exam #3 practice questions

_____________ is movement that runs the sole of the foot inward. ____________ is rotation of the forearm so that the palm of the hand is up. ______________is the return movement from flexion.

Inversion Supination Eversion

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client?

Partial blindness may result from pressure on the optic nerve.

A 23-year-old client requires chest physiotherapy while in the hospital for treatment for cystic fibrosis. The nurse assists the respiratory therapist by helping the client with postural drainage. Which of the following actions best describes this process? Encourage the client to cough and deep breathe Place the client in Trendelenburg position Teach the client how to clap or percuss the affected area Assist the client to sit up in bed at a 90-degree angle

Place the client in Trendelenburg position

The nurse providing care for a client with cystic fibrosis receives orders for albuterol nebulizers as well as chest percussion and postural drainage every 4 hours. Which of the following is the correct order to administer albuterol? Immediately before chest percussion and postural drainage 30 minutes after chest percussion and postural drainage During chest percussion and postural drainage 1 hour before chest percussion postural drainage

"Immediately before chest percussion and postural drainage" is correct because administering this before chest percussion and postural drainage opens the bronchi and allows for easier expectoration of mucus.

Serum albumin is a sensitive indicator of protein deficiency. Levels below _______ are associated with hypoalbuminemic tissue edema and increased risk of pressure ulcers.

3 g/mL

he nurse assessing a client on a rehabilitation units notices that the patient experiences pain when his right arm is moved away from the midline of his body. The nurse documents pain upon which type of movement? Adduction Abduction Flexion Extension

Abduction is movement away from the midline of the body.

__________is movement toward the midline of the body. _____________ is the bending of a joint so that the angle of the joint diminishes.______________is the return movement from flexion.

Adduction Flexion Extension

Which of the following is seen in a client with a flail chest? Affected side goes in with inspiration and out with expiration Hyperresonance on auscultation Rhonchi heard on auscultation A sucking chest wound

Affected side goes in with inspiration and out with expiration

A 46-year-old patient was involved in a motorcycle accident and comes in to the emergency department with rib fractures and a flail chest. The physician orders to set up for treatment utilizing pneumatic stabilization. Which actions would be included as part of this treatment? Select all that apply. a. Administration of epinephrine b. Oro- and nasogastric suctioning c. Endotracheal intubation d. Use of PEEP with ventilation e. Mechanical ventilation

C,D,E

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for? Atelectasis Emphysema Pleurisy Pneumonia

In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

A patient with COPD has developed malnutrition and weight loss since his diagnosis 8 years ago. Which describes the most likely reason why a COPD patient is at higher risk of malnutrition? Frequent aspiration of stomach contents that causes breathing difficulties An inability to absorb fat-soluble vitamins in the digestive tract Increased instances of gastroesophageal reflux Increased energy expenditure used to maintain adequate breathing

Increased energy expenditure used to maintain adequate breathing patient with advanced COPD is at risk of malnutrition and weight loss because of the high-energy expenditure he requires for breathing. A COPD patient may spend a large amount of his time working to breathe, which uses up many calories.

A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient? Glucose Sodium Calcium Potassium

Increased secretion of parathormone results in bone resorption. Calcium is released into the blood, increasing serum levels.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? Infusing IV fluids rapidly as ordered Encouraging increased oral intake Restricting fluids Administering glucose-containing I.V. fluids as ordered

Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load

which laboratory value should the nurse review to determine if the patients hypothyroidism is caused by the pituitary glans

TSH low TSH level indicates that the patients hypothyroidism is caused by decreased anterior pituitary secretion of TSH

A nurse is caring for a client who has been diagnosed with Addison's disease. The nurse is teaching about symptoms of Addisonian crisis in order to best manage and prevent it before it occurs. What symptoms should the client look for that the nurse should include as part of teaching? Select all that apply. a. Generalized weakness b. High blood pressure c. Dehydration d. Severe headache e. Sudden pain in the lower back or abdomen

a. generalized weakness c. dehydration d. severe headache e. sudden pain in lower back or abdomen Addisonian crisis is another complication of the condition. It is characterized by sudden pain in the lower back, severe headache, generalized weakness, shock, and dehydration.

The nurse is evaluating the laboratory values of a client whose nursing diagnosis is "risk for impaired skin integrity." Which of the following values places the client at greatest risk? Albumin, 1.5 g/dL ' Hemoglobin, 10.5 Hematocrit, 43.5 Potassium, 3.0

albumin 1.5 g/dl

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? Anxiety Imbalanced nutrition: More than body requirements Impaired swallowing Unilateral neglect

anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis.

A client is experiencing an adrenal crisis due to Addison's Disease. Which of the following would NOT be a priority nursing intervention for this client? a. Monitor for fluid volume deficit b. Monitor for hypocalcemia c. Monitor for hypoglycemia d. Monitor for hyponatremia

b.hypocalcemia Clients in adrenal crisis (severe adrenal insufficiency) are more likely to experience hypercalcemia, NOT hypocalcemia, due to less excretion by the kidneys and calcium being pushed out of the cells.

A client spends most of his time in a wheelchair. The nurse would be especially alert for the development of pressure ulcers in which area? Greater trochanter Lateral malleous Scapula Ischial tuberosity

ischial tuberosity

A type of therapeutic exercise, performed by a client, in which the muscle alternately contracts and relaxes is isometric. resistive. passive. active-assistive.

isometric

The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? A. Heart rate of 62 b. Blood pressure 90/58 mm Hg c. Oxygen saturation of 96% d.Temperature of 102ºF

d. temp. 102 F Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.

When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of:

fresh fruit- Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase intake of potassium-rich foods, such as fresh fruit. The client should restrict consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium.

A client with Addison's disease is deficient in aldosterone. Which of the following are symptoms of this condition? Select all that apply. Hypotension Dehydration Hyperkalemia Bradypnea Hyponatremia

hypotension dehydration hyperkalemia hyponatremia

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. Hypothermia Hypertension Hypotension Hypoventilation Hyperventilation

hypothermia, hypotension, hypoventilation

When are cortisol levels highest?

in the morning

A 79-year-old client with Cushing's disease has developed some cognitive effects that are impacting his ability to care for himself. Which cognitive effects are most likely to develop in a client with Cushing's disease? Seizures Coma Memory loss Aggression

memory loss Cushing's disease occurs when the pituitary gland produces excess amounts of adrenocorticotropic hormone. The client can experience changes in body structure, as well as changes in skin, muscles, and cognition. One of the most common cognitive effects associated with Cushing's disease over time is memory loss.

A nurse is performing passive range of motion to a client's upper extremeities. The nurse touches the client's thumb to each fingertip on the same hand. The nurse is performing which of the following?

opposition

Vision and visual fields are altered in disorders of which of the following endocrine glands?

pituitary the pituitary gland is located close to the optic nerves and hence causes pressure on these nerves; thus, changes in the vision and the visual fields may occur.

The nurse working on a rehabilitation unit rotates a client's forearm so that the palm of the hand is facing down. The nurse documents this as which type of movement? Inversion Spination Pronation Eversion

pronation rotation of the forearm so that the palm of the hand is down.

A nurse is caring for a client with a kidney disorder. What hormone released by the kidneys initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume?

renin

A patient learning to ambulate with crutches advances both crutches and then lifts both feet, moving them forward and landing them in front of the crutches. The patient then repeats this motion. The nurse identifies this as which type of crutch gait? 4-point 3-point Swing-to Swing-through

swing through