b. The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy.
While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, the nurse asks about the patient's perception of the reason for admission. The nurse expects the patient to relate which of the following respo
c. It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for sig
The nurse is caring for a patient with osteoarthritis who is about to undergo total left knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which of the following in the preoperative period?
A. Pain
B. Left
c. Great emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the first day after surgery.
The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 78-year-old patient following left total knee replacement. Which of the following would be an appropriate nursing intervention for this patie
a. The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and often the use of a continuous passive motion (CPM) machine.
The nurse is caring for a 76-year-old man who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively the nurse expects which of the following will be included in the
d. The nurse should apply a knee immobilizer for stability before assisting the patient to get out of bed. This is a standard measure to protect the knee during movement following surgery.
The nurse is caring for a 75-year-old woman who underwent left total knee arthroplasty and has a new physician order to be "up in chair today before noon." Which of the following actions would the nurse take to protect the knee joint while carrying out th
d. The patient should not cross legs, force hip into adduction, or force hip into internal rotation.
The nurse is completing discharge teaching with an 80-year-old male patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to do which of the following?
A. Avoid crossing his
b. OA is a degeneration or breakdown of the articular cartilage in synovial joints. The condition has also been referred to as degenerative joint disease.
The nurse is working with a 73-year-old patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient describes the condition as which of the following?
A. Joi
c. A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with osteoarthritis.
The nurse is assessing the recent health history of a 63-year-old patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which of the following activity patterns?
b. OA is characterized predominantly by joint pain upon movement and is a classic feature of the disease.
The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis (OA). Which of the following findings would the nurse expect to be present on examination of the patient's knees?
A. Ulnar drift
B. Pain with joint movement
C
b. Because maintaining an appropriate load on the joints is essential to the preservation of articular cartilage integrity, the patient should maintain an optimal overall body weight or lose weight if overweight.
The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to do which of the following?
A. Use a wheelchair to avoid walking as much as possible.
B.
d, e.
The nurse is reinforcing general health teaching with a 64-year-old patient with osteoarthritis (OA) of the hip. Which of the following points would the nurse include in this review of the disorder (select all that apply)?
A. OA cannot be successfully tre
b. It is important to maintain a balance between rest and activity to prevent overstressing the joints with OA.
When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which of the following statements?
A. "I should take the Celebrex as prescribed to help control t
d. AS primarily affects the axial skeleton. Based on this, symptoms of inflammatory spine pain are often the first clues to a diagnosis of AS. Knee or elbow involvement is not consistent with the typical course of AS. Back pain is likely to precede the de
Which of the following patient statements most clearly suggests a need to assess the patient for ankylosing spondylitis (AS)?
A. "My right elbow has become red and swollen over the last few days."
B. "I wake up stiff every morning and my knees just don't
c. SLE carries an increased risk of infection, sun damage, and arthritis. Surgery is not a key treatment modality for SLE.
A female patient's complex symptomatology over the past year has culminated in a diagnosis of systemic lupus erythematosus (SLE). Which of the patient's following statements demonstrates the need for further teaching about the disease?
A. "I'll try my bes
d. Flumazenil is the antidote for benzodiazepine overdose. The other options are only effective against opioid effects.
A patient is admitted to the emergency department with a severe overdose of a benzodiazepine. The nurse immediately prepares to administer which of the following antidotes from the emergency drug cart?
A. naloxone (Narcan)
B. naltrexone (ReVia)
C. nalmefe
b. Benzodiazepine doses for children and the elderly should be small with gradual increases to avoid ataxia and excessive sedation. Thus, these patients should be closely monitored for these adverse effects.
Older adults who are prescribed a benzodiazepine for treatment of insomnia need to be monitored for
A. hallucinations.
B. ataxia.
C. alertness.
D. dyspnea.
c. Sedative-hypnotics cause CNS depression, putting the patient at risk for injury.
Which nursing diagnosis is appropriate for a patient who has received a sedative-hypnotic drug?
A. Ineffective peripheral tissue perfusion
B. Fluid volume excess
C. Risk for injury
D. Risk for infection
b. There is no antidote for barbiturates. The use of activated charcoal absorbs any drug in the gastrointestinal tract, preventing absorption.
A patient is admitted to the emergency department with an overdose of a barbiturate. The nurse immediately prepares to administer which of the following from the emergency drug cart?
A. Naloxone HCl (Narcan)
B. Activated charcoal
C. Flumazenil (Romazicon)
c. Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.
During patient teaching, the nurse explains the difference between a sedative and hypnotic with which statement?
A. "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time."
B. "Sedative drugs induce sleep, where
b. Dantrolene is a direct-acting musculoskeletal muscle relaxant and is the drug of choice to treat malignant hyperthermia, a complication of generalized anesthesia.
The patient's chart notes the administration of dantrolene (Dantrium) immediately postoperatively. The nurse suspects that the patient experienced
A. delirium tremens.
B. malignant hyperthermia.
C. a tonic-clonic seizure.
D. respiratory arrest.
a, b, d. Zolpidem (Ambien) is a short-acting nonbenzodiazepine hypnotic drug. It is indicated for the short-term treatment of insomnia and should be limited to 7 to 10 days of treatment; it is pregnancy category C. Zolpidem is less likely to produce grogg
A 25-year-old female patient asks the nurse about a new drug advertised on television. The patient wants to know if Ambien would be better for her to use than her current medication, Restoril, for periodic insomnia. The nurse's response is based on knowle
b. Versed is known to cause amnesia and anxiolysis as well as sedation and is therefore commonly used prior to certain procedures.
Midazolam (Versed) has been ordered for a patient to be administered by injection 30 minutes prior to a colonoscopy. The nurse informs the patient that one of the most common side effects of this medication is which effect?
A. Decreased heart rate
B. Amne
b. About 50% of people with acute spinal cord injury experience a temporary loss of reflexes, sensation, and motor activity that is known as spinal shock. Central cord syndrome is manifested by motor and sensory loss greater in the upper extremities than
The nurse is caring for a patient admitted with a spinal cord injury following a motor vehicle accident. The patient exhibits a complete loss of motor, sensory, and reflex activity below the injury level. The nurse recognizes this condition as which of th
a. Neurogenic shock is due to the loss of vasomotor tone caused by injury and is characterized by hypotension and bradycardia. Loss of sympathetic innervation causes peripheral vasodilation, venous pooling, and a decreased cardiac output.
Which of the following clinical manifestations would the nurse interpret as representing neurogenic shock in a patient with acute spinal cord injury?
A. Bradycardia
B. Hypertension
C. Neurogenic spasticity
D. Bounding pedal pulses
d. Autonomic dysreflexia is related to reflex stimulation of the sympathetic nervous system reflected by hypertension, bradycardia, throbbing headache, and diaphoresis.
The nurse is caring for a patient admitted 1 week ago with an acute spinal cord injury. Which of the following assessment findings would alert the nurse to the presence of autonomic dysreflexia?
A. Tachycardia
B. Hypotension
C. Hot, dry skin
D. Throbbing
d. Maintaining a patent airway is the most important goal for a patient with a high cervical fracture. Although all of these are appropriate nursing diagnoses for a patient with a spinal cord injury, respiratory needs are always the highest priority. Reme
When planning care for a patient with a C5 spinal cord injury, which nursing diagnosis is the highest priority?
A. Risk for impairment of tissue integrity caused by paralysis
B. Altered patterns of urinary elimination caused by quadriplegia
C. Altered fam
c. Although all of the assessments are necessary in the care of patients with Guillain-Barr� syndrome, the acute risk of respiratory failure necessitates vigilant monitoring of the patient's respiratory status.
The nurse is providing care for a patient who has been diagnosed with Guillain-Barr� syndrome. Which of the following assessments should the nurse prioritize?
A. Pain assessment
B. Glasgow Coma Scale
C. Respiratory assessment
D. Musculoskeletal assessment
a. Among the manifestations of autonomic dysreflexia are hypertension (up to 300 mm Hg systolic) and a throbbing headache. Respiratory manifestations, decreased level of consciousness, and gastrointestinal manifestations are not characteristic.
Which of the following signs and symptoms in a patient with a T4 spinal cord injury should alert the nurse to the possibility of autonomic dysreflexia?
A. Headache and rising blood pressure
B. Irregular respirations and shortness of breath
C. Decreased le
a. Because the most common cause of autonomic dysreflexia is bladder irritation, immediate catheterization to relieve bladder distention may be necessary. The patient should be positioned upright. Benzodiazepines are contraindicated and suctioning is like
Which of the following interventions should the nurse perform in the acute care of a patient with autonomic dysreflexia?
A. Urinary catheterization
B. Administration of benzodiazepines
C. Suctioning of the patient's upper airway
D. Placement of the patien
b. Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech.
The patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. The nurse immediately assesses the patient for which of the following?
A. An aura
B. Nystagmus or confusion
C. Abdominal pain or cramping
D. Irregula
b. 100 mg � 50 mg/ml = 2
The patient has an order for phenytoin (Dilantin) 100 mg q8hr IV. Available is a phenytoin injection containing 50 mg/ml. How many milliliters of solution should the nurse draw up for the dose?
A. 0.5
B. 2
C. 5
D. 20
b. The most common complex partial seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.
Which of the following characteristics of a patient's recent seizure is congruent with a partial seizure?
A. The patient lost consciousness during the seizure.
B. The seizure involved lip smacking and repetitive movements.
C. The patient fell to the groun
a. Infection control is a priority in the care of patients with MS, since infection is the most common precipitator of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in hypotension or flui
Which of the following measures should the nurse prioritize when providing care for a patient with a diagnosis of multiple sclerosis (MS)?
A. Vigilant infection control and adherence to standard precautions
B. Careful monitoring of neurologic vital signs
c. Nutritional support is a priority in the care of individuals with PD. Such patients may benefit from meals that are smaller and more frequent than normal and that are easy to chew and swallow. Multivitamins are not necessary at each meal, and vitamin i
A male patient with a diagnosis of Parkinson's disease (PD) has been admitted recently to a long-term care facility. Which of the following actions should the health care team take in order to promote adequate nutrition for this patient?
A. Provide multiv
c. The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern.
Which of the following nursing diagnoses is likely to be a priority in the care of a patient with myasthenia gravis (MG)?
A. Acute confusion
B. Bowel incontinence
C. Activity intolerance
D. Disturbed sleep pattern
a. Risperidone is an antipsychotic drug that reduces agitation and produces a restful state in patients with delirium. However, it should be used with caution.
The nurse who has administered a dose of risperidone (Risperdal) to a patient with delirium assesses for which of the following intended effects of the medication?
A. Lying quietly in bed
B. Alleviation of depression
C. Reduction in blood pressure
D. Disa
b, c, d, e.
When providing community health care teaching regarding the early warning signs of Alzheimer?s disease, which of the following signs would the nurse advise family members to report (select all that apply)?
A. Misplacing car keys
B. Losing sense of time
C.
c. When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is
Which of the following nursing interventions is most appropriate when caring for patients with dementia?
A. Avoid direct eye contact.
B. Lovingly call the patient "honey" or "sweetie."
C. Give simple directions, focusing on one thing at a time.
D. Treat t
a. There is presently no cure for Alzheimer's disease, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.
Which of the following statements by the wife of a patient with Alzheimer's disease (AD) demonstrates an accurate understanding of her husband's medication regimen?
A. "I'm really hoping his medications will slow down his mental losses."
B. "We're both ho
d. Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, ma
Which of the following patients may face the greatest risk of developing delirium?
A. A patient with fibromyalgia whose chronic pain has recently worsened
B. An elderly patient whose recent computed tomography shows brain atrophy
C. A patient with a fract
a. Patients in the early stages of Alzheimer's disease are particularly susceptible to depression, since the patient is acutely aware of his or her cognitive changes and the expected disease trajectory. Delirium is typically a shorter-term health problem
For which of the following patients should the nurse prioritize an assessment for depression?
A. A patient in the early stages of Alzheimer's disease
B. A patient who is in the final stages of Alzheimer's disease
C. A patient experiencing delirium seconda
c. Benzodiazepines can be used to treat delirium associated with sedative and alcohol withdrawal. However, these drugs may worsen delirium caused by other factors and must be used cautiously.
Benzodiazepines are indicated in the treatment of cases of delirium that have which of the following causes?
A. Polypharmacy
B. Cerebral hypoxia
C. Alcohol withdrawal
D. Electrolyte imbalances
c. Patients who have been on levodopa for a period of time may experience periods of symptom return. Changing to Sinemet CR or adding another medication can help reduce the on-off phenomenon.
The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate?
A. "You have obviously developed resistance to your current med
a. Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery.
When teaching a patient about carbidopa-levodopa (Sinemet), the nurse responds based on knowledge that
A. carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.
B. carbidopa increase
c. Selegiline is an MAO-B inhibitor that has been shown to cause an increase in the levels of dopaminergic stimulation in the central nervous system and thus allow the dose of levodopa to be decreased.
Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system and therefore allows a decreased dose of other medications?
A. levodopa
B. carbidopa
C. selegiline
D. diphenhydramine
c. Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity, leaving an imbalance with too much cholinergic (excitatory) activity. By increasing dopamine, the neurotransmitter activity becomes more balanced and symptoms become con
What is the goal of pharmacologic therapy in treating Parkinson's disease?
A. Increase the amount of acetylcholine at the presynaptic neurons.
B. Decrease the amount of dopamine available in the substantia nigra.
C. Balance cholinergic and dopaminergic ac
a. Ropinirole is a newer antiparkinson drug that directly stimulates specific dopamine receptors. It is more specific for the receptors associated with parkinsonian symptoms, the D2 family. This in turn may have more specific antiparkinsonian effects, wit
The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). The nurse's response is based on knowledge that
A. ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa.
B.
d. Patients should be instructed that entacapone (Comtan) can turn urine a brownish orange so that the patient will not be alarmed when this side effect occurs.
The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brownish-orange urine. The nurse's response is based on the kno