Med Surg

  Application Exercises Med Surg Final Exam ATI Questions. 1. A nurse is caring for a client who displays signs of stage III Parkinson’s disease. Which of the following actions should the nurse include in the plan of care? A. Recommend a community support group. B. Integrate a daily exercise routine. C. Provide a walker for ambulation. D. Perform ADLs for the client. 2. A nurse is developing a plan of care for the nutritional needs of a client who has stage IV Parkinson’s disease. Which actions should the nurse include in the plan of care? (Select all that apply.) A. Provide three large balanced meals daily. B. Record diet and fluid intake daily. C. Document weight every other week. D. Place the client in Fowler’s position to eat. E. Offer nutritional supplements between meals. 3. A nurse is reinforcing teaching with a client who has Parkinson’s disease and has a new prescription for bromocriptine. Which of the following instructions should the nurse include in the teaching? A. Rise slowly when standing. B. Expect urine to become dark-colored. C. Avoid foods containing tyramine. D. Report any skin discoloration. 4. A nurse is assessing a client for manifestations of Parkinson’s disease. Which of the following are expected findings? (Select all that apply.) A. Decreased vision B. Pill-rolling tremor of the fingers C. Shuffling gait D. Drooling E. Bilateral ankle edema F. Lack of facial expression 5. A nurse is caring for a client who has Parkinson’s disease and is starting to display bradykinesia. Which of the following is an appropriate action by the nurse? A. Teach the client to walk more quickly when ambulating. B. Complete passive range-of-motion exercises daily. C. Place the client on a low-protein, low-calorie diet. D. Give the client extra time to perform activities. RN ADULT MEDICAL SURGICAL NURSING CHAPTER 7 PARKINSON’S DISEASE 43 Application Exercises Key 1. A. The client/family should be involved in a community support group at the onset of the disease process to enhance coping mechanisms. B. The client should perform daily exercises with the onset of the disease process to promote mobility and independence for as long as possible. C. CORRECT: The client should use a walker for ambulation in stage III of Parkinson’s disease because movement slows down significantly and gait disturbances occur. D. The client loses ability to perform ADLs during stage V of Parkinson’s disease and is dependent on others for care at that time. During earlier stages, the client should be encouraged to remain as independent as possible. NCLEX® Connection: Safety and Infection Control, Accident/Error/Injury Prevention 2. A. The nurse should plan to provide small frequent meals during the day to maintain adequate nutrition. B. CORRECT: The nurse should record the client’s diet and fluid intake daily to assess for dietary needs and to maintain adequate nutrition and hydration. C. The nurse should document the client’s weight weekly to identify weight loss and intervene to maintain the client’s weight. D. The nurse should ensure that the client is sitting upright for meals rather than in a supported Fowler’s position, where the client’s head is elevated to 45 to 60°. E. CORRECT: The nurse should offer nutritional supplements between meals to maintain the client’s weight. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration 3. A. CORRECT: Orthostatic hypotension is a common adverse effect of bromocriptine, a dopamine receptor agonist. Therefore, rising slowly when standing up will decrease the risk of dizziness and lightheadedness. B. The client should expect urine to turn dark when taking entacapone, a COMT inhibitor. Dark urine is not an expected finding when taking bromocriptine. C. The client should avoid tyramine in the diet when taking selegiline, a monoamine type B inhibitor. However, bromocriptine does not interact with foods that contain tyramine. D. Skin discoloration is an adverse effect of amantadine, an anti-viral medication. However it is not an adverse effect of bromocriptine. NCLEX® Connection: Pharmacological and Parenteral Therapies, Adverse Effects/Contraindications/Side Effects/Interactions 4. A. Decreased vision is not an expected finding in a client who has PD. B. CORRECT: The client who has PD can manifest pill-rolling tremors of the fingers due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. C. CORRECT: The client who has PD can manifest shuffling gait because of overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. D. CORRECT: The client who has PD can manifest drooling because of overstimulation of the basal ganglia by acetylcholine, making the controlled movement of swallowing secretions difficult. E. Bilateral ankle edema is not an expected finding in a client who has PD, but can be an adverse effect of certain medications used for treatment. F. CORRECT: The client who has PD can manifest a lack of facial expressions due to overstimulation of the basal ganglia by acetylcholine, making controlled movement difficult. NCLEX® Connection: Physiological Adaptation, Pathophysiology 5. A. The client who has PD develops a propulsive gait and tends to walk increasingly rapidly. The client should be reminded to stop occasionally when walking to prevent a propulsive gait and decrease the risk for falls. B. The nurse should encourage active, not passive, range-of-motion exercises to promote mobility in the client who has PD and is displaying bradykinesia. C. The client who has PD often requires high-calorie, high-protein supplements between meals in order to maintain adequate weight. D. CORRECT: Bradykinesia is abnormally slowed movement and is seen in clients who have PD. The client should be given extra time to perform activities and should be encouraged to remain active. NCLEX® Connection: Reduction of Risk Potential, System Specific Assessments Application Exercises 1. A nurse is providing teaching to the partner of an older adult client who has Alzheimer’s disease and has a new prescription for donepezil. Which of the following statements by the partner indicates the teaching is effective? A. “This medication should increase my husband’s appetite.” B. “This medication should help my husband sleep better.” C. “This medication should help my husband’s daily function.” D. “This medication should increase my husband’s energy level.” 2. A nurse working in a long-term care facility is planning care for a client in stage V of Alzheimer’s disease. Which of the following interventions should be included in the plan of care? A. Use a gait belt for ambulation. B. Thicken all liquids. C. Provide protective undergarments. D. Assist with ADLs. 3. A nurse is making a home visit to a client who has AD. The client’s partner states that the client is often disoriented to time and place, is unsteady on his feet, and has a history of wandering. Which of the following safety measures should the nurse review with the partner? (Select all that apply.) A. Remove floor rugs. B. Have door locks that can be easily opened. C. Provide increased lighting in stairwells. D. Install handrails in the bathroom. E. Place the mattress on the floor. 4. A nurse is caring for a client who has AD and falls frequently. Which of the following actions should the nurse take first to keep the client safe? A. Keep the call light near the client. B. Place the client in a room close to the nurses’ station. C. Encourage the client to ask for assistance. D. Remind the client to walk with someone for support. 5. A nurse is caring for a client who has Alzheimer’s disease. A family member of the client asks the nurse about risk factors for the disease. Which of the following should be included in the nurse’s response? (Select all that apply.) A. Exposure to metal waste products B. Long-term estrogen therapy C. Sustained use of vitamin E D. Previous head injury E. History of herpes infection RN ADULT MEDICAL SURGICAL NURSING CHAPTER 8 ALZHEIMER’S DISEASE 47 Application Exercises Key 1. A. Donepezil does not affect appetite. B. Donepezil does not affect sleep or sleep patterns. C. CORRECT: Donepezil helps slow the progression of AD and can help improve behavior and daily functions. D. Donepezil does not affect energy levels. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration 2. A. Ambulation is affected as the client advances into stage VII of Alzheimer’s disease. B. Impaired swallowing is a finding as the client advances into stage VII of Alzheimer’s disease. C. The client in stages VI and VII of Alzheimer’s disease experiences episodes of urinary and fecal incontinence. D. CORRECT: A client in Alzheimer’s disease stage V requires assistance with ADLs as increasing cognitive deficits emerge. NCLEX® Connection: Safety and Infection Control, Home Safety 3. A. CORRECT: Removing floor rugs can decrease the risk of falling. B. Easy-to-open door locks increase the risk for a client who wanders to get out of his home and get lost. C. CORRECT: Good lighting can decrease the risk for falling in dark areas, such as stairways. D. CORRECT: Installing handrails in the bathroom can be useful for the client to hold on to when his gait is unsteady. E. CORRECT: By placing the client’s mattress on the floor, the risk of falling or tripping is decreased. NCLEX® Connection: Health Promotion and Maintenance, Developmental Stages and Transitions 4. A. Keeping the call light within the client’s reach is an appropriate action, but not the first action because the client might not remember to use it. B. CORRECT: Using the safety and risk reduction priority-setting framework, placing the client in close proximity to the nurses’ station for close observation is the first action the nurse should take. C. Encouraging the client to ask for assistance is an appropriate action, but not the first action because the client might not remember to ask for assistance. D. Reminding the client to walk with someone is an appropriate action, but not the first action because the client might not remember to call for assistance. NCLEX® Connection: Safety and Infection Control, Home Safety 5. A. CORRECT: Exposure to metal and toxic waste is a risk factor for Alzheimer’s disease. B. Long-term estrogen therapy can prevent Alzheimer’s disease. C. Long-term use of vitamin E is not a risk factor for Alzheimer’s disease. D. CORRECT: A previous head injury is a risk factor for Alzheimer’s disease. E. CORRECT: A history of herpes infection is a risk factor for Alzheimer’s disease. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention Application Exercises 1. A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Fluctuations in blood pressure B. Loss of cognitive function C. Ineffective cough D. Drooping eye lids 2. A nurse is beginning a physical assessment of a client who has a new diagnosis of multiple sclerosis. Which of the following findings should the nurse expect? (Select all that apply.) A. Areas of paresthesia B. Involuntary eye movements C. Alopecia D. Increased salivation E. Ataxia 3. A nurse is teaching a client who has multiple sclerosis and a new prescription for baclofen. Which of the following statements should the nurse include in the teaching? A. “This medication will help you with your tremors.” B. “This medication will help you with your bladder function.” C. “This medication may cause your skin to bruise easily.” D. “This medication may cause your skin to appear yellow in color.” Application Exercises Key 1. A. Fluctuations in blood pressure is a manifestation associated with amyotrophic lateral sclerosis. B. CORRECT: Loss of cognitive function is a manifestation associated with MS. C. Ineffective cough is a manifestation associated with amyotrophic lateral sclerosis. D. Drooping eyelids is a manifestation associated with myasthenia gravis. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems 2. A. CORRECT: Areas of loss of skin sensation are a finding in a client who has MS. B. CORRECT: Nystagmus is a finding in a client who has MS. C. Hair loss is not a finding in a client who has MS. D. Dysphagia, swallowing difficulty, is a finding in a client who has MS. E. CORRECT: Ataxia occurs in the client who has MS as muscle weakness develops and there is loss of coordination. NCLEX® Connection: Pharmacological and Parenteral Therapies, Adverse Effects/Contraindications/Side Effects/Interactions 3. A. Primidone and clonazepam are beta blockers given to clients who have MS to treat tremors. B. Propantheline is an anticholinergic medication that is given to clients who have MS to treat bladder dysfunction. C. Prednisone is a corticosteroid medication that is given to clients who have MS to treat inflammation. An adverse effect of this medication is bruising of the skin. D. CORRECT: Dantrolene and tizanidine are antispasmodic medications that are given to clients who have MS to treat muscle spasms. An adverse effect of this medication is a yellow appearance of the skin, also known as jaundice. The nurse should instruct the client to monitor for this finding, as this can be an indication of impaired liver function. NCLEX® Connection: Physiological Adaptation, Pathophysiology Using the ATI Active Learning Template: System Disorder ALTERATION IN HEALTH (DIAGNOSIS): MS is an autoimmune disorder characterized by the development of plaque in the white matter of the central nervous system. Plaque damages the myelin sheath and interferes with impulse transmission between the CNS and the body. LABORATORY TESTS: Cerebrospinal fluid analysis DIAGNOSTIC PROCEDURES: MRI of the brain and spine MEDICATIONS ● Immunosuppressive agents such as azathioprine and cyclosporine: Long-term effects include increased risk for infection, hypertension, and kidney dysfunction. ● Corticosteroids such as prednisone: Increased risk for infection, hypervolemia, hypernatremia, hypokalemia, GI bleeding, and personality changes. ● Antispasmodics such as dantrolene, tizanidine, baclofen, and diazepam are used to treat muscle spasticity. Report increased weakness and jaundice to provider. Avoid stopping baclofen abruptly. ● Immunomodulators such as interferon beta are used to prevent and treat relapses. ● Anticonvulsants such as carbamazepine are used for paresthesia. ● Stool softeners such as docusate sodium are used for constipation. ● Anticholinergics such as propantheline are used for bladder dysfunction. ● Beta-blockers such as primidone and clonazepam are used for tremors. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems Application Exercises 1. A nurse is caring for an older adult client who has diabetes mellitus and reports a gradual loss of peripheral vision. The nurse should recognize this as a manifestation of which of the following diseases? A. Cataracts B. Open-angle glaucoma C. Macular degeneration D. Angle-closure glaucoma 2. A nurse is providing postoperative teaching to a client following cataract surgery. Which of the following statements should the nurse include in the teaching? A. “You can resume playing golf in 2 days.” B. “You need to tilt your head back when washing your hair.” C. “You can get water in your eyes in 1 day.” D. “You need to limit your housekeeping activities.” 3. A nurse is caring for a male older adult client who has a new diagnosis of glaucoma. Which of the following should the nurse recognize as risk factors associated with this disease? (Select all that apply.) A. Gender B. Genetic predisposition C. Hypertension D. Age E. Diabetes mellitus 4. A nurse is caring for a client who has a new diagnosis of cataracts. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Eye pain B. Floating spots C. Blurred vision D. White pupils E. Bilateral red reflexes 5. A nurse is providing teaching for a client who has a new diagnosis of dry macular degeneration. Which of the following instructions should the nurse include in the teaching? A. Increase intake of deep yellow and orange vegetables. B. Administer eye drops twice daily. C. Avoid bending at the waist. D. Wear an eye patch at night. Application Exercises Key 1. A. A client who has cataracts experiences a decrease in peripheral and central vision due to opacity of the lens. B. CORRECT: This is a manifestation of open-angle glaucoma. A gradual loss of peripheral vision is a manifestation associated with this diagnosis. C. A client who has macular degeneration experiences a loss of central vision. D. A client who has angle-closure glaucoma experiences sudden nausea and severe pain and halos around lights. NCLEX® Connection: Health Promotion and Maintenance, Health Screening 2. A. The nurse should not instruct the client to resume playing golf for several weeks. This could cause a rise in intraocular pressure (IOP) or possible injury to the eye. B. The nurse should not instruct the client to tilt his head back when washing his hair. This could cause a rise in IOP or possible injury to the eye. C. The client should not get water in his eyes for 3 to 7 days following cataract surgery to reduce the risk for infection and promote healing. D. CORRECT: The nurse should instruct the client to limit housekeeping activities following cataract surgery. This activity could cause a rise in IOP or injury to the eye. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 3. A. Gender is not a risk factor associated with glaucoma. B. CORRECT: Genetic predisposition is a risk factor associated with glaucoma. C. CORRECT: Hypertension is a risk factor associated with glaucoma. D. CORRECT: Age is a risk factor associated with glaucoma. E. CORRECT: Diabetes mellitus is a risk factor associated with glaucoma. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 4. A. Eye pain is manifestation associated with primary angle-closure glaucoma. B. Floating spots are a manifestation associated with retinal detachment. C. CORRECT: Blurred vision is a manifestation associated with cataracts. D. CORRECT: White pupils are a manifestation associated with cataracts. E. Bilateral red reflexes are absent in a client who has cataracts. NCLEX® Connection: Physiological Adaptation, Pathophysiology 5. A. CORRECT: The nurse should instruct the client to increase dietary intake of carotenoids and antioxidants to slow the progression of the macular degeneration. B. A client who has primary open-angle glaucoma should administer eye drops twice daily. C. A client who is at risk for increased intraocular pressure, such as following cataract surgery, should avoid bending at the waist. D. A client who has had eye surgery, such as cataract surgery, should wear an eye patch at night to protect the eye from injury. NCLEX® Connection: Physiological Adaptation, Unexpected Response to Therapies Application Exercises 1. A nurse is performing an otoscopic examination of a client. Which of the following is an unexpected finding? A. Pearly, gray tympanic membrane (TM) B. Malleus visible behind the TM C. Presence of soft cerumen in the external canal D. Fluid bubble seen behind the TM 2. A nurse is reviewing the health record of a client who has severe otitis media. Which of the following are expected findings? (Select all that apply.) A. Enlarged adenoids B. Report of recent colds C. Client prescription for daily furosemide D. Light reflex visible on otoscopic exam in the affected ear E. Ear pain relieved by meclizine 3. A nurse in a clinic is caring for a client who has been experiencing mild to moderate vertigo due to benign paroxysmal vertigo for several weeks. Which of the following actions should the nurse recommend to help control the vertigo? (Select all that apply.) A. Reduce exposure to bright lighting. B. Move head slowly when changing positions. C. Do not eat fruit high in potassium. D. Plan evenly spaced daily fluid intake. E. Avoid fluids containing caffeine. 4. A nurse is caring for a client who has suspected Ménière’s disease. Which of the following is an expected finding? A. Presence of a purulent lesion in the external ear canal B. Feeling of pressure in the ear C. Bulging, red bilateral tympanic membranes D. Unilateral hearing loss 5. A nurse is completing discharge teaching to a client following middle ear surgery. Which of the following statements by the client indicates understanding of the teaching? A. “I should restrict rapid movements and avoid bending from the waist for several weeks.” B. “I should wait until the day after surgery to wash my hair.” C. “I will remove the dressing behind my ear in 7 days.” D. “My hearing should be back to normal right after my surgery.” Application Exercises Key 1. A. A pearly, gray TM is an expected finding during an otoscopic examination. B. Visualization of the malleus behind the TM is an expected finding during an otoscopic examination. C. Cerumen of various colors, depending on the client’s skin color or ethnic background, is an expected finding in the external ear canal. D. CORRECT: Fluid behind the TM indicates the possibility of otitis media and is not an expected finding. NCLEX® Connection: Reduction of Risk Potential, Potential for Complications of Diagnostic Tests/Treatments/Procedures 2. A. CORRECT: Enlarged tonsils and adenoids are a finding associated with a middle ear infection. B. CORRECT: Frequent colds are findings associated with a middle ear infection. C. Furosemide is an ototoxic medication and can cause sensorineural hearing loss, but taking furosemide does not cause a middle ear disorder. D. Light reflexes are absent or in altered positions in a client who has a middle ear disorder. E. CORRECT: Meclizine is prescribed to relieve vertigo for inner ear disorders, but does not relieve the pain of a middle ear infection. NCLEX® Connection: Physiological Adaptation, Pathophysiology 3. A. CORRECT: Remaining in a darkened, quiet environment can reduce vertigo, particularly when it is severe. B. CORRECT: Moving slowly when standing or changing positions can reduce vertigo. C. The client who has vertigo should be instructed to avoid foods containing high levels of sodium to reduce fluid retention, which can cause vertigo. D. CORRECT: Fluid intake should be planned so that it is evenly spaced throughout the day to prevent excess fluid accumulation in the semicircular canals. E. CORRECT: The client should avoid fluids containing caffeine or alcohol to minimize vertigo. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems 4. A. Ménière’s disease is an inner ear disorder. A purulent lesion in the external ear canal is not an expected finding. B. A feeling of pressure in the ear can occur with otitis media, but is not an expected finding in Ménière’s C. Ménière’s disease is an inner ear disorder. Bulging, red bilateral tympanic membranes is a finding associated with a middle ear infection. D. CORRECT: Unilateral sensorineural hearing loss is an expected finding in Ménière’s disease. NCLEX® Connection: Physiological Adaptation, Illness Management 5. A. CORRECT: Rapid movements and bending from the waist should be avoided for 3 weeks following ear surgery. B. The client should avoid showering and washing hair for at least several days up to 1 week following ear surgery. The ear must remain dry during this time. C. Middle ear surgery is performed through the tympanic membrane, and the client will have a dry dressing within the ear canal. There is no external excision. D. Decreased hearing is expected following middle ear surgery due to presence of a dressing within the ear canal and possible drainage. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures Application Exercises 1. A nurse is instructing a client how to perform Kegel exercises. Which of the following instructions should the nurse include? (Select all that apply.) A. Perform exercises about 50 times each day. B. Contract the circumvaginal and/or perirectal muscles. C. Gradually increase the contraction period to 10 seconds. D. Follow each contraction with at least a 10-second relaxation period. E. Perform while sitting, lying, and standing. F. Tighten abdominal muscles during contractions. 2. A nurse is performing a preoperative assessment for a client who is scheduled for an anterior colporrhaphy. Which of the following client statements should the nurse expect? A. “I have to push the feces out of a pouch in my vagina with my fingers.” B. “I have pain and bleeding when I have a bowel movement.” C. “I have had frequent urinary tract infections.” D. “I am embarrassed by uncontrollable flatus.” 3. A nurse is reviewing the medical record of a client who has a cystocele. Which of the following findings should the nurse identify as a risk factor for the development of this disorder? A. BMI of 18 B. Nulliparity C. Chronic constipation D. Postmenopausal 4. A nurse is preparing to discharge a client following an anterior and posterior colporrhaphy. Which of the following instructions should the nurse provide? A. “Do not bend over for at least 6 weeks.” B. “You can lift objects as heavy as 10 pounds.” C. “Do not engage in intercourse for at least 6 weeks.” D. “You might have foul-smelling drainage for the first week after surgery.” 5. A nurse in a provider’s office is reviewing the medical record of a client who has fibrocystic breast condition. Which of the following findings should the nurse expect? A. Palpable rubberlike lump in the upper outer quadrant B. BRCA1 gene mutation C. Elevated CA-125 D. Peau d’orange dimpling of the breast Application Exercises Key 1. A. CORRECT: The client should perform Kegel exercises 30 to 80 times a day. B. CORRECT: The client should contract her circumvaginal and perirectal muscles as if trying to stop the flow of urine or passing flatus. C. CORRECT: The client should hold the contraction for 10 seconds. She might need to gradually increase the contraction period to reach this goal. D. CORRECT: The client should follow each contraction with a relaxation period of 10 seconds. E. CORRECT: The client can perform the exercises while lying, sitting, or standing. F. The client should relax her other muscles, such as those in her abdomen and her thighs. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 2. A. Pouching of feces is an expected finding associated with a rectocele. The surgical procedure for a rectocele is posterior colporrhaphy. B. Pain and bleeding with a bowel movement is an expected finding associated with a rectocele. C. CORRECT: Due to urinary stasis associated with a cystocele, this finding is an expected finding of a cystocele. The surgery for a cystocele is an anterior colporrhaphy. D. Uncontrollable flatus is an expected finding associated with a rectocele. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems 3. A. The nurse should identify obesity as a risk factor for the development of a cystocele. A BMI of 18 indicates the client is underweight. B. The nurse should identify multiparity as a risk factor for the development of a cystocele. C. The nurse should identify constipation as a risk factor for the development of a rectocele. D. CORRECT: The nurse should identify that the advancing age and loss of estrogen that correlate with postmenopausal status are risk factors for the development of a cystocele. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 4. A. The client does not have a restriction regarding bending over. B. The client should not lift an object that weighs more than 5 lb. C. CORRECT: The client should refrain from intercourse to allow time for the surgical site to heal, which is typically about 6 weeks. D. Foul-smelling drainage is an indication of infection, which should be reported to the provider. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 5. A. CORRECT: Clients who have fibrocystic breast condition typically have breast pain and rubbery palpable lumps in the upper outer quadrant of the breasts. B. BRCA1 gene mutation is a risk factor for breast cancer. C. An elevated CA-125 is a finding associated with ovarian cancer. D. Peau d’orange dimpling of the breast is a finding associated with breast cancer. NCLEX® Connection: Physiological Adaptation, Pathophysiology Application Exercises 1. A nurse at a provider’s office is caring for an older adult client who is having an annual physical exam. Which of the following findings indicates additional follow-up is needed in regard to the prostate gland? (Select all that apply.) A. Prostate-specific antigen (PSA) is 7.1 ng/mL. B. A digital rectal exam (DRE) reveals an enlarged and nodular prostate. C. The client reports a weak urine stream. D. The client reports urinating once during the night. E. Smegma is present below the glans of the penis. 2. A nurse is providing information to a client who is scheduled for a transrectal ultrasound (TRUS). Which of the following information should the nurse include? A. “This procedure will determine whether you have prostate cancer.” B. “The procedure is contraindicated if you have an allergy to eggs.” C. “Sound waves will be used to create a picture of your prostate.” D. “You should avoid having a bowel movement for 1 hr prior to the procedure.” Application Exercises Key 1. A. CORRECT: Although the PSA level is typically elevated in an older adult male, a PSA level greater than 4 ng/mL warrants additional follow-up. B. CORRECT: An enlarged and nodular prostate is a possible indication of prostate cancer and requires further evaluation. C. CORRECT: A weak urine stream is a manifestation of benign prostatic hyperplasia and warrants follow-up D. Urinating once during the night is an expected finding for an older adult male. E. Smegma is a normal secretion that can accumulate beneath the glans penis. NCLEX® Connection: Health Promotion and Maintenance, Health Screening 2. A. A biopsy or EPCA-2 is used to make the diagnosis of prostate cancer. B. A TRUS is contraindicated if the client has an allergy to latex. C. CORRECT: A transrectal ultrasound creates an image of the prostate using sound waves. D. The provider may prescribe an enema prior to the procedure to decrease the interference of feces with obtaining accurate test results. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests Application Exercises 1. A nurse in a provider’s office is obtaining a history from a client who is undergoing an evaluation for benign prostatic hyperplasia (BPH). The nurse should identify that which of the following findings are indicative of this condition? (Select all that apply.) A. Backache B. Frequent urinary tract infections C. Weight loss D. Hematuria E. Urinary incontinence 2. A nurse is caring for a client who has a new diagnosis of benign prostatic hyperplasia (BPH). The nurse should anticipate a prescription for which of the following medications? A. Oxybutynin B. Diphenhydramine C. Ipratropium D. Tamsulosin 3. A nurse is instructing a client who is scheduled for a transurethral resection of the prostate (TURP) about his postoperative care. Which of the following information should the nurse include in the teaching? A. “You may have a continuous sensation of needing to void even though you have a catheter.” B. “You will be on bed rest for the first 2 days after the procedure.” C. “You will be instructed to limit your fluid intake after the procedure.” D. “Your urine should be clear yellow the evening after the surgery.” 4. A nurse is providing discharge instructions to a client who is postoperative following a TURP. Which of the following instructions should the nurse include? (Select all that apply.) A. Avoid sexual intercourse for 3 months after the surgery. B. If urine appears bloody, stop activity and rest. C. Avoid drinking caffeinated beverages. D. Take a stool softener once a day. E. Treat pain with ibuprofen. Application Exercises Key 1. A. Backache occurs in the presence of prostate cancer that has spread to other areas of the body. B. CORRECT: In the presence of BPH, pressure on urinary structures leads to urinary stasis, which in turn promotes the occurrence of urinary tract infections. C. Weight loss occurs in the presence of prostate cancer. D. CORRECT: Hematuria occurs in the presence of BPH. E. CORRECT: Overflow incontinence occurs in the presence of BPH due to an increased volume of residual urine. NCLEX® Connection: Physiological Adaptation, Pathophysiology 2. A. Oxybutynin is an anticholinergic medication that is used to treat overactive bladder. Anticholinergic medications are contraindicated for a client who has BPH. Oxybutynin causes urinary retention. B. Diphenhydramine is an antihistamine and is contraindicated for a client who has BPH. Diphenhydramine causes urinary retention. C. Ipratropium is an anticholinergic medication used to treat asthma and other respiratory conditions. Ipratropium causes urinary retention. D. CORRECT: Tamsulosin is an alpha-adrenergic receptor antagonist that relaxes the bladder outlet and the prostate gland, which improves urinary flow. NCLEX® Connection: Pharmacological and Parenteral Therapies, Medication Administration 3. A. CORRECT: To reduce the risk of postoperative bleeding, the client will have a catheter with a large balloon that places pressure on the internal sphincter of the bladder. Pressure on the sphincter causes a continuous sensation of needing to void. B. The client is ambulated early in the postoperative period to reduce the risk of deep-vein thrombosis and other complications that occur due to immobility. C. The client is encouraged to increase his fluid intake unless contraindicated by another condition. A liberal fluid intake reduces the risks of urinary tract infection and dysuria. D. The client’s urine is expected to be pink the first 24 hr after surgery. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 4. A. The client should follow the provider’s instructions, which typically includes avoidance of sexual intercourse for 2 to 6 weeks after the surgery. B. CORRECT: Excessive activity can cause recurrence of bleeding. The client should rest to promote reclotting at the incisional site. C. CORRECT: The client should avoid caffeine and other bladder stimulants. D. CORRECT: The client should take a stool softener to keep the stool soft and thus prevent the complication of bleeding at the time of a bowel movement. E. The client should avoid taking nonsteroidal anti-inflammatory drugs because they can cause bleeding. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures Application Exercises 1. A nurse is completing preoperative teaching for a client who is to undergo an arthroscopy to repair a shoulder injury. Which of the following statements should the nurse include? (Select all that apply.) A. “Avoid damage or moisture to the cast on your arm.” B. “Inspect your incision daily for indications of infection.” C. “Apply ice packs to the area for the first 24 hours.” D. “Keep your arm in a dependent position.” E. “Perform isometric exercises.” 2. A nurse is planning care for a client who is postoperative following an arthroscopy of the knee. Which of the following actions should the nurse take? (Select all that apply.) A. Assess color and temperature of the extremity. B. Apply warm compresses to incision sites. C. Place pillows under the extremity. D. Administer analgesic medication. E. Assess pulse and sensation in the foot. 3. A nurse is teaching a client who is going to have a bone scan. Which of the following statements should the nurse include? A. “You will receive an injection of a radioactive isotope when the scanning procedure begins.” B. “You will be inside a tube-like structure during the procedure.” C. “You will need to take radioactive precautions with your urine for 24 hours after the procedure.” D. “You will have to urinate just before the procedure.” 4. A nurse is educating clients at a health fair about dual-energy x- ray absorptiometry (DXA) scans. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. The test requires the use of contrast material. B. The hip and spine are the usual areas the device scans. C. The scan detects osteoarthritis. D. Bone pain can indicate a need for a scan. E. At age 40 years, you should have a baseline scan. 5. A nurse is planning care for a client who will undergo an electromyography (EMG). Which of the following actions should the nurse include in the plan of care? (Select all that apply.) A. Assess for bruising. B. Apply ice to insertion sites. C. Determine whether the client takes a muscle relaxant. D. Instruct the client to flex her muscles during needle insertion. E. Expect swelling, redness, and tenderness at the insertion sites. Application Exercises Key 1. A. The client should wear a sling to immobilize the arm of the affected shoulder to limit activity and promote healing. B. CORRECT: The client should inspect the incision for evidence of infection, such as redness, swelling, or purulent drainage. C. CORRECT: The client should apply ice packs to the affected area for the first 24 hr to reduce swelling and discomfort. D. The client should elevate the affected extremity for 12 to 24 hr to reduce swelling. E. CORRECT: The client should perform the isometric exercises as the provider prescribed and as physical therapist directed. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 2. A. CORRECT: Assessing color and temperature of the affected extremity helps the nurse identify alterations in circulation. B. Cold compresses on the incisional site for the first 24 hr help decrease swelling and pain. C. CORRECT: Elevating the leg will help decrease swelling and pain in the affected extremity. D. CORRECT: Administering analgesic medication helps relieve joint pain in the affected extremity. E. CORRECT: Assessing pulse and sensation of the affected extremity helps the nurse identify alterations in circulation. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems 3. A. The nurse should inform the client that the radioactive isotope is injected through an IV 2 to 3 hr before the scanning. B. The nurse should inform the client that the procedure does not use a tube-like structure as for an MRI. C. The nurse should inform the client that radioactive precautions for his urine are not necessary following the procedure. D. CORRECT: The nurse should inform the client that he will need to urinate prior to the procedure. An empty bladder promotes visualization of the pelvic bones. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 4. A. The nurse should inform the client that a DXA scan does not require contrast material. B. CORRECT: The nurse should inform the client that the most common areas for a DXA scan are the hip and spine for more clear visualization of a large area of bone. C. The nurse should inform the client that a DXA scan detects osteoporosis, not osteoarthritis. D. CORRECT: The nurse should inform the client that bone pain, loss of height, and fractures are findings that can indicate the need for a DXA scan. E. CORRECT: The nurse should inform the client that a baseline scan at age 40 is helpful for comparison with a scan during the postmenopausal period. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 5. A. CORRECT: Some bruising can occur at the needle insertion sites. B. CORRECT: The nurse should apply ice to the insertion sites to prevent hematoma development. C. CORRECT: The nurse should assess the client’s medications to determine whether she takes a muscle relaxant, which can decrease the accuracy of the test results. D. CORRECT: The nurse should ask the client to flex her muscles for an easier insertion of the needle into the muscle. E. The nurse should instruct the client to report swelling, redness, and tenderness at the insertion sites to the provider because this can indicate an infection. NCLEX® Connection: Reduction of Risk Potential, Diagnostic Tests Application Exercises 1. 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 2. 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. 3. 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. 4. 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 5. 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. Application Exercises Key 1. A. Age greater than 70 is not a contraindication for a total joint arthroplasty unless there are comorbidity factors. B. History of cancer is not a contraindication for a total joint arthroplasty unless there are comorbidity factors. C. Previous joint arthroplasty surgery is a contraindication for total joint arthroplasty unless there are comorbidity factors. 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. NCLEX® Connection: Physiological Adaptation, Pathophysiology 2. 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. C. The nurse should place one pillow under the lower calf and foot to cause a slight extension of the knee joint and to prevent flexion contractures. The knee can also rest flat on the bed. D. CORRECT: The nurse should prevent pressure ulcers on the client’s heels by elevating the heels off the bed with a pillow. E. The nurse should apply cold therapy to reduce postoperative swelling. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 3. A. CORRECT: The client should wash the surgical incision daily with soap and water to decrease the risk of infection. B. The client should externally rotate toes to prevent dislocation of the hip prosthesis. 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. D. Bending at the waist places the hip in a position greater than a 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. NCLEX® Connection: Reduction of Risk Potential, Potential for Complications of Diagnostic Tests/Treatments/Procedures 4. A. Skin over the knee that is red can indicate infection and is not an expected finding. 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. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems 5. A. CORRECT: The nurse should encourage the client to donate blood that can be used postoperatively. B. The nurse should have the client sit in a hard back chair to keep the hip at a 90° angle. This prevents dislocation. C. The nurse should avoid turning the client to the operative side to prevent dislocation of the prosthesis. 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. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures Application Exercises 1. A nurse is presenting information to a group of clients at a health fair about measures to reduce the risk of amputation. Which of the follow information should the nurse provide? (Select all that apply.) A. Encourage clients who smoke to consider smoking cessation programs. B. Encourage clients who have diabetes mellitus to maintain blood glucose within the expected reference range. C. Instruct clients to unplug electrical equipment when performing repairs. D. Encourage clients who have vascular disease to maintain good foot care. E. Advise clients to wait 2 hr after taking pain medication before driving. 2. A nurse is assessing an older adult client who has arteriosclerosis and is scheduled for a possible right lower extremity amputation. Which of the following are expected findings in the affected extremity? (Select all that apply.) A. Skin cool to touch from mid-calf to the toes B. Lower leg appearing dusky when client is sitting C. Palpable pounding pedal pulse D. Lack of hair on lower leg E. Blackened areas on several toes 3. A nurse is caring for a client following a below-the-elbow amputation. Which of the following actions should the nurse take? (Select all that apply.) A. Encourage dependent positioning of the residual limb. B. Inspect for presence and amount of drainage. C. Implement shrinkage intervention of the residual limb. D. Wrap the residual limb in a circular manner using gauze. E. Assess for feelings of body image changes. 4. A nurse is caring for a client who had an above-the-knee amputation. The client reports a sharp, stabbing type of phantom pain. Which of the following actions should the nurse take? A. Facilitate counseling services. B. Encourage use of cold therapy. C. Question whether the pain is real. D. Administer an antiepileptic medication. 5. A nurse is preparing a plan of care to prevent a client from developing flexion contractions following a below-the-knee amputation 24 hr ago. Which of the following actions should the nurse include in the plan of care? A. Limit any type of exercise to the residual limb for the first 48 hr after surgery. B. Position the client prone several times each day. C. Wrap the stump in a figure-eight pattern. D. Encourage sitting in a chair during the day. Application Exercises Key 1. A. CORRECT: The nurse should provide information about smoking cessation, which can decrease the development of arteriosclerosis and possible amputation of a lower extremity. B. CORRECT: The nurse should provide information about regulating blood glucose levels within a normal reference range to prevent the development of arteriosclerosis and possible amputation of a lower extremity. C. CORRECT: The nurse should provide information about unplugging electrical equipment when performing repairs to prevent electrocution and injury to an extremity, which can lead to amputation. D. CORRECT: The nurse should provide information about maintaining good foot care to prevent infection, which can result in amputation. E. Driving under the influence of pain medication can lead the client to an accident or injury to an extremity requiring amputation. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 2. A. CORRECT: The client can have coolness of the affected extremity where decreased vascularization starts. B. CORRECT: The affected extremity can become dusky when sitting due to decreased vascularization of the extremity. C. The client will have a lack of or diminished pedal pulse of the affected extremity due to decreased vascularization. D. CORRECT: The client can have decreased hair growth on areas of the affected extremity due to decreased vascularization. E. CORRECT: The client can have blackened areas on several toes suggestive of gangrene due to decreased vascularization to the affected extremity. NCLEX® Connection: Physiological Adaptation, Pathophysiology 3. A. CORRECT: The nurse should place the residual limb in a dependent position to improve circulation to the end of the stump and promote healing. B. CORRECT: The nurse should inspect the residual limb for the presence and amount of drainage to determine early manifestations of infection. C. CORRECT: The nurse should prepare the residual limb to include shrinkage interventions before fitting of the prosthesis. D. The nurse should wrap the residual limb with an elastic bandage in a figure-eight manner to prevent restriction of blood flow before fitting for the prosthesis. E. CORRECT: The nurse should assess for feelings of depression, anger, withdrawal, and grief due to body image changes. NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems 4. A. Counseling services can assist the client to cope with body image changes and is not prescribed for treatment of phantom pain. B. Heat therapy, not cold therapy, to the residual limb is an alternative therapy that the nurse can implement to relieve phantom pain. C. Phantom pain is related to the severed nerve pathways following the amputation. The nurse should not question whether the pain is real. D. CORRECT: An antiepileptic medication can relieve a sharp, stabbing type of phantom pain. NCLEX® Connection: Pharmacological and Parenteral Therapies, Pharmacological Pain Management 5. A. To avoid flexion contractures, the nurse should encourage the client to perform range-of-motion exercise to the residual limb to prevent flexion contractures. B. CORRECT: The nurse should have the client lie prone several times each day for 20 to 30 min to prevent flexion contractures. C. The client can have the residual limb wrapped in a figure eight to prepare for the prosthesis, but this action does not prevent flexion contractures. D. The client can develop flexion contractures by allowing the residual stump to hang in a bent position when sitting for an extended period following the amputation. NCLEX® Connection: Reduction of Risk Potential, Potential for Complications of Diagnostic Tests/Treatments/Procedures Application Exercises 1. 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 2. 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. 3. 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 4. 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 5. 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. Application Exercises Key 1. A. A client who consumes more than three glasses of alcohol each day is at risk for developing osteoporosis because alcohol can increase bone loss. 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. NCLEX® Connection: Physiological Adaptation, Pathophysiology 2. A. The client should have cold therapy applied to the puncture site to decrease bleeding and swelling following the procedure. 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. C. The client should remain in a supine position with bed flat for 1 to 2 hr following the procedure. D. The client should remain in a supine position with bed flat for 1 to 2 hr following the procedure. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures 3. A. White bread is not a calcium-rich food, but it is a good source of carbohydrates. B. CORRECT: White beans should be included in the teaching because they are a good source of calcium. C. White meat of chicken is not a calcium-rich food, but it is a good source of protein. D. White rice is not a calcium-rich food, but it is a good source of carbohydrates. NCLEX® Connection: Basic Care and Comfort, Nutrition and Oral Hydration 4. A. CORRECT: Prednisone affects the absorption and metabolism of calcium and places the client at risk for osteoporosis. B. Weight-bearing activities decrease the risk for osteoporosis due to placing stress on bones, which promotes bone rebuilding and maintenance. 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. NCLEX® Connection: Health Promotion and Maintenance, Health Promotion/Disease Prevention 5. 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. D. The client should avoid walking on icy surfaces during inclement weather to help prevent a fall and bone fracture. E. CORRECT: Good lighting in doorway areas can prevent a fall and bone fracture. NCLEX® Connection: Safety and Infection Control, Home Safety Application Exercises 1. 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.” 2. 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 3. 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 4. 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. 5. 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 Application Exercises Key 1. 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. D. The external fixation device should never be used to lift or move the affected leg, due to the risk of injuring and dislocating the fractured bone. E. The client should report redness, heat, and drainage at the pin sites, which can indicate an infection that can lead to osteomyelitis. NCLEX® Connection: Basic Care and Comfort, Mobility/Immobility 2. A. CORRECT: Altered mental status is an early manifestation of fat emboli. Other manifestations include dyspnea, chest pain, and hypoxemia. B. Reduced bowel sounds is an adverse effect of opioid narcotics and can result in constipation. C. Swelling of the toes distal to the injury is a manifestation of reduced circulation and can be the result of a tight cast. The nurse should elevate the extremity and apply ice. D. Pain with passive movement of the foot distal to the injury is an expected finding. Severe pain or pain unrelieved by narcotics is a manifestation of compartment syndrome. NCLEX® Connection: Basic Care and Comfort, Mobility/Immobility 3. 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. B. Capillary refill of 3 seconds is within the expected reference range. Pallor 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. NCLEX® Connection: Reduction of Risk Potential, Potential for Complications from Surgical Procedures and Health Alterations 4. A. CORRECT: Treatment of osteomyelitis includes continuing antibiotic therapy for 3 months. B. Relief of pain does not indicate that osteomyelitis is resolved, and the client should continue antibiotic therapy as prescribed. C. When performing wound care contact precautions are implemented to prevent spread of the organism. D. The client should monitor and report manifestations of neurovascular compromise, such as paresthesia. NCLEX® Connection: Reduction of Risk Potential, Potential for Complications from Surgical Procedures and Health Alterations 5. A. Skeletal traction is an immobilization device applied surgically to a long bone (femur, or tibia), and cervical spine. It is not used for a hip fracture. 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. C. Halo traction immobilizes the cervical spine when a cervical fracture occurs. D. Bryant’s traction is used for congenital hip dislocation in children. NCLEX® Connection: Reduction of Risk Potential, Therapeutic Procedures Application Exercises 1. 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 2. 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. 3. 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. 4. 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 5. 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. Application Exercises Key 1. A. CORRECT: Heberden’s nodes are enlarged nodules on the distal interphalangeal joints of the hands and feet of a client who has ost