NU 665 final Exam (600 questions with 100% SOLUTIONS ) 2024 FINAL EXAM GRADED A+, Exams of Nursing

Download NU 665 final Exam (600 questions with 100% SOLUTIONS ) 2024 FINAL EXAM GRADED A+ and more Exams Nursing in PDF only on Docsity! NU 665 final Exam (600 questions with 100% SOLUTIONS ) 2024 FINAL EXAM GRADED A+ A school-age child has a fractured wrist with a Salter Harris Type II fracture, according to the radiologist. What is true about this type of fracture? - SOLUTION There is a metaphyseal fragment on the compression side of fracture. What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip? - SOLUTION Dislocation of an unstable hip A 3-year-old child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do? - SOLUTION Gently attempt a supination and flexion technique. A school-age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed? - SOLUTION Immobilization with a sling to support the affected extremity A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do? - SOLUTION Recommend NSAIDs, stretching exercises, and ice packs to the area. A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? - SOLUTION Discuss posture and exercise and ask about backpacks and books. The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6-month-old infant not previously noted in the medical record. What is the correct treatment? - SOLUTION Surgical intervention A 14-year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition? - SOLUTION Place the child on crutches or in a wheelchair to prevent weight-bearing. A parent is concerned that a 12-month-old child is "bowlegged." A physical examination reveals internal tibial torsion bilaterally. A radiograph reveals asymmetric bowing of the legs with an angle greater than 15 degrees. What is the correct action for the primary care pediatric nurse practitioner? - SOLUTION Refer to a pediatric orthopedic specialist for treatment. A child who plays soccer is in the clinic reporting pa in and swelling in both knees. A physical examination reveals swelling and focal tenderness at the tibial tuberosities, with pain worsening when asked to extend the knees against resistance. What is the treatment for this condition? - SOLUTION Apply ice packs to both knees and avoid activities that cause pain. During a well baby examination of a newborn, the primary care pediatric nurse practitioner notes adduction of the right forefoot, with normal position of the mid and hindfoot, along with a convex shaped lateral border of the foot. What will the nurse practitioner do to evaluate this deformity? - SOLUTION Grasp the heel with one hand and abduct the forefoot with the other hand. During a well child examination on a 4-month-old infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent-infant relationship? - SOLUTION "I let my baby cry a while to learn to be patient." A child has a difficult temperament. What will the primary care pediatric nurse practitioner tell the parent about managing this child's behavior? - interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient? - SOLUTION Determining suicidal ideation and risk of suicide An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk? - SOLUTION Cognitive behavioral therapy A 13-year-old child has exhibited symptoms of mild depression for several weeks. The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do? - SOLUTION Refer the child to a child psychiatrist for evaluation of bipolar disorder. A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do? - SOLUTION Engage the parent in positive parenting strategies to facilitate appropriate child coping. A 14-year-old female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect? - SOLUTION Anorexia nervosa Which type of heat-related illness involves a core body temperature of at least 104.9°F, acute mental status changes, absent sweat, and tachypnea? - SOLUTION Heat stroke What percentage of burns is involved using the rule of nines if both front legs are burned? - SOLUTION 18% Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full-thickness thermal injuries? - SOLUTION Silver sulfadiazine (Silvadene) A sunscreen with a sun-protection factor of at least what number will block most harmful ultraviolet radiation? - SOLUTION 15 Which clinical feature is the first to be affected in increased intracranial pressure? - SOLUTION Decrease in level of consciousness What is the normal number for the Glasgow Coma Scale? - SOLUTION 15 Which diagnostic test is the best to diagnose a subdural hematoma? - SOLUTION Magnetic resonance imaging (MRI) Patients with a spontaneous pneumothorax should be counseled that up to what percentage may experience a reoccurrence at some point? - SOLUTION 30% Most adult poisonings are: - SOLUTION Intentional and self-inflicted Which method is used to remove heavy metals, such as lead, that are ingested as poisons? - SOLUTION Chelation If a previously frostbitten area becomes frostbitten again after it has healed, what might occur? - SOLUTION Permanent tissue damage may occur, resulting in necrosis to that body part. What percentage of all visits to the emergency department (ED) are related to wounds? - SOLUTION 12% Which solution should be used when irrigating lacerated tissue over a wound on the arm? - SOLUTION Saline irrigation or soapy water Which type of burn injury results in destruction of the epidermis with most of the dermis, yet the epidermal cells lining hair follicles and sweat glands remain intact? - SOLUTION Deep partial-thickness burns Which carboxyhemoglobin (COHb) level correlates with the clinical symptoms of confusion, lethargy, and ST-segment depression on the electrocardiogram? - SOLUTION 30% COHb Which causes the greatest percentage of mammalian bites? - SOLUTION Dogs Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue? - SOLUTION Brown recluse spider Which of the following characteristics separates anaphylaxis from a vasovagal reaction? - SOLUTION Severe bronchoconstriction Delayed serum sickness-type reactions in response to multiple bee, wasp, or fire ant stings can be managed with which of the following? - SOLUTION A corticosteroid such as prednisone (Deltasone), 60 to 100 mg, tapered over 2 weeks After a head injury, what is it called when air enters into the cerebrospinal fluid (CSF)-filled spaces within the head? - SOLUTION Pneumocephalus Cerebrospinal fluid (CSF) may leak through the cribriform plate region of the skull following a head injury and cause which of the following? - SOLUTION Nasal CSF rhinorrhea Which classic feature of an epidural hematoma may distinguish it from other skull hematomas? - SOLUTION A brief loss of consciousness, then a brief "lucid" moment, followed by momentary unconsciousness minutes after the injury A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve? - SOLUTION CN IV A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury? - SOLUTION A strain disoriented to place. The nurse recognizes that these findings are caused by what complication? - SOLUTION Pulmonary embolus The nurse is assigned to care for a patient who was admitted 2 days previous after a four- wheeler accident. The patient sustained a closed fracture to the left femur and had an open reduction with internal fixation the same day. What is a priority for the nurse to assess for this patient? - SOLUTION Pulse oximetry A patient has been brought into the Emergency Department via ambulance with resuscitation efforts being performed. It is unlikely that the patient will survive the severe injuries sustained. Two adult children of the patient are present and are requesting to be with the patient at this time. What is the best response by the nurse? - SOLUTION You may come in with your parent and I will have someone stay with you to explain what is happening. The nurse is caring for the patient with chest tubes. Which observation by the nurse is a priority concern? - SOLUTION 250 mL/hr of blood in drainage collection system A patient is admitted to the emergency department after he was hit by a car. The car was going about 30 mph and was braking at the time of impact. The patient was struck just above the right knee, fell forward over the hood of the car, striking his anterior chest, and then slipped off the hood of the car and hit the pavement head first. Based on the mechanism of injury and transfer of force, what injuries does the nurse most expect? Select all that apply. - SOLUTION Fracture of the left femur and damage to the left knee, fractured ribs and cardiac and lung contusion, closed head injury and cervical spine fracture The patient has received a gunshot wound. To help predict the amount of damage, what information does the nurse collect? - SOLUTION Type of weapon and caliber of bullet A patient was in a serious motor vehicle crash. At the scene, what is the highest priority of care? - SOLUTION Cervical spine protection On initial admission of a trauma victim to the emergency department, the nurse completes a primary survey. The patient is awake and tachypneic, is using accessory muscles of respiration, has unequal chest expansion, and is very anxious. There are absent breath sounds on the right and cyanosis on 100% oxygen, and the trachea is deviated to the left. What action takes the highest priority during the primary survey? - SOLUTION Chest tube insertion A patient has been admitted to the emergency department after being in a severe motor vehicle crash. The patient was a passenger and had a lap and seat belt in place. The patient is lethargic and moaning. Initial exposure and head-to-toe examination reveals scattered minor abrasions and contusions and bruising over the upper abdomen. The patient moans more when the abdomen is palpated, and the abdomen is rigid. Heart rate is 110, capillary refill is greater than 4 seconds, and blood pressure is 140/88 mm Hg. What is the nursing priority of care? - SOLUTION Increase rate of IV crystalloid As part of a major trauma, a patient has suffered a flail chest injury. What hallmark sign of flail chest does the nurse expect to find? - SOLUTION Flail segment depression during inhalation A patient is admitted to the CCU after experiencing blunt trauma to the chest. Among other injuries, the patient has a flail chest on the left and several extremity fractures. About 12 hours after admission, the patient is tachypneic and complaining of shortness of breath. Breath sounds are present bilaterally with scattered fine crackles. Chest radiograph shows an ill-defined, patchy, ground-glass area of density on the left. If the patient has a pulmonary contusion, what is the nursing priority? - SOLUTION Monitor pulse oximetry and arterial blood gases closely A patient has suffered severe blunt trauma to the abdomen with bruising, diffuse pain, guarding, and rigidity evident. Damage to which structure is most likely? - SOLUTION Liver As part of a multiple trauma injury, the patient has suffered a closed fracture of the radius. What nursing assessment finding indicates a significant complication warranting immediate treatment? - SOLUTION Loss of pulses distal to the fracture A patient has experienced multiple fractures, including pelvic and long bone fractures. After 72 hours, the patient complains of tachypnea and dyspnea and is found to have cyanosis, tachycardia, confusion, and fever. Laboratory analysis reveals a normal complete blood count except for thrombocytopenia and progressive respiratory insufficiency. What is the nursing care priority? - SOLUTION Administer oxygen and monitor pulse oximetry During a motor vehicle accident, a patient sustained blunt trauma to the head and face, resulting in hairline skull fracture and a LeFort III maxillofacial fracture. The patient also has bruising across the chest and upper abdomen and multiple small superficial bleeding abrasions and lacerations. On admission to the emergency department, what is the nursing care priority? - SOLUTION Perform endotracheal intubation As part of a multiple trauma injury, a patient developed hemorrhagic hypovolemic shock, necessitating fluid resuscitation with massive amounts of intravenous crystalloid fluids and blood products as well as extensive surgical repair under general anesthesia. Twenty- four hours later, the patient develops hypoxia unresponsive to oxygen therapy and diffuse white, ground-glass infiltrates of the lung fields on a chest radiograph. Development of this complication has what effect on the patients recovery? - SOLUTION Significantly greater chance of death Which of the following is likely to result from lead poisoning? - SOLUTION Damage to the brain and peripheral nerves During the development of hyperthermia, the state of heat exhaustion is indicated when: - SOLUTION hypovolemia and fainting occur What is/are signs of hypothermia? - SOLUTION Lethargy and confusion Which of the following types of cells are most likely to be damaged by exposure to radiation? - SOLUTION Epithelial tissue and bone marrow Which of the following events would most likely cause a person to faint and experience difficulty breathing? - SOLUTION An insect sting A patient arrives at the ICU after being injured by car bomb that exploded 20 feet away. The patient sustained only primary blast injuries. Which of the following are injuries he might have sustained? - SOLUTION Perforated eardrum caused by a sudden change in atmospheric pressure. Hemorrhagic contusion of the lungs. Gastrointestinal hemorrhage A group of patients, colleagues from the same office, arrive at the ICU with symptoms of nausea, vomiting, and diarrhea. It is determined that they are suffering from radiation exposure as a result of an inconspicuous device placed in the office that leaked radiation over a period of days. The nurse suspects that which of the following was used in this terrorist attack? - SOLUTION Simple radiological device A patient arrives at the ICU with symptoms of radiation exposure. While in the ICU, he begins gasping for air and clutching his throat with his hand. What intervention should take priority at this point? - SOLUTION Perform CPR on the patient to restore normal respiratory function. A woman arrives at the ICU after being the victim of a terrorist attack in a nearby shopping center involving a gas that spewed from a metal canister. The woman complains of a burning sensation in her eyes, mouth, and throat, and the nurse observes blistering on her face and arms. What chemical agent should the nurse suspect, and what intervention should she implement? - SOLUTION Vesicant agent; soap and water blot A worker at a local chemical plant arrives at the ICU following an industrial accident involving a gas leak. The patient shows signs of pulmonary edema and bronchospasm. What chemical should the nurse suspect is involved, and what intervention would be most appropriate? - SOLUTION Chlorine; airway management and ventilatory support A man presents to the ICU with a severe case of H1N1 viral infection. What would be the most appropriate intervention for this patient? - SOLUTION Administer an antiviral agent. A young man arrives at the ICU after being held hostage while a passenger on a commercial airplane. He sustained a bullet wound in his chest and has undergone surgery to repair his lung. He is now receiving an analgesic for his pain. The nurse observes that the patient frequently complains that he is sick to his stomach and has no appetite. His sleep is regularly interrupted by nightmares, and he is prone to outbursts of anger and grief. What is the most likely cause of these symptoms? - SOLUTION Post-traumatic stress disorder The nurse is caring for a group of patients from the same workplace who have similar symptoms of cough, respiratory distress, and nausea and vomiting. What should the nurse suspect? - SOLUTION Mass exposure to an inhaled agent The nurse is part of a planning committee developing a disaster response plan for a hospital that serves as the major trauma center for the local area. The committee has identified that the most likely cause of a disaster in the community is a devastating tornado that significantly damages most major structures, including hospitals of all sizes, in the community. What component of the plan is least likely to be realistic? - SOLUTION Transfer all noncritical patients to smaller hospitals in the community. The nurse is preparing to assist with triage of victims from a large mass casualty incident. The patients are sorted into categories at the door of the facility. What category will receive care last? - SOLUTION Expectant The nurse is assisting with triage in the emergency department. A large group of patients from a mass casualty incident arrive. These patients have been classified at the scene as minimal, delayed, immediate, and expectant. What is the best nursing approach? - SOLUTION Reassess and reclassify patients quickly to determine the order of treatment. The nurse is caring for a patient who was exposed to a high dose of external radiation. What is the least likely nursing action? - SOLUTION Assist in removing penetrating radioactive materials. The nurse is caring for a patient who has been exposed to radiation. The patient has been increasingly unstable, with decreasing lymphocytes, leukocytes, thrombocytes, and erythrocytes, along with shock, diarrhea, and altered level of consciousness for some weeks. Today, there is clear evidence of worsening shock, subnormal body temperature, and increased intracranial pressure. The family asks what the patients prognosis is. The best nursing response is based on what rationale? - SOLUTION Increased intracranial pressure following other symptoms is a sign of impending death. The nurse is caring for a patient with a suspected cyanide exposure. The patient is anxious and hyperventilating. What is the nursing priority of care? - SOLUTION Give cyanide antidote. The nurse is assisting with the initial care and assessment of a group of patients with a massive topical toxic chemical exposure. What is the best way to decontaminate these patients? - SOLUTION Soap-and-water shower first for most chemicals A worker in a tanning factory comes to the emergency department with itchy, papular lesions on his hands and arms. Some of the lesions have black eschar in the center and some are vesicular. What biological exposure is most likely? - SOLUTION Cutaneous anthrax A patient and his family have been exposed to probable anthrax spores through contaminated postal contents within the past 8 hours. Upon arrival at the emergency department, all members of the family are anxious and say they are afraid of dying. The best nursing response is based on what rationale? - SOLUTION Antibiotic therapy is very effective for cutaneous anthrax. A male client asks the nurse about the purpose of the prostate gland. The nurse should respond that it is a structure that: - SOLUTION provides a milky alkaline substance that neutralizes the acidity of the male urethra and the female vagina. A 50-year-old male client has had a prostate-specific antigen test. The nurse realizes that the normal range for this test would be: - SOLUTION 3.0 to 4 ng/mL. A male client, having difficulty voiding, tells the nurse that he thinks something is wrong with his penis. The nurse reviews the structures of the penis with the client and explains that the structure that surrounds the urethra is the: - SOLUTION corpus spongiosum. During the examination of a female clients breasts, the nurse determines that which of the following assessment findings would be normal? - SOLUTION Symmetrical nipples The nurse is instructing a female client on the importance of having routine mammograms because mammograms: - SOLUTION can detect masses before they become palpable. The nurse is instructing a female client on what should be done if a lump is discovered while performing breast self-examination (BSE). What should the nurse instruct the client to do? - SOLUTION Call her physician and immediately schedule an appointment. The nurse determines that a female client has a lower risk for developing breast cancer when which of the following is assessed? - SOLUTION Breastfeeding The nurse should instruct the client that when performing a breast self- examination, pay particular attention to which of the following areas since the greatest number of malignancies are found in this breast area? - SOLUTION Upper outer quadrant of the breast to the axilla The nurse should instruct a client, diagnosed with mastalgia, to do which of the following? - SOLUTION Decrease the intake of caffeine. A female client tells the nurse that she is planning on having plastic surgery to correct a minor facial defect and then have her breasts done. The nurse would identify which of the following nursing diagnoses as being appropriate for this client? - SOLUTION Body dysmorphic disorder The nurse is determining if a female client is at risk for benign breast disease. Which of the following is a risk factor for this disorder? - SOLUTION Caffeine use A client is scheduled for a prophylactic mastectomy. The nurse should remind the client that skin flaps will be left after the surgery for: - SOLUTION reconstruction. When instructing a client on breast self-examination, the nurse reviews the importance of visual inspection of the breasts. Which of the following should the nurse instruct the client to focus on when doing this part of the examination? - SOLUTION Contour and symmetry of the breasts, Skin changes, Position of the nipples, Presence or absence of masses The nurse is preparing to assess a clients nipples during a breast examination. Which of the following are considered pathological conditions that affect the nipple? - SOLUTION Bleeding, discharge, fissures Which of the following should the nurse do if a female client is experiencing nipple discharge? - SOLUTION Note the color of the discharge. Determine if the discharge is from one or both breasts. Obtain a sample of the discharge with a sterile cotton-tipped swab. Assess the nipple drainage for occult blood. A client is experiencing galactorrhea. Which of the following should the nurse assess in this client? - SOLUTION Recent vigorous nipple stimulation. Prescribed hormones, blood pressure medications, or antidepressants. Intake of herbal remedies such as fennel or anise. Use of street drugs such as opiates and marijuana. Recent chest trauma. A client is considering breast augmentation surgery. Which of the following postoperative complications should the nurse discuss with the client regarding this surgery? - SOLUTION Change in sensation. Development of a hematoma. Fibrous tissue around the implant. A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners. Which of the following conditions should the clinician be particularly alert for during her examination? - SOLUTION Human papillomavirus A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? - SOLUTION Ceftriaxone A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to? - SOLUTION Chlamydia A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? - SOLUTION Bacterial Vaginosis Which of the following medications is the treatment of choice for trichomonas? - SOLUTION Metronidazole A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? - SOLUTION "We will order a mammogram and ultrasound to help establish a diagnosis." A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority? - SOLUTION Pregnancy test A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia? - SOLUTION Menopause A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate? - SOLUTION Fluconazole A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive? - SOLUTION Pregnancy test A 40-year-old woman is seen for her yearly examination. She is single and not in a monogamous relationship. Her social history includes smoking cigarettes "occasionally" and drinking about two beers a day. Her body Most breast cancer cases are in women with a family history of breast cancer. - SOLUTION False A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? - SOLUTION Benign prostatic hypertrophy A 76-year-old man is seen in the office for complaints of urinary incontinence. The clinician should explore which of these causes of incontinence in men? - SOLUTION Urinary tract infection (UTI) A 14-year-old male is seen with complaints of severe testicular pain. The clinician suspects testicular torsion. Which of the following is the appropriate action? - SOLUTION Refer to a urologist immediately. An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses? - SOLUTION Benign prostatic hyperplasia (BPH), Parkinson's disease, Prostate cancer Which of the following would be an appropriate treatment for a patient with mild BPH? - SOLUTION Reevaluate symptoms in 1 to 3 months. A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis? - SOLUTION Testosterone level Which of the following should be considered in a patient presenting with erectile dysfunction? - SOLUTION Diabetes mellitus, hypertension, atherosclerosis A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis? - SOLUTION Peyronie's disease The patient with BPH is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects? - SOLUTION Erectile dysfunction The clinician should prescribe an antibiotic that covers which of these organisms for a patient with acute prostatitis? - SOLUTION Gram- negative bacillus The 56-year-old man with chronic prostatitis should be treated with trimethoprim 80 mg- sulfamethoxazole 400 mg (TMP-SMX, Bactrim) for how long? - SOLUTION 6 to 12 weeks A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate, and a diagnosis of prostatodynia is made. Which is the appropriate treatment? - SOLUTION Terazosin 2 mg PO once a day A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis. In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism? - SOLUTION Chlamydia trachomatis Which test is used to confirm a diagnosis of epididymitis? - SOLUTION Ultrasound of the scrotum Treatment for epididymitis includes which of the following? - SOLUTION Scrotal elevation Which of the following data is indicative of testicular torsion? - SOLUTION Absent cremasteric reflex 60-year-old man presents with an enlarged scrotum. The clinician uses a penlight to transilluminate the scrotum. In a patient with a hydrocele, what would the clinician expect to find? - SOLUTION The scrotum will appear light pink or yellow. During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious? - SOLUTION An enlarged rubbery gland A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which of these understandings of the Jewett rating system? - SOLUTION The cancer involves the seminal vesicles. A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects? - SOLUTION Risk of osteoporosis. May have hot flushes. May have impotence A 22-year-old male is seen in the clinic because he found a hard lump in his testicle when performing testicular self-examination (TSE). Which of the following should be included in the list of differential diagnoses? - SOLUTION Testicular cancer, inguinal hernia, varicocele What is the treatment of choice for a patient diagnosed with testicular cancer? - SOLUTION Radical orchidectomy A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan? - SOLUTION Every 3 to 4 months Patients treated for Neisseria gonorrhoeae also should be treated for Chlamydia trachomatis. - SOLUTION True Hepatitis A is considered a sexually transmitted infection by the Centers for Disease Control and Prevention. - SOLUTION True The nurse is instructing a client diagnosed with acute prostatitis. Which of the following instructions would be the least beneficial to the client? - SOLUTION Sit for as long as you can. The nurse is documenting the health history of a client diagnosed with benign prostatic hyperplasia (BPH). In which of the following areas would the nurse take a careful history? - SOLUTION Urinary patterns It is documented in the medical record that a patient has gummas. For which sexually transmitted infection should the nurse plan care? - SOLUTION Syphilis The nurse is assisting with teaching a 22-year-old female patient who is diagnosed with a sexually transmitted infection (STI). She says, I dont understand. My boyfriend always wears a condom. Which understanding by the nurse should guide teaching in this situation? - SOLUTION Condoms can decrease the risk of STIs, but they are not foolproof. The nurse is providing care for a patient with genital herpes who has vesicular lesions. What term should the nurse use to describe these lesions to the patient? - SOLUTION Blisters Human papillomavirus (HPV) produces verrucous growths. What term should the nurse use to describe these lesions to the patient? - SOLUTION Warts The nurse is collecting data on a patient with Chlamydia. Which assessment finding should be reported immediately to the RN or physician? - SOLUTION Sharp pain at the base of the ribs Because Trichomonas is relatively large, unusually shaped, and diagnosed quickly, the nurse is asked to assist the physician obtain which type of specimen? - SOLUTION Wet mount A patient diagnosed with Trichomonas asks the nurse how the diagnosis will affect her risk for cervical cancer. Which response by the nurse is best? - SOLUTION Papanicolaou smears should be done more frequently because results may be altered by Trichomonas. A patient asks why the physician has recommended systemic interferon treatment for genital warts. Which explanation should the nurse provide to the patient? - SOLUTION Interferon therapy can attack warts all over the body at the same time. A patient with hepatitis B virus (HBV) delivers a 6-pound 2-ounce baby boy. Which action should the nurse anticipate will be needed for the infant? - SOLUTION HBV-immune globulin less than 12 hours after birth and then HBV vaccine series The nurse must bathe a patient with herpes. What is the nurses best protection against contracting sexually transmitted infections (STIs) from patients while providing perineal hygiene? - SOLUTION Practicing standard precautions The nurse is caring for a pregnant woman who is fearful that her unborn child will be born blind because of having a sexually transmitted infection (STI). For which STI should the nurse plan care to prevent ophthalmia neonatorum in the newborn? - SOLUTION Gonorrhea The nurse is caring for a young woman who is newly diagnosed with genital warts. She states, I heard you can get cancer from STIs. Is that true? Which response by the nurse is correct? - SOLUTION Yes, some STIs have been linked to cancer, so adequate treatment is very important. The nurse is identifying ways for a young adult to reduce the risk of contracting a sexually transmitted infection (STI). What should the nurse teach about the relationship between consumption of alcohol and immediate risk of contracting an STI? - SOLUTION Alcohol may reduce inhibitions The nurse reviews the ways to prevent condom breakage with a patient. Which patient statement indicates that more teaching is necessary? - SOLUTION Before I use a condom, I should inflate it and check it for holes and leaks. The nurse is assisting with the admission of a known intravenous drug abuser to a medical unit. In addition to drug abuse, which disorder in the patients history is most consistent with a diagnosis of hepatitis? - SOLUTION Jaundice The nurse is teaching a patient the importance of completing treatment for gonorrhea. On which information is the nurse basing this teaching? - SOLUTION Men and women may be asymptomatic and still transmit the infection. The nurse is assisting in the preparation of a teaching seminar for adolescents to prevent the development of a sexually transmitted infection (STI). Which nonsexual activity should the nurse teach that may transmit a sexually transmitted infection (STI)? - SOLUTION Sharing intravenous drug equipment A patient asks for the best way to prevent contracting a sexually transmitted infection (STI). What response should the nurse make to this patients question? - SOLUTION Abstinence A patient diagnosed with genital warts asks how they developed. Which pathogen should the nurse explain as causing genital warts? - SOLUTION Human papillomavirus The nurse is caring for a 76-year-old retired man who is undergoing evaluation for dementia. What would be an important part of the mans history to report to the physician? - SOLUTION The patient has a history of syphilis A patient is undergoing treatment that involves the burning of lesions with heat or chemical agents. The nurse recognizes that this patient most likely has which condition? - SOLUTION Genital warts The nurse is providing care for a newborn. Which intervention should the nurse make to prevent development of ophthalmia neonatorum? - SOLUTION Antibiotic eyedrops The nurse is preparing a poster presentation identifying the frequency of sexually transmitted infections (STIs) in the United States. Which STI should the nurse highlight as being the most commonly diagnosed? - SOLUTION Trichomoniasis The nurse is preparing a poster presentation identifying the frequency of sexually transmitted infections (STIs) in the United States. Which STI should the nurse highlight as being the most commonly diagnosed? - SOLUTION Chlamydia While assisting a health care provider (HCP) conduct a pelvic examination, the patient complains of severe pain during the bimanual examination. For Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right- handed. Based on her examination and medical history, you suspect adhesive capsulitis, or "frozen shoulder." Which clue in Mrs. Gray's history supports this diagnosis? - SOLUTION Her history of diabetes mellitus Jennifer is an 18-year-old who comes to the emergency room after a fall during a soccer game. Jennifer explains that she fell on her left side and kept her arm out straight to break her fall. She has been experiencing severe pain and limited ROM in her left shoulder. The clinician has diagnosed Jennifer with a dislocated shoulder. Which of the following statements are true concerning shoulder dislocation? - SOLUTION There is a risk of neurovascular and neurosensory trauma, so the clinician should check for distal pulses. Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome? - SOLUTION Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. Which of the following statements is true regarding the treatment of carpal tunnel syndrome? - SOLUTION The goal of treatment is to prevent flexion and extension movements of the wrist. Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection. Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc? - SOLUTION Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain. The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs? - SOLUTION "You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage." Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression? - SOLUTION Paresthesia of the perineum and buttocks Which of the following statements is true concerning the management of the client with a herniated disc? - SOLUTION Intolerable pain for more than a 3-month period is an indication for surgical intervention. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? - SOLUTION McMurray circumduction test The clinician suspects that a client has patellar instability. In order to test for this, the client is seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is displaced laterally, and the knee flexed to 30°. If instability is present, this maneuver displaces the patella to an abnormal position on the lateral femoral condyle, and the client will perceive pain. Testing for patellar instability in this way is known as: - SOLUTION Apprehension sign The clinician is caring for Diane, a 22-year-old woman who presents with an injured ankle. Diane asks the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the examination and Diane's description of her injury. Which of the following clues in Diane's examination or history would alert the clinician to the need for obtaining radiographs? - SOLUTION Inability to bear weight immediately after the injury. Development of marked ankle swelling and discoloration after the injury. Crepitation with palpation or movement of the ankle. Mr. Jackson is a 65-year-old man recently diagnosed with osteoarthritis. The clinician has explained to Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing functional independence and mobility, minimizing disability, and preserving quality of life. Mr. Jackson explains to the clinician that his first choice would be to use complementary therapies to control his condition and asks what therapies are most effective in treating osteoarthritis. What would be the most appropriate response from the clinician? - SOLUTION "I would be happy to discuss all the treatment options available to you. Complementary therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment of osteoarthritis and have shown promise when used with standard medical therapy." Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways? - SOLUTION By decreasing the erosive activity of osteoclasts Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis? - SOLUTION Bone mass density measurement by densitometry What is the recommended daily calcium intake for adults over the age of 50 with low bone mass? - SOLUTION 1,500 mg/day Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer The nurse is contributing to the plan of care for a patient who has a right fractured femur. What intervention should the nurse include in the plan of care to prevent fat emboli? - SOLUTION Maintain immobilization of the right leg. A patient has an open reduction of a radial fracture and is casted. Several hours after the operation, the patient reports a throbbing pain in the arm. What nursing action is essential for the nurse to take? - SOLUTION Perform neurovascular checks. The nurse is monitoring a patient with a casted left tibial fracture and a contusion of the thigh. The patient reports increasing pain in the left foot that has not been relieved by morphine injections. What should the nurse do? - SOLUTION Ensure physician is immediately notified. The nurse finds a 2-day postoperative patient who had a right total hip replacement lying supine with crossed legs. What data should the nurse collect on this patient? - SOLUTION The right leg for shortening The nurse is caring for a patient who had a closed reduction of the ulna with a cast applied. Later the patient reports left arm pain. What should the nurse do first? - SOLUTION Perform neurovascular check on fingers. The nurse is reinforcing teaching provided to a patient recovering from right total hip replacement. Which patient statement indicates a correct understanding of the teaching? - SOLUTION Keep legs apart. A patient with a casted, fractured left leg asks why the leg has to be elevated. What should the nurse respond to this patient? - SOLUTION Decreases swelling. The nurse is caring for a patient who has had a right hip replacement. For which position is the nurse attempting to achieve when a pillow is placed between the legs during turning? - SOLUTION Abduction of the thighs The nurse sees a neighbor fall and fracture a leg. What should the nurse do first for the neighbor? - SOLUTION Immobilize the affected limb using minimal movement. The nurse is reinforcing teaching provided to a patient with rheumatoid arthritis (RA). Which patient statement indicates understanding of the symptoms of RA? - SOLUTION Fatigue A patient with a 36-hour-old fractured femur is in traction and is prescribed morphine 10 mg every 3 hours as needed. The patient received a dose 3 hours ago and is now reporting a pain level of 8. The patient is stable. Which action should the nurse take? - SOLUTION Give pain medication as ordered. The nurse is caring for a patient who has a newly casted, fractured wrist. Data collection reveals slightly puffy fingers with good capillary refill. What should the nurse do now to prevent complications? - SOLUTION Elevate the cast on pillows. A patient with gout has been instructed on the prescribed medication allopurinol (Zyloprim). Which patient statement indicates understanding of the action of this medication? - SOLUTION Blocks formation of uric acid. The nurse is evaluating teaching provided to a patient with gout. Which patient menu selection indicates that additional teaching is required? - SOLUTION Sardines The nurse is reinforcing teaching provided to a patient with gout. Which food should the patient state will be avoided that indicates teaching has been effective? - SOLUTION Liver The nurse is contributing to the plan of care for a patient with Pagets disease. Which outcome should the nurse identify as being appropriate for this patient? - SOLUTION Pain is relieved at a satisfactory level. The nurse is contributing to the plan of care for a patient who has a fractured hip and is placed in Bucks (boot) traction while awaiting surgery. What is the desired outcome for placing the patient in Bucks traction? - SOLUTION Relieve patient pain. The nurse is reinforcing teaching for a patient who has had a total hip replacement on correct sitting positions. Which position should the nurse teach the patient to avoid? - SOLUTION Crossing legs The nurse is contributing to the plan of care for a patient who has an upper extremity amputation. Why should the nurse keep in mind that this type of amputation can be more debilitating than a lower extremity amputation when planning care? - SOLUTION The upper extremity is more specialized. The nurse observes a petechial rash and respiratory distress in a patient recovering from a fractured femur. What should these findings suggest to the nurse? - SOLUTION Fat embolism A patient who has a displaced mid-shaft fracture of the left femur and is in balanced suspension skeletal traction with 35 pounds of weights is experiencing calf pain with right foot dorsiflexion. Which action should the nurse take? - SOLUTION Notify the RN. The nurse is contributing to the plan of care for a patient who is scheduled for a below-the- knee amputation. What nursing diagnosis should be recommended for the preoperative plan of care? - SOLUTION Anxiety The nurse is reinforcing teaching on positioning for a patient after a right total knee replacement. Which patient statement indicates a correct understanding of the teaching? - SOLUTION Supine with pillow under right knee. The nurse is reinforcing teaching provided to a patient for carpal tunnel syndrome treatment. Which patient statement indicates a correct understanding of the teaching? - SOLUTION Wrist splint. A patient with a fractured pelvis and a left acetabular fracture is prescribed bedrest. When the patient asks to toilet, which measure would be appropriate? - SOLUTION Ask patient to lift straight up using a trapeze mounted above the bed and slide a bedpan underneath from the right side. The nurse is caring for a patient with a minor rotator cuff shoulder injury. What should the nurse emphasize when reviewing care with this patient? - SOLUTION Apply ice, rest the shoulder, take NSAIDs as prescribed, begin out-patient physical therapy During a health history the nurse becomes concerned that a patient is at risk for developing osteoporosis. Which modifiable risk factors did the nurse use to come to this conclusion? - SOLUTION Cigarette smoking, sedentary lifestyle, low calcium intake The nurse is assisting in the development of an educational seminar on prevention of osteoporosis for a group of community members. Which actions should the nurse suggest be included in this presentation? - SOLUTION Ensure an adequate intake of calcium each day, participate in weight-bearing exercise every day, wear well-supporting nonskid shoes at all times, consider participating in resistance exercise training What is a sign of a dislocation? - SOLUTION Deformity at a joint How is Duchennes muscular dystrophy inherited? - SOLUTION X-linked recessive gene Which of the following is true about Duchennes muscular dystrophy? - SOLUTION There is difficulty climbing stairs or standing up at 2 to 3 years of age. The most common type of joint, which are freely movable, are called: - SOLUTION Diarthroses Which of the following is characteristic of osteoarthritis? - SOLUTION Degeneration of articulating cartilage occurs in the large joints. What is a typical characteristic of the pain caused by osteoarthritis? - SOLUTION Increased with weight-bearing and activity What is the typical joint involvement with rheumatoid arthritis? - SOLUTION Bilateral small joints, symmetrical progression to other joints What is the basic pathology of rheumatoid arthritis? - SOLUTION Systemic inflammatory disorder due to an autoimmune reaction How is the articular cartilage damaged in rheumatoid arthritis? - SOLUTION Enzymatic destruction by the pannus How does the joint appear during an exacerbation of rheumatoid arthritis? - SOLUTION Red, warm, swollen, and tender to touch What limits joint movement in osteoarthritis? - SOLUTION The osteophytes and irregular cartilage surface Joints affected by osteoarthritis can sometimes affect healthy joints by: - SOLUTION the affected individuals exerting stress on the normal joint to protect the damaged one. Systemic effects of rheumatoid arthritis are manifested as: - SOLUTION nodules in various tissues, severe fatigue, and anorexia. What is a common effect of long-term use of glucocorticoids to treat rheumatoid arthritis? - SOLUTION Osteoporosis Juvenile rheumatoid arthritis (JRA) differs from the adult form in that: - SOLUTION rheumatoid factor is not present in JRA, but systemic effects are more severe. Which of the following distinguishes septic arthritis? - SOLUTION Purulent synovial fluid present in a single, swollen joint Which of the following may precipitate an attack of gout? - SOLUTION A sudden increase in serum uric acid levels Where does inflammation usually begin in an individual with ankylosing spondylitis? - SOLUTION Sacroiliac joints with progression up the spine What is a common outcome of fibrosis, calcification, and fusion of the spine in ankylosing spondylitis? - SOLUTION Rigidity, postural changes, and osteoporosis Which statement applies to menisci? - SOLUTION They prevent excessive movement of joints. Which factors delay healing of bone fractures? - SOLUTION Prolonged inflammation and ischemia, presence of osteomyelitis What is the likely immediate result of fat emboli from a broken femur? - SOLUTION Pulmonary inflammation and obstruction A sprain is a tear in a: - SOLUTION ligament. When a patient recovering from a fractured tibia asks what callus formation is, the nurse tells her it is: - SOLUTION a part of the bone healing process after a fracture when new bone is being formed over the fracture site. Which patient statement indicates the need for additional teaching for a patient with rheumatoid arthritis who is taking meloxicam (Mobic)? - SOLUTION I take aspirin before I go to bed. Which foods should the home health nurse suggest for the patient with osteoporosis to help slow the disease? - SOLUTION Leafy green vegetables What should the nurse include in the teaching plan for a patient who is taking alendronate (Fosamax)? - SOLUTION Take drug first thing in the morning What should the nurse do when a patient with osteomyelitis is admitted with an open wound that is draining? - SOLUTION Initiate drainage and secretion precautions A 16-year-old male patient presents in the emergency room with a pathologic fracture of the left femur and complains of pain on weight approaches to treating these side effects? - SOLUTION Treat the patient with anticholinergics. According to Kübler-Ross, the stages of grief occur in which order? - SOLUTION Denial, anger, bargaining, depression, acceptance The clinician is educating a patient about the effects of marijuana. The patient stated she has been smoking for years and believes the use does not interfere with her life. What is a significant long-term sequelae of marijuana use that the clinician should educate this patient about? - SOLUTION Memory impairment Cocaine acts as a stimulant by blocking the reuptake of which neurotransmitter? - SOLUTION Dopamine What blood alcohol level corresponds with the signs of stupor and confusion? - SOLUTION 0.3 Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep? - SOLUTION Every 90 minutes Which of the following is a laboratory finding commonly found in patients with anorexia nervosa? - SOLUTION Hypercholesterolemia Which of the following is the only drug for bulimia approved by the U.S. Food and Drug Administration? - SOLUTION Fluoxetine Which of the following would be important to monitor in a child receiving methylphenidate for treatment of attention deficit-hyperactivity disorder (ADHD)? - SOLUTION Growth parameters It is important for the clinician to discuss the long-term effects of sexual assault with survivors. Which of the following is the most common long- term effect of sexual assault? - SOLUTION PTSD Women are at the highest risk for developing postpartum depression for up to how long after childbirth? - SOLUTION 6 months Which is the most prevalent psychiatric condition in the United States? - SOLUTION Anxiety What is recorded as clinical category two of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 5th edition (text revision)? - SOLUTION Environmental and psychosocial stressors Which of the following may be used to evaluate a person's suicide risk? - SOLUTION SAD PERSONAS Assessing for adherence with prescribed medications and developing a plan for what to do if they are stopped is a major treatment issue for which of the following diagnostic groups? - SOLUTION Bipolar Bipolar disorder requires differential diagnosis from all of the following except? - SOLUTION Obsessive-compulsive disorder The use of benzodiazepines in the patient with generalized anxiety disorder and comorbid depression can exacerbate depressive symptoms. - SOLUTION True Depressive episodes associated with bipolar disorder are treated the same as major depressive disorder. - SOLUTION False Women in abusive relationships have a greater chance of being killed by their batterers when they leave the relationship than women who stay. - SOLUTION True Adults must show childhood onset of symptoms to receive a diagnosis of ADHD. - SOLUTION True Parkinson's disease and dementing illnesses may commonly manifest depressive symptoms. - SOLUTION True The best predictor of suicide risk is a history of suicide attempts. - SOLUTION True A no-suicide contract can prevent a suicide attempt. - SOLUTION False Depression is the most chronic disabling and economically catastrophic medical disorder of the severe mental illnesses. - SOLUTION False Clozapine (Clozaril) requires laboratory monitoring at specified frequencies with results reported to a national registry. - SOLUTION True When combined with certain other medications, serotonin-specific antidepressants can have significant liver P450-interaction effects. - SOLUTION True A 60-year-old man was admitted for cholecystitis that resulted in a cholecystectomy. On his third day of hospitalization, he begins to sweat profusely, tremble, and has a blood pressure of 160/100. Based on these findings, what focused assessment should the nurse complete? - SOLUTION Withdrawal problems What age of onset of alcohol consumption is most predictive of alcohol addiction? - SOLUTION 14 or younger Alcohol is involved in motor vehicle accidents, suicides, and homicides. Approximately how many deaths each year are related to alcohol consumption? - SOLUTION 100,000 What stage of dependence is described by a patient when he tells the nurse that he has tried to stop his drug habit, but he does not feel normal without it? - SOLUTION Middle What must a patient in the late stages of dependence do in order to recover? - SOLUTION Receive treatment for substance abuse What is the best response by a nurse when a patient inquires how alcohol acts so quickly on his system? - SOLUTION Alcohol is metabolized into ethanol rapidly. What nursing intervention should be included in the plan of care for a baby born to a drug- addicted mother? - SOLUTION Swaddle the baby closely What is the greatest problem with lysergic acid diethylamide (LSD) use? - SOLUTION The drug causes flashbacks. What should the nurse do to decrease the damage of bruxism seen in a patient who has been abusing the drug ecstasy? - SOLUTION Provide the patient with a pacifier What should the nurse do when suspecting a co-worker of abusing drugs while at work? - SOLUTION Report observations to a supervisor Which statement describes the impaired nurse who is in a peer assistance program? - SOLUTION The nurse will be allowed to work as a nurse under supervision. During the initial intake assessment of a drug user, the nurse should attempt to obtain which subjective data? - SOLUTION Usual pattern of use, Specific drug, Amount of drug used, Time of last use The nurse should assess a patient for which criteria of addiction? - SOLUTION Excessive use of the substance, Uncontrollable consumption, Psychological disturbances A nurse suspects her a co-worker is abusing drugs. Which of the following symptoms, noticed in the co-worker, would contribute to the suspicions? - SOLUTION Frequently absent from the unit, rapid changes in mood and performance, increased somatic complaints, patients report they did not receive their medications When assessing an alcoholic patient, the nurse notes short-term memory loss, painful extremities, footdrop, and muttered incoherent responses to questions. The nurse recognizes these symptoms as most likely related to a condition caused by long-term alcohol abuse, which is known as __________ syndrome. - SOLUTION Korsakoff The nurse uses the CAGE questionnaire to assess a patient. The nurse suspects the patient is an alcoholic if there are affirmative answers for _____ items on the questionnaire. - SOLUTION Two The nurse cautions that a person who chronically abuses drugs may experience mental impairment. The area of the brain that can be affected and permanently damaged is the ________ _________. - SOLUTION Limbic system The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following? - SOLUTION Echolalia While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is speaking directly to him. The nurse interprets this finding as which of the following? - SOLUTION Referential thinking A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. His clothing is disheveled, his hair is uncombed and matted, and his body has a strange odor. During an interview, the clients family voices a desire for the client to live with them when he is discharged. Based on the assessment findings, which nursing diagnosis would be the priority? - SOLUTION Bathing Self-Care Deficit related to symptoms of schizophrenia. The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinsons disease. Which agent would the nurse expect the physician to prescribe? - SOLUTION Anticholinergic The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the clients eyes are fixed on the ceiling. The nurse interprets this finding as which of the following? - SOLUTION Oculogyric crisis A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? - SOLUTION Diphenhydramine (Benadryl) The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following? - SOLUTION Tardive dyskinesia A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the following? - SOLUTION Diabetes The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the clients vital signs and finds that the client has a fever. The nurse notifies the physician, expecting an order to obtain which laboratory test? - SOLUTION A white blood cell count A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective when they state which of the following should be reported immediately? - SOLUTION Elevated temperature A nurse is preparing an in-service program for a group of psychiatricmental health nurses about schizophrenia. Which of the following would the nurse include as a major reason for relapse? - SOLUTION Non-adherence to prescribed medications While assessing a client with schizophrenia, the client states, Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies. The nurse interprets this statement as indicating which type of delusion? - SOLUTION Persecutory would the instructor include as reflecting schizoaffective disorder? - SOLUTION It is episodic in nature. The nurse is caring for a client who was diagnosed with schizoaffective disorder. Based on the nurses understanding of this disorder, the nurse develops a plan of care to address which issue as the top priority? - SOLUTION Suicide A family member of a client diagnosed with schizoaffective disorder asks a nurse what causes the disorder. Which response by the nurse would be most appropriate? - SOLUTION Research has suggested that the cause is predominately genetic. The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client? - SOLUTION Clozapine The nurse is assessing a newly admitted client diagnosed with schizoaffective disorder. The nurse assesses the client's level of anxiety and reactions to stressful situations, obtaining this information for which reason? - SOLUTION To act as a predictor of the client's risk for a suicide attempt The nurse is caring for a client diagnosed with a delusional disorder. While assessing this client, which of the following would the nurse expect to find? - SOLUTION Living with one or more delusions for a period of time The nurse is preparing to interview a client who has a delusional disorder. Which of the following would the nurse expect? - SOLUTION Normal behavior The nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which of the following would the nurse most likely document? - SOLUTION Body complaints A client with schizoaffective disorder is prescribed clozapine to treat her symptoms. Which of the following instructions would the nurse provide? - SOLUTION Keep an eye on your weight, and if you gain weight rapidly, notify your doctor. After teaching a group of students about the epidemiology of schizoaffective disorder, the instructor determines that the teaching was successful when the students state which of the following? - SOLUTION It is more likely to occur in women. A client with schizoaffective disorder is having difficulty adhering to the medication regimen that requires the use of several agents. The client also is experiencing several side effects contributing to this nonadherence. The physician plans to change the client's medication. Which agent would the nurse anticipate that the physician would prescribe? - SOLUTION Aripiprazole While interviewing a client diagnosed with a delusional disorder, the client states, I have this really strange odor coming out of my mouth. I stop to brush my teeth almost every hour and then rinse with mouthwash every half hour to get rid of this smell. I've seen so many doctors, and they can't tell me what's wrong. The nurse interprets the client's statement as reflecting which type of delusion? - SOLUTION Somatic A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would the nurse expect to most likely administer? - SOLUTION Haloperidol lactate (Haldol) A client asks the nurse if he needs to alter any of his activities because he is taking lithium carbonate. Which of the following responses would be most appropriate? - SOLUTION Increase your salt intake if an activity causes you to perspire heavily. The nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, I'm just so beautiful. Everyone just stops and stares at how gorgeous I am. Men constantly want to have sex with me. The nurse interprets these statements as indicative of which type of mood? - SOLUTION Expansive The nurse is reviewing the medical record of a client with bipolar disorder. The nurse would most likely expect to find a history of which of the following? - SOLUTION Panic disorder A nurse is developing a presentation for families who have members that have been diagnosed with bipolar disorders. When describing this condition to the group, which of the following would the nurse most likely include? - SOLUTION The risk for suicide is high with either depression or mania. A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the clients medication history, which agents would alert the nurse to the possibility that a decrease in lithium dosage may be needed? - SOLUTION Lisinopril, hydrochlorothiazide, indomethacin A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the clients blood level for this drug, which level would alert the nurse to the need to change the dosage? - SOLUTION 30 ng/mL A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After teaching the client about this medication, the nurse determines that the teaching was successful when the client states which of the following? - SOLUTION I need to notify my physician if I develop a skin rash. A nurse is preparing to administer medications to a female client with bipolar disorder who is experiencing acute mania. Which of the following would be most appropriate for the nurse to do? - SOLUTION Allow the client to participate in the treatment decision. A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate? - SOLUTION Assist the client in minimizing exposure to stressors. A clients blood level of carbamazepine is increased. When reviewing the clients medication history, which of the following would alert the nurse to a possible interaction? - SOLUTION Diltiazem would be most appropriat - SOLUTION Tell the client this is an acute exacerbation with a positive prognosis and low morbidity. A nurse determines that a client who is experiencing anxiety is using relief behaviors. The nurse determines that the client is experiencing which degree of anxiety? - SOLUTION Severe A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they state which of the following? - SOLUTION Women experience anxiety disorders more often than do men. While interviewing a client, the client reports an intense fear of spiders, stating, I cant be near them. I get so upset. I start to sweat and hyperventilate if I see one. The nurse documents this finding as which of the following? - SOLUTION Arachnophobia After teaching a class about the biochemical theories associated with panic disorder, the instructor determines a need for additional teaching when the students identify which neurotransmitter as being implicated? - SOLUTION Dopamine A nurse is preparing an in-service presentation about panic disorders and associated theories related to the cause. When describing the cognitivebehavioral concepts associated with panic disorders, which of the following would the nurse expect to address? - SOLUTION Conditioned response A nurse is developing the plan of care for a client with panic disorder that will include pharmacologic therapy. Which of the following would the nurse most likely expect to administer? - SOLUTION Selective serotonin reuptake inhibitor (SSRI) A client with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, I stopped taking the alprazolam about 2 days ago. I was feeling really sleepy and tired. Which of the following would alert the nurse to suspect possible withdrawal? - SOLUTION Metallic taste, irritability, tremor A client with obsessive-compulsive disorder (OCD) is using cue cards to help restructure thought patterns. Which statements would be appropriate to include on a cue card? - SOLUTION These are the OCD thoughts, trust myself, I did it right the first time A client is diagnosed with obsessive-compulsive disorder (OCD) and is to receive medication therapy. Which of the following agents might the nurse expect to be prescribed? - SOLUTION Clomipramine, sertraline, fluvoxamine, paroxetine A woman diagnosed with obsessive-compulsive disorder comes to the clinic with her husband. During the visit, the husband states, She's always checking and rechecking to make sure that all of the appliances are turned off before we go out. It's nerve-wracking. We can never get out of the house on time. Isn't checking once enough? An understanding of which of the following would the nurse need to incorporate into the response? - SOLUTION The client performs the ritual to relieve anxiety temporarily. A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which of the following as representing the psychoanalytic theory for this disorder? - SOLUTION Unresolved unconscious conflicts A nurse is developing a teaching plan for a client with generalized anxiety disorder, focusing on nutrition. Which of the following would the nurse encourage the client to avoid? - SOLUTION Coffee and ginseng The nurse is assessing a client with posttraumatic stress disorder (PTSD). Which of the following would the nurse categorize as reflecting intrusion? - SOLUTION Flashbacks and short-term memory deficits A group of students is reviewing information about social phobia in preparation for an oral class presentation on this topic. Which of the following would the students expect to include when describing a person with this condition? - SOLUTION Fear that others will judge them negatively, demonstrate a distorted view of their own strengths, and exaggerate personal flaws A group of students is reviewing the signs and symptoms associated with anxiety. The students demonstrate an understanding of the information when they identify which of the 24. following as cognitive symptoms? - SOLUTION Feelings of unreality, difficulty concentrating, and tunnel vision A client is diagnosed with generalized anxiety disorder and is prescribed medication therapy. Which agent would the nurse expect to administer to the client to obtain the quickest relief from anxiety symptoms? - SOLUTION Alprazolam When planning care for a female patient diagnosed with obsessive and compulsive behavior, Nurse Barbara and case manager Marc must recognize that the ritual: - SOLUTION Helps the patient to be in control of their anxiety. A patient is frequently late for appointments because he goes back to his room numerous times to assure himself that none of his belongings have been stolen. What does this behavior represent? - SOLUTION Obsessive-compulsive A 14-year-old survivor of a school shooting screams and dives under a table when firecrackers go off. What does this behavior represent? - SOLUTION Post-traumatic stress disorder The nurse is working with the family of a patient with obsessive-compulsive disorder (OCD). Which concept should the nurse incorporate in the teaching plan? - SOLUTION The thoughts, images, and impulses tend to worsen with stress. The nurse has identified a nursing diagnosis of disturbed thought processes for a patient with obsessive-compulsive disorder. What abilities displayed by the patient would be related to an appropriate outcome for this problem? - SOLUTION Can identify when obsessions are worsening, describes lessening anxiety when compulsive rituals are interrupted, and limits time focusing on obsessive thoughts to 15 minutes, 4 times a day the nurses suspicions? - SOLUTION I have a very important position in life; everyone I know wants to be like me. A nurse is developing a teaching plan for a client with an impulse-control disorder. The nurse is planning to explain the emotional aspects associated with the behavior as part of the plan. Which of the following would the nurse describe as occurring first before the individual commits the act? - SOLUTION Tension A nurse is reading an article about a young girl who developed gastrointestinal symptoms from a hair ball because of a ritual that she engaged in. The girl would pull out hair over several hours to relieve tension and anxiety and then eat the hair. The nurse most likely is reading an article about which of the following? - SOLUTION Trichotillomania A nurse is working with a client who is a compulsive gambler. Which of the following would the nurse emphasize as crucial for relapse prevention? - SOLUTION Family involvement and identification of triggers A nursing instructor is describing depressive and negativistic personality traits to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as characteristic of negativistic personality traits? - SOLUTION Hostility, oppositionality, guilt The nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior? - SOLUTION I have felt so down lately. I don't enjoy doing anything anymore. A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The client's sister is visiting, and the sister asks the nurse to explain why her sister sometimes does this to herself. Which response by the nurse would be most appropriate? - SOLUTION Sometimes the self-injurious behavior is undertaken to relieve stress. The nurse has explained some of the biologic theories of causation to a client diagnosed with borderline personality disorder and his family. The nurse determines that the client and family have understood the instructions when they state which of the following? - SOLUTION A frontal lobe dysfunction may be causing this condition. The nurse is assessing a client who has borderline personality disorder. Which of the following would be a priority? - SOLUTION Nutrition patterns A client diagnosed with borderline personality disorder tells the nurse that she frequently spaces out. Which response by the nurse would be most appropriate? - SOLUTION What's happening around you when this occurs? The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when he states which of the following? - SOLUTION I should start by stating my feelings as an I statement. A client with borderline personality disorder tells the nurse, I'm afraid to get on a train because well probably get into a wreck. Which response by the nurse would be most appropriate? - SOLUTION What are the chances of that actually happening? A nursing instructor is preparing a class discussion on personality disorders and characteristics. Which term would the instructor include to differentiate personality disorders from normal personality? - SOLUTION Inflexible, pervasive, unstable over time, and distressing A group of nursing students is reviewing possible risk factors for development of borderline personality disorder. The students demonstrate understanding of the information when they identify which of the following as a risk factor? - SOLUTION Childhood sexual abuse and parental loss A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which of the following would the nurse most likely note? - SOLUTION Participating in relationships in which the client has control A nurse is assessing a client with borderline personality disorder. Which question would be most appropriate to assess the client's level of impulsivity? - SOLUTION Have you ever felt sorry after acting as you did on the spur of the moment? As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills? - SOLUTION Self-management skills A client with borderline personality disorder has difficulty maintaining boundaries of the professional relationship. Which of the following would be most effective for the nurse to do? - SOLUTION Respond to the clients arrogance in a neutral, nonconfrontational manner. Discuss the purpose of the limits in the therapeutic relationship. State the parameters of the limits and boundaries clearly. Ensure that any established limits are maintained consistently. A nurse is engaged in role-playing with a client with borderline personality disorder to assist the client in learning how to communicate effectively. Which of the following would the nurse encourage the client to use? - SOLUTION Validating perceptions with others, paraphrasing before responding, compromising A nurse is assisting a client with borderline personality disorder in how to manage transient psychotic episodes that involve auditory hallucinations. The teaching is planned for times when the client is free of these symptoms. Which of the following would the nurse instruct the client to do first? - SOLUTION Practice deep abdominal breathing. The nurse is discussing the differences between a patient with a neurosis and one with a psychosis. What is true of the patient experiencing a neurosis? - SOLUTION The patient has insight that there is an emotional problem. When the patient with a psychosis is thought to be a danger to self or others, by what method should the patient be admitted to the hospital? - SOLUTION Probating When a patient demonstrates accelerated heart rate, trembling, choking, and chest pain along with acute, intense, and overwhelming anxiety, the nurse should recognize that the patient is most likely experiencing what condition? - SOLUTION Panic When a patient is experiencing a panic attack, how should the nurse best assist the patient? - SOLUTION Coach in deep breathing A patient is frequently late for appointments because he goes back to his room numerous times to assure himself that none of his belongings have been stolen. What does this behavior represent? - SOLUTION Obsessive-compulsive A 14-year-old survivor of a school shooting screams and dives under a table when firecrackers go off. What does this behavior represent? - SOLUTION Post-traumatic stress disorder What should the nurse preparing a patient for a scheduled appointment for electroconvulsive therapy (ECT) remind the patient to do? - SOLUTION Arrange for transportation to and from the appointment. The nurse is told that a patient believes he was born into the wrong body. What is the correct terminology for the desire to have the body of the opposite sex? - SOLUTION Transsexualism The patient complains of recurrent, multiple physical ailments for which there is no organic cause. How should the nurse assess this? - SOLUTION Somatoform disorder What disorder is a severe form of self-starvation that can lead to death? - SOLUTION Anorexia nervosa The patient is concerned about confidentiality and asks the nurse not to tell anyone what is said. What is the best response by the nurse? - SOLUTION I am required to report any intent to hurt yourself or others. What is the term for a long-term and intense form of psychotherapy developed by Sigmund Freud that allows a patients unconscious thoughts to be brought to the surface? - SOLUTION Psychoanalysis What is the typical schedule for electroconvulsive therapy (ECT)? - SOLUTION 10 treatments over several weeks A patient who is taking a monoamine oxidase inhibitor (MAOI) asks the nurse about the addition of St. Johns wort to help with his depression. What would be the best response of the nurse? - SOLUTION Did you know that St. Johns wort can raise your blood pressure dramatically? Adjunctive therapies are used for which reasons? - SOLUTION To increase self-esteem, promote positive interaction, and enhance reality orientation What are considered warning signs of suicide? - SOLUTION Talking about suicide, drug or alcohol abuse, difficulty concentrating on work or school, and personality changes The nurse recognizes that a woman who has experienced physical abuse and has inadequate income to care for herself and her family would be categorized under Axis ____. - SOLUTION four The nurse instructs a patient who has just been prescribed a protocol of fluoxetine HCl (Prozac) that the drug takes ____ to ____ weeks to take effect. - SOLUTION Two, four The nurse explains that an alternative therapy that uses essential oils and scented candles to help a patient relax and focuses on the atmosphere of the moment is ______________. - SOLUTION Aromatherapy