is gradual, therefore more medication is dispersed c. Absorption is direct, therefore results are felt quickly d. Absorption is painless, therefore a more preferred form

Absorbed quickly, less medication is used and wasted

What are some characteristics that cultures have in common? (Select all that apply.) a. Economic practices b. Survival modes c. Transportation systems d. Language e. Family systems

All

Ointments

An ointment is an oil-based semisolid medications; the nurse applies it to the skin or a mucous mebrane.

A common complication of patients with limited mobility is a thrombus or emboli. Which nursing intervention assists in the prevention of a thrombus? 1. Applying TED stockings 2. Assessing the circulation of lower extremities 3. Assessing for a positive Homan sign 4. Elevating lower extremities off the bed

Applying TED stockings

glenoid cavity

Articulates with humerus to form shoulder joint, allows rotation of arm

A Mexican American patient is about to give birth. She is requesting family support. The father is in the waiting room and does not want to be present at the delivery. Which action is appropriate for the nurse to take? 1 Insist that the father be present at the delivery. 2 Ask a female family member to support the patient. 3 Request the father to leave and return the following day. 4 Threaten to notify Child Protective Services about abandonment.

Ask a female family member to support the patient.

A Hispanic American child is brought to the clinic by her mother to be examined by the primary health care provider. Which nursing action is most important when gathering data about the child? 1 Avoid eye contact. 2 Use only body language. 3 Avoid any talking with the child. 4 Provide therapeutic touch with assessment.

Avoid eye contact.

43. There are how many pairs of true ribs? A. 14 B. 7 C. 5 D. 3

B. 7

10. Which of the following is not an important function of the skin? A. Sense organ activity B. Absorption C. Protection D. Temperature regulation

B. Absorption

43. Pushing against a wall is an example of which type of contraction? A. Isotonic B. Isometric C. Twitch D. Tetanic

B. Isometric

42. Walking is an example of which type of contraction? A. Isometric B. Isotonic C. Twitch D. Tetanic

B. Isotonic

6. Which of the following statements about oxygen debt is true? A. It is caused when excess oxygen is present in the environment B. It causes lactic acid buildup and soreness in muscles C. It can be replaced by slow, shallow breathing D. All of the above are true

B. It causes lactic acid buildup and soreness in muscles

4. Which of the following statements is true of the hamstring group of muscles? A. It includes the rectus femoris B. It flexes the knee C. It originates on the pubis D. All of the above are true

B. It flexes the knee

5. Which of the following, if any, is not found in the dermis layer of the skin? A. Nerves B. Melanin C. Blood vessels D. All of the above are found in the dermis

B. Melanin

7. Blackheads can result from the blockage of which of the following glands? A. Lacrimal B. Sebaceous C. Ceruminous D. Sudoriferous

B. Sebaceous

40. The mastoid process is part of which bone? A. Parietal B. Temporal C. Occipital D. Frontal

B. Temporal

2. Which of the following statements about synovial membranes is true? A. They are classified as epithelial B. They line joints C. They contain a parietal layer D. All of the above are true

B. They line joints

42. Which bone is the "funny" bone? A. Radius B. Ulna C. Humerus D. Carpal

B. Ulna

39. Any disorder of the skin may be called: A. dermatitis B. dermatosis C. dermatotomy D. none of the above

B. dermatosis

44. The 27 bones in the wrist and the hand allow for more: A. strength B. dexterity C. protection D. red blood cell products

B. dexterity

49. Prolonged inactivity causes muscles to shrink in mass, a condition called: A. hypertrophy B. disuse atrophy C. paralysis D. muscle fatigue

B. disuse atrophy

5. Muscles that help other muscles in producing movement are called: A. prime movers B. synergists C. antagonists D. bursae

B. synergists

47. Individual contractions "melt" together to produce a sustained contraction or: A. twitch B. tetanus C. isotonic response D. isometric response

B. tetanus

Why do skeletal muscles appear striated?

Because muscle cells only contract not extend; skeletal muscles work in pairs. While one muscle contracts the other muscle in the returns to its original state.

Folk health belief system

Belief that health and illness are controlled by supernatural forces. May use native healers, plants, religious rituals, and prayers.

When lifting and moving a patient up in bed, a lift sheet may be used. Where is the best place for a lift sheet under the patient? 1. Between the upper back and the thighs 2. Between the head and buttocks 3. Between the waist knees 4. Between the waist and ankles

Between the upper back and the thighs

For an older female who is at risk for osteoporosis, which associated complication can be minimized by participating in a regular exercise program as prescribed by the health care provider? 1. Bone loss that results in fractures 2. Immobility secondary to joint degeneration 3. Tissue ischemia and pressure ulcers 4. Thrombophlebitis secondary to blood clots

Bone loss that results in fractures Patients who are at risk for osteoporosis should be encouraged to exercise. This strengthens bones and reduces the risk for fractures. The other complications are more related to mobility

osteoclasts

Bone-destroying cells

Rickets

Both diseases are characterized by demineralization, or loss of minerals, from bone related to vitamin D deficiency.

10. Which of the following statements about skeletal muscle contraction is true? A. Its attachment to the more stationary bone is called its origin B. Its attachment to the more movable bone is called its insertion C. Both A and B are true D. None of the above is true

C. Both A and B are true

9. What is the fold of skin that hides the root of a nail called? A. Lunula B. Body C. Cuticle D. Papillae

C. Cuticle

2. Which is the longest bone in the body? A. Humerus B. Ulna C. Femur D. Radius

C. Femur

4. Which of the following statements regarding the female pelvis is not true? A. Its shape can be described as more broad, shallow, and basinlike when compared with that of the male B. Its pelvic inlet, or brim, is usually wider than that of the male C. Its individual hipbones are usually larger and heavier than those of the male D. All of the above statements are true

C. Its individual hipbones are usually larger and heavier than those of the male

49. The spinal cord enters the cranium through a large hole (foramen magnum) in which bone? A. Temporal B. Parietal C. Occipital D. Sphenoid

C. Occipital

8. Which of the following bones is not classified as a cranial bone? A. Sphenoid B. Parietal C. Palatine D. Temporal

C. Palatine

66. Moving a part away from the midline is: A. flexion B. extension C. abduction D. adduction

C. abduction

44. Endurance training is also known as: A. isometrics B. hypertrophy C. aerobic training D. strength training

C. aerobic training

45. Furuncles are local staphylococci infections and are also known as: A. scabies B. warts C. boils D. impetigo

C. boils

48. In a child, there are five of these bones. In an adult, they are fused into one. A. Pelvic B. Lumbar vertebrae C. Sacrum D. Carpals

C. Sacrum

7. Which of the following bones are components of the axial skeletal system? A. Ilium, ethmoid, clavicle B. Ulna, palatine, occipital C. Sacrum, parietal, zygomatic D. Scapula, patella, fibula

C. Sacrum, parietal, zygomatic

5. Which of the following statements is/are true about the normal curves of the spine (two concave and two convex)? A. They are present at birth B. They extend from the skull to the bottom of the ribcage C. They give the spine strength to support the weight of the rest of the body D. All of the above are true

C. They give the spine strength to support the weight of the rest of the body

3. According to the sliding filament theory of muscle contraction: A. muscle fibers contain thin myofilaments made of a protein called myosin B. muscle fibers contain thick myofilaments made up of a protein called actin C. thin and thick myofilaments move toward each other to cause muscle contraction D. all of the above are true

C. thin and thick myofilaments move toward each other to cause muscle contraction

36. The shinbone is also known as the: A. fibula B. femur C. tibia D. ulna

C. tibia

What is important consideration for an older patient who is using a continuous passive motion (CPM) machine after knee arthroplasty? 1. CPM is a potential fire hazard, so care must be taken to avoid flammable materials. 2. CPM creates a risk for skin impairment so pressure points must be frequently assessed 3. CPM is preferred for home-bound seniors because it is easy to use 4. Many older patients prefer CPM because it is less strenuous than physical therapy

CPM creates a risk for skin impairment so pressure points must be frequently assessed

What does the skeleton consist of in a baby before birth?

Cartilage and fibrous structures

First-Degree Burns

Causes minor discomfort and some reddening of the skin, actual tissue damage is minimal

Creams

Combination of water, oil and other substances that are less greasy than ointments and usually absorbed by the skin

ligaments

Connect bone to bone

6. What characterizes second-degree burns? A. Blisters B. Swelling C. Severe pain D. All of the above

D. All of the above

1. Which of the following statements about a motor unit is true? A. It consists of a muscle cell group and a motor neuron B. The point of contact between the nerve ending and the muscle fiber is called the neuromuscular junction C. Chemicals generate events within the muscle cell that result in contraction of the muscle cell D. All of the above are true

D. All of the above are true

4. Which of the following statements about apocrine glands is true? A. They can be classified as sudoriferous B. They are found primarily in armpit and genital regions C. They secrete a thick substance that has a strong odor associated with it D. All of the above are true

D. All of the above are true

6. Which of the following statements regarding diarthrotic joints is not true? A. They contain a synovial membrane that secretes a lubricating fluid called synovial fluid B. Diarthrotic joints may permit flexion, extension, abduction, adduction, or rotation C. These joints make up the largest category of body joints D. All of the above statements are true

D. All of the above statements are true

9. Which of the following statements characterizes the skeleton of a growing child? A. Epiphyses are separated from diaphyses by a layer of cartilage B. Osteoblasts deposit calcium in the gel-like matrix of cartilage C. The periosteum is present D. All of the above statements characterize the skeleton of a growing child

D. All of the above statements characterize the skeleton of a growing child

38. Which one of the following is not a bone of the upper extremity? A. Radius B. Clavicle C. Humerus D. Ilium

D. Ilium

32. Which one of the following is not a cranial bone? A. Frontal B. Parietal C. Occipital D. Lacrimal E. Sphenoid

D. Lacrimal

68. ______________ occurs when you turn the palm of your hand from an anterior to posterior position. A. Dorsiflexion B. Plantarflexion C. Supination D. Pronation

D. Pronation

7. What is a quick, jerky response of a given muscle to a single stimulus called? A. Isometric B. Lockjaw C. Tetanus D. Twitch

D. Twitch

47. Which bones form the cheekbones? A. Mandible B. Palatine C. Maxillary D. Zygomatic

D. Zygomatic

65. Moving a part toward the midline is: A. flexion B. extension C. abduction D. adduction

D. adduction

44. Tinea is a fungal infection and may appear as: A. ringworm B. jock itch C. athlete's foot D. all of the above

D. all of the above

42. An example of a skin disorder that may produce fissures is: A. acne B. a bedsore C. psoriasis D. athlete's foot

D. athlete's foot

45. Benefits of regular exercise include all of the following except: A. improved lung functioning B. more efficient heart C. less fatigue D. atrophy

D. atrophy

34. True ribs: A. attach to the cartilage of other ribs B. do not attach to the sternum C. attach directly to the sternum without cartilage D. attach directly to the sternum by means of cartilage

D. attach directly to the sternum by means of cartilage

37. The bones in the palm of the hand are called: A. metatarsals B. tarsals C. carpals D. metacarpals

D. metacarpals

50. Muscle hypertrophy can be best enhanced by a program of: A. isotonic exercise B. better posture C. high-protein diet D. strength training

D. strength training

41. An example of a papule is a: A. scratch B. bedsore C. freckle D. wart

D. wart

It is the patient's first night after an abdominal hysterectomy. She has not voided for 9 hours, and the nurse is to insert a 16Fr. Foley catheter into her bladder. What patient position best allows insertion of the catheter? 1. Dorsal recumbent 2. Lithotomy 3. Sims 4. Prone

Dorsal recumbent

In the absence of the priest, the nurse has baptized a newborn baby. Which additional action would the nurse also perform? 1 Arrange for a prayer with the patient's family and friends. 2 Read the Bible to the mother and the newborn baby. 3 Document the prescriptions required for the newborn baby 4 Check document the baptism in the nurse's notes.

Document the prescriptions required for the newborn baby

The patient will be immobilized for an extended period due to extensive injuries. Which intervention will the nurse use to prevent respiratory complications? 1. Suction the airway every hour 2. Change the patient's position every 4-8 hours 3. Use oxygen and nebulizer treatments regularly 4. Encourage deep breathing and coughing every hour

Encourage deep breathing and coughing every hour

The nurse is preparing an Orthodox Jewish patient's tray during Passover. What intervention is appropriate for this patient? a. Avoid fish dishes b. Encourage time for prayer c. Offer the patient leavened products d. Encourage the use of loud music in celebration

Encourage time for prayer Orthodox Jews say prayers over the bread and wine before meals. Time and a quiet environment should be provided for this. During Passover, no leavened products are eaten.

What is the term for a group of people who share a common social and cultural heritage based on shared traditions, national origin, and physical and biologic characteristics? a. Race b. Culture c. Religion d. Ethnicity

Ethnicity

The nurse and a UAP are to move a dependent patient from the supine to the lateral position. Which action should be performed first? 1. Move the patient to the side of the bed 2. Ensure that the upper arm and leg are supported with pillows 3. Explain to the patient what actions the nurse and UAP are going to perform 4. Turn the patient with use of a lift sheet.

Explain to the patient what actions the nurse and UAP are going to perform

The patient experienced a cerebrovascular accident (CVA) that left her with severe left-sided paralysis and very limited mobility. Which device would prevent plantar flexion? 1. Footboard 2. Bed board 3. Trapeze bar 4. Trochanter roll

Foot board

The nurse is feeding a Jewish patient with a low body mass index. The diet contains meat and dairy products. Which precaution would the nurse take while providing nutrition? 1 Give milk first, followed by meat. 2 Avoid meat and milk on Wednesdays. 3 Avoid meat on the day of Sabbath. 4 Give only milk on the day of Yom Kippur.

Give milk first, followed by meat.

A nurse is caring for an Orthodox Jewish woman immediately after she has given birth. What can the nurse expect regarding the spouse's participation in his wife's care? a. He will share a bed with the patient. b. He will ask to bathe with the patient. c. He will touch the patient frequently. d. He will avoid physical contact with the patient.

He will avoid physical contact with the patient For observant Jews, a woman is considered to be in a ritual state of impurity whenever blood is coming from her uterus, such as during menstrual periods and after the birth of a child. During this time, her husband will not have physical contact with her. When this time is completed, she will bathe herself in a pool called a mikvah. Nurses need to be aware of this practice and be sensitive to the husband and wife because the husband will not touch his wife.

A nurse is caring for a female neonate born to observant Orthodox Jewish parents. What book does the nurse know will be used when naming this neonate? a. Bible b. Koran c. Holy Torah d. Book of Mormon

Holy Torah

Endosteum

Inner lining of the medullary cavity of a long bone

Second-Degree Burns (Partial Thickness)

Involves the deep epidermal layers and always causes injury to the upper layers of the dermis; blisters, severe pain, and fluid loss occur

Which religious faith restricts artificial birth control measures? 1 Taoism 2 Buddhism 3 Islam 4 Hinduism

Islam

A patient admitted to the medical-surgical unit insists that the nurse provide a private space for prayers. To which religion might this patient belong? Select all that apply. 1 Islam 2 Judaism 3 Hinduism 4 Christianity 5 Taoism

Islam Judaism

The nurse is working with a patient who has poor balance to move from the bed to the chair. What is included in the correct technique for assisting the patient to stand and pivot the chair? 1. Keep the knees slightly bent 2. Maintain a narrow base with the feet 3. Keep the stomach muscles loose 4. Stand arm's length from he patient

Keep the knees slightly bent

The nurse is working with a patient who has poor balance to move from the bed to the chair. What is included in the correct technique for assisting the patient to stand and pivot the chair? 1. Keep the knees slightly bent 2. Maintain a narrow base with the feet 3. Keep the stomach muscles loose 4. Stand arm's length from he patient

Keep the stomach muscles loose

What position is appropriate for patients in shock?

Laying supine. (Trendelenburg or head downwards with body and legs elevated was also historically used for shock, but is used less frequently now)

The parietal layer

Lines the walls of the body cavities. Like wallpaper covers the wall.

Lotions

Lotions are generally aqueous preparations that are used as soothing agents to reliee pruritus to protect the skin, lcleanse the skin intack, or act as astringents.

Which medications are most likely to contribute to orthostatic hypotension? 1. Medications used to treat osteoporosis 2. Medications to prevent thrombophlebitis 3. Medication to reduce high blood pressure 4. Medications to treat arthritis pain

Medication to reduce high blood pressure

Which medications are most likely to contribute to orthostatic hypotension? 1. Medications used to treat osteoporosis 2. Medications to prevent thrombophlebitis 3. Medication to reduce high blood pressure 4. Medications to treat arthritis pain

Medication to reduce high blood pressure

A female patient from a Protestant family wishes to wear her head covering while being treated in the health care facility. Which Protestant faith does she belong to? 1 Unitarian Universalist Association 2 Church of Jesus Christ of Latter-day Saints 3 Mennonite 4 Jehovah's Witness

Mennonite

The nurse weighs 106 pounds. According to the National Institute for Occupational Safety and Health (NIOSH) Division of Safety research, what is the maximum weight she should safely lift? 1. Depends on the nurse's health and personal strength 2. No more than 35 pounds of the patient's weight 3. No more than 35% of her own 106 pounds 4. Maximum of 50 pounds regardless of patient's or nurse's weight

No more than 35 pounds of the patient's weight

alternative or complementary belief system

Non-medical forms of Terapy to treat illness. Example: Accupuncture

During an interview with a patient scheduled to have surgery, the patient states that alternative therapy and non medical remedies are being used. Which action by the nurse would be most appropriate? 1 Notify the health care provider. 2 Note the health practices in the patient's record. 3 Recognize the patient's right to participate in alternative therapies. 4 Inform the patient that the facility will be unable to provide information about those therapies during the patient's stay.

Notify the health care provider.

What are the different ways bones can be injured?

Oblique and Transverse

saddle joints

Only one pair exists and is between the thumb and wrist.

The membrane lining the interior of the chest wall is called the

Parietal pleura

Which patient behavior should be corrected to reduce the risk of thrombophlebitis? 1. Patient gets out of bed and forgets to put on slippers 2. Patient sits in a chair and crosses legs while reading a book 3. Patient forgets to rise slowly when getting out of bed 4. Patient sits in a slouched position on a soft couch

Patient sits in a chair and crosses legs while reading a book

Which patient has a contracture? 1. Patient has abnormal extension of a finger joint 2. Patient's wrist is abnormally flexed and joint is fixed 3. Patient's knee is hyperextended 4. Patient has abnormal lateral movements of ankle joint

Patient's wrist is abnormally flexed and joint is fixed

pivot joints

Pivot joints allow rotation arround an axis. The neck and forearms have pivot joints. In the neck the occipital bone spins over the top of the axis. In the forearms the radius and ulna twist arround each other.

The patient has had a surgical procedure and is getting up to ambulate for the first time. While ambulating down the hallway, the patient says "I'm going to faint". What should the nurse do first? 1. Call out for someone to obtain a wheelchair 2. Pull the patient close and lower him gently to the floor 3. Lean the patient against the wall until the episode passes 4. Support the patient and move quickly back to the room

Pull the patient close and lower him gently to the floor

When assessing the neurovascular status of a patient, what is an expected finding? 1. Capillary refill after 8 seconds 2. Pulses strong and easily palpated 3. Loss of sensation to an affected area 4. Mild localized discomfort

Pulses strong and easily palpated

A Protestant patient is admitted to a health care facility. The nurse is asked to avoid pork in the patient's diet. To which Protestant denomination might the patient belong? 1 Unitarian Universalist Association 2 Church of Jesus Christ of Latter-day Saints 3 Christian Science 4 Seventh-Day Adventist

Seventh-Day Adventist

The use of a lift (draw) sheet prevents which type of injury to the patient? A. Shearing B. Fracture C. Ulcerations D. Laceration

Shearing

The use of a lift (draw) sheet prevents which type of injury to the patient? A. Shearing B. Fracture C. Ulcerations D. Laceration

Shearing

Death rites of Mexican Americans

Small children are shielded from the dying and death scene; families take turns staying around the clock with the dying person; grief sometimes is expressed with hyperkinetic or seizure type of behavior that serves to release emotions

Communication of Mexican Americans

Sustained direct eye contact is considered rude, immodest, or dangerous; touch is used often and has the potential to neutralize "evil eye"; closeness and physical contact are value in familiar situation; modesty is highly valued, so it is possible that both men ad women will be embarrassed when exposure of the body is necessary

A footboard is used to prevent

The complication of footdrop

meniscus

The convex or concave upper surface of a column of liquid in a container is known as

Why is it important to position the patient in the 30 degree lateral position?

This move removes pressure from bony prominences of the entire back, especially the greater trochanters.

A nurse is caring for an Orthodox Jewish patient. What is the most appropriate dietary requirement for the nurse to implement? a. Mixing of milk and meat at a meal b. Use of separate cooking utensils for meat and milk products c. Use of one set of cooking utensils for meat and milk products d. Consumption of food not slaughtered in accordance with Jewish law

Use of separate cooking utensils for meat and milk products

cyanosis

When blood oxygen levels decrease or if actual blood flow is reduced dramatically the skin turns a blue-gray color

myasthenia gravis

a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles. (face and throat)

rheumatoid arthritis

a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked

z track

a method of injection that involves displacing the skin and the subcutaneous tissue at the injection site, maintaining this displacement throughout the injection, and releasing it immediately after withdrawing the needle from the skin

Dorsiflexion

bending of the foot or the toes upward

spongy bone

also called cancellous bone; located primarily at the ends of long bones and in the center of other bones

What basic philosophy in the United States is relevant to health care? a. Folk remedies b. Biomedical therapy c. Holistic therapy d. Spiritual intervention

biomedical therapy

sinuses

are spaces or cavities inside some of the cranial bones frontal maxillia sphenoid paranasal

gliding joint

are the least movable diarthrotic joints. Their flat articulating surfaces allow limited gliding movements, such as that at the superior and inferior articulating processes between successive vertebrae.

condlyoid joint

are those in which a condyle (an oval projection) fits into an elliptical socket. An example is the fit of the distal end of the radius into depressions in the carpal bones.

What is the main organ that inactivates and metabolizes drugs? a. Spleen b. Liver c. Lungs d. Pancreas

b. Liver absorption occurs when the active ingredient of the drug enters the body fluids. main organ that inactivates and metabolizes drugs.

What screening test is accomplished by performing an intradermal injection? a. Diabetes b. Tuberculosis c. Hepatitis d. Meningitis

b. Tuberculosis Intradermal injection absorption is slow, which makes it the best route for tuberculosis screening. -absorption is slow -TB-skin tests -desensitization injections of local anesthetics and vaccines.

appendicular skeleton

bones of the shoulder, pelvis, and upper and lower extremities

Melanin

brown pigmentthis is produced by cells in the basal layer called melanocytes -Primary function is to absorb harmful UV radiation from the sun

What landmarks are used for the administration of an intramuscular injection into the gluteal site? a. The tip of the coccyx and the greater trochanter b. Between the center of the gluteus and the iliac spine c. Between the posterior iliac crest and the greater trochanter d. On an imaginary line between the center of the gluteus and the greater trochanter

c. Between the posterior iliac crest and the greater trochanter the gluteal site is marked by the greater trochanter and the posterior iliac crest.

The nurse administered a sedative to an older adult who was having difficulty sleeping. Later, the patient was walking the halls and becoming agitated. What is this drug response known as? a. Expected b. Untoward c. Idiosyncratic d. Hypersensitive

c. Idiosyncratic An unexpected response to a medication. reaction to a drug results from the individual's unique hypersensitivity to it.

Medullary cavity

central, hollowed-out area in the shaft of a long bone

vertebrae

cervical, thoracic, lumbar, sacrum, coccyx

Psoriasis

chronic skin condition producing red lesions covered with scaly plaques +develops from excessive rate of epithelial cell growth +Plaques found on elbows, knees and scalp often

The nurse must assess neurovascular function, also called CMS assessment. CMS stands for A. constant movement and sensation B. contained movement of systems C. circulation, movement, and sensation D. circulation, movement, and saturation

circulation, movement, and sensation

two types of bone

compact (hard), and spongy (soft)

articular cartilage

covers the surfaces of bones where they come together to form joints

The three types of Epithelial membranes

cutaneous, mucous, serous

A 5 month old is to be immunized for DTP. What type of injection will be given and which site? a. Sub Q - Deltoid b. Sub Q - Abdominal c. IM - Gluteus Maximus d. IM - Vastus Lateralis

d. IM - Vastus Lateralis preferred on children younger than 12 months for immunizations(younger than 3) free of nerves and blood vessels. most fully developed muscle in newborns

enternal route

delivery of a medication through the gastrointestinal tract

The upper region of the dermis forms projections called _________ that form unique fingerprints

dermal papillae

Semi-fowlers position is a position in which the head of the bed is: A. elevated at a 90-degree angle B. flat C. slightly lower than the foot of the bed D. elevated at a 30-degree angle

elevated at a 30-degree angle

pelvic girdle

filium, ischium, pubis

How many types of bones are there?

four

Diarthroses

freely movable joints

biomedical health belief system

health is the absence of the disease; disease is the alteration of the structure and function of the body; treatment focuses on the use of physical and chemical intervention

synarthroses

immovable joints

three types of joints

immovable, slightly movable, and freely movable

gouty arthritis

inflammation and painful swelling of joints caused by excessive uric acid in the body

Infectious arthritis

inflammation of joint tissues caused by a variety of pathogens

Osteoarthritis

is the most common noninflammatory disorder of movable joints. Abnormal formation of new bone (bone spurs) at joint surfaces and degeneration of articular cartilage are characteristic features of osteoarthritis. Weight-bearing joints, such as the hips, lumbar spine, and knees are often involved.

What are the classifications of bone shape?

long, short, flat, irregular

prone

lying face down in horizontal position

dorsal recumbent

lying on back with legs bent and feet flat

sims

lying on side with knee and thigh drawn toward chest

three parts of the sternum

manubrium, sternal body, xiphoid process

Duchenne muscular dystrophy (DMD)

most common form of MD - primarily affects boys age 3-5 - progresses rapidly (pg. 111)

Any ______________ including that caused by a muscle strain, is termed myositis.

muscle inflammation

eccentric contraction

muscle lengthens

prime mover

muscle with the major responsibility for a certain movement

When osteoblasts eventually become "trapped" between lamellae of hard bone matrix, they stop forming bone and are called __________. Osteocytes resume their bone-making activity when ___________ remove the surrounding bone.

osteocytes; osteocytes

Name the three types of muscles.

skeletal, smooth, cardiac

Pleura

serous membrane around each lung

orthopneic

sitting up in bed at 90 degree angle or sometimes resting in forward tilt while supported by pillow on overbed table

The axial skeleton

skull cranial bones ear bones face bones spine vertebrae thorax ribs sternum hyoid

Amphiarthroses

slightly movable joints

the most common types of skin cancer is _________carcinoma

squamous cell

What is a sprain?

stretching or tearing of ligaments

Functions of the skeletal system

supports body weight, protects organs, enables movement, stores minerals (calcium, phosphorus), contains bone marrow which produces blood cellsf

A tetanic contraction is a more _________ response than a twitch. It is produced by a series of stimuli bombarding the muscle in rapid succession. Contractions ________ together to produce a sustained contraction or tetanus.

sustained and steady; "melt"

The connective tissue membrane that lines the space between bone and joint capsule is called

synovial membrane

A trochanter roll is used to prevent

the external rotation of the legs

Before assisting a patient to ambulate to the bathroom, the nurse should first assess: A. the patient's footwear B. the bed alarm has been disarmed C. the patient's ability to assist with ambulation D. that assistive devices are within the patient's reach

the patient's ability to assist with ambulation

Appendicular skeleton

upper and lower extremities pectoral girdle arm and forearm bones wrist bones hand bones lower bones lower extremeties pelvic girdle thigh and leg bones ankle bones foot bones

The membrane covering the organs of the abdomen is called the

visceral peritoneum

Passive assisted ROM

weak or partially paralyzed are able to move a limb partially through ROM and the nurse may then assist the patient to finish the full ROM.

Clark's Rule for Child's Dosing

weight/150 x adult dose = childs dose

Active assisted ROM

when the patient uses the strong arm to exercise the weaker or paralyzed arm.