MED SURG EXAM 2

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs? Assess the client's coping skills and support systems. Explain that the surgery leads to a longer life expectancy. Refer the client to the social worker or hospital chaplain. Reinforce physical therapy to aid with ambulating normally.

A

A patient who had arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen, hot knee. Which assessment finding should the nurse report immediately to the health care provider? The blood pressure is 86/50 mm Hg. The patient says the knee pain is severe. The white blood cell count is 11,500/μL. The patient is taking ibuprofen (Motrin).

A

The nurse is caring for a 60-year-old female client who sustained a thoracic spinal cord injury 10 years ago. For which potential complication will the nurse assess during this client's care? a. Fracture b. Malabsorption c. Delirium d. Anemia

A

Which action should the nurse take when caring for a patient with osteomalacia? A. Teach about the use of vitamin D supplements. B. Educate about the need for weight-bearing exercise. C.Instruct the patient to avoid dairy products in the diet. D.Discuss the use of medications such as bisphosphonates.

A

6. A 29-yr-old woman is taking methotrexate to treat rheumatoid arthritis. Considering this treatment, which information should the nurse report to the health care provider? The patient had a history of infectious mononucleosis as a teenager. The patient is trying to get pregnant before her disease becomes more severe. The patient has a family history of age-related macular degeneration of the retina. The patient has been using large doses of vitamins and health foods to treat the RA.

B

7. A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first? 1. Patient who reports foot pain after hammertoe surgery. 2. Patient who has not voided 8 hours after a laminectomy .3. Patient with low back pain and a positive straight-leg-raise test. 4. Patient with osteomyelitis who has a temperature of 100.5° F (38.1° C).

B

A client has been prescribed denosumab. What health teaching about this drug is most appropriate for the nurse to include? "Drink at least 8 ounces (240 mL) of water with it." "Make appointments to come get your injection." "Sit upright for 30 to 60 minutes after taking it." "Take the drug on an empty stomach."

B

A patient is taking entacapone (Comtan) along with carbidopa-levodopa to treat parkinsonism. The nurse notes that the patient's urine is orange in color. The nurse will a. notify the provider of possible drug toxicity. b. reassure the patent that this is a harmless side effect. c. request an order for liver function tests. d. request an order for a urinalysis.

B

A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics, which patient statement indicates the teaching has been effective? "I will keep my back straight when I lift above than my waist." "I will begin doing exercises to strengthen and support my back." "I will tell my boss I need a job where I can stay seated at a desk." "I can sleep with my hips and knees extended to prevent back strain."

B

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include in the plan of care? Logroll the patient every 2 hours. Assist the patient with ambulation. Discuss the need for genetic testing with the patient. Teach the patient about the muscle biopsy procedure.

B

The nurse is assessing a patient with osteoarthritis who uses naproxen (Naproxyn) for pain management. Which assessment finding should the nurse recognize as likely to require a change in medication? a. The patient has gained 3 pounds. b. The patient has dark-colored stools .c. The patient's pain affects multiple joints. d. The patient uses capsaicin cream (Zostrix).

B

Which action should the nurse take first when a patient is seen in the outpatient clinic with neck pain? Provide information about therapeutic neck exercises. Ask about numbness or tingling of the hands and arms. Suggest the patient alternate the use of heat and cold to the neck. Teach about the use of nonsteroidal antiinflammatory drugs (NSAIDs).

B

Which assessment finding for a 55-yr-old patient should alert the nurse to the presence of osteoporosis? Bowed legs Loss of height Report of frequent falls Aversion to dairy products

B

Which finding should the nurse expect when assessing a patient who has osteoarthritis (OA) of the knee? Presence of Heberden's nodules Discomfort with joint movement Redness and swelling of the knee joint Stiffness that increases with movement

B

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the- knee amputation. Which patient statement indicates to the nurse that additional teaching is needed? "I will need to participate in physical therapy after surgery." "I wish I did not need to have chemotherapy after this surgery." "I did not have this bone cancer until my leg broke a week ago." "I can use the patient-controlled analgesia (PCA) to manage postoperative pain."

C

The nurse teaches a patient with osteoarthritis (OA) of the hip about how to manage the OA. Which patient statement indicates to the nurse a need for additional teaching? "A shower in the morning will help relieve stiffness." "I can exercise every day to help maintain joint mobility." "I will take 1 gram of acetaminophen (Tylenol) every 4 hours." "I can use a cane to decrease the pressure and pain in my hip."

C

When a patient arrives in the emergency department with a facial fracture, which action should the nurse take first? Assess for nasal bleeding and pain. Apply ice to the face to reduce swelling. Use a cervical collar to stabilize the spine. Check the patient's alertness and orientation.

C

A client has rheumatoid arthritis (RA) and the visiting nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.) a. Grab bars to reach high items b. Long-handled bath scrub brush c. Soft rocker-recliner chair d. Toothbrush with built-up handle e. Wheelchair cushion for comfort

A, B, D

A client asks the nurse about what medications may be included for nonopioid multimodal analgesia following a total knee arthroplasty. What medications may be given to the client? (Select all that apply.) a. Gabapentin b. Ketorolac c. Hydrocodone d. Ketamine e. Morphine f. Bupivacaine

A,B,D,F

5. What action should the nurse complete before administering alendronate (Fosamax) to a patient with osteoporosis? Ask about any leg cramps or hot flashes Assist the patient to sit up at the bedside Be sure that the patient has recently eaten Administer the ordered calcium carbonate.

B

2.Which information should the nurse include when teaching a patient with acute low back pain? (Select all that apply.) Sleep in a prone position with the legs extended. Keep the knees straight when leaning forward to pick something up. Expect symptoms of acute low back pain to improve in a few weeks. Avoid activities that require twisting of the back or prolonged sitting. Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.

B,C ,D

.A patient is taking methotrexate to treat rheumatoid arthritis (RA). Which laboratory result is important for the nurse to communicate to the health care provider? Rheumatoid factor is positive. Fasting blood glucose is 90 mg/dL. The white blood cell count is 1500/μL. The erythrocyte sedimentation rate is increased.

C

1.The nurse should anticipate the need to teach a patient who has osteoarthritis (OA) about which medication? Prednisone Adalimumab (Humira) Capsaicin cream (Zostrix) Sulfasalazine (Azulfidine)

C

8. What should the nurse include when teaching older adults at a community recreation center about ways to prevent fractures? Tack down scatter rugs on the floor in the home. Expect most falls to happen outside the home in the yard. Buy shoes that provide good support and are comfortable to wear. Get instruction in range-of-motion exercises from a physical therapist.

C

9. The nurse is performing an assessment of a client with possible plantar fasciitis in the right foot. What assessment finding would the nurse expect in the right foot? Multiple toe deformities Numbness and paresthesias Severe pain in the arch of the foot Redness and severe swelling

C

A nurse assesses a client with a spinal cord injury at level T5. The client's blood pressure is 184/95 mm Hg, and the client presents with a flushed face and blurred vision. After raising the head of the bed, what action would the nurse take next? 1.Initiate oxygen via a nasal cannula. 2.Recheck the client's blood pressure. 3.Palpate the bladder for distention. 4.Administer a prescribed beta blocker.

C

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance? "I'm frustrated with this endless treatment!" "I will take my oral temperature twice a day." "I think my left foot is starting to droop down." "I use crutches to avoid weight bearing on the left leg."

C

A patient who takes multiple medications develops acute gout arthritis. Which medication should the nurse discuss with the health care provider before administering a prescribed dose? sertraline (Zoloft) . famotidine (Pepcid) hydrochlorothiazide. oxycodone (Roxicodone)

C

When the nurse brings medications to a patient with rheumatoid arthritis, the patient refuses the prescribed methotrexate. The patient tells the nurse, "My arthritis isn't that bad yet. The side effects of methotrexate are worse than the arthritis." What is the most appropriate response by the nurse? "You have the right to refuse to take the methotrexate." "Methotrexate is less expensive than some of the newer drugs." "It is important to start methotrexate early to decrease the extent of joint damage." "Methotrexate is effective and has fewer side effects than some of the other drugs."

C

The nurse reviews a list of drugs that can cause secondary osteoporosis.Which drugs are most commonly associated with this health problem? (Select all that apply.) Antianxiety agents Antibiotics Barbiturates Corticosteroids Loop diuretics

C,D,E

3. Which action should the nurse take before administering gentamicin (Garamycin) to a patient with acute osteomyelitis? Ask the patient about any nausea. Obtain the patient's oral temperature. Change the prescribed wet-to-dry dressings. Review the patient's serum creatinine results.

D

4. Which patient seen by the nurse in the outpatient clinic is most likely to need teaching about ways to reduce the risk for osteoarthritis (OA)? A 56-yr-old man who has a sedentary office job A 38-yr-old man who plays on a summer softball team A 38-yr-old woman who is newly diagnosed with diabetes A 56-yr-old woman who works on an automotive assembly line

D

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient? With a family history of osteoporosis, there is no way to prevent or slow bone resorption. Estrogen replacement therapy must be started to prevent rapid progression to osteoporosis. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

D

A factory line worker has repetitive strain syndrome in the left elbow. What topic should the nurse plan to include in patient teaching? Surgical options Elbow injections Wearing a left wrist splint Modifying arm movements

D

An older client has returned to the surgical unit after a total hip replacement. The client is confused and restless. What intervention by the nurse is most important to prevent injury? a. Administer mild sedation .b. Keep all four siderails up. c. Restrain the clients hands. d. Use an abduction pillow.

D

The home health nurse is making a follow-up visit to a patient recently diagnosed with rheumatoid arthritis (RA). Which finding indicates to the nurse that additional patient teaching is needed? The patient takes a 2-hour nap each day. The patient has been taking 16 aspirins each day. The patient sits on a stool while preparing meals. The patient sleeps with two pillows under the head.

D

The nurse assesses a 78-yr-old who uses naproxen (Aleve) daily for hand and knee osteoarthritis management. Which information should the nurse discuss with the health care provider for an urgent change in the treatment plan? Knee crepitation is noted with normal knee range of motion. Patient reports embarrassment about having Heberden's nodes. Patient's knee pain while golfing has increased over the last year. Laboratory results indicate blood urea nitrogen (BUN) is elevated.

D

The nurse is caring for a young client who has been diagnosed with osteopenia. Which risk factor in the client's history most likely contributed to the bone loss? 1. Osteoarthritis 2. Hypothyroidism 3. Addison disease 4. Rheumatoid arthritis

D

The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option? Client with diabetes who has a serum creatinine of 0.8 mg/dL (61 mcmol/L). Client who recently fell and has vertebral compression fractures. Hypertensive client who takes calcium channel blockers. Client with a spinal cord injury who cannot tolerate sitting up.

D

The nurse is collaborating with the occupational therapist to assist a client with a complete cervical spinal cord injury to transfer from the bed to the wheelchair. What ambulatory aid would be most appropriate for the client to meet this outcome? Rolling walker Quad cane Adjustable crutches Sliding board

D