Musculoskeletal System
1. 1. Taking the medication before leaving the house could be a danger to the client and others because this medication can cause drowsiness. The client should not be driving or operating equipment until the client has determined the effect of the medication on his or her body. 2. There is no need to drink a full glass of water when taking Flexeril. 3. The medication acts on the central nervous system and can cause drowsiness. The client should be warned not to drive until the client understands the effects on his or her body. Driving could be dangerous for the client and others. 4. This is prescribing. The HCP will prescribe how frequently the dose should be administered. 5. A side effect of Flexeril is a dry mouth, so using hard candy is an appropriate intervention.
1. The client is diagnosed with low back pain and is prescribed the muscle relaxant cyclobenzaprine (Flexeril). Which instructions should the clinic nurse teach the client? Select all that apply. 1. Take the medication just before leaving home for work each day. 2. Drink a full glass of water with each dose of medication. 3. The medication can cause drowsiness that will make driving unsafe. 4. Divide the dose of medication between early morning and bedtime. 5. Suck on hard candy if the client experiences a dry mouth.
10. 1. The client should be kept recumbent during and for at least 15 minutes following the administration of Robaxin IV to reduce the risk of orthostatic hypotension. 2. The medication must be administered slowly at a rate of no greater than 300 mg per minute, not by rapid infusion. 3. The IV site should be assessed prior to the initiation of the medication to prevent complications from extravasation of the medication into the tissues. 4. Robaxin is detoxified by the kidneys, not the liver.
10. The client is admitted with severe low back pain and prescribed the muscle relaxant methocarbamol (Robaxin), IVPB every 8 hours. Which nursing intervention has priority when administering this medication? 1. Ask the client to lie flat for 15 minutes following the IV infusion. 2. Infuse at a rapid rate of 200-250 mL/hr via an infusion pump. 3. Assess the IV site for extravasation after the infusion is complete. 4. Monitor liver function laboratory tests daily.
11. 1. The client should not take aspirin with an NSAID because it can increase the risk of gastrointestinal upset and possible gastrointestinal bleeding. 2. Allergies to antibiotics are not a contraindication to the use of NSAIDs. 3. Obesity is not contraindicated in clients taking NSAIDs. 4. Exercising is recommended for clients with osteoarthritis unless it causes pain; therefore, this activity would not warrant the client not taking Celebrex.
11. The client with osteoarthritis is prescribed the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID). Which statement by the client warrants intervention by the nurse? 1. "I take aspirin daily to help prevent heart disease." 2. "I am allergic to penicillin and aminoglycosides." 3. "I know I am overweight and need to lose 50 pounds." 4. "I walk 30 minutes at least three times a week."
12. 1. Any bleeding into the joint is a complication. Bleeding into a joint would not be the expected benefit of any type of medication. 2. After the injection the client can walk and perform routine daily activities, but running, bicycling, or strenuous activity should be avoided. Hyalgan is a preparation of a chemical normally found in high amounts in the synovial fluid. The injection replaces or supplements the body's natural hyaluronic acid that deteriorates as a result of the inflammation of osteoarthritis. 3. The treatment includes three to five injections; the client receives one injection every week. 4. This injection is done in an HCP's office, and the client will be able to walk out of the clinic after the injection. MEDICATION MEMORY JOGGER: The nurse should realize that the joint must have time for the medication to be effective and injecting daily would not allow this. The nurse should realize that a medication should not cause an abnormal body function, such as bleeding into the joint.
12. The client with severe osteoarthritis of the left knee is receiving sodium hyaluronate (Hyalgan) injected directly into the left knee. Which information should be discussed with the client? 1. Explain that this medication will cause some bleeding into the joint. 2. Instruct the client to avoid any strenuous activity for 48 hours after injection. 3. Discuss that the medication will be injected daily for 7 days. 4. Tell the client that strict bed rest is required for 24 hours after the injection.
13. 1. NSAIDs do not interfere with the effectiveness of loop diuretics; therefore, the nurse would not question administering the Motrin. 2. COX-2 inhibitors do not interfere with the effectiveness of cardiac glycosides; therefore, the nurse would not question administering the Relafen. 3. Aspirin displaces warfarin from proteinbinding sites and will increase the client's bleeding; therefore, the nurse should question administering the aspirin. 4. Toradol is often administered around the clock to a client in pain, along with a narcotic analgesic. Toradol decreases the inflammation to help decrease the pain.
13. The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. Ibuprofen (Motrin), an NSAID, to a client receiving furosemide (Lasix). 2. Nabumetone (Relafen), a COX-2 inhibitor, to a client receiving digoxin (Lanoxin). 3. Acetylsalicylic acid (ASA), a salicylate, to a client receiving warfarin (Coumadin). 4. Ketorolac (Toradol), an NSAID, intramuscularly to a client on a morphine PCA.
14. 1. Alcohol displaces warfarin from proteinbinding sites and will increase the client's bleeding; therefore, the nurse should instruct the client not to drink alcohol. 2. ASA poisoning can kill children, and all medications, prescription or nonprescription, should be kept out of the reach of children. 3. High doses of ASA can cause bleeding; therefore, the dentist should be made aware of the client's medication use. 4. Aspirin toxicity can occur when the client is taking ASA four to five times a day; therefore, the serum level should be kept within normal limits (15-30 mg/dL). Mild toxicity occurs with serum levels above 30 mg/dL and severe toxicity occurs above 50 mg/dL. 5. Tinnitus (ringing in the ears) is a sign of aspirin toxicity and should be reported to the health-care provider.
14. The client is taking acetylsalicylic acid (ASA) four to five times a day for severe osteoarthritic pain. Which teaching interventions should the nurse discuss with the client? Select all that apply. 1. Do not drink any type of alcoholic beverages. 2. Keep the ASA bottle out of the reach of children. 3. Inform the dentist about taking high doses of ASA. 4. Maintain a serum salicylate level between 15 and 30 mg/dL. 5. Explain that ringing in the ears is a common side effect.
15. 1. Enteric-coated aspirin should not be crushed. 2. The charge nurse should not correct the primary nurse in front of other staff and, at 0900, there would be other nurses in the medication room. 3. The charge nurse should explain to the primary nurse that enteric-coated ASA should not be crushed because the coating that ensures the ASA will dissolve only in the small intestine, where the coating dissolves. The aspirin will be absorbed in the stomach if the coating is crushed. 4. Because the client did not receive the crushed enteric-coated ASA, no adverse occurrence report needs to be completed. This form is completed if the client's condition has been compromised in some way.
15. At 0900 the charge nurse observes the primary nurse crushing an enteric-coated aspirin in the medication room. Which action should the charge nurse implement? 1. Take no action because this is an acceptable standard of practice. 2. Correct the primary nurse's behavior in the medication room. 3. Explain that enteric-coated medication should not be crushed. 4. Complete an adverse occurrence report on the primary nurse.
16. 1. This medication is being administered for the hands; therefore, the client should not wash off the medication immediately after application. 2. The client should know that transient burning occurs with the application. 3. The client should not apply heat because this will increase the burning of the skin secondary to the cream application. Burning is increased by heat, sweating, bathing in warm water, humidity, and clothing. 4. The topical cream should be kept in place at least 30 minutes after application because it is being administered for osteoarthritis of the hands. If not being applied for hands, the cream should be washed off immediately.
16. The client with osteoarthritis of the hands is prescribed capsaicin (Capsin) cream, a nonopioid topical analgesic. Which intervention should the nurse discuss with the client concerning this medication? 1. Wash the hands immediately after applying the cream. 2. Remove cream immediately if burning of the skin occurs. 3. Apply a heating pad to the affected area after applying the cream. 4. Do not remove the cream for at least 30 minutes after application.
17. 1. These medications are administered around the clock and are not specifically for acute pain. 2. Aspirin has side effects, such as gastrointestinal discomfort, and is not the drug of choice for elderly clients. 3. Acetaminophen is generally preferred for use in older clients because it has fewer toxic side effects. 4. Morphine is a narcotic, is not used to treat chronic arthritis pain, and should be used cautiously in elderly clients.
17. The elderly client in the hospital is complaining of arthritic pain. Which intervention should the nurse implement? 1. Administer meloxicam (Mobic), an NSAID COX-2 inhibitor. 2. Administer acetylsalicylic acid (ASA), a salicylate. 3. Administer acetaminophen (Tylenol), a nonnarcotic analgesic.
18. 1. The first intervention the nurse should implement is to determine if the client is taking any medication that will interact with the herb. Ginkgo, along with dong quai, feverfew, and garlic, when taken with NSAIDs may cause bleeding. 2. Gingko is used to treat allergic rhinitis, Alzheimer's disease, anxiety or stress, dementia, tinnitus, vertigo, and poor circulation. It is not known to decrease inflammation. 3. The nurse should determine what medications the client is currently taking and if gingko interacts with them prior to notifying the HCP. 4. The nurse does not need to know why the client thought he or she needed to take the herb; this is an accusatory intervention. The nurse should support alternative-type medicine if it does not interfere with other medications the client is currently taking. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client. The nurse should always be the client's advocate.
18. The female client with osteoarthritis tells the clinic nurse that she started taking the herb ginkgo. Which intervention should the nurse implement? 1. Determine what medications the client is currently taking. 2. Praise the client because this herb helps decrease inflammation. 3. Notify the health-care provider that the client is taking ginkgo. 4. Examine why the client thought she needed to take herbs.
19. 1. Resting the knee after the injection is an appropriate action for the client to take. It would not warrant intervention by the nurse. 2. Physical therapy for range-of-motion exercises is an acceptable conservative treatment for osteoarthritis. The client should inform the physical therapist of the treatment, but this statement does not warrant immediate intervention by the nurse. 3. Alternating ice and heat is an acceptable conservative treatment for easing the pain secondary to osteoarthritis. This statement would not warrant intervention by the nurse. 4. This procedure does provide marked pain relief, but it should not be done more than every 4-6 months because it can hasten the rate of cartilage breakdown. This statement should be reported to the HCP. Clients often go to more than one HCP.
19. The HCP is administering an intraarticular corticosteroid mixed with lidocaine to a client with severe osteoarthritis in the right knee. Which statement by the client warrants intervention by the nurse? 1. "I have taken off work tomorrow so I can rest my knee." 2. "I am attending physical therapy once a week." 3. "I alternate heat and ice on my knee when I am having pain." 4. "I had one of these just last month and it really helped the pain."
2. 1. Physical therapy for heat and massage is standard therapy for back pain. There is no reason to question this order. 2. Many medications can affect the kidneys or the liver and the blood counts. Baseline data should be obtained. There is no reason to question this order. 3. This medication order is incomplete. The nurse should contact the HCP for a time limitation. 4. Soma comes in one strength, so this order is complete. There is no reason to question this order. MEDICATION MEMORY JOGGER: All medication orders must be complete, and the nurse is responsible for determining all the parameters before administering a medication.
2. The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with back pain. Which HCP order should the charge nurse question? 1. Physical therapy for hot packs and massage. 2. CBC and CMP (complete metabolic panel). 3. Hydrocodone (Vicodin), an opioid analgesic, PRN. 4. Carisoprodol (Soma), a muscle relaxant, po, b.i.d.
20. 1. Iron preparations can cause black, tarry stool, but because the client is taking an NSAID the nurse should realize tarry stools are a sign of gastrointestinal distress, which is a complication of NSAID medications. 2. NSAIDs are notorious for causing gastrointestinal upset and peptic ulcer disease. Black, tarry stool indicates GI bleeding; therefore, the client should stop taking the medication. 3. A specimen is not sent to the laboratory when the stool is black and tarry. The nurse should know these are signs of GI bleeding. 4. This is not an expected side effect of the medication, and the NSAID should be discontinued immediately. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.
20. The client with osteoarthritis who is taking the COX-2 inhibitor celecoxib (Celebrex), a nonsteroidal anti-inflammatory drug (NSAID), calls the clinic and reports having black, tarry stools. Which intervention should the clinic nurse implement? 1. Ask if the client is taking any type of iron preparation. 2. Tell the client to not take any more of the Celebrex. 3. Instruct the client to bring a stool specimen to the clinic. 4. Explain that this is a side effect of the medication.
21. 1. The client should swallow the medication. The client should not crush, chew, or suck on the medication. 2. The medication should be taken on an empty stomach at least 30 minutes before eating or drinking any liquid. Foods and beverages greatly decrease the effect of Fosamax. 3. The medication should be taken on an empty stomach at least 30 minutes before eating or drinking any liquid. Foods and beverages greatly decrease the effect of Fosamax. 4. The medication will irritate the stomach and esophagus if the client lies down; therefore, the medication should be taken when the client can remain upright for at least 30 minutes first thing in the morning. 5. This client must remain upright to facilitate the passage of the medication to the stomach and minimize the risk of esophageal irritation.
21. The postmenopausal client is prescribed alendronate (Fosamax), a bisphosphonate, to help prevent osteoporosis. Which information should the nurse discuss with the client? Select all that apply. 1. Chew the tablet thoroughly before swallowing. 2. Eat a meal prior to taking the medication. 3. Drink one glass of water when taking the medication. 4. Take the medication first thing in the morning. 5. Remain upright 30 minutes after taking the medication.
22. 1. Nausea and vomiting occur during the initial therapy and will disappear as the treatment continues; therefore, the client does not need to notify the HCP. 2. The client should consume an adequate amount of calcium and vitamin D while taking this medication. 3. The nasal spray should be room temperature before using. The nasal spray is not kept in the refrigerator. 4. Rhinitis, a runny nose, is the most common side effect with calcitonin nasal spray, but the client should not quit taking the medication if this occurs.
22. The client with postmenopausal osteoporosis is prescribed calcitonin (Calcimar) intranasal. Which instruction should the nurse discuss with the client? 1. Notify the health-care provider if nausea and vomiting occur. 2. Decrease calcium and vitamin D intake during drug therapy. 3. Remove the nasal spray from the refrigerator immediately before using. 4. Expect to experience rhinitis when taking the medication
23. 1. Evista increases the risk of venous thrombosis; therefore, the client should avoid prolonged immobilization including driving long distances in a car. 2. The client should not just decrease smoking and alcohol. The client needs to stop both of these activities because they interact with the medication. 3. Evista will not reduce hot flashes or flushes associated with estrogen deficiency and may cause hot flashes. 4. The nurse should emphasize the importance of regular weightbearing exercise to help increase bone density.
23. The client is prescribed raloxifene (Evista), a selective estrogen receptor modulator (SERM). Which information should the nurse discuss with the client? 1. Instruct the client to walk for 10 minutes every hour when traveling in a car. 2. Encourage the client to decrease smoking cigarettes and drinking alcohol. 3. Explain that Evista will decrease the hot flashes experienced with menopause. 4. Discuss the importance of performing non-weightbearing activities.
24. 1. Safety is priority for clients diagnosed with osteoporosis; therefore, the client requesting a walker would not warrant the nurse's questioning the administration of this medication. 2. This indicates the client's kidneys are functioning adequately. The nurse would question administering the calcium if the client had signs of renal deficiency. 3. The nurse must monitor for signs of hypercalcemia, which include drowsiness, lethargy, weakness, headache, anorexia, nausea or vomiting, increased urination, and thirst. 4. Abnormal bleeding is a cause for the nurse to investigate, but it would not warrant questioning this medication because this is not an expected side effect or adverse effect of this medication. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable of accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.
24. The long-term care nurse is preparing to administer calcium gluconate (Kalcinate) to a client with osteoporosis. Which data warrants the nurse questioning administering this medication? 1. The client asks the nurse for a walker to ambulate. 2. The client's oral intake is 850 mL and urinary output is 1250 mL. 3. The client is lethargic, is drowsy, and has increasing weakness. 4. The client has abnormal bleeding when brushing the teeth.
25. 1. Blocking estrogen receptors is the scientific rationale for administering selective estrogen receptor modulators (SERMS) to clients with osteoporosis. 2. Inhibiting bone reabsorption by suppressing osteoclast activity is the scientific rationale for administering bisphosphonates to clients with osteoporosis. 3. Calcimar is a natural product obtained from salmon and is approved for treatment of osteoporosis in women who are more than 5 years postmenopause. It increases bone density and reduces the risk of vertebral fractures. 4. The scientific rationale for administering hormone replacement therapy is to increase progesterone and estrogen levels.
25. Which statement best describes the scientific rationale for administering calcitonin (Calcimar) to a client diagnosed with osteoporosis? 1. It blocks estrogen receptors in the uterus and breast. 2. It inhibits bone reabsorption by suppressing osteoclast activity. 3. It increases bone density and reduces the risk of vertebral fractures. 4. It increases the progesterone and estrogen levels in the blood.
26. 1. There are medications to treat and prevent osteoporosis that are safer than HRT and do not result in the serious complications that occur with HRT. HRT is better than some medications in treating osteoporosis, but because of possible complications HRT is not recommended for this purpose. 2. Expense should not be an issue when treating chronic illnesses. 3. Until recently, HRT with estrogen was one of the most common treatments for osteoporosis in postmenopausal women, but research has shown that serious complications can occur from HRT use; therefore, it is no longer recommended. 4. HRT was one of the most common treatments for osteoporosis, but as a result of complications associated with its use, it is no longer recommended.
26. The nurse is discussing ways to prevent osteoporosis to a group of elderly women. A woman in the audience asks, "Why aren't doctors prescribing hormone replacement therapy?" Which statement by the nurse is most appropriate? 1. "There are many other, better ways to treat osteoporosis than HRT." 2. "HRT treatment is very expensive and many insurances will not pay." 3. "There is an increased risk of cancer and deep vein thrombosis associated with HRT." 4. "Research has shown that it is not effective in treating osteoporosis."
27. 1. The normal serum calcium level is 8.5-11.5 mg/dL; a low calcium level indicates the medication therapy is not effective. 2. As a result of decreased bone density, a client with osteoporosis is at risk for pathologic fractures. If the client does not experience these types of fractures, it indicates that the medication therapy is effective. 3. The client must have normal renal function to take these medications, but this does not indicate the medication is effective. 4. Any loss of height indicates the medication is not effective. The loss of height occurs as a result of collapse of the vertebral bodies. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.
27. Which assessment data best indicates to the nurse that the medication therapy for a client with osteoporosis has been effective? 1. The client's serum calcium level is 7.5 mg/dL. 2. The client does not experience any pathological fractures. 3. The client has adequate urinary output. 4. The client loses less than 1 inch in height.
28. 1. Serum fluoride levels are monitored every 3 months. 2. Bone mineral density studies are usually conducted every 6 months to document progress in bone growth. 3. When taking fluoride, a relatively new but promising treatment for osteoporosis, the client should maintain an adequate calcium intake. Because the main risk factor for developing osteoporosis is low calcium level, the client should keep taking calcium no matter what medication is prescribed to help prevent or treat osteoporosis. 4. The sodium fluoride tablets should be taken after meals and the client should avoid milk or dairy products because they cause a reduction in gastrointestinal absorption of the sodium fluoride. 5. When the nurse is providing information for medication, the nurse should also teach the client how to treat the disease. Walking on hard surfaces helps increase bone density. MEDICATION MEMORY JOGGER: Few (electrolyte, hormone) levels are monitored daily, one being glucose levels.
28. The client with osteoporosis is prescribed sodium fluoride, a mineral. Which information should the nurse discuss with the client? Select all that apply. 1. Monitor serum fluoride levels every 3 months. 2. Have bone mineral density studies monthly. 3. Maintain an adequate calcium intake. 4. Sprinkle medication on food. 5. Walk 30 minutes a week on a hard surface.
29. 1. A woman who does not take estrogen needs about 1500 mg of calcium daily to minimize the risk of developing osteoporosis. The client understands the teaching. 2. The best dietary sources of vitamin D are milk and other dairy products, including yogurt, which indicates the client understands the teaching. 3. Calcium is not available in injections; therefore, the client does not understand the teaching. Dietary treatment, sunshine, or calcium supplements are recommended to maintain adequate serum calcium levels. 4. Osteoporosis is usually diagnosed in older clients, but the prevention starts when the client is young. Steps must be taken to maintain bone density and prevent bone demineralization. The client understands this.
29. Which statement indicates the 30-year-old client does not understand the teaching concerning how to prevent osteoporosis? 1. "I need to take at least 1500 mg of calcium daily." 2. "Milk and dairy products are good sources of vitamin D." 3. "I must get shots weekly to increase my calcium level." 4. "I should take steps to prevent osteoporosis now."
3. 1. NSAIDs decrease prostaglandin production in the stomach, increasing the client's risk of developing ulcers. This client has a known risk of peptic ulcer disease. The nurse should question the medication and discuss this with the HCP. 2. Opioid analgesics are administered for pain. The client is in the moderate to severe pain range. The nurse would administer this medication. 3. Muscle relaxant medications are administered to clients with back pain to relax the muscles and decrease the pain. The nurse would administer this medication. 4. Darvon N is a pain medication. The nurse would administer this medication.
3. The nurse is administering medications to clients on an orthopedic unit. Which medication should the nurse question? 1. Ibuprofen (Motrin), an NSAID, to a client with back pain and a history of ulcers. 2. Morphine, an opioid analgesic, to a client with back pain rated as 6. 3. Methocarbamol (Robaxin), a muscle relaxant, to a client with chronic back pain. 4. Propoxyphene (Darvon N), a narcotic agonist, to a client with mild back pain.
30. 1. The client should use sunscreen and protective clothing to prevent a photosensitivity reaction that is caused by this medication. 2. The medication must be taken with a full glass of water to ensure proper swallowing of the medication and reduce the risk of mouth or throat irritation. 3. The client should not take the medication with orange juice, mineral water, coffee, or other beverages (other than water) because it will greatly decrease the absorption of the medication. 4. Taking the medication incorrectly may result in mouth or throat irritation or esophageal irritation. Therefore, if the client experiences pain or difficulty swallowing, retrosternal pain, or heartburn, the client should notify the HCP.
30. Which statement indicates the postmenopausal client with osteoporosis understands the medication teaching concerning the bisphosphonate alendronate (Fosamax)? 1. "I do not use sunscreen when working outside in my yard." 2. "I take the medication with 6-8 ounces of tap water." 3. "I drink orange juice when I take the medication at breakfast." 4. "I may experience some heartburn when taking this medication."
31. 1. The nurse will be given time limit parameters for the administration of PRN medication, usually a longer time interval than 45 minutes. Because the client has received no relief of pain the nurse needs to determine the reason for the continued pain. 2. Distraction may be needed if the nurse determines that a complication is not occurring. 3. The client is not receiving pain relief from the morphine. The client should have better relief than "severe" 45 minutes after an IVP. One cause of unrelieved pain would be dislocation of the affected joint. The nurse should assess the situation to determine further action. 4. The nurse should assess the client before notifying the HCP.
31. The client who had surgery for a hip fracture is complaining of severe pain 45 minutes after the nurse administered morphine IVP. Which intervention should the nurse implement first? 1. Administer another dose of morphine. 2. Turn on the television to distract the client. 3. Assess the client's affected leg for alignment. 4. Notify the health-care provider of the problem.
32. 1. The client should be allowed to rest until the therapist is ready to have the client ambulate. Ambulating is not sitting in a bedside chair. 2. The client will be better able to work with the therapist if not experiencing pain. The nurse should anticipate the need for pain control and administer the medication before the therapist arrives to start the therapy. 3. Brushing the client's hair will not assist the therapist in gaining the cooperation of the client with therapy. 4. The client should be encouraged to work with the therapist when the therapy is scheduled. The client may be too tired to perform therapy if waiting until late in the day.
32. The client postoperative from hip surgery is scheduled to ambulate with the physical therapist. Which intervention should the nurse implement to assist the client to be able to perform the therapy? 1. Assist the client to the bedside chair with the therapist's help. 2. Administer pain medication 30 minutes before the therapy. 3. Ask the unlicensed assistive personnel to brush the client's hair. 4. Allow the client to delay the therapy until late in the day.
33. 1. The nurse should attempt to use another method of rating pain because the client is cognitively unable to use the numeric scale. Young children are able to point at a face and tell the nurse how they feel. This scale should be presented to the client for use. 2. Pain is a subjective symptom; the nurse should attempt to get the client to describe her pain. 3. Pain is a subjective symptom; the nurse should attempt to get the client to describe her pain. The nurse is not experiencing the pain. 4. Acute pain does cause an elevated pulse and blood pressure, but many other reasons could cause these same elevations. The nurse should attempt to have the client rate her own pain.
33. The 84-year-old female client with a fractured knee is unable to rate her pain on a numeric pain scale. Which intervention should the nurse implement? 1. Have the client use a pediatric faces scale. 2. Do not try to get the client to rate the pain. 3. The nurse should decide the amount of pain. 4. Check the pulse and blood pressure for elevation.
34. 1. Antibiotics might cause a rash on the trunk of the body but not this phenomenon. 2. Straining to have a bowel movement would not cause external bruising on the abdomen. 3. The client is not positioned on the abdomen for a knee replacement, and great care is taken in the operating room to prevent any injury to the client. The nurse should never suggest that the client was not positioned correctly. 4. Lovenox is a low-molecular-weight heparin and is administered in the "love handles" or upper anterior lateral abdominal walls. Small "bruises" or hematomas in this area suggest a non-life-threatening side effect of this medication's administration.
34. The male client who has had bilateral knee replacement surgery calls the nurse's desk and reports that he noticed bruises on both sides of his abdomen while taking his bath. The client's MAR notes Ancef, an antibiotic; morphine, a narcotic analgesic; and Lovenox, a low-molecular-weight heparin. Which statement is the nurse's best response to the client? 1. "This is a reaction to the antibiotic you are receiving and it will need to be changed." 2. "This is caused by straining when trying to have a bowel movement." 3. "This occurs because of the positioning during the surgical procedure." 4. "This happened because of the medication used to prevent complications."
35. 1. An autotransfusion drainage system is used to collect the client's own blood after a particularly bloody surgery. The surgeon is unable to cauterize or suture bones to prevent bleeding. The collections should be monitored frequently and the blood should be reinfused when the amount of drainage is approximately 200 mL. Any blood remaining in the system longer than 4 hours is discarded. 2. The drainage is not stored for future use. If not used in the immediate postoperative period, it is discarded. 3. There could be fat globules, tiny bone fragments, and clots in the drainage; a filter must be attached before infusing the product back into the client. 4. A second nurse is not required to attach the drainage from the client back to the client. 5. The client should be monitored every 5-15 minutes during the initial reinfusion as per all blood protocols.
35. The client who has had a total knee surgery returns to the room with an autotransfusion drainage system (cell saver) device inserted into the wound. Which interventions should the nurse implement? Select all that apply. 1. Monitor the drainage in the collection chamber every 30-45 minutes. 2. Take the drainage to the blood bank when it reaches 200 mL. 3. Attach a filter to the drainage before administering. 4. Have a second nurse verify the client's ID band. 5. Monitor vital signs every 5-15 minutes when transfusing the blood.
36. 78 mL per hour. A total of 310 mL of blood product is to be infused (250 mL + 60 mL) over a 4-hour period: 310 mL ÷ 4 = 77.5 mL, or 78 mL/hour. Blood cannot hang any longer than 4 hours to prevent an infection and contaminated blood. The client has symptoms of congestive heart failure (bilateral cackles and edema of the sacrum), and the nurse should plan to administer the blood over the entire 4-hour time period to prevent any further fluid volume overload.
36. The 78-year-old client who had hip surgery is to receive a unit of packed red blood cells (PRBC). The nurse's assessment reveals bilateral crackles in the lungs and 2+ edema of the sacrum. The PRBCs contain 250 mL of cells and 60 mL of preservative solution. At what rate will the nurse set the IV infusion pump after the initial 15 minutes?
37. 1. Children should be included in their care at the level that they can understand and participate in. A 10-year-old should be able to describe his or her own pain and rate it on a pain scale. The nurse should determine the child's ability and work from there. 2. The parents may not want the child to receive pain medication because of a fear of narcotics, or they may want the child medicated when the child is not in pain. Pain is a subjective symptom and the child should request his or her own medication. 3. A heat pack would not be applied to the cast. An ice pack is sometimes ordered to reduce swelling and pain. 4. The child's neurovascular status should be monitored every 15 minutes when first returning to the floor and then every 2 hours. 5. The client will have a prophylactic antibiotic prescribed since this is a surgical procedure.
37. A 10-year-old child sustained a compound fracture of the left forearm and has just returned to the unit after an open reduction and internal fixation (ORIF). Which interventions should the nurse implement? Select all that apply. 1. Assess the child's ability to rate the pain on a pain scale. 2. Ask the parent to determine when the child needs pain medication. 3. Apply a heat pack to the cast until the cast is completely dry. 4. Check the child's fingertips for warmth and color every 15 minutes. 5. Administer the prophylactic antibiotic as prescribed by surgeon.
38. 1. NSAID medications should provide pain relief for the pain resulting from an arthroscopy. 2. Opioid analgesics are frequently used to provide pain relief for all types of surgeries. 3. A sedative hypnotic (sleeping pill) would not be questioned for a client with a total knee replacement. 4. An 89-year-old male client who is not able to stand to void could develop bladder retention when taking muscarinic antagonists. Muscarinic antagonists relax the bladder muscles by blocking involuntary bladder contractions and are used to treat urge incontinence. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable of accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.
38. The nurse is administering medications at 2100. Which medication should the nurse question? 1. An NSAID to a 24-year-old female client recovering from an arthroscopy. 2. An opioid analgesic to a 50-year-old male client with a fractured femur. 3. A sedative hypnotic to a 65-year-old female client with a total knee replacement. 4. A muscarinic antagonist to an 89-year-old male client with a hip fracture.
39. 1. The PCA pump was developed for clients to be able to control their own pain. The nurse should assess the amount of relief the client is obtaining and any complications, but it is not necessary for the client to notify the nurse when needing pain medication. 2. The client can push the button on the PCA pump whenever the client feels pain. There is a 4-hour lock out programmed into the machine to prevent overdose. 3. No one but the client should push the button for the client to receive medication. The antidote for pain is narcotic medication. If the client is resting and does not have pain, continuous administration of medication could result in an overdose. 4. The client should not be concerned with narcotic addiction. The medication should be discontinued prior to this becoming a problem.
39. The client is postoperative for a cervical laminectomy and is prescribed meperidine (Demerol), a narcotic analgesic, by patient-controlled analgesia (PCA) pump. Which instruction regarding pain control should the nurse teach the client? 1. Notify the nurse when needing pain medication. 2. Press the button on the pump when the client feels pain. 3. Have the significant other push the button on the pump frequently. 4. Use the pain medication sparingly to prevent narcotic addiction.
4. 1. Narcotic pain medications slow peristalsis in the small and large intestines, increasing the risk for constipation and fecal impaction. The nurse should discuss a bowel regimen with the HCP. 2. The nurse should attempt to have the client quantify the pain so that the effectiveness of interventions can be evaluated. The numeric pain scale is one method of objectifying the pain. 3. Rising quickly from a flat-on-the-back (supine) position could increase the client's pain. Some of the medications administered for back pain can cause orthostatic hypotension. The nurse should teach the client to turn on the side and push up on the elbow slowly when getting out of bed. 4. The client may be taking antispasmodic and pain medications, but there is no reason for anticonvulsant medications. 5. This is a safety issue. The client should call for assistance to prevent falls.
4. The client diagnosed with low back pain is prescribed morphine sulfate, an opioid analgesic. Which interventions should the nurse implement? Select all that apply. 1. Discuss with the HCP starting the client on a stool softener. 2. Teach the client about rating the pain on a numeric pain scale. 3. Inform the client to rise quickly from a supine position. 4. Administer anticonvulsant medications around the clock. 5. Tell the client to call for assistance when getting out of bed.
40. 1. A fracture pan is preferred for clients who have back pain or surgeries because the pan has a smaller rim and will displace the back less. The nurse would not need to intervene. 2. The UAP should be instructed not to get the client out of bed immediately after taking pain medication. The client may be drowsy and could fall. 3. A back rub prior to bedtime would assist the client to rest. The nurse would not need to intervene. 4. UAPs are allowed to apply barrier protectant creams as part of their duties when changing a client who has soiled himself or herself. The nurse would not need to intervene.
40. The nurse and unlicensed assistive personnel (UAP) are caring for clients on an orthopedic unit. Which action by the UAP requires immediate intervention? 1. The UAP obtains a fracture pan for a client with a laminectomy to use. 2. The UAP attempts to ambulate an elderly client immediately after receiving pain medication. 3. Prior to bedtime, the UAP provides a back rub to a client with low back pain. 4. The UAP places moisture barrier cream on a client's perineal area.
41. 1. Warfarin is an anticoagulant that would cause increased bleeding; therefore, the nurse would not prepare to administer this medication. 2. Vitamin K increases clotting; therefore, the surgeon would order this medication to decrease the prolonged PT. (A normal PT is 12.9 seconds.) 3. Applying direct pressure will help decrease bleeding but will not correct a prolonged PT. 4. Protamine sulfate is the antidote for heparin and the postoperative client would not be taking heparin, an anticoagulant.
41. The client is 4 hours postamputation. The nurse notes a large amount of bright red blood on the dressing and notifies the surgeon. The client's prothrombin time (PT) result is 22.5/INR 25. Which intervention should the nurse implement based on the PT/INR results? 1. Prepare to administer warfarin (Coumadin). 2. Prepare to administer vitamin K (AquaMEPHYTON). 3. Apply direct pressure to the residual limb. 4. Prepare to administer protamine sulfate.
42. 1. An arthrocentesis is an aspiration of synovial fluid and an injection of pain medication and anti-inflammatory medication, which would be a steroid; if the client were allergic to the steroid prednisone, the nurse should notify the surgeon. 2. The client would not be receiving any type of NSAID during this procedure; therefore, this information would not warrant notifying the surgeon. 3. A history of PUD would be pertinent if the client was receiving oral steroids, not intraarticular steroids. Therefore, this information would not warrant notifying the surgeon. 4. This information would not be pertinent to this procedure; therefore, this information would not warrant notifying the surgeon. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the healthcare provider because medications can result in serious or even life-threatening complications.
42. The day surgery nurse is caring for a client scheduled for an arthrocentesis. Which information warrants notifying the surgeon? 1. The client reports an allergy to prednisone, a glucocorticoid. 2. The client is allergic to ibuprofen, an NSAID. 3. The client has a history of peptic ulcer disease (PUD). 4. The client informs the nurse of getting a rash with soaps.
43. 1. The PT is monitored when the client is receiving oral anticoagulant therapy. 2. The INR is monitored when the client is receiving oral anticoagulant therapy. 3. This anticoagulant is administered prophylactically to prevent deep vein thrombosis, but it will not achieve a therapeutic value because of its short half-life; therefore, no bleeding studies are monitored. 4. The PTT is monitored when the client is receiving continuous intravenous anticoagulant therapy. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about diagnostic tests and surgical procedures.
43. The client is 2 days postoperative right total hip replacement and is receiving the low-molecular-weight heparin (Lovenox) subcutaneously. Which laboratory data should the nurse monitor? 1. The prothrombin time (PT). 2. The International Normalized Ratio (INR). 3. There is no laboratory data to monitor. 4. The partial thromboplastin time (PTT).
44. 1. Nothing should be put down the cast; therefore, a topical medication would not be appropriate for this client. 2. This medication is prescribed for allergy or colds and would not be appropriate for this client. 3. The intravenous route for administering an antihistamine is appropriate to prevent or reduce the severity of an anaphylactic reaction. It is not used to treat itching. 4. Vistaril is effective in reducing itching; therefore, this would be an expected order.
44. Which medication would the nurse prepare to administer to a client with a right long leg cast who is complaining of severe itching under the cast? 1. The topical anti-itch medication Caladryl. 2. The antiallergy medication pseudoephedrine (Sudafed). 3. The intravenous antihistamine diphenhydramine (Benadryl). 4. The oral antihistamine hydroxyzine (Vistaril).
45. 1. An infection at the insertion site could lead to osteomylitis; therefore, the health-care provider should be notified so that further action can be taken. 2. Alcohol swabs may cause burning and they have a drying effect on the skin; therefore, they are not used to cleanse the area. A sterile normal saline swab should be used to cleanse the area. 3. The insertion sites are left open to air because of the external fixator frame. A reddened, inflamed area must be treated, not covered up. 4. The nurse never adjusts the clamps; only the HCP adjusts the clamps. 5. A topical antibiotic ointment is used to help prevent infection at the insertion sites.
45. The client with a fractured femur has an external fixation device. The nurse assesses reddened, inflamed skin around the insertion site. Which interventions should the nurse implement? Select all that apply. 1. Notify the client's health-care provider. 2. Cleanse the insertion site with alcohol swabs. 3. Put a sterile, nonadhesive dressing on the site. 4. Readjust the clamps on the external fixator frame. 5. Apply topical Neosporin antibiotic ointment.
46. 1. This would be an appropriate question prior to x-raying the ankle to determine if there is a fracture, but it has nothing to do with the ecchymotic area. 2. Ecchymosis (bruising) is secondary to bleeding in the tissue, an abnormal amount of bruising may indicate a bleeding problem, and taking aspirin daily would increase the bleeding. 3. Applying ice would not increase bruising to the right ankle. 4. Antihypertensive medication would not affect the ecchymotic area.
46. The female client comes to the clinic with an injured right ankle and has an abnormally large amount of ecchymotic tissue. Which question is most appropriate for the nurse to ask the client concerning the ecchymotic tissue? 1. "Is there any chance you could be pregnant?" 2. "Are you currently taking aspirin routinely?" 3. "How long did you apply ice to the ankle?" 4. "Do you take any antihypertensive medications?"
47. 1. The drug of choice for acute deep vein thrombosis is intravenous heparin, an anticoagulant. These signs and symptoms should indicate DVT to the nurse. 2. Oral anticoagulants are prescribed for a resolving DVT to a client prior to discharge from the hospital. 3. Antiplatelets are for arterial blood disorders, and they are not administered subcutaneously. 4. Aspirin is prescribed as an antiplatelet for arterial disorders, not venous disorders. MEDICATION MEMORY JOGGER: Remember that antiplatelet medications are prescribed for arterial blood disorders, such as arteriosclerosis, whereas anticoagulant medications are prescribed for venous blood disorders, such as DVTs.
47. The client in pelvic traction on strict bed rest has a red, edematous, tender left calf. Which medication should the nurse prepare to administer? 1. The intravenous anticoagulant heparin. 2. The oral anticoagulant warfarin (Coumadin). 3. The subcutaneous antiplatelet clopidogrel (Plavix). 4. The oral antiplatelet acetylsalicylic acid (aspirin).
48. 1. A stage I pressure ulcer should not be massaged because it may cause further tissue breakdown and damage. 2. The moisture barrier cream would prevent the protective dressing from adhering, and rubbing the area may cause further tissue breakdown and damage. 3. A Duoderm dressing provides a barrier and cushion for the reddened area and is used to prevent further breakdown of the reddened area. 4. This dressing is used to absorb moisture and exudate from an open wound. A stage I is a reddened area that does not resolve after 30 minutes without pressure; it is not an open wound.
48. The elderly client with a fractured hip in Buck's traction has a stage I pressure ulcer on the lateral ankle over the bony prominence. Which intervention should the nurse implement? 1. Massage the reddened area gently. 2. Rub moisture barrier cream into the area. 3. Apply a Duoderm dressing to the area. 4. Put a hydrophilic foam dressing on the area.
49. 3, 5, 2, 1, 4 3. The nurse should first have the trough level drawn to determine how much medication is remaining in the blood after the drug has been metabolized and excreted. 5. If the facility has the capability, the nurse should obtain the trough results prior to administering the medication. This medication is nephrotoxic and ototoxic. If the trough level is above therapeutic range, the nurse should hold the medication. 2. Prior to administering any medication, the nurse must determine if it is the right client. 1. After the trough level is drawn and evaluated and the ID band is checked, then the nurse can administer the medication to the client. 4. After the medication has infused over 1 hour, the peak level is drawn 30 minutes to an hour later, depending on hospital policy.
49. The client diagnosed with osteomyelitis of the right trochanter is receiving the aminoglycoside antibiotic vancomycin intravenously. The HCP has ordered a peak and trough on the third dose. Which interventions should the nurse implement when administering the third dose? Rank in order of performance. 1. Administer the medication via an IV pump. 2. Check the client's identification band. 3. Have the laboratory draw the trough level. 4. Request the laboratory to draw the peak level. 5. Determine the client's trough level.
5. 1. Intrathecal indicates into the central nervous system via a lumbar puncture. The client will be positioned with the back arched, much like a Halloween cat, for the HCP to be able to insert the needle between the vertebrae. 2. The procedure provides temporary relief of inflammation of affected nerves. 3. The injections are into the intravertebral space, not into the hips. An injection in the hips indicates an intramuscular injection. 4. There is risk with any procedure. In this procedure, nerve damage is the greatest risk.
5. The client diagnosed with low back pain is scheduled to have a steroid injection into the intrathecal space. Which statement by the client indicates the client understands the procedure? 1. "I will have to curl up like a Halloween cat." 2. "This procedure will cure my back pain." 3. "I will have an injection in each of my hips." 4. "There is no risk with this procedure."
50. 1. This medication causes agranulocytosis; the flulike symptoms are indicative of this reaction and warrant intervention by the nurse. 2. Drowsiness is an expected side effect of the medication and would not warrant intervention by the nurse. The nurse should discuss the expected drowsiness with the client. 3. The client's not driving the car is an expected comment because this medication causes drowsiness. The comment would not require intervention. 4. Missed doses should be taken within 1 hour of the normal dosing schedule time or the dose should be omitted until the next normal dosing schedule time. Do not double dose. This comment would not warrant intervention.
50. The client with low back pain syndrome is prescribed chlorzoxazone (Parafon Forte), a skeletal muscle relaxant. Which statement by the client warrants intervention by the nurse? 1. "I have had this flu since I started taking the medication." 2. "I am always drowsy after taking this medication." 3. "I do not drive my car when I take my back pain medicine." 4. "If I miss a dose, I wait until the next dose time to take a pill."
51. 1. A vitamin C deficiency would result in an increased susceptibility to infection, but not osteomalacia. 2. Osteomalacia, adult rickets, is a metabolic bone disorder characterized by inadequate or delayed mineralization of bone. The major risk factors are a diet low in vitamin D, decreased endogenous production of vitamin D because of inadequate sun exposure, impaired intestinal absorption of fats (vitamin D is fat-soluble), and disorders that interfere with the metabolism of vitamin D to its active form. 3. An increase in uric acid production causes gout. 4. An increase in calcium intake decreases the risk for osteomalacia, or adult rickets.
51. Which risk factor should the nurse assess for the client diagnosed with osteomalacia? 1. A vitamin C deficiency. 2. A vitamin D deficiency. 3. An increase in uric acid production. 4. An increase in calcium intake.
52. 1. NSAIDs are used to help decrease the inflammation in the joints. 2. These medications do not treat rheumatoid arthritis (joint deformities), which this client does not have. 3. These medications do not affect the production of synovial fluid. 4. These OTC medications are recommended to clients with osteoarthritis to help build up and reduce the destruction of cartilage in the joints.
52. The male client tells the clinic nurse that he takes glucosamine and chondroitin for joint aches. Which statement best describes the scientific rationale for the efficacy of these over-the-counter medications? 1. This medication will help reduce the inflammation in the joints to decrease pain. 2. They will help prevent joint deformity and improve mobility for the client. 3. This medication will increase the production of synovial fluid in the joint. 4. They improve tissue function and retard the breakdown of cartilage in the joint.
53. 1. The height lost in a client with osteoporosis is the result of fractures of the vertebrae and is permanent. 2. This medication inhibits bone resorption and reduces bone turnover; it normalizes serum alkaline phosphatase and reverses the progression of osteoporosis. 3. This medication works by reducing bone loss, not by increasing calcium reabsorption. 4. This medication improves the bone structure, not the joint flexibility.
53. The elderly female client diagnosed with osteoporosis is prescribed risedronate (Actonel), a bone resorption inhibitor. Which statement best describes the therapeutic goal of this therapy? 1. This medication helps the client regain lost height. 2. It strengthens the bone and prevents fractures. 3. It increases the absorption of calcium by the body. 4. This medication improves the movement of the joint.
54. 1. A DEXA is a painless test that determines the bone density at the waist, hip, or spine to estimate the extent of osteoporosis or to monitor the client's response to treatment. 2. This test determines how much calcium there is in the blood, not the strength of the bone. 3. This test is used to visualize the joint cavity and identify acute or chronic tears in a joint capsule. 4. A bone scan is performed to detect metastatic or primary bone tumors, osteomyelitis, and aseptic necrosis.
54. Which test is most useful to determine the efficacy of the pharmacologic therapy for the client diagnosed with osteoporosis? 1. A dual energy x-ray absorptiometry (DEXA). 2. A serum calcium level. 3. An arthrography. 4. A bone scan.
55. 1. This is a true statement, but the nurse should refer the client to the HCP because of the potential adverse effects of the medication. 2. COX-2 inhibitors do not inhibit the isoform of COX that protects the stomach; therefore, there is a lower incidence of gastroduodenal ulcers, but there are potential life-threatening adverse effects associated with COX-2 inhibitors. Therefore, this is not the nurse's best response. 3. Celecoxib (Celebrex), a COX-2 inhibitor, is used to treat osteoarthritis, but more data is needed to determine how safe the medication is for certain clients. Research shows an increase in heart attacks and strokes, and the drug is contraindicated in clients with liver and renal disease. The nurse should refer the client to the HCP. 4. The client should be cautious about what is advertised on the television about medication and ask the nurse or HCP for further clarification prior to taking the medication.
55. The client with osteoarthritis asks the nurse, "I saw on the television that a medication called Celebrex was good for osteoarthritis. What do you think about it?" Which statement is the nurse's best response? 1. "This medication is very good at reducing the pain and stiffness of osteoarthritis." 2. "This medication does not have the gastrointestinal side effects of other NSAIDs." 3. "There are some concerns about that medication. You should talk to your doctor." 4. "You should be cautious about information that you see on the television."
56. 1. The client should increase the fluid intake because Vicodin slows peristalsis and creates a risk for constipation, but the client is already constipated so this is not the nurse's best response. 2. The client should be taking stool softeners because Vicodin slows peristalsis and creates a risk for constipation, but the client is already constipated so this is not the nurse's best response. 3. The client does not need to go to the emergency department yet; the client needs a stimulant laxative to attempt to evacuate the bowel. 4. The nurse can recommend an overthe- counter stimulant laxative to help evacuate the bowel because the nurse is aware that constipation is a side effect of Vicodin. Giving the client a 24-hour deadline for having a bowel movement is a safeguard.
56. The client taking the combination medication hydrocodone and acetaminophen (Vicodin), a narcotic analgesic, calls the clinic and tells the nurse, "I have not had a bowel movement in more than 3 days." Which statement is the nurse's best response? 1. "This medication causes constipation. You need to increase your fluid intake." 2. "Have you been taking the stool softeners that I told you to take along with Vicodin?" 3. "You should go to the emergency department so that you can see a doctor." 4. "You should take a laxative, and if you do not have a BM within 24 hours, call me."
57. 1. An NSAID decreases prostaglandin production, a protective mechanism to prevent ulcers. The nurse should question administering this medication to a client with a history of ulcers. 2. A client with an ORIF of the left tibia would be expected to have pain and the nurse would not question administering a PRN pain medication. 3. A COX-2 inhibitor is prescribed for a client with osteoarthritis and joint stiffness; therefore, the nurse would not question administering this medication. 4. Cephalosporins are second- or thirdgeneration penicillins, but they do not have cross-sensitivity to sulfa drugs. The nurse would not question administering this medication.
57. The nurse is preparing to administer medications to clients on an orthopedic floor. Which medication should the nurse question administering? 1. An NSAID to the client diagnosed with tendonitis that has a history of duodenal ulcer. 2. A PRN narcotic to a client with an open reduction and internal fixation of the left tibia. 3. A COX 2-inhibitor to a client who is diagnosed with osteoarthritis and has joint stiffness. 4. A cephalosporin antibiotic to a client with osteomyelitis and an allergy to sulfa drugs.
58. 1. The client cannot use the pumice stone until the callus or corn is softened; therefore, this is not the best answer. 2. Dissolved aspirin may help erode the corn over time, but it will also erode good skin. This is not the best answer because it would be very difficult to keep the aspirin on the corn only. 3. Medicated disks impregnated with salicylic acid are available OTC to help dissolve calluses and corns. The salicylic acid softens the callus, which can then be removed with a pumice stone. 4. Folk remedies often are based on fact and should not be immediately discounted.
58. The client has a callus on the bony protuberance of the left fifth metatarsal. The client asks the clinic nurse, "My grandmother told me to dissolve an aspirin to put on my corn. Is that all right to use?" Which statement is the nurse's best response? 1. "I would recommend using a pumice stone to rub it off, but not the aspirin." 2. "Yes, but make sure you do not get the dissolved aspirin on the surrounding skin." 3. "There are OTC preparations using salicylic acid that will help remove the corn." 4. "This is an old wives' tale and you should not pay attention to these remedies."
59. 1. The surgery causes extreme pain, and potent narcotics are frequently prescribed for this client. 2. A hallux valgus is a deformity in which the great toe deviates laterally. The surgery to correct this deformity may cause an intense throbbing pain at the operative site that requires liberal amounts of potent analgesics. 3. This surgery causes intense throbbing pain, and distraction techniques could be used in conjunction with narcotics, but they could not be used alone. 4. The nurse should assess the client for any surgical complications prior to administering the narcotic analgesic. 5. The client should not be walking on the surgical incision site. The surgery was done on the foot.
59. The client 4 hours postoperative bunionectomy (removal of hallux valgus) is prescribed hydromorphone (Dilaudid), a narcotic analgesic. The client is complaining of pain 9 on pain scale of 1-10. Which interventions should the nurse implement? Select all that apply. 1. Request the HCP to prescribe a less potent analgesic. 2. Administer the pain medication as prescribed. 3. Encourage the client to use distraction techniques. 4. Assess the client's foot for signs of hemorrhaging. 5. Encourage the client to ambulate in the hall.
6. 1. The client's complaint of a headache occurs frequently when clients have not been able to eat or drink, especially caffeine drinks. This is not a priority at this time. 2. The standard surgical scrub is a povidoneiodine (Betadine) antiseptic skin preparation. This should be brought to the attention of the surgical nurse who will be preparing the surgical site so that a substitute can be used. 3. Clients going to surgery should be NPO for several hours to prevent aspiration during anesthesia. 4. This is a normal hematocrit.
6. The nurse is completing the preoperative checklist for a client diagnosed with a herniated disc. Which information is priority for the nurse to notify the operating room staff? 1. The client is complaining of a headache. 2. The client is allergic to iodine and aspirin. 3. The client has not had anything to drink. 4. The client's hematocrit is 43%.
60. 1. This is considered conservative treatment designed to balance the metatarsal pads, spread the metatarsal heads, and balance foot posture for Morton's neuroma. This does not address the injection procedure. 2. Warm water would not do anything for the injection procedure; therefore, the nurse should not recommend this action. 3. The Morton's neuroma results in ischemia of the nerve, and exercise will not help the pathologic changes nor the injection procedure. 4. Moon face is a sign of prednisone toxicity and occurs with long-term therapy not a one-time injection of steroids. 5. Morton's neuroma is a plantar digital neuroma of the third branch of the median plantar nerve on the foot resulting in a burning pain of the foot. The injection relieves the burning and pain, but it does cause edema and pain at the injection site. Elevating the foot and applying ice will address the acute discomfort associated with the injection.
60. The client with a Morton's neuroma in the right foot is being injected with bupivacaine (Marcaine), a local anesthetic, along with hydrocortisone, a steroid. Which discharge instruction should the nurse discuss with the client? Select all that apply. 1. Instruct the client to put inner soles in the shoe. 2. Tell the client to soak the foot in warm water. 3. Teach the client to exercise the foot daily. 4. Explain a moon face may occur after injection. 5. Apply ice and elevate the foot for 24 hours.
7. 1. This is important, but it is not priority during the initial assessment. The nurse should determine how the client has been treating the injury. This would be the second query, not the first. 2. The priority at this time is to determine what medications have been tried in order to assess the full extent of the injury. This is the first intervention. Adult clients will frequently only seek the HCP's advice and treatment when over-the-counter remedies have failed. 3. This is an accusatory statement and most likely will make the client mistrust the nurse's objectives. This should not be asked at this time. 4. This is the third query the nurse could ask. Missed work time is important, but to treat the client, the HCP must be aware of the attempted treatments.
7. The client presents to the outpatient clinic complaining of back pain. Which assessment question should the nurse ask first? 1. "What activity did you do to hurt your back?" 2. "Which over-the-counter medications have you taken?" 3. "Have you used illegal drugs to treat the back pain?" 4. "Did you miss any work time because of this pain?"
8. 1. This medication is not known to increase the risk of ulcers. 2. The client should be warned not to consume any alcohol while taking baclofen. Baclofen is a central nervous system depressant, as is alcohol. The combination of alcohol and baclofen could intensify the depressant effects. 3. Baclofen must be tapered off when being discontinued. Abrupt withdrawal after prolonged use can cause anxiety, agitated behavior, hallucinations, severe tachycardia, acute spasticity, and seizures. 4. The medication can cause drowsiness, which might assist the client to rest. Administration at bedtime is preferred if this is so. MEDICATION MEMORY JOGGER: There is rarely any medication for which the client will be told that concurrent administration with alcohol is appropriate.
8. The client with chronic low back pain has been taking baclofen (Lioresal), a muscle relaxant. Which instruction should the nurse review with the client? 1. The medication can cause gastric ulcer formation. 2. The client may consume no more than one glass of wine per day. 3. The medication must be tapered off when discontinued. 4. The client should not take the medication before bedtime.
9. 1. MS Contin is a sustained-release tablet. This medication is to provide relief of chronic pain over the course of the day. It does not need to be the first medication administered. 2. The client prescribed bed rest usually takes a muscle relaxant as a routine medication; it does not need to be administered first. 3. A headache that is to be treated with Tylenol (for mild pain) would not be the first medication for the nurse to administer. 4. A client having muscle spasms is a priority for the nurse. Muscle spasms can be extremely painful. This medication should be administered first.
9. The nurse is administering 0900 medications to clients on a medical unit. Which medication should be administered first? 1. MS Contin, a narcotic analgesic, to a client with low back pain. 2. Chlorzoxazone (Parafon Forte), a muscle relaxant, to a client on bedrest. 3. Acetaminophen (Tylenol), an analgesic, to a client with a headache. 4. Diazepam (Valium), a benzodiazepine, to a client with muscle spasms.
