Quizes Exam 5

A nurse working in an outpatient clinic is assessing a client who has rheumatoid arthritis (RA). The client reports increased joint tenderness and swelling. Which ofthe following findings should the nurse expect? (Select all that apply.) A. Recent influenza B. Decreased range of motion C. Hypersalivation D. Increased blood pressure E. Pain at rest

A. CORRECT: Exacerbating factors, such as a recent illness like influenza, are indicative in clients who have RA. B. CORRECT: A decrease in range of motionis indicative in clients who have RA. E. CORRECT: Pain at rest is indicative of RA

A nurse is teaching a client who has a new diagnosis of rheumatoid arthritis. Which of the following statements should the nurse include in the teaching? A. "You can experience morning stiffness when you get out bed." B. "You can experience abdominal pain." C. "You can experience weight gain." D. "You can experience low blood sugar."

A. CORRECT: The nurse should include in the teaching that the client who has RA can experience stiffness in her joints upon rising.

A nurse in the emergency department is planning care for a client who has a right hip fracture. Which of the following immobilization devices should the nurse anticipate in the plan of care? A. Skeletal traction B. Buck's traction C. Halo traction D. Bryant's traction

B. CORRECT: Buck's traction is a temporary immobilization device applied to a client who has a femur or hip fracture to diminish muscle spasms and immobilize the affected extremity until surgery is performed.

A nurse is assessing a client who has a casted compound fracture of the femur. Which of the following findings is a manifestation of a fat emboli? A. Altered mental status B. Reduced bowel sounds C. Swelling of the toes distal to the injury D. Pain with passive movement of the foot distal to the injury

A. CORRECT: Altered mental status is an early manifestation of fat emboli. Other manifestations include dyspnea, chest pain, and hypoxemia.

A nurse is providing information to a client who has osteoarthritis of the hip and knee. Which of the following information should the nurse include in the information? (Select all that apply.) A. Apply heat to joints to alleviate pain. B. Ice inflamed joints following activity. C. Install an elevated toilet seat. D. Take tub baths. E. Complete high‑energy activities in the morning

A. CORRECT: Applying heat to joints can provide temporary relief of pain. B. CORRECT: Applying ice to inflamed joints following activity can decrease edema. C. CORRECT: Installing an elevated toilet seat can help decrease strain and pain of the affected joints. D. Taking a tub bath places the client at risk for increased strain and pain on the affected joints when getting in and out of the tub and increases the risk for falls. E. CORRECT: Encouraging high‑energy activity in the morning is recommended as part of a daily routine to promote independence.

A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.) A. "I will clean the pins twice a day." B. "I will use a separate cotton swab for each pin." C. "I will report loosening of the pins to my doctor." D. "I will move my leg by lifting the device in the middle." E. "I will report increased redness at the pin sites."

A. CORRECT: Clean the external fixation pins one to two times each day to remove exudate that can harbor bacteria. B. CORRECT: Using a separate cotton swab on each pin will decrease the risk of cross‑contamination, which could cause pin site infection. C. CORRECT: Notify the provider if a pin is loose because the provider will know how much to tighten the pin and prevent damage to the tissue and bone.

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following manifestations should the nurse expect to find? (Select all that apply.) A. Heberden's nodes B. Swelling of all joints C. Small body frame D. Enlarged joint size E. Limp when walking

A. CORRECT: Heberden's nodes are enlarged nodules on the distal interphalangeal joints of the hands and feet of a client who has osteoarthritis. B. Swelling and pain of all joints is a manifestation of rheumatoid arthritis. A local inflammation of a joint is related to osteoarthritis. C. A small body frame is a risk factor for rheumatoid arthritis. Obesity is a risk factor for osteoarthritis. D. CORRECT: A client can manifest enlarged joints due to bone hypertrophy. E. CORRECT: A client can manifest a limp when walking due to pain from inflammation in the localized joint.

A nurse is assessing a client who had an external fixation device applied 2 hr ago for a fracture of the left tibia and fibula. Which of the following findings is a manifestation of compartment syndrome? (Select all that apply.) A. Intense pain when the client's left foot is passively moved B. Capillary refill of 3 sec on the client's left toes C. Hard, swollen muscle in the client's left leg D. Burning and tingling of the client's left foot E. Client report of minimal pain relief following a second dose of opioid medication

A. CORRECT: Intense pain of the left foot when passively moved can indicate pressure from edema on nerve endings and is a manifestation of compartment syndrome. C. CORRECT: A hard, swollen muscle on the affected extremity indicates edema build‑up in the area of injury and is a manifestation of compartment syndrome. D. CORRECT: Burning and tingling of the left foot indicates pressure from edema on nerve endings and is an early manifestation of compartment syndrome. E. CORRECT: Minimal pain relief after receiving opioid medication can indicate pressure from edema on nerve endings and is an early manifestation of compartment syndrome.

A nurse is assessing the pain level of a client who came to the emergency department reporting severe abdominal pain. The nurseasks the client whether he has nausea and has been vomiting. The nurse is assessing which of the following components of a pain assessment? A. Presence of associated manifestations B. Location of the pain C. Pain quality D. Aggravating and relieving factors

A. CORRECT: Nausea and vomiting are common manifestations clients have when they are in pain.

A nurse is performing health screenings at a health fair. Which of the following clients are at risk for osteoporosis? (Select all that apply.) A. A 40‑year‑old client who takes prednisone for asthma B. A 30‑year‑old client who jogs 3 miles daily C. A 45‑year‑old client who takes phenytoin for seizures D. A 65‑year‑old client who has a sedentary lifestyle E. A 70‑year‑old client who has smoked for 50 years

A. CORRECT: Prednisone affects the absorption and metabolism of calcium and places the client at risk for osteoporosis. C. CORRECT: Phenytoin affects the absorption and metabolism of calcium and places the client at risk for osteoporosis. D. CORRECT: A sedentary lifestyle places the client at risk for osteoporosis because bones need the stress of weight bearing activity for bone rebuilding and maintenance. E. CORRECT: Smoking increases the risk for osteoporosis because it decreases osteogenesis.

A nurse is providing teaching for a client who has a history of low back injury. Which of the following instructions should the nurse give the client to prevent future problems with low back pain? (Select all that apply) A. Engage in regular exercise including walking. B. Sit for up to 10 hr each day to rest the back. C. Maintain weight within 25% of ideal body weight. D. Create a smoking cessation plan. E. Wear low‑heeled shoes

A. CORRECT: Regular exercise, including walking or swimming, is a strategy that can prevent low back pain B. Long periods of sitting or standing can cause low‑back pain. Advise the client to use footstools or ergonomic chairs when sitting is necessary. C. The client should maintain weight within 10% of ideal body weight, as obesity can cause low‑back pain. D. CORRECT: Stopping or cutting down on smoking is a strategy that can decrease problems with low‑back pain, as smoking can cause disk degeneration. E. CORRECT: Wearing low‑heeled, well‑fitting shoes can prevent low back pain. The nurse should instruct the client to avoid high‑heeled shoes.

A nurse is planning discharge teaching on home safety for an older adult client who has osteoporosis. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Remove throw rugs in walkways. B. Use prescribed assistive devices. C. Remove clutter from the environment. D. Walk with caution on icy surfaces. E. Maintain lighting of doorway areas.

A. CORRECT: Removing throw rugs in walkways can help to prevent a fall and bone fracture. B. CORRECT: Using prescribed assistive devices can help to prevent a fall and bone fracture. C. CORRECT: Removing clutter from the environment can help to prevent tripping, falling, and a bone fracture. E. CORRECT: Good lighting in doorway areas can prevent a fall and bone fracture.

A nurse is planning discharge teaching for a client who had a total hip arthroplasty. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Clean the incision daily with soap and water. B. Turn the toes inward when sitting or lying. C. Sit in a straight‑backed armchair. D. Bend at the waist when putting on socks. E. Use a raised toilet seat.

A. CORRECT: The client should wash the surgical incision daily with soap and water to decrease the risk of infection. C. CORRECT: Using a straight‑backed armchair decreases the chance of bending at a greater than 90° angle, which can cause dislocation of the hip prosthesis. E. CORRECT: Using a toilet riser decreases the chance of bending greater than 90°, which can cause dislocation of the hip prosthesis.

A nurse is admitting a client to the orthopedic unit following a total knee arthroplasty. Which of the following actions by the nurse are appropriate? (Select all that apply.) A. Check continuous passive motion device settings. B. Palpate dorsal pedal pulses. C. Place a pillow behind the knee. D. Elevate heels off bed. E. Apply heat therapy to incision.

A. CORRECT: The nurse should check the continuous passive motion device settings to determine if the settings are as prescribed. B. CORRECT: The nurse should assess the strength of the pulses of both lower extremities to help determine adequate circulation. D. CORRECT: The nurse should prevent pressure ulcers on the client's heels by elevating the heels off the bed with a pillow.

A nurse is completing a preoperative teaching plan for a client who is scheduled to have a total hip arthroplasty. Which of the following should the nurse include in the teaching plan? (Select all that apply.) A. Encourage complete autologous blood donation. B. Sit in a low reclining chair. C. Instruct the client to roll onto the operative hip. D. Use an abductor pillow when turning the client. E. Perform isometric exercises.

A. CORRECT: The nurse should encourage the client to donate blood that can be used postoperatively. D. CORRECT: The nurse should place an abductor device or pillow between the client's legs when turning to prevent dislocation of the affected hip. E. CORRECT: The nurse should instruct the client to perform isometric exercises to prevent blood clots and maintain muscle tone.

A nurse is completing discharge teaching to a client who had a wound debridement for osteomyelitis. Which of the following information should the nurse include in the teaching? A. Antibiotic therapy should continue for 3 months. B. Relief of pain indicates the infection is eradicated. C. Airborne precautions are used during wound care. D. Expect paresthesia distal to the wound.

A. CORRECT: Treatment of osteomyelitis includes continuing antibiotic therapy for 3 months.

A nurse is providing information about capsaicin cream to a client who reports continuous knee pain from osteoarthritis. Which of the following information should the nurse include in the discussion? A. Continuous pain relief is provided. B. Inspect for skin irritation and cuts prior to application. C. Cover the area with tight bandages after application. D. Apply the medication every 2 hr during the day

A. Capsaicin cream provides temporary relief of pain rather than continuous relief when applied several times daily. B. CORRECT: Inspect the skin for irritation and cuts before applying capsaicin cream, because hot peppers in the cream can cause a painful burning sensation in areas of skin breakdown. C. After capsaicin cream is applied, avoid covering the area with a tight bandage, which can cause increased skin irritation. D. For maximum pain relief benefit, apply capsaicin cream up to four times a day.

A nurse is caring for a client who injured her lower back during a fall and describes sharp pain in her back and down her left leg. In which of the following positions should the nurse plan to place the client to attempt to decrease her pain? A. Prone without use of pillows B. Semi‑Fowler's with a pillow under the knees C. High‑Fowler's with the knees flat on the bed D. Supine with the head flat

A. Prone position without use of pillows has not been found to decrease acute low back pain. B. CORRECT: Williams position, with the client in semi‑Fowler's position with the knees flexed by pillows, has been found to relieve low‑back pain caused by a bulging disk and nerve root involvement. C. High‑Fowler's position with the knees flat has not been found to decrease acute low back pain. D. Supine position with the head flat has not been found to decrease acute low back pain.

A client has undergone an external fixation. Which of the following is the most important nursing action to be taken for such a client? A: Perform pin care. B: Plan the client's diet. C: Monitor the client's urine output. D: Monitor the client's blood pressure.

A: Perform pin care.

A client who is undergoing skeletal traction complains of pressure on bony areas. Which of the following nursing actions would comfort the client? A: Assist with range-of-motion and isometric exercises. B: Change the client's position within prescribed limits. C: Administer prescribed analgesics. D: Apply warm compresses.

B: Change the client's position within prescribed limits.

A nurse is caring for a client who has rheumatoid arthritis. Which of the following laboratory tests are used to diagnose this disease? (Select all that apply.) A. Urinalysis B. Erythrocyte sedimentation rate (ESR) C. BUN D. Antinuclear antibody (ANA) titer E. WBC count

B. CORRECT: ESR is a laboratory test used to diagnose RA. This laboratory test will show an elevated result in clients who have RA. D. CORRECT: ANA titer is a laboratory test used to diagnose RA. This laboratory test will show a positive result in clients who have RA. E. CORRECT: WBC count is a laboratory test used to diagnose RA. This laboratory test will show a decreased result in clients who have RA.

A nurse is assessing a client who is scheduled to undergo a right knee arthroplasty. The nurse should expect which of the following findings? (Select all that apply.) A. Skin reddened over the joint B. Pain when bearing weight C. Joint crepitus D. Swelling of the affected joint E. Limited joint motion

B. CORRECT: Pain when bearing weight is an expected finding due to degeneration of the joint. C. CORRECT: Joint crepitus due to degeneration of the joint tissue is an expected finding. D. CORRECT: Swelling of the affected joint due to degeneration of the joint tissue is an expected finding. E. CORRECT: Limited joint motion is due to degeneration of the joint tissue and is an expected finding.

A nurse is providing care for a client who had a vertebroplasty of the thoracic spine. Which of the following is an appropriate action by the nurse? A. Apply heat to the puncture site. B. Place the client in a supine position. C. Turn the client every 1 hr. D. Ambulate the client within the first hour postprocedure.

B. CORRECT: The client should remain in a supine position with bed flat for the first 1 to 2 hr following the procedure to allow for hardening of the cement.

A nurse is admitting an older adult client who has suspected osteoporosis. Which of following is an expected finding? (Select all that apply.) A. History of consuming one glass of wine daily B. Loss in height of 2 in (5.1 cm) C. Body mass index (BMI) of 21 D. Kyphotic curve at upper thoracic spine E. History of lactose intolerance

B. CORRECT: The loss of 2 inches of height is suggestive of osteoporosis due to fractures of the vertebral column. C. CORRECT: A client who has a BMI of 21 is at risk of developing osteoporosis due to low body weight and thin body build, suggesting decreased bone mass. D. CORRECT: Kyphosis curve is highly suggestive of osteoporosis due to fractures of the vertebrae causing the curve. E. CORRECT: Lactose intolerance is highly suggestive of osteoporosis due to possible lack of calcium intake.

A nurse is providing dietary teaching about calcium‑rich foods to a client who has osteoporosis. Which of the following foods should the nurse include in the instructions? A. White bread B. White beans C. White meat of chicken D. White rice

B. CORRECT: White beans should be included in the teaching because they are a good source of calcium.

Which of the following is the most important nursing action that may help clients who undergo a knee or hip replacement? A: Provide crutches to the client. B: Assist in early ambulation. C: Use a continuous passive motion (CPM) machine. D: Encourage expressions of anxiety or depression.

B: Assist in early ambulation. Early ambulation is needed to prevent the hazards of immobility.

How would the nurse identify rheumatoid nodules in a client with rheumatoid arthritis? A: The nodules usually are tender and red. B: The nodules usually are nontender and movable. C: The nodules usually are red and movable. D: The nodules are miniscule and occur over nonbony areas.

B: The nodules usually are nontender and movable. In some clients, subcutaneous nodules, known as rheumatoid nodules, develop. Appearing in more advanced stages of RA, they usually are nontender and movable and evident over bony prominences, such as the elbow or the base of the spine.

The nurse has to conduct the physical assessment of a client with a traumatic injury. The physical assessment should begin with the collection of which of the following data? A: The age of the client B: The vital signs of the client C: The nature of the injury D: The level of sensation of the injured part

B: The vital signs of the client

A client who is immobilized after an orthopedic surgery is at risk for the pooling of his or her secretions. Which of the following nursing actions will help minimize the risk? A: Encourage the client to sneeze hard. B: Turn the client at least every 2 hours. C: Administer analgesics as prescribed. D: Elevate the affected extremity and use cold applications.

B: Turn the client at least every 2 hours.

A nurse is assessing a client who is reporting pain despite analgesia. Which of the following actions should the nurse take to assess the intensity of the client's pain? A. Ask the client what precipitates his pain. B. Question the client about the location of his pain. C. Offer the client a pain scale to measure his pain. D. Use open‑ended questions to identify the sensation of his pain.

C. CORRECT: The nurse should use a pain scale to help the client measure the amount of pain he has and its intensity.

Which of the following clients is at greatest risk for osteoporosis and needs to be educated about the condition by the nurse? A: An overweight African-American woman approaching menopause B: A teenaged male with asthma C: A small-framed, thin white woman approaching menopause D: A young male athlete who plays contact sports and is constantly injured

C: A small-framed, thin white woman approaching menopause

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? A: Consult a skin specialist. B: Scrub the area vigorously to remove the crust. C: Apply lotions and take warm baths or soaks. D: Avoid harsh sunlight.

C: Apply lotions and take warm baths or soaks.

The nurse is required to care for a client with a musculoskeletal injury who underwent a surgical incision. Which of the following nursing actions would help prevent the backflow of the drainage into the incision? A: Block the incision with sterilized gauze. B: Block the incision with a temporary cast. C: Keep the wound drainage system below the level of the incision. D: Keep the wound drainage system above the level of the incision.

C: Keep the wound drainage system below the level of the incision.

A male client, an ace professional tennis player, sprains his right ankle during a tennis match. The client is immediately rushed to the nurse, who provides him with first-aid care. Which of the following immediate combination of treatments should the nurse provide to the client? A: Heat, compression, analgesics, and exercise B: Rest, heat, compression, and elevation C: Rest, ice, compression, and elevation D: Exercise, ice, compression, and elevation

C: Rest, ice, compression, and elevation

A client is scheduled for a joint replacement surgery. Which of the following actions should a nurse take at this stage? A: Ensure adequate fluid intake before the surgery. B: Withhold intake of solid food before the surgery. C: Withhold administration of aspirin before the surgery. D: Ensure adequate sleep before the surgery.

C: Withhold administration of aspirin before the surgery.

A nurse is reviewing the health record of a client who is to undergo total joint arthroplasty. The nurse should recognize which of the following findings as a contraindication to this procedure? A. Age 78 years B. History of cancer C. Previous joint replacement D. Bronchitis 2 weeks ago

D. CORRECT: The client who recently had bronchitis or a recent infection can cause micro‑organisms to migrate to the surgical area and cause the prosthesis to fail.

A nurse is discussing pain assessment with a newly licensed nurse. Which of the following information should the nurse include? A. Most clients exaggerate their level of pain. B. Pain must have an identifiable source to justify the use of opioids. C. Objective data are essential in assessing pain. D. Pain is whatever the client says it is.

D. CORRECT: The nurse should identify that pain is a subjective experience, and the client is the best source of information about it.

Which of the following is the reason why older adults are more prone to skeletal fractures? A: Because there is a 10% decrease in cortical bone B: Because of calcium deficiency C: Because there is no bone reformation D: Because bone resorption is more rapid than bone formation

D: Because bone resorption is more rapid than bone formation

A 68-year-old female client who received treatment for a fracture is to be discharged because her healing is almost complete. Which of the following nursing actions is most critical for the client? A: Advise the client to avoid red meat. B: Advise the client to keep the affected limb in an elevated position. C: Educate the client about the effects of menopause. D: Explore factors related to the client's home environment.

D: Explore factors related to the client's home environment.

What advice should the nurse give to a client recovering from a fractured hip to facilitate calcium absorption from food and supplements? A: Increase intake of amino acids. B: Increase intake of vitamin B6. C: Increase intake of vitamin D. D: Increase intake of dairy products.

D: Increase intake of dairy products. Without adequate vitamin D, calcium is excreted, not absorbed, even if calcium intake is adequate.

A client has undergone hip surgery. Which of the following dietary suggestions would help the client prevent constipation? A: Intake of a high-protein diet B: Intake of a diet rich in potassium C: Intake of dairy products D: Intake of a high-fiber diet

D: Intake of a high-fiber diet

What advice can the nurse give a client with degenerative joint disease to avoid unusual stress on a joint? A: Keep shifting weight from one foot to the other. B: Perform aerobic exercises. C: Maintain complete bed rest. D: Maintain good posture

D: Maintain good posture

Which condition needs to be carefully assessed in a client with a fracture reduction? A: Cardiac problems B: Renal dysfunction C: Sleep disorders D: Neurovascular and systemic complications

D: Neurovascular and systemic complications