Nokea
With the assistance of the translator, the nurse correctly instructs the client to use which technique when picking something up?
- A. Squat with the knees bent.
- B. Keep both feet together.
- C. Lift with the arms extended.
- D. Bend from the waist.
Correct Answer: A
Rationale: Squatting with knees bent uses leg muscles to lift, reducing spinal strain and protecting the surgical site post-laminectomy. Bending from the waist or other techniques risks reinjury.
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The client has been diagnosed with OA for the last seven (7) years and has tried multiple medical treatments and alternative treatments but still has significant joint pain. Which psychosocial client problem should the nurse identify?
- A. Severe pain.
- B. Body image disturbance.
- C. Knowledge deficit.
- D. Depression.
Correct Answer: D
Rationale: Chronic OA pain often leads to depression due to persistent discomfort and functional limitations. Pain is physiological, body image is less relevant, and knowledge deficit is not indicated.
The elderly client is admitted to the hospital for severe back pain. Which data should the nurse assess first during the admission assessment?
- A. The client’s use of herbs.
- B. The client’s current pain level.
- C. The client’s sexual orientation.
- D. The client’s ability to care for self.
Correct Answer: B
Rationale: Pain level assessment is the priority in severe back pain to guide treatment. Herbs, orientation, and self-care are secondary.
The client newly diagnosed with osteoporosis is prescribed calcitonin by nasal spray. Which assessment data indicate to the nurse an adverse effect of the medication?
- A. The client complains of nausea and vomiting.
- B. The client is drinking two (2) glasses of milk a day.
- C. The client has a runny nose and nasal itching.
- D. The client has had numerous episodes of nosebleeds.
Correct Answer: C
Rationale: Runny nose and nasal itching are common adverse effects of nasal calcitonin. Nausea is less common, milk intake is unrelated, and nosebleeds are not typical.
Which nursing intervention is most appropriate for preventing a pathological fracture?
- A. Encouraging a high fluid intake
- B. Providing a nutritional diet
- C. Supporting the limb during movement
- D. Relieving pressure on bony prominences
Correct Answer: C
Rationale: Supporting the limb during movement minimizes stress on the necrotic bone, reducing the risk of a pathological fracture in osteomyelitis. Fluid, diet, and pressure relief are less directly preventive.
Which assessment finding is the best indication that the client is experiencing secondary complications from the fractured ribs?
- A. Irregular pulse rate
- B. The client's affected leg is shorter than her unaffected leg.
- C. The client's affected leg is shorter than her unaffected leg.
- D. The client's affected leg is executed leg is externally rotated.
- E. The client prefers to sit rather than lie flat.
Correct Answer: E
Rationale: Fractured ribs can cause complications like pneumothorax or hemothorax, leading to difficulty breathing when lying flat. The client's preference to sit upright suggests respiratory distress, a secondary complication. Leg findings are unrelated to rib fractures, and irregular pulse is less specific.