Detailed Answer Ke4
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1.44A44nurse44is44reviewing44the44cause44of44gout44with44a44group44of44nurses.44Which44of44the44following44stateme
nts44should44the44nurse44make?
A. "Uric44acid44levels44drop44and44calcium44forms44precipitate."
Rationale:44With44gout,44clients44 have44hyperuricemia,44rather44than44 a44reduction44 in44uric44 acid.
B. "Tophi44form44in44the44kidneys44and44they44impair44the44excretion44of44uric44acid."
Rationale:44Tophi,44or44deposits44in44tissues44near44a44joint,44develop44in44chronic,44late-
stage44gout.44They44are44not44part44of44the44primary44disease44process.
C. "The44intra-articular44deposition44of44urate44crystals44causes44inflammation."
Rationale:44Gout,44or44gouty44arthritis,44develops44when44urate44crystals44deposit44in44joints44and44tissues
44and44cause44inflammation44and44pain.
D. "Articular44cartilage44thins,44leading44to44splitting44and44fragmentation."
Rationale:44Gout44does44not44thin44and44fragment44cartilage.
2.44A44nurse44is44teaching44a44group44of44clients44about44osteoarthritis.44Which44of44the44following44reco
mmendations44should44thenurse44include44in44the44teaching?
A. Use44 Echinacea44 to44 manage44 joint4 4 pain.
Rationale:44The4 4 nurse4 4 may4 4 include4 4 the4 4 use4 4 of4 4 complementary4 4 and4 4 alternative4 4 therapi
es4 4 in4 4 the4 4 teaching.44However,44Echinacea44is44used44for44the44treatment44of44the44com
mon44cold,44not44osteoarthritis.44Alterna4 4 tivetherapies44that44are44used44for44osteoarthritis44i
nclude44glucosamine,44chondroitin,44and44topical44cap44saicin.
B. Apply44 ice44 to44 the44 joint44 before44 exercising.
Rationale:44The4 4 nurse4 4 should4 4 recommend4 4 that4 4 the4 4 clients4 4 begin4 4 exercising4 4 im
mediately4 4 followi44ng4 4 theapplication44of44heat.44This44reduces44pain44and44improv
es44mobility,44allowing44for44incr4 4 eased44range-of-
motion44during44exercises.44Cold44application44may44be44applied44following44exercis
e44todecrea44se44discomfort44and44inflammation.
C. Maintain4 4 a44 recommended44 body44 weight.
Rationale:4 4 Obesity44is4 4 a44risk44factor44for4 4 the44development44 of4 4 osteoarthritis.4 4 Maintenance4
4 of4 4 an4 4 ideal4 4 weig44ht4 4 isone4 4 way44a44client44can44prevent44added4 4 wear4 4 and4 4 t
ear4 4 on44joints4 4 and4 4 promote44overall44joint44health.
D. Reduce4 4 the4 4 amount44 of4 4 purine44 in44 the44 diet.
Rationale:44The44nurse44should44recognize44that4 4 limiting44purine44in4 4 the4 4 diet,44which44is44often44fou
nd4 4 in4 4 organ44me44ats,is44recommended44for44clients44who44have44gout.
3.44A4 4 nurse4 4 is4 4 caring4 4 for4 4 a4 4 client4 4 who4 4 has4 4 had4 4 a4 4 myocardial4 4 infarction.4 4 Upon4 4 his4 4 first4 4 v
isit4 4 to4 4 cardiac4 4 rehabilitatio44n,4 4 hetells4 4 the4 4 nurse4 4 that4 4 he4 4 doesn't4 4 understand4 4 why44he4 4 need
s4 4 to4 4 be4 4 there4 4 because4 4 there4 4 is4 4 nothing4 4 more4 4 to44do,44as44the
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,Detailed Answer Ke4
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damage44 is44 done.44Which44 of44 the44 following4 4 is44 the4 4 correcttynursing44 response?
A. "Cardiac44rehabilitation4 4 cannot44undo44the44damage44to4 4 your44heart4 4 but44it44can44help4 4 you44get
44back4 4 to44your44prev44iouslevel44of44activity44safely."
Rationale:44With44this44response,44the44nurse44uses44the44therapeutic44communication44technique4
4of44presentingr44eality44by44indicating44her44perception44of44the44situation44for44the44clie
nt.
B. "It’s4 4 not44 unusual44 to44 feel44 that4 4 way44at44 first,44 but44 once4 4 you44 learn44 the44 routine,4 4 you’ll44 enjoy44it."
Rationale:44With4 4 this4 4 response,4 4 the4 4 nurse4 4 illustrates4 4 the4 4 nontherapeutic4 4 communication4
4 technique4 4 of4 4 giv44ingreassurance,44thus44discouraging44the44client44from44further44comm
unication.
C. "Exercise4 4 is44 good44 for4 4 you44 and44 good44 for4 4 your44 heart."
Rationale:44With4 4 this4 4 response,4 4 the4 4 nurse4 4 illustrates4 4 the4 4 nontherapeutic4 4 communication4 4 tec
hniques4 4 ofdis44agreeing44and44giving44advice.
D. "Your44 doctor44 is44 the44 expert44 here,44 and44 I’m4 4 sure44 he44 would44 only44recommend44 what44 is44 best44 for4
4 you."
Rationale:44With4 4 this4 4 response,4 4 the4 4 nurse4 4 illustrates4 4 the4 4 nontherapeutic4 4 communication4
4 technique4 4 ofdef44ending.
4.44A44 nurse4 4 is4 4 caring4 4 for4 4 a44client4 4 who4 4 has4 4 heart4 4 failure4 4 and4 4 a4 4 potassium4 4 level44 of4 4 2.444mEq/L
.44 The44 nurse44should44 id44entifyywhich44of44the44following44medications4 4 as44the44cause44of44the4 4 client’s44lo
w44potassium4 4 level?
A. Furosemide
Rationale:4 4 Furosemide44 is44 a44 loop44 (high-
ceiling)44diuretic44that44inhibits44the44reabsorption44of44sodium44and44chlorideand44results44i
n44diuresis,44wh44ich44decreases44potassium44through44excretion44in44the44distal44nephrons.
Hypokalemia44 is44 an44 adverse4 4 effect44 of44 furosemide.
B. Nitroglycerin
Rationale:44A44potassium44level44of442.444mEq/L44is44not44an44adverse44effect44of44nitroglycerin.44Nitrog
lycerin44is44a tvy 44 asod44ilator44medication44to44treat44angina.
C. Metoprolol
Rationale:4 4 A44potassium4 4 level44of4 4 2.444mEq/L44 is4 4 not44an44 adverse44effect44of44met
oprolol.44 Metoprolol44is44abeta-
blocker44 that44 slows4 4 the4 4 heart44 rate44 and44 improves44 contractility44of4 4 the44 heart44 muscle.
D. Spironolactone
Rationale:44 Spironolactone44is44 a44potassium-
sparing44diuretic44medication;44 therefore,44 hyperkalemia44is44 anadverse44 effect44 of4 4 this44 medica
tion.
5.44A4 4 nurse4 4 is4 4 caring4 4 for4 4 a4 4 client4 4 who4 4 is4 4 postoperative4 4 following4 4 an4 4 open4 4 reduction4 4 internal4
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,Detailed Answer Ke4
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4 fixation4 4 (ORIF)4 4 of4 4 a4 4 fem44ur4 4 fracture.44Which44of44the44following4 4 parameters44should44the44nurse4 4 in
clude4 4 in4 4 the44evaluation44of4 4 the44neurovascular4 4 st44atus44ofthe44client's44affected44extremity?44(Select44al
l44that44apply.)
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, Detailed Answer Ke4
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A. Color
B. Temperature
C. Ecchymosis
D. Skin44 integrity
E. Sensation
Rationale:4 4 Color4 4 is4 4 correct.4 4 Clients4 4 who4 4 have4 4 sustained4 4 trauma4 4 to4 4 an4 4 extremity,4 4 suc
h4 4 as4 4 a4 4 fracture,4 4 are44at44increased44risk44for44neurovascular44compromise.44The44nurs
e44should44check4 4 the44color44of44the44clie4 4 nt's4 4 affected4 4 extremity4 4 as4 4 part4 4 of4 4 this
4 4 assessment.4 4 The4 4 nurse4 4 should4 4 identify4 4 pallor4 4 or4 4 cyanosi44s4 4 of4 4 theextremity4 4
as4 4 an4 4 indication4 4 of4 4 peripheral4 4 neurovascular4 4 dysfunction4 4 and4 4 should4 4 notify4 4 t4
4he4 4 provider.Temperature4 4 is4 4 correct.4 4 Clients4 4 who4 4 have4 4 sustained4 4 trauma4 4 to4 4 a
n4 4 extremity,4 4 such44as4 4 a44fracture,4 4 are44at44increased44risk44for4 4 neurovascular4 4 comp
romise.44The44nurse44should44monitor44the4 4 temperature4 4 of4 4 the4 4 extremity4 4 as4 4 a4 4 par
t4 4 of4 4 this4 4 assessment4 4 and4 4 identify4 4 skin4 4 thattyis4 4 cool4 4 o44r4 4 cold4 4 to4 4 the4 4 touch
4 4 as4 4 having4 4 decreased4 4 perfusion4 4 to4 4 the4 4 tissues4 4 of4 4 the4 4 extremity,4 4 which4 4 is4 4
an44indication4 4 ofperipheral4 4 neurovascular4 4 dysfunction.4 4 The4 4 nurse4 4 should4 4 report4 4
skin4 4 that4 4 is4 4 cool4 4 t44o44the44touch44to44the44provider.Ecchymosis44is44incorrect.44Ecchy
mosis,44or44bruising,44is44an44expected44f4 4 inding4 4 with44leg44injuries4 4 and4 4 is44not44a44c
omponent44of4 4 a44neurovascular4 4 check.Skin44integrity44is44inc44orrect.4 4 While4 4 the4 4 nurs
e4 4 should4 4 assess4 4 the4 4 incision4 4 of4 4 a4 4 client4 4 who4 4 is4 4 postoperative4 4 following44a
n4 4 open4 4 reduction4 4 and4 4 internal4 4 fixation4 4 of4 4 the4 4 femur,4 4 it4 4 is4 4 not4 4 a4 4 componen
t4 4 of4 4 a4 4 neurovascula44r4 4 check.Sensation4 4 is4 4 correct.44Clients4 4 who44have4 4 sustained
4 4 trauma44to44an44extremity,4 4 such44as4 4 a44f44racture,44are44at44increased44risk44for44neur
ovascular44compromise.44The44nurse44should44assess44the44cli4 4 ent's44extremity44for44num
bnessor44tingling.44The44nurse44should44recognize44diminished44pain44or44pares4 4 thesia44as
44an44indication44of44damage44to44the44nerves44or44peripheral44neurovascular44dysfunction44
and4 4 should44report44it44to44the44provider.
6.44A44nurse44is44monitoring44a44client44following44a44thoracentesis.44The44nurse44should44identify44which44of4 4 the
44follo4 4 wingmanifestations44as44a44complication44and44contact44the44provider44immediately?
A. Serosanguineous44 drainage44 from4 4 the44puncture44site
Rationale:44A44small44amounttyof44serosanguineous44drainage44attythe44puncture44site44is44expected44aft
er44athoracent44esis.
B. Discomfort44 at44 the44 puncture4 4 site
Rationale:44 Mild4 4 discomfort4 4 at4 4 the4 4 puncture4 4 site4 4 is4 4 expected4 4 after4 4 a4 4 thoracentesis.
C. Increased44 heart44 rate
Rationale:44Clients44are44at44risk44for44developing44pulmonary44edema44or44cardiovascular44distress44du
e44mediastinalc44ontent4 4 shift4 4 after4 4 the4 4 aspiration4 4 of4 4 a4 4 large4 4 amount4 4 of4 4 fluid4 4 f
rom4 4 the44client's4 4 pleural4 4 space.
Therefore,44the44client44may44experience44an44increase44in44heart44and44respiratory44rate,44al
ong44with44co4 4 ughing44with44blood-
tinged44frothy44sputum,44and44tightness44in44the44chest.44These44findings44requirenotification
44of44the44prov44ider44immediately.
D. Decreased44temperature
Rationale:4 4 Infection44is44possible44after44any44invasive44procedure;44however,44it44takes44tim
Page4 4
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ty ty
4y Medical Surgical,
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A
1.44A44nurse44is44reviewing44the44cause44of44gout44with44a44group44of44nurses.44Which44of44the44following44stateme
nts44should44the44nurse44make?
A. "Uric44acid44levels44drop44and44calcium44forms44precipitate."
Rationale:44With44gout,44clients44 have44hyperuricemia,44rather44than44 a44reduction44 in44uric44 acid.
B. "Tophi44form44in44the44kidneys44and44they44impair44the44excretion44of44uric44acid."
Rationale:44Tophi,44or44deposits44in44tissues44near44a44joint,44develop44in44chronic,44late-
stage44gout.44They44are44not44part44of44the44primary44disease44process.
C. "The44intra-articular44deposition44of44urate44crystals44causes44inflammation."
Rationale:44Gout,44or44gouty44arthritis,44develops44when44urate44crystals44deposit44in44joints44and44tissues
44and44cause44inflammation44and44pain.
D. "Articular44cartilage44thins,44leading44to44splitting44and44fragmentation."
Rationale:44Gout44does44not44thin44and44fragment44cartilage.
2.44A44nurse44is44teaching44a44group44of44clients44about44osteoarthritis.44Which44of44the44following44reco
mmendations44should44thenurse44include44in44the44teaching?
A. Use44 Echinacea44 to44 manage44 joint4 4 pain.
Rationale:44The4 4 nurse4 4 may4 4 include4 4 the4 4 use4 4 of4 4 complementary4 4 and4 4 alternative4 4 therapi
es4 4 in4 4 the4 4 teaching.44However,44Echinacea44is44used44for44the44treatment44of44the44com
mon44cold,44not44osteoarthritis.44Alterna4 4 tivetherapies44that44are44used44for44osteoarthritis44i
nclude44glucosamine,44chondroitin,44and44topical44cap44saicin.
B. Apply44 ice44 to44 the44 joint44 before44 exercising.
Rationale:44The4 4 nurse4 4 should4 4 recommend4 4 that4 4 the4 4 clients4 4 begin4 4 exercising4 4 im
mediately4 4 followi44ng4 4 theapplication44of44heat.44This44reduces44pain44and44improv
es44mobility,44allowing44for44incr4 4 eased44range-of-
motion44during44exercises.44Cold44application44may44be44applied44following44exercis
e44todecrea44se44discomfort44and44inflammation.
C. Maintain4 4 a44 recommended44 body44 weight.
Rationale:4 4 Obesity44is4 4 a44risk44factor44for4 4 the44development44 of4 4 osteoarthritis.4 4 Maintenance4
4 of4 4 an4 4 ideal4 4 weig44ht4 4 isone4 4 way44a44client44can44prevent44added4 4 wear4 4 and4 4 t
ear4 4 on44joints4 4 and4 4 promote44overall44joint44health.
D. Reduce4 4 the4 4 amount44 of4 4 purine44 in44 the44 diet.
Rationale:44The44nurse44should44recognize44that4 4 limiting44purine44in4 4 the4 4 diet,44which44is44often44fou
nd4 4 in4 4 organ44me44ats,is44recommended44for44clients44who44have44gout.
3.44A4 4 nurse4 4 is4 4 caring4 4 for4 4 a4 4 client4 4 who4 4 has4 4 had4 4 a4 4 myocardial4 4 infarction.4 4 Upon4 4 his4 4 first4 4 v
isit4 4 to4 4 cardiac4 4 rehabilitatio44n,4 4 hetells4 4 the4 4 nurse4 4 that4 4 he4 4 doesn't4 4 understand4 4 why44he4 4 need
s4 4 to4 4 be4 4 there4 4 because4 4 there4 4 is4 4 nothing4 4 more4 4 to44do,44as44the
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,Detailed Answer Ke4
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damage44 is44 done.44Which44 of44 the44 following4 4 is44 the4 4 correcttynursing44 response?
A. "Cardiac44rehabilitation4 4 cannot44undo44the44damage44to4 4 your44heart4 4 but44it44can44help4 4 you44get
44back4 4 to44your44prev44iouslevel44of44activity44safely."
Rationale:44With44this44response,44the44nurse44uses44the44therapeutic44communication44technique4
4of44presentingr44eality44by44indicating44her44perception44of44the44situation44for44the44clie
nt.
B. "It’s4 4 not44 unusual44 to44 feel44 that4 4 way44at44 first,44 but44 once4 4 you44 learn44 the44 routine,4 4 you’ll44 enjoy44it."
Rationale:44With4 4 this4 4 response,4 4 the4 4 nurse4 4 illustrates4 4 the4 4 nontherapeutic4 4 communication4
4 technique4 4 of4 4 giv44ingreassurance,44thus44discouraging44the44client44from44further44comm
unication.
C. "Exercise4 4 is44 good44 for4 4 you44 and44 good44 for4 4 your44 heart."
Rationale:44With4 4 this4 4 response,4 4 the4 4 nurse4 4 illustrates4 4 the4 4 nontherapeutic4 4 communication4 4 tec
hniques4 4 ofdis44agreeing44and44giving44advice.
D. "Your44 doctor44 is44 the44 expert44 here,44 and44 I’m4 4 sure44 he44 would44 only44recommend44 what44 is44 best44 for4
4 you."
Rationale:44With4 4 this4 4 response,4 4 the4 4 nurse4 4 illustrates4 4 the4 4 nontherapeutic4 4 communication4
4 technique4 4 ofdef44ending.
4.44A44 nurse4 4 is4 4 caring4 4 for4 4 a44client4 4 who4 4 has4 4 heart4 4 failure4 4 and4 4 a4 4 potassium4 4 level44 of4 4 2.444mEq/L
.44 The44 nurse44should44 id44entifyywhich44of44the44following44medications4 4 as44the44cause44of44the4 4 client’s44lo
w44potassium4 4 level?
A. Furosemide
Rationale:4 4 Furosemide44 is44 a44 loop44 (high-
ceiling)44diuretic44that44inhibits44the44reabsorption44of44sodium44and44chlorideand44results44i
n44diuresis,44wh44ich44decreases44potassium44through44excretion44in44the44distal44nephrons.
Hypokalemia44 is44 an44 adverse4 4 effect44 of44 furosemide.
B. Nitroglycerin
Rationale:44A44potassium44level44of442.444mEq/L44is44not44an44adverse44effect44of44nitroglycerin.44Nitrog
lycerin44is44a tvy 44 asod44ilator44medication44to44treat44angina.
C. Metoprolol
Rationale:4 4 A44potassium4 4 level44of4 4 2.444mEq/L44 is4 4 not44an44 adverse44effect44of44met
oprolol.44 Metoprolol44is44abeta-
blocker44 that44 slows4 4 the4 4 heart44 rate44 and44 improves44 contractility44of4 4 the44 heart44 muscle.
D. Spironolactone
Rationale:44 Spironolactone44is44 a44potassium-
sparing44diuretic44medication;44 therefore,44 hyperkalemia44is44 anadverse44 effect44 of4 4 this44 medica
tion.
5.44A4 4 nurse4 4 is4 4 caring4 4 for4 4 a4 4 client4 4 who4 4 is4 4 postoperative4 4 following4 4 an4 4 open4 4 reduction4 4 internal4
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,Detailed Answer Ke4
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4 fixation4 4 (ORIF)4 4 of4 4 a4 4 fem44ur4 4 fracture.44Which44of44the44following4 4 parameters44should44the44nurse4 4 in
clude4 4 in4 4 the44evaluation44of4 4 the44neurovascular4 4 st44atus44ofthe44client's44affected44extremity?44(Select44al
l44that44apply.)
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, Detailed Answer Ke4
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4y Medical Surgical,
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A. Color
B. Temperature
C. Ecchymosis
D. Skin44 integrity
E. Sensation
Rationale:4 4 Color4 4 is4 4 correct.4 4 Clients4 4 who4 4 have4 4 sustained4 4 trauma4 4 to4 4 an4 4 extremity,4 4 suc
h4 4 as4 4 a4 4 fracture,4 4 are44at44increased44risk44for44neurovascular44compromise.44The44nurs
e44should44check4 4 the44color44of44the44clie4 4 nt's4 4 affected4 4 extremity4 4 as4 4 part4 4 of4 4 this
4 4 assessment.4 4 The4 4 nurse4 4 should4 4 identify4 4 pallor4 4 or4 4 cyanosi44s4 4 of4 4 theextremity4 4
as4 4 an4 4 indication4 4 of4 4 peripheral4 4 neurovascular4 4 dysfunction4 4 and4 4 should4 4 notify4 4 t4
4he4 4 provider.Temperature4 4 is4 4 correct.4 4 Clients4 4 who4 4 have4 4 sustained4 4 trauma4 4 to4 4 a
n4 4 extremity,4 4 such44as4 4 a44fracture,4 4 are44at44increased44risk44for4 4 neurovascular4 4 comp
romise.44The44nurse44should44monitor44the4 4 temperature4 4 of4 4 the4 4 extremity4 4 as4 4 a4 4 par
t4 4 of4 4 this4 4 assessment4 4 and4 4 identify4 4 skin4 4 thattyis4 4 cool4 4 o44r4 4 cold4 4 to4 4 the4 4 touch
4 4 as4 4 having4 4 decreased4 4 perfusion4 4 to4 4 the4 4 tissues4 4 of4 4 the4 4 extremity,4 4 which4 4 is4 4
an44indication4 4 ofperipheral4 4 neurovascular4 4 dysfunction.4 4 The4 4 nurse4 4 should4 4 report4 4
skin4 4 that4 4 is4 4 cool4 4 t44o44the44touch44to44the44provider.Ecchymosis44is44incorrect.44Ecchy
mosis,44or44bruising,44is44an44expected44f4 4 inding4 4 with44leg44injuries4 4 and4 4 is44not44a44c
omponent44of4 4 a44neurovascular4 4 check.Skin44integrity44is44inc44orrect.4 4 While4 4 the4 4 nurs
e4 4 should4 4 assess4 4 the4 4 incision4 4 of4 4 a4 4 client4 4 who4 4 is4 4 postoperative4 4 following44a
n4 4 open4 4 reduction4 4 and4 4 internal4 4 fixation4 4 of4 4 the4 4 femur,4 4 it4 4 is4 4 not4 4 a4 4 componen
t4 4 of4 4 a4 4 neurovascula44r4 4 check.Sensation4 4 is4 4 correct.44Clients4 4 who44have4 4 sustained
4 4 trauma44to44an44extremity,4 4 such44as4 4 a44f44racture,44are44at44increased44risk44for44neur
ovascular44compromise.44The44nurse44should44assess44the44cli4 4 ent's44extremity44for44num
bnessor44tingling.44The44nurse44should44recognize44diminished44pain44or44pares4 4 thesia44as
44an44indication44of44damage44to44the44nerves44or44peripheral44neurovascular44dysfunction44
and4 4 should44report44it44to44the44provider.
6.44A44nurse44is44monitoring44a44client44following44a44thoracentesis.44The44nurse44should44identify44which44of4 4 the
44follo4 4 wingmanifestations44as44a44complication44and44contact44the44provider44immediately?
A. Serosanguineous44 drainage44 from4 4 the44puncture44site
Rationale:44A44small44amounttyof44serosanguineous44drainage44attythe44puncture44site44is44expected44aft
er44athoracent44esis.
B. Discomfort44 at44 the44 puncture4 4 site
Rationale:44 Mild4 4 discomfort4 4 at4 4 the4 4 puncture4 4 site4 4 is4 4 expected4 4 after4 4 a4 4 thoracentesis.
C. Increased44 heart44 rate
Rationale:44Clients44are44at44risk44for44developing44pulmonary44edema44or44cardiovascular44distress44du
e44mediastinalc44ontent4 4 shift4 4 after4 4 the4 4 aspiration4 4 of4 4 a4 4 large4 4 amount4 4 of4 4 fluid4 4 f
rom4 4 the44client's4 4 pleural4 4 space.
Therefore,44the44client44may44experience44an44increase44in44heart44and44respiratory44rate,44al
ong44with44co4 4 ughing44with44blood-
tinged44frothy44sputum,44and44tightness44in44the44chest.44These44findings44requirenotification
44of44the44prov44ider44immediately.
D. Decreased44temperature
Rationale:4 4 Infection44is44possible44after44any44invasive44procedure;44however,44it44takes44tim
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