A client has a foreign body in one eye. What action by the nurse is appropriate for the client’s care?

Administering ordered antibiotics

Clients chart indicates sensorineural hearing loss. What assessment question does nurse ask to determine possible cause

“Have you been exposed to loud noises?”

Best goal for frail, elderly patient with history of emphysema and nursing diagnosis of Risk for Injury post hip surgery

Remain free from injury or falls throughout hospital stay.

A client is admitted to the ED with a fractured femur resulting from a MV crash. Priority action?

Assess airway, breathing, and circulation

Post teaching client w/fractured humerus nurse assess client understanding.Which choice indicate nutrition understanding

Roast beef with lowfat milk and a a vitamin C supplement

Patient on extended bedrest + experiencing constipation requests fiber supplement. Which statement by the nurse is best

That is a good choice to manage constipation. I will contact physician.”

Which statement made by the nurse is an example of stereotyping?

Patients with a Japanese background are always quite and emotionless

A client is taking timolol eyedrops. The nurse assesses the client’s pulse at 48 beats/min. What action is the priority?

Hold the eyedrops and notify the primary health care provider.

Nurse is teaching client about cataracts surgery. Which statement should nurse include as part of preop preparation?

“You will put several types of eyedrops in ur eyes before+ after surgery.”

The nurse is aware that which approach is best to validate a clinical inference?

Have sufficient supportive data

Nurse is helping older patient to ambulate. She starts to feel faint and starts to fall. What is best action?

Assist the patient to slide down ur leg and guide her to safe position

ID most appropriate nursing diagnosis for promoting safety of frail older patient post hip replacement and has emphysema

Risk for Injury related to medical condition

When encouraging a fitness program for healthy older adults, what must the nurse consider

Older adults w/ fall risk should do activities that maintain + improve bal.

Which of the following describes the most important purpose for developing a nursing diagnosis?

Describes the client's needs for nursing care

Nurse cares for client who had wrist cast applied 3 days ago. Client says cast if loose enough to slide off. Respond?

You need a new cast now that the swelling has decreased

Which statement related to the nurse prioritizing patient problems is most accurate?

Nurses prioritize problems in the order of problem urgency.

Nurse plans care for client with external fixator on lower leg. Which intervention would nurse include in care plan?

Scheduling for pin care to be provided every shift.

Transfer a total dependent patient from stretcher to bed. Best action to reduce the musculoskeletal risk factors nurse

Use transfer roller sheet when transferring.

Which of the following is the best example of a nursing diagnosis statement?

Acute pain R/T out of bed activities

A client who is nearly blind is admitted to the hospital. What action by the nurse is most important?

Orient the client to the room using a focal point

Nurse is caring for client who recently sustained a sport injury to his right leg. Appropriate Interventions?

Use compression to support the leg, Obtain an X-Ray to detect possible fracture, Immobilize the right leg, Elevate the right leg to decrease swelling

A patient has started a fitness program. What program show he has started a well-rounded program? Select all that apply.

Balance training, Resistance trainign, Flexibility training, Aerobic conditioning

A patient asks the nurse what tests he may need for a strain or a fracture. How should the nurse reply?

Sprains,strains,fractures are similar, you will need an x-ray of the joint"

What action is most important in limiting the nurse's risk of back injuries?

Avoid manual lifting by using assistive devices as often as possible

Which nursing diagnosis is written in the correct format when using NANDA-I taxonomy?

Impaired Skin Integrity, R/T physical immobility, AEB skin tear over sacral

The patient care team consists of both RNs and LPNs/LVNs. Which action by the nurse is a possible theoretical error?

Assigning an LPN/LVN to formulate a nursing diagnosis

The nurse is teaching new AP about caring for older adults. Which statement would the nurse include about hearing

“Remember to face the client when talking with him or her.”

Nurse plans care for client recovering from ORIF for right hip fracture. Appropriate interventions?

Ambulate the client on the first post op day, Re-positiont he client every 2 hours, Eevate heels off the bed

Nurse teaches client about prosthesis care post amputation. Which statements should be included in teaching?

I have scheduled a follow up appointment for you, Make sure that you wear the correct liners with your prosthetic, The device has been custom made especially for you

Nurse in extended care facility. Residents primarily older w/ health factors + danger of falling. Nursing Diagnosis?

A risk diagnosis because it is based on data about the patients

Nurse assesses client who is admitted with a pelvic fracture.Which assessment needs monitioring to prevent complication?

Urinary output, Skin color, Blood Pressure

Client brought to the ED post car crash. Client has large glass in left eye. What action by the nurse takes priority

Ensure that the client has a patent airway

Nurse asseses older adult admitted 2 days ago - fractured hip. Notes confusion and restless with 88% O2. What action?

Administer oxygen via nasal cannula

When caring for a patient w/ osteoporosis, which is most important action to take to minimize progression of the disease

Start a weight-bearing exercise program.

Nurse is caring for client who is recovering from above the knee amputation + reports pain in the removed limb. Respond?

How would you describe the pain you are feeling

“Our son is staring off into space; won’t talk to us. Isn’t acting himself.” Which response by nurse is best

“He had major injury, + immobility may be causing feelings of depression

Which action,when demonstrated by the patient with osteoporosis, would indicate to the nurse that teaching was effective

Participating in aerobic barbell strength class at the gym 3 times a week

Client w/ family history of glaucoma asks the nurse how to prevent glaucoma? What statement by the nurse is appropriate

“You should have your intraocular pressure measured once or twice a year.”

studbud

MDC Med Surg 32,42,47

99 termsStudBud Administration21 plays

32,42,47

Flashcards99 cardsFPractice quizPHost liveL

Questions 99

Answers

1
A client has a foreign body in one eye. What action by the nurse is appropriate for the client’s care?
Administering ordered antibiotics
Assessing the patient’s visual acuity
Obtaining consent for enucleation
Removing the object immediately
2
Clients chart indicates sensorineural hearing loss. What assessment question does nurse ask to determine possible cause
“Do you have frequent ear infections?”
“Have you been exposed to loud noises?”
“Have you been told your ear bones don’t move?”
“Do you feel like something is in your ear?”
3
Best goal for frail, elderly patient with history of emphysema and nursing diagnosis of Risk for Injury post hip surgery
Remain free from injury or falls throughout hospital stay.
Demonstrate effective breathing when ambulating
Increase activity tolerance by discharge from hospital.
Increase mobility by the time of discharge from hospital.
4
Nurse gathered and sorted client info and is preparing to ID the diagnostic label. What are diagnostic labels used for?
To make cue clusters
To understnad disease etiology
To set the client's goals
To identify interventions
5
A client is admitted to the ED with a fractured femur resulting from a MV crash. Priority action?
Maintain the client in a supine position
Keep the client warm and comfortable.
Immobolize the injured extremity with a splint
Assess airway, breathing, and circulation
6
Post teaching client w/fractured humerus nurse assess client understanding.Which choice indicate nutrition understanding
Vegetable lasagna with a green salad and vitamin A supplement
Roast beef with lowfat milk and a a vitamin C supplement
Baked fish with OJ and a vitamin D supplement.
BLT with vitamin B supplement
7
Patient on extended bedrest + experiencing constipation requests fiber supplement. Which statement by the nurse is best
“Stool softener could be used in place of fiber. Let’s try that med now.”
That is a good choice to manage constipation. I will contact physician.”
“A fiber supplement won’t be effective; we need to get you moving soon.”
“I will check on allergies before I order fiber supplement for you.”
8
Which statement made by the nurse is an example of stereotyping?
I am confused why the client at 2yrs old is having a tantrum;my child never
Patients w/ type 1 diabetes do not make insulin + will need to take insulin
Patients with a Japanese background are always quite and emotionless
Patient needs to understand the benefit of getting out of bed and not cry
9
A client is taking timolol eyedrops. The nurse assesses the client’s pulse at 48 beats/min. What action is the priority?
Hold the eyedrops and notify the primary health care provider.
Ask the client about excessive salivation
Take the client’s blood pressure and temperature
Give the drops using punctual occlusion
10
Older patient, unsteady when walking. Reports feeling sore but no complaints of weakness. What is best for helping her
Cane
Walker
Transfer belt
Crutches
11
Nurse is caring for client recovering from above knee amputation of right leg. Client reports pain in right foot. Meds?
Oral ibuprofen
IV morphine
IV calcitonin
Oral acetaminoprophen
12
Nurse is teaching client about cataracts surgery. Which statement should nurse include as part of preop preparation?
“You will be on bedrest for about a week after the surgical procedure.”
“You will put several types of eyedrops in ur eyes before+ after surgery.”
“You will be in hospital for only 1-2 days if everything goes as expected.”
“You will receive general anesthesia for the surgical procedure.”
13
The nurse is aware that which approach is best to validate a clinical inference?
Have the physician evaluate it
Have sufficient supportive data
Have the client's family confirm it
Have another nurse evaluate it
14
Nurse is helping older patient to ambulate. She starts to feel faint and starts to fall. What is best action?
Assist the patient to slide down ur leg and guide her to safe position
Immediately release transfer device + place wheelchair behind the patient
Instruct patient to grab rail in hallway while you call for assistance
Grasp under the arms and across the chest to support + call for assistance
15
ID most appropriate nursing diagnosis for promoting safety of frail older patient post hip replacement and has emphysema
Activity Intolerance related to injury
Impaired Mobility related to weakness
Ineffective Breathing Pattern related to illness
Risk for Injury related to medical condition
16
Based on the patient's problems, using Maslow's Hierarchy. Which nursing diagnosis would have the highest priority
Self Care Deficit
Impaired physical mobility
Functional urinary incontinence
Risk for Aspiration
17
To achieve balance, body mass must be distributed around which point?
Line of gravity
Base of support
Center of balance
Center of gravity
18
When encouraging a fitness program for healthy older adults, what must the nurse consider
Older adults should engage in 75-150 min of moderate physical activity/week
Above 150 min of moderate-intensity physical activity can be harmful 2 bone
Older adults w/ fall risk should do activities that maintain + improve bal.
Structured fitness programs achieve greater health benefits for the older.
19
Which of the following describes the most important purpose for developing a nursing diagnosis?
Identifies a body f nowledge unique to nursing
Differentiates the nurse's role from that of the physician
Helps nursing develop a more professioanl image
Describes the client's needs for nursing care
20
Nurse cares for client who had wrist cast applied 3 days ago. Client says cast if loose enough to slide off. Respond?
You need a new cast now that the swelling has decreased
Keep your arm above the level of your heart
As your muscles atrophy, the cast is expected to loosen
I will wrap a bandage around the cast to preven tit from slipping
21
Which statement related to the nurse prioritizing patient problems is most accurate?
Nurses give priority to actual problems instead of risk problems
Nurses give the highest priority to problems most important tot he patient
Nurses prioritize problems in the order of problem urgency.
Nurses must resolve one problem before addressing anothe rproblem
22
Nurse teaching group of elderly about basic eye exams. What would the nurse recommend about the frequency of eye exams
a. Every 2 to 4 years
a. Every 3 to 5 years
a. When the primary health care provider recommends
a. Every 1 to 2 years
23
Nurse plans care for client with external fixator on lower leg. Which intervention would nurse include in care plan?
Releasing fixator tension for 30 mins twice a day
Washing the frame of the fixator once daily.
Scheduling for pin care to be provided every shift.
Avoiding moving the extremity by holding th fixator
24
Transfer a total dependent patient from stretcher to bed. Best action to reduce the musculoskeletal risk factors nurse
Ask a coworker to help transfer the patient.
Use transfer roller sheet when transferring.
Use a wide base of support when transferring.
Use a mechanical lift to transfer the patient.
25
Which of the following is the best example of a nursing diagnosis statement?
Pain R/T appendicitis
Acute pain R/T out of bed activities
Impaired mobility R/T fractured left leg
Fractured leg R/T impaired mobility
26
A client who is nearly blind is admitted to the hospital. What action by the nurse is most important?
Orient the client to the room using a focal point
Let the client arrange objects on the bedside table
Speak loudly and slowing when talking to the client
Allow the client to feel his or her way around
27
Nurse is caring for client who recently sustained a sport injury to his right leg. Appropriate Interventions?
Use compression to support the leg
Obtain an X-Ray to detect possible fracture
Immobilize the right leg
Elevate the right leg to decrease swelling
28
Nurse asseses a client with a pelvic fracture. Which assesment finding would the nurse ID as a complication of surgery
Hematuria
Infection
Diarrhea
Hypertension
29
Nurse cares for client with a recently fractured tibia. Which assesment would alert the nurse to take immediate action?
Numbness in the extremity
Pain of 4 on a scale of 0-10
Feeling cold while laying in bed
Swollen extremity at the injury site
30
A patient has started a fitness program. What program show he has started a well-rounded program? Select all that apply.
Balance training
Resistance trainign
Flexibility training
Aerobic conditioning
31
Which type of joint are the sutures between cranial bones
Synarthroses
Diarthroses
Amphiarthroses
Synovial
32
A patient asks the nurse what tests he may need for a strain or a fracture. How should the nurse reply?
“You don’t need tests; I can tell by the way your ankle looks and feels.
Sprains,strains,fractures are similar, you will need an x-ray of the joint"
“We need an MRI to determine if you have a fracture, strain, or a sprain.”
"A venous Doppler study to make sure that there is not a fracture.”
33
Which type of exercise is performed by using specialized apparatuses that use resistance at a constant, preset speed?
Isomorphic
Isokinetic
Isotonic
Isometric
34
Nurse asked to design exercise program with goal of increasing client's muscle strength and endurance. Which is best?
Anaerobic conditioning
Resistance training
Flexibility Training
Aerobic conditioning
35
What action is most important in limiting the nurse's risk of back injuries?
Develop a lift team at the clinical site
Work with another nurse or an aide when lifting and turning patient
Avoid manual lifting by using assistive devices as often as possible
Use good body mechanics at all times
36
Which nursing diagnosis is written in the correct format when using NANDA-I taxonomy?
Impaired Skin Integrity, R/T physical immobility, AEB skin tear over sacral
Inability to ingest food R/T imbalanced nutrition AEB inadequate food intak
Cregiver role strain R/T alienation from family+friends AEB 24 hr care role
Bowel obstruction, R/T ab surgery, AEB nausea vomiting and abdominal pain
37
The patient care team consists of both RNs and LPNs/LVNs. Which action by the nurse is a possible theoretical error?
Instructing an LPN/LVN to perform a prescribed dressing change
Delagating an RN to perform the admitting history of a new client
Assigning an LPN/LVN to formulate a nursing diagnosis
Expecting RNs and LPNs/LVNs to administer meds to assigned clients
38
The nurse is teaching new AP about caring for older adults. Which statement would the nurse include about hearing
“You need to talk very loudly when communicating with these clients.”
You always need to check client’s ears for excess ear wax.”
“Assess each client’s hearing ability using the voice or whisper test.”
“Remember to face the client when talking with him or her.”
39
Nurse plans care for client recovering from ORIF for right hip fracture. Appropriate interventions?
Ambulate the client on the first post op day
Use pillows to encourage subluxation of the hip
Re-positiont he client every 2 hours
Eevate heels off the bed
40
Client has been prescribed brinzolamide for glaucoma. What assessment by the nurse requires communication with the PCP
a. Allergy to eggs
a. Allergy to sulfonamides
a. Use of beta blockers
a. Use of contact lenses
41
Nurse teaches client about prosthesis care post amputation. Which statements should be included in teaching?
A prosthetist will clean your inserts for you each month
I have scheduled a follow up appointment for you
Make sure that you wear the correct liners with your prosthetic
The device has been custom made especially for you
42
Nurse is helping patient perform leg exercises post surgery to avoid thrombophlebitis. What muscle is the patient using
Cardiac
Smooth
Skeletal
Slow - Twitch fibers
43
Nurse in extended care facility. Residents primarily older w/ health factors + danger of falling. Nursing Diagnosis?
A risk diagnosis because it is based on data about the patients
A possible diagnosis because a suspected diagnosis is present
A rwellness diagnosis because of the health status and patient environment
Syndrome diagnosis because of the age and physical condition of the patient
44
Nurse assesses client who is admitted with a pelvic fracture.Which assessment needs monitioring to prevent complication?
Temperature
Urinary output
Skin color
Blood Pressure
45
Client brought to the ED post car crash. Client has large glass in left eye. What action by the nurse takes priority
Administer a tetanus booster shot
Ensure that the client has a patent airway
Prepare to irrigate the client’s eye
Turn the client on the unaffected side
46
Nurse asseses older adult admitted 2 days ago - fractured hip. Notes confusion and restless with 88% O2. What action?
Administer oxygen via nasal cannula
Assess response to pain medication
Increase the IV flow rate
Re-position to a semi-fowler position
47
When caring for a patient w/ osteoporosis, which is most important action to take to minimize progression of the disease
Take a calcium supplement twice a day.
Start a weight-bearing exercise program.
Avoid strenuous activity that puts stress on bones.
Schedule regular healthcare checkups.
48
Nurse is caring for client who is recovering from above the knee amputation + reports pain in the removed limb. Respond?
How would you describe the pain you are feeling
Would you like to learn how to use imagery to to minize the pain
The pain you are feeling does not actually exist
This type of pain is common and will eventually go away
49
“Our son is staring off into space; won’t talk to us. Isn’t acting himself.” Which response by nurse is best
“He had major injury, + immobility may be causing feelings of depression
“I will inform his doctor and inquire about starting him on antidepressants
Teens are often moody, and being in the hospital with an injry doesnt help
“He is bored because he has been in the hospital for 3 weeks
50
Which action,when demonstrated by the patient with osteoporosis, would indicate to the nurse that teaching was effective
Participating in aerobic barbell strength class at the gym 3 times a week
Seeking healthcare by scheduling a follow-up exam with bone density testing
Taking a calcium supplement every day and increasing her phosphorus intake
Using a wheelchair to reduce risk of spontaneous fractures to legs and feet
51
Client w/ family history of glaucoma asks the nurse how to prevent glaucoma? What statement by the nurse is appropriate
“You should have your intraocular pressure measured once or twice a year.”
“You should have genetic testing to determine your risk for glaucoma.”
“Check with your health care provider about preventative drug therapy.”
“You should check your primary health care provider about eye examination.”
52
Client who had a surgical fractured femur repair reports new onset SOB and increase resp. What is the nurse 1st action?
Start O2 therapy @ 2L/min via nasal cannula
Contact the primary health care provider
Place the client in a high fowlers position
Document the client's O2 sat
53
Nurse teaches client at risk for carpal tunnel syndrome. What health promotion should nurse include in teaching?
Frequently assess the ergonomics of the equipment being used.
Take breaks to stretch fingers and wrists during working hours
Take ibuprofen to decrease pain and swelling in wrists
Adjust chair height to allow for good posture
54
Which nursing diagnosis is written in the correct format?
Imbalanced nutrition Less than body requirements,R/T weight under 20% ideal
Excess fluid volume R/T 3lb weight gain in 24 hrs
Ineffective airway clearance R/T increased resp rate and irregular rhythm
Impaired swallowing R/T absent gag reflex
55
Nurse assesses client for factors that present a risk for cataracts. Which factor places the client at the highest risk?
Heart Disease
Glaucoma
Advanced age
Diabetes mellitus
56
Cast removed,Orthopedic surgeon prescribes isometric exercises for arm.Which of the following complies with orders
Press right hand against wall; hold position for 6- 8 sec, repeat 5 -10 x
Grasp right wrist w/ left hand, move right arm up, down, and lateral; hold
Grasp right wrist w/ left hand, pull right arm across the body; hold
Place a 5-pound dumbbell in the right hand and squeeze; hold for 6 to 8 sec
57
Nurse is caring for a client with daibetes mellitus who has a fractured arm. Which action should the nurse take first?
Place the client in a supine position with a awarm blanket
Immobilize the arm by splinting the fractured site
Cover any open areas with sterile dressing.
Remove the medical alert bracelet from the fractured arm
58
Nurse caring for older adult recovering from leg amputation. Client states "one leg, I should've died". Best response?
Your children are waiting outside. Do you want them to grow up without you?
Your vital signs are good and you are doing just fine right now.
You will be able to do most of same things as before you became disabled
This is a big change. What support system do you have to help you cope?
59
25 yr old male quadriplegic. Which treatment would nurse perform to lower risk of joint contracture + promote mobility
Passive ROM
Administering glucosamine supplements
Turning the patient every 2 hrs
Active ROM
60
Nurse is caring for post op patient with regional nerve bloackade for a surgical tibial fracture. Assesment findings?
Reports little to no pain
Responds well to imagery
Nausea and vomiting
Tingling in the surgical leg
61
What is the best intervention to protect the integument of a frail, malnourished, immobile patient?
Assisting the pt to sit in a chair three times a day
Offering the pt six small meals a day
Turning the pt at least every 2 hrs
Administering fluid boluses as directed by the healthcare provider
62
Nurse is teaching client how to use a cane post right surgical fractured fibula repair. What health teaching is needed?
Place the cane on your left side
Be sure the cane is parallel to your waist
Use the cane only when your right leg is painful
Move the cane and your left leg at the same time.
63
Which of the following is an example of what the nurse recognizes as a cluster of related cues?
Respiratory rate 20 breaths/min, heart rate 85 beats/min, BP 136/84 mm Hg
Complains of nausea and stomach pain after eating
Has a daily bowel movement and eats a high fiber diet
Has a productive cough and states stools are loose
64
When making diagnosis using NANDA-I, which part of the statement provides support for the diagnostic label you choose?
Related Factors
Diagnostic Label
Etiology
Defining Characteristics
65
Nurse is performing neurovascular assesment for older adult who has an extremity fracture. How many sec for cap refill
15
20
10
5
66
Nurse teaches AP about hygiene for client in traction. Which statement would the nurse include as part of the teaching
Ensure that the weights remian freely hanging at all times
Remove the traction when re-positioning the client
Provide pin care by using alcohol wipes to clean sites
Assess the client's skin when performing bed bath
67
A client’s intraocular pressure (IOP) is 28 mm Hg. What action would the nurse anticipate
Educate the client on corneal transplantation
Refer the patient to local Braille classes
Facilitate scheduling the eye surgery
Teach about drugs for glaucoma
68
Nurse is caring for client who had closed reduction of left arm & notes a large wet area of drainage on cast. Action?
Wrap the cast with gauze
Document the assesment
Cut off the old cast
Notify the PCP
69
Nurse is teaching about signs +symptoms of cataracts. Which change would the nurse note as possibly indicating cataract
Cloudy pupil
Blurred vision
Diplopia
Loss of peripheral vision
70
The nurse assessing the mobility of a patient with Parkinson’s disease might expect to observe which type of gait?
Antalgic
Steppage
Scissors
Propulsive
71
Older client fell at home - admitted to the ED - reports pain in her left groin and behind her left knee. What action?
Administer IV push morphine
Obtain left hip X-ray
Begin O2 at 6L/min via mask
Prepare for application of a leg cast
72
Which type of cells will the nurse indicate repairs damaged bone and builds new bone to keep the skeleton strong?
Amphiarthroses
Osteoclasts
Osteoblasts
Articular Cartilage
73
Which of the following patients would you expect to be at risk for decreased activity? Select all that apply.
Someone living in a skilled nursing facility
The patient with impaired arterial circulation
Obese child who enjoys video games
Healthy adult who works as a computer programmer
74
Nurse plans care for a client who is recovering from below knee amputation of left leg. Nursing intervention?
Place pillows between client's knees
Administer prophylactic antibiotics
Encourage ROM exercises
Implement strict bed rest in supine position
75
Nurse is caring for several clients with fractures. Which client would the nurse ID as highest risk for DVT
74 yo male who smokes and has a fractured pelvis
55 yo female prescribed ibuprofen for osteoarthritis
An 18 yo male athlete with fractured clavicle
36 yo female with Type 2 diabetes and fractured ribs
76
The nurse is formulating a nursing diagnosis for a patient. What definition most accurately describes nursing diagnoses?
Identifies a client's response to a health problem
Supports the nurse's diagnostic reasoning
Supports the client's medical diagnosis
Identifies a client's health problem
77
Nurse providing acute care for various patients. Which patient issue is a problem that nurses can treat independently
Fracture pain following an accident
Infection in a wound
Hemmorage following surgery
Nausea after ambulating in the hall
78
Admitted to hospital for antibiotic therapy for pneumonia. Lives independently + has strong upper-body. which device?
Transfer belt
Mechanical lift
Transfer board
Draw sheet
79
Nurse teaches client with fractured tibia about external fixation. Which advantages about fixation should nurse share?
IT promoted healing
It leads to minimal blood loss
It allows for early ambulation
It decreases the risk of infection
80
Nurse is planning care for patient post severe head trauma + long-term unresponsiveness. Effect of immobility on lungs?
Atelectasis
Reactive airway
Pooled secretions
Hyperventilation
81
Client with traumatic above knee amputation fears he will never have an intimate relationship again. Best response?
You think you won't be able to have sex again?
I will ask your social worker to talk with you
Are you marries now or have agirl friend?
You'll be able to get a leg prosthesis soon
82
A client has external otitis. About what comfort measure would the nurse instruct the client?
Instilling vinegar and water drops
Using a home humidifier
Use of heating pad to ear
Applying ice four times a day
83
According to the U.S. DOH 2018 Physical Activity Guidelines for Americans, which of the following statements is correct
Lesser amounts of activity provide little to no health benefits.
Physical activity should be enjoyable,and a variety will improve adherence.
Physical activity in excess of recommendations for age is harmful.
The risks of participating in physical activity outweigh the benefits.
84
Client presents to the ED reporting foreign body in the eye. For what diagnostic testing would the nurse prepare client
Opthalmoscopy
Tonometry
Corneal staining
Fluorescien angiography
85
A nurse is seeing clients in the ophthalmology clinic. Which client should the nurse see first?
Client with tearing, reddened eye with exudate
d. Client who has had cataract surgery and has worsening vision
Client whose red reflex is absent on ophthalmologic examination
Client with intraocular pressure reading of 24mm Hg
86
Nurse completes assessment + begins to formulate nursing diagnosis .Which action does the nurse take before write diag
Checks the medical diagnosis for consistency in treatment
Verifies the nursing diagnosis with the patient
Reviews the data and diagnosis with another nurse
Validates information with the primary care provider
87
Which of the following body systems must interact to produce mobility and locomotion?
Skeleton
Digestive
Muscles
Nervous
88
Post surgery,patient to begin ambulating with walker + avoid weight bearing on left leg. What is the best intervention
Aerobic exercise with deep breathing
Quadriceps and gluteal repetitions
Arm resistance training
Isometric toning of lower legs
89
Nurse enters exam room to aid in eye assesment. The client is directed towards a Ishihara chart. What is being assesed
Spatial perception
Depth perception
VIsual acuity
color vision
90
Nurse is teaching client about ear hygiene and health. Which statement by client indicates a need for further teaching
“I make sure my ears are dry after I go swimming.”
A soft cotton swab is alright to clean my ears with.”
“Keeping my diabetes under control helps my hearing.”
“I use good earplugs when I practice with the band.”
91
Nurse cares for a client placed in skeletal traction. Client asks what is the primary purpose of traction. Response?
This treatment will prevent future complications and back pain.
Traction decreases muscle spasms that occur wiht a fracture
This type of traction minimizes damage as a result os fracture treatment
Skeletal traction will assist in realigning your fractured bone
92
Post teaching client recovering from vetebroplasty, nurse checks understanding. Which indicates need for more teaching?
I will monitor the puncture site for signs of infection
I will start walking tomorrow and increase my activity slowly.
I can drive myself home after the procedure
I will remove my dressing the day after discharge/
93
Healthy 32 yo man wants to start fitness program to increase muscle and strength. Based on the U.S. DOH the nurse should
Exercising 1 weekly for 20 to 30 minutes is essential to increase strength.
Moderately intense exercise for 1 hour three times a week will be adequate.
Moderate physical activity 150 to 300 minutes or more per week is needed
Thirty minutes of moderate physical activity 3 times a week is appropriate.
94
Client with fractured ankle ORIF 4 weeks ago reports burning pain and tingling in the affected foot. WHat complication?
Compartment Syndrome
Delayed bone healing
Complex regional pain syndrome
Peripheral neuropathy
95
Which of the following actions present good body mechanics for nurses caring + teaching patients about safe body moves
Stand with the body in alignment and erect posture
Use a wide base of support with your feet at shoulder width
Keep objects close to your body when carrying them.
Bend at waist to lift heavy objects from the floor
96
Patient w/ spinal cord injury is experiencing autonomic dysfunctions. Which is an important aspect to assist in managing
Hold the patient upright if she begins to fall until assistance arrives.
Ask the patient to assist with turning by holding the siderails of the bed.
Ask patient if a transfer belt would be helpful to support assisted walking
Place patient in a high-back reclining wheelchair which can be lowered.
97
Older patient with newly diagnosed osteoporosis asks nurse to explain. Which is the correct description of osteoporosis?
Acute infection in the bone that must be treated with antibiotics
Loss of bone density that increases the risk of fracture
Degenerative joint disease that produces pain and decreased function
Chronic inflammatory joint disease that must be treated with steroids
98
Male admitted to hospital w/ medical diagnosis of COPD. He is receiveing oxygen. Which position technique is best
Sims
Fowlers
Prone
Lateral
99
Client had a retinal detachment and has undergone surgery. What discharge health teaching is most important to include?
“Report immediate loss of vision of pain in the affected eye.”
“Remove your eye patch every hour for eyedrops.”
“Keep the follow-up appointment with the ophthalmologist.”
Avoid reading, writing, or close work such as sewing.”

MDC Med Surg 32,42,47 Flashcards | StudBud