CONCEPTUALIZH
ED
ESI EXIT
QUESTIONS AND RATIONALE
The nurse has completed giving discharge instructions to a client who has had a total joint replacement
(TJR) of the knee with a metal prosthetic system. The nurse determines that the client understands the
instructions if the client makes which statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is norm
-C
alO
."RRECT ANSW-3ER
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers of the
presence of the metal implant because certain tests and procedures will need to be avoided. After total
knee replacement, the client should report signnsdasymptoms of infection and any changes in the
shape of the knee. These could indicate developing complications. With a metal implant, the client may
be on anticoagulant therapy and should report adverse effects of this therapy, including bleeding from a
variety of sources, and the client will need antibiotic prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse
should suspect impairment |with |the |neurovascultaartuss |of |the |client's |casted |extremity |if |which
findings |are |noted? |Select |all |that |apply.
1.Capillary |refill |is |less |than |3 |seconds |2.Pulses |present |and |with |swollen, |pink
|fingers|3.Client |report |of |severe, |deep, |unrelenting |pain
4. Client |report |of |pani |as |nurse |assesses |finger |movement
5. Client |report |of |numbness |and |tingling |sensation |in |the |fing
- |C
erO
s|RRECT |ANSW-3E,R4, |5
The |pressure |in |compartment |syndrome, |if |unrelieved, |will |cause |permanent |damage |to |nerve |and
|muscle |tissue |distal |to |the |prseusre. |Circulatory |damage |may |result |in |necrosis. |Nerve |and |muscle
|damage |may |result |in |permanent |contractures, |deformity |of |the |extremity, |and |functional
|impairment.
Normal |capillary |refill |time |is |3 |seconds |or |less. |Pink |appearance |and |a |pulse |indeicqauta
ete
adblood
flow; |swelling |is |expected |after |a |fracture. |Client |report |of |severe, |deep, |unrelenting |pain; |client |report
,when |you |examine |them. |What |should |you |do? |- |CORRECT |ANSWER |-Ask |how
|she|acquired |them.
A |58-year-old |man |comes |to |your |office |complaining |of |bilateral |back |pain |that |now
|awakens |him |at |night. |This |has |been |steadily |increasing |for |the |past |2 |months.
|Which|one |of |the |following |is |the |most |reassuring |in |this |patient |with |back |pain? |-
|CORRECT|ANSWER |-Pain |that |is |bilateral
The |Phalen's |test |is |used |to |evaluate: |- |CORRECT |ANSWER |-inflammation |of
|the|median |nerve
Which |of |the |following |would |lead |you |to |suspect |a |hydrocele |versus |other |causes
|of|scrotal |swelling? |- |CORRECT |ANSWER |-A |positive |transillumination |test
You are examining a newborn and note that the right testicle is not in the scrotum. What
,Which |of |the |following |conditions |involves |a |tight |prepuce |which, |once |retracted,
|cannot|be |returned? |- |CORRECT |ANSWER |-Paraphimosis
A |12-year-old |is |brought |to |your |clinic |by |his |father. |He |was |taught |in |his |health |class
|at |school |to |do |monthly |testicular |self-examinations. |Yesterday, |when |he |felt |his |left
|testicle, |it |was |enlarged |and |tender. |He |isn't |sure |if |he |has |had |burning |with |urination
|and |he |says |he |has |never |had |sexual |intercourse. |He |has |had |a |sore |throat, |cough,
|and|runny |nose |for |the |last |three |days. |His |past |medical |history |is |significant |for |a
|tonsillectomy |as |a |small |child. |His |father |has |high |blood |pressure |and |his |mother |is
|healthy. |On |examination, |you |see |a |child |in |no |acute |distress. |His |temperature |is
|100.8 |and |his |blood |pressure |and |pulse |are |unremarkable. |On |visualization |of |his
|penis, |he |is |uncircumcised |and |has |no |lesions |or |discharge. |His |scrotum |is |red |and
|tense |on |the |left|and |normal |appearing |on |the |right. |Palpating |his |left |testicle |reveals
|a |mildly |sore |swollen |testicle. |The |right |testicle |is |unremarkable. |An |examin |-
|CORRECT |ANSWER |- |Acute |orchitis
The |most |common |cause |of |cancer |deaths |in |males |is: |- |CORRECT |ANSWER |-
Colon|cancer
Important |techniques |in |performing |the |rectal |examination |include |which |of
|the|following? |- |CORRECT |ANSWER |-All |of |the |above
Jim |is |a |47-year-old |man |who |is |having |difficulties |with |sexual |function. |He |is
|recently|separated |from |his |wife |of |20 |years. |He |notes |that |he |has |early |morning |erections
|but|otherwise |cannot |function. |Which |of |the |following |is |a |likely |cause |for |his |problem? |-
|CORRECT |ANSWER |-Psychological |issues
Which |of |the |following |is |true |of |human |papilloma |virus |(HPV) |infection? |-
|CORRECT|ANSWER |-It |commonly |resolves |spontaneously |in |one |to |two |years.
Which |of |the |following |is |the |most |effective |pattern |of |palpation |for |breast
|cancer? |-|CORRECT |ANSWER |-Beginning |at |the |nipple, |make |an |ever-enlarging
|spiral.
A |14-year-old |junior |high |school |student |is |brought |in |by |his |mother |and |father
|because |he |seems |to |be |developing |breasts. |The |mother |is |upset |because |she |read
|on |the |Internet |that |smoking |marijuana |leads |to |breast |enlargement |in |males. |The
|young |man |adamantly |denies |using |any |tobacco, |alcohol, |or |drugs. |He |has |recently
|noticed |changes |in |his |penis, |testicles, |and |pubic |hair |pattern. |Otherwise, |his |past
|medical |history |is |unremarkable. |His |parents |are |both |in |good |health. |He |has |two
|older |brothers |who |never |had |this |problem. |On |examination, |you |see |a |mildly
|overweight |teenager |with|enlarged |breast |tissue |that |is |slightly |tender |on |both |sides.
|Otherwise, |his |examination |is |normal. |He |is |agreeable |to |taking |a |drug |test. |What |is
|the |most |likely |cause |of |his |gynecomastia? |- |CORRECT |ANSWER |-Imbalance |of
|hormones |of |puberty
Which |of |the |following |represents |metrorrhagia? |- |CORRECT |ANSWER |-
Bleeding|between |periods
, What |does |a |KOH |(potassium |hydroxide) |prep |help |the |nurse |practitioner
|diagnose? |-|CORRECT |ANSWER |-Yeast |infections
Abby |is |a |newly |married |woman |who |is |unable |to |have |intercourse |because |of
|vaginismus. |Which |of |the |following |is |true? |- |CORRECT |ANSWER |-
Psychosocial|reasons |may |cause |this |condition.
A |30-year-old |man |notices |a |firm, |2-cm |mass |under |his |areola. |He |has |no |other
|symptoms |and |no |diagnosis |of |breast |cancer |in |his |first-degree |relatives. |What |is
|the|most |likely |diagnosis? |- |CORRECT |ANSWER |-Breast |tissue
Which |of |the |following |is |true |regarding |breast |self-examination? |- |CORRECT |ANSWER
-A |high |proportion |of |breast |masses |are |detected |by |breast |self-examination.
A |23-year-old |computer |programmer |comes |to |your |office |for |an |annual |examination.
|She |has |recently |become |sexually |active |and |wants |to |be |placed |on |birth |control.
|Her |only |complaint |is |that |the |skin |in |her |armpits |has |become |darker. |She |states |it
|looks |like|dirt, |and |she |scrubs |her |skin |nightly |with |soap |and |water |but |the |color
|stays. |Her |past |medical |symptoms |consist |of |acne |and |mild |obesity. |Her |periods |have
|been |irregular |for|3 |years. |Her |mother |has |type |2 |diabetes, |and |her |father |has |high
|blood |pressure. |The |patient |denies |using |tobacco |but |has |four |to |five |drinks |on
|Friday |and |Saturday |nights. |She |denies |any |illegal |drug |use. |On |examination, |you
|see |a |mildly |obese |female |who |is|breathing |comfortably. |Her |vital |signs |are
|unremarkable. |Looking |under |her |axilla, |you |see |dark, |velvet-like |skin. |Her |annual
|examination |is |otherwise |unremarkable. |What |disorder |of |the |breast |or |axilla |is |she
|most |likely |to |have? |- |CORRECT |ANSWER |- |Acanthosis |nigricans
Which |of |the |following |is |true |of |women |who |have |had |a |unilateral |mastectomy? |-
|CORRECT |ANSWER |-They |should |be |examined |carefully |along |the |surgical |scar
|for|masses.
A 76-year-old retired farmer comes to your office complaining of abdominal pain,
constipation, and a low-grade fever for about three days. He denies any nausea,
vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of
popcorn at the movies with his grandson, three days before his symptoms began. He
denies any other recent illnesses. His past medical history is significant for coronary
artery disease and high blood pressure. He has been married for over fifty years. He
denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father
had a stroke. On examination, he appears his stated age and is in no acute distress. His
temperature is 100.9 degrees and his other vital signs are unremarkable. His head,
cardiac, a
ED
ESI EXIT
QUESTIONS AND RATIONALE
The nurse has completed giving discharge instructions to a client who has had a total joint replacement
(TJR) of the knee with a metal prosthetic system. The nurse determines that the client understands the
instructions if the client makes which statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is norm
-C
alO
."RRECT ANSW-3ER
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers of the
presence of the metal implant because certain tests and procedures will need to be avoided. After total
knee replacement, the client should report signnsdasymptoms of infection and any changes in the
shape of the knee. These could indicate developing complications. With a metal implant, the client may
be on anticoagulant therapy and should report adverse effects of this therapy, including bleeding from a
variety of sources, and the client will need antibiotic prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse
should suspect impairment |with |the |neurovascultaartuss |of |the |client's |casted |extremity |if |which
findings |are |noted? |Select |all |that |apply.
1.Capillary |refill |is |less |than |3 |seconds |2.Pulses |present |and |with |swollen, |pink
|fingers|3.Client |report |of |severe, |deep, |unrelenting |pain
4. Client |report |of |pani |as |nurse |assesses |finger |movement
5. Client |report |of |numbness |and |tingling |sensation |in |the |fing
- |C
erO
s|RRECT |ANSW-3E,R4, |5
The |pressure |in |compartment |syndrome, |if |unrelieved, |will |cause |permanent |damage |to |nerve |and
|muscle |tissue |distal |to |the |prseusre. |Circulatory |damage |may |result |in |necrosis. |Nerve |and |muscle
|damage |may |result |in |permanent |contractures, |deformity |of |the |extremity, |and |functional
|impairment.
Normal |capillary |refill |time |is |3 |seconds |or |less. |Pink |appearance |and |a |pulse |indeicqauta
ete
adblood
flow; |swelling |is |expected |after |a |fracture. |Client |report |of |severe, |deep, |unrelenting |pain; |client |report
,when |you |examine |them. |What |should |you |do? |- |CORRECT |ANSWER |-Ask |how
|she|acquired |them.
A |58-year-old |man |comes |to |your |office |complaining |of |bilateral |back |pain |that |now
|awakens |him |at |night. |This |has |been |steadily |increasing |for |the |past |2 |months.
|Which|one |of |the |following |is |the |most |reassuring |in |this |patient |with |back |pain? |-
|CORRECT|ANSWER |-Pain |that |is |bilateral
The |Phalen's |test |is |used |to |evaluate: |- |CORRECT |ANSWER |-inflammation |of
|the|median |nerve
Which |of |the |following |would |lead |you |to |suspect |a |hydrocele |versus |other |causes
|of|scrotal |swelling? |- |CORRECT |ANSWER |-A |positive |transillumination |test
You are examining a newborn and note that the right testicle is not in the scrotum. What
,Which |of |the |following |conditions |involves |a |tight |prepuce |which, |once |retracted,
|cannot|be |returned? |- |CORRECT |ANSWER |-Paraphimosis
A |12-year-old |is |brought |to |your |clinic |by |his |father. |He |was |taught |in |his |health |class
|at |school |to |do |monthly |testicular |self-examinations. |Yesterday, |when |he |felt |his |left
|testicle, |it |was |enlarged |and |tender. |He |isn't |sure |if |he |has |had |burning |with |urination
|and |he |says |he |has |never |had |sexual |intercourse. |He |has |had |a |sore |throat, |cough,
|and|runny |nose |for |the |last |three |days. |His |past |medical |history |is |significant |for |a
|tonsillectomy |as |a |small |child. |His |father |has |high |blood |pressure |and |his |mother |is
|healthy. |On |examination, |you |see |a |child |in |no |acute |distress. |His |temperature |is
|100.8 |and |his |blood |pressure |and |pulse |are |unremarkable. |On |visualization |of |his
|penis, |he |is |uncircumcised |and |has |no |lesions |or |discharge. |His |scrotum |is |red |and
|tense |on |the |left|and |normal |appearing |on |the |right. |Palpating |his |left |testicle |reveals
|a |mildly |sore |swollen |testicle. |The |right |testicle |is |unremarkable. |An |examin |-
|CORRECT |ANSWER |- |Acute |orchitis
The |most |common |cause |of |cancer |deaths |in |males |is: |- |CORRECT |ANSWER |-
Colon|cancer
Important |techniques |in |performing |the |rectal |examination |include |which |of
|the|following? |- |CORRECT |ANSWER |-All |of |the |above
Jim |is |a |47-year-old |man |who |is |having |difficulties |with |sexual |function. |He |is
|recently|separated |from |his |wife |of |20 |years. |He |notes |that |he |has |early |morning |erections
|but|otherwise |cannot |function. |Which |of |the |following |is |a |likely |cause |for |his |problem? |-
|CORRECT |ANSWER |-Psychological |issues
Which |of |the |following |is |true |of |human |papilloma |virus |(HPV) |infection? |-
|CORRECT|ANSWER |-It |commonly |resolves |spontaneously |in |one |to |two |years.
Which |of |the |following |is |the |most |effective |pattern |of |palpation |for |breast
|cancer? |-|CORRECT |ANSWER |-Beginning |at |the |nipple, |make |an |ever-enlarging
|spiral.
A |14-year-old |junior |high |school |student |is |brought |in |by |his |mother |and |father
|because |he |seems |to |be |developing |breasts. |The |mother |is |upset |because |she |read
|on |the |Internet |that |smoking |marijuana |leads |to |breast |enlargement |in |males. |The
|young |man |adamantly |denies |using |any |tobacco, |alcohol, |or |drugs. |He |has |recently
|noticed |changes |in |his |penis, |testicles, |and |pubic |hair |pattern. |Otherwise, |his |past
|medical |history |is |unremarkable. |His |parents |are |both |in |good |health. |He |has |two
|older |brothers |who |never |had |this |problem. |On |examination, |you |see |a |mildly
|overweight |teenager |with|enlarged |breast |tissue |that |is |slightly |tender |on |both |sides.
|Otherwise, |his |examination |is |normal. |He |is |agreeable |to |taking |a |drug |test. |What |is
|the |most |likely |cause |of |his |gynecomastia? |- |CORRECT |ANSWER |-Imbalance |of
|hormones |of |puberty
Which |of |the |following |represents |metrorrhagia? |- |CORRECT |ANSWER |-
Bleeding|between |periods
, What |does |a |KOH |(potassium |hydroxide) |prep |help |the |nurse |practitioner
|diagnose? |-|CORRECT |ANSWER |-Yeast |infections
Abby |is |a |newly |married |woman |who |is |unable |to |have |intercourse |because |of
|vaginismus. |Which |of |the |following |is |true? |- |CORRECT |ANSWER |-
Psychosocial|reasons |may |cause |this |condition.
A |30-year-old |man |notices |a |firm, |2-cm |mass |under |his |areola. |He |has |no |other
|symptoms |and |no |diagnosis |of |breast |cancer |in |his |first-degree |relatives. |What |is
|the|most |likely |diagnosis? |- |CORRECT |ANSWER |-Breast |tissue
Which |of |the |following |is |true |regarding |breast |self-examination? |- |CORRECT |ANSWER
-A |high |proportion |of |breast |masses |are |detected |by |breast |self-examination.
A |23-year-old |computer |programmer |comes |to |your |office |for |an |annual |examination.
|She |has |recently |become |sexually |active |and |wants |to |be |placed |on |birth |control.
|Her |only |complaint |is |that |the |skin |in |her |armpits |has |become |darker. |She |states |it
|looks |like|dirt, |and |she |scrubs |her |skin |nightly |with |soap |and |water |but |the |color
|stays. |Her |past |medical |symptoms |consist |of |acne |and |mild |obesity. |Her |periods |have
|been |irregular |for|3 |years. |Her |mother |has |type |2 |diabetes, |and |her |father |has |high
|blood |pressure. |The |patient |denies |using |tobacco |but |has |four |to |five |drinks |on
|Friday |and |Saturday |nights. |She |denies |any |illegal |drug |use. |On |examination, |you
|see |a |mildly |obese |female |who |is|breathing |comfortably. |Her |vital |signs |are
|unremarkable. |Looking |under |her |axilla, |you |see |dark, |velvet-like |skin. |Her |annual
|examination |is |otherwise |unremarkable. |What |disorder |of |the |breast |or |axilla |is |she
|most |likely |to |have? |- |CORRECT |ANSWER |- |Acanthosis |nigricans
Which |of |the |following |is |true |of |women |who |have |had |a |unilateral |mastectomy? |-
|CORRECT |ANSWER |-They |should |be |examined |carefully |along |the |surgical |scar
|for|masses.
A 76-year-old retired farmer comes to your office complaining of abdominal pain,
constipation, and a low-grade fever for about three days. He denies any nausea,
vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of
popcorn at the movies with his grandson, three days before his symptoms began. He
denies any other recent illnesses. His past medical history is significant for coronary
artery disease and high blood pressure. He has been married for over fifty years. He
denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father
had a stroke. On examination, he appears his stated age and is in no acute distress. His
temperature is 100.9 degrees and his other vital signs are unremarkable. His head,
cardiac, a
