MS: safety prepu questions

A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority? A) Assess vital signs and level of consciousness. B) Administer pain medication per orders. C) Assess pedal pulses. D) Assess the diameter of the thigh every 15 minutes.

A) Assess vital signs and level of consciousness. Femur fractures can lead to hypovolemic shock due to blood loss in the tissue. By assessing the vital signs and level of consciousness, the nurse can assess for shock. Assessing the pedal pulses and measuring the diameter of the thigh are appropriate interventions for someone with a femur fracture, but assessing for hypovolemic shock would be a priority. Pain medication should be safely administered per orders to help control pain. Many pain medications lower blood pressure (BP). If the client is in shock, BP may be too low to administer the pain medication safely.

A patient is participating in aural rehabilitation. The nurse understands that this type of training emphasizes which of the following? A· Listening skills B· Occupational skills C· Social skills D· Functional skills

A· Listening skills · Auditory training emphasizes listening skills, so the person who is hearing-impaired concentrates on the speaker.

You are admitting a 30-year-old who has a hearing impairment. The client is accompanied by family members. What information would be important to ask the family members to help you care for your client? A)· How much the client weighs B)· The client's preferred method of communication C)· How the client lost their hearing D)· What allergies the client has

B)· The client's preferred method of communication · Some clients with hearing deficits learn sign language, a method for communication that uses a hand-spelled alphabet and word symbols. Clients also learn speech reading, also called lip reading. Knowing when the client lost their hearing, or what allergies the client has or how much the client weighs will not help you communicate, thereby, care for the client better.

What intervention is a priority for a client diagnosed with osteoarthritis? A· Colchicine B· Allopurinol C· Hydrotherapy D· Physical therapy and exercise

D· Physical therapy and exercise · Clients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and allopurinol are used for gout, not osteoarthritis. Hydrotherapy is not a priority for care.

The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? A· joint swelling B· weakness C· stiffness D· pain

D· pain · The symptom that most commonly causes a person to seek medical attention is pain. Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue.

The nurse admits a client to the emergency department who has been referred by the eye clinic. Which condition is an emergency where the nurse should refer the client for medical treatment immediately? a) Chalazion b) Acute angle-closure glaucoma c) Hordeolum d) Blepharitis

a) Acute angle-closure glaucoma Acute angle-closure glaucoma is an emergency where the nurse should refer the client for medical treatment immediately because vision may be permanently lost in 1 to 2 days. Treatment of a chalazion is not necessary if the cyst is small and does not interfere with vision. Occurrence of a hordeolum or blepharitis is not an emergency and may be treated with warm soaks or frequent washing of the eye.

A client has just been diagnosed with Parkinson's disease. The nurse is teaching the client and family about dietary issues related to this diagnosis. Which of the following are risks for this client? Select all that apply. A) Fluid overload B) Dysphagia C) Choking D) Constipation E) Anorexia

B) Dysphagia C) Choking D) Constipation Eating problems associated with Parkinson's disease include aspiration, choking, constipation, and dysphagia. Fluid overload and anorexia are not specifically related to Parkinson's disease.

The nurse is reviewing the medical record of a client with glaucoma. Which of the following would alert the nurse to suspect that the client was at increased risk for this disorder? A)· Hyperopia since age 20 years B)· Age younger than 40 years C)· History of respiratory disease D)· Prolonged use of corticosteroids

D) Prolonged use of corticosteroids · Explanation: · Risk factors associated with glaucoma include prolonged use of topical or systemic corticosteroids, older age, myopia, and a history of cardiovascular disease.

On ocular examination, the health care provider notes severely elevated IOP, corneal edema, and a pupil that is fixed in a semi-dilated position. The nurse knows that these clinical signs are diagnostic of the type of glaucoma known as: A)· Normal tension. B)· Chronic angle-closure. C)· Chronic open-angle. D)· Acute angle-closure.

D)· Acute angle-closure. · Acute angle-closure glaucoma is characterized by the symptoms listed, as well as by being rapidly progressive and accompanied by pain.

A major role for nursing in the management of glaucoma is health education. Which of the following is the most important teaching point that the nurse should advise the patient of? A)· Keep all follow-up appointments. B)· Keep a record of eye pressure measurements. C)· Adhere to the medication regimen. D)· Participate in the decision-making process.

C)· Adhere to the medication regimen. All of the teaching points are important but the most important is emphasizing the strict adherence to the medication regimen because glaucoma cannot be cured but its progression can be slowed.

A nurse is managing the care of a client with osteoarthritis. What is the appropriate treatment strategy the nurse will teach the about for osteoarthritis? A)· administration of opioids for pain control. B)· administration of monthly intra-articular injections of corticosteroids. C)· administration of nonsteroidal anti-inflammatory drugs (NSAIDs) D)· vigorous physical therapy for the joints.

C)· administration of nonsteroidal anti-inflammatory drugs (NSAIDs) · NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, which causes pain. Opioids aren't used for pain control in osteoarthritis. Intra-articular injection of corticosteroids is used cautiously for an immediate, short-term effect when a joint is acutely inflamed. Normal joint range of motion and exercise (not vigorous physical therapy) are encouraged to maintain mobility and reduce joint stiffness.

The nurse is completing a health history with a client in a clinic. What assessment finding best correlates with a diagnosis of osteoarthritis? A)· fever and malaise B)· anorexia and weight loss C)· joint stiffness that decreases with activity D)· erythema and edema over the affected joint

C)· joint stiffness that decreases with activity · A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases with activity and movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.

Which of the following medications needs to be withheld for 5 to 7 days prior to cataract surgery? · Lasix · Prednisone · Glucophage · Coumadin

· Coumadin · It has been common practice to withhold any anticoagulant therapy such as Coumadin to reduce the risk for retrobulbar hemorrhage (after retrobulbar injection) for 5 to 7 days before surgery.

The nurse is performing an assessment of the visual fields for a patient with glaucoma. When assessing the visual fields in acute glaucoma, what would the nurse expect to find? A)· Watery ocular discharge B)· Clear cornea C)· Marked blurring of vision D)· Constricted pupil

C)· Marked blurring of vision · Glaucoma is often called the "silent thief of sight" because most patients are unaware that they have the disease until they have experienced visual changes and vision loss. The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.

Which nursing diagnosis takes the highest priority for a client with parkinsonian cris0is? A) Imbalanced nutrition: Less than body requirements B) Ineffective airway clearance C) Impaired urinary elimination D) Risk for injury

B) Ineffective airway clearance In parkinsonian crisis, dopamine-related symptoms are severely exacerbated, virtually immobilizing the client. A client confined to bed during such a crisis is at risk for aspiration and pneumonia. Also, excessive drooling

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? A) Promote intake of omega-3 fatty acids B) Administer prescribed enema to prevent constipation C) Use frequent dependent positioning to prevent edema D) Encourage participation in ADLs

D) Encourage participation in ADLs General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure.

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? A) Clawlike deformity of the right hand without ability to extend fingers B) Extension of the fingers of the right hand C) Nodules on the knuckles of the third and fourth finger D) Dislocation of the fingers

A) Clawlike deformity of the right hand without ability to extend fingers. · If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

Which is an appropriate nursing intervention in the care of the client with osteoarthritis? A)· Encourage weight loss and an increase in aerobic activity B)· Avoid the use of topical analgesics C)· Provide an analgesic after exercise D)· Assess for gastrointestinal complications associated with COX-2 inhibitors

A)· Encourage weight loss and an increase in aerobic activity · Weight loss and an increase in aerobic activity such as walking, with special attention to quadriceps strengthening, are important approaches to pain management. Clients should be assisted to plan their daily exercise at a time when the pain is least severe, or plan to use an analgesic, if appropriate, before an exercise session. Gastrointestinal complications, especially bleeding, are associated with the use of nonsteroidal anti-inflammatory drugs. Topical analgesics such as capsaicin and methylsalicylate may be used for pain management.

102 After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client? A) With the affected hip flexed acutely B) With the leg on the affected side abducted C) With the leg on the affected side adducted D) With the affected hip rotated externally

B) With the leg on the affected side abducted The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? A)· detection of systemic complications B)· prevention of joint deformity C)· strategies for remaining active ·D) disease-modifying antirheumatic drug therapy

C)· strategies for remaining active · The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.

A client has been prescribed eye drops for the treatment of glaucoma. At the yearly follow-up appointment, the client tells the nurse that she has stopped using the medication because her vision did not improve. Which action by the nurse is appropriate? A)· Talk with the doctor about switching to a different glaucoma medication. B)· Administer the medication immediately. C)· Refer the patient to the emergency department. D)· Explain the therapeutic effect and expected outcome of the medication.

D)· Explain the therapeutic effect and expected outcome of the medication. · The nurse needs to explain the therapeutic effect and expected outcome of the medication. The medication is not a cure for glaucoma, but can slow the progression. The client will not see improvements in vision with the use of the medication but should experience little to no deterioration of vision. The doctor may choose to switch the medication, but not because the vision is not improving; it would be based on not obtaining the set intraocular pressure. Administering the medication immediately or referring the client to the emergency department is not appropriate because this is not an emergent situation.

The nurse identifies a nursing diagnosis of imbalanced nutrition, less than body requirements related to difficulty in chewing and swallowing for a client with Parkinson's disease. Which of the following would be most appropriate for the nurse to integrate into the client's plan of care? A) Raise the head of the client's bed about 30 degrees during meals. B) Encourage the use of liquids that are thin in consistency. C) Arrange for specialized utensils for the client to use when eating. D) Encourage the client to massage the facial and neck muscles before eating.

D) Encourage the client to massage the facial and neck muscles before eating. The client is having difficulty swallowing, which is interfering with nutritional intake. Therefore, the nurse should encourage the client to massage the facial and neck muscles before meals, sit in an upright position during meals, consume a semisolid diet with thick rather than thin liquids (which are easier to swallow), and think through the swallowing sequence. Raising the head of the bed 30 degrees is not high enough. Using specialized utensils would be more appropriate for a nursing diagnosis of self-care deficit, feeding to foster a sense of greater independence and control with eating.

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of A) avascular necrosis of bone. B) heterotrophic ossification. C) a reaction to an internal fixation device. D) complex regional pain syndrome.

D) complex regional pain syndrome. Complex regional pain syndrome is frequently chronic and occurs most often in women. Avascular necrosis is manifested by pain and limited movement. Pain and decreased function are the prime indicators of reaction to an internal fixation device. Heterotrophic ossification causes muscular pain and limited muscular contraction and movement

Which of the following statements is accurate regarding osteoarthritis? A)· It is caused by an overproduction of uric acid. B)· It is the most common inflammatory arthritic disorder. C)· It affects young males. D)· It is a noninflammatory disorder and the most common and frequently disabling of joint disorders.

D)· It is a noninflammatory disorder and the most common and frequently disabling of joint disorders. · Osteoarthritis (OA), also known as degenerative joint disease, is a chronic, noninflammatory (even though inflammation may be present), progressive disorder that causes cartilage deterioration in synovial joints and vertebrae. OA is the most common and most frequently disabling of the joint disorders that is overdiagnosed and trivialized and frequently over or undertreated. Aging is the risk factor most strongly correlated with OA. Gout is caused by an overproduction of uric acid. Rheumatoid arthritis is the most common inflammatory arthritic disorder.

A client you are caring for has a hearing loss. The client tells you he is self-conscious about his hearing loss. What advice should the nurse give a self-conscious client with hearing loss to protect his self-esteem? A)· Follow lip movements closely. B)· Avoid excess socializing. C)· Pretend to follow conversations by nodding the head. D)· Be forthright and inform others about the hearing deficit.

D)· Be forthright and inform others about the hearing deficit. · The nurse should encourage clients with a hearing loss to be forthright and inform others about their hearing deficit. Clients should be advised not to hide the fact that they do not understand what has been said and should be encouraged to maintain friendships because a physical impairment is unlikely to affect genuine friendships.

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? A)· Exercising in the evening before going to bed is beneficial. B)· The time of day when exercise is performed isn't important. C)· Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy. D)· Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

D)· Delaying exercise for at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. · A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime.

Osteoarthritis is known as a disease that A)· affects young males. B)· affects the cartilaginous joints of the spine and surrounding tissues. C)· requires early treatment because most of the damage seems to occur early in the course of the disease. D)· is the most common and frequently disabling of joint disorders.

D)· is the most common and frequently disabling of joint disorders. · The functional impact of osteoarthritis on quality of life, especially for elderly clients, is often ignored. Reiter syndrome is a spondyloarthropathy that affects young adult males and is characterized primarily by urethritis, arthritis, and conjunctivitis. Psoriatic arthritis, characterized by synovitis, polyarthritis, and spondylitis, requires early treatment because of early damage caused by disease. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues, making them rigid and decreasing mobility; it is usually diagnosed in the second or third decade of life.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? A) Avascular necrosis B) Infection C) Pulmonary embolism D) Hypovolemic shock

A) Avascular necrosis Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care? A) Traction B) Joint immobilization C) Limited weight bearing D) Ice and NSAIDs

A) Traction Joint immobilization, limited weight bearing, ice, and NSAIDs would be included in the initial treatment. Traction is not required because there is no break, and surgery is not required.

A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"? A) stretched or pulled beyond its capacity B) injury resulting from a blow or blunt trauma C) injuries to ligaments surrounding a joint D) subluxation of a joint

A) stretched or pulled beyond its capacity A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury? A) Septicemic B) Hypovolemic C) Cardiogenic D) Neurogenic

B) Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments.

Which may occur if a client experiences compartment syndrome in an upper extremity? A) Whiplash injury B) Volkmann's contracture C) Callus D) Subluxation

B) Volkmann's contracture If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess? A)· patchy hair loss on the scalp B)· low back pain C)· increased urine output D)· red, butterfly-shaped facial rash

B)· low back pain · The COX-2 inhibitor celecoxib (Celebrex) is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? A) Keep the affected leg in a position of adduction. B) Use measures other than turning to prevent pressure ulcers. C) Prevent internal rotation of the affected leg. D) Keep the hip flexed by placing pillows under the client's knee.

C) Prevent internal rotation of the affected leg. The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

The nurse identifies the nursing diagnosis of deficient knowledge related to a new hearing aid for a client. After teaching a client about caring for his new hearing aid, the nurse determines that the outcome has been achieved when the client states which of the following? A)· "I need to wipe the ear mold daily with a moist washcloth." B)· "I should wash the receiver with soap and water once a week." C)· "I need to keep my ear canal clean and dry." D)· "I should insert the ear mold when it is wet."

C)· "I need to keep my ear canal clean and dry." · Auditory training emphasizes listening skills, so the person who is hearing-impaired concentrates on the speaker.

The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about? A· Piroxicam B· Ibuprofen C· Celecoxib D· Tolmetin sodium

C· Celecoxib · The COX-2 inhibitor celecoxib (Celebrex) is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.

The nurse is caring for a client hospitalized after a motor vehicle accident. The client has a comorbidity of Parkinson's disease. Why should the nurse closely monitor the condition and the drug regimen of a client with Parkinson's disease? A) Dugs administered may not cause the requisite therapeutic effect. B) Clients take an assortment of different drugs. C) Clients generally do not adhere to the drug regimen. D) Drugs administered may cause a wide variety of adverse effects.

Drugs administered may cause a wide variety of adverse effects. Drugs administered for Parkinsonism may cause a wide variety of adverse effects, which requires careful observation of the client. Over time, clients may respond less and less to their standard drug therapy and have more frequent "off episodes" of hypomobility. As a result, the nurse should administer the drugs closely to the schedule. Generally, a single drug called levodopa is administered to clients with Parkinson's disease. It is also not true that drugs may not cause the requisite therapeutic effect or such clients do not adhere to the drug regimen.

A nurse is caring for a client with new hip fracture. Which nursing intervention is most appropriate for minimizing muscle spasms? · Assist the client with use of a trapeze. · Apply a soft compression dressing. · Maintain Buck's traction. · Maintain the internal fixator.

· Maintain Buck's traction. · The use of Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture. Applying a compression dressing will not relieve spasms. The use of a trapeze will help the client with movement and not help with muscle spasms. An internal fixator is not used for a client with a hip fracture