While giving a lecture on attention-deficit/hyperactivity disorder, the nurse encourages which of the following to reduce children's stress regarding homework assignments?

While giving a lecture on attention-deficit/hyperactivity disorder, the nurse encourages which of the following to reduce children's stress regarding homework assignments?

a. Time management skills
b. Prevention of iron deficiency anaemia
c. Routine preventative health visits
d. Speech articulation skills


ANS: A

Identify a sociocultural factor that can lead to developmental problems.

Identify a sociocultural factor that can lead to developmental problems.

a. Family relocation
b. Childhood obesity
c. Prolonged poverty
d. Loss of stamina


ANS: C

The purpose of unconscious ego defence mechanisms is to do which of the following for the individual?

The purpose of unconscious ego defence mechanisms is to do which of the following for the individual?

a. Protect against feelings of worthlessness and anxiety.
b. Facilitate the use of problem-focused coping.
c. Evaluate an event for its personal meaning.
d. Trigger the stress control functions of the medulla oblongata.


ANS: A

An adult who was in a motor vehicle accident is brought into the emergency department by paramedics, who report the following in-transit vital signs:

An adult who was in a motor vehicle accident is brought into the emergency department by paramedics, who report the following in-transit vital signs:

Oral temperature: 99.0° F
Pulse: 102 beats per minute
Respiratory rate: 26 breaths per minute
Blood pressure: 140/106
The nurse can identify which hormones are the likely causes of the abnormal vital signs?


a. ADH and ACTH
b. ACTH and epinephrine
c. ADH and norepinephrine
d. Epinephrine and norepinephrine



ANS: D

The nursing student gave a wellness lecture on the importance of accurate assessment and intervention from a personal, family, and community perspective. The other nursing students enjoyed the lecture about which nursing theory?

The nursing student gave a wellness lecture on the importance of accurate assessment and intervention from a personal, family, and community perspective. The other nursing students enjoyed the lecture about which nursing theory?

a. Ego defense model
b. Situational model
c. Evidence-based practice model
d. Neuman systems model


ANS: D

A young adult's chief complaint is "seizure fits." A chart review shows a negative EEG report and a normal neurological consultation report. A psychosocial history reveals increased family stress, bankruptcy, and a recent divorce. The nurse recognizes that this young man's pseudo-seizures most likely are an example of which unconscious coping mechanism?

A young adult's chief complaint is "seizure fits." A chart review shows a negative EEG report and a normal neurological consultation report. A psychosocial history reveals increased family stress, bankruptcy, and a recent divorce. The nurse recognizes that this young man's pseudo-seizures most likely are an example of which unconscious coping mechanism?

a. Compensation
b. Conversion
c. Dissociation
d. Denial



ANS: B

An assessment finding example for caregiver strain would be which of the following?

An assessment finding example for caregiver strain would be which of the following?

a. Caregiver routinely creates a weekly menu plan.
b. The caregiver has not received medical care when ill.
c. A caregiver can identify respite care provider.
d. Caregiver attends religious service.



ANS: B

A person states that he was not shoplifting from the store despite very clear evidence on the store surveillance tape. This person is demonstrating which ego defence mechanism?

A person states that he was not shoplifting from the store despite very clear evidence on the store surveillance tape. This person is demonstrating which ego defence mechanism?

a. Dissociation
b. Conversion
c. Denial
d. Compensation


ANS: C

A trauma survivor is requesting sleep medication because of "bad dreams." Concerned about posttraumatic stress disorder, the nurse asks

A trauma survivor is requesting sleep medication because of "bad dreams." Concerned about posttraumatic stress disorder, the nurse asks

a. "Are you reliving your trauma?"
b. "Are you having chest pain?"
c. "Can you describe your phobias?"
d. "Can you tell me when you wake up?"


ANS: A

A teen with the celiac disease continues to eat the food she knows will make her ill several hours after ingestion. Given appropriate tertiary level interventions, the nursing intervention would be to

A teen with the celiac disease continues to eat the food she knows will make her ill several hours after ingestion. Given appropriate tertiary level interventions, the nursing intervention would be to

a. Teach the patient about the food pyramid.
b. Administer antidiarrheal medications with meals.
c. Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends.
d. Admonish the teen and her parents regarding her consistently poor diet choices.



ANS: C

Despite working in a highly stressful nursing unit and accepting additional shifts, a new nursing graduate has a strategy to prevent burnout. The best strategy would be for the new nurse to

Despite working in a highly stressful nursing unit and accepting additional shifts, a new nursing graduate has a strategy to prevent burnout. The best strategy would be for the new nurse to

a. Identify the limits and scope of work responsibilities.
b. Write for 10 minutes in a journal every day.
c. Use progressive muscle relaxation.
d. Delegate complex nursing tasks to licensed professional nurses.



ANS: A

A senior college student contacts the college health clinic about a freshman student living on the same dormitory floor. The senior student reports that the freshman is crying and is not adjusting to college life. The clinic nurse recognizes this as a combination of situational and maturational stress factors. The best comment to the senior student would be

A senior college student contacts the college health clinic about a freshman student living on the same dormitory floor. The senior student reports that the freshman is crying and is not adjusting to college life. The clinic nurse recognizes this as a combination of situational and maturational stress factors. The best comment to the senior student would be

a. "I'd better call 911 because your friend is suicidal."
b. "Give her this list of university and community resources."
c. "You must make an appointment for the student to obtain medications."
d. "I'd recommend you help the student pack her bags to go home."


ANS: B

During the evaluation stage of the critical thinking model applied to a patient coping with stress, the nurse will

During the evaluation stage of the critical thinking model applied to a patient coping with stress, the nurse will

a. Select nursing interventions to promote the patient's adaptation to stress.
b. Establish short- and long-term goals with the patient experiencing stress.
c. Identify stress management interventions for achieving expected outcomes.
d. Reassess patient's stress-related symptoms and compare with expected outcomes.


ANS: D

Pediatric stressors related to self-esteem and changes in family structure reflect which maturational school age category?

Pediatric stressors related to self-esteem and changes in family structure reflect which maturational school age category?

a. Elementary school-age
b. Preadolescence
c. Adolescence
d. Early adulthood


ANS: B

After a natural disaster occurred, an emergency worker referred a family for crisis intervention services. One family member refused to attend the services, stating "No way, I'm not crazy." The best response the nurse can give is which of the following?

After a natural disaster occurred, an emergency worker referred a family for crisis intervention services. One family member refused to attend the services, stating "No way, I'm not crazy." The best response the nurse can give is which of the following?

a. "Many times disasters can create mental health problems, so you really should participate with your family."
b. "Crisis intervention is a short-term problem-solving type of help, and seeking this help does not mean that you have a mental illness."
c. "Don't worry now. The psychiatrists are well trained to help."
d. "Crisis intervention will help your family communicate better."


ANS: B

A nurse is teaching guided imagery to a prenatal class. Identify an example of guided imagery from the options below.

A nurse is teaching guided imagery to a prenatal class. Identify an example of guided imagery from the options below.

a. Singing
b. Back massage
c. Sensory peaceful words
d. Listening to music


ANS: C

The nurse teaches stress reduction and relaxation training to a health education group of patients after cardiac bypass surgery. The nurse is performing which level of intervention?

The nurse teaches stress reduction and relaxation training to a health education group of patients after cardiac bypass surgery. The nurse is performing which level of intervention?

a. Primary
b. Secondary
c. Tertiary
d. Quad level


ANS: C

A woman who was sexually assaulted a month ago presents to the emergency department with complaints of recurrent nightmares, fear of going to sleep, repeated vivid memories of the sexual assault, and inability to feel much emotion. The nurse recognizes the signs and symptoms of which medical problem?

A woman who was sexually assaulted a month ago presents to the emergency department with complaints of recurrent nightmares, fear of going to sleep, repeated vivid memories of the sexual assault, and inability to feel much emotion. The nurse recognizes the signs and symptoms of which medical problem?

a. General adaptation syndrome
b. Posttraumatic stress disorder
c. Developmental crisis
d. Alarm reaction


ANS: B

In a natural disaster relief facility, the nurse observes that an elderly man has a recovery plan, while a 25-year-old man is still overwhelmed by the disaster situation. These different reactions to the same situation would be explained best by which of the following?

In a natural disaster relief facility, the nurse observes that an elderly man has a recovery plan, while a 25-year-old man is still overwhelmed by the disaster situation. These different reactions to the same situation would be explained best by which of the following?

a. Restorative care
b. Strong financial resources
c. Maturational and sociocultural factors
d. Immaturity and intelligence factors


ANS: C

Scleroderma typically starts with which type of organ involvement?

Scleroderma typically starts with which type of organ involvement?

a) Lung
b) Skin
c) Kidney
d) Brain


Answer: b) Skin

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it?

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it?

a) Extension
b) Internal rotation
c) Hyperextension
d) Slight dorsiflexion


Answer: d) Slight dorsiflexion

A client informs the nurse that he has been diagnosed with the degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are?

A client informs the nurse that he has been diagnosed with the degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are?

a) Rheumatoid nodules
b) Tophi
c) Heberden's nodes
d) Bouchard's nodes


Answer: c) Heberden's nodes

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective?

The nurse is teaching the client newly diagnosed with systemic lupus erythematous about the condition. Which statement by the client indicates teaching was effective?

a) "I do not need to make any changes in my diet."
b) "I should avoid prolonged sun exposure."
c) "My energy level will gradually increase over time."
d) "My medications will ultimately correct my problem."


Answer: b) "I should avoid prolonged sun exposure."

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse?

A patient is being placed on a purine-restricted diet. What food should be suggested by the nurse?

a) Raw vegetables
b) Organ meats
c) Dairy products
d) Shellfish


Answer: c) Dairy products

Which of the following is the definitive diagnostic of gouty arthritis?

Which of the following is the definitive diagnostic of gouty arthritis?

a) Radiologic studies
b) Polarized light microscopy of the synovial fluid
c) Synovial biopsy
d) Arthrocentesis


Answer: b) Polarized light microscopy of the synovial fluid

The side effect of bone marrow depression may occur with which medication used to treat gout?

The side effect of bone marrow depression may occur with which medication used to treat gout?

a) Allopurinol (Zyloprim)
b) Colchicine
c) Prednisone
d) Probenecid (Benemid)


Answer: a) Allopurinol (Zyloprim)

Which of the following clinical manifestations would the nurse expect to find in a client who has had rheumatoid arthritis for several years?

Which of the following clinical manifestations would the nurse expect to find in a client who has had rheumatoid arthritis for several years? 

a) Small joint involvement
b) Asymmetric joint involvement
c) Bouchard's nodes
d) Obesity


Answer: a) Small joint involvement

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped?

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped?

a) Nausea and vomiting
b) Tingling in the arms
c) Increase in pain in the affected extremity
d) Intestinal cramping
e) Diarrhea


Answer:

e) Diarrhea
d) Intestinal cramping
a) Nausea and vomiting

A physician order tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis?

A physician order tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis?

a) Increased total serum complement levels
b) Negative antinuclear antibody test
c) An above-normal anti-deoxyribonucleic acid (DNA) test
d) Negative lupus erythematosus cell test


Answer: c) An above-normal anti-deoxyribonucleic acid (DNA) test

A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds?

A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds?

a) Lung sounds are diminished in the apical area.
b) Crackles in the bases
c) Pericardial friction rub
d) Rhonchi


Answer: a) Lung sounds are diminished in the apical area.

Which of the following newer pharmacological therapies, used for the treatment of osteoarthritis, is thought to improve cartilage function and retard degradation as well as have some anti-inflammatory effects?

Which of the following newer pharmacological therapies, used for the treatment of osteoarthritis, is thought to improve cartilage function and retard degradation as well as have some anti-inflammatory effects?

a) Viscosupplementation
b) Glucosamine
c) Capsaicin
d) Chondroitin


Answer: a) Viscosupplementation

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen?

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen?

a) Eradicating pain
b) Promoting sleep
c) Eliminating deformities
d) Minimizing damage


Answer: d) Minimizing damage

A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities?

A patient with an acute exacerbation of arthritis is temporarily confined to bed. What position can the nurse recommend to prevent flexion deformities?

a) Supine with pillows under the knees
b) Semi-Fowler's
c) Side-lying with pillows supporting the shoulders and legs
d) Prone


Answer: d) Prone

The immune abnormalities that characterize systemic lupus erythematosus (SLE) include which of the following? Select all that apply.

The immune abnormalities that characterize systemic lupus erythematosus (SLE) include which of the following? Select all that apply.

a) Autoantibodies immune complexes
b) Susceptibility
c) Damage
d) Abnormal innate and adaptive immune responses
e) Inflammation


Answer:

b) Susceptibility
d) Abnormal innate and adaptive immune responses
a) Autoantibodies immune complexes
e) Inflammation
c) Damage

The nurse is caring for a patient who is being treated for fibromyalgia. What intervention will best assist the patient to restore normal sleep patterns?

The nurse is caring for a patient who is being treated for fibromyalgia. What intervention will best assist the patient to restore normal sleep patterns?

a) Administering opioids at bed time
b) Tricyclic antidepressants
c) Range-of-motion exercise prior to sleeping
d) Increasing activity during the day


Answer: b) Tricyclic antidepressants

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client's stage of disease?

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client's stage of disease?

a) Auscultate the client's lung sounds.
b) Observe the client's gait.
c) Review the client's medical record.
d) Inspect the client's mouth.


Answer: c) Review the client's medical record.

A 68-year-old client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which of the following activities might enhance an acute attack?

A 68-year-old client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which of the following activities might enhance an acute attack?

a) Frequently drinking coffee
b) Frequently ingesting salicylates
c) Frequently drinking alcohol
d) Eating organ meats and sardines


Answer: d) Eating organ meats and sardines

Which of the following may be the first and only physical sign of symptomatic osteoarthritis (OA)?

Which of the following may be the first and only physical sign of symptomatic osteoarthritis (OA)?

a) Limited passive movement
b) Limb shortening
c) Joint enlargement
d) Joint instability


Answer: a) Limited passive movement

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client?

Answer: The client weighs 50 kg (110 lbs/2.2 lbs per kg). The client will receive 100 milligrams per day (50 kg x 2 milligrams/kg). The medication is to be given in two divided doses or 50 mg per dose.

After teaching a class comparing rheumatoid arthritis and osteoarthritis, the instructor determines that the teaching was successful when the students identify which of the following as characteristic of osteoarthritis?

After teaching a class comparing rheumatoid arthritis and osteoarthritis, the instructor determines that the teaching was successful when the students identify which of the following as characteristic of osteoarthritis?

a) Swan neck deformity
b) Ulnar deviation
c) Boutonniere deformity
d) Heberden nodes


Answer: d) Heberden nodes

Of the following, which drug is not used in the treatment of rheumatoid arthritis?

Of the following, which drug is not used in the treatment of rheumatoid arthritis?

a) Allopurinol (Zyloprim)
b) Adalimumab (Humira)
c) Methotrexate (Rheumatrex)
d) Etanercept (Enbrel


Answer: a) Allopurinol (Zyloprim)

The nurse is performing discharge teaching for a patient with rheumatoid arthritis. What teachings are priorities for the patient? Select all that apply.

The nurse is performing discharge teaching for a patient with rheumatoid arthritis. What teachings are priorities for the patient? Select all that apply.

a) Dressing changes
b) Narcotic safety
c) Safe exercise
d) Medication dosages and side effects
e) Assistive devices


Answer:

c) Safe exercise
d) Medication dosages and side effects
e) Assistive devices

All of the following are symptoms of osteoarthritis, except?

All of the following are symptoms of osteoarthritis, except?

a) Limited joint motion
b) Morning stiffness that lasts at least 1 hour.
c) Instability of weight-bearing joints
d) Deep, aching pain with motion early in the disease


Answer: b) Morning stiffness that lasts at least 1 hour.

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?

a) Ulnar deviation
b) Boutonnière deformity
c) Rheumatoid nodules
d) Swan neck deformity


Answer: d) Swan neck deformity

Which nursing diagnosis is most inappropriate for the client with osteoarthritis?

Which nursing diagnosis is most inappropriate for the client with osteoarthritis?

a) Imbalanced nutrition: less than body requirements
b) Impaired physical mobility
c) Deficient knowledge: symptom management
d) Chronic pain


Answer: a) Imbalanced nutrition: less than body requirements

Which of the following classifications are considered antiarthritic drugs? Select all that apply.

Which of the following classifications are considered antiarthritic drugs? Select all that apply.

a) Disease-modifying antirheumatics (DMARDs)
b) Diuretics
c) Anti-inflammatory
d) Muscle relaxants
e) Glucocorticoids


Answer:

c) Anti-inflammatory
a) Disease-modifying antirheumatics (DMARDs)
e) Glucocorticoids

Primary gout is often caused by an inherited disorder in which type of metabolism?

Primary gout is often caused by an inherited disorder in which type of metabolism?

a) Glucose
b) Fat
c) Purine
d) Carbohydrate


Answer: c) Purine

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about?

A patient is prescribed a DMARD that is successful in the treatment of RA but has side effects, including retinal eye changes. What medication does the nurse anticipate educating the patient about?

a) Azathioprine (Imuran)
b) Hydroxychloroquine (Plaquenil)
c) Aurothioglucose (Solganal)
d) Diclofenac (Voltaren)


Answer: b) Hydroxychloroquine (Plaquenil)

Ms Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of the teaching plan for her condition?

Ms Dowe was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. Which of the following would not be a part of the teaching plan for her condition?

a) Encouraging the client to eat a healthy diet
b) Regular exercise and stress reduction
c) Avoiding caffeine and alcohol
d) Applications of ice


Answer: d) Applications of ice

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates an understanding of the disease process?

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates an understanding of the disease process?

a) "It will get better and worse again."
b) "It will never get any better than it is right now."
c) "When it clears up, it will never come back."
d) "I'll definitely need surgery for this."


Answer: a) "It will get better and worse again."

A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response?

A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response?

a) Hand and finger deformities are associated with the development of rheumatoid arthritis.
b) A small percentage of osteoarthritis sufferers do eventually develop hand and arm deformities.
c) He should discuss this concern with his physician.
d) It's impossible to determine at the time of diagnosis of how the disease will progress.


Answer: a) Hand and finger deformities are associated with the development of rheumatoid arthritis.

Which of the following refers to fixation of a joint?

Which of the following refers to fixation of a joint?

a) Synovitis
b) Ankylosis
c) Pannus
d) Articulations


Answer: b) Ankylosis

The nurse is caring for a client with rheumatoid arthritis who suffers from chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises?

The nurse is caring for a client with rheumatoid arthritis who suffers from chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises?

a) After the client has had a warm paraffin hand bath
b) First thing in the morning when the client wakes
c) After the client has a diagnostic test
d) After cool compresses have been applied to the hands


Answer: a) After the client has had a warm paraffin hand bath

A client who was diagnosed with scleroderma 2 years ago is withdrawn, does not look at the nurse, and asks to be left alone. Appropriate nursing diagnosis for the client is:

A client who was diagnosed with scleroderma 2 years ago is withdrawn, does not look at the nurse, and asks to be left alone. Appropriate nursing diagnosis for the client is:

a) Disturbed body image
b) Risk for loneliness
c) Chronic low self-esteem
d) Spiritual distress


Answer: a) Disturbed body image

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues?

Which of the following connective tissue disorders is characterized by insoluble collagen being formed and accumulating excessively in the tissues?

a) Systemic lupus erythematosus
b) Polymyalgia rheumatic
c) Rheumatoid arthritis
d) Scleroderma


Answer: d) Scleroderma

Which of the following would be consistent with the diagnosis of rheumatoid arthritis?

Which of the following would be consistent with the diagnosis of rheumatoid arthritis?

a) Increased C4 complement component
b) Increased red blood cell count
c) Cloudy synovial fluid
d) Decreased ESR


Answer: c) Cloudy synovial fluid

Which of the following procedures involves surgical fusion of the joint?

Which of the following procedures involves surgical fusion of the joint?

a) Synovectomy
b) Tenorrhaphy
c) Osteotomy
d) Arthrodesis


Answer: d) Arthrodesis

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

a) Nonsteroidal anti-inflammatory drugs (NSAIDs)
b) Opioid therapy
c) Surgery
d) Ice packs

Answer: a) Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which of the following terms refers to fixation or immobility of a joint?

Which of the following terms refers to fixation or immobility of a joint?

a) Hemarthrosis
b) Ankylosis
c) Arthroplasty
d) Diarthrodial


Answer: b) Ankylosis

Which client is most likely to develop systemic lupus erythematosus (SLE)?

Which client is most likely to develop systemic lupus erythematosus (SLE)?

a) A 27-year-old black female
b) A 25-year-old white male
c) A 35-year-old Hispanic male
d) A 25-year-old Jewish female


Answer: a) A 27-year-old black female

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan?

The client asks the nurse about types of exercise that do not stress the joints. Which of the following would be an inappropriate type of exercise for the nurse to include in the teaching plan?

a) T'ai chi
b) Yoga
c) Pilates
d) Jogging


Answer: d) Jogging

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is:

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is:

a) obesity.
b) congenital deformity.
c) trauma.
d) age.


Answer: d) age.

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.)

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.)

a) Dyspnea owing to fibrotic cardiac tissue
b) Productive cough
c) Butterfly-shaped rash on the face
d) Dysphagia owing to hardening of the esophagus
e) Decreased ventilation owing to lung scarring


Answer:

e) Decreased ventilation owing to lung scarring
d) Dysphagia owing to hardening of the esophagus
a) Dyspnea owing to fibrotic cardiac tissue

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication?

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication?

a) Allopurinol (Zyloprim)
b) Propoxyphene hydrochloride (Darvon)
c) Prednisone (Deltasone)
d) Colchicine


Answer: d) Colchicine

A nurse is a poviding care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?

A nurse is a poviding care for a client with progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis?

a) Ineffective thermoregulation
b) Risk for imbalanced nutrition: More than body requirements
c) Constipation
d) Risk for impaired skin integrity


Answer: d) Risk for impaired skin integrity

A nurse is assigned to a client with polymyositis. Which expected the outcome in the care plan relates to a potential problem associated with polymyositis?

A nurse is assigned to a client with polymyositis. Which expected the outcome in the care plan relates to a potential problem associated with polymyositis?

a) "Client will lose 2 lb (0.91 kg) per week on a calorie-restricted diet."
b) "Client will exhibit alertness and orientation to person, place, and time."
c) "Client will exhibit no signs or symptoms of aspiration."
d) "Client will exhibit bowel and bladder continence."


Answer: c) "Client will exhibit no signs or symptoms of aspiration."

A client with rheumatoid arthritis is prescribed a tumour necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed?

A client with rheumatoid arthritis is prescribed a tumour necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed?

a) Etanercept
b) Celecoxib
c) Diclofenac
d) Indomethacin


Answer: a) Etanercept

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

a) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers
b) Weight gain, hypervigilance, hypothermia, and edema of the legs
c) Hypothermia, weight gain, lethargy, and edema of the arms
d) Facial erythema, pericarditis, pleuritis, fever, and weight loss


Answer: d) Facial erythema, pericarditis, pleuritis, fever, and weight loss

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?

a) Sicca syndrome
b) Episcleritis
c) Cataracts
d) Glaucoma


Answer: Sicca syndrome

Which of the following medications are used in the treatment of gout? Select all that apply.

Which of the following medications are used in the treatment of gout? Select all that apply.

a) Probenecid (Benemid)
b) Febuxostat (Uloric)
c) Sulfasalazine (Azulfidine)
d) Hydroxychloroquine (Plaquenil)
e) Allopurinol (Zyloprim)


Answer:

a) Probenecid (Benemid)
e) Allopurinol (Zyloprim)
b) Febuxostat (Uloric)

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout?

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is suffering from an acute attack of gout?

a) penicillamine
b) colchicine
c) methotrexate
d) prednisone


Answer: b) colchicine

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

a) "Exposure to sunlight will help control skin rashes."
b) "Monitor your body temperature."
c) "Corticosteroids may be stopped when symptoms are relieved."
d) "There are no activity limitations between flare-ups."


Answer: b) "Monitor your body temperature."

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?

a) Computed tomography (CT)
b) Bone scan
c) Muscle biopsy
d) Magnetic resonance imaging (MRI)


Answer: c) Muscle biopsy

Which of the following statements is accurate regarding osteoarthritis?

Which of the following statements is accurate regarding osteoarthritis?

a) It is the most common inflammatory arthritic disorder.
b) It is caused by an overproduction of uric acid.
c) It is a noninflammatory disorder and the most common and frequently disabling of joint disorders.
d) It affects young males.


Answer: c) It is a noninflammatory disorder and the most common and frequently disabling of joint disorders.

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?

Which of the following are usually the first choice in the treatment of rheumatoid arthritis (RA)?

a) Disease-modifying antirheumatic drugs (DMARDS)
b) Glucocorticoids
c) Nonsteroidal anti-inflammatory drugs (NSAIDs)
d) Tumor necrosis factor (TNF) blockers


Answer: c) Nonsteroidal anti-inflammatory drugs (NSAIDs)

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to:

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to:

a) wear protective devices when exercising.
b) get help when lifting objects.
c) install safety devices in the home.
d) wear worn, comfortable shoes.


Answer: c) install safety devices in the home.

Which of the following clinical manifestations would the nurse expect to find in a client with osteoarthritis?

Which of the following clinical manifestations would the nurse expect to find in a client with osteoarthritis? 

a) Small joint involvement
b) Joint pain that diminishes with rest
c) Early morning stiffness
d) Subcutaneous nodules


Answer: c) Early morning stiffness

Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except?

Ms. Wilson is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). You are teaching her and her family information about managing her disease. All of the following would be included, except?

a) Avoid sunlight and ultraviolet radiation.
b) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.
c) If you have problems with a medication, you may stop it until your next physician visit.
d) Pace activities.


Answer: c) If you have problems with a medication, you may stop it until your next physician visit.

Which of the following is the most common joint affected in gout?

Which of the following is the most common joint affected in gout?

a) Tarsal area
b) Metatarsophalangeal
c) Knee
d) Ankle


Answer: b) Metatarsophalangeal

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal?

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain a 10 out of 10. With a diagnosis of gout, what should the laboratory results reveal?

a) Hyperproteinuria
b) Hyperuricemia
c) Glucosuria
d) Ketonuria


Answer: b) Hyperuricemia

A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication?

A patient is taking NSAIDs for the treatment of osteoarthritis. What education should the nurse give the patient about the medication?

a) Inform the physician if there is ringing in the ears.
b) Since the medication is able to be obtained over the counter, it has few side effects.
c) Take the medication with food to avoid stomach upset.
d) Take the medication on an empty stomach in order to increase effectiveness.


Answer: c) Take the medication with food to avoid stomach upset.

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is a very specific indicator of this diagnosis?

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is a very specific indicator of this diagnosis?

a) Positive Anti-Sm antibodies
b) Positive ANA titre
c) Elevated ESR
d) Positive Anti-dsDNA antibody test


Answer: d) Positive Anti-dsDNA antibody test

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?

a) "My finger joints are oddly shaped."
b) "I have pain in my hands."
c) "My legs feel weak."
d) "I have trouble with my balance."


Answer: a) "My finger joints are oddly shaped."

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain?

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain?

a) Acupuncture
b) Cold therapy
c) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs)
d) An exercise routine that includes range-of-motion (ROM) exercises


Answer: d) An exercise routine that includes range-of-motion (ROM) exercises

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

The client with rheumatoid arthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

a) Reports decreased joint pain
b) Reports ability to perform ADLs
c) Reports increased fatigue
d) Shows a weight gain of 2 pounds


Answer: c) Reports increased fatigue

A nurse should expect to administer which medication to a client with gout?

A nurse should expect to administer which medication to a client with gout?

a) Colchicine
b) Furosemide (Lasix)
c) Calcium gluconate (Kalcinate)
d) Aspirin


Answer: a) Colchicine

What is the priority intervention for a patient who has been admitted repeatedly with attacks of gout?

What is the priority intervention for a patient who has been admitted repeatedly with attacks of gout?

a) Increase fluids
b) Place patient on bed rest
c) Assess dietary diet and activity at home
d) Insert a foley catheter


Answer: c) Assess dietary diet and activity at home

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

a) Risk for constipation
b) Impaired gas exchange
c) Impaired skin integrity
d) Imbalanced nutrition: More than body requirements


Answer: c) Impaired skin integrity

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result?

A patient has a serum study that is positive for the rheumatoid factor. What does the nurse understand is the significance of this test result?

a) Specific for RA
b) Diagnostic for Sjögren's syndrome
c) Diagnostic for SLE
d) Suggestive of RA


Answer: d) Suggestive of RA

Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis?

Which of the following would the nurse most commonly assess in a client with ankylosing spondylitis?

a) Patchy hair loss on the scalp
b) Red, butterfly-shaped facial rash
c) Increased urine output
d) Low back pain


Answer: d) Low back pain

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following?

After teaching a group of students about systemic lupus erythematosus, the instructor determines that the teaching was successful when the students state which of the following?

a) The symptoms are primarily localized to the skin but may involve the joints.
b) This disorder is more common in men in their thirties and forties than in women.
c) The belief is that it is an autoimmune disorder with an unknown trigger.
d) It has very specific manifestations that make diagnosis relatively easy.


Answer: c) The belief is that it is an autoimmune disorder with an unknown trigger.

A patient is seen in the office for complaints of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA?

A patient is seen in the office for complaints of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of RA?

a) Positive antinuclear antibody (ANA)
b) Positive C-reactive protein (CRP)
c) Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L
d) Red blood cell (RBC) count of <4.0 million/mcL
e) Red blood cell (RBC) count of >4.0 million/mcL


Answer:

a) Positive antinuclear antibody (ANA)
b) Positive C-reactive protein (CRP)
d) Red blood cell (RBC) count of <4.0 million/mcL

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:

a) green vegetables.
b) organ meats.
c) fresh fish.
d) citrus fruits.


Answer: b) organ meats.

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?

a) "You should discuss that matter with your physician."
b) "Tell me more about your concerns about this potential diagnosis."
c) "The diagnosis won't be based on the findings of a single test but by combining all data found."
d) "SLE is a very serious systemic disorder."


Answer: c) "The diagnosis won't be based on the findings of a single test but by combining all data found."

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis?

Which diagnostic study finding is decreased in patients diagnosed with rheumatoid arthritis?

a) Uric acid
b) Creatinine
c) Red blood cell count
d) Erythrocyte sedimentation rate (ESR)


Answer: c) Red blood cell count

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

a) "Do all your chores after performing morning exercises to loosen up."
b) "Do all your chores in the morning, when pain and stiffness are least pronounced."
c) "Do all your chores in the evening, when pain and stiffness are least pronounced."
d) "Pace yourself and rest frequently, especially after activities."


Answer: d) "Pace yourself and rest frequently, especially after activities."

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand the action of this compound?

A patient is receiving gold sodium thiomalate (Myochrysine) for the treatment of RA. What does the nurse understand the action of this compound?

a) Inhibits DNA synthesis
b) Inhibits lysosomal enzymes
c) Inhibits T- and B-cell activity
d) Inhibits platelet aggregation


Answer: c) Inhibits T- and B-cell activity

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

a) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints."
b) "OA is more common in women. RA is more common in men."
c) "OA affects joints on both sides of the body. RA is usually unilateral."
d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."


Answer: d) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?

a) Widespread chronic pain
b) Jaw locking
c) Butterfly facial rash
d) Heberden nodes


Answer: a) Widespread chronic pain

What should the nurse teach the patient about the diagnosis of osteoarthritis?

What should the nurse teach the patient about the diagnosis of osteoarthritis?

a) "It affects young males."
b) "It is the most common and frequently disabling of joint disorders."
c) "It requires early treatment because most of the damage appears to occur early in the course of the disease."
d) "It affects the cartilaginous joints of the spine and surrounding tissues."


Answer: b) "It is the most common and frequently disabling of joint disorders."

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

a) The time of day when exercise is performed isn't important.
b) Exercising immediately upon awakening allows the client to participate in activities when he has the greatest amount of energy.
c) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
d) Exercising in the evening before going to bed is beneficial.


Answer: c) Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

A patient arrives at the clinic with complaints of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What does the nurse determine that the symptoms are most likely related to?

A patient arrives at the clinic with complaints of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What does the nurse determine that the symptoms are most likely related to?

a) Fibromyalgia
b) Osteoarthritis
c) Gout
d) Rheumatoid arthritis


Answer: c) Gout

A client is recovering from an attack of gout. Client teaching should include the need to lose weight because:

A client is recovering from an attack of gout. Client teaching should include the need to lose weight because:

a) weight loss will reduce uric acid levels and reduce stress on joints.
b) weight loss will reduce purine levels.
c) weight loss will increase uric acid levels and reduce stress on joints.
d) weight loss will reduce inflammation.


Answer: a) weight loss will reduce uric acid levels and reduce stress on joints.

The nurse intervenes to assist the patient with fibromyalgia to cope with what symptoms?

The nurse intervenes to assist the patient with fibromyalgia to cope with what symptoms?

a) Pain, viral infection, and tremors
b) Generalized muscle aching, mood swings, and loss of balance
c) Diminished vision, chronic fatigue, and reduced appetite
d) Chronic fatigue, generalized muscle aching, and stiffness


vd) Chronic fatigue, generalized muscle aching, and stiffness

What intervention is a priority for a patient diagnosed with osteoarthritis?

What intervention is a priority for a patient diagnosed with osteoarthritis?

a) Hydrotherapy
b) Allopurinol (Zyloprim)
c) Colchicine
d) Physical therapy and exercise


Answer: d) Physical therapy and exercise

Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following?

Nursing assessment findings reveal joint swelling and tenderness of the great toe. The nurse suspects which of the following?

a) Rheumatoid arthritis
b) Ankylosing spondylitis
c) Osteoarthritis
d) Gout


Answer: d) Gout

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

a) Performing meticulous skin care
b) Administering ordered analgesics and monitoring their effects
c) Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes
d) Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware


Answer: b) Administering ordered analgesics and monitoring their effects

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process?

The nurse teaches the patient that the presence of crystals in his or her synovial fluid obtained from an arthrocentesis confirms which disease process?

a) Inflammation
b) Degeneration
c) Gout
d) Infection


Answer: c) Gout

Which of the following is the leading cause of disability and pain in the elderly?

Which of the following is the leading cause of disability and pain in the elderly?

a) SLE
b) Scleroderma
c) Rheumatoid arthritis (RA)
d) Osteoarthritis


Answer: d) Osteoarthritis

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?

a) Reiter's syndrome
b) Ankylosing spondylitis
c) Sjögren's syndrome
d) Raynaud's phenomenon


Answer: d) Raynaud's phenomenon

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"?

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"?

a) "Your symptoms are a result of your body attacking itself."
b) "You are not immune to the disease causing the symptoms."
c) "You have inherited your parent's immunity to the disease."
d) "You have antigens to the disease, but it they do not prevent the disease."


Answer: a) "Your symptoms are a result of your body attacking itself."

Which of the following is the leading cause of disability and pain in the elderly?

Which of the following is the leading cause of disability and pain in the elderly?

a) Systemic lupus erythematous (SLE)
b) Osteoarthritis
c) Scleroderma
d) Rheumatoid arthritis (RA)


Answer: b) Osteoarthritis

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?

a) Elevated erythrocyte sedimentation rate
b) Increased albumin levels
c) Increased red blood cell count
d) Increased C4 complement


Answer: a) Elevated erythrocyte sedimentation rate

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

A physician orders corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

a) combat inflammation.
b) prevent platelet aggregation.
c) promote diuresis.
d) prevent infection.


Answer: a) combat inflammation.

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

a) Scoliosis
b) Paget's disease
c) Muscular dystrophy
d) Degenerative joint disease


Answer: d) Degenerative joint disease

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client?

The client with rheumatoid arthritis has a red blood cell count of 3.2 cells/cu mm. Which nursing diagnosis has the highest priority for the client?

a) Self-care deficit: Bathing
b) Ineffective airway clearance
c) Fatigue
d) Risk for infection


Answer: c) Fatigue

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

Which of the following is an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

a) Subchondral bone
b) Pannus
c) Joint effusion
d) Tophi


Answer: d) Tophi

Nursing care for the patient with fibromyalgia should be guided by what assumption?

Nursing care for the patient with fibromyalgia should be guided by what assumption?

a) Patients with fibromyalgia may feel as if their symptoms are not taken seriously.
b) All patients with fibromyalgia have the same type of symptoms.
c) Patients with fibromyalgia will eventually lose their ability to walk.
d) Patients with fibromyalgia rarely respond to treatment.


Answer: a) Patients with fibromyalgia may feel as if their symptoms are not taken seriously.

Which of the following would a nurse encourage a client with gout to limit?

Which of the following would a nurse encourage a client with gout to limit?

a) Carbohydrates
b) Purine-rich foods
c) Fluid intake
d) Protein-rich foods


Answer: b) Purine-rich foods

Which of the following suggests to the nurse that the client with systemic lupus erythematosus is having renal involvement?

Which of the following suggests to the nurse that the client with systemic lupus erythematosus is having renal involvement?

a) Hypertension
b) Chest pain
c) Behavioral changes
d) Decreased cognitive ability


Answer: a) Hypertension

Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis?

Which of the following is an appropriate nursing intervention in the care of the patient with osteoarthritis?

a) Provide an analgesic after exercise.
b) Avoid the use of topical analgesics.
c) Encourage weight loss and an increase in aerobic activity.
d) Assess for the gastrointestinal complications associated with COX-2 inhibitors.


Answer: c) Encourage weight loss and an increase in aerobic activity.

Which findings best correlate with a diagnosis of osteoarthritis?

Which findings best correlate with a diagnosis of osteoarthritis?

a) Joint stiffness that decreases with activity
b) Fever and malaise
c) Erythema and edema over the affected joint
d) Anorexia and weight loss


Answer: a) Joint stiffness that decreases with activity

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)?

Which of the following points should be included in the medication-teaching plan for a patient taking adalimumab (Humira)?

a) The medication is administered IM.
b) The medication is given at room temperature.
c) It is important to monitor for injection site reactions.
d) The patient should continue taking the medication if fever occurs.


Answer: c) It is important to monitor for injection site reactions.

A client with gout has been advised to lose weight. She informs the nurse that she plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate?

A client with gout has been advised to lose weight. She informs the nurse that she plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate? 

a) "The fasting is okay, but make sure you drink fluids when exercising."
b) "Make sure to eat some fat occasionally with all that exercise."
c) "Try combining the fasting with moderate exercise."
d) "There might be some difficulties with your plan and fasting."


Answer: d) "There might be some difficulties with your plan and fasting."

Osteoarthritis is known as a disease that

Osteoarthritis is known as a disease that

a) requires early treatment because most of the damage appears to occur early in the course of the disease.
b) affects the cartilaginous joints of the spine and surrounding tissues.
c) affects young males.
d) is the most common and frequently disabling of joint disorders.


Answer: d) is the most common and frequently disabling of joint disorders.

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions?

The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions?

A. "This medication will help me digest fats and fat-soluble vitamins."
B. "I will apply the medicated lotion sparingly to the areas where I itch."
C. "The medication is a powder and needs to be mixed with milk or juice."
D. "I should take this medication on an empty stomach at the same time each day."


Answer: C. "The medication is a powder and needs to be mixed with milk or juice."

The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer?

The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer?

A. A 38-year-old Hispanic female who is obese and has hyperinsulinemia
B. A 23-year-old who has cystic fibrosis-related pancreatic enzyme insufficiency Incorrect
C. A 72-year-old African American male who has smoked cigarettes for 50 years
D. A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus


Answer: C. A 72-year-old African American male who has smoked cigarettes for 50 years

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit?

The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit?

A. Hematochezia
B. Left upper abdominal pain
C. Ascites and peripheral edema
D. Temperature over 102o F (38.9o C)


Answer: B. Left upper abdominal pain

The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral oedema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?

The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral oedema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?

A. "It is safe to take acetaminophen up to four times a day for pain."
B. "Lactulose (Cephulac) should be taken every day to prevent constipation."
C. "Herbs and other spices should be used to season my foods instead of salt."
D. "I will eat foods high in potassium while taking spironolactone (Aldactone)."


Answer: C. "Herbs and other spices should be used to season my foods instead of salt." 

The nurse is caring for a woman recently diagnosed with viral hepatitis

The nurse is caring for a woman recently diagnosed with viral hepatitis 

A. Which individual should the nurse refer for an immunoglobin (IG) injection?
B. A friend who delivers meals to the patient and family each week
C. A relative with a history of hepatitis A who visits the patient daily
D. A child living in the home who received the hepatitis A vaccine 3 months ago


Answer: A. A caregiver who lives in the same household with the patient

When providing discharge teaching for the patient after laparoscopic cholecystectomy, what information should the nurse include?

When providing discharge teaching for the patient after laparoscopic cholecystectomy, what information should the nurse include?

A. A lower-fat diet may be better tolerated for several weeks.
B. Do not return to work or normal activities for 3 weeks.
C. Bile-colored drainage will probably drain from the incision.
D. Keep the bandages on and the puncture site dry until it heals.


Answer: A. A lower-fat diet may be better tolerated for several weeks.

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment?

The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment?

A. Spiral CT scan
B. A PET/CT scan
C. Abdominal ultrasound
D. Cancer-associated antigen 19-9


Answer: D. Cancer-associated antigen 19-9

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?

A. Immediately start enteral feeding to prevent malnutrition.
B. Insert an NG and maintain NPO status to allow pancreas to rest.
C. Initiate early prophylactic antibiotic therapy to prevent infection.
D. Administer acetaminophen (Tylenol) every 4 hours for pain relief.


Answer: B. Insert an NG and maintain NPO status to allow pancreas to rest.

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation?

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation?

A. Has completed a college education
B. Has been able to stop smoking cigarettes
C. Has well-controlled type 1 diabetes mellitus
D. The chest x-ray showed another lung cancer lesion.


Answer: D. The chest x-ray showed another lung cancer lesion.

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?

A. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."
B. "I need to take good care of my belly and ankle skin where it is swollen."
C. "A scrotal support may be more comfortable when I have scrotal edema."
D. "I can use pillows to support my head to help me breathe when I am in bed."


Answer: A. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)?

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)?

A. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin.
B. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention.
C. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.
D. Osmoreceptors in the hypothalamus stimulates thirst, which causes the stimulation to take in fluids orally.
E. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.


Answer:

A. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin.
B. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention.
C. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.

When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?

When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?

A. "I will use care when kissing my wife to prevent giving it to her."
B. "I will need to take adofevir (Hepsera) to prevent chronic HCV."
C. "Now that I have had HCV, I will have immunity and not get it again."
D. "I will need to be checked for chronic HCV and other liver problems."



Answer: D. "I will need to be checked for chronic HCV and other liver problems."

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy?

A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy?

A. Low-grade fever of 100° F and dehydration
B. Abscess in the right upper quadrant of the abdomen
C. Activated partial thromboplastin time (aPTT) of 54 seconds
D. Multiple obstructions in the cystic and common bile duct


Answer: C. Activated partial thromboplastin time (aPTT) of 54 seconds

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient?

The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient?

A. Prevent all oral intake.
B. Control abdominal pain.
C. Provide enteral feedings.
D. Avoid dietary cholesterol.


Answer: B. Control abdominal pain.

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer?

The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer?

A. Serum a-fetoprotein level
B. Ventilation/perfusion scan
C. Hepatic structure ultrasound
D. Abdominal girth measurement


Answer: C. Hepatic structure ultrasound Correct 

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications?

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications?

A. Tramadol (Ultram)
B. Hydromorphone (Dilaudid)
C. Oxycodone with aspirin (Percodan)
D. Hydrocodone with acetaminophen (Vicodin)


Answer: D. Hydrocodone with acetaminophen (Vicodin)

When caring for a patient with biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)?

When caring for a patient with biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)?

A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K
E. Vitamin B


Answer:

A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge?

A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge?

A. Milk thistle may affect liver enzymes and thus alter drug metabolism.
B. Milk thistle is generally safe in recommended doses for up to 10 years.
C. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis.
D. Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.


Answer: A. Milk thistle may affect liver enzymes and thus alter drug metabolism.

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)?

When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)?

A. Use smallest gauge needle possible when giving injections or drawing blood.
B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing.
C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food.
D. Apply gentle pressure for the shortest possible time period after performing venipuncture.
E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.


Answer:

A. Use smallest gauge needle possible when giving injections or drawing blood.
B. Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing.
C. Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food.
E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

When planning care for a patient with cirrhosis, the nurse will give the highest priority to which nursing diagnosis?

When planning care for a patient with cirrhosis, the nurse will give the highest priority to which nursing diagnosis?

A. Impaired skin integrity related to edema, ascites, and pruritus
B. Imbalanced nutrition: less than body requirements related to anorexia
C. Excess fluid volume related to portal hypertension and hyperaldosteronism
D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume


Answer: D. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate?

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate?

A. "The hepatitis vaccine will provide immunity from this exposure and future exposures."
B. "I am afraid there is nothing you can do since the patient was infectious before admission."
C. "You will need to be tested first to make sure you don't have the virus before we can treat you."
D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."


Answer: D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?

A. Relief of constipation
B. Relief of abdominal pain
C. Decreased liver enzymes
D. Decreased ammonia levels


Answer: D. Decreased ammonia levels.

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?

A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?

A. Malnutrition
B. Osteomyelitis
C. Alcohol abuse
D. Diabetes mellitus


Answer: C. Alcohol Use

Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent?

Elective cardioversion is similar to defibrillation except that the electrical stimulation waits to discharge until an R wave appears. What does this prevent?

a) Disrupting the heart during the critical period of atrial repolarization.
b) Disrupting the heart during the critical period of ventricular repolarization.
c) Disrupting the heart during the critical period of ventricular depolarization.
d) Disrupting the heart during the critical period of atrial depolarization.


Answer: b) Disrupting the heart during the critical period of ventricular repolarization.

The nurse is analyzing the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The patient's ECG strip demonstrates PR intervals that measure 0.24 seconds. Which of the following is the nurse's most appropriate action?

The nurse is analyzing the electrocardiogram (ECG) strip of a stable patient admitted to the telemetry unit. The patient's ECG strip demonstrates PR intervals that measure 0.24 seconds. Which of the following is the nurse's most appropriate action?

a) Apply oxygen via nasal cannula and obtain a 12-lead ECG.
b) Document the findings and continue to monitor the patient.
c) Instruct the patient to bear down as if having a bowel movement.
d) Notify the patient's primary care provider of the findings.


Answer: b) Document the findings and continue to monitor the patient.

You are caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia?

You are caring for a client with atrial fibrillation. What procedure would be recommended if drug therapies did not control the dysrhythmia?

a) Pacemaker implantation
b) Elective cardioversion
c) Mace procedure
d) Defibrillation


Answer: b) Elective cardioversion

A 28-year-old female patient presents to the emergency department (ED) stating severe restlessness and anxiety. Upon assessment, the patient's heart rate is 118 bpm and regular, the patient's pupils are dilated, and the patient appears excitable. Which action should the nurse take next?

A 28-year-old female patient presents to the emergency department (ED) stating severe restlessness and anxiety. Upon assessment, the patient's heart rate is 118 bpm and regular, the patient's pupils are dilated, and the patient appears excitable. Which action should the nurse take next?

a) Place the patient on supplemental oxygen.
b) Prepare to administer a calcium channel blocker.
c) Question the patient about alcohol and illicit drug use.
d) Instruct the patient to hold her breath and bear down.


Answer: c) Question the patient about alcohol and illicit drug use.

A 78-year-old client was just admitted to the cardiac step-down unit where you practice nursing. Upon stabilizing his condition, you begin a conversation about his symptoms and you answer his questions to the best of your ability. In your discussion of cardiac dysrhythmias, which of the following would you rule out as a likely origination point for cardiac dysrhythmias?

A 78-year-old client was just admitted to the cardiac step-down unit where you practice nursing. Upon stabilizing his condition, you begin a conversation about his symptoms and you answer his questions to the best of your ability. In your discussion of cardiac dysrhythmias, which of the following would you rule out as a likely origination point for cardiac dysrhythmias?

a) Ventricles
b) Bundle of His
c) Atria
d) Atrioventricular node


Answer: b) Bundle of His

The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education.

The nurse is caring for a client who had a permanent pacemaker surgically placed yesterday and is now ready for discharge. Which statement made by the client indicates the need for more education.

a) "I will call the doctor if my incision becomes swollen and red."
b) "I will check my pulse every day and report to the doctor if the rate is below the pacemaker setting."
c) "I will avoid any large magnets that may affect my pacemaker."
d) "We will be getting rid of our microwave oven so it will not affect my pacemaker."


Answer: d) "We will be getting rid of our microwave oven so it will not affect my pacemaker."

The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button?

The nurse is preparing to defibrillate a client with no breathing or pulse. Which nursing action precedes the nurse pressing the discharge button?

a) Shouts, "All clear"
b) States, "Charging"
c) Placing gel on the chest
d) Checking the ECG rhythm


Answer: a) Shouts, "All clear"

A patient's ECG tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as which of the following?

A patient's ECG tracing reveals a ventricular rate between 250 and 400, with saw-toothed P waves. The nurse correctly identifies this dysrhythmia as which of the following?

a) Atrial flutter
b) Atrial fibrillation
c) Ventricular tachycardia
d) Ventricular fibrillation


Answer: a) Atrial flutter

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?

When the nurse observes an electrocardiogram (ECG) tracing on a cardiac monitor with a pattern in lead II and observes a bizarre, abnormal shape to the QRS complex, the nurse has likely observed which of the following ventricular dysrhythmias?

a) Premature ventricular contraction (PVC)
b) Ventricular fibrillation
c) Ventricular bigeminy
d) Ventricular tachycardia


Answer: a) Premature ventricular contraction (PVC)

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?

A patient is 2 days postoperative after having a permanent pacemaker inserted. The nurse observes that the patient is having continuous hiccups as the patient states, "I thought this was normal." What does the nurse understand is occurring with this patient?

a) Lead wire dislodgement
b) Faulty generator
c) Fracture of the lead wire
d) Sensitivity is too low


Answer: a) Lead wire dislodgement

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis for this client would be which of the following?

The nurse is caring for a client who is displaying a third-degree AV block on the EKG monitor. The client is symptomatic due to the slow heart rate. The most appropriate nursing diagnosis for this client would be which of the following?

a) Decreased cardiac output
b) Ineffective health maintenance
c) Ineffective breathing pattern
d) Risk for vascular trauma


Answer: a) Decreased cardiac output

In looking at the ECG of a new patient, 43-year-old Mrs. Smith, you see what appears to be a P wave slightly different than normal. You're considering the possibility of premature atrial contractions (PAC). Which of the following questions will you ask her when taking her history?

In looking at the ECG of a new patient, 43-year-old Mrs. Smith, you see what appears to be a P wave slightly different than normal. You're considering the possibility of premature atrial contractions (PAC). Which of the following questions will you ask her when taking her history?

a) Caffeine
b) Nicotine
c) Hyperthyroidism or other metabolic disorders
d) All options are correct


Answer: d) All options are correct

Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which difference will the nurse confirm?

Two clients in cardiac rehabilitation are discussing the differences between scheduled cardioversion and unexpected defibrillation. Which difference will the nurse confirm?

a) Both procedures sedate the clients.
b) Cardioversion uses less electrical energy.
c) Both used to eliminate ventricular dysrhythmias.
d) Machine determines when electrical energy is delivered.


Answer: b) Cardioversion uses less electrical energy.

The treatment for symptomatic junctional rhythm is the same as for which of the following other heart rhythms?

The treatment for symptomatic junctional rhythm is the same as for which of the following other heart rhythms?

a) Atrial flutter
b) Tachycardia
c) Atrial fibrillation
d) Bradycardia


Answer: d) Bradycardia

A physician orders esmolol (Brevibloc) for a client with supraventricular tachycardia. During esmolol therapy, the nurse should monitor the client's:

A physician orders esmolol (Brevibloc) for a client with supraventricular tachycardia. During esmolol therapy, the nurse should monitor the client's:

a) heart rate and blood pressure.
b) ocular pressure.
c) cerebral perfusion pressure.
d) body temperature.


Answer: a) heart rate and blood pressure.

When the nurse observes that the patient's heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating

When the nurse observes that the patient's heart rate increases during inspiration and decreases during expiration, the nurse reports that the patient is demonstrating

a) sinus bradycardia.
b) normal sinus rhythm.
c) sinus tachycardia.
d) sinus dysrhythmia.


Answer: d) sinus dysrhythmia.

The nursing instructor is discussing pacemakers with her clinical group. One of the students is caring for a client with a transvenous pacemaker. One of the students asks why this client has a transvenous pacemaker. What would be the instructor's best response?

The nursing instructor is discussing pacemakers with her clinical group. One of the students is caring for a client with a transvenous pacemaker. One of the students asks why this client has a transvenous pacemaker. What would be the instructor's best response?

a) "A transvenous pacemaker is used in place of a transarterial pacemaker."
b) "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."
c) "A transvenous pacemaker is used for a ventricular tachyarrhythmia."
d) "A transvenous pacemaker is a permanent pacemaker that is asynchronous."


Answer: b) "A transvenous pacemaker is used to manage transient bradydysrhythmias like those that occur during acute MIs."

The nurse is participating in the care of a client requiring emergent defibrillation. The nurse will complete the following steps in which order?

The nurse is participating in the care of a client requiring emergent defibrillation. The nurse will complete the following steps in which order?

a) Turn on the defibrillator and place it in "not sync" mode.
b) Call "clear" three times ensuring patient and environmental safety.
c) Deliver the prescribed electrical charge.
d) Charge the defibrillator to the prescribed voltage.
e) Apply the multifunction conductor pads to the patient's chest.


Answer:

a) Turn on the defibrillator and place it in "not sync" mode.
d) Charge the defibrillator to the prescribed voltage.
e) Apply the multifunction conductor pads to the patient's chest.
b) Call "clear" three times ensuring patient and environmental safety.
c) Deliver the prescribed electrical charge.

The nurse receives a telephone call from a client with an implanted pacemaker who reports that his pulse is 68 beats per minute, but his pacemaker rate is set at 72 beats per minute. The best response by the nurse is which of the following?

The nurse receives a telephone call from a client with an implanted pacemaker who reports that his pulse is 68 beats per minute, but his pacemaker rate is set at 72 beats per minute. The best response by the nurse is which of the following?

a) "This is okay as long as you are not having any symptoms."
b) "Try walking briskly for about 5 minutes to see if that gets your heart rate to increase."
c) "Don't worry. The pacemaker's rate is often higher than the client's actual heart rate."
d) "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."


Answer: d) "Please come to the clinic right away so that we may interrogate the pacemaker to see if it is malfunctioning."

John, an 82-year-old retired librarian is brought into the ED where you practice nursing. The client's heart rate is greater than 155 beats/minute. As you connect him to the ECG, you notice that his rhythm is regular, rate is 162 beats/minute, and diastole is shortened. He is intermittently alert and reports chest pain. P waves cannot be identified. What condition would you expect the physician to diagnose?

John, an 82-year-old retired librarian is brought into the ED where you practice nursing. The client's heart rate is greater than 155 beats/minute. As you connect him to the ECG, you notice that his rhythm is regular, rate is 162 beats/minute, and diastole is shortened. He is intermittently alert and reports chest pain. P waves cannot be identified. What condition would you expect the physician to diagnose?

a) Atrial flutter
b) Sinus tachycardia
c) Heart block
d) Supraventricular tachycardia


Answer: d) Supraventricular tachycardia

An 83-year-old resident in the long-term care facility where you practice nursing has an irregular heart rate of around 100 beats/minute. He also has a significant pulse deficit. What component of his history would produce such symptoms?

An 83-year-old resident in the long-term care facility where you practice nursing has an irregular heart rate of around 100 beats/minute. He also has a significant pulse deficit. What component of his history would produce such symptoms?

a) Bundle branch block
b) Heart block
c) Atrial flutter
d) Atrial fibrillation


Answer: d) Atrial fibrillation

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?

The licensed practical nurse is setting up the room for a client arriving at the emergency department with ventricular arrhythmias. The nurse is most correct to place which of the following in the room for treatment?

a) A suction machine
b) Cardioversion equipment
c) An ECG machine
d) A defibrillator


Answer: d) A defibrillator

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following?

Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following?

a) P wave resent before each QRS
b) Normal PR interval
c) Atrial rate of 300 to 400
d) Regular rhythm


Answer: c) Atrial rate of 300 to 400

Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds?

Electrocardiogram (ECG) waveforms are printed on graph paper that is divided by light and dark vertical and horizontal lines at standard intervals. When the nurse is interpreting the heart rhythm, he or she understands that each large block equals how many seconds?

a) 0.3
b) 0.2
c) 0.1
d) 0.4


Answer: b) 0.2

A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding?

A patient admitted to the telemetry unit has a serum potassium level of 6.6 mEq/L. Which of the following electrocardiographic (ECG) characteristics is commonly associated with this laboratory finding?

a) Peaked T waves
b) Flattened P waves
c) Prolonged QT interval
d) Occasional U waves


Answer: a) Peaked T waves

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification?

The nurse is caring for a client who is being discharged after insertion of a permanent pacemaker. Which question by the client indicates a need for clarification?

a) "I should ask for a handheld device search when I go through airport security."
b) "I should avoid contact sports."
c) "I'll watch the incision for swelling or redness and will report if either occurs."
d) "I should avoid large magnetic fields, such as an MRI machine or large motors."


Answer: a) "I should ask for a handheld device search when I go through airport security."

The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first?

The nurse is working on a monitored unit assessing the cardiac monitor rhythms. Which waveform pattern needs attention first?

a) Sustained asystole
b) Supraventricular tachycardia
c) Ventricular fibrillation
d) Atrial fibrillation


Answer: c) Ventricular fibrillation

A 73-year-old client has returned to the postanesthesia care unit where you practice nursing. The client had a pacemaker implanted and it is your responsibility to begin client education upon his becoming alert. Which of the following postimplantation instructions must you provide to the client now that he has a permanent pacemaker?

A 73-year-old client has returned to the postanesthesia care unit where you practice nursing. The client had a pacemaker implanted and it is your responsibility to begin client education upon his becoming alert. Which of the following postimplantation instructions must you provide to the client now that he has a permanent pacemaker?

a) Keep moving the arm on the side where the pacemaker is inserted.
b) Keep the arm on the side of the pacemaker higher than the head.
c) Avoid sources of electrical interference.
d) Delay for at least 3 weeks activities such as swimming and bowling.


Answer: c) Avoid sources of electrical interference.

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?

The nurse is assigned the following client assignment on the clinical unit. For which client does the nurse anticipate cardioversion as a possible medical treatment?

a) A client with poor kidney perfusion
b) A new myocardial infarction client
c) A client with atrial dysrhythmias
d) A client with third-degree heart block


Answer: A client with atrial dysrhythmias

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?

A client is unconscious on arrival to the emergency department. The nurse in the emergency department identifies that the client has a permanent pacemaker due to which characteristic?

a) "Spike" on the rhythm strip
b) Quality of the pulse
c) Scar on the chest
d) Vibration under the skin


Answer: a) "Spike" on the rhythm strip

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients?

You are caring for a client who has been admitted to have a cardioverter defibrillator implanted. You would know that implanted cardioverter defibrillators are used in what clients?

a) Clients with recurrent life-threatening bradycardias
b) Clients with sinus tachycardia
c) Clients with ventricular bradycardia
d) Clients with recurrent life-threatening tachydysrhythmias


Answer: d) Clients with recurrent life-threatening tachydysrhythmias

The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation?

The nurse is caring for a client who has just been diagnosed with sinus bradycardia. The client asks the nurse to explain what sinus bradycardia is. What would be the nurse's best explanation?

a) In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output.
b) Sinus bradycardia means your heart is not beating fast enough to keep you alive.
c) Sinus bradycardia is nothing to worry about.
d) In many clients a heart rate slower than 70 beats per minute is considered to slow to maintain an adequate cardiac output.


Answer: a) In many clients a heart rate slower than 60 beats per minute is considered to slow to maintain an adequate cardiac output.

Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block?

Which of the following tends to be prolonged on the electrocardiogram (ECG) during a first-degree atrioventricular (AV) block?

a) PR interval
b) T wave
c) P wave
d) QRS


Answer: a) PR interval 

You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?

You are caring for a client who has premature ventricular contractions. What sign or symptom is observed in this client?

a) Nausea
b) Hypotension
c) Fluttering
d) Fever


Answer: c) Fluttering

A nurse is evaluating a client with a temporary pacemaker. The patient's ECG tracing shows each P wave followed by the pacing spike. The nurse's best response is which of the following?

A nurse is evaluating a client with a temporary pacemaker. The patient's ECG tracing shows each P wave followed by the pacing spike. The nurse's best response is which of the following?

a) Reposition the extremity and turn the patient to left side.
b) Obtain a 12-lead ECG and a portable chest x-ray.
c) Check the security of all connections and increase the milliamperage.
d) Document the findings and continue to monitor the patient.


Answer: d) Document the findings and continue to monitor the patient

Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for elective electrical cardioversion?

Which of the following nursing interventions is required to prepare a patient with cardiac dysrhythmia for elective electrical cardioversion?

a) Administer digitalis and diuretics 24 hours before cardioversion
b) Facilitate CPR until the patient is prepared for cardioversion
c) Instruct the patient to restrict food and oral intake
d) Monitor blood pressure every 4 hours


Answer: c) Instruct the patient to restrict food and oral intake

Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker?

Which of the following postimplantation instructions must a nurse provide a patient with a permanent pacemaker?

a) Avoid sources of electrical interference
b) Keep moving the arm on the side where the pacemaker is inserted
c) Keep the arm on the side of the pacemaker higher than the head
d) Delay for at least 3 weeks activities such as swimming and bowling


Answer: a) Avoid sources of electrical interference

Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke?

Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke?

a) Plavix
b) Lovenox
c) Aspirin
d) Coumadin


Answer: d) Coumadin

You are overseeing a 62-year-old who has started to exhibit dangerous PVCs in the cardiac postoperative unit. He's been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should you be ready to do?

You are overseeing a 62-year-old who has started to exhibit dangerous PVCs in the cardiac postoperative unit. He's been given a bolus of lidocaine and is under continuous IV infusion, but serious side effects, including hypotension during administration, could occur. What should you be ready to do?

a) Call for the doctor and just wait.
b) Administer additional lidocaine.
c) Prepare for defibrillation.
d) Adjust the IV infusion.


Answer: d) Adjust the IV infusion.

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following?

The nurse is teaching a beginning EKG class to staff nurses. As the nurse begins to discuss the parts of the EKG complex, one of the students asks what the normal order of conduction through the heart is. The correct response would be which of the following?

a) SA node, AV node, right and left bundle branches, bundle of His, and the Purkinje fibers
b) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers
c) SA node, AV node, bundle of His, the Purkinje fibers, and the right and left bundle branches
d) AV node, SA node, bundle of His, right and left bundle branches, and the Purkinje fibers


Answer: b) Sinoatrial (SA) node, atrioventricular (AV) node, bundle of His, right and left bundle branches, and the Purkinje fibers

Treatment of symptomatic bradycardia includes which of the following?

Treatment of symptomatic bradycardia includes which of the following?

a) Cardioversion
b) Adenocard
c) Lidocaine
d) Atropine


Answer: d) Atropine

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip?

A nursing instructor is reviewing the parts of an EKG strip with a group of students. One student asks about the names of all the EKG cardiac complex parts. Which of the following items are considered a part of the cardiac complex on an EKG strip? 

a) T wave
b) P-R interval
c) QRT wave
d) P wave
e) S-Q segment


Answer:

d) P wave
b) P-R interval
a) T wave

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client?

Your client has been diagnosed with an atrial dysrhythmia. The client has come to the clinic for a follow-up appointment and to talk with the physician about options to stop this dysrhythmia. What would be a procedure used to treat this client?

a) Elective electrical cardioversion
b) Elective electrical defibrillation
c) Chemical cardioversion
d) Mace procedure


Answer: a) Elective electrical cardioversion