Med surg1 exam #4 - LVN PDF

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Chapter 43: Musculoskeletal System Introduction Linton: Medical-Surgical Nursing, 7th Edition MULTIPLE CHOICE 1. A nurse is collecting a health history from a patient with a connective tissue disease. What is the most important inquiry by the nurse? a. Family history of atherosclerosis b. Last time the patient had his or her blood tested c. History of a prior injury to a specific body part d. Family history of a fracture 2. A nurse is educating an osteoporotic patient taking alendronate (Fosamax). Which instruction should the nurse stress? a. Take the drug after breakfast. b. Avoid the use of supplemental vitamin D. c. Decrease fluid intake. d. Sit or stand for 30 minutes after administration. 3. Which diagnostic test result should the nurse expect for a patient with polymyositis? a. Muscle biopsy positive for muscle degeneration b. Positive antinuclear antibody (ANA) blood test result c. Positive 24-hour urine test result for urate crystals d. Urate crystals in the synovial fluid 4. A nurse is educating a patient with gout about the medication probenecid (Benemid). What active effect should the nurse relay when explaining why this medication is prescribed? a. Reduces inflammation in the affected jointb. Relieves pain c. Diminishes swelling d. Increases excretion of uric acid

5. The physician orders antinuclear antibodies for a patient with suspected rheumatoid arthritis. What information will the nurse provide to the patient in preparation for this study? a. Fast for 8 hours before test. b. Refrain from exercise the day before test. c. Do not take medications 24 hours before test. d. Void prior to test. 6. A patient is preparing for tomography as ordered to enhance visualization of tissue hidden by bone. What assessment by the nurse should be immediately addressed? a. History of recent urinary tract infection b. Allergy to Sulfa c. Reports of claustrophobia d. Diagnosis of bipolar disorder MULTIPLE RESPONSE 1. A nurse questions an older patient about the age-related changes she has experienced in her connective tissue, which have lessened her mobility. What do these changes most commonly include? (Select all that apply.) a. Loss of bone mass, which may cause fragile bones b. Decline in muscle mass, causing loss of strength c. Bony deposits in the joints, causing pain and altered movement d. Loss of cartilage, causing more friction in joints e. Diminished energy, causing decreased activity COMPLETION 1. Immobility reduces muscle contractions and can produce muscle ______. ANS:

2. A(n) ______ measures the range of movement of the joints. ANS: 3. ______ uses sound waves to determine the presence of pulses in the extremities. ANS: 44: Connective Tissue Disorders Linton: Medical-Surgical Nursing, 7th Edition MULTIPLE CHOICE 1. A 51-year-old professional tennis instructor is newly diagnosed with osteoarthritis. What is the nurse’s best explanation to the patient when asked what this diagnosis means? a. Presence of antibodies in the synovial fluid b. Dislocation of the patella over the tibia c. Degeneration of articular cartilage d. Body’s autoimmune response 2. A nurse explains to a patient with rheumatoid arthritis that the drug leflunomide (Arava) is a disease-modifying antirheumatic drug (DMARD). What is the action of this medication? a. Retards the progress of the disease b. Builds new bone c. Decreases inflammation d. Increases flexibility 3. A nurse is caring for a patient with osteoarthritis. What is the best recommendation by the nurse to this patient to control chronic pain? a. Administer analgesics only when needed. b. Administer analgesics as prescribed on a routine basis. c. Plan activities with no rest periods to complete the activities quickly. d. Wear high-heeled shoes to keep the body in alignment.

4. An older patient with osteoarthritis complains of stomach discomfort and shortness of breath after years of taking aspirin for pain relief. What change in pain control medication would be most appropriate for the home health care nurse to suggest? a. Nonsteroidal anti-inflammatory drugs (NSAIDs) b. Oral corticosteroids c. Mild exercise d. Warm baths 5. A home health care nurse is visiting a patient after a total hip replacement. What should the nurse include when teaching the patient how to protect the new joint? a. Put an extension on the toilet seat. b. Keep the legs crossed when at rest. c. Frequently change positions from side to side. d. Slowly pull the knee to the chest twice a day to stretch the hip abductors. 6. After a knee replacement, an 87-year-old patient rejects the use of the continuous passive motion (CPM) machine, saying, “I did not march when I was a child, and I am not marching now.” What benefits of CPM should the nurse point out to encourage patient use? a. Decrease in pain b. Increase in circulation in the new joint c. Increase in leg strength d. Increase in flexibility for the new joint 7. What do connective tissue diseases affect? a. Bones, ligaments, cartilage, and tendons b. Bones, ligaments, and tendons c. Spurs, ligaments, cartilage, and tendons

d. Tendons, cartilage, and tophiANS: A 8. Which patient is most likely to develop a connective tissue disease? a. A teenage girl who swims b. A 30-year-old woman who plays tennis c. A 35-year-old male golfer d. A 40-year-old male computer analyst 9. Which is true regarding connective tissue function? a. Helps provide a source of storage for calcium b. Stores hormones in the pores of bone tissue c. Controls the distribution of minerals d. Provides protection to body parts 10. Which characteristic should a nurse recognize as diagnostic of rheumatoid arthritis? a. Absence of pain b. Symmetric bilateral joint swelling c. Evening stiffness that improves with activity d. Increased appetite 11. A patient asks why systemic glucocorticoid medications are used as the last choice for the treatment of rheumatoid arthritis. What is the nurse’s most informative reply? a. “The other drugs are just as effective and work in similar ways.” b. “They are used as a last choice or for short periods because they have many side effects.” c. “Those drugs are given three or four times daily, which is more difficult for patients to remember.” d. “A higher incidence of vomiting occurs with prolonged use.” 12. A nurse, in conjunction with a patient, establishes a plan to treat the pain associated with arthritis. What is the most effective strategy? a. Avoid exercise to spare painful joints.

b. Use narcotics for pain relief. c. Apply warm, moist compresses before doing activity. d. Avoid assistive devices that encourage dependence. 13. What is the best physiologic reason for a patient with osteoporosis to maintain a regular exercise regimen? a. Involves the patient in her or his own care b. Increases cardiac output c. Promotes better mental health d. Promotes bone formation and improves strength 14. A nurse is organizing a teaching plan for a patient with gout. What should the nurse caution this patient he is at an increased risk for? a. Kidney stones b. Tophi c. Visual disturbances d. Facial lesions 15. A nurse is educating a patient with gout about a low-purine diet. Which food choice by the patient would indicate the need for further teaching? a. Pizza with pepperoni b. Seafood platter with scallops and mussels c. Chicken salad with nuts d. Tuna sandwich with potato chips 16. A nurse is caring for a patient immediately after total knee replacement surgery. What assessment requires priority? a. Quality of pulses in the affected limb b. Degree of nausea and vomiting

c. Understanding of the procedure d. Amount of pain 17. Inadequate nutrition is the patient problem applicable to a patient with progressive systemic sclerosis. What is the most important point for the nurse to teach this patient? a. Eat three large meals spaced throughout the day. b. Schedule rest periods to prevent overtiring. c. Severe stress can trigger vasospasm. d. Eat smaller, more frequent meals. 18. What instruction should a nurse include in a teaching plan for a patient with carpal tunnel syndrome? a. Anticoagulants and glucocorticoids b. Methotrexate c. Lubricating ointmentsd. Splinting to prevent flexion and hyperextension 19. Two days after a total hip replacement, a patient is being discharged. Which statement indicates that the patient understands the discharge teaching? a. “I can sit comfortably with my legs crossed.” b. “I will ask my husband to tie my shoes for me.” c. “I am glad I won’t have to use that bulky pillow between my legs at night.” d. “My straight dining room chair will be helpful when I do the hip flexion exercises.” 20. What action would best benefit the patient diagnosed with bursitis of the shoulder? a. Lifting a 5-lb weight as a daily exercise b. Walking the fingers of the affected arm up the wall c. Splinting the affected arm to keep the shoulder immobile d. Performing gentle push-ups on the floor

MULTIPLE RESPONSE 1. What are the goals of therapy for patients with rheumatic arthritis? (Select all that apply.) a. Decrease inflammation. b. Balance activity and rest. c. Promote adaptation to limitations. d. Plan frequent periods of bed rest. e. Supply patient education and support. 2. What actions would be best for patients with osteoarthritis to seek the assistance of physical therapy? (Select all that apply.) a. Isotonic exercises b. Moist heat application c. Instruction with a transcutaneous electrical nerve stimulation (TENS) unit d. Measures to increase range of motion e. Measures to increase strength 3. What signs of progressive systemic sclerosis does the anonym CREST represent? (Select all that apply.) a. Calcinosis b. Rash c. Esophageal dysfunction d. Sore joints e. Telangiectasis COMPLETION 1. To decrease osteoporosis, a nurse explains that women can benefit from ______ for 15 years after the onset of menopause. 2. A nurse assesses ischemic spots around the nail beds of a patient with rheumatoid arthritis

and recognizes that these are a complication of medical diagnosis, rheumatoid arthritis, related to ______. 3. A nurse clarifies that a postmenopausal woman who is not taking hormone replacement therapy should take ______ mg elemental calcium on a daily basis. (Use numeric characters only.) Chapter 45: Fractures Linton: Medical-Surgical Nursing, 7th Edition MULTIPLE CHOICE 1. Two days after surgery for a crushed pelvis, a certified nursing assistant (CNA) reports that the patient is complaining of a shortness of breath and is demonstrating signs of confusion and restlessness. What should a nurse suspect, from these signs alone, that the patient has developed? a. Impending shock b. Fat embolus c. Anxiety d. Neurovascular compromise 2. What should a nurse teach an older patient with a newly casted Colles fracture? a. Apply cool compresses to the cast. b. Let the hand and arm dangle to increase the drainage. c. Keep the hand immobile to reduce swelling. d. Move the shoulders to reduce contractures. 3. A patient who has osteomyelitis after multiple fractures inquires what the physician meant when he said that surgery would follow the antibiotic therapy. What is the nurse’s most helpful reply to explain why this surgery will be performed? a. To remove dead bone

b. To close the open draining wound c. To close the area with casting material d. To amputate 4. A patient with a crushed forearm cannot get pain relief with opioid medications. The injury is swollen, cool, and cyanotic, with weak distal pulses. What should the nurse suspect? a. Compartment syndrome b. Overwhelming infection c. Fat embolus d. Osteomyelitis 5. A patient who sustained a simple fracture of the left fibula 7 days earlier asks in what stage of bone healing he might be. What stage of healing should the nurse relay to the patient? a. Hematoma formation b. Ossification c. Callus formation d. Fibrocartilage formation 6. Which assessment is of the greatest concern to a nurse when caring for a patient just admitted with a pelvic fracture? a. Pain level rating of 8 on a scale of 1 to 10 b. No urinary output for 8 hours c. Evidence of bruising along the patient’s hips and buttocks d. Complaints of the need for back care from resting in bed 7. An older woman falls down at church and immediately complains of severe pain in her left hip. Which observation is recognized as the cardinal sign of a fractured hip?

a. Shortened left leg compared with the right b. Downward curled toes c. Internal rotation of the left leg d. Hematoma on the left hip 8. A patient has just had a plaster of Paris upper extremity cast placed because of a fractured radius. Which statement indicates that the patient understands the discharge teaching related to cast care? a. “When I get home, I will remove some of the padding if it feels tight so my fingers don’t swell.” b. “When I get home, I will wrap the cast in plastic so it will conserve the heat.” c. “When I get home, I will use a spoon handle to scratch inside if my arm itches.” d. “When I get home, I am going to rest in bed with my arm elevated above my heart.” 9. What special precaution should a nurse implement when assisting with the application of a short arm plaster cast? a. Dampen the skin to make the stockinette adhere. b. Tape the arm before applying the stockinette. c. Smooth the stockinette to prevent a pressure ulcer. d. Roll the stockinette tightly above and below the margins of the cast. 10. An older patient who sustained a fractured hip and femur in a motor vehicle accident is to be in Russell traction for several weeks. What should be the focus of care for the nurse? a. Offering frequent distractions b. Encouraging nutrition c. Offering pain relief d. Preventing deep vein thrombosis (DVT)

11. A 78-year-old retired teacher with a history of osteoporosis has fallen in her bathroom and sustained a subcapital femoral fracture. She is scheduled for an open reduction and internal fixation (ORIF) procedure in the morning. Which type of traction will most likely be implemented? a. Bryant b. Buck c. Pelvic d. Crutchfield tongs 12. A nurse is told that a patient has a compound comminuted fracture. What characteristic of the bone in this type of fracture causes the nurse to be concerned? a. It is bent but not completely broken, and the bent piece protrudes through the skin. b. It is compressed, and bone pieces protrude through the skin. c. It is twisted, and the fragments are separated. d. It is broken into two or more pieces, and bone fragments protrude through the skin. 13. A patient with bilateral avascular necrosis of the hips is to walk with crutches using a four-point gait for 6 weeks after her bone decompression surgeries. Which statement would indicate that the patient understands this technique? a. “The axillary bars on the crutches should support my weight when I walk.” b. “I will move both crutches and then swing my legs to the crutches—2 and 2 equals 4!” c. “I will move my right crutch and then my left leg and then the left crutch and my right leg.” d. “I will move both crutches and then swing my legs through the crutches together.” 14. What action should a nurse implement when caring for a patient diagnosed with a compound fracture?

a. Limit narcotics for 8 hours after surgery. b. Monitor the patient’s respirations every hour. c. Assess for pulses distal to the injury. d. Verify that the patient is not allergic to sulfa. 15. Assistive devices such as canes, crutches, and walkers are used for people who need to limit weight-bearing activities on joints. Which statement by a nurse best illustrates an understanding of the appropriate use of these devices? a. “Canes provide minimal support and balance and are carried on the unaffected side.” b. “When using a cane, slide it as you go to decrease the arm strain.” c. “A three-point gait is used when walking with a walker.” d. “When using crutches, the unaffected leg goes down the steps first.” 16. Which patient is most appropriate for a nurse to refer to home health care? a. A married man with a laundry room on the first floor b. A single woman with a bedroom in a rooming house c. A student living in a college dormitory but going home to stay with parents d. A woman staying with her daughter and son-in-law at their one-story home 17. What should a nurse who is documenting and reporting the signs and symptoms of an infection underneath a cast include in the medical record? a. Elevated temperature b. Tingling and decreased sensation c. Full pulses and absence of pain d. Swelling and diminished motor function 18. Which patient problem has the highest priority after surgery for the open reduction and external fixation of an ankle?

a. Potential activity intolerance b. Potential for infection c. Immobility d. constipation 19. A patient in a full body cast (spica) complains of nausea and abdominal distention. What potential complication should a licensed vocational nurse (LVN) suspect? a. Constipation b. Compartment syndrome c. Cast syndrome d. Shock 20. An older adult patient is at risk for constipation after sustaining a pelvic fracture. Which nutritional suggestion by the nurse is most appropriate? a. Select food with high sodium content. b. Avoid foods high in dietary fiber. c. While immobilized, drink at least 2 to 3 L of fluids daily. d. Include milk products at every meal. 21. Which finding should produce the most concern when performing pin care for a patient with an external fixator? a. Crusts around the pin b. Serous drainage on the dressing c. Purulent drainage d. Absence of pain 22. Which assessment is considered abnormal when a nurse performs a neurovascular assessment on a patient in skeletal traction? a. Delayed capillary refill

b. Bilateral equal pulses c. Absence of pain and swelling d. Limb is the same color as the unaffected side 23. What action should a nurse implement when dealing with the weights that are applying traction to a patient? a. Remove them to pull the patient up in bed. b. Hold them while the patient is changing positions in bed. c. Hold them for a few minutes if the patient complains of pain. d. Allow them to hang freely. 24. Which is true about a greenstick fracture? a. Line of the fracture goes across the bone in right angles to the longitudinal axis.b. Periosteum is not torn away from the bone. c. Fracture is incomplete, and one side is bent. d. Fracture occurred in one of the long bones of the body. 25. A patient with a fractured pelvis says that she will not ambulate because of pain. What should a nurse inform the patient can be prevented with early ambulation? a. Back injury b. DVT c. Callus formation d. Disuse syndrome MULTIPLE RESPONSE 1. To what can delayed union of a fracture be attributed? (Select all that apply.) a. Inadequate immobilization b. Hormone replacement therapy c. Long-term use of corticosteroids d. Infection

e. Poor nutrition 2. Which characteristics are present when crutches are properly fitted? (Select all that apply.) a. The axilla piece is 3 to 4 fingerbreadths below the axilla. b. They fit close to the axilla for secure support. c. They are measured and adjusted when the patient is in the tripod position. d. Adjusted hand grips allow for a 45-degree flexion of the elbow. e. They are padded so patient can bear weight on the axilla piece when ambulating COMPLETION 1. A fracture that occurs because of osteoporosis is classified as a(n) ______ fracture. 2. A nurse uses a diagram to show the process of a fractured bone healing. ______ (Arrange the options in the appropriate sequence. Do not separate answers with a space or punctuation. Example: ABCD.) a. Ossification b. Hematoma c. Fibrocartilage d. Consolidation e. Callus 3. Arrange the process of stair climbing with crutches in the correct sequence: ______ (Arrange the options in the appropriate sequence. Do not separate answers with a space or punctuation. Example: ABCD.) a. Body weight is supported with crutches. b. Crutches are moved to the next step. c. The affected leg moves to the next step. d. The unaffected leg is moved to the next step. e. Body weight is transferred to the unaffected leg. Chapter 46: Amputations

Linton: Medical-Surgical Nursing, 7th Edition MULTIPLE CHOICE 1. A nurse is aware that a patient who is having his leg amputated is also having a pro...