Exam 3 Questions from Iggy 10th

Question 1

Chapter 17: HIV

Answer 1

LET’S DO THIIIIIIIIIS!

Question 2

What is the first action a nurse should take after sustaining a needlestick injury after injecting a client who is known to be HIV positive?

A) Send the syringe and needle to the laboratory for analysis of viral load.
B) Inform the charge nurse.
C) Thoroughly scrub and flush the puncture site.
D) Go to the employee clinic for postexposure prophylaxis.

Answer 2

C) Thoroughly scrub and flush the puncture site.

Although the nurse would also inform the charge nurse and go to the employee clinic to initiate postexposure prophylaxis, the first action is to clean the puncture site by washing it thoroughly with soap and water for at least 1 minute as recommended by the CDC. Viral load cannot be determined by analyzing the syringe and needle.

Question 3

Which signs and symptoms does the nurse expect to find in a client diagnosed with Pneumocystis jiroveci infection?
A) Dyspnea, tachypnea, persistent dry cough, and fever
B) Substernal chest pain and difficulty swallowing
C) Fever, persistent cough, and vomiting blood
D) Cough with copious thick sputum, fever, and dyspnea

Answer 3

A) Dyspnea, tachypnea, persistent dry cough, and fever

P. jiroveci causes pneumonia with dry cough, shortness of breath, breathlessness, and fever. Thick sputum and vomiting blood are not present. Substernal chest pain and difficulty swallowing are associated with an oral and esophageal candida infection. Vomiting blood is not associated with any type of pneumonia.

Question 4

Which point is most important for the nurse to include when teaching assistive personnel (AP) about protecting themselves from HIV exposure when caring for HIV-positive clients?
A) “Always wear a mask when entering an HIV-positive client’s room.”
B) “Talk to the employee health nurse about starting preexposure prophylaxis.”
C) “Wear gloves when in contact with clients’ mucous membranes or nonintact skin.”
D) “Wear full protective gear when providing any care to HIV-positive clients.”

Answer 4

C) “Wear gloves when in contact with clients’ mucous membranes or nonintact skin.”

Standard Precautions are all that is needed when caring for any client, including those who have HIV. Masks and full protective gear are not needed. Preexposure prophylaxis is not used for potential occupational exposure.

Question 5

Which concept is the highest priority for the nurse to consider in planning care for the client with HIV-III who has candidal stomatitis?
A) Cellular regulation
B) Gas exchange
C) Comfort
D) Nutrition

Answer 5

C) Comfort

Candidal stomatitis causes considerable oral discomfort and difficulty eating and swallowing. Ice chips and cool liquids can help reduce the discomfort until prescribed antifungal agents have reduced the infection symptoms. Some clients may have pain to the point that opioid analgesics are needed. Gas exchange and cellular regulation are not directly affected by the problem. Although nutrition is negatively affected, it is the pain that interferes most with nutrition.

Question 6

Which laboratory test does the nurse analyze to determine the effectiveness of combination antiretroviral drug therapy in an HIV-positive client?
A. Viral load testing
B. Enzyme-linked immunosorbent assay
C. Fourth generation testing
D. Western blot analysis

Answer 6

A. Viral load testing

Only viral load testing directly measures the actual amount of HIV viral RNA particles present in 1 mL of blood. Changes in the number indicate therapy effectiveness. Higher numbers indicate lack of effectiveness and lower numbers indicate the drugs are working. The other tests are used to determine whether the client is infected with HIV and do not change with therapy.

Question 7

Which statement made to the nurse by an assistive personnel (AP) assigned to care for an HIV-positive client indicates a breach of confidentiality and requires further education by the nurse?
A. “The client’s spouse told me she got HIV from a blood transfusion.”
B. “The other assistive personnel and I were out in the hallway discussing our concern about getting HIV from our client.”
C. “I told family members they need to wash their hands when they enter and leave the room.”
D. “Yes, I understand the reasons why I have don’t need to wear gloves when I feed the client.”

Answer 7

B. “The other assistive personnel and I were out in the hallway discussing our concern about getting HIV from our client.”

Discussing this client’s illness outside of the client’s room is a breach of confidentiality and requires further education by the nurse. Instruction on handwashing to family members or other visitors is not a breach of confidentiality. Understanding the reasons for when and when not to wear gloves when performing direct client care is not a breach of confidentiality. Relaying a direct conversation to the nurse is not a breach of confidentiality.

Question 8

Which statement made by the nurse during an admission assessment for a client who is HIV positive demonstrates a nonjudgmental approach in discussing sexual practices and behaviors?
A. “You must tell me all of your partners’ names, so I can let them know about possibly being infected.”
B. “I hope you use condoms to protect your partners.”
C. “Have you had sex with men or women or both?”
D. “You don’t participate in anal intercourse, do you?”

Answer 8

C. “Have you had sex with men or women or both?”

The straightforward approach of asking the client about having sex with men or women is nonjudgmental and most appropriate. “I hope you use…” is a judgmental statement. Naming partners is voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. By stating the question about anal intercourse as a negative is very judgmental.

Question 9

Which statements about the transmission of HIV are true? (Select all that apply.)
A. Clients with HIV-III and no drug therapy are very infectious.
B. Even with appropriate drug therapy, most clients infected with HIV live only about 5 years after diagnosis.
C. HIV may be transmitted only during the end stages of the disease.
D. The most common transmission route is casual contact.
E. Newly infected clients with a high viral load are very infectious.
F. HIV-positive clients who have an undetectable viral load appear to not transmit the disease.

Answer 9

A. Clients with HIV-III and no drug therapy are very infectious.
E. Newly infected clients with a high viral load are very infectious.
F. HIV-positive clients who have an undetectable viral load appear to not transmit the disease.

In the first 4 to 6 weeks after infection, the viral numbers in the bloodstream and genital tract are high and sexual transmission is possible. Clients at the end stage of HIV disease (HIV-III [AIDS]) without drug therapy have a high viral load and are particularly infectious. An undetectable viral load now means noninfectious and therefore, not transmittable. Casual contact does not transmit the infection. With appropriate drug therapy, clients with HIV disease live for decades.

Question 10

Which practices are generally recommended to prevent sexual transmission of HIV? (Select all that apply.)
A. Oral contraceptives taken consistently
B. Natural-membrane condoms for genital and anal intercourse
C. Latex gloves for finger or hand contact with the vagina or rectum
D. Latex dental dam genital and anal intercourse
E. Water-based lubricant with a latex condom
F. Latex or polyurethane condoms for genital and anal intercourse

Answer 10

C. Latex gloves for finger or hand contact with the vagina or rectum
D. Latex dental dam genital and anal intercourse
E. Water-based lubricant with a latex condom
F. Latex or polyurethane condoms for genital and anal intercourse

Latex or polyurethane condoms, dental dams, and gloves for genital and anal intercourse can prevent HIV from contacting susceptible tissues. Water-based lubricants must be used instead of oil-based or greasy lubricants because these can easily rub holes in the condoms. Oral contraceptives provide no protection against transmission of HIV or any other sexually transmitted infection.

Question 11

Which laboratory results does the nurse expect to decrease in a client who has untreated HIV-III (AIDS)? (Select all that apply.)
A. Total white blood cell count
B. Viral load
C. CD8+ T-cell
D. HIV antibodies
E. CD4+ T-cell
F. Lymphocytes

Answer 11

A. Total white blood cell count
E. CD4+ T-cell
F. Lymphocytes

The immune target of HIV is the CD4+ T-cell. With infection of this cell, its circulating levels decline and immune function is reduced over time. As a result, total white blood cell counts decrease and circulating lymphocytes decrease. CD8+ T-cell counts are unaffected. HIV antibodies and viral load increase.

Question 12

Which conditions or factors will the nurse teach at a community seminar as probable transmission routes for HIV? (Select all that apply.)
A. Using injection drugs
B. Sitting on public toilets
C. Changing a diaper on an HIV positive child
D. Having unprotected intercourse with multiple partners
E. Breast-feeding
F. Being bitten by mosquitos

Answer 12

A. Using injection drugs
D. Having unprotected intercourse with multiple partners
E. Breast-feeding

HIV can be transmitted via breast milk from an infected mother to the child. Unprotected intercourse with an HIV-positive adult is a major transmission route. HIV is not spread by mosquito bites or by other insects. It is not transmitted by casual contact. Sharing toilet facilities with an HIV-positive adult does not cause transmission of HIV. The use of injection drugs is a common transmission route. Casual contact such as changing a diaper, even with feces and urine (unless there is significant blood in these excretions), is not a probable transmission route.

Question 13

Chapter 18: SLE

Answer 13

You are AWESOME!

Question 14

Which of the drugs or supplements taken daily taken by a client who is newly diagnosed with drug-induced systemic lupus erythematosus (SLE) does the nurse suspect is most likely to have caused this problem?
A. Vitamin D
B. Lisinopril
C. Aspirin
D. Hydralazine

Answer 14

D. Hydralazine

Hydralazine is a blood pressure medication that has been found to cause drug-induced SLE. None of the other drugs are associated with drug-induced SLE, although lisinopril, an angiotensin-converting enzyme inhibitor, is associated with development of angioedema.

Question 15

Which client with persistent joint and muscle pain will the nurse consider as most likely to have a systemic lupus erythematosus (SLE) diagnosis?
A. A 33-year-old African-American man whose father died from a myocardial infarction.
B. A 33-year-old white woman whose sister has Grave disease.
C. A 33-year-old African-American woman whose mother has psoriasis.
D. A 33-year-old man whose identical twin brother has acute myelogenous leukemia.

Answer 15

C. A 33-year-old African-American woman whose mother has psoriasis.

SLE is an autoimmune disorder that is much more common in women than in men and has a genetic predisposition related to tissue type. A client with SLE is very likely to have another close relative who also has an autoimmune disorder, such as psoriasis (myocardial infarction, type 2 diabetes mellitus, and thrombotic stroke are not autoimmune disorders). In addition, the incidence of SLE is about eight times greater for African-American women than for white women.

Question 16

What precaution is most important for the nurse to teach the client with systemic lupus erythematosus (SLE) prescribed to take 45 mg of a corticosteroid daily for 2 weeks to manage an SLE flare?
A. Check all your stools for the presence of blood or a black, tarry appearance.
B. Do not suddenly stop taking the drug when your flare is over.
C. Be sure to take this drug with food.
D. Take 30 mg in the morning and 15 mg at night.

Answer 16

B. Do not suddenly stop taking the drug when your flare is over.

All of the precautions are correct and important. However, the most critical precaution is to not suddenly stop taking the drug, which could lead to acute adrenal insufficiency and even death. This dose of the drug (45 mg daily) would need to be tapered down over a period of weeks to prevent adrenal insufficiency.

Question 17

What is the nurse’s best response to a client newly diagnosed with systemic lupus erythematosus (SLE) who asks why nicotine use, especially cigarette smoking or vaping, should be avoided?
A. “Nicotine reduces blood flow to your organs and increases the risk for permanent damage.”
B. “Using nicotine in any form reduces the effectiveness of drug therapy for lupus.”
C. “Nicotine promotes muscle cell loss, increases joint inflammation, and reduces functional mobility.”
D. “Smoking or vaping increases your risk for lung cancer development.”

Answer 17

A. “Nicotine reduces blood flow to your organs and increases the risk for permanent damage.”

Nicotine in any form constricts blood vessels and reduces perfusion. Perfusion is already reduced by the vasculitis that is part of the disease. Thus, use of nicotine greatly increases the risk for necrosis of many tissues and organs. Although smoking or vaping do increase the risk for lung cancer, their effects on blood vessels are a greater issue for the client with SLE. Nicotine neither reduces the effectiveness of drug therapy nor promotes muscle cell loss.

Question 19

Which statement by a client who has systemic lupus erythematosus (SLE) indicates to the nurse that more education about the disorder and its management is needed?
A. “My friend and I are going to start walking 2 miles daily.”
B. “Taking my temperature every day can help me recognize when a flair is starting.”
C. “If I still have a lot of pain after taking an NSAID, I can also take acetaminophen.”
D. “At the first sign of a flare, I will begin taking my medication again.”

Answer 19

D. “At the first sign of a flare, I will begin taking my medication again.”

The client’s statement suggests that he or she believes that daily medication is not needed and would be required only during a flare. However, daily drug therapy is essential to slow the progression of the disease and organ damage.
Low-impact exercise such as walking is highly recommended to maintain mobility and promote cardiovascular health. Fevers are often associated with a flare. There is no contraindication to taking both NSAIDs and acetaminophen.

Question 20

What response by the nurse would be most therapeutic when a client who has systemic lupus erythematosus (SLE) says, “My face has changed so much. I feel really ugly”?
A. “I know what you mean, I feel that way sometimes too.”
B. “I bet that was hard to say. Thank you for trusting me with your feelings.”
C. “Don’t worry, treatment will make everything better.”
D. “You look great. It’s what is inside that counts.”

Answer 20

B. “I bet that was hard to say. Thank you for trusting me with your feelings.”

This is an empathetic response in a hard conversation. It acknowledges the client’s bravery for sharing and encourages further therapeutic communication.
“You look great. It’s what is inside that counts” is dismissive of the client’s feelings. “Don’t worry we will make everything better” is considered false reassurance, this can discount the client’s feelings. “I know what you mean, I feel that way sometimes too” is focused on the nurse at a time when the focus should be on the client. All three responses hinder continued conversation and therapeutic communication.

Question 21

Which assessment findings will the nurse expect to see in a client who is suspected to have systemic lupus erythematosus (SLE)? (Select all that apply.)
A. Anemia
B. Joint pain and swelling
C. Hair loss
D. Fever
E. Fatigue
F. Facial redness

Answer 21

A. Anemia
B. Joint pain and swelling
C. Hair loss
D. Fever
E. Fatigue
F. Facial redness

Each of these assessment findings has been associated with systemic lupus erythematosus (SLE).

Question 22

Chapter 42: Sensory-Eyes

Answer 22

“Eye” See you killing it!

Question 23

A client reports “something scratching on the inside of my eyelid.” Before examining the eyelid, what is the appropriate nursing action?
A. Test the visual field.
B. Obtain informed consent.
C. Wash the hands.
D. Don sterile gloves.

Answer 23

C. Wash the hands.

Hands must always be washed, and clean gloves donned, before touching the external eye structures to prevent infection.
The eye care provider will test the visual field. Informed consent and sterile gloves are not needed for the nurse to examine the client’s eye.

Question 24

Which eye procedure requires the nurse to assure that informed consent has been obtained from the client?
A. Ophthalmoscopy
B. Fluorescein angiography
C. Snellen test
D. Eyedrop instillation

Answer 24

B. Fluorescein angiography

Fluorescein angiography is an invasive test and requires informed consent from the client.
Eyedrop instillation, ophthalmoscopy, and the Snellen test are not invasive procedures and do not require informed consent from the client.

Question 25

When performing an eye or vision assessment, which comment by the client alerts the nurse that immediate care by an ophthalmologist is needed?
A. “My vision has been getting worse gradually.”
B. “One of my eyes is green and the other is blue.”
C. “My eyes are red and itchy due to allergies.”
D. “Something hit my eye while I was cutting grass.”

Answer 25

D. “Something hit my eye while I was cutting grass.”

The client who is experiencing trauma, a foreign body in the eye, sudden ocular pain, or sudden redness should be seen immediately by an ophthalmologist.

All other reports will be communicated to the ophthalmologist, but do not require immediate intervention. Heterochromia is an ocular condition, usually genetically inherited, that causes the iris to vary in color. This is not an emergency. Itching and redness can be caused by allergies, irritation, or ocular drug effects but do not require immediate attention. Gradual vision loss could be caused by uncontrolled hypertension and diabetes, or other eye changes, but this does not require immediate care by an ophthalmologist.

Question 26

A client who is using eye drops in both eyes develops a viral infection in one eye. What teaching will the nurse provide?
A. “Wash your hands between eyes and put drops in the uninfected eye first.”
B. “Don’t touch the eyes with the dropper, and you can still use the drops in both eyes.”
C. “The other eye has already likely been infected with the virus.”
D. “You will need to use a separate bottle of drops for each eye.”

Answer 26

D. “You will need to use a separate bottle of drops for each eye.”

The appropriate nursing response is that the client will need a separate bottle of eyedrops for each eye. Because of the risk of transmitting the infection to the uninfected eye, clients would receive two bottles of drops labeled “right” and “left” to use in the correct eyes.
There is still a risk of transmitting the infection when the dropper is kept from contacting the eye or when hands are washed. With proper technique, transmission of infection to the other eye can be prevented.

Question 27

The nurse is caring for four clients with eye concerns. Which client, who has a family history of an eye disorder, does the nurse identify at risk for increased intraocular pressure (IOP)?
A. Client with family history of diabetic retinopathy
B. Client with family history of anisocoria
C. Client with family history of presbyopia
D. Client with family history of glaucoma

Answer 27

D. Client with family history of glaucoma

Glaucoma can be caused by increased IOP, which reduces blood flow to the eyes. Adults with a family history of glaucoma should have their IOP measured once or twice a year.
Anisocoria is characterized by unequal pupil size, which normally affects about 5% of the population. This condition is not a sign of increased IOP. Presbyopia is a condition related to aging with a progressive loss of the ability to focus on near objects. Increased IOP is not a factor. Diabetic retinopathy is microvascular damage caused by uncontrolled diabetes, not by increased IOP.

Question 28

The nurse is teaching an older adult client about visual changes that occur with age. Which statement does the nurse include?
A. “You will have to move reading materials closer to your eyes to focus.”
B. “When the sclera turns yellow, you have developed liver problems.”
C. “It may take your eyes longer to adjust in a darkened room.”
D. “Most visual changes occur before age 40.”

Answer 28

C. “It may take your eyes longer to adjust in a darkened room.”

The nurse teaches the client that, “It may take your eyes longer to adjust in a dark room.” With increasing age, the iris has less ability to dilate, which leads to difficulty in adapting to dark environments.
Adults older than 40 years are at increased risk for both glaucoma and cataract formation. Presbyopia also commonly begins in the 40s. The sclera appears yellow or blue as a process of aging, and this condition should not be used to assess for jaundice in the older adult. The near-point of vision (the closest distance at which the eye can see an object clearly) increases with aging. Near objects (especially reading material) must be placed farther from the eye to be seen clearly.

Question 29

A client is to undergo gonioscopy. When the client asks what this test is for, what is the appropriate nursing response?
A. “This test creates a three-dimensional view of the back of the eye.”
B. “Retinal circulation is evaluated by this test.”
C. “The ophthalmologist uses the test to determine if you have open-angle or closed-angle glaucoma.”
D. “This method of testing will determine if you have blood vessel changes due to disease or drugs.”

Answer 29

C. “The ophthalmologist uses the test to determine if you have open-angle or closed-angle glaucoma.”

Gonioscopy is performed for clients with high IOP to determine whether open-angle or closed-angle glaucoma is present.
A three-dimensional view of the back of the eye is created by ultrasonic imaging of the retina and optic nerve (called ocular coherence tomography). Electroretinography helps the eye care provider to determine if a client has blood vessel changes resulting from disease or drugs. Retinal circulation is evaluated by fluorescein angiography.

Question 30

Which systemic disorder may affect vision and require yearly eye examination by an ophthalmologist? (Select all that apply.)
A. Hypertension
B. Diabetes mellitus
C. Hepatitis
D. Anemia
E. Multiple sclerosis (MS)

Answer 30

A. Hypertension
B. Diabetes mellitus
E. Multiple sclerosis (MS)

Clients who are diabetic are at risk for diabetic retinopathy and are in need of annual eye examinations. Clients with elevated blood pressure need to have annual eye examinations because of the increased risk for retinal damage. Clients with MS should have annual examinations because of changes that occur with the neurologic effects of MS that impact visual acuity.
Anemia does not require eye examination on a routine basis. Hepatitis does not increase eye risk and is not indicated as a disorder requiring annual examinations.

Question 31

The nurse providing education on eye protection suggests protective eyewear for which client? (Select all that apply.)
A. Racquetball player
B. Lifeguard
C. Cab driver
D. Registered nurse
E. College student

Answer 31

A. Racquetball player
B. Lifeguard
C. Cab driver
D. Registered nurse
E. College student

All clients are in need of eye protection from ultraviolet (UV) A and UVB rays because of exposure to the sun. People who play sports need to wear protective eyewear to prevent possible eye injury. Nurses may need protective eyewear to avoid getting or transmitting infection.

Question 32

Chapter 43: Sensory-Hearing

Answer 32

I hear that you’re working extra hard! What a bad azz

Question 33

The nurse is talking to a client about cerumen removal from the ear canal. Which statement by the client indicates a need for further teaching?
A. “I dry my ears using my fingertip and a towel.”
B. “I use a cotton swab to remove earwax.”
C. “I use Swim-Ear after I go swimming.”
D. “I should not use an ear candle to soften the wax.”

Answer 33

B. “I use a cotton swab to remove earwax.”

Further teaching is needed when the client states, “I use a cotton swab to remove earwax.” Nothing smaller than the client’s own fingertip should be inserted into the ear canal. Use of a cotton swab or other device like a key can scrape the skin of the canal, push cerumen up against the eardrum, and even puncture the eardrum.
Using the fingertip and a towel and irrigating the ear canal with tap water are acceptable. Clients are discouraged from using ear candles. Using a product like Swim-Ear to help the ears dry after swimming is appropriate.

Question 34

An older adult client comes in for a routine visit. During the assessment he appears frustrated and says, “Speak up and quit mumbling!” What is the appropriate nursing response?
A. Suggests moving to a soundproof examination room.
B. Shout to ensure that the client can hear.
C. Ask if the client has hearing loss.
D. Apologize and speak louder and clearer.

Answer 34

D. Apologize and speak louder and clearer.

The nurse would repeat and speak more clearly first and then determine whether further assessment is needed.
It would not be assumed that the client has a hearing loss; this suggestion may frustrate the client, especially if he is in denial. Shouting is not recommended because it can make understanding more difficult; this is also considered rude and nontherapeutic. Soundproof rooms are used for hearing tests, not for routine assessments.

Question 35

A client is in the immediate postoperative period after tympanoplasty. How will the nurse position the client?
A. Supine, with eyes toward the ceiling
B. On the affected side
C. With the head elevated 60 degrees
D. With the affected ear facing up

Answer 35

D. With the affected ear facing up

The nurse keeps the client flat, with the head turned to the side and the operative ear facing up, for at least 12 hours after surgery.
All other choices are incorrect and do not facilitate healing.

Question 36

Which client does the nurse identify that is at high risk for developing hearing problems? (Select all that apply.)
Select all that apply.
A. Teenager listening to music using earbuds
B. Airline mechanic
C. Drummer in a rock band
D. Client with Down syndrome
E. Telephone operator

Answer 36

A. Teenager listening to music using earbuds
B. Airline mechanic
C. Drummer in a rock band

Clients who are at high risk for hearing problems include an airline mechanic who is exposed to excessive noise, a client with Down syndrome, (a genetic condition associated with frequent hearing problems), a drummer in a rock band due to exposure to loud noise, and a teenager listening to music using earbuds. Earbuds are known risk factors for increasing potential hearing loss among people who use them on a regular basis with elevated noise levels.
A telephone operator is not at risk for hearing problems simply because he or she may wear headphones or audio equipment.

Question 37

Chapter 45: Osteoporosis

Answer 37

Don’t forget to give yourself a bone (or a beer…)

Question 38

An older adult client who has osteoporosis is discharged from the hospital. What does the nurse include in health teaching related to the client’s home safety?
A. “Keep walkways free of clutter.”
B. “Keep light low to prevent glare.”
C. “Walk slowly on wet floor areas after mopping.”
D. “Use area rugs on tile floors.”

Answer 38

A. “Keep walkways free of clutter.”

The nurse teaches the client that walkways in the home must be clear of clutter and obstacles to help prevent falls.
Clients with metabolic bone problems should not use area rugs at home because they may cause tripping or falling. Clients with metabolic bone problems must not walk on wet floors because the potential for falling is too great. Keeping the lights low would not allow the client to see adequately to walk safely or avoid an object on the floor.

Question 39

The nurse is teaching a postmenopausal client about the need for bone health and screening. What diagnostic test would the nurse recommend?
A. Serum Vitamin D
B. Dual x-ray absorptiometry (DXA)
C. Serum calcium and phosphorus
D. Vertebral x-rays

Answer 39

B. Dual x-ray absorptiometry (DXA)

The DXA scan screens for bone loss and provides a score to indicate the amount of loss, if any. It is a noninvasive test performed every 2 years to monitor for bone loss as one ages.

Question 40

What will the nurse recommend as the most appropriate way to decrease the risk for osteoporosis in a client who has just been determined to be at high risk for the disease?
A. Increase nutritional intake of phosphorus.
B. Walk for 30 minutes three times a week.
C. Increase nutritional intake of calcium.
D. Engage in high-impact exercises, such as running.

Answer 40

B. Walk for 30 minutes three times a week.

Walking for 30 minutes three to five times a week is the best and single most effective exercise for osteoporosis prevention. Osteoporosis occurs most often in older, lean-built Euro-American and Asian women, particularly those who do not exercise regularly. Walking is a safe way to promote weight-bearing and muscle strength.

A variety of nutrients are needed to maintain bone health, so the promotion of a single nutrient will not prevent or treat osteoporosis.
High-impact exercise and overtraining, such as running, may cause vertebral compression fractures and should be avoided.
Calcium loss occurs at a more rapid rate when intake of phosphorus is high; people who drink large amounts of carbonated beverages each day (over 40 ounces [1.2 L]) are at high risk for calcium loss and subsequent osteoporosis, regardless of age or gender.

Question 41

The nurse is caring for a client who is diagnosed with osteopenia. Which T-score will the nurse expect to see for this client after a bone mineral density (BMD) test?
A. −2
B. −3
C. 0 to −1
D. +1.5

Answer 41

A. −2

The T-score represents the standard deviations above or below the average BMD for young, healthy adults.
A T-score of −1 to −2.5 represents osteopenia.
The T-score in a young, healthy adult is 0.
A normal T-score is between +1 and −1.
A score of +1.5 is not a part of the T-score.
A T-score of −3 represents osteoporosis.

Question 42

A young female client whose mother and grandmother have osteoporosis asks whether she needs to take steps to prevent this disease in herself. What will the nurse tell this client?
A. “Now is the time to begin building strong bones.”
B. “Your risk isn’t present until age 50; we can talk about it then.”
C. “You do not have to worry about symptoms at your age.”
D. “You should begin to take steps to prevent disease at age 30.”

Answer 42

A. “Now is the time to begin building strong bones.”

The nurse will tell this client that peak bone mass is achieved by about 30 years of age in most women, so building strong bone as a young person may be the best defense against osteoporosis in later adulthood. She needs to begin getting adequate calcium and vitamin D now as well as exercising to help build strong bones.
The nurse will not tell the client not to worry about symptoms at her age. Beginning at age 30 may be too late. By the time symptoms appear in older adulthood, it is too late to build strong bones.

Question 43

A middle-age female client has osteoporosis and is at risk for developing vertebral fractures. She asks the nurse about exercises to help minimize this risk. Which exercise will the nurse recommend?
A. Cycling
B. Running
C. Walking
D. Yoga

Answer 43

D. Yoga

Yoga helps to strengthen abdominal and back muscles which improves posture and support for the spine.

Cycling, running, and walking help to develop range of motion and muscle strengthening but do not have specific effects on posture and spinal stability.

Question 44

Which of the following are risk factors for male clients who have osteoporosis? (Select all that apply.)
A. High alcohol intake
B. Homelessness
C. High BMI
D. A history of smoking
E. Inadequate exposure to sunlight

Answer 44

A. High alcohol intake
C. High BMI
D. A history of smoking

Question 45

The nurse is caring for a client who is at risk for osteoporosis. What lifestyle changes might the client be able to implement to decrease this risk? (Select all that apply.)
A. Avoiding excessive alcohol consumption
B. Increasing foods high in phosphorus
C. Decreasing consumption of carbonated beverages
D. Preventing a sedentary daily lifestyle
E. Seeking a smoking cessation program, if needed
F. Including more calcium-rich foods into the diet

Answer 45

A. Avoiding excessive alcohol consumption
C. Decreasing consumption of carbonated beverages
D. Preventing a sedentary daily lifestyle
E. Seeking a smoking cessation program, if needed
F. Including more calcium-rich foods into the diet

All of these lifestyle changes are needed to avoid modifiable risk factors that contribute to the development of osteoporosis except that foods high in phosphorus should be avoided. If the serum phosphorous/phosphate level increases, the serum calcium level decreases due to their inverse relationship. Low calcium levels can result in bone loss.

Question 46

Chapter 46: Joints

OA, RA, Gout

Answer 46

I could really use one right about now..

Question 47

The nurse is developing a health teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan?
A. Take up knitting to slow down joint degeneration.
B. Eat at least 2 yogurts every day.
C. Wear supportive shoes at all times.
D. Begin a jogging or running program.

Answer 47

C. Wear supportive shoes at all times.

Wearing supportive shoes will help prevent falls and damage to foot joints, especially metatarsal joints. Running and running promotes stress on joints and should be avoided. Repetitive stress activities such as knitting or typing should be avoided for prolonged periods. No single food can cure OA; a well-balanced diet should be recommended.

Question 48

The nurse is caring for a client with osteoarthritis (OA) in the left knee. What factor does the nurse suspect is the most likely cause of this client’s OA?
A. Trauma to the joint
B. Aging
C. Osteoporosis
D. Familial history

Answer 48

A. Trauma to the joint

The client has OA in one knee which suggests that the client has secondary OA rather than primary disease. Secondary OA occurs as a result of joint injury or obesity.

Question 49

The nurse is caring for a client with an inflamed, reddened, and severely painful first metatarsal joint. With what type of arthritis are these signs and symptoms associated?
A. Rheumatoid arthritis
B. Infectious arthritis
C. Gouty arthritis
D. Osteoarthritis

Answer 49

C. Gouty arthritis

Clients who have gout (also called gouty arthritis) experience severe inflammation in small joints, especially the metatarsal of the great (first) toe. Gout results when urate crystals created by errors in purine metabolism deposit in small synovial joints.

Question 50

The nurse is assessing an older client who has bony nodules on finger joints (Heberden and Bouchard nodes). What priority question would the nurse want to ask as part of the client interview?
A. “When did your bony nodules develop?”
B. “How do you feel about having these bony nodules?”
C. “Are you able to independently perform ADLs?”
D. “Are your bony nodules painful or tender?”

Answer 50

C. “Are you able to independently perform ADLs?”

As a result of the client having bony nodules in his or her hands, the most important question for the nurse to ask is to determine if the client is ADL independent. The nurse would also ask the other questions, but they are not the first questions to be asked.

Question 51

A client was recently diagnosed with osteoarthritis and asks the nurse which over-the-counter drug would be the best to take? What would the nurse’s recommendation be?
A. Ibuprofen
B. Acetaminophen
C. Tramadol
D. Gabapentin

Answer 51

B. Acetaminophen

Several major medical organizations, including the American Pain Society and OARSI committee recommend acetaminophen as the primary drug of choice.

(Want to ask Messer about this…)

Question 52

The nurse is caring for a client with osteoarthritis who reports severe pain in both knees. What nonpharmacologic intervention is the most appropriate for the nurse to recommend for this client?
A. Massage and hypnosis.
B. Hot compresses or moist heating pad.
C. Glucosamine and chondroitin combination.
D. Ice packs used every 3 to 4 hours during the day.

Answer 52

B. Hot compresses or moist heating pad.

Heat sources such as compresses and heating pads cause vasodilation which promotes healing in the affected joints. Ice is best for inflamed joints rather than those that are degenerative. Glucosamine and chondroitin are integrative therapies that help some clients but their effectiveness has not been validated. Massage would be painful and hypnosis may or may not be helpful, depending on the client.

Question 53

The nurse is caring for an older, alert adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies?
A. “I do not know how long my wife will be able to take care of me at home.”
B. “I am helping with the dishes and laundry, but I hurt so badly when I am doing it.”
C. “I do not know how much longer my neighbor can continue to help clean my house.”
D. “The bus is coming to pick me up from the senior center three times a week so I can play cards.”

Answer 53

D. “The bus is coming to pick me up from the senior center three times a week so I can play cards.”

Participation in diversional activities is a way to cope with daily stressors of osteoarthritis and shows good use of available resources for support. Caregiving responsibilities can be a source of stress; the client worrying about his wife’s caregiving abilities does not indicate that the client is effectively coping. Routine tasks, such as doing dishes and laundry, need to be reassigned or effective pain management should be instituted before activities are undertaken to demonstrate effective coping. Neighbors are not reliable resources for in-home needs, and asking a neighbor to help does not indicate that the client is coping effectively.

Question 54

The nurse assesses a client diagnosed with Sjögren syndrome. The nurse anticipates that the client will also have which symptom?
A. Excessive production of saliva in the mouth
B. Intermittent episodes of diarrhea
C. Abdominal bloating after eating
D. Dry eyes

Answer 54

D. Dry eyes

Clients with Sjögren syndrome experience dry eyes (keratoconjunctivitis sicca), dry mouth, and if female, dry vagina.

Question 55

The nurse is caring for a client who has a continuous femoral nerve blockade following a total knee arthroplasty. What nursing assessment does the nurse need to perform to ensure client safety?
A. Monitor vital signs frequently to detect early complications.
B. Perform focused cardiovascular and respiratory assessments.
C. Check that the client can dorsiflex and plantarflex the foot on the operative leg.
D. Monitor for excessive blooding and bruising during the infusion.

Answer 55

Check that the client can dorsiflex and plantarflex the foot on the operative leg.

To ensure that the client is not receiving excessive anesthesia, the client should be able to dorsiflex and plantarflex the foot on the operative leg. The purpose of the continuous femoral nerve blockade is to help control postoperative pain.

Question 56

The nurse is caring for a postoperative client with total hip arthroplasty. What actions would the nurse take to prevent venous thromboembolism (VTE) postoperatively? (Select all that apply.)
A. Apply pneumatic or sequential compression devices.
B. Administer anticoagulant therapy.
C. Ambulate the client on the day of surgery.
D. Elevate the client’s legs.
E. Keep the legs slightly abducted.

Answer 56

A. Apply pneumatic or sequential compression devices.
B. Administer anticoagulant therapy.
C. Ambulate the client on the day of surgery.

Preventive postoperative actions that help prevent VTE include pharmacology (anticoagulants), ambulation, and compression.
Don’t want to elevate or adduct the legs! Choice (E) is true, but not relevant to DVT prevention.

Question 57

The nurse recognizes that a client who has persistent pain may have difficulty with pain management after a total joint arthroplasty. What collaborative interventions are needed to help the client manage postoperative pain? (Select all that apply.)
A. Establish trust and explain the postoperative pain management plan.
B. Consult the pain management team if needed and available.
C. Plan continuing pain management after discharge.
D. Use multimodal and alternative pain management modalities.
E. Identify at-risk clients preoperatively using a comprehensive assessment.

Answer 57

A. Establish trust and explain the postoperative pain management plan.
B. Consult the pain management team if needed and available.
C. Plan continuing pain management after discharge.
D. Use multimodal and alternative pain management modalities.
E. Identify at-risk clients preoperatively using a comprehensive assessment.

All of these interventions are needed to successfully manage pain for clients who have persistent (chronic) pain.

Question 58

Chapter 47: Fractures

Answer 58

Almost there! Just keep swimming!

Question 59

The nurse is caring for an older client who has a large bulky lower leg dressing with a posterior splint to maintain alignment after closed reduction for an ankle fracture. Which client assessment finding would the nurse report to the primary health care provider or Rapid Response Team immediately?
A. Affected foot slightly cooler than the other foot.
B. Reports pain level is 4 on a 0-10 pain intensity scale.
C. Pedal pulse on affected foot is 1+ and regular.
D. Reports tingling and numbness in affected foot.

Answer 59

D. Reports tingling and numbness in affected foot.

Question 60

The nurse is caring for an older client who has a large bulky lower leg dressing with a posterior splint to maintain alignment after closed reduction for an ankle fracture. Which client assessment finding would the nurse report to the primary health care provider or Rapid Response Team immediately?
A. Affected foot slightly cooler than the other foot.
B. Reports pain level is 4 on a 0-10 pain intensity scale.
C. Pedal pulse on affected foot is 1+ and regular.
D. Reports tingling and numbness in affected foot.

Answer 60

D. Reports tingling and numbness in affected foot.

This client is at risk for neurovascular compromise or compartment syndrome from the external dressing. Pain and a slightly cooler foot is to be expected. However, the client should not have tingling and numbness suggesting that arterial blood flow is diminished.

Question 61

A client had a fractured tibia repair several weeks ago and tells the nurse that she has persistent burning pain, ongoing edema, and muscle spasms in her affected leg. For which chronic complication is the client at risk?
A. Chronic osteomyelitis
B. Complex regional pain syndrome
C. Severe osteoporosis
D. Compartment syndrome

Answer 61

B. Complex regional pain syndrome

When pain is not managed appropriately or interventions are not implemented to prevent complex regional pain syndrome (CRPS), the client is at risk for developing CRPS, a chronic debilitating complication of traumatic injury.
(*only added this Q bc I thought the answer was D…)

Question 62

A client in the emergency department receives moderate sedation while having a closed reduction of a fractured ankle. What is the nurse’s priority assessment during this procedure?
A. Check the client’s blood pressure frequently.
B. Monitor the client’s pain level.
C. Monitor the client’s respiratory rate.
D. Perform circulation checks before and after the procedure.

Answer 62

C. Monitor the client’s respiratory rate.

The drugs used for moderate sedation can suppress respiratory rate which requires constant monitoring during the procedure. The client should not feel any pain.

Question 63

Buck’s (skin) traction for a fractured hip is applied to a client while a urinary tract infection is treated before surgery. What instruction will the nurse give assistive personnel (AP) for providing client care related to the traction?
A. “Inspect the pins in the traction for signs of infection.”
B. “Remove the boot every shift to inspect the skin.”
C. “Do not allow the traction weights to rest on the ground.”
D. “Remove traction weights when turning the client.”

Answer 63

C. “Do not allow the traction weights to rest on the ground.”

Although Buck’s traction is not used commonly today because clients have surgical hip repairs to reduce pain, for some clients such as this client, it is used short term until surgery can be performed. The AP should allow the weights to hang freely and not remove them. There are no pins and the boot can be removed by the nurse for skin inspection.

Question 64

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan?
A. “Avoid rigorous exercise.”
B. “Avoid contact sports.”
C. “Wear helmets when riding a motorcycle.”
D. “Avoid driving in inclement weather.”

Answer 64

C. “Wear helmets when riding a motorcycle.”

Those who ride motorcycles or bicycles should wear helmets to prevent head injury.
Telling the general public to avoid contact sports or to avoid driving in inclement weather is not realistic.
Telling the general public to avoid rigorous exercise is not only unrealistic, but it is also opposed to what many health care professionals recommend to maintain health.

Question 65

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client?
A. Keep the client’s heels off the bed at all times.
B. Reposition the client every 3 to 4 hours.
C. Avoid the use of anti-embolism stockings.
D. Administer pain medication before deep-breathing exercises.

Answer 65

A. Keep the client’s heels off the bed at all times.

Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client’s heels must be kept off the bed at all times to avoid constant pressure on this sensitive area.

Repositioning must be done every 2 hours to prevent skin breakdown and to inspect the skin for any signs of breakdown.
Pain medication would not be administered for deep-breathing exercises because this client typically would not experience pain upon breathing.
Antiembolic stockings or sequential compression devices are used for older adults to help prevent venous thromboembolism (VTE).

Question 66

The nurse is caring for a client who has an external fixator for an open fracture of the tibia and fibula. What is the nurse’s priority for care related to the fixator?
A. Inspect the pins to monitor for infection and do not remove crusts.
B. Make sure that the wound is managed using a moist wound healing method.
C. Keep the leg covered to keep the extremity warm to promote circulation.
D. Keep the extremity elevated to three pillows while in bed or in a chair.

Answer 66

A. Inspect the pins to monitor for infection and do not remove crusts.

An external fixator is a series of pins attached to a metal frame to hold the bone ends in place while the wound can be managed.
The nurse would frequently monitor the pin insertion sites for signs and symptoms of infection.
Crusting that occurs at the sites should not be removed because it helps seal the open pin site areas to prevent infection.
Leg elevation is important but the client would not necessarily need three pillows.

Question 67

The nurse is teaching a client about the use of crutches following a foot fracture. When adjusting the crutches to ensure a correct fit, what action will the nurse take?
A. Ensure that each crutch fits firmly into the client’s armpit.
B. Be sure that the top of each crutch is well padded.
C. Use the crutch on the affected side only.
D. Check to see how many steps the client can take with the crutches.

Answer 67

B. Be sure that the top of each crutch is well padded.

Crutches are used as a set and require that the nurse ensure that the client does not develop axillary nerve damage. The tops of the crutches should be well-padded and should be at least 2 to 3 finger-breadths below the armpit.

Question 68

A client sustains a fracture of one arm and the primary health care provider applies a synthetic cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department?
A. Monitor neuromuscular status for decreased circulation and sensation in the extremity.
B. Check the fit of the cast by inserting a tongue blade between the cast and the skin.
C. Apply a heating pad for 15 to 20 minutes four times daily to help with pain.
D. Keep the cast covered with a soft towel to help it to dry quickly.

Answer 68

A. Monitor neuromuscular status for decreased circulation and sensation in the extremity.

The most important intervention the nurse teaches the client is to monitor the neurovascular status during the first 24 hours after ED discharge.

The client should apply ice for discomfort, not heat.
The client should not place anything between the cast and the skin. In assessing fit, one finger should easily fit between the cast and the skin.
The cast dries quickly because it is made of synthetic materials.

Question 69

A client is in skeletal traction for a complex femoral fracture. Which nursing intervention ensures proper care of this client?
A. Ensure that weights are placed on the floor.
B. Remove the traction weights only for bathing.
C. Ensure that pins are not loose and tighten as needed.
D. Inspect the skin at least every 8 hours.

Answer 69

D. Inspect the skin at least every 8 hours.

The client’s skin should be inspected at least every 8 hours for signs of irritation, inflammation, or actual skin breakdown.
Weights must never rest on the floor because they will not be effective. They must hang freely at all times.
Pin sites would be checked for signs and symptoms of infection and for security in their position to the fixation and the client’s extremity. However, the nurse does not adjust the pins. Any loose pin site or alteration must be reported to the health care provider.
Traction weights are not removed for bathing.

Question 70

The nurse is caring for a client immediately after a vertebroplasty. In what position would the nurse most likely place the client?
A. Prone for the first 1 to 2 hours
B. High-Fowler for the first hour
C. Side-lying for the first 2 hours
D. Flat supine for the first 1 to 2 hours

Answer 70

D. Flat supine for the first 1 to 2 hours

The flat supine position provides support for the percutaneous or minimally invasive surgical procedure.

Question 71

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment?
A. Surgical repair of the rotator cuff
B. Patient-controlled analgesia with morphine
C. Activity limitations for the affected arm
D. Prescribed exercises of the affected arm

Answer 71

C. Activity limitations for the affected arm

The immediate conservative treatment for this client is to limit activity in the injured arm.
Surgical intervention is not considered immediate conservative treatment.
Exercises are prohibited immediately after a rotator cuff injury.
The client with a rotator cuff injury is treated primarily with nonsteroidal anti-inflammatory drugs to manage pain.

Question 72

A client with an open fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is essential for the nurse to take first?
A. Check the dorsalis pedis pulses.
B. Administer the prescribed analgesic.
C. Place a dressing on the affected area.
D. Immobilize the left leg with a splint.

Answer 72

A. Check the dorsalis pedis pulses.
ALWAYS ASSESS FIRST!
The essential nursing action is to check the dorsalis pedis pulses. It is necessary to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome, which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if the neurovascular status is compromised.

Immobilization will be needed, but the nurse must assess the client’s condition first.
Administering an analgesic and placing a dressing on the affected area would both be done after the nurse has assessed the client.

Question 73

Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury?
A. Lungs for bilateral normal breath sounds
B. Urine specimen to assess for the red blood cells
C. Pain score and level of alertness
D. Skin to evaluate lacerations and abrasions

Answer 73

B. Urine specimen to assess for the red blood cells

It is most important for the nurse to determine the presence of blood in the urine as well as assessing the abdomen for rigidity.
Clients with crushing injuries to the pelvis are at increased risk of internal hemorrhage. Pelvic injuries are the second cause of death from trauma after head injuries.
Assessing the skin for external trauma and monitoring pain and alertness will be performed as part of the overall assessment but are not critical nursing actions at this time.
Assessing lung sounds is more critical with chest injuries and rib fractures.

Question 74

A client is admitted to the emergency department following a left severe ankle sprain caused by playing football with friends. What nursing actions will the nurse implement at this time? (Select all that apply.)
A. Elevate the left leg above the level of the heart.
B. Tell the client to keep his left leg still.
C. Apply an elastic wrap or ankle or compression brace.
D. Administer morphine via IV push.
E. Apply heat to promote blood flow and healing.

Answer 74

A. Elevate the left leg above the level of the heart.
B. Tell the client to keep his left leg still.
C. Apply an elastic wrap or ankle or compression brace.

The nurse follows the RICE approach to emergency care of clients who experience a sports-related injury, which includes rest, ice, compression, and elevation of the affected part.
Heat may be used after 24 hours, but ice is needed now to reduce swelling. The client does not need a strong opioid for this injury.

Question 75

A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 m) fall 2 days ago. The nurse plans to assess the client for which potential complications? (Select all that apply.)
A. Urinary tract infection (UTI)
B. Acute compartment syndrome (ACS)
C. Fat embolism syndrome (FES)
D. Osteomyelitis
E. Heart failure

Answer 75

B. Acute compartment syndrome (ACS)
C. Fat embolism syndrome (FES)
D. Osteomyelitis

ACS is a serious condition in which increased pressure within one or more compartments reduces circulation to the area. A fat embolus is a serious complication in which fat globules are released from yellow bone marrow into the bloodstream within 12 to 48 hours after the injury. FES usually results from long bone fracture or fracture repair but is occasionally seen in clients who have received a total joint replacement. Bone infection, or osteomyelitis, is most common in open fractures.
Heart failure is not a potential complication for this client; pulmonary embolism is a potential complication of venous thromboembolism, which can occur with a fracture. The client is at risk for wound infection resulting from orthopedic trauma, not a UTI.