A nurse measures the residual gastric volume of a patient receiving intermittent tube feedings. The patient's last residual volume was 250 mL. Which finding would lead the nurse to notify the physician?

A nurse measures the residual gastric volume of a patient receiving intermittent tube feedings. The patient's last residual volume was 250 mL. Which finding would lead the nurse to notify the physician? 

a) 200 mL
b) 225 mL
c) 150 mL
d) 175 mL


Answer: b) 225 mL

After teaching a patient about the procedure for inserting a nontunneled central catheter, the nurse determines that the patient has understood the instructions based on which of the following statements?

After teaching a patient about the procedure for inserting a nontunneled central catheter, the nurse determines that the patient has understood the instructions based on which of the following statements? 

a) "I need to keep my head turned directly toward you and the physician."
b) "I will need to take long, slow, deep breaths when the catheter is inserted."
c) "I'll have to wear a thick, bulky dressing over the site."
d) "I will be lying on my back but my legs will be higher than my head."


Answer: d) "I will be lying on my back but my legs will be higher than my head."

The nurse is attempting to unclog a patient's feeding tube. Attempts with warm water agitation and milking the tube have been unsuccessful. The nurse uses evidence-based practice principles when she then uses which of the following to unclog the tube?

The nurse is attempting to unclog a patient's feeding tube. Attempts with warm water agitation and milking the tube have been unsuccessful. The nurse uses evidence-based practice principles when she then uses which of the following to unclog the tube?

a) Cola mixed with cranberry juice
b) Digestive enzymes and sodium bicarbonate
c) Alka Seltzer mixed with water
d) Meat tenderizer diluted with saline


Answer: b) Digestive enzymes and sodium bicarbonate 

A patient is receiving a continuous tube feeding. The nurse notes that the feeding tube was last irrigated at 2 p.m. The nurse would plan to irrigate the tube again at which time?

A patient is receiving a continuous tube feeding. The nurse notes that the feeding tube was last irrigated at 2 p.m. The nurse would plan to irrigate the tube again at which time? 

a) 10 p.m. to 12 a.m.
b) 8 p.m. to 10 p.m.
c) 6 p.m. to 8 p.m.
d) 4 p.m. to 6 p.m.


Answer: c) 6 p.m. to 8 p.m.

A nurse providing care to a patient who is receiving nasogastric tube feedings finds that the tube is clogged. Which of the following would be least appropriate to use to unclog the tube?

A nurse providing care to a patient who is receiving nasogastric tube feedings finds that the tube is clogged. Which of the following would be least appropriate to use to unclog the tube? 

a) Commercial enzyme product
b) Air insufflation
c) Cranberry juice
d) Digestive enzyme mixed with warm water


Answer: c) Cranberry juice 

A patient has a gastric sump tube attached to low intermittent suction. The nurse empties the suction collection chamber and records an output of 320 mL for this 8-hour shift. The record shows that the tube had been irrigated with 20 mL of normal saline twice this shift. What would be the actual output of the gastric sump tube?

A patient has a gastric sump tube attached to low intermittent suction. The nurse empties the suction collection chamber and records an output of 320 mL for this 8-hour shift. The record shows that the tube had been irrigated with 20 mL of normal saline twice this shift. What would be the actual output of the gastric sump tube?

Answer: 280

A client is receiving continuous tube feedings at 75 mL/hr. The nurse has checked the residual volume 4 hours ago as 250 mL. The nurse now assesses the residual volume as 325 mL. The first action of the nurse is to

A client is receiving continuous tube feedings at 75 mL/hr. The nurse has checked the residual volume 4 hours ago as 250 mL. The nurse now assesses the residual volume as 325 mL. The first action of the nurse is to

a) Stop the continuous feeding
b) Discard the residual volume
c) Notify the physician
d) Decrease the rate to 40 mL/hr


Answer: c) Notify the physician 

The nurse inserts a nasogastric tube into the right nares of a patient. When testing the tube aspirate for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs?

The nurse inserts a nasogastric tube into the right nares of a patient. When testing the tube aspirate for pH to confirm placement, what does the nurse anticipate the pH will be if placement is in the lungs?

a) 1
b) 4
c) 6
d) 2


Answer: c) 6

A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use?

A patient is receiving continuous tube feedings via a small bore feeding tube. The nurse irrigates the tube after administering medication to maintain patency. Which size syringe would the nurse use? 

a) 30-mL
b) 20-mL
c) 5-mL
d) 10-mL


Answer: a) 30-mL

A nurse is caring for a patient receiving parenteral nutrition at home. The patient was discharged from the acute care facility 4 days ago. Which of the following would the nurse include in the patient's plan of care? Select all that apply.

A nurse is caring for a patient receiving parenteral nutrition at home. The patient was discharged from the acute care facility 4 days ago. Which of the following would the nurse include in the patient's plan of care? Select all that apply.

a) Daily transparent dressing changes
b) Intake and output monitoring
c) Calorie counts for oral nutrients
d) Daily weights
e) Strict bedrest


Answer:

d) Daily weights
b) Intake and output monitoring
c) Calorie counts for oral nutrients

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate?

A patient is receiving parenteral nutrition. The current solution is nearing completion, and a new solution is to be hung, but it has not arrived from the pharmacy. Which action by the nurse would be most appropriate? 

a) Have someone go to the pharmacy to obtain the new solution.
b) Slow the current infusion rate so that it will last until the new solution arrives.
c) Hang a solution of dextrose 10% and water until the new solution is available.
d) Begin an infusion of normal saline in another site to maintain hydration.


Answer: c) Hang a solution of dextrose 10% and water until the new solution is available.

The primary source of microorganisms for catheter-related infections are the skin and

The primary source of microorganisms for catheter-related infections are the skin and

a) IV fluid bag.
b) IV tubing.
c) catheter tubing.
d) catheter hub.


Answer: d) catheter hub. 

The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? (Select all that apply.)

The nurse is inserting a nasoenteric tube for a patient with a paralytic ileus. How long does the nurse anticipate the tube will be required? (Select all that apply.)

a) Until bowel sound is present
b) Until the tube comes out on its own
c) Until the patient stops vomiting
d) Until peristalsis is resumed
e) Until flatus is passed


Answer:

a) Until bowel sound is present
e) Until flatus is passed
d) Until peristalsis is resumed

Which of the following is the best noninvasive means of unclogging tubes?

Which of the following is the best noninvasive means of unclogging tubes?

a) Cranberry juice
b) Cola
c) Meat tenderizer
d) Pancreatic enzymes and water


Answer: d) Pancreatic enzymes and water

When assessing whether a patient is a candidate for home parenteral nutrition, which of the following would be important to address? Select all that apply.

When assessing whether a patient is a candidate for home parenteral nutrition, which of the following would be important to address? Select all that apply. 

a) Health status
b) Family support
c) Telephone access
d) Motivation for learning
e) Marital status


Answer:

a) Health status
b) Family support
c) Telephone access
d) Motivation for learning 

A nurse is providing home care to a patient receiving intermittent tube feedings. The patient wants to take an over-the-counter allergy medication. The medication would need to be given via feeding tube because the patient has difficulty swallowing. The nurse checks the medication and finds that it is a timed-release tablet. Which action by the nurse would be most appropriate?

A nurse is providing home care to a patient receiving intermittent tube feedings. The patient wants to take an over-the-counter allergy medication. The medication would need to be given via feeding tube because the patient has difficulty swallowing. The nurse checks the medication and finds that it is a timed-release tablet. Which action by the nurse would be most appropriate? 

a) Have the patient mix it with the feeding formula after crushing the tablet.
b) Check with the pharmacy for an alternative formulation for the drug.
c) State that the patient cannot take the drug anymore.
d) Tell the patient to dissolve the tablet in water to administer it.


Answer: b) Check with the pharmacy for an alternative formulation for the drug.

A nurse is preparing to perform a dressing change to the site of a patient's central venous catheter used for parenteral nutrition. Which equipment and supplies would the nurse need to gather? Select all that apply.

A nurse is preparing to perform a dressing change to the site of a patient's central venous catheter used for parenteral nutrition. Which equipment and supplies would the nurse need to gather? Select all that apply. 

a) Sterile gauze pads
b) Masks
c) Skin antiseptic
d) Clean gloves
e) Extension set tubing
f) Alcohol wipes


Answer:

b) Masks
c) Skin antiseptic
f) Alcohol wipes
a) Sterile gauze pads

When preparing to insert a nasogastric tube, the nurse determines the length of the tube to be inserted. The nurse nurse places the distal tip of the tube at which location?

When preparing to insert a nasogastric tube, the nurse determines the length of the tube to be inserted. The nurse nurse places the distal tip of the tube at which location? 

a) Base of the neck
b) Tip of patient's nose
c) Tragus of the ear
d) Tip of the xiphoid process


Answer: b) Tip of patient's nose 

A client is receiving a parenteral nutrition admixture that contains carbohydrates, electrolytes, vitamins, trace minerals, and sterile water and is now scheduled to receive an intravenous fat emulsion (Intralipid). The nurse

A client is receiving a parenteral nutrition admixture that contains carbohydrates, electrolytes, vitamins, trace minerals, and sterile water and is now scheduled to receive an intravenous fat emulsion (Intralipid). The nurse

a) Attaches the fat emulsion tubing to a Y connector close to the infusion site
b) Starts a peripheral IV site to administer the fat emulsion
c) Stops the admixture while the fat emulstion infuses
d) Connects the tubing for the fat emulsion above the 1.5 micron filter


Answer: a) Attaches the fat emulsion tubing to a Y connector close to the infusion site

A nurse administered a full strength feeding with an increased osmolality through a jejunostomy tube to a client. Immediately following the feeding, the client expelled a large amount of liquid brown stool and exhibited a blood pressure of 86/58 and pulse rate of 112 beats/min. The nurse

A nurse administered a full strength feeding with an increased osmolality through a jejunostomy tube to a client. Immediately following the feeding, the client expelled a large amount of liquid brown stool and exhibited a blood pressure of 86/58 and pulse rate of 112 beats/min. The nurse

a) Discusses with the nutritionist about increasing the osmolality of the feeding
b) Increases the amount of feeding at the next feeding
c) Administers the feeding at a cooler temperature
d) Consults with the physician about decreasing the feeding to half-strength


Answer: d) Consults with the physician about decreasing the feeding to half-strength

A patient is to receive parenteral nutrition. The duration of therapy is planned for 4 weeks. The nurse develops a teaching plan for the patient to prepare for insertion of which of the following as most likely?

A patient is to receive parenteral nutrition. The duration of therapy is planned for 4 weeks. The nurse develops a teaching plan for the patient to prepare for insertion of which of the following as most likely? 

a) Peripherally inserted central catheter
b) Implanted port
c) Tunneled central catheter
d) Nontunneled central catheter


Answer: d) Nontunneled central catheter

A patient is receiving nasogastric tube feedings. The intake and output record for the past 24 hours reveals an intake of 3100 mL and an output of 2400 mL. The nurse identifies which nursing diagnosis as most likely?

A patient is receiving nasogastric tube feedings. The intake and output record for the past 24 hours reveals an intake of 3100 mL and an output of 2400 mL. The nurse identifies which nursing diagnosis as most likely? 

a) Excess fluid volume
b) Risk for imbalanced nutrition, more than body requirements
c) Deficient fluid volume
d) Impaired urinary elimination


Answer: a) Excess fluid volume

The nurse is caring for a comatose patient and administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to nasogastric (NG) feedings in the comatose patient?

The nurse is caring for a comatose patient and administering gastrostomy feedings. What does the nurse understand is the reason that gastrostomy feedings are preferred to nasogastric (NG) feedings in the comatose patient?

a) Gastroesophageal sphincter is intact, lessening the possibility of regurgitation.
b) The patient cannot experience the deprivational stress of not swallowing.
c) Digestive process occurs more rapidly because the feedings do not have to pass through the esophagus.
d) Feedings can be administered with the patient in the recumbent position.


Answer: a) Gastroesophageal sphincter is intact, lessening the possibility of regurgitation.

A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate?

A nurse is caring for a patient with a Salem sump gastric tube attached to low intermittent suction for decompression. The patient asks, "What's this blue part of the tube for?" Which response by the nurse would be most appropriate? 

a) "It is a vent that prevents backflow of the secretions."
b) "It works as a marker to make sure that the tube stays in place."
c) "It acts as a siphon, pulling secretions into the clear tubing."
d) "It helps regulate the pressure on the suction machine."


Answer: a) "It is a vent that prevents backflow of the secretions."

A patient is receiving a continuous tube feeding via an open delivery system. The patient is to receive 480 mL in 24 hours. The maximum amount of formula in the bag should not exceed which amount?

A patient is receiving a continuous tube feeding via an open delivery system. The patient is to receive 480 mL in 24 hours. The maximum amount of formula in the bag should not exceed which amount? 

a) 120 mL
b) 50 mL
c) 240 mL
d) 80 mL


Answer: d) 80 mL

The client has just had a central line inserted for parenteral nutrition. The client is awaiting transport to the Radiology Department for catheter placement verification. The client reports feeling anxious. Respirations are 28 breaths/minute. The first action of the nurse is

The client has just had a central line inserted for parenteral nutrition. The client is awaiting transport to the Radiology Department for catheter placement verification. The client reports feeling anxious. Respirations are 28 breaths/minute. The first action of the nurse is

a) Auscultate lung sounds.
b) Elevate the head of the bed.
c) Position client flat in bed.
d) Consult with the healthcare provider.


Answer: a) Auscultate lung sounds.

The nurse is caring for a patient who is at receiving continuous enteral tube feedings who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. Which of the following is the correct action by the nurse?

The nurse is caring for a patient who is at receiving continuous enteral tube feedings who is at low risk for aspiration. The nurse assesses the gastric residual volume to be 350 mL. Which of the following is the correct action by the nurse?

a) Lower the head of the bed.
b) Flush the feeding tube.
c) Increase the feeding rate.
d) Monitor the feeding closely.


Answer: d) Monitor the feeding closely.

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion?

The nurse is inserting a nasogastric tube for a patient with pancreatitis. What intervention can the nurse provide to allow facilitation of the tube insertion?

a) Spray the oropharynx with an anesthetic spray.
b) Have the patient maintain a backward tilt head position.
c) Allow the patient to sip water as the tube is being inserted.
d) Have the patient eat a cracker as the tube is being inserted.


Answer: c) Allow the patient to sip water as the tube is being inserted.

The nurse is caring for a patient who has dumping syndrome from high carbohydrate foods being administered over a period of less than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome?

The nurse is caring for a patient who has dumping syndrome from high carbohydrate foods being administered over a period of less than 20 minutes. What is a nursing measure to prevent or minimize the dumping syndrome?

a) Administer the feeding at a warm temperature to decrease peristalsis.
b) Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity.
c) Administer the feeding by bolus to prevent continuous intestinal distention.
d) Administer the feeding with about 100 mL of fluid to dilute the high carbohydrate concentration.


Answer: b) Administer the feeding with the patient in semi-Fowler's position to decrease transit time influenced by gravity.

A client is recovering from percutaneous endoscopic gastrostomy (PEG) tube placement. The nurse

A client is recovering from percutaneous endoscopic gastrostomy (PEG) tube placement. The nurse 

a) Maintains a gauze dressing over the site for 3 days
b) Administers an initial bolus of 50 mL water
c) Pushes the stabilizing disk firmly against the skin
d) Immediately starts the prescribed tube feeding


Answer: b) Administers an initial bolus of 50 mL water 

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and makes a recommendation when noting the following:

A client is receiving parenteral nutrition (PN) through a peripherally inserted central catheter (PICC) and will be discharged home with PN. The home health nurse evaluates the home setting and makes a recommendation when noting the following:

a) No land line; cell phone available and taken by family member during working hours
b) Water of low pressure that can be obtained through all faucets
c) Little food in the working refrigerator
d) Electricity that loses power, usually for short duration, during storms


Answer: a) No land line; cell phone available and taken by family member during working hours

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). The nurse performs the following actions while the client receives PN (select all that apply):

The client cannot tolerate oral feedings due to an intestinal obstruction and is NPO. A central line has been inserted, and the client is being started on parenteral nutrition (PN). The nurse performs the following actions while the client receives PN (select all that apply):

a) Cover insertion site with a transparent dressing that is changed daily.
b) Weigh the client every day.
c) Document intake and output.
d) Use clean technique for all catheter dressing changes.
e) Check blood glucose level every 6 hours.

Answer:


b) Weigh the client every day.
e) Check blood glucose level every 6 hours.
c) Document intake and output.

The nurse is conducting discharge education for a patient who is to go home with parenteral nutrition (PN). The nurse sees that the patient understands the education when the patient indicates which of the following is a sign and/or symptom of metabolic complications?

The nurse is conducting discharge education for a patient who is to go home with parenteral nutrition (PN). The nurse sees that the patient understands the education when the patient indicates which of the following is a sign and/or symptom of metabolic complications?

a) Loose, watery stools
b) Decreased pulse rate
c) Increased urination
d) Elevated blood pressure


Answer: a) Loose, watery stools

The nurse is inserting a nasogastric tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred?

The nurse is inserting a nasogastric tube and the patient begins coughing and is unable to speak. What does the nurse suspect has occurred?

a) The nurse has inadvertently inserted the tube into the trachea.
b) The nurse has inserted a tube that is too large for the patient.
c) This is a normal occurrence and the tube should be left in place.
d) The tube is most likely defective and should be immediately removed.


Answer: a) The nurse has inadvertently inserted the tube into the trachea. 

The client is receiving 50% dextrose parenteral nutrition with fat emulsion therapy through a peripherally inserted central catheter (PICC). The nurse has developed a care plan for the nursing diagnosis "Risk for infection related to contamination of the central catheter site or infusion line." The nurse includes the intervention

The client is receiving 50% dextrose parenteral nutrition with fat emulsion therapy through a peripherally inserted central catheter (PICC). The nurse has developed a care plan for the nursing diagnosis "Risk for infection related to contamination of the central catheter site or infusion line." The nurse includes the intervention

a) Change the transparent dressing every 3 days.
b) Assess the PICC insertion site daily.
c) Use clean gloves when providing site care.
d) Wear a face mask during dressing changes.


Answer: d) Wear a face mask during dressing changes.

A nurse is caring for a client with a long-term central venous catheter. Which care principle is correct?

A nurse is caring for a client with a long-term central venous catheter. Which care principle is correct?

a) If the needle becomes contaminated before accessing the port, clean the needle with povidone-iodine solution.
b) Clean the port with an alcohol pad before administering I.V. fluid through the catheter.
c) If unsuccessful with the first attempt to access the catheter, reuse the needle and try again.
d) Use clean technique when accessing the port with a needle.


Answer: b) Clean the port with an alcohol pad before administering I.V. fluid through the catheter. 

The nurse is inserting a sump tube in a patient with Crohn's disease who is suspected of having a bowel obstruction. What does the nurse understand is the benefit of the gastric (Salem) sump tube in comparison to some of the other tubes?

The nurse is inserting a sump tube in a patient with Crohn's disease who is suspected of having a bowel obstruction. What does the nurse understand is the benefit of the gastric (Salem) sump tube in comparison to some of the other tubes?

a) The tube is radiopaque.
b) The tube is shorter.
c) The tube can be connected to suction and others cannot.
d) The tube is less expensive.


Answer: a) The tube is radiopaque.

Semi-Fowler's position is maintained for at least which timeframe following completion of an intermittent tube feeding?

Semi-Fowler's position is maintained for at least which timeframe following completion of an intermittent tube feeding?

a) 2 hours
b) 1 hour
c) 90 minutes
d) 30 minutes


Answer: b) 1 hour 

The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly?

The nurse is managing a gastric (Salem) sump tube for a patient who has an intestinal obstruction and will be going to surgery. What interventions should the nurse perform to make sure the tube is functioning properly?

a) Tape the tube to the head of the bed to avoid dislodgement.
b) Irrigate only through the vent lumen.
c) Keep the vent lumen above the patient's waist to prevent gastric content reflux.
d) Maintain intermittent or continuous suction at a rate greater than 120 mm Hg.


Answer: c) Keep the vent lumen above the patient's waist to prevent gastric content reflux.

Which of the following medications requires the nurse to contact the pharmacist in consultation when the patient receives all oral medications by feeding tube?

Which of the following medications requires the nurse to contact the pharmacist in consultation when the patient receives all oral medications by feeding tube?

a) Soft gelatin capsules filled with liquid
b) Enteric-coated tablets
c) Buccal or sublingual tablets
d) Simple compressed tablets


Answer: b) Enteric-coated tablets

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for:

A client who can't tolerate oral feedings begins receiving intermittent enteral feedings. When monitoring for evidence of intolerance to these feedings, the nurse must remain alert for:

a) constipation, dehydration, and hypercapnia.
b) manifestations of electrolyte disturbances.
c) diaphoresis, vomiting, and diarrhea.
d) manifestations of hypoglycemia.


Answer: c) diaphoresis, vomiting, and diarrhea.

Hickman and Groshong are examples of which type of central venous access device?

Hickman and Groshong are examples of which type of central venous access device?

a) Nontunneled central catheter
b) Peripherally inserted central catheters (PICC)
c) Tunneled central catheters
d) Implanted ports


Answer: c) Tunneled central catheters

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?

A client with a gastrojejunostomy is beginning to take solid food. Which finding would lead the nurse to suspect that the client is experiencing dumping syndrome?

a) Slowed heart beat
b) Dry skin
c) Diarrhea
d) Hyperglycemia


Answer: c) Diarrhea

Rebound hypoglycemia is a complication of parenteral nutrition caused by which of the following?

Rebound hypoglycemia is a complication of parenteral nutrition caused by which of the following?

a) Feedings stopped too abruptly
b) Fluid infusing rapidly
c) Cap missing from the port
d) Glucose intolerance


Answer: a) Feedings stopped too abruptly

To ensure patency of central venous line ports, diluted heparin flushes are used in which of the following situations?

To ensure patency of central venous line ports, diluted heparin flushes are used in which of the following situations?

a) Daily when not in use
b) When the line is discontinued
c) With continuous infusions
d) Before drawing blood


Answer: a) Daily when not in use

A nurse suspects that a patient is developing rebound hypoglycemia secondary to parenteral nutrition being discontinued too rapidly. Which of the following would support the nurse's suspicions? Select all that apply.

A nurse suspects that a patient is developing rebound hypoglycemia secondary to parenteral nutrition being discontinued too rapidly. Which of the following would support the nurse's suspicions? Select all that apply.

a) Weakness
b) Confusion
c) Dry, hot skin
d) Reports of feeling flushed
e) Tachycardia
f) Shakiness

Answer:

f) Shakiness
e) Tachycardia
a) Weakness
b) Confusion

The client has the intake and output shown in the accompanying chart for an 8-hour shift. What is the positive fluid balance?

The client has the intake and output shown in the accompanying chart for an 8-hour shift. What is the positive fluid balance?

Answer: 260

A nurse is inserting a nasogastric tube in an alert client. During the procedure, the client begins to cough constantly and has difficulty breathing. The nurse suspects the nasogastric tube is

A nurse is inserting a nasogastric tube in an alert client. During the procedure, the client begins to cough constantly and has difficulty breathing. The nurse suspects the nasogastric tube is

a) Coiling in the client's mouth
b) Irritating the epiglottis
c) Inserted into the lungs
d) Passing into the esophagus


Answer: c) Inserted into the lungs

A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.

A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.

Answer: 42 

A nurse prepares a patient for insertion of a nasoenteric tube. What position should the nurse place the patient in?

A nurse prepares a patient for insertion of a nasoenteric tube. What position should the nurse place the patient in?

a) Flat in bed
b) On his or her right side
c) In semi-Fowler's position with his or her head turned to the left
d) In high-Fowler's position


Answer: d) In high-Fowler's position

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to

A nonresponsive client has a nasogastric tube to low intermittent suction due to gastrointestinal bleeding. It is most important for the nurse to

a) Auscultate lung sounds every 4 hours.
b) Inspect the nose daily for skin irritation.
c) Apply water-based lubricant to the nares daily.
d) Change the nasal tape every 2 to 3 days.


Answer: a) Auscultate lung sounds every 4 hours.

The most significant complication related to continuous tube feedings is

The most significant complication related to continuous tube feedings is

a) a disturbance in the sequence of intestinal and hepatic metabolism.
b) an interruption in fat metabolism and lipoprotein synthesis.
c) the potential for aspiration,
d) the interruption of GI integrity,


Answer: c) the potential for aspiration,

When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration?

When assisting with the plan of care for a client receiving tube feedings, which of the following would the nurse include to reduce the client's risk for aspiration?

a) Aspirating for residual contents every 4 to 8 hours.
b) Keeping the client in a semi-Fowler's position at all times.
c) Giving the feedings at room temperature.
d) Administering 15 to 30 mL of water every 4 hours.


Answer: b) Keeping the client in a semi-Fowler's position at all times. 

The nurse is preparing to administer all of a patient's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes on the patient's medication administration record which of the following types of oral medication?

The nurse is preparing to administer all of a patient's medications via feeding tube. The nurse consults the pharmacist and/or physician when the nurse notes on the patient's medication administration record which of the following types of oral medication?

a) Enteric-coated tablets
b) Simple compressed tablets
c) Soft gelatin capsules filled with liquid
d) Buccal or sublingual tablets


Answer: a) Enteric-coated tablets 

The physician orders the insertion of a single lumen nasogastric tube. When gathering the equipment for the insertion, the nurse would select which of the following?

The physician orders the insertion of a single lumen nasogastric tube. When gathering the equipment for the insertion, the nurse would select which of the following?

a) Miller-Abbott tube
b) Levin tube
c) Sengsten-Blakemore tube
d) Salem sump tube


Answer: b) Levin tube 

The nurse is monitoring a patient with nasoenteric intubation. The nurse contacts the physician when which of the following is noted?

The nurse is monitoring a patient with nasoenteric intubation. The nurse contacts the physician when which of the following is noted?

a) Blood pressure 118/72
b) Moist mucous membranes
c) Heart rate of 100
d) Urinary output 20 mL/hr


Answer: d) Urinary output 20 mL/hr 

The nurse is administering a tube feeding to a patient via intermittent gravity drip method. The nurse should administer the feeding over at least which period of time?

The nurse is administering a tube feeding to a patient via intermittent gravity drip method. The nurse should administer the feeding over at least which period of time?

a) 60 minutes
b) 80 minutes
c) 30 minutes
d) 15 minutes


Answer: c) 30 minutes

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. It is best for the nurse to

A client recovering from gastric bypass surgery accidentally removes the nasogastric tube. It is best for the nurse to

a) Place the nasogastric tube to the level of the esophagus.
b) Document the discontinuation of the nasogastric tube.
c) Notify the surgeon about the tube's removal.
d) Reinsert the nasogastric tube to the stomach.


Answer: c) Notify the surgeon about the tube's removal.

A patient has a gastric sump tube inserted and attached to low intermittent suction. The physician has ordered the tube to be irrigated with 30 mL of normal saline every 6 hours. When reviewing the patient's intake and output record for the past 24 hours, the nurse would expect to note that the patient received how much fluid with the irrigation?

A patient has a gastric sump tube inserted and attached to low intermittent suction. The physician has ordered the tube to be irrigated with 30 mL of normal saline every 6 hours. When reviewing the patient's intake and output record for the past 24 hours, the nurse would expect to note that the patient received how much fluid with the irrigation?

Answer: 120 

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds

The client is experiencing swallowing difficulties and is now scheduled to receive a gastric feeding. She has the following oral medications prescribed: furosemide (Lasix), digoxin, enteric coated aspirin (Ecotrin), and vitamin E. The nurse withholds

a) enteric coated aspirin
b) digoxin
c) furosemide
d) vitamin E


Answer: a) enteric coated aspirin

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed?

The nurse checks residual content before each intermittent tube feeding. When should the patient be reassessed?

a) When the residual is greater than 200 mL
b) When the residual is between 50 and 80 mL
c) When the residual is about 50 mL
d) When the residual is about 100 mL


Answer: a) When the residual is greater than 200 mL 

The primary source of microorganisms for catheter-related infections include the skin and which of the following?

The primary source of microorganisms for catheter-related infections include the skin and which of the following?

a) IV fluid bag
b) Catheter hub
c) IV tubing
d) Catheter tubing


Answer: b) Catheter hub

The nurse on an evidence-based practice council is making recommendations to ensure patency of nontunneled central venous lines. The nurse recommends that daily saline and diluted heparin flushes be used in which of the following situations?

The nurse on an evidence-based practice council is making recommendations to ensure patency of nontunneled central venous lines. The nurse recommends that daily saline and diluted heparin flushes be used in which of the following situations?

a) Before drawing blood
b) With continuous infusions
c) Daily when not in use
d) When the line is discontinued


Answer: c) Daily when not in use

The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, and tachycardia in the patient would indicate to the nurse what common complication?

The nurse assesses a patient who recently had a nasoenteric intubation. Symptoms of oliguria, lethargy, and tachycardia in the patient would indicate to the nurse what common complication?

a) Pulmonary complications
b) Fluid volume deficit
c) Mucous membrane irritation
d) A cardiac dysrhythmia


Answer: b) Fluid volume deficit 

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach?

As part of the process of checking the placement of a nasogastric tube, the nurse checks the pH of the aspirate. Which pH finding would indicate to the nurse that the tube is in the stomach? 

a) 6
b) 4
c) 8
d) 10


Answer: b) 4

The nurse prepares to give a bolus tube feeding to the patient and determines that the residual gastric content is 150 cc. The priority nursing action is to

The nurse prepares to give a bolus tube feeding to the patient and determines that the residual gastric content is 150 cc. The priority nursing action is to

a) give the tube feeding.
b) reassess the residual gastric content in 1 hour.
c) withhold the tube feeding indefinitely.
d) notify the physician.


Answer: b) reassess the residual gastric content in 1 hour.

The patient is on a continuous tube feeding. How often should the tube placement be checked?

The patient is on a continuous tube feeding. How often should the tube placement be checked?

a) Every hour
b) Every 24 hours
c) Every shift
d) Every 12 hours


Answer: c) Every shift

Which of the following is the gold standard for assessing placement of a nasogastric (NG) tube for the patient receiving feedings?

Which of the following is the gold standard for assessing placement of a nasogastric (NG) tube for the patient receiving feedings?

a) Use of capnographic device
b) pH testing
c) Visual assessment of aspiration
d) X-ray


Answer: d) X-ray 

A patient has just had a nasogastric (NG) tube inserted and the nurse is waiting for verification of placement of the tube prior to starting tube feedings. Which is the best method of verification the nurse should use for determining new NG tube placement?

A patient has just had a nasogastric (NG) tube inserted and the nurse is waiting for verification of placement of the tube prior to starting tube feedings. Which is the best method of verification the nurse should use for determining new NG tube placement?

a) Observing gastric aspirate
b) Gastric aspirate pH testing
c) Air auscultation
d) X-ray confirmation


Answer: d) X-ray confirmation

Initially, which diagnostic should be completed following placement of a NG tube?

Initially, which diagnostic should be completed following placement of a NG tube?

a) X-ray
b) pH measurement of aspirate
c) Measurement of tube length
d) Visual assessment of aspirate


Answer: a) X-ray

The nurse is to insert a postpyloric feeding tube. One way that the nurse can aid in placement past the pylorus is to

The nurse is to insert a postpyloric feeding tube. One way that the nurse can aid in placement past the pylorus is to

a) Assist the client to drink 8 ounces of water.
b) Administer prescribed metoclopramide (Reglan).
c) Have the client lay on his left side.
d) Instruct the client to swallow several times.


Answer: b) Administer prescribed metoclopramide (Reglan).

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following?

A client has a gastrointestinal tube that enters the stomach through a surgically created opening in the abdominal wall. The nurse documents this as which of the following?

a) Nasogastric tube
b) Jejunostomy tube
c) Orogastric tube
d) Gastrostomy tube


Answer: d) Gastrostomy tube

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura?

Which of the following is caused by improper catheter placement and inadvertent puncture of the pleura?

a) Air embolism
b) Pneumothorax
c) Fluid overload
d) Sepsis


Answer: b) Pneumothorax

The patient is on a continuous tube feeding. The tube placement should be checked every

The patient is on a continuous tube feeding. The tube placement should be checked every

a) hour.
b) 24 hours.
c) shift.
d) 12 hours.


Answer: c) shift.

A client has been receiving intermittent tube feedings for several days at home. The nurse notes the findings as shown in the accompanying documentation. The nurse reports the following as an adverse reaction to the tube feeding:

A client has been receiving intermittent tube feedings for several days at home. The nurse notes the findings as shown in the accompanying documentation. The nurse reports the following as an adverse reaction to the tube feeding:

a) Liver function tests
b) Physical assessment data
c) Fasting blood glucose level
d) Renal studies


Answer: c) Fasting blood glucose level

The nurse is teaching an unlicensed caregiver about bathing patients who are receiving tube feedings. Which of the following is the most significant complication related to continuous tube feedings?

The nurse is teaching an unlicensed caregiver about bathing patients who are receiving tube feedings. Which of the following is the most significant complication related to continuous tube feedings?

a) The potential for aspiration
b) A disturbance in the sequence of intestinal and hepatic metabolism
c) An interruption in fat metabolism and lipoprotein synthesis
d) The interruption of GI integrity


Answer: a) The potential for aspiration 

The nurse is to discontinue a nasogastric tube that had been used for decompression. The first thing the nurse does is

The nurse is to discontinue a nasogastric tube that had been used for decompression. The first thing the nurse does is

a) Flush with 10 mL of water.
b) Remove the tape from the nose of the client.
c) Withdraw the tube gently for 6 to 8 inches.
d) Provide oral hygiene.


Answer: a) Flush with 10 mL of water.

A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis?

A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis?

a) Bone pain and tenderness
b) Bone fractures and kyphosis
c) Muscle weakness and spasms
d) Softened and compressed vertebrae


Answer: a) Bone pain and tenderness

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

a) Skull narrowing
b) Long bone bowing
c) Lordosis
d) Waddling gait


Answer: b) Long bone bowing 

Instructions for the patient with low back pain include that when lifting the patient should

Instructions for the patient with low back pain include that when lifting the patient should

a) use a narrow base of support.
b) avoid overreaching.
c) bend the knees and loosen the abdominal muscles.
d) place the load away from the body.


Answer: b) avoid overreaching.

The physician has prescribed plicamycin (Mithracin) to control serum calcium levels in a client with Paget's disease. The dose prescribed is 25 micrograms per kg. The client weighs 132 lbs. How many milligrams will the nurse expect the client to receive?

The physician has prescribed plicamycin (Mithracin) to control serum calcium levels in a client with Paget's disease. The dose prescribed is 25 micrograms per kg. The client weighs 132 lbs. How many milligrams will the nurse expect the client to receive?

Answer: 1.5 

The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following?

The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following?

a) Hammertoe
b) Hallux valgus
c) Pes cavus
d) Flatfoot


Answer: b) Hallux valgus

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include?

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include?

a) Take the supplement with meals or with orange juice.
b) Take the supplement on an empty stomach with a full glass of water.
c) Remain in an upright position 30 minutes after taking the supplement.
d) Take weekly on the same day and at the same time.


Answer: a) Take the supplement with meals or with orange juice.

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?

a) Alendronate (Fosamax)
b) Calcium gluconate
c) Tamoxifen (Nolvadex)
d) Raloxifene (Evista)


Answer: d) Raloxifene (Evista)

Which is a deformity in which the great toe deviates laterally?

Which is a deformity in which the great toe deviates laterally?

a) Hammertoe
b) Hallux valgus
c) Pes cavus
d) Plantar fasciitis


Answer: b) Hallux valgus 

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following?

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following?

a) Mallet toe
b) Hammer toe
c) Bunion
d) Hallux valgus


Answer: b) Hammer toe 

Ms. Malcolm has come to your clinic complaining of jaw pain. This is also associated with muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply.

Ms. Malcolm has come to your clinic complaining of jaw pain. This is also associated with muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply.

a) Referral to a dentist who has experience managing clients with TMD
b) Analgesics
c) Custom-fitted mouth guard during sleep
d) Corticosteroids

Answer:


a) Referral to a dentist who has experience managing clients with TMD
b) Analgesics
c) Custom-fitted mouth guard during sleep

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications?

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? 

a) Osteomyelitis
b) Avascular necrosis
c) Fat embolism
d) Compartment syndrome


Answer: a) Osteomyelitis 

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD?

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD?

a) Teriparatide (Forteo)
b) Vitamin D
c) Calcitonin (Miacalcin)
d) Raloxifene (Evista)


Answer: c) Calcitonin (Miacalcin)

Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

a) Dupuytren's contracture
b) Callus
c) Hallux valgus
d) Hammertoe


Answer: a) Dupuytren's contracture 

A physician diagnoses primary osteoporosis in a client who has lost bone mass. In this metabolic disorder, the rate of bone resorption accelerates while bone formation slows. Primary osteoporosis is most common in:

A physician diagnoses primary osteoporosis in a client who has lost bone mass. In this metabolic disorder, the rate of bone resorption accelerates while bone formation slows. Primary osteoporosis is most common in:

a) young menstruating women.
b) elderly postmenopausal women.
c) young children.
d) elderly men.


Answer: b) elderly postmenopausal women.

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing?

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing?

a) Surgical debridement
b) Vitamin supplements
c) Wound irrigation
d) Wound packing


Answer: a) Surgical debridement

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 at risk for osteoporosis?

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 at risk for osteoporosis?

a) penicillamine (Cuprimine)
b) raloxifene (Evista)
c) plicamycin (Mithracin)
d) methotrexate (Rheumatrex)


Answer: b) raloxifene (Evista)

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

a) Elevated levels of alkaline phosphatase
b) Increased and decreased areas of bone metabolism
c) Demineralization of the bone
d) A bone biopsy


Answer: d) A bone biopsy

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?

a) Impaired physical mobility
b) Risk for infection
c) Disturbed body image
d) Inadequate nutrition


Answer: c) Disturbed body image

When an infection is blood borne the manifestations include which of the following symptoms?

When an infection is blood borne the manifestations include which of the following symptoms?

a) Chills
b) Bradycardia
c) Hypothermia
d) Hyperactivity


Answer: a) Chills

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate?

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? 

a) Walking
b) Yoga
c) Bicycling
d) Swimming


Answer: a) Walking

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

a) The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor.
b) The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit.
c) The nurse is caring for this client on the intensive care unit.
d) The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor.


Answer: c) The nurse is caring for this client on the intensive care unit.

Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

a) Dupuytren's contracture
b) Callus
c) Hammertoe
d) Hallux valgus


Answer: a) Dupuytren's contracture

Which of the following inhibits bone resorption and promotes bone formation?

Which of the following inhibits bone resorption and promotes bone formation?

a) Estrogen
b) Calcitonin
c) Corticosteroids
d) Parathyroid hormone


Answer: b) Calcitonin

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

a) Fatigue
b) Risk for falls
c) Delayed wound healing
d) Risk for infection


Answer: b) Risk for falls

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

a) Use the large muscles of the leg when lifting items.
b) Avoid twisting and flexion activities.
c) Sleep on the stomach to alleviate pressure on the back.
d) A soft mattress is most supportive by conforming to the body.


Answer: a) Use the large muscles of the leg when lifting items. 

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

a) 7 to 10 days
b) 3 to 6 weeks
c) 6 months
d) 3 months


Answer: b) 3 to 6 weeks

Which medication classification is prescribed when allergy is a factor causing the skin disorder?

Which medication classification is prescribed when allergy is a factor causing the skin disorder?

a) Antibiotics
b) Local anesthetics
c) Antihistamines
d) Corticosteroids

Answer: c) Antihistamines 

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?

a) Prone, with a pillow under the shoulders
b) Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
c) High-Fowler's to allow for maximum hip flexion
d) Supine, with the bed flat and a firm mattress in place


Answer: b) Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?

Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?

a) Mallet toe
b) Hallux valgus (bunion)
c) Heberden's nodes
d) Hammer toe


Answer: d) Hammer toe

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?

a) Denosumab
b) Forteo
c) Raloxifene
d) Fosamax


Answer: c) Raloxifene

Which of the following should be included in the teaching plan for a patient diagnosed with plantar fasciitis?

Which of the following should be included in the teaching plan for a patient diagnosed with plantar fasciitis?

a) The pain of plantar fasciitis diminishes with warm water soaks.
b) Management of plantar fasciitis includes stretching exercises.
c) Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot that occurs when pressure is placed upon it and diminishes when pressure is released.
d) Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.


Answer: b) Management of plantar fasciitis includes stretching exercises.

A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include?

A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include?

a) "Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical."
b) "Because of the increase in home burglaries involving the elderly, these clients should have burglar bars on every window in the home."
c) "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars."
d) "Most accidental injuries among the elderly are automobile-related. Elderly clients should have vision testing every 6 months while they're still driving."


Answer: c) "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars."

A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate?

A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate?

a) Maintaining vitamin levels
b) Maintaining protein levels
c) Promoting range-of-motion (ROM) exercises
d) Promoting weight-bearing exercises


Answer: d) Promoting weight-bearing exercises 

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?

a) Applying a cock-up splint and immobilization
b) Changing the dressing
c) Having the patient exercise the fingers to avoid future contractures
d) Performing hourly neurovascular assessments for the first 24 hours


Answer: d) Performing hourly neurovascular assessments for the first 24 hours

Which of the following terms refers to disease of a nerve root?

Which of the following terms refers to disease of a nerve root?

a) Radiculopathy
b) Contracture
c) Involucrum
d) Sequestrum


Answer: a) Radiculopathy

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

a) Potassium level
b) Magnesium level
c) Alkaline phosphatase
d) Troponin levels


Answer: c) Alkaline phosphatase

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

a) "After age 40, height may show a gradual decrease as a result of spinal compression"
b) "After menopause, the body's bone density declines, resulting in a gradual loss of height."
c) "The posture begins to stoop after middle age."
d) "There may be some slight discrepancy between the measuring tools used."


Answer: b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." 

Dupuytren's contracture causes flexion of which area(s)?

Dupuytren's contracture causes flexion of which area(s)?

a) Fourth and fifth fingers
b) Ring finger
c) Thumb
d) Index and middle fingers


Answer: a) Fourth and fifth fingers

Which of the following was formerly called a bunion?

Which of the following was formerly called a bunion?

a) Hallux valgus
b) Ganglion
c) Morton's neuroma
d) Plantar fasciitis


Answer: a) Hallux valgus

A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?

A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?

a) Urinary tract infection (UTI)
b) Renal calculi
c) Benign prostatic hyperplasia
d) Dehydration


Answer: b) Renal calculi

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?

a) Raloxifene (Evista)
b) Teriparatide (Forteo)
c) Denosumab (Prolia)
d) Alendronate (Fosamax)


Answer: d) Alendronate (Fosamax) 

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

a) "This condition is associated with various sports."
b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
c) "Surgery is the only sure way to manage this condition."
d) "Using arm splints will prevent hyperflexion of the wrist."


Answer: b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?

a) Gastrocnemius
b) Quadriceps
c) Rectus abdominis
d) Latissimus dorsi


Answer: b) Quadriceps 

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as?

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as?

a) Hammer Toe
b) Corn
c) Clawfoot
d) Bunion


Answer: b) Corn

Treatment of metastatic bone cancer includes which of the following?

Treatment of metastatic bone cancer includes which of the following?

a) Palliation
b) Radiation
c) Combination chemotherapy and radiation
d) Chemotherapy


Answer: a) Palliation 

Which sign may be helpful in identifying carpal tunnel syndrome?

Which sign may be helpful in identifying carpal tunnel syndrome?

a) Brudzinski's
b) Babinski's
c) Tinel's
d) Kernig's


Answer: c) Tinel's

Morton's neuroma is exhibited by which of the following clinical manifestations?

Morton's neuroma is exhibited by which of the following clinical manifestations?

a) Inflammation of the foot-supporting fascia
b) Longitudinal arch of the foot is diminished
c) High arm and a fixed equinus deformity
d) Swelling of the third (lateral) branch of the median plantar nerve


Answer: d) Swelling of the third (lateral) branch of the median plantar nerve

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?

a) Temporomandibular disorder
b) Trigeminal neuralgia
c) Loose teeth
d) Dislocated jaw


Answer: a) Temporomandibular disorder

A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

Answer: 0.5

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with:

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with:

a) Carpal tunnel syndrome
b) Dupuytren's contracture
c) Impingement syndrome
d) Morton's neuroma


Answer: a) Carpal tunnel syndrome

A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about?

A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about?

a) Cyclobenzaprine (Flexeril)
b) Amitriptyline (Elavil)
c) Duloxetine (Cymbalta)
d) Gabapentin (Neurontin)


Answer: c) Duloxetine (Cymbalta) 

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

a) "You will receive IV antibiotics for 3 to 6 weeks."
b) "Use your continuous passive motion machine (CPM) 2 hours each day."
c) "You need to perform weight-bearing exercises twice a week."
d) "You need to limit the amount of protein and calcium in your diet."


Answer: a) "You will receive IV antibiotics for 3 to 6 weeks."

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

a) Decrease the intake of vitamin A and D
b) Reduce stress
c) Walk or perform weight-bearing exercises outdoors
d) Increase fiber in the diet


Answer: c) Walk or perform weight-bearing exercises outdoors 

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

a) Negative calcium balance
b) Dowager's hump
c) Bone fracture
d) Loss of estrogen


Answer: c) Bone fracture

Of the following, which is not a risk factor for osteoporosis?

Of the following, which is not a risk factor for osteoporosis?

a) Being male
b) Small-framed, thin White or Asian women
c) Being postmenopausal
d) Family history


Answer: a) Being male 

A patient diagnosed with osteoporosis is being discharged home. Which of the following is the priority education the nurse should provide?

A patient diagnosed with osteoporosis is being discharged home. Which of the following is the priority education the nurse should provide?

a) Classifying medications
b) Increasing calcium and vitamin D in the diet
c) Participating in weight-bearing exercises
d) Removing all small rugs from the home


Answer: d) Removing all small rugs from the home

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location?

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location?

a) Wrist-hand junction
b) Femur-hip area
c) Distal femur around the knee
d) Proximal humerus


Answer: c) Distal femur around the knee

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

a) Walk or perform weight-bearing exercises
b) Decrease the intake of vitamin A and D
c) Reduce stress
d) Increase fiber in the diet


Answer: a) Walk or perform weight-bearing exercises 

What food can the nurse suggest to the client at risk for osteoporosis?

What food can the nurse suggest to the client at risk for osteoporosis?

a) Carrots
b) Broccoli
c) Bananas
d) Chicken


Answer: b) Broccoli 

The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?

The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?

a) Monitor vital signs every 4 hours.
b) Administer pain medication per client request.
c) Examine surgical dressing every hour.
d) Perform neuromuscular assessment every hour.


Answer: d) Perform neuromuscular assessment every hour. 

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

a) Cervical
b) Thoracic
c) Upper lumbar
d) Lower lumbar


Answer: d) Lower lumbar 

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?

a) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
b) The recommended daily allowance of calcium may be found in a wide variety of foods.
c) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
d) To prevent fractures, the client should avoid strenuous exercise


Answer: b) The recommended daily allowance of calcium may be found in a wide variety of foods.

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true?

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true?

a) Dorsiflexion exacerbates signs and symptoms of a ganglion.
b) Surgical excision is the treatment of choice for a ganglion.
c) A ganglion is a precursor to a primary bone tumor.
d) A ganglion is the most common benign soft-tissue mass in the foot.


Answer: a) Dorsiflexion exacerbates signs and symptoms of a ganglion.

Which is a risk-lowering strategy for osteoporosis?

Which is a risk-lowering strategy for osteoporosis?

a) Diet low in calcium and vitamin D
b) Increased age
c) Smoking cessation
d) Low initial bone mass


Answer: c) Smoking cessation

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

a) The patient placed the load close to the body.
b) The patient reached over head with arms fully extended.
c) The patient used a narrow base of support.
d) The patient bent at the hips and tightened the abdominal muscles.


Answer: a) The patient placed the load close to the body.

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

a) Staphylococcus aureus
b) Psuedomonas aeruginosa
c) Escherichia coli
d) Proteus vulgaris


Answer: a) Staphylococcus aureus 

Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis?

Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis?

a) Rapid pulse
b) Tenderness over the affected area
c) Persistent draining sinus
d) High fever


Answer: c) Persistent draining sinus

The nurse recognizes that the goal of treatment for metastatic bone cancer is to:

The nurse recognizes that the goal of treatment for metastatic bone cancer is to:

a) Promote pain relief and quality of life
b) Cure the diseased bone and cartilage
c) Diagnose the extent of bone damage
d) Reconstruct the bone with a prosthesis


Answer: a) Promote pain relief and quality of life 

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? 

a) Pruritus and uremic frost
b) Petechiae over the chest and abnormal ABGs
c) Leukocytosis and localized bone pain
d) Thrombocytopenia and ecchymosis


Answer: c) Leukocytosis and localized bone pain

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis?

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis?

a) Proteus
b) Staphylococcus aureus
c) Salmonella
d) Pseudomonas


Answer: b) Staphylococcus aureus 

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
b) "Bunions are congenital and can't be prevented."
c) "Bunions are caused by a metabolic condition called gout."
d) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."


Answer: a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

a) Arthroplasty
b) Open reduction
c) Needle aspiration
d) Arthroscopy


Answer: d) Arthroscopy

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows an understanding of the education the nurse provided?

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows an understanding of the education the nurse provided?

a) "I will bend at the waist when I am lifting objects from the floor."
b) "Instead of turning around to grasp an object, I will twist at the waist."
c) "I will lie prone with my legs slightly elevated."
d) "I will avoid prolonged sitting or walking."


Answer: d) "I will avoid prolonged sitting or walking." 

Which of the following presents with an onset of heel pain with the first steps of the morning?

Which of the following presents with an onset of heel pain with the first steps of the morning?

a) Morton's neuroma
b) Hallux valgus
c) Plantar fasciitis
d) Ganglion


Answer: c) Plantar fasciitis

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?

a) Wound irrigation
b) Vitamin supplements
c) Wound packing
d) Surgical debridement


Answer: d) Surgical debridement

Which group is at the greatest risk for osteoporosis?

Which group is at the greatest risk for osteoporosis?

a) Asian women
b) Men
c) African American women
d) Caucasian women


Answer: d) Caucasian women 

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

a) Instructing the client to ambulate twice daily
b) Administering large doses of I.V. antibiotics as ordered
c) Withholding all oral intake
d) Administering large doses of oral antibiotics as ordered


Answer: b) Administering large doses of I.V. antibiotics as ordered