MSN 277 Final Review

A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurse's best action? A. Administer pain medication as ordered. B. Assess the surgical site and the affected extremity. C. Reassure the patient that pain is a direct result of increased activity. D. Notify the surgeon that you suspect a hip dislocation.

B. Assess the surgical site and the affected extremity.

Which laboratory result will the nurse monitor to determine if prednisone has been effective for a patient with an acute exacerbation of rheumatoid arthritis? A. Blood glucose B. C-reactive protein C. Serum electrolytes D. Liver function tests

B. C-reactive protein

The nurse is admitting a patient with a diagnosis of Small Bowel Obstruction. Which of the following clinical manifestations would the nurse expect to observe in this patient? (Select all that apply.) A. Rigid, board-like abdomen B. Frequent vomiting C. Abdominal distention D. Tachycardia E. Cramp-like pain

B. Frequent vomiting C. Abdominal distention E. Cramp-like pain

A 42-year-old female is interested in making dietary changes to reduce her risk of colon cancer. What dietary selections would you suggest? A. Croissant with jelly, oatmeal, blueberries, whole milk B. Grilled pork chop, bran muffin, stir-fired broccoli, iced tea C. Granola, bagel with cream cheese, scrambled eggs, orange juice D. Lean roast beef, baked potato with sour cream, cauliflower salad, red wine

B. Grilled pork chop, bran muffin, stir-fired broccoli, iced tea

Which of the following are risk factors for the development of gout? (Select all that apply.) A. Repetitive motion to the joints B. Hypertension C. Obesity D. Alcohol consumption E. Diuretic use F. Corticosteroid use

B. Hypertension C. Obesity D. Alcohol consumption E. Diuretic use

A nurse is caring for an older adult patient who is preparing for discharge following recovery from a total hip replacement. Which of the following outcomes must be met prior to discharge? A. Patient is able to perform ADLs independently. B. Patient is able to perform transfers safely. C. Patient is able to weight-bear equally on both legs. D. Patient is able to demonstrate full ROM of the affected hip.

B. Patient is able to perform transfers safely.

The nurse is caring for a patient one week post-operatively following the creation of a colostomy. Which of the following assessment findings would be a priority for the nurse to report? A. The patient is experiencing flatlulence B. The color of the stoma is dusky blue C. The skin under the colostomy bag is red D. The patient appears depressed

B. The color of the stoma is dusky blue

The nurse is caring for a patient that is newly diagnosed with peptic ulcer disease. The patient has a history of diabetes mellitus and coronary artery disease. He smokes 1/2 pack of cigarettes per day. He enjoys a nightly beer while watching sports on television. He has a BMI of 35. Considering his new diagnosis of peptic ulcer disease, what is most important to include in a teaching plan? (Select all that apply.) A. The patient has diabetes mellitus. B. The patient has coronary artery disease. C. The patient smokes daily. D. The patient drinks alcohol nightly. E. He has a BMI of 35.

C. The patient smokes daily. D. The patient drinks alcohol nightly. Smoking inhibits ulcer repair and increases acid secretion. Alcohol delays healing and increases acid production.

A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. The best response by the nurse is: A. "A low-fat diet will prevent the development of further gallstones and should be continued." B. "Yes, because you will not have a gallbladder to store bile, you will not be able to digest fats adequately." C. "A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile." D. "Removal of the gallbladder will eliminate the source of your pain associated with fat intake, so you may eat whatever you like."

C. "A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile."

A patient scheduled for a vagotomy asks the nurse what a vagotomy is. Which of the following statements by the nurse best describes the purpose of the vagotomy? A. "It decreases food transit time in the stomach." B. "It regenerates the gastric mucosa." C. "It reduces the stimulus for acid secretion." D. "It stops stress-related reactions."

C. "It reduces the stimulus for acid secretion."

The nurse should assess a patient suspected of having peritonitis for which of the following clinical manifestations? (Select all that apply.) A. Heartburn B. Diarrhea C. Abdominal muscle rigidity D. Abdominal pain E. Tachycardia

C. Abdominal muscle rigidity D. Abdominal pain E. Tachycardia

Which of the following are clinical manifestations associated with a gastric peptic ulcer? (Select all that apply.) A. Burning pain B. Cramping pain C. Pain located high in the epigastric area D. Pain that occurs 2-5 hours after eating E. Pain radiating to the shoulder

A. Burning pain C. Pain located high in the epigastric area

A patient with colon cancer undergoes surgical removal of a segment of colon with sigmoid ostomy creation. What assessments indicate the patient is developing complications within the first 24 hours? (Select all that apply.) A. Course breath sounds auscultated bilaterally at the bases B. Dusky appearance of the stoma C. Scant amount of blood draining from the stoma D. Temperature at 101.3 F E. Absent bowel sounds

A. Course breath sounds auscultated bilaterally at the bases B. Dusky appearance of the stoma D. Temperature at 101.3 F

The nurse is caring for a patient with diverticulitis. Which of the following diets would be essential to include in the patient's plan of care? A. High-fiber B. Low-fat C. High-calorie D. Milk-free

A. High-fiber

During an acute exacerbation of Crohn's disease, which of the following nursing diagnoses should have priority? A. Imbalanced nutrition: less than body requirements R/T anorexia and diarrhea B. Anxiety R/T altered self-concept and health status C. Fatigue R/T decreased nutrient intake and anemia D. Knowledge deficit R/T lack of information about disease process

A. Imbalanced nutrition: less than body requirements R/T anorexia and diarrhea

A total knee replacement was performed on a patient with osteoarthritis of the right knee. Following the procedure, the nurse advises the patient that rehabilitation for the knee should begin A. Immediately. B. After 1 week. C. After 3-4 weeks. D. In 2 months.

A. Immediately.

To care for a T-tube placed in a patient following an open cholecystectomy, the nurse: A. Keeps the tube supported and free of kinks. B. Attaches the tube to low continuous suction. C. Clamps the tube when ambulating the patient. D. Irrigates the tube with 10 ml sterile saline every 2-4 hours.

A. Keeps the tube supported and free of kinks.

A nurse assesses a 38 year old patient with joint pain and stiffness who has a diagnosis of rheumatoid arthritis. Which additional characteristic should the nurse expect? A. Presence of nodules B. Consistent muscle strength C. Localized disease symptoms D. Joint space narrowing

A. Presence of nodules D is incorrect because it doesn't cause joint space narrowing, it destroys the synovial joint

The nurse is caring for a patient with GERD. Which of the following measures would be essential to include in the patient's discharge instructions? (Select all that apply.) A. Small, frequent meals B. High calorie, high-protein diet C. Bulk-forming laxatives D. Sleep with head of bed elevated E. Avoid caffeine

A. Small, frequent meals D. Sleep with head of bed elevated E. Avoid caffeine

A 34-year-old female patient has been diagnosed with Irritable Bowel Syndrome. Which of the following interventions would the nurse include in the patient's plan of care to address IBS? (Select all that apply.) A. Take Imodium, prn for diarrhea B. Avoid foods that have a high fructose content C. Keep a diary of food intake, symptoms and stress D. Sleep at least 8 hours every night E. Drink only clear liquids until the symptoms subside

A. Take Imodium, prn for diarrhea B. Avoid foods that have a high fructose content C. Keep a diary of food intake, symptoms and stress

A patient being seen in the clinic has rheumatoid nodules on the elbows. Which action will the nurse take? A. Draw blood for rheumatoid factor analysis. B. Teach the patient about injections for the nodules. C. Assess the nodules for skin breakdown or infection. D. Discuss the need for surgical removal of the nodules.

C. Assess the nodules for skin breakdown or infection.

Following a laparoscopic cholecystectomy, the nurse would expect the patient to: A. Return to work in 2-3 weeks. B. Be hospitalized for 3-5 days postoperatively. C. Have four small abdominal incisions covered with small dressings or bandaids. D. Have a T-tube placed in the common bile duct to provide bile drainage.

C. Have four small abdominal incisions covered with small dressings or bandaids.

A 67-year-old patient is newly diagnosed with diverticular disease. The patient has a history of heart failure, diabetes melitus, and peptic ulcer disease. The patient weighs 187lbs and 5'6" tall. Based on the nurse's knowledge of this patient, which of the following interventions should be questioned when preparing a patient-centered plan of care? A. High-fiber, low-fat diet B. Weight reduction C. Increase fluid intake D. Avoid straining, bending, heavy lifting

C. Increase fluid intake

A patient with rheumatoid arthritis (RA) complains to the clinic nurse about having chronically dry eyes. Which action by the nurse is appropriate? A. Ask the HCP about discontinuing methotrexate. B. Remind the patient that RA is a chronic health condition. C. Suggest the patient use over-the-counter artificial tears. D. Teach the patient about adverse effects of the RA medications.

C. Suggest the patient use over-the-counter artificial tears.

The nurse monitors a client for signs of dumping syndrome. Which of the following does the nurse evaluate as early clinical manifestations? (Select all that apply.) A. Hematemesis B. Abdominal muscle rigidity C. Tachycardia D. Sweating E. Diarrhea F. Weakness

C. Tachycardia D. Sweating E. Diarrhea F. Weakness

A 24 year old female patient with SLE tells the nurse she wants to have a baby and is considering getting pregnant. Which response by the nurse is most appropriate? A. "Temporary remission of your signs and symptoms are common during pregnancy." B. "SLE symptoms usually peak during the first trimester." C. "Autoantibodies transferred to the baby during pregnancy will cause congenital heart defects." D. "The best time to plan pregnancy is during a remission when the symptoms are a minimum."

D. "The best time to plan pregnancy is during a remission when the symptoms are a minimum."

A patient is receiving pharmacologic therapy with ursodeoxycholic acid (Actigall) for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the best response by the nurse? A. 1-2 weeks B. 3-5 months C. 6-8 weeks D. 6-12 months

D. 6-12 months

Nursing interventions for a patient with Crohn's disease includes: A. Teaching weight reduction measures and low-calorie diet B. Frequent oral care with non-alchol-based mouth rinses C. Teaching the importance of follow-up liver function tests after discharge D. Perianal care and restoration of fluids and electolytes

D. Perianal care and restoration of fluids and electolytes

A patient who has a cast in place after fracturing the radius asks when the cast can be removed. The nurse will instruct the patient that the cast will need to remain in place a. for several months. b. for at least 3 weeks. c. until swelling of the wrist has resolved. d. until x-rays show complete bony union.

b. for at least 3 weeks. Bone healing starts immediately after the injury, but since ossification does not begin until 3 weeks post-injury, the cast will need to be worn for at least 3 weeks. Complete union may take up to a year. Resolution of swelling does not indicate bone healing.

A patient has chronic osteomyelitis of the left femur, which is being managed at home with administration of IV antibiotics. The nurse chooses a nursing diagnosis of ineffective health maintenance when the nurse finds that the patient a. takes and records the oral temperature twice a day. b. is unable to plantar flex the foot on the affected side. c. uses crutches to avoid weight bearing on the affected leg. d. is irritable and frustrated with the length of treatment required

b. is unable to plantar flex the foot on the affected side. Foot drop is an indication that the foot is not being supported in a neutral position by a splint. Using crutches and monitoring the oral temperature are appropriate self-care activities. Frustration with the length of treatment is not an indicator of ineffective health maintenance of the osteomyelitis.

In which order will the nurse take these actions when caring for a patient with left leg fractures after a motor vehicle accident? Put a comma and space between each answer choice (a, b, c, d, etc.) ____________________ a. Obtain x-rays. b. Check pedal pulses. c. Assess lung sounds. d. Take blood pressure. e. Apply splint to the leg. f. Administer tetanus prophylaxis.

c, d, b, e, a, f The initial actions should be to ensure that airway, breathing, and circulation are intact. This should be followed by checking the neurovascular status of the leg (before and after splint application). Application of a splint to immobilize the leg should be done before sending the patient for x-rays. The tetanus prophylaxis is the least urgent of the actions.

While testing the patients muscle strength, the nurse finds that the patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should document the patients muscle strength as level a. 1. b. 2. c. 3. d. 4.

c. 3. A level 3 indicates that the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.

When counseling an older patient about ways to prevent fractures, which information will the nurse include? a. Tack down scatter rugs in the home. b. Most falls happen outside the home. c. Buy shoes that provide good support and are comfortable to wear. d. Range-of-motion exercises should be taught by a physical therapist

c. Buy shoes that provide good support and are comfortable to wear.

Following a motor vehicle accident, a patient arrives in the emergency department with massive right lower leg swelling. Which action will the nurse take first? a. Elevate the leg on pillows. b. Apply a compression bandage. c. Check leg pulses and sensation. d. Place ice packs on the lower leg

c. Check leg pulses and sensation.

The nurse obtains this information when assessing a 74-year-old patient in the outpatient clinic. Which finding is of highest priority when the nurse is planning care for the patient? a. Symmetrical joint swelling of fingers b. Decreased right knee range of motion c. History of recent loss of balance and fall d. Complaint of left hip aching when jogging

c. History of recent loss of balance and fall A history of falls requires further assessment and development of fall prevention strategies. The other changes are more typical of bone and joint changes associated with normal aging.

Which statement by the patient indicates a good understanding of the nurses teaching about a new short-arm plaster cast? a. I can get the cast wet as long as I dry it right away with a hair dryer. b. I should avoid moving my fingers and elbow until the cast is removed. c. I will apply an ice pack to the cast over the fracture site off and on for 24 hours. d. I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.

c. I will apply an ice pack to the cast over the fracture site off and on for 24 hours.

The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the pt experiencing, and what serum bilirubin results would be expected? a. hemolytic jaundice with normal conjugated bilirubin b. posthepatic icterus with decreased unconjugated bilirubin c. Obstructive jaundice with elevated unconjugated and conjugated bilirubin d. Hepatocellular jaundice with decreased conjugated bilirubin in severe disease

c. Obstructive jaundice with elevated unconjugated and conjugated bilirubin

Which nursing action will the nurse include in the plan of care for a patient who has had a total knee arthroplasty? a. Avoid extension of the knee beyond 120 degrees. b. Use a compression bandage to keep the knee flexed. c. Start progressive knee exercises to obtain 90-degree flexion. d. Teach about the need to avoid weight bearing for 4 weeks.

c. Start progressive knee exercises to obtain 90-degree flexion After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression bandage is used to hold the knee in an extended position after surgery. Full weight bearing is expected before discharge.

After the health care provider has recommended an amputation for a patient who has ischemic foot ulcers, the patient tells the nurse, If they want to cut off my foot, they should just shoot me instead. Which response by the nurse is best? a. Many people are able to function normally with a foot prosthesis. b. I understand that you are upset, but you may lose the foot anyway. c. Tell me what you know about what your options for treatment are. d. If you do not want the surgery, you do not have to have an amputation

c. Tell me what you know about what your options for treatment are.

When the nurse is assessing a new patient in the clinic, which information about the patients medications will be of most concern? a. The patient takes a daily multivitamin and calcium supplement. b. The patient has migraine headaches that are treated with nonsteroidal anti-inflammatory drugs (NSAIDs). c. The patient has severe asthma and requires frequent therapy with oral steroids. d. The patient takes hormone replacement therapy (HRT) to prevent hot flashes.

c. The patient has severe asthma and requires frequent therapy with oral steroids. Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems.

Which information obtained during the nurses assessment of the patients nutritional-metabolic pattern may indicate the risk for musculoskeletal problems? a. The patient takes a multivitamin daily. b. The patient dislikes fruits and vegetables. c. The patient is 5 ft 2 in and weighs 180 lb. d. The patient prefers whole milk to nonfat milk.

c. The patient is 5 ft 2 in and weighs 180 lb.

Which information will the nurse include when discharging a patient with a sprained wrist from the emergency department? a. Keep the wrist loosely wrapped with gauze. b. Apply a heating pad to reduce muscle spasms. c. Use pillows to elevate the arm above the heart. d. Gently move the wrist through the range of motion.

c. Use pillows to elevate the arm above the heart. Elevation of the arm will reduce the amount of swelling and pain. Compression bandages are used to decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling. The wrist should be rested and kept immobile to prevent further swelling or injury.

a pt with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse? a. A low-fat diet will prevent the development of further gallstones and should be continued. b. yes; because you will not have a gallbladder to store bile, you will not be able to digest fats adequately. c. a low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile. d. Removal of gallbladder will eliminate the source of your pain that was associated with fat intake, so you may eat whatever you like.

c. a low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile.

When administering alendronate (Fosamax) to a patient, the nurse will first a. be sure the patient has recently eaten. b. ask about any leg cramps or hot flashes. c. assist the patient to sit up at the bedside. d. administer the ordered calcium carbonate.

c. assist the patient to sit up at the bedside. To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates.

A patient has muscle spasms and acute low back pain. An appropriate nursing intervention for this problem is to teach the patient to a. avoid the use of cold because it will exacerbate the muscle spasms. b. keep both feet flat on the floor when prolonged standing is required. c. keep the head elevated slightly and flex the knees when resting in bed. d. twist gently from side to side to maintain range of motion in the spine.

c. keep the head elevated slightly and flex the knees when resting in bed. Resting with the head elevated and knees flexed will reduce the strain on the back and decrease muscle spasms. Twisting from side to side will increase tension on the lumbar area. A pillow placed under the upper back will cause strain on the lumbar spine. Alternate application of cold and heat should be used to decrease pain.

When assessing the musculoskeletal system, the nurses initial action will usually be to a. feel for the presence of crepitus during joint movement. b. have the patient move the extremities against resistance. c. observe the patients body build and muscle configuration. d. check active and passive range of motion for the extremities.

c. observe the patients body build and muscle configuration. The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of abnormal areas. The other assessments also are included in the assessment but are usually done after inspection.

During discharge instructions for a pt following a laparoscopic cholecystectomy, what should the nurse include in the teaching? a. keep the incision area clean and dry for at least a week b. report the need to take pain medication for shoulder pain c. report any bile-colored or purulent drainage from the incisions. d. expect some postoperative nausea and vomiting for several days.

c. report any bile-colored or purulent drainage from the incisions.

Before assisting a patient with ambulation on the day after a total hip replacement, which action is most important for the nurse to take? a. Administer the ordered oral opioid pain medication. b. Instruct the patient about the benefits of ambulation. c. Ensure that the incisional drain has been discontinued. d. Change the hip dressing and document the wound appearance.

a. Administer the ordered oral opioid pain medication.

A 20-year-old patient with a history of muscular dystrophy is hospitalized with a respiratory tract infection. Which nursing action will be included in the plan of care? a. Assist the patient with ambulation. b. Logroll the patient every 1 to 2 hours. c. Discuss the need for genetic testing with the patient. d. Teach the patient about the muscle biopsy procedure.

a. Assist the patient with ambulation. Since the goal for the patient with muscular dystrophy is to keep the patient active for as long as possible, assisting the patient to ambulate will be part of the care plan. The patient will not require logrolling. Muscle biopsies are necessary to confirm the diagnosis but are not necessary for a patient who already has a diagnosis. There is no need for genetic testing since the patient already knows the diagnosis.

A patient complains of pain during circumduction of the shoulder when the nurse moves the arm behind the patient. Which question should the nurse ask? a. Do you have difficulty in putting on a jacket? b. Are you able to feed yourself without difficulty? c. Are you able to sleep through the night without waking? d. Do you ever have trouble lowering yourself to the toilet?

a. Do you have difficulty in putting on a jacket?

what treatment for acute cholecystitis will prevent further stimulation of the gallbladder? a. NPO with NG suction b. incisional cholecystectomy c. administration of antiemetics d. administration of anticholinergics

a. NPO with NG suction

A patient with knee pain who is diagnosed with bursitis asks the nurse to explain just what bursitis is. The nurse will respond that bursitis is an inflammation of a. a small, fluid-filled sac found at many joints. b. the synovial membrane that lines the joint area. c. the fibrocartilage that acts as a shock absorber in the knee joint. d. any connective tissue that is found supporting the joints of the body.

a. a small, fluid-filled sac found at many joints. Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa.

The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the pt about this test? a. it is noninvasive and is a very reliable method of detecting gallstones. b. it is the only test to use when the pt is allergic to contrast medium c. it will outline the gallbladder and the ductal system to enable visualization of stones. d. it is an adjunct to liver function test to determine whether the gallbladder is inflamed

a. it is noninvasive and is a very reliable method of detecting gallstones.

What must the nurse do to care a T-tube in a pt following a cholecystectomy? a. keep the tube supported and free of kinks. b. attach the tube to low, continuous suctioning c. clamp the tube when ambulating the pt. d. irrigate the tube with 10-ml sterile saline every 2-4 hrs

a. keep the tube supported and free of kinks.

An assessment finding that alerts the nurse to the presence of osteoporosis in a middle-aged patient is a. measurable loss of height. b. the presence of bowed legs. c. an aversion to dairy products. d. statements about frequent falls.

a. measurable loss of height. Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia. Low intake of dairy products is a risk factor for osteoporosis, but it does not indicate that osteoporosis is present. Frequent falls increase the risk for fractures but are not an indicator of osteoporosis.

Of the following characteristics, identify those that are most commonly associated with cholelithiasis (select all that apply) a. obesity b. age over 40 c. multiparous female d. history of excessive alcohol intake e. family history of gallbladder disease f. use of estrogen or oral contraceptives

a. obesity b. age over 40 c. multiparous female e. family history of gallbladder disease f. use of estrogen or oral contraceptives

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. Which action is best for the nurse to take? a. Explain the reasons for the phantom limb pain. b. Administer prescribed analgesics to relieve the pain. c. Loosen the compression bandage to decrease incisional pressure. d. Remind the patient that this phantom pain will diminish over time.

b. Administer prescribed analgesics to relieve the pain.

A patient has hip replacement surgery using the posterior approach. Which patient action requires rapid intervention by the nurse? a. The patient uses crutches with a swing-to gait. b. The patient leans over to pull shoes and socks on. c. The patient sits straight up on the edge of the bed. d. The patient bends over the sink while brushing the teeth.

b. The patient leans over to pull shoes and socks on.

Which information in a 60-year-old womans health history will alert the nurse to the need for a more focused assessment of the musculoskeletal system? a. The patient experienced a sprained ankle at age 13. b. The patients mother became much shorter with aging. c. The patients father died of complications of miliary tuberculosis. d. The patient reports taking ibuprofen (Advil) for occasional headaches.

b. The patients mother became much shorter with aging.

A patient is seen at the urgent care center after falling on the right arm and shoulder. Which finding is most important for the nurse to communicate to the health care provider? a. There is bruising at the shoulder area. b. The right arm appears shorter than the left. c. There is decreased range of motion of the shoulder. d. The patient is complaining of arm and shoulder pain.

b. The right arm appears shorter than the left. A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Bruising, pain, and decreased range of motion also should be reported, but these do not indicate that emergent treatment is needed to preserve function.

A pt with an obstruction of the common bile duct has c clay-colored fatty stools among other manifestations. What is the pathophysiologic change that causes this clinical manifestation? a. water soluble (conjugated) bilirubin in the blood excreted into the urine. b. absence of bilirubin and bile salts in the small intestine prevents conversion to urobilinogen an fat emulsion and digestion c. contraction of the inflamed gallbladder and obstructed ducts stimulated by cholecystoknin when fats enter the duodenum d. obstruction of the common duct prevents bile drainage into the duodenum, resulting in congestion of bile in the liver and subsequent absorption into the blood

b. absence of bilirubin and bile salts in the small intestine prevents conversion to urobilinogen an fat emulsion and digestion

The second day after admission with a fractured pelvis, a patient develops acute onset confusion. Which action should the nurse take first? a. Take the blood pressure. b. Assess patient orientation. c. Check pupil reaction to light. d. Assess the oxygen saturation.

d. Assess the oxygen saturation.

When giving home care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include? a. Keep the hand immobile to prevent soft tissue swelling. b. Keep the right shoulder elevated on a pillow or cushion. c. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48 hours after the injury. d. Call the health care provider for increased swelling or numbness.

d. Call the health care provider for increased swelling or numbness.

Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care? a. return to work in 2-3 weeks b. be hospitalized for 3-5 days postoperatively c. have a T-tube placed in the common bile duct to provide bile drainage. d. Have up to four small abdominal incisions covered with small dressings

d. Have up to four small abdominal incisions covered with small dressings

Which menu choice by a patient with osteoporosis indicates that the nurses teaching about appropriate diet has been effective? a. Pancakes with syrup and bacon b. Whole wheat toast and fruit jelly c. Two-egg omelet and a half grapefruit d. Oatmeal with skim milk and fruit yogurt

d. Oatmeal with skim milk and fruit yogurt Skim milk and yogurt are high in calcium. The other choices do not contain any high calcium foods.

Which information obtained by the emergency department nurse when admitting a patient with a left femur fracture is most important to report to the health care provider? a. Bruising of the left thigh b. Complaints of left thigh pain c. Outward pointing toes on the left foot d. Prolonged capillary refill of the left foot

d. Prolonged capillary refill of the left foot

A patient is seen in the clinic complaining of knee pain following an arthroscopic procedure 7 days previously and the health care provider performs arthrocentesis. Which finding will be of most concern to the nurse? a. Scant thin fluid b. Sanguineous fluid c. Straw-colored fluid d. Purulent appearing fluid

d. Purulent appearing fluid

A patient is receiving gentamicin (Garamycin) 80 mg IV twice daily for acute osteomyelitis. Which action should the nurse take before administering the gentamicin? a. Ask the patient about any nausea. b. Obtain the patients oral temperature. c. Change the prescribed wet-to-dry dressing. d. Review the patients blood urea nitrogen (BUN) and creatinine levels.

d. Review the patients blood urea nitrogen (BUN) and creatinine levels.

The nurse is caring for a patient who has had a surgical reduction of an open fracture of the left tibia. Which assessment finding is most important to report to the health care provider? a. Left leg muscle spasms b. Serous wound drainage c. Left leg pain with movement d. Temperature 101.4 F (38.6 C)

d. Temperature 101.4 F (38.6 C)

Which of these nursing actions included in the care of a patient after laminectomy can the nurse delegate to experienced nursing assistive personnel (NAP)? a. Ask about pain control with the patient-controlled analgesia (PCA). b. Determine the patients readiness to ambulate. c. Check ability to plantar and dorsiflex the foot d. Turn the patient from side to side every 2 hours

d. Turn the patient from side to side every 2 hours

A nurse is caring for a client who has GERD and a new prescription for metoclopramide. The nurse should plan to monitor for which of the following adverse effects? a. thrombocytopenia b. hearing loss c. hypersalivation d. ataxia

d. ataxia the nurse should plan to monitor the client for extrapyramidal symptoms, such as ataxia, and should report any of these findings to the provider.

A 58-year-old woman who has a family history of osteoporosis is diagnosed with osteopenia following densitometry testing. In teaching the woman about her osteoporosis, the nurse explains that a. estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. b. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. c. with a family history of osteoporosis, there is no way to prevent or slow gradual bone resorption. d. calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

d. calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

Following a laminectomy with a spinal fusion, a patient reports numbness and tingling of the right lower leg. The first action indicated by the nurse is to a. report the patients complaint to the surgeon. b. check the vital signs for indications of hemorrhage. c. turn the patient to the side to relieve pressure on the right leg. d. check the chart for preoperative neuromuscular assessment data

d. check the chart for preoperative neuromuscular assessment data The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient will not relieve the numbness.

A patient is admitted to the emergency department with possible left lower leg fractures. The initial action by the nurse should be to a. elevate the left leg. b. splint the lower leg. c. obtain information about the tetanus immunization status. d. check the popliteal, dorsalis pedis, and posterior tibial pulses.

d. check the popliteal, dorsalis pedis, and posterior tibial pulses.

A patient with a comminuted fracture of the right femur has Bucks traction in place while waiting for surgery. To assess for pressure areas on the patients back and sacral area and to provide skin care, the nurse should a. loosen the traction and have the patient turn onto the unaffected side. b. place a pillow between the patients legs and turn gently to each side. c. turn the patient partially to each side with the assistance of another nurse. d. have the patient lift the buttocks by bending and pushing with the left leg.

d. have the patient lift the buttocks by bending and pushing with the left leg. The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.

A checkout clerk in a grocery store has repetitive strain syndrome in the left elbow. The nurse will plan to teach the patient about a. surgical options. b. elbow injections. c. utilization of a left wrist splint. d. modifications in arm movement

d. modifications in arm movement

A patient in the emergency department who is experiencing severe pain is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for a. a knee immobilizer. b. gentle knee flexion. c. activity restrictions. d. monitored anesthesia care (conscious sedation).

d. monitored anesthesia care (conscious sedation). The first goal of collaborative management is realignment of the knee to its original anatomic position, which will require anesthesia or monitored anesthesia care (MAC), formerly called conscious sedation. Immobilization, gentle range of motion (ROM) exercises, and discussion about activity restrictions will be implemented after the knee is realigned.

When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to a. do stretching and warm-up exercises before starting work. b. wrap the wrists with a compression bandage every morning. c. use acetaminophen (Tylenol) instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for wrist pain. d. obtain a keyboard pad to support the wrist while word processing

d. obtain a keyboard pad to support the wrist while word processing

In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is a. activity intolerance related to deconditioning. b. risk for constipation related to prolonged bed rest. c. risk for impaired skin integrity related to immobility. d. risk for infection related to disruption of skin integrity.

d. risk for infection related to disruption of skin integrity. A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis. After an ORIF, patients typically are mobilized starting the first postoperative day, so problems caused by immobility are not as likely.

A patient has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should a. keep the left arm in dependent position. b. avoid handling the cast using fingertips. c. place gauze around the cast edge to pad any roughness. d. cover the cast with a small blanket to absorb the dampness.

b. avoid handling the cast using fingertips. Until a plaster cast has dried, using the palms rather than the fingertips to handle the cast helps prevent creating protrusions inside the cast that could place pressure on the skin. The left arm should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.

A patient undergoes a right above-the-knee amputation with an immediate prosthetic fitting. When the patient first arrives on the orthopedic unit after surgery, the nurse should a. place the patient in a prone position. b. check the surgical site for hemorrhage. c. remove the prosthesis and wrap the site. d. keep the residual leg elevated on a pillow.

b. check the surgical site for hemorrhage. The nurse should monitor for hemorrhage after the surgery. The prosthesis will not be removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.

Which would be the appropriate menu selection for a patient diagnosed with diverticulitis? A. Turkey, cranberries and green beans B. Baked fish, macaroni and cheese, French bread C. Cream of potato soup with saltine crackers D. Lean roast beef sandwich on white bread with Swiss cheese and low-fat mayonnaise

A. Turkey, cranberries and green beans

The nurse is helping to set up Buck's traction on an orthopedic patient. How often should the nurse assess circulation to the affected leg? A. Within 30 minutes, then every 1 to 2 hours. B. Within 30 minutes, then every 4 hours. C. Within 30 minutes, then every 8 hours. D. Within 30 minutes, then every shift.

A. Within 30 minutes, then every 1 to 2 hours.

A patient is admitted to the hospital with possible cholelithiasis. Which diagnostic test will the nurse anticipate will be ordered first to provide data for diagnosis? A. X-ray of the abdomen B. Ultrasound of the liver, gall bladder, and pancreas C. ERCP D. CT scan of the abdomen

B. Ultrasound of the liver, gall bladder, and pancreas

A patient, newly diagnosed with rheumatoid arthritis, arrives at the clinic for a follow-up visit. For which of the following extraarticular manifestations should the nurse assess? (Select all that apply.) A. Rheumatoid nodules B. Morning stiffness that lasts > 1 hour C. Weight loss D. Fatigue E. Sjogren's syndrome F. Discoid rash

C. Weight loss D. Fatigue E. Sjogren's syndrome

A patient is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. Which of the following is the most plausible explanation for this patient's signs and symptoms? A. Sprained right hip B. Right hip contusion C. Hip strain D. Traumatic hip dislocation

D. Traumatic hip dislocation

Which statement by a patient who is scheduled for an above-the-knee amputation for treatment of an osteosarcoma of the right tibia indicates that patient teaching is needed? a. I did not have this bone cancer until my leg broke a week ago. b. I wish that I did not have to have chemotherapy after this surgery. c. I know that I will need to participate in physical therapy after surgery. d. I will use the patient-controlled analgesia (PCA) to control postoperative

a. I did not have this bone cancer until my leg broke a week ago.

A patient whose work involves lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates that the teaching has been effective? a. I plan to start doing exercises to strengthen the muscles of my back. b. I will try to sleep with my hips and knees extended to prevent back strain. c. I can tell my boss that I need to change to a job where I can work at a desk. d. I will keep my back straight when I need to lift anything higher than my waist

a. I plan to start doing exercises to strengthen the muscles of my back.

Which statement by a patient who has had an above-the-knee amputation indicates that the nurses discharge teaching has been effective? a. I should lay on my abdomen for 30 minutes 3 or 4 times a day. b. I should elevate my residual limb on a pillow 2 or 3 times a day. c. I should change the limb sock when it becomes soiled or stretched out. d. I should use lotion on the stump to prevent drying and cracking of the skin.

a. I should lay on my abdomen for 30 minutes 3 or 4 times a day. The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limb sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage flexion contracture.

A patient with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the hand. Which patient statement to the nurse indicates realistic expectation for the surgery? a. I will be able to use my fingers to grasp objects better. b. I will not have to do as many hand exercises after the surgery. c. This procedure will prevent further deformity in my hands and fingers. d. My fingers will appear more normal in size and shape after this surgery.

a. I will be able to use my fingers to grasp objects better. The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Hand exercises will be prescribed after the surgery.

A patient is hospitalized for initiation of regional antibiotic irrigation for acute osteomyelitis of the right femur. Which intervention will be included in the plan of care? a. Immobilization of the right leg b. Frequent weight-bearing exercise c. Avoiding administration of nonsteroidal anti-inflammatory drugs (NSAIDs) d. Support of the right leg in a flexed position

a. Immobilization of the right leg Immobilization of the affected leg helps decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent contractures.

Which assessment information will the nurse obtain to evaluate the effectiveness of the prescribed calcitonin (Cibacalcin) and ibandronate (Boniva) for a patient with Pagets disease? a. Pain level b. Oral intake c. Daily weight d. Grip strength

a. Pain level Bone pain is one of the common early manifestations of Pagets disease, and the nurse should assess the pain level to determine whether the treatment is effective. The other information will also be collected by the nurse, but will not be used in evaluating the effectiveness of the therapy.

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. Which of these prescribed collaborative interventions will the nurse implement first? a. Wrap the ankle and apply an ice pack. b. Administer naproxen (Naprosyn) 500 mg PO. c. Give acetaminophen with codeine (Tylenol #3). d. Take the patient to the radiology department for x-rays.

a. Wrap the ankle and apply an ice pack. Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.

A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? a. You have an appointment with a physical therapist for tomorrow. b. You can still play baseball but you will not be able to return to pitching. c. The doctor will use the drop-arm test to determine the success of surgery. d. Leave the shoulder immobilizer on for the first few days to minimize pain.

a. You have an appointment with a physical therapist for tomorrow. Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent frozen shoulder. A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion (ROM). The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.

A patient with lower leg fracture has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching? a. You will need to assess and clean the pin insertion sites daily. b. The external fixator can be removed during the bath or shower. c. You will need to remain on bed rest until bone healing is complete. d. Prophylactic antibiotics are used until the external fixator is removed.

a. You will need to assess and clean the pin insertion sites daily.

A patient who has had an open reduction and internal fixation (ORIF) of left lower leg fractures complains of constant severe pain in the leg, which is unrelieved by the prescribed morphine. Pulses are faintly palpable and the foot is cool. Which action should the nurse take next? a.Notify the health care provider. b. Assess the incision for redness. c. Reposition the left leg on pillows. d. Check the patients blood pressure

a.Notify the health care provider.

A patient who has been hospitalized for 3 days with a hip fracture has sudden onset shortness of breath and tachypnea. The patient tells the nurse, I feel like I am going to die! Which action should the nurse take first? a. Stay with the patient and offer reassurance. b. Administer the prescribed PRN oxygen at 4 L/min. c. Check the patients legs for swelling or tenderness. d. Notify the health care provider about the symptoms.

b. Administer the prescribed PRN oxygen at 4 L/min. The patients clinical manifestations and history are consistent with a pulmonary embolus, and the nurses first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiologic need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for fat embolus or venous thromboembolism (VTE) are obtained.

A patient is being discharged after 2 weeks of IV antibiotic therapy for acute osteomyelitis in the left leg. Which information will be included in the discharge teaching? a. How to apply warm packs safely to the leg to reduce pain b. How to monitor and care for the long-term IV catheter site c. The need for daily aerobic exercise to help maintain muscle strength d. The reason for taking oral antibiotics for 7 to 10 days after discharge

b. How to monitor and care for the long-term IV catheter site

Which action can the nurse delegate to unlicensed assistive personnel (UAP) who are working in the orthopedic clinic? a. Grade leg muscle strength for a patient with back pain. b. Obtain blood sample for uric acid from a patient with gout. c. Perform straight-leg-raise testing for a patient with sciatica. d. Check for knee joint crepitation before arthroscopic surgery.

b. Obtain blood sample for uric acid from a patient with gout.

When planning care for a patient who has had hip replacement surgery, which nursing action can the nurse delegate to experienced nursing assistive personnel (NAP)? a. Teach quadriceps-setting exercises. b. Reposition the patient every 1 to 2 hours. c. Assess for skin irritation on the patients back. d. Determine the patients pain level and tolerance.

b. Reposition the patient every 1 to 2 hours.