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Tom reports a history of carpal tunnel syndrome. What else would you expect to find in his history?
- A. Crepitus (grating feeling on palpation over joint during range of motion) due to loss of articular cartilage and bony overgrowth in joint.
- B. Excessive forward curvature of the thoracic spine (kyphosis) due to pathologic vertebral fractures and collapsing of the anterior portion of the vertebral bodies in the thoracic area.
- C. Pain and numbness or tingling sensation in the hand over the palmar surface of the thumb, index, and middle fingers, and lateral aspect of the ring finger, that is worse at night.
- D. Acute onset of excruciating pain in joint due to accumulation of uric acid within the joint.
Correct Answer: C
Rationale: Carpal tunnel syndrome affects the median nerve, causing pain and numbness in specific areas.
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A healthcare professional is assessing a client who has a fracture of the femur. Vital signs are obtained on admission and again in 2 hours. Which of the following changes in assessment should indicate to the healthcare professional that the client could be developing a serious complication?
- A. Increased respiratory rate from 18 to 44/min
- B. Increased oral temperature from 36.6° C (97.8° F) to 37° C (98.6° F)
- C. Increased blood pressure from 112/68 to 120/72 mm Hg
- D. Increased heart rate from 68 to 72/min
Correct Answer: A
Rationale: Step 1: Increased respiratory rate from 18 to 44/min indicates potential respiratory distress, a serious complication post-fracture.
Step 2: Rapid breathing can signify hypoxemia, pulmonary embolism, or infection, requiring immediate intervention.
Step 3: Increased oral temperature and blood pressure within normal range are not as critical as respiratory distress.
Step 4: A slight increase in heart rate is common after a fracture and not indicative of a serious complication.
How should the nurse respond to Mrs. West’s statement, “Oh well, I have already lived my life anyway.”
- A. “Oh, you have nothing to worry about Mrs. West. We’re going to take good care of you.”
- B. “You feel that your life is ending, Mrs. West? Can you tell me more about your feelings?”
- C. “Your doctor is one of the best and our surgical staff is excellent.”
- D. “The x-rays indicate that your tumor is accessible and the surgery will cure your problem.”
Correct Answer: B
Rationale: Encouraging the patient to express feelings fosters trust and understanding.
A patient who has been taking ibuprofen (Motrin) and imipramine (Tofranil) for control of cancer pain is having increased pain. What would the health care provider recommend as an appropriate change in the medication plan?
- A. Add PO oxycodone (Oxycontin) to the other medications
- B. Substitute PO propoxyphene (Darvon), a mild opioid, for imipramine
- C. Add transdermal fentanyl (Duragesic) to the use of the other medications
- D. Substitute PO hydrocodone with acetaminophen (Lortab, Vicodin) for the other medications
Correct Answer: C
Rationale: The correct answer is C. Adding a stronger opioid like transdermal fentanyl can address increased pain.
What information should be included as effective for preventing chronic bronchitis in a community presentation?
- A. Maintenance of ideal weight
- B. Annual influenza immunization
- C. Smoking cessation
- D. Regular moderate exercise
Correct Answer: C
Rationale: The correct answer is C: Smoking cessation. Chronic bronchitis is often caused by smoking. By quitting smoking, individuals can significantly reduce their risk of developing chronic bronchitis. This is the most effective prevention strategy.
A: Maintenance of ideal weight may have some benefits for overall health but is not directly linked to preventing chronic bronchitis.
B: Annual influenza immunization is important for preventing the flu, but it does not directly prevent chronic bronchitis.
D: Regular moderate exercise is beneficial for overall health, but it is not as directly related to preventing chronic bronchitis as smoking cessation.
Which client(s) would be best to assign to an experienced nurse in an ambulatory eye surgery center? (Choose all that apply.)
- A. A client who needs post-operative instructions for cataract surgery.
- B. A client who needs an eye-pad and a metal shield applied.
- C. A client who needs home health referral for dressing changes and eye drops.
- D. A client who needs teaching about self-administration of eye drops.
Correct Answer: A
Rationale: Clients requiring complex post-operative instructions, such as those for cataract surgery, benefit most from the expertise of an experienced nurse.