NUR 109 FINAL EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2024 BEST EXAM SOLUTION TOP RATED, Exams of Nursing

Download NUR 109 FINAL EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2024 BEST EXAM SOLUTION TOP RATED and more Exams Nursing in PDF only on Docsity! NUR 109 FINAL EXAM QUESTIONS AND ANSWERS LATEST UPDATE 2024 BEST EXAM SOLUTION TOP RATED A+  The nurse is teaching a patient being discharged with a long leg cast. Which of the following instructions is appropriate? a. Keep plaster casts covered until thoroughly dry. b. Apply lotion under cast edges to lubricate the skin. c. Elevate the cast above the level of the heart whenever possible. d. Put talcum powder down the cast to prevent perspiration.  Ms. R. is a 40 year old woman who underwent total hip replacement. Which of the following activities would be appropriate for Ms. R. after discharge? a. Sitting in only a low chair b. Resuming all ADLs as soon as possible c. Sitting at least 8 hours a day d. Putting a pillow between her legs when sleeping  Ms. K’s right knee appears to be swollen. To further evaluate this, the nurse should first: a. put the knee through range of motion. b. test muscle strength. c. compare it to the left knee. d. palpate for crepitus.  Ms. E. is a 78 year old woman who was admitted with an impacted right hip. She was placed in traction. When caring for a patient in traction, the nurse is guided by which principle? a. Weights should rest on the bed b. Knots in the ropes should touch the pulley c. Weights are removed routinely d. Skeletal traction is never interrupted  The nurse is assessing the patient for the presence of a Chvostek’s sign. What electrolyte imbalance does a positive Chvostek’s sign indicate? a. Hypermagnesemia b. Hypercalce mia c. Hypocalcemia d. Hyperkalemia The next 9 question will show your ability to analyze ABG (arterial blood gas) results. Some questions will give preview information.  A patient has arrived at the ER complaining to tingling in her face, hands, and eet. She stated she feels “light-headed” and has been studying for NUR 109 Final Exam for 3 straight days. Assessments reveals BP 165/110, HR 124, RR 36, skin clammy and pale. ABG’s: pH = 7.49, PaCO2 = 31, HCO3 = 19 a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis d. Metabolic alkalosis  You are an ER nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH = 7.26, PaCO2 = 28, HCO3 = 11 mEq/L. How would you interpret these results? a. Respiratory acidosis with no compensation b. Metabolic alkalosis with a compensatory alkalosis c. Metabolic acidosis with no compensation d. Metabolic acidosis with a compensatory alkalosis  A patient in the ICU starts complaining of being “short of breath.” An arterial blood gas (ABG) is drawn. The ABG has the following c. Platelet count d. Electrolytes  Your are teaching a nutrition class in the local high school. One student tells you that he has heard that certain foods can increase the incidence of cancer. You respond, "Research has shown that certain foods appear to increase the risk of cancer." Which of the following menu selections would be the best choice for reducing the risks of cancer? a. Smoked salmon and green beans b. Pork chops and fired green tomatoes c. Baked apricot chicken and steamed broccoli d. Liver, onions, and steamed peas  Traditionally, nurses have been involved with tertiary prevention with their cancer patients. However, emphasis is also placed on both primary and secondary prevention. What would be an example of primary prevention? a. Yearly Papanicolaou tests b. Testicular self-examination c. Teaching patients to wear sunscreen d. Screening mammogram  While a patient is receiving intravenous doxorubicin, the nurse observes that there is swelling and pain at the IV site. The nurse should: a. stop the administration of the drug immediately. b. notify the patient's physician. c. continue to administer but decrease the rate of infusion. d. apply a warm compress to the site.  A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment. The patient asks the nurse what the most common side effect of chemotherapy is. What would be the best answer the nurse could give? a. Alopecia b. Nausea and vomiting c. Altered glucose metabolism d. Increased appetite  Your patient is receiving carmustine, a chemotherapy agent. A significant side effect of this medication is thrombocytopenia. Which symptom would the nurse assess for in patients at risk for thrombocytopenia? a. Interrupted sleep pattern b. Hot flashes c. Nose bleed d. Increased weight  When a client is immobilized, what is the most appropriate plan to prevent constipation? a. Encourage daily laxative use b. Limit fluid intake c. Encourage frequent periods of sitting on the bedpan d. Increase fluids and fiber in the client’s diet  The nurse is caring for a patient who has had a plaster leg cast applied. Immediately post-application, the nurse should inform the patient that: a. the cast will cool in 5 minutes. b. the cast should be covered with a towel. c. the cast should be supported on a board while drying. d. the cast will only have full strength when dry.  A female patient states that she has pain and numbness to her thumb, first, and second finger of her right hand. The nurse discovers that the patient’s occupation is an auto mechanic, and the pain is increased at work. This may indicate that the patient could possibly have: a. Carpel tunnel syndrome b. Tendonitis c. Impingement syndrome d. Dupuytren’s contracture  Which of the following nursing actions demonstrates proper technique when caring for a patient with skeletal traction for a fractured femur? a. Lift weights when sliding patient up in bed b. Rest both feet against a footboard c. Remove weight immediately if patient complains of muscle spasms d. Be certain weights and ropes hang freely  Which of the following exercises would be contraindicated for a patient who has recently been discharged following a total hip replacement? a. Abduction exercises b. Deep- knee bends c. Gluteal setting d. Quadriceps setting  The nurse is teaching a patient and family signs of compromised circulation to a casted arm. The patient should be instructed to report? a. Discoloration of the fingers b. Foul odor from the cast c. Severe itching under the cast d. Bounding radial pulse in the affected arm  A nurse is teaching Mrs. P. about appropriate and safe position changes after her total hip replacement. Which of the following statements indicates that Mrs. P. understands proper positioning? a. “I’ll avoid sitting straight up in bed.” b. “I’ll turn my leg slightly inward when I am in bed or in a chair.” c. “I’ll cross my legs when I sit in the chair.” d. “I’ll bend forward to put on my shoes and socks.”  The nurse is evaluating patient teaching while caring for a client who has undergone total hip replacement. Which of the following highest risk of acquiring HIV for an HIV-infected patient is: a. a patient who spits in the nurse's face. b. contamination of open skin lesions with vaginal secretions. c. a needlestick with a needle and syringe used to draw blood. .. 3d30 03. 333333333333333333333333333203..0 32300000000000000220..312000202300000000000020022100000000 000000000000000+00000000000000000000000000000000002221232 0000000000000000 splashing the eyes when emptying a bedpan containing stool.  Drug therapy is being considered for and HIV-infected patient who has a CD4+ cell count of 400. The nursing assessment that is most important in determining whether therapy will be used is the patient's: a. social support system offered by significant others and family. b. socioeconomic status and availability of medical insurance. c. understanding of the multiple side effects that the drugs may cause. d. willingness and ability to comply with stringent medication schedules.  While teaching community groups about AIDS, the nurse informs people that the most common method of transmission of the HIV virus currently is: a. perinatal transmission of the fetus. b. sharing equipment to inject illegal drugs. c. blood transfusions. d. sexual contact with an infected partner.  A 24-year old woman who uses IV illegal drugs asks the nurse about preventing AIDS. The nurse informs the patient that the best way to reduce the risk of HIV infection from drug use is: a. participate in a needle-exchange program. b. clean drug injection equipment before use. c. ask those who share equipment to be tested for HIV. d. avoid sexual intercourse when using IV drugs.  At the health promotion level of care HIV infection, which question is most appropriate for the nurse to ask? a. "Are you having any symptoms such as severe weight loss or confusion?" b. "Are you experiencing any side effects from the antiretroviral medication?" c. "Do you need any assistance to obtain drugs or treatments?" d. "Do you use any IV drugs or have multiple sexual partners?"  A patient with HIV infection has developed Mycobacterium avium complex infection with diarrhea. An appropriate outcome for the patient is that the patient will: a. be free from injury. b. maintain intact perineal skin. c. have adequate oxygenation. d. receive immunizations.  When designing a program to decrease the incidence of HIV infection in the community, the nurse will prioritize education about: a. how to prevent transmission between sexual partners. b. methods to prevent perinatal HIV transmission. c. ways to sterilize needles used by IV drug users. d. means to prevent transmission through blood transfusions.  When assessing a patient for breast cancer risk, the nurse considers that the patient has a significant family history of breast cancer if she has a: a. cousin who was diagnosed with breast cancer at age 38 b. mother who was diagnosed with breast cancer at age 42 c. sister who died from ovarian cancer at age 56 d. grandmother who died from breast cancer at age 72  Select all that apply. A healthy 2 month old whose immunizations are up to date is attending the well child clinic for a check-up. The nurse anticipates that this infant may receive several vaccinations including: a. HiB(Haemophilus influenze type b conjugate vaccine) b. DTaP (Diptheria and tetanus toxoids and acellular pertussis vaccine) c. MMR (Measles, mumps, and rubella vaccine) d. Influenza vaccine e. IPV (Inactivated polio vaccine)  Strict isolation is required for a child who is hospitalized with: a. mumps. b. chickenpox. c. exanthema subitum (roseola). d. erythema infectiosum (fifth disease).  Which of the following clinical manifestations should the nurse expect when a child with sickle cell anemia experiences an acute vaso-occlusive crisis? a. Circulatory collapse b. Cardiomegaly, systolic murmurs c. Hepatomegaly, intrahepatic cholestasis d. Painful swelling of hands and feet; painful joints  A school-age child is admitted in vaso-occlusive sickle cell crisis. The child’s care should include which of the following? a. Correction of acidosis b. Adequate hydration and pain management c. Pain management and administration of heparin d. Adequate oxygenation and replacement of factor VIII  Which of the following statements best describes β-thalassemia major (Cooley anemia)? a. All formed elements of the blood are depressed. b. Inadequate numbers of red blood cells are present. c. Increased incidence occurs in families of Mediterranean extraction. d. Increased incidence occurs in persons of West African descent.  In which of the following conditions are all the formed elements of the blood simultaneously depressed? a. Femur b. Humerus c. Pelvis d. Tibia  Which statement by a 32-year-old patient newly diagnosed with stage I breast cancer indicates to the nurse that the goals of therapy are being met? a. “I am not sure how my husband will react when I tell him about this cancer.” b. “I am ready to die if that is God’s plan for me.” c. “I need to know all the options before making a decision about treatment.” d. “I will do whatever the doctor thinks is best.”  An abnormal finding noted during physical assessment of the female reproductive system is: a. watery cervical mucus b. dark pink color c. triangular hair distribution d. dimpling of breast  The nurse is caring for a patient diagnosed with breast cancer who just underwent an axillary lymph node dissection. Which of the following nursing interventions would the nurse plan to prevent lymphedema? a. Apply an elastic bandage on the affected arm. b. Keep affected arm flat at the patient’s side. c. Assess blood pressure on unaffected arm only d. Restrict exercise of the affected arm for 1 week  A patient who has undergone a vaginal hysterectomy has not voided for 8 hours following surgery and is complaining of bladder distention. The most appropriate action by the nurse is to: a. insert a straight catheter per the PRN order b. increase the patient’s oral fluid intake to 200 ml/hr. c. notify the health care provider of the patient’s inability to void d. ambulate the patient short distances every hour  The health care provider orders blood test for prostate-specific antigen (PSA) when an enlarged prostate is palpated during a routine examination of a 56-year- old man. When the patient asks the nurse the purpose of the test, the nurse’s response is based on the knowledge that: a. elevated levels of PSA are indicative of metastatic cancer of the prostate b. PSA testing is the “gold standard” for making a diagnosis of prostate cancer c. baseline PSA levels are necessary to determine whether treatment is effective d. PSA levels are usually elevated in patients with cancer of the prostate  A 22-year-old man tells the nurse at the health clinic that he has recently become unable to achieve an erection. When assessing for possible etiologic factors, which question should the nurse ask first? a. “Have you been experiencing an unusual amount of stress?” b. “Do you have any history of an erection that lasted for 6 hours or more?” c. “Are you using any recreational drugs or drinking a lot of alcohol?” d. “Do you have any chronic diseases, such as diabetes mellitus?”  The nurse working in a health clinic receives calls from all these patients. Which patient should be seen by the doctor first? a. A 23-year-old man who states he had difficulty maintaining an erection last night. b. A 44-year-old man who has perineal pain and a temperature of 100.4º F. c. A 62-year-old man who has light pink urine after having a TURP 3 days ago d. A 66-year-old man who has a painful erection that has lasted over 9 hours.  A patient with gonorrhea is treated with a single IM dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100 mg bid for 7 days. The nurse explains to the patient that this combination of antibiotics is prescribed to a. prevent reinfection during treatment. b. treat any coexisting chlamydial infection. c. eradicate resistant strains of N. gonorrhoeae. d. prevent the development of resistant organisms.  A Gram stain smear of a patient’s urethral discharge reveals the presence of Neisseria gonorrhoeae. The patient tells the nurse about recent sexual contact with a woman but says she did not appear to have any disease. In responding to the patient, the nurse explains that a. many women are not aware they have gonorrhea because they often do not have symptoms of infection. b. when gonorrhea infections occur in women, the disease affects only the ovaries and not the genital organs. c. women develop subclinical cases of gonorrhea that do not cause tissue damage or clinical manifestations. d. women do not develop gonorrhea infections but can serve as carriers to spread the disease to males.  A patient with positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT- ABs) tests has a rash on the palms and the soles of the feet and moist papules in the anal and vulvar area. While caring for the patient, it is important for the nurse to a. wear gloves when touching the patient. b. apply antibiotic ointments to the perineum. c. place the patient in a private room. d. monitor the heart sounds for new murmurs. c. Scar d. Erosion  A nurse is caring for a patient during the acute phase of the burn. The nurse knows he is responsible for what? a. Restricting visitors to prevent infection. b. Closely scrutinizing the burn wound to detect early signs of infection. c. Cleaning the patient’s room. d. Maintaining the patient in a sterile environment.  A patient diagnosed with basal cell carcinoma asks the nurse how he got cancer. The nurse tells the patient that the most common cause of basal cell carcinoma is what? a. Immunosuppression b. Radiation exposure c. Sun exposure d. Burns  A patient is brought to the Emergency Department from the site of a chemical fire. The paramedics report that the patient has a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. When you assess the patient he verbalizes no pain in the right arm and the skin appears charred. Based upon these assessment findings, what is the depth of the burn on the patient’s right arm? a. Superficial partial-thickness b. Deep partial-thickness c. Full partial- thickness d. Full- thickness  A patient in the emergent/resuscitative phase of a burn injury has had her lab work drawn. Upon analysis of the patient’s laboratory studies, the nurse will expect the results to indicate what? a. Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis b. Hypokalemia, hypernatremia, decreasd hematocrit, and metabolic acidosis c. Hyperkalemia, hypernatremia, decreased hematocrit, and metabolic alkalosis d. Hypokalemia, hyponatremia, elevated hematocrit, and metabolic alkalosis  The occupational health nurse is called to the floor of the factory where a patient has sustained a flash burn to the right arm. The nurse arrives and the flames have been extinguished. The next step is to “cool the burn.” How will the nurse cool the burn? a. Apply ice to the site of the burn for 5 to 10 minutes. b. Wrap the patient’s affected extremity in ice until help arrives. c. Apply an oil-based substance or butter to the burned area until help arrives. d. Wrap cool towels around the affected extremity intermittently.  The emergency department nurse has just admitted a patient with a burn. The nurse recognizes that the patient is likely to experience a local and systemic response to the burn when the burn exceeds a total body surface area (TBSA) of what? a. 10% b. 15% c. 20% d. 25%  The nurse is preparing the patient for mechanical debridement and informs the patient that this will involve: a. a spontaneous separation of dead tissue fron the viable tissue. b. use of surgical scissors, scalpels or forceps to remove the eschar until the point of pain and bleeding occurs. c. shaving of burned skin layers until bleeding and viable tissue is revealed. d. early closure of the wound.  When admitting a patient who has sustained a burn injury over 40% of her body, which of the following nursing diagnoses would receive priority during the first 1- 2 days of treatment? a. Knowledge deficit b. Fluid volume deficit c. Impaired physical mobility d. Increased tissue perfusion  You are caring for a patient admitted with a diagnosis of renal failure. When you review your patient’s laboratory reports, you note that the patient’s magnesium levels are high. What would be important for you to assess? a. Diminished deep tendon reflexes b. Tachycardia c. Cool, clammy skin d. Increased serum magnesium  You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would you expect the patient to demonstrate? a. Hypertension b. Bradycardia c. Hypervole mia d. Hypovolemia  A patient with anxiety presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance? a. Respiratory acidosis b. Respiratory alkalosis c. Increased PaCO2  Isotonic IV fluids are fluids with a total osmolality close to that of the ECF. Most IV fluids contain either dextrose or electrolytes in water. When would you infuse electrolyte-free water intravenously? a. Never, it rapidly enters red blood cells, causing them to rupture. b. When the patient is severely dehydrated. c. When the patient is in an excess of an electrolyte, i.e. hypercalcemia d. When the patient is in a deficit of an electrolyte, i.e. hypocalcemia  You are doing discharge teaching with a patient who is going home with a diagnosis of hypophosphatemia. The patient has a diet ordered that is high is phosphate. What foods would you teach this patient to include in his diet? (Mark all that apply.) a. Milk b. Beef c. Poultry d. Green vegetables e. Liver  When assessing the musculoskeletal system, the nurse’s initial action will usually be to: a. have the patient move the extremities against resistance b. feel for the presence of crepitus during joint movement c. observe the patient’s body build and muscle configuration d. check active and passive range of motion for the extremities  When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to: a. do stretching and warm-up exercises before starting work b. wrap the wrist with a compression bandage every morning c. use acetaminophen (Tylenol) instead of NSAIDs for wrist pain d. obtain a keyboard pad to support the wrist  Following a motor-vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. Which action will the nurse take first? a. elevate the leg on pillows b. apply a compression bandage c. place ice packs on the lower leg d. check leg pulses and sensation  A patient with comminuted fractures of the tibia and fibula is treated with open reduction and application of an external fixator. The next day, the patient complains of severe pain in the leg, which is unrelieved by ordered analgesics. The patient’s toes are pink, but the patient complains of numbness and tingling. The most appropriate action by the nurse is to: a. notify the patient’s health care provider b. check the patient’s blood pressure c. assess the external fixator pins for redness or drainage d. elevate the extremity and apply ice over the wound site  An assessment finding that alerts the nurse to the presence of osteoporosis in middle-aged patient is: a. the presence of bowed legs b. measurable loss of height c. an aversion to dairy products d. statements about frequent falls  A 58-year-old woman who has been menopausal for 5 years is diagnosed with osteoporosis following densitometry testing. The woman has been concerned about her risk for osteoporosis because her mother has the condition. In teaching the woman about her osteoporosis, the nurse explains that: a. with a family history of osteoporosis, there is no way to prevent or slow gradual bone resorption b. estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis c. even with a family history of osteoporosis the calcium loss from bones can be slowed by increased calcium intake and exercise. d. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis  A patient with an acute exacerbation of rheumatoid arthritis (RA) has localized pain and inflammation of the fingers, wrist, and feet with swelling, redness, and limited movement of the joints. When developing the plan of care, the nurse recognizes that the most appropriate patient outcome at this time is to: a. maintain a positive self-image b. perform activities of daily living independently c. achieve satisfactory control of pain d. make a successful adjustment to disease progression  A client is diagnosed with osteoporosis. Which statements should a nurse include when teaching the client about the disease? Select all that apply. 1. It’s common in females after menopause. 2. It’s a degenerative disease characterized by decreased bone density. 3. It’s a congenital disease caused by poor dietary intake of milk products. 4. It can cause pain and injury. 5. Passive range-of-motion (ROM) exercises can promote bone growth. 6. Weight-bearing exercise should be avoided. a. 1,3,5 b. 1,2,5 c. 2,4,6 d. 1,2,4 e. All of the above  The nurse notes that the patient has developed a hematoma at the knee replacement surgical site with a decreased pedal pulse of the same leg. The most appropriate nursing diagnosis for this patient is: a. risk of infection. b. risk of peripheral neurovascular dysfunction. c. pain. d. self-esteem disturbance.  A patient’s lab results show a slight decrease in potassium. The physician has declined to treat with drug therapy but has suggested increasing potassium through diet. Which of the following would be a good source of potassium? a. Apples b. Asparagus c. Carrots  The nurse caring for a patient receiving a transfusion notes that 15 minutes after the infusion of packed red blood cells (RBCs) has begun, the patient is having difficulty breathing and chest tightness. What is the most appropriate initial action for the nurse to take? a. Notify the patient's physician. b. Stop the transfusion immediately. c. Remove the patient's intravenous access. d. Assess the patient's chest sounds and vital signs.  A patient with advanced leukemia is responding poorly to treatment. You find the patient tearful and trying to express his feelings, but he is having difficulty. What would be your first nursing action? a. Tell him that you will leave for now but you will be back. b. Offer to call pastoral care. c. Ask if he would like you to sit with him while he collects his thoughts. d. Tell him that you can understand how he's feeling.  The nurse is providing education to a patient with iron deficiency anemia who has been prescribed iron supplements. What will the nurse include in her teaching? a. Take the iron with diary products to enhance absorption. b. Increase the intake of vitamin E to enhance absorption. c. Iron will cause the stools to darken in color. d. Limit foods high in fiber due to the risk for diarrhea.  A nursing student is caring for a patient with acute myeloid leukemia who is preparing to undergo induction therapy. In preparing a plan of care for this patient, the student should assign the highest priority to which nursing diagnosis? a. Activity intolerance b. Risk for infection c. Disturbed processes d. Risk for spiritual distress  A patient comes to the clinic complaining of fatigue and pica. Laboratory findings reveal a low serum iron level and low ferritin level. What would the nurse suspect that the patient will be diagnosed with? a. Iron deficiency anemia b. Pernicious anemia c. Sickle cell anemia d. Hemolytic anemia  The nurse is assessing a patient who was diagnosed with metastatic prostate cancer. The nurse notes that the patient is exhibiting sighs of loss, grief, and intense sadness. Based upon this assessment data, the nurse will document that the patient is in what stage of death and dying? a. Depression b. Denial c. Anger d. Acceptance  Your patient has just been told that her illness is terminal. The patient states, "I can't believe I am going to die. Why me?" What is your best response? a. "I know how you are feeling." b. "You have lived a long life." c. "This must be very difficult for you." d. "Life can be so unfair."  Ethical issues have been raised within hospitals regarding patient care. Ethical committees have been formed to address these numerous ethical issues. As health care professionals, nurses are often members of these ethical committees. What issue has raised the most troubling ethical issues? a. The increase in cultural diversity. b. Staffing shortages in health care and questions concerning quality of care. c. The increased cost of health care. d. The ability of technology to prolong life beyond meaningful quality of life.  The spread of cancer cell as a result of angiogenesis can be described as: a. mechanical invasion of the primary tumor into the surrounding area. b. spread of malignant cells via the lymphatics. c. tumor cells in a body cavity that seed the surfaces of adjacent organs. d. malignant cells that induce growth of new capillaries from host tissue and then travel to distant sites via this vascular network.  An expected outcome of chest tube insertion is that: a. mild chest pain is maintained b. breath sounds are auscultated in all lobes c. drainage from the pleural cavity increases over time d. lung expansion is increased beyond the unaffected side  Within the first 2 days after central venous line insertion, the nurse is alert to the possibility of a pneumothorax. The nurse observes the client for: a. dizziness and restlessness b. shortness of breath and chest pain c. malaise, elevated white count d. decreased level of consciousness and chills  The nurse can best prevent the complication of air embolus in a patient with a central venous access device by: a. clamping the central line anytime the line is opened to air b. flushing the line with 100 units/ml Heparin flush after each use c. using a volume control device for all infusions d. ensuring that the transparent central line dressing is dry and intact  A nurse, while checking a client’s record, determines that intraspinal analgesia is contraindicated as a result of: a. the postoperative state b. elevated prothrombine times c. a history of hypertention d. a diagnosis of advanced cancer  When locking an IV catheter with Heparin or Saline, reflux of blood into the catheter will occur unless: a. positive pressure is maintained on the syringe plunger while A. Healing is usually delayed in this type of fracture. B. Bone growth can be affected with this type of fracture. C. This is an unusual fracture site in young children. D. This type of fracture is inconsistent with a fall.  Immobilization causes which of the following effects on metabolism? A. Hypocalcemia B. Decreased metabolic rate C. Positive nitrogen balance D. Increased production of stress hormones  A young girl has just injured her ankle at school. In addition to calling the child’s parents, the most appropriate, first action by the school nurse is which of the following? A. Apply ice and elevate the extremity. B. Observe for edema and discoloration. C. Splint and wrap the extremity with an ace bandage. D. Obtain parental permission for administration of acetaminophen or aspirin.  Which of the following terms is used to describe a type of fracture that does not fragment or produce a break in the skin? A. Simple B. Compound C. Complicated D. Comminuted  A child has just returned to the orthopedic unit after being placed in a hip spica cast. The instructions to parents for home care should include which of the A. Turn every 8 hours. B. Diapers should be avoided to reduce soiling of the cast. C. Use abduction bar between legs to aid in turning D. Specially designed car seats are indicated and required.  A four-year-old is placed in Buck extension traction for Legg-Calvé- Perthes disease. He is crying with pain as the nurse assesses that the skin of his right foot is pale with an absence of pulse. What should the nurse do first? A. Notify the practitioner of the changes noted. B. Give the child medication to relieve the pain. C. Reposition the child and notify physician. D. Chart the observations and check the extremity again in 15 minutes  Drug therapy for juvenile rheumatoid arthritis will probably include which of the following medications (Select all that apply): A. Methotrexate B. sedatives. C. corticosteroids. D. NSAIDS.  The treatment of a child with Legg-Calve-Perthes disease is aimed at preventing: A. deformity of the tibia. B. degenerative changes in the knee joint. C. muscle spasm. D. pressure on the head of the femur  In formulating teaching plans for orthopedic disorders, genetic counseling would be indicated for: A. osteogenesis imperfecta. B. congenital hip dysplasia. C. Legg-Calve-Perthes disease. D. juvenile rheumatoid arthritis  Which of the following is a progressive infantile spinal muscular atrophy and the most common paralytic form of the floppy infant syndrome? a. Kugelberg-Welander disease b. Charcot-Marie-Tooth disease c. Werdnig-Hoffmann disease d. Duchenne muscular dystrophy  The nurse is caring for an infant with developmental dysplasia of the hip. Which of the following clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb .  The nurse should not administer which immunizations to a immune- compromised 6- year old child ( such as a child on chemo-therapy)? a. IPV (Inactivated polio vaccine) b. Influenza vaccine (trivalent inactivated influenza vaccine) c. Varicella vaccine (live-attenuated varicella vaccine) d. DTaP (Diptheria and tetanus toxoids and acellular pertussis vaccine)  An 18-month-old child is seen in the clinic with AOM. Trimethoprim- sulfamethoxazole (Bactrim) is prescribed. Which of the following statements made by the parent indicates a correct understanding of the instructions? a. “I should administer all of the prescribed medication.” b. “I should continue medication until the symptoms subside.” c. “I will immediately stop giving medication if I notice a change in hearing.” d. “I will stop giving medication if fever is still present in 24 hours.” .  Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by which of the following? a. Fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear