Module 13
A client with multiple sclerosis (MS) is observed transferring from the bed to a motorized wheelchair and applying splints to the lower extremities before entering the bathroom to perform morning self-care. What could the nurse conclude regarding this observation? A) The client uses assistive devices to optimize autonomy. B) The client should be instructed to conduct morning care before applying splints to the lower extremities. C) The client is dependent on assistive devices. D) The client should be advised to avoid use of a motorized wheelchair when possible.
a
The nurse is caring for a preadolescent male client who is accompanied by his mother. Which statement by the mother would be consistent with the client experiencing growing pains? A) "My son often complains that his arms and legs feel sore." B) "My son seems to get injured very easily, especially broken bones." C) "My son often doesn't want to walk because his knees hurt." D) "My son occasionally complains of pain in his lower back."
a
The nurse is providing care to a client who is experiencing back pain. Which of the following items in the client's history is a known risk factor for disc herniation? A) 49 years of age B) Female gender C) Short stature D) Anorexia
a
Which of the following medications is used to treat tertiary symptoms of multiple sclerosis (MS)? A) Bupropion B) Ciprofloxacin C) Magnesium hydroxide D) Glatiramer acetate
a
Within the human body, which type of connective tissue connects bones to other bones to form a joint? A) Tendon B) Ligament C) Cartilage D) Myelin
b
A client is recovering from surgery to repair a fractured hip. Which actions by the nurse may reduce this client's risk for osteomyelitis in the postoperative period? Select all that apply. A) Assess for pain every 1-2 hours. B) Use sterile technique for dressing changes. C) Assess wound for size, color, and drainage. D) Administer antibiotics as prescribed. E) Administer anticoagulants as prescribed.
bcd
The nurse is caring for a client who is experiencing limited mobility related to a musculoskeletal alteration. Which laboratory tests would be useful to diagnose the client appropriately? Select all that apply. A) Magnetic resonance imaging (MRI) B) Alkaline phosphatase (ALP) C) Human leukocyte antigen-B27 (HLA-B27) D) Rheumatoid factor (RF) E) Electromyography (EMG)
bcd
A female client who sustained a spinal cord injury (SCI) several years ago tells the nurse she is interested in becoming pregnant. She asks the nurse for more information about how her SCI might impact a potential pregnancy. Which of the following statements should the nurse include in her response to the client? A) "Women with SCI should avoid pregnancy, because it puts too much stress on their bodies and can exacerbate their injuries." B) "If you become pregnant, your risk for autonomic dysreflexia will likely decrease." C) "The good news is that none of the medications used in the treatment of SCI are known to have detrimental effects on the fetus." D) "Should you have a baby and opt to breastfeed, you may experience an increase in muscle spasticity."
d
An older adult client experiences a hip fracture. Prior to the injury, the client had an active lifestyle. Based on this information, which surgical procedure should the nurse anticipate? A) Total hip replacement B) Open reduction and external fixation C) Arthroplasty D) Open reduction and internal fixation
d
Clients with osteoarthritis (OA) can reduce their risk of further joint damage by doing which of the following? A) Applying topical analgesic creams as prescribed B) Avoiding movement of affected joints C) Taking acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) before joint pain becomes severe D) Receiving cortisone injections in affected joints no more than three times per year
d
For non-elderly adult clients who fracture a hip, why is internal fixation or casting of the fracture generally preferred over hip replacement? A) Internal fixation or casting is preferred because it does not disturb the client's epiphyseal plate. B) Internal fixation or casting is preferred because of the lower risk of deep vein thrombosis. C) Internal fixation or casting is preferred because of the shorter recovery time. D) Internal fixation or casting is preferred because of the limited longevity of hip prostheses.
d
Which of the following would be classified as a secondary symptom of multiple sclerosis (MS)? A) Pressure sores B) Urinary retention C) Depression D) Unsteady gait
a
The nurse is teaching an older adult client and caregiver about appropriate ways to decrease the client's risk for falls. Which interventions are appropriate for the nurse to include in this teaching session? Select all that apply. A) Start walking for exercise several times per week. B) Wear sensible shoes with good support when shopping. C) Wear socks when walking in the kitchen. D) Encourage the use of throw rugs throughout the home. E) Make sure hallways and stairways have adequate lighting, even at night.
abe
A client in the initial stages of Parkinson disease (PD) would most likely exhibit which of the following symptoms? A) Bilateral rigidity B) Unilateral tremors C) Bilateral tremors D) Unilateral rigidity
b
The nurse completes a teaching session for a young adult client who was recently diagnosed with Parkinson disease (PD). Which client statement indicates this teaching has been effective? A) "I could have prevented PD with diet and exercise." B) "I probably have a genetic mutation that caused my PD." C) "My brain contains too much of a chemical called dopamine." D) "Most people with PD first experience symptoms when they are about my age."
b
The nurse instructs a client with Parkinson disease (PD) about levodopa/carbidopa. Which client statement indicates that this teaching has been effective? A) "I should eat a high-protein diet when taking this medication." B) "When taking this medication, I should sit up for several minutes before going from lying down to standing up." C) "This medication will not affect my blood pressure medications." D) "Given enough time, this medication will cure my Parkinson disease."
b
The nurse is caring for an adult client who sustained a right distal radial fracture and a left tibia fracture. Which mobility aid does the nurse anticipate being used for this client? A) Lofstrand crutches B) Platform crutches C) Walker D) Axillary crutches
b
The nurse is evaluating the effectiveness of interventions to address a client's bowel and bladder dysfunction as a result of a spinal cord injury. Which finding would indicate that these interventions have been successful? A) The client had two episodes of impacted stool over the last week. B) The client is improving in ability to perform self-urinary catheterization. C) The client is limiting fluids to reduce need to void. D) The client has an indwelling urinary catheter and is provided with stool softeners every morning.
b
Which condition or symptom is most common in clients with a herniated cervical disc? A) Sciatica B) Stiff neck and shoulder pain C) Changes in knee and ankle reflexes D) Cauda equina syndrome
b
The nurse is caring for a client who sustained a gunshot wound below the level of T12, resulting in ipsilateral motor paralysis, ipsilateral loss of proprioception and vibratory sense, and contralateral loss of pain and temperature sensation. When planning care for this client, which interpretations of this data by the nurse are likely to be correct? Select all that apply. A) The client's American Spinal Injury Association Impairment Scale score is A. B) The spinal cord injury is incomplete. C) These findings are consistent with Brown-Sequard syndrome. D) Hemisection of the spinal cord is likely. E) Some recovery of sensory function is likely.
bcde
The nurse is evaluating the success of a bowel and bladder retraining program with a client who is recovering from a lower motor neuron spinal cord injury. Which observations indicate that this teaching has been successful? Select all that apply. A) One episode of bladder incontinence in 8 hours B) Client performs self-urinary catheterization every 4 hours while awake C) Client transfers to use bedside commode after breakfast to evacuate bowels D) Two episodes of impacted stool in 1 week E) Client maintains a high-fluid, high-fiber diet
bce
A client who sustained a cervical neck injury 2 days ago is demonstrating an irregular respiratory pattern with a rate of 8-10 breaths per minute. Based on this data, which is the priority nursing diagnosis? A) Impaired Physical Mobility B) Autonomic Dysreflexia C) Ineffective Breathing Pattern D) Impaired Gas Exchange
c
A school nurse is treating a school-age client who has fallen down a flight of stairs. The client is breathing but unconscious. After calling the ambulance, which is the priority action by the nurse? A) Open the airway using the head tilt maneuver. B) Try to rouse the client by gently shaking the shoulders. C) Protect the client's neck and head from any movement. D) Place the client on the side to prevent aspiration.
c
A young adult client complains of blurred vision and muscle spasms that have come and gone over the past several months. The physician suspects that the client has multiple sclerosis. What in the client's history would the nurse recognize as a risk factor for MS? A) The client is a male. B) The client is of Native American descent. C) The client is of European descent. D) The client takes a vitamin D supplement daily.
c
An adolescent client with scoliosis has a Cobb angle of 32 degrees. Given this information, what treatment will the nurse likely need to prepare the client for? A) This client will not need specific treatment. B) The nurse will prepare the client for physical therapy. C) The nurse will prepare the client for wearing a brace. D) The nurse will prepare the client for undergoing spinal fusion surgery.
c
An adolescent is brought into the emergency department (ED) with injuries sustained from a motor vehicle crash. What is a priority while providing nursing care for this client? A) Adequate urine output B) Stable blood pressure C) Continued stabilization of the neck and spinal cord D) Insertion of an intravenous access line
c
The nurse in an orthopedic outpatient clinic expects to see several clients with fractures for follow-up. Based on the information provided below, which of the nurse's clients is at highest risk for a delayed union? A) A 20-year-old college student with type I diabetes mellitus who sustained a fractured tibia in a bicycle accident. The nutrition recall tool completed during the client's last visit was consistent with American Diabetic Association (ADA) guidelines. B) A 62-year-old bartender with a history of peptic ulcer disease who sustained a fractured clavicle breaking up a fight at work. During his prior visit, the client stated he was upset that his injury required him to abstain from upper body resistance training. C) A 49-year-old teacher with osteoporosis who sustained an open ulnar fracture in a motor vehicle crash. At her last visit, the client reported that she had cut down smoking to 10 cigarettes per day. D) A 55-year-old accountant who sustained fractures to the 4th and 5th right metatarsals. The client has a history of hypertension that is well controlled with medication.
c
The nurse in the emergency department is preparing to administer methylprednisone to a client with a spinal cord injury. What does the nurse recognize as the intended therapeutic effect of the medication? A) To increase blood glucose level B) To improve the client's level of consciousness C) To prevent cord damage from ischemia and edema D) To improve the client's ability to be adequately ventilated
c
The nurse is presenting a talk on spinal cord injury for a community health fair. Which statement on the part of the attendees indicates that they understand the risk factors and prevention methods associated with spinal cord injury? A) "There isn't much I can do to prevent a head injury when another vehicle hits my car." B) "As long as my grandson wears a helmet, he will be safe on his motorcycle." C) "I'm going to spend extra time discussing this talk with my college-age son because of his higher risk for spinal cord injury." D) "Due to their elevated risk, I'd like you to present this talk to members of the local Native American population."
c
Which region of the spine is the most common location of herniated discs? A) Cervical region B) Thoracic region C) Lumbar region D) Sacral region
c
Which of the clients described below are at increased risk for back problems? Select all that apply. A) A 45-year-old man who has played golf three times a week for the past 20 years B) An 18-year-old woman who has been a distance runner since middle school C) A 62-year-old man who is a heavy truck mechanic and has a body mass index (BMI) of 30 D) A 12-year-old boy who has a history of cerebral palsy and a current BMI of 21 E) A 78-year-old man with a 40 pack-year smoking history who was recently widowed
cde
Which of the following procedures used in the treatment of osteoarthritis (OA) involves removing a small amount of bone at the articulating surface of the joint and fitting a metal replacement over the end of the bone? A) Osteotomy B) Arthroplasty C) Arthroscopy D) Joint resurfacing
d
Which of the following clients is at highest risk for autonomic dysreflexia? A) A client with an injury to T9 B) A client with an injury to C7 C) A client with an injury to L2 D) A client with an injury to S1
b
Which of the following fractures presents the greatest risk for development of fat embolism syndrome? A) Open fracture of the fibula B) Closed fracture of the femur C) Open fracture of the humerus D) Closed fracture of the clavicle
b
Which of the following terms is used to describe osteoarthritis (OA) that is caused by an underlying condition, such as injury, congenital malformation, or metabolic disease? A) Idiopathic B) Secondary C) Localized D) Generalized
b
1) The nurse is presenting a program at a senior center on how to survive a fall. Which statement by a program participant indicates that this person needs clarification about what emergency actions to take after a fall? A) "I should crawl to a phone on the affected side to keep it stable against a hard surface." B) "I should try to cover myself with a blanket while I wait for help to arrive." C) "To call for help, I can scoot on my bottom to a low wall-mounted phone." D) "If possible, I can crawl to a stairway and use the stairs to lift up to a standing position."
a
A client complains of a right-hand tremor, increasing weakness, and muscles that feel tight. The nurse notes that the client has poor voice volume and facial muscles that do not move easily. The nurse recognizes that these symptoms are consistent with which condition? A) Parkinson disease B) Spinal cord injury C) Cerebrovascular accident D) Multiple sclerosis
a
A client with permanent paralysis of the trunk, arms, and legs would be said to be experiencing which of the following conditions? A) Tetraplegia B) Paraplegia C) Spinal shock D) Complete spinal cord injury (SCI)
a
A nurse is teaching a mother warning signs and symptoms to watch for in her child, who will be discharged with a full leg cast. Which statements by the mother indicate the need for further instruction? Select all that apply. A) "If her foot turns white and cold, I should call the physical therapist." B) "I can expect that my child will have some pain, but the medicine should help." C) "We can use a blow dryer on warm to help with the itching that my child will experience." D) "We can cut a hole in the cast if my child's foot swells until we get to the doctor's office." E) "It is okay if the plaster cast gets damp as long as I blow dry it."
acde
Which of the following treatment options would least likely be considered for a 71-year-old client with osteoarthritis (OA)? A) Physical therapy B) Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) C) Weekly tai chi sessions D) Administration of narcotics
b
Which score would a nurse select from the muscle function grading scale if the client has full strength and range of motion in a given joint? A) 0 B) 5 C) 8 D) 10
b
The nurse is planning care for a client who is 1 day postoperative after spinal fusion surgery. Which of the following is an appropriate outcome for this client? A) The client will remain in prone position. B) The client will maintain urine output at 20 mL per hour. C) The client will use the incentive spirometer every 2 hours. D) The client will void 12 hours after surgery.
c
A client who is hospitalized after a left hip fracture is scheduled for surgery late this afternoon. After receiving report, the nurse evaluates the Buck traction applied by a new physical therapist. Which finding would indicate that the traction is correctly applied? A) A foam boot covers the right lower leg from the knee down. B) Twenty-pound weights are connected to the bottom of a foam boot. C) Weights are supported by a stool at the end of the bed. D) The left knee and hip are in alignment above a foam boot.
d
A client with chronic hip pain is diagnosed with osteoarthritis. Which instruction regarding home safety is most appropriate for the nurse to provide to this client? A) Walk up and down the steps at home as much as possible. B) Rest in a recliner. C) Place scatter rugs in high-traffic areas. D) Install grab bars in the bathroom near the commode and in the shower.
d
The nurse is planning care for a client admitted with a high thoracic spinal cord injury. Which interventions would be appropriate for the nursing diagnosis of Ineffective Peripheral Tissue Perfusion? Select all that apply. A) Discuss future care needs when the client is discharged. B) Increase fluids to 3000 mL per day. C) Turn and reposition the client every 2 hours. D) Assess for a full bladder. E) Assess blood pressure every 2-3 minutes.
de
The nurse is assessing an older adult client in a long-term care facility after a fall. Which finding requires priority action? A) The injured leg is shortened and externally rotated. B) Redness and severe swelling are found at the hip joint. C) Pain is relieved by moving the affected extremity. D) The client is repeatedly flexing the injured leg at the hip.
a
A client with multiple sclerosis is prescribed diazepam (Valium). What assessment finding indicates that this medication is effective for the client? A) Muscle spasticity is reduced. B) Blood glucose level is within normal limits. C) The client states that muscles are weak. D) Ophthalmologic examination shows no evidence of cataracts.
a
A client with relapsing-remitting multiple sclerosis (MS) tells the nurse that even though her primary symptoms of exacerbation are leg spasms and blurred vision, her greatest struggle is getting through the day because she is always tired. Which diagnosis should the nurse identify as a priority for this client? A) Fatigue B) Disturbed Sensory Perception C) Impaired Physical Mobility D) Self-Care Deficit
a
The nurse is caring for a client with osteoarthritis. Which factor in the client's history and physical assessment would the nurse recognize as a risk factor for developing this condition? A) Body mass index of 36.5 B) History of esophageal reflux disease C) Client plays tennis three times each week D) Blood pressure of 136/78 mmHg
a
A middle-aged female client states to the nurse, "I have noticed a slight tremor in my left hand when it's at rest. I think I might have Parkinson disease because my mother had it." Which response by the nurse is the most appropriate? A) "Having a close relative with Parkinson disease can increase your chance of developing it as well." B) "You shouldn't worry too much, because Parkinson disease has a higher prevalence in males." C) "It is unlikely that you have the same illness as your mother." D) "You probably don't have Parkinson disease. Your mother was probably exposed to a toxin that caused her illness."
a
In clients with Parkinson disease, increasing doses of and long-term exposure to levodopa can cause which of the following conditions? A) Dyskinesia B) Insomnia C) Hypertension D) Compulsive behavior
a
The nurse is planning care for a client who is experiencing an alteration in mobility. Which would the nurse include as an independent nursing intervention? A) Instructing on the importance of proper nutrition and an active lifestyle B) Administering a prescribed nonsteroidal anti-inflammatory drug (NSAID) C) Identifying necessary modifications to the home environment D) Prescribing a skeletal muscle relaxant
a
During which phase of the fracture healing process is woven bone replaced by lamellar bone? A) Reactive phase B) Reparative phase C) Remodeling phase D) Inflammatory phase
c
The cells that produce the matrix for bone formation are known as A) osteoclasts. B) sarcomeres. C) osteoblasts. D) epiphyseal plates.
c
The first day after surgery to repair a fractured hip sustained from a fall, an older adult client refuses to ambulate but states, "I will consider it tomorrow." In this situation, which is the priority action by the nurse? A) Coordinate personnel to assist with ambulation B) Document the client's refusal C) Assess why the client is refusing to ambulate D) Notify the healthcare provider
c
Which category of multiple sclerosis (MS) is characterized by a slow but nearly continuous worsening of the disease from the time of onset with no distinct remissions? A) Relapsing-remitting B) Progressive-relapsing C) Primary-progressive D) Secondary-progressive
c
Which of the following is not a common clinical manifestation of Parkinson disease (PD)? A) Restless leg syndrome B) Cogwheel rigidity C) Malignant hypertension D) Pill-rolling
c
Lab results are back for a client who has limiting joint pain. Synovial fluid analysis shows no uric acid crystals or bacteria. The client asks what the test results mean. How should the nurse respond? A) "These test results mean that your joint pain is likely not caused by gout or septic arthritis." B) "These test results mean that your joint pain is likely not related to any form of arthritis." C) "These test results mean that your joint pain is likely caused by either rheumatoid arthritis or septic arthritis." D) "These test results mean that your joint pain is likely caused by either cancer of the joint or gout."
a
The nurse assesses a young adult client who was involved in a swimming accident that resulted in tetraplegia. The client makes eye contact with the nurse and states, "I'm going to beat this and walk out of here." Based on this statement, which nursing diagnosis is most appropriate for this client? A) Risk for Post-Trauma Syndrome B) Impaired Physical Mobility C) Self-Care Deficit D) Noncompliance
a
Which of the following procedures would be most appropriate to repair a finger joint that is affected by severe osteoarthritis (OA)? A) Osteotomy B) Joint resurfacing C) Joint fusion D) Internal fixation
c
A client with a history of relapsing-remitting multiple sclerosis (MS) is expecting her first child. Which of the following nursing interventions would be indicated for this client? A) Suggest the client seek reproductive counseling. B) Tell the client to expect a period of remission after delivery. C) Instruct the client to expect an exacerbation of symptoms while pregnant. D) Discuss the client's options for pain control during labor, as her contractions will be especially severe.
a
The nurse is planning care for a client with acute back pain who is a single mother of two small children and works part-time as a receptionist. Based on this information, which nursing intervention is the highest priority? A) Instructing the client in appropriate body mechanics for lifting and ways to modify her work environment B) Suggesting that the client take time off from work until her back is healed C) Obtaining an order for nonsteroidal anti-inflammatory drugs (NSAIDs) from the client's healthcare provider D) Suggesting that the client's children be taken care of by an extended family member until the client's back is healed
a
The nurse is planning care for a client with osteoarthritis of the hip. Which intervention would be appropriate for this client? A) Provide moist heat packs to the affected joint 3 times each day. B) Instruct the client on the importance of strict bedrest. C) Provide nonsteroidal anti-inflammatory drugs (NSAIDs) when pain becomes severe. D) Provide opioid pain medication as prescribed.
a
The nurse is providing care for several clients. For which client should the nurse anticipate an order for administering 1000 mg of aspirin? A) A 68-year-old client with rheumatoid arthritis who is experiencing hand pain B) A 5-year-old client who is experiencing ankle pain after a fall from a horse C) A 38-year-old client who is experiencing headache pain after a skiing accident D) A 70-year-old client who is experiencing back pain after laminectomy
a
A preadolescent client is recovering from spinal fusion surgery for scoliosis. Which nursing interventions should the nurse carry out to address comfort and mobility? Select all that apply. A) Reposition every 2 hours. B) Monitor intake and output. C) Encourage and assist with range of motion (ROM) exercises every 4 hours while awake. D) Administer pain medication around the clock. E) Encourage incentive spirometer use every 4 hours while awake.
acd
A client sustained multiple fractures in a motor vehicle crash. Of the various fracture types sustained by the client, which places the client at highest risk for osteomyelitis? A) Avulsion fracture B) Open fracture C) Comminuted fracture D) Depression fracture
b
The nurse is planning care for a client with osteoarthritis. Which nursing diagnosis would have the highest priority? A) Fatigue B) Chronic Pain C) Ineffective Coping D) Disturbed Body Image
b
Why do clients with Parkinson disease (PD) nearly always take carbidopa in combination with levodopa? A) Carbidopa minimizes the conversion of levodopa to dopamine within the brain, thus minimizing levodopa's unwanted side effects. B) Carbidopa enhances levodopa's conversion to dopamine throughout the body, thus intensifying levodopa's effectiveness. C) Carbidopa prevents levodopa from converting to dopamine until it reaches the brain, thus minimizing levodopa's unwanted side effects. D) Carbidopa prevents levodopa's conversion to dopamine in the brain, thus intensifying levodopa's effectiveness.
c
The nurse is documenting the interdisciplinary team report on an adolescent client who has a 35-degree Cobb angle confirmed by x-ray. What interventions should the nurse anticipate being included in the collaborative plan of care for this client? Select all that apply. A) Obtaining a physical therapy consult prior to surgical intervention B) Maintaining the existing curvature with no increase C) Bracing for 12-23 hours per day and providing a support group referral D) Administering nonopioid analgesics and a TLSO or Milwaukee brace E) Instructing the client on exercises and appropriate support groups
cde
A client presents with an alteration in mobility. Which finding would suggest damage to the muscle? A) Increased PTH levels B) Decreased PTH levels C) Decreased CK levels D) Increased CK levels
d
The nurse is evaluating care provided to a client with osteoarthritis (OA). Which client statement indicates to the nurse that interventions for OA have been successful? A) "I had to take early retirement and now stay at home all day and rest my legs." B) "I am sleeping throughout the night and have not missed any work because of knee pain." C) "I am moving from my two-story house into the first floor of my daughter's home so I won't have to walk steps anymore." D) "I changed my work hours so now I work part time and have a nursing assistant who helps me bathe twice a week at home."
b
The nurse is providing care for a client who experienced a fracture requiring a plaster cast. Which nursing intervention is appropriate for this client? A) Prescribing opioid pain medication B) Assessing the client's neurovascular status C) Discouraging client ambulation D) Encouraging the client to keep the cast damp
b
The nurse is providing care to a client who returns to the medical-surgical unit after herniated disc surgery. The client's vitals are as follows: HR 100, RR 22, BP 130/86 mmHg, T 98.8°F, and pain rating of 7 on a scale of 0 to 10. Which nursing diagnosis is the highest priority for this client based on these assessment data? A) Impaired Physical Mobility B) Acute Pain C) Activity Intolerance D) Chronic Pain
b
The x-ray of a client 14 weeks post-ulnar fracture exhibits no callus formation. Based on this data, which collaborative intervention should the nurse anticipate? A) The physical therapist will set up Buck traction. B) The surgeon will schedule a consultation with the client. C) The pharmacist will educate the client on antibiotics. D) The nurse will counsel the client on starting range-of-motion exercise.
b
The nurse is caring for a client who is 28 weeks pregnant. The client says she has recently begun to experience frequent lower back pain and asks the nurse what can be done to control this pain. What is the nurse's best response? A) "Back pain is common during pregnancy and can usually be managed by taking nonsteroidal anti-inflammatory drugs (NSAIDs)." B) "Let's talk about some postural adjustments that might help alleviate your pain." C) "Back pain during pregnancy is often related to kidney infection. Have you experienced any recent urinary problems, including pain when voiding?" D) "The physician will likely order an x-ray to investigate potential causes of your pain."
b
The nurse is planning care for the client with chronic pain from herniated intervertebral discs who is also experiencing constipation. Which intervention should the nurse carry out to address constipation? A) Restrict foods high in fiber. B) Avoid the use of stool softeners. C) Encourage fluid intake of 2500-3000 mL each day. D) Medicate for pain around the clock.
c
The nurse is providing care for a client who is experiencing subjective symptoms of carpal tunnel syndrome. Which test should the nurse anticipate being performed by a provider during the physical assessment of this client? A) Bulge test B) Ballottement test C) Phalen test D) McMurray test
c
The nurse is providing teaching to the client recently diagnosed with osteoarthritis. Which statement by the nurse is correct? A) "Osteoarthritis is most commonly seen in thin, small-built female clients." B) "Osteoarthritis is a result of joint inflammation." C) "Osteoarthritis occurs due to erosion of cartilage in the joints." D) "Osteoarthritis is a metabolic bone disease."
c
The nurse is caring for clients in an assisted living facility. Which resident would the nurse identify as being at the highest risk for the development of fractures from a fall? A) A resident who participates in resistance training exercises three times a week and takes a calcium supplement B) A resident who hikes in the woods once a week and smokes 14 cigarettes per day C) A resident who line dances twice per week and has a glass of wine with dinner D) A resident who teaches yoga four times per week and is lactose intolerant
b
A client with osteoarthritis (OA) of the knees and hips returns for a 3-month follow-up visit with the provider. The nurse calculates that the client's body mass index (BMI) is now 22. The client reports starting a water aerobics and running program three times per week. The client is also using hot packs for edema for 20 minutes and cold packs for pain for 40 minutes daily. After evaluating the client's actions, which follow-up interventions should the nurse plan? Select all that apply. A) Reinforce the correct use of hot packs. B) Suggest the client replace running with a lower impact exercise. C) Explain the risk of injury associated with use of cold packs. D) Advise the client to continue weight loss. E) Congratulate the client on starting water aerobics.
abce
The nurse is caring for a client admitted with an exacerbation of multiple sclerosis (MS). The client is demonstrating frustration with eating because he is experiencing hand and arm spasms that prevent the proper use of utensils. Which intervention should the nurse implement to best assist this client? A) Consult with the occupational therapist regarding assistive devices for meals. B) Counsel the client to select finger foods for meals. C) Plan time to feed the client. D) Consult with the physical therapist regarding hand and arm exercises.
a
During an outpatient clinic follow-up appointment, a client with multiple sclerosis (MS) has lab tests completed. The results show elevated levels of aspartate aminotransferase (AST), serum glutamic-oxaloacetic transaminase (SGOT), alanine aminotransferase (ALT), serum glutamic-pyruvic transaminase (SGPT), and alkaline phosphatase (ALP). The nurse recognizes that these elevated enzyme levels are a potential adverse effect of which medications? Select all that apply. A) Interferon beta-1a (Avonex) B) Teriflunomide (Aubagio) C) Glatiramer acetate (Copaxone) D) Mitoxantrone (Novantrone) E) Fingolimod (Gilenya)
ab
The nurse is providing discharge instructions to an older adult client who is recovering from a fractured hip. The client is planning to stay with an adult child, who is included in the discharge teaching. Which statements on the part of the client indicate appropriate understanding of the information presented by the nurse? Select all that apply. A) "I have signed a contract with Lifeline." B) "We are removing the area rugs in the hallway." C) "I've borrowed a toilet seat riser from the equipment closet." D) "I will be sure to take oxycodone before I go downstairs in the morning." E) "I can help with housework while I'm staying at my child's house."
abc
The wife of a client with Parkinson disease (PD) expresses frustration about trying to communicate with her husband. What can the nurse do to facilitate communication between the client and spouse? A) Recommend that the client and spouse learn sign language. B) Suggest that the spouse obtain a hearing aid. C) Consult with speech therapy for exercises to aid the client with speech and language. D) Suggest the client and spouse communicating by writing.
c
The mother of a preadolescent client meets with the school nurse to discuss the client's recent diagnosis of scoliosis. Which interventions would be appropriate for the nursing diagnosis of Disturbed Body Image related to deformity and brace? Select all that apply. A) Including the student and family in a meeting to elicit her feelings about scoliosis and wearing a brace B) Offering to arrange a meeting for the student with an 8th grader who has scoliosis C) Encouraging the student and family to register for home schooling to minimize the risk of ridicule D) Teaching the student and family about clothing that will hide the brace E) Suggesting that the pediatrician prescribe an anti-anxiety agent for the student
abd
The nurse gives discharge instructions to an adult client who sustained a bicycle fall and underwent open reduction and internal fixation of a fractured hip. After the teaching is complete, which statements by the client indicate appropriate understanding of the information presented? Select all that apply. A) "I will use my abduction pillow while sleeping to maintain proper hip alignment." B) "I will use a high toilet seat to prevent excess flexion of my hip." C) "I only need to use my walker during physical therapy appointments." D) "I will take my prescribed ibuprofen to decrease the risk for deep vein thrombosis." E) "I might experience bruising because of the warfarin I've been prescribed."
abe
The interdisciplinary treatment team proposes interventions to improve and maintain physical function for an adult client with Parkinson disease (PD). Which of the following interventions are supported by research? Select all that apply. A) Low-intensity treadmill training B) Walking barefoot indoors C) Use of resistance bands D) Active and passive range-of-motion exercises E) High-intensity treadmill training
acde
A client hospitalized with an open reduction and internal fixation of a fractured femur reports right calf pain. The nurse notes that the client's right calf is 3.5 cm larger than the left calf with generalized posterior erythema. The right calf is tender to touch, and the dorsalis pedis pulse is 3/4+ bilaterally. Which of the following is the priority action by the nurse? A) Use a Doppler stethoscope to confirm pedal pulses. B) Notify the healthcare provider of the findings. C) Prepare to apply a cast to the right leg. D) Prepare to administer intravenous heparin.
b
A client is admitted to your inpatient rehabilitation unit. This client is currently in halo traction. (See exhibit.) Based on this information, which of the following should be the priority nursing diagnosis for the client? A) Risk for Peripheral Neurovascular Dysfunction related to disruption of traction weights B) Risk for Infection related to surgical incision and insertion of hardware C) Risk for Disuse Syndrome related to use of traction to stabilize fracture D) Acute Pain related to bone and soft tissue damage
b
A client seeking treatment for severe knee pain has worked in a factory for 30 years in a position requiring repetitive lifting and carrying of 20- to 40-pound boxes. Based on the client's history, the nurse should anticipate which initial recommendation from the multidisciplinary healthcare team? A) Joint replacement surgery B) Pharmacologic therapy C) Referral for a disability application D) Intermittent use of a cane
b
A client with Parkinson disease (PD) ambulates with a shuffling gait and leans slightly forward. When seated, the client conducts a conversation, reads, and is able to self-feed without assistance. Which nursing diagnosis is a priority for this client? A) Ineffective Coping B) Impaired Physical Mobility C) Imbalanced Nutrition: More than Body Requirements D) Anxiety
b
A client with a BMI of 35 is recovering from total hip replacement surgery and experiencing pain that is exacerbated with movement. The client says to the nurse, "I live alone. How will I ever be able to return to my home?" Based on this information, which is the priority nursing diagnosis for this client? A) Overweight B) Acute Pain C) Impaired Physical Mobility D) Ineffective Coping
b
A client with multiple sclerosis (MS) is said to be experiencing an exacerbation when he or she experiences symptoms that: A) last at least 1 week and are separated from a previous attack by at least 30 days. B) last at least 24 hours and are separated from a previous attack by at least 30 days. C) last at least 2 weeks and are separated from a previous attack by at least 2 months. D) last at least 30 days and are separated from a previous attack by at least 2 months.
b
A postmenopausal client asks the nurse what she can do to prevent fracturing her hips, as her mother and grandmother both experienced this health problem. Which response by the nurse is most appropriate? A) "You should avoid all types of exercise." B) "You should consider a smoking cessation program." C) "You should limit your exposure to the sun." D) "You should use throw rugs throughout your home."
b
A preadolescent client who fell from a balance beam in physical education class injured her ankle. Given this information, which action by the nurse is appropriate? A) Referring the client to physical therapy B) Placing an ice pack on the client's ankle C) Planning for a corticosteroid injection D) Ordering an x-ray of the ankle
b
An adult client is diagnosed with a degenerative bone disease that is impairing mobility. Based on this information alone, which of the following actions should be the nurse's first priority? A) Implementing a low-level exercise program for the client B) Assessing the client's pain management C) Teaching the client relaxation techniques D) Referring the client to a dietitian
b
An older adult client with bilateral osteoarthritis of the knees tells the nurse, "I know I need to lose weight, but exercising makes my knees ache." What instruction should the nurse provide to this client? A) "You should discuss knee replacement surgery with your physician." B) "Exercising the muscles in your legs might be hard now, but over time, it will help protect your knees." C) "Try eating a reduced-calorie diet for several months before attempting exercise." D) "You need to stretch your muscles, because stretching is the only form of exercise that improves osteoarthritis."
b
On the first postoperative day after spinal fusion, the nurse assesses a client and notes the following vital signs: T 39.2°C, BP 100/50 mmHg, HR 118, and RR 23. Drainage at the client's incision site is clear and tests positive for glucose. Which assessment parameter indicates the highest risk for surgical wound infection? A) Temperature B) Incisional drainage positive for glucose C) Heart rate 118 bpm D) Presence of incisional drainage
b
An adult client recently diagnosed with multiple sclerosis (MS) reports engaging in vigorous exercise on a regular basis. Which statements contain the correct information to give this client when answering specific questions about lifestyle? Select all that apply. A) "Hyperbaric oxygen treatment is recommended prior to vigorous physical exercise." B) "You will tolerate exercise better in an air-conditioned room." C) "Acupuncture may benefit some of your symptoms." D) "Drinking cold water is recommended during exercise." E) "You will be able to maintain your current exercise schedule."
bcd
A client is being evaluated for Parkinson disease (PD). Which findings on the Unified Parkinson Disease Rating Scale (UPDRS) would be considered positive for PD? Select all that apply. A) Diarrhea B) Dystonia C) Retropulsion D) Hyperphonia E) Festination
bce
A client diagnosed with multiple sclerosis has an acute onset of visual changes, fatigue, and leg weakness. The client states that the last time this happened, she recovered in a few weeks. Which classification of multiple sclerosis is the client experiencing? A) Progressive-relapsing B) Secondary-progressive C) Relapsing-remitting D) Primary-progressive
c
A client is undergoing surgery for a fractured hip. The surgeon has stated that careful attention will be paid to preserving the epiphyseal plate. Which client will require this precaution during surgery? A) A postmenopausal woman with paraplegia B) A 32-year-old man who is a competitive body builder C) A prepubescent girl who is a vegetarian D) An 85-year-old woman with osteoporosis
c
A client with osteoarthritis tells the nurse she has difficulty walking to the bathroom first thing in the morning. Which nursing action would assist this client? A) Suggesting a family member provide the client with a bedpan B) Discussing the option of residing in an assisted-living facility C) Consulting with physical therapy for an assistive walking device such as a walker or cane D) Suggesting the client use a bedside commode at home
c
A hip fracture that occurs in the trochanter region would be classified as a(n) A) intracapsular fracture. B) intercapsular fracture. C) extracapsular fracture. D) subcapsular fracture.
c
A nurse is teaching the parents of a client who was recently diagnosed with multiple sclerosis (MS) about what to expect as their child's condition progresses. Which statement by the parents indicates the need for further instruction? A) "My child is at increased risk for seizures because of the MS diagnosis." B) "It's not unusual for kids with MS to have problems with their schoolwork." C) "MS usually progresses faster in children than in adults." D) "Making friends may be more difficult for our child because of the MS."
c
A nurse is teaching the parents of a client who was recently diagnosed with osteoarthritis (OA) about their child's condition. Which statement by the parents indicates the need for further instruction? A) "Our daughter's OA is likely related to a joint injury she sustained last year." B) "Most kids with OA usually have only one or two affected joints." C) "Because our daughter developed OA as a child, she is more likely to become disabled as a result of this condition." D) "Our daughter may outgrow her OA as she ages."
c
The nurse is caring for a 30-year-old female client who was recently diagnosed with Parkinson disease (PD). Which of the following statements should the nurse include in the teaching for this client? A) "Having the early-onset form of PD puts you at greater risk for dementia." B) "If you get pregnant, it is highly unlikely that you will be able to carry the baby to term." C) "Given your age, your PD is likely to progress more slowly than it does for people who develop the condition later in life." D) "You can continue using birth control pills, because PD medications do not have an impact on their efficacy."
c
The nurse is caring for several clients from various cultural backgrounds. Which client would the nurse assess as having the highest risk for multiple sclerosis? A) A Brazilian woman with chronic parasitic infestation B) A Hispanic man with colonized methicillin-resistant Staphylococcus aureus (MRSA) C) A Northern Canadian woman who has smoked for 25 years D) An African man in his 20s who has a vitamin D deficiency
c
The nurse is conducting a gait and posture assessment for a client who is experiencing mobility issues. Which action by the nurse is appropriate during this assessment? A) Assessing the client's muscle mass and strength B) Measuring the length and circumference of the client's extremities C) Inspecting the client's spine for curvature D) Palpating the client for tenderness and pain
c
The nurse is evaluating care provided to a client recovering from hip replacement surgery. Which piece of documentation in the medical record indicates that the client has achieved the expected outcome for pain management? A) The client states pain is a 6 on a numeric pain scale of 0 to 10 prior to evening care. B) The client is crying and requesting pain medication prior to morning care. C) The client is using a PCA pump around the clock and rates pain as a 2 on a numeric pain scale of 0 to 10. D) The client refuses pain medication prior to physical therapy. Pain is rated as a 7 on a numeric pain scale of 0 to 10.
c
The nurse is evaluating the care of a client with Parkinson disease (PD). Which finding indicates an improvement in the client's nutritional status? A) The client filled out the menu card for each meal. B) The client coughs frequently when drinking fluids. C) The client was able to feed himself and had no weight change in 1 week. D) The client had a 4-pound weight loss in 1 week.
c
The nurse is planning care for a client with Parkinson disease (PD). Which of the following nursing interventions aimed at the client's spouse would best support the client's continued mobility? A) Suggesting that the spouse use a blender to make foods easier for the client to swallow B) Reviewing the client's medication administration schedule with the spouse C) Instructing the spouse to ambulate the client at least four times a day D) Instructing the spouse on proper turning and repositioning techniques
c
The nurse is planning care for a client with multiple sclerosis. Which intervention would address the nursing diagnosis of Fatigue? A) Encourage increased activity. B) Schedule physical therapy three times a day. C) Plan activities with sufficient rest periods between them. D) Group activities together so care will not be interrupted.
c
During a home care visit, an older adult client begins to cry softly when asked about coping with back pain. The client states, "My back hurts bad all the time. I am so confused about all these tests and scared that the doctor wants me to have surgery." In this scenario, which of the following nursing interventions is the highest priority? A) Asking the client to rate the pain on a scale of 0 to 10 B) Explaining potential procedures in a way the client will understand C) Administering all pain medication as ordered D) Attentively listening to the client's thoughts and fears
d