Med Surg Exam 1 -- Ch 9, 10, 11, 12, 16
According to the US census (2010), what percentage of people are diagnosed with a disability?
20
According to federal guidelines, hospices may provide no more than what percentage of the aggregate annual patient-days at the inpatient level?
20%
The nurse determines that a walker is at the right height when a clients elbows are in which position?
20-30 degree flexion when the hands are resting on the hand grip
In which phase of the trajectory model of chronic illness is characterized by the gradual or rapid decline in the condition despite efforts to halt the disorder?
Dying
The nurse needs to carefully monitor a client with traumatic injuries. Which action by the nurse demonstrates understanding of the most essential component of the clients pain assessment?
The nurse administers pain medication based on the clients reported pain level
During unplanned, spontaneous moments, dying clients usually discuss fears or concerns that nurses should not ignore or rush. What is the nurses best response in such situations?
The nurse can communicate interest and willingness to listen by sitting down, leaning forward in the client's direction, and making direct eye contact.
Which is an accurate rationale for why older adults are more susceptible to serious infections?
They have less efficient defense mechanisms
Which is a true statement regarding placebos?
They should never be used to test a clients truthfulness about pain
Which is a true statement regarding hospice care?
Clients have a life expectancy of 6 months or less
Which awareness context occurs when the client is unaware of their terminal state, wheras others are aware?
Closed awareness
The nurse is conducting a community education program on chronic illness. The nurse evaluates that additional education is needed when the participants make which statement?
"Out-of-pocket expenses for chronic illness are low"
Which condition, approved by the U.S. FDA, is the only use for the lidocaine 5% patch?
Postherpetic neuralgia
Recognizing a spouse is exemplifying the Kubler-Ross stage of acceptance for his dying wife, which statement by the nurse is most appropriate?
"Tell me how you plan to react when you first realize that your spouse is breathless and has no pulse."
The nurse is caring for an adult paraplegic with an ostomy. Which is an appropriate statement for the nurse to make?
"Do you need assistance managing your ostomy?"
Which statement made by a client with cancer who has moderate to severe pain and was prescribed oxymorphone indicates further instruction is required?
"I will take this medication with breakfast for the best results." -must be taken on an empty stomach
The nurse is performing an initial assessment of a client with a disability. The nurse should assess for which condition? Select all that apply.
-Depression -Abuse
The initial sign of skin pressure is erythema, which normally resolves in less than
1 hour
Which is an age-related change associated with the nervous system?
Postural hypotension
Therapeutic effects of tricyclic antidepressants occur at which time point?
3 weeks
A fentanyl patch should be replaced every
48-72 hours
What precentage of deaths due to chronic diseases occur in low and middle income countries?
80
Which older adult is at highest risk for medication-related toxicity?
A 65 yr old with renal insufficiency
Which term means to move away from the midline of the body?
Abduction
Which is a true statement regarding pharmacologic aspects of aging?
Absorption may be affected by changes in gastric pH
Spinal cord injury is an example of what kind of disability?
Acquired
Which intervention should a nurse perform during the grieving period when caring for a dying client?
Avoid criticizing or giving advice
Which action by the nurse indicates understanding of one basic principle of providing effective pain management?
Awakening a new postoperative client to take pain medication
According to Kubler-Ross, when a dying patient pleas for more time to reach an important goal, the client is in which state of grief?
Bargaining
Which term refers to the period of time during which mourning of a loss takes place?
Bereavement
Which type of scale is used to systematically assess and quantify a clients risk for pressure ulcer?
Braden scale
Which statement is a misconception about chronic diseases?
Chronic illness cannot be prevented
Which is an age-related change in the respiratory system?
Decreased gas exchange
Which factor alters urinary elimination patterns in older adults?
Decreased muscle tone
Which condition is characterized by a decline in intellectual functioning?
Dementia
What barrier to end-of-life care does a dying client demonstrate with the statement, "I don't need hospice. Hospice is for people who are dying."?
Denial
The family members of a dying client are finding it more difficult to verbalize their feelings for and show tenderness to the client. Which intervention should a nurse perform in such a situation?
Encourage the family members to express their feelings and listen to them in their frank communication
Which substance reduces the transmission of pain?
Endorphins
The nurse needs to carefully monitor a client with traumatic injuries. How often should the nurse check and document the clients pain?
Every time the clients vital signs are assessed
The nurse is completing an initial assessment on an elderly client. When asked about urinary patterns, the client states, "I can never get to the bathroom in time." The nurse documents this as which type of incontinence?
Functional incontinence
Which is the leading cause of death among the elderly?
Heart disease
What should a nurse include in a teaching to a middle-aged group adults on aging?
How old you feel will be determined by your physical and cognitive abilities
Prostaglandins are chemical substances with what property?
Increase the sensitivity of pain receptors
For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?
Increased restlessness
Which model of disability is the most appropriate for use by nurses to provide care that empowers clients?
Interface model
Which is a sign of approaching death?
Irregular breathing patterns
Which model of disability views disability as a problem of the person?
Medical
Which term best describes a living will?
Medical directive
A client who is an avid runner had an emergency below-the-knee amputation after a motor vehicle accident. The nurse hears a physical therapists tell the client that the client may have to stop running. The nurse considers this comment as an indication that the physical therapist has which frame of reference for caring for clients with disabilities?
Medical model
Which pain assessment tool will a nurse most likely use to assess the pain level of a client who hurt his foot playing football?
Numeric Rating Scale (NRS)
Serum albumin is an indicator of which type of deficiency?
Protein
Which is a factor that contributes to urinary incontinence in older female adults?
Relaxed perineal muscle
Which action by the nurse demonstrates an effective method to assess the client and the clients family's ability to cope with end-of-life interventions?
Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care
When assessing an older adult, the nurse anticipates an increase in which component of respiratory status?
Residual lung volume
Exercises that involve the use of light weight is referred to as
Resistive
A wound documented as a partial-thickness wound whose etiology is pressure would be a pressure ulcer in what stage?
Stage II
In which stage is a pressure ulcer considered a partial-thickness wound?
Stage II
Which assessment finding by the nurse and statement by an older adult would require the nurse to report suspected elder abuse?
Stage II decubitus ulcer on coccyx; "No one is able to turn or life me anymore."
During which stage of pressure ulcer development does the ulcer extend into the subcutaneous tissue?
Stage III
Which characteristic distinguishes normal aging from pathological changes associates with aging?
Universality
In which phase of the trajectory model of chronic illness is characterized by reactivation of an illness?
Unstable
In which phase of the trajectory model of chronic illness is characterized by the reactivation of an illness in remission?
Unstable
Which route of medication administration should the nurse consider first after IV removal in a postoperative client with an NPO order?
rectal
A client with spinal cord injury has no awareness of the need to void. This type of incontinence is termed
reflex (neurogenic) incontinence
Down Syndrome is categorized as a(n)
developmental disability
Half of all spinal cord injuries are related to
substance abuse
What pain assessment scale would be best to use with a 5-year-old child?
the FACES scale
To prevent footdrop, the client is positioned
to keep the feet at right angles to the leg
When a client who has been taking opioids becomes less sensitive to the drug's analgesic properties, that client is said to have developed a(n)
tolerance
The advance practice nurse is treating a client experiencing a neuropathic pain syndrome. Which statements by the client demonstrates an understanding of concepts related to neuropathic pain?
"My phantom limb pain serves no purpose, and i may need to take antidepressants to help."
Which statement by the nurse demonstrates that the nurse is providing spiritually sensitive care?
"Tell me who or what gives you strength."
A 25-year-old client with cancer is experiencing unrelieved pain of 9/10 requests the hospice nurse to induce a state of unconsciousness until the client dies. Which statement by the nurse demonstrates an understanding of a key difference between conscious sedation and euthanasia?
"Your doctor can prescribe medications necessary to relieve pain; however; this treatment will not hasten death."
An older adult develops sudden onset of confusion and is hospitalized. The family expresses concern that their loved one is developing Alzheimer disease. What response by the nurse is most appropriate?
"several possible underlying factors could be causing the confusion. Alzheimer's usually does not present with sudden confusion."
Which of the following comments by a client confirm the clients understanding of the fundamental concepts of pain? Select all that apply
-"I am tired of living with this nagging pain; I'm not sure how much longer I can go on." -"I used to walk everyday for exercise; pain in my knee made me stop walking." -"I would love to go to church, but my back pain is too uncomfortable to make it through service."
The nurse is working with a client with a chronic condition. The nurse includes which elements in the plan of care? Select all that apply.
-Assessment for identity changes -Interventions to manage symptoms -Interventions to prevent complications
Which actions by the nurse will assist in promoting an older adult's adherence to medication therapy? Select all that apply
-Encourage the client to keep a list of medications and review it frequently for updates -Use easy-to-open lids -Provide a written medication schedule
Nociception included four specific processes: transduction, transmission, perception, and modulation. Which action illustrates the nociception process of pain transmission?
A child quickly removing a hand when touching a hot object
A 72-year-old client with a malignant brain tumor rarely sleeps and frequently reports seeing things that are not real. Which intervention is an appropriate request for the hospice nurse to suggest to the physician?
Add haloperidol to the clients treatment plan -may reduce hallucinations
A client is being treated in a substance abuse unit of a local hospital. The nurse understands that when this client has compulsive behavior to use a drug for its psychic effect, the client needs to be monitored for which effect?
Addiction
A 75 year old client had surgery for a hip fracture yesterday. Which nursing intervention to treat the clients pain should the nurse question when ordered by the doctor?
Advil for pain management -NSAIDS increase risk of GI toxicity >60 yrs of age
Which at mandates that people with disabilities have access to job opportunities and to the community?
Americans with Disabilities Act of 1990
A client with a terminal illness has feelings of rage toward the nurse. According to Kubler-Ross, the client is in which stage of dying?
Anger
To monitor the presence of expected side effects of hydrocodone, what should the nurse incude in the assessment of the client?
Ask about the client's bowel pattern
The nurse is helping a client who experiences frequent constipation select meal choices for the day. Which food should the nurse encourage the client to order?
Bran cereal
Hospice care is for clients with a life expectancy of 6 months or less, however, the median length of stay in a hospice program is just 21.3 days. Which response explains the underuse of hospice care services?
Clients and families view palliative care as giving up
Which is the initial stage of grief, according to Kubler-Ross?
Denial
Which action by the nurse demonstrates ageism?
Directing all health decisions to the older adult's child
A client with Alzheimer disease becomes agitated while the nurse is attempting to take vital signs. What action by the nurse is most appropriate?
Distract the client with a familiar object or music
Which is an indicator of orthostatic hypotension?
Dizziness
Which nursing intervention should a nurse perform when caring for a client who is prescribed opiate therapy for pain?
Do not administer if respirations are <12 breath per minute
The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe?
Gabapentin (first line analgesic agent for neuropathic pain)
Which herb, when taken in in junction with acetaminophen, enhances the risk of bleeding?
Gingko
The nurse is creating a bowel evacuation program for a paraplegic client. When should the nurse plan to administer a suppository?
Just before breakfast
Which "awareness context" is characterized by the client, family, and health care professionals understanding that the client is dying, but all pretend otherwise?
Mutual pretense awareness
The reason that federal and state governments carefully regulate treatment given in licensed health care facilities, particularly long-term care facilities, is expressed by which statement?
Older adult clients are vulnerable
Why are IV solutions usually given at a slower rate to older adults?
Older adults may have cardiac or renal disorders
Touching the thumb to each finger on a hand is referred to as
Opposition
The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using?
Palliative care
Which of the following is a physiologic response to pain?
Pallor
Which therapeutic exercise is done by the nurse without assistance from the client?
Passive
The nurse is planning a community education program on disabilities. The nurse plans to include which statement?
People with disabilities are most likely to work part time.
Older adults who are more subject to falls, may fracture one or more ribs and be more susceptible to which condition after a rib fracture?
Pneumonia
Which refers to the decrease in lens flexibility that occurs with age, resulting in the near point of focus getting further away?
Presbyopia
The nurse is caring for a client who communicates via sign language. What should the nurse do to promote communication?
Provide a sign language interpreter
Which action is included in a nurses role when providing home care for a client with Alzheimer disease?
Provide emotional and physical support
Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth?
Provide gentle oral care after each meal
Which is a GI route for administration of analgesics?
Rectal
A client has been declared to have a terminal illness. What intervention will a nurse perform regarding the final decision of a dying client?
Respect the clients and family members' choices
Which is one level of hospice care covered under Medicare and Medicaid hospice benefits, includes a 5-day inpatient stay, and is provided occasionally to relive the family care givers?
Respite care
Which condition is a heightened response that occurs after exposure to a noxious stimulus?
Sensitization
Which neurotransmitter is implicated in depression?
Serotonin
In which phase of the trajectory model of chronic illness are symptoms under control and managed?
Stable
During which stage of pressure ulcer development does the ulcer extend into the underlying structures, including the muscle and possibly the bone?
Stage IV
Which type of incontinence is associated with weakened perineal muscles that permit the leakage of urine when intra-abdominal pressure is increased?
Stress incontinence
In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and reduce the dyspnea?
Use imagery, humor, and progressive relaxation
In which case is it most likely the pain management may not be readily forthcoming to an adult client who is in pain?
When the client's expressions of pain are incongruent with the nurses expectations
To help prevent the development of an external rotation deformity of the hip in a client who must remain in bed for any period of time, the most appropriate nursing action would be to use
a trochanter roll extending from the crest of the ilium to the midthigh
Regarding tolerance and addiction, the nurse understands that
although clients may need increasing levels of opioids, they are not addicted
Agism refers to
bias against older people based solely on chronological age
Through which activity does a client learn to consciously contract excretory sphincters and control voiding cues?
biofeedback
An age-related change associated with the cardiovascular system is
decreased cardiac output (CO)
The most common effective or mood disorder of old age is
depression
Approximately what percentage of home care required by elderly people with Alzheimer disease is provided by informal caregivers?
family member provide at least 80% of the home care required
A cause related to the increasing number of people with chronic conditions is
improved screening and diagnostic procedures
Which issue should the nurse inform clients who use pain medications on a regular basis?
inform the primary health care provider about the use of salicylates before any procedure, and avoid over-the-counter analgesics consistently without consulting a physician
Which route of administration of medication is preferred in the most acute care situations?
intravenous IV
Which is a true statement regarding characteristics of chronic conditions?
managing chronic conditions must be a collaborative process
A client explains that he in interested in being comfortable and no longer wants to fight his cancer. This approach to end-of-life care is known as
palliative care
A type of comprehensive care for clients whose disease is not responsive to cure is
palliative care
Rotation of the forearm so that the palm of the hand is down is termed
pronation
The nurse is attempting to take vital signs of an older adult hospitalized following knee surgery. The client continuously yells, "Its 1999 and you are going to hurt me!" Whats action should the nurse do first?
reorient the patient
The nurse is caring for a client with muscular dystrophy who is confined to bed. The client develops a pressure ulcer on the sacrum. The nurse documents the pressure ulcer as a(n)
secondary condition
A community nurse is working to decrease the incidence of cardiac disease in Nicaragua. The nurse should plan educational health promotion activities around which element?
smoking cessation
The nurse is working with a coalition that is creating a global strategy to prevent and control diabetes. The nurse suggests which strategies? Select all that apply.
-Focusing on healthy lifestyle programming -Monitoring incidence and prevalence rates -Creating policies for diabetes prevention -Partnering with the American Diabetes Association
A nurse is providing a fall prevention clinic for a group of older adults. what information should the nurse include? Select all that apply
-Place grab bars in the shower and tub -Have a routine vision and hearing screenings -Wear nonslip shoes or socks when walking -Review medications routinely for side effects
For which reasons are nonpharmacologic pain management techniques used? Select all that apply.
-They help decrease the distress a client experiences as a result of pain -They help decrease the sensation of pain -They allow clients to match the techniques to their own individual and cultural preferences
An older adult has a score of 12 on the Geriatric Depression Scale (GDS). What action should the nurse complete first?
Assess for the potential for self-harm
A hospitalized older adult complains of increased coughing and shortness of breath. The nurse assesses the vital signs as a temperature 100.2F oral, respirations 18, pulse 88, and BP 128/80. What action should the nurse do next?
Assess lung sounds and sputum
A client with long-term breast cancer ho was recently enrolled in a hospice program demonstrates signs and symptoms f clinical depression. Which Action by the hospice nurse is appropriate?
Perform a thorough pain assessment
A type of therapeutic exercise, performed by a client, in which the muscle alternately contracts and relaxes is
isometric
When applying a fentanyl patch, the last dose of sustained-release morphine should be administered at what point?
At the same time the first patch is applied
Which term is used to describe the personal feelings that accompany an anticipated or actual loss?
Grief
The nurse is caring for a client in the unstable phase of the Trajectory Model of Chronic Illness. The nurse should focus on providing which type of care?
Guidance
True or False: It is appropriate to restrict fluids for a client who is having urinary incontinence?
False
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Despite various medication regimes, the client's symptoms are gradually increasing. The nurse realize sthat this client is which phase of the Trajectory Model of Chronic Illness?
Downward
Which is known as a proxy directive?
Durable power of attorney for health care
Which statement provides accurate information related to chronic illness?
Most people with chronic illness do not consider themselves sick or ill
