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MEDICAL-SURGICAL RN B PROPHECY RELIAS LATEST VERSION QUESTIONS AND CORRECT ANSWERS 2024-2025
Typology: Exams
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A patient with a comminuted fracture of the femur is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization. b. the patient cannot tolerate the surgery of a closed reduction. c. a temporary cast would be too unstable to provide normal mobility. d. adequate alignment cannot be obtained by other nonsurgical methods. - ANSWER✔✔d. adequate alignment cannot be obtained by other nonsurgical methods. Rationale: A comminuted fracture has more than two bone fragments. Open reduction with internal fixation (ORIF) is indicated for a comminuted fracture and is used to realign and maintain bony fragments. ORIF has become the preferred method to manage a femoral fracture. Other nonsurgical methods can result in a failure to obtain satisfactory reduction. Internal fixation reduces the hospital stay and the complications associated with prolonged bed rest. Ch. 63 Bridge to NCLEX Examination #
An indication of an neurovascular problem noted during assessment of the patient with a fracture is a. exaggeration of strength with movement. b. increased redness and heat below the injury. c. decreased sensation distal to the fracture site. d. purulent drainage at the site of an open fracture. - ANSWER✔✔c. decreased sensation distal to the fracture site. Rationale: Musculoskeletal injuries have the potential for causing changes in the neurovascular status of an injured extremity. In cases of musculoskeletal trauma, application of a cast or constrictive dressing, poor positioning, and the physiologic responses to the traumatic injury can cause nerve or vascular damage, usually distal to the injury. The neurovascular assessment consists of a peripheral vascular assessment (i.e., color, temperature, capillary refill, peripheral pulses, and edema) and a peripheral neurologic assessment (i.e., sensation, motor function, and pain). Ch. 63 Bridge to NCLEX Examination # A patient with a stable, closed fracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects compartment syndrome and notifies the physician when the patient experiences a. increasing edema of the limb. b. muscle spasms of the lower arm.
c. rebounding pulse at the fracture site. d. pain when passively extending the fingers. - ANSWER✔✔d. pain when passively extending the fingers. Rationale: One or more of the following are characteristic of compartment syndrome: (1) paresthesia (i.e., numbness and tingling); (2) pain distal to the injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compartment; (3) increased pressure in the compartment; (4) pallor, coolness, and loss of normal color of the extremity; (5) paralysis or loss of function; and (6) pulselessness or diminished or absent peripheral pulses. The examination also assesses peripheral edema, especially pitting edema, which may occur with severe injury. Ch. 63 Bridge to NCLEX Examination # A patient with a fracture of the pelvis should be monitored for a. changes in urinary output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden decrease in blood pressure. - ANSWER✔✔a. changes in urinary output. Rationale: Pelvic fractures may cause serious intraabdominal injury, such as paralytic ileus, hemorrhage, and laceration of the urethra, bladder, or colon. Patients may survive the initial pelvic injury, only to die of sepsis, fat embolism syndrome, or thromboembolism. Because a
pelvic fracture can damage other organs, the nurse should assess bowel and urinary elimination and distal neurovascular status. Ch. 63 Bridge to NCLEX Examination # During the postoperative period, the nurse instructs the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contractures. b. skin irritation and breakdown. c. clot formation at the incision site. d. increased risk of wound dehiscence. - ANSWER✔✔a. hip flexion contractures. Rationale: Flexion contractures may delay the rehabilitation process after amputations. The most common and debilitating contracture is hip flexion. To prevent flexion contractures, have patients avoid sitting in a chair for more than 1 hour with hips flexed or having pillows under the surgical extremity. Unless specifically contraindicated, patients should lie on their abdomen for 30 minutes 3 or 4 times each day and position the hip in extension while prone. Ch. 63 Bridge to NCLEX Examination # A patient with rheumatoid arthritis is scheduled for a total hip arthroplasty. The nurse explains that the purpose of this procedure is to (select all that apply)
a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint. - ANSWER✔✔b. replace the joint. d. improve or maintain ROM. Rationale: Arthroplasty is the reconstruction or replacement of a joint. This surgical procedure is performed to relieve pain, improve or maintain range of motion, and correct deformity. Total hip arthroplasty (THA) provides significant relief of pain and improvement of function for a patient with rheumatoid arthritis (RA). Ch. 63 Bridge to NCLEX Examination # In teaching a patient scheduled for a total ankle replacement it is important that the nurse tell the patient that after surgery he should avoid a. lifting heavy objects. b. sleeping on the back. c. abduction exercises of the affected ankle. d. bearing weight on the affected leg for 6 weeks. - ANSWER✔✔d. bearing weight on the affected leg for 6 weeks.
Rationale: After total ankle arthroplasty (TAA), the patient may not bear weight for 6 weeks and must elevate the extremity to reduce and prevent edema. The patient must be careful to prevent postoperative infection and should maintain immobilization as directed by the physician. Ch. 63 Bridge to NCLEX Examination # Rank in order the sequence of events leading to joint destruction in secondary osteoarthritis (OA) beginning with the effect of an injury to the cervical spine. A. Exacerbation of abdominal tissue growth B. Bony articular surfaces in joint exposed C. Fragile, soft, dull joint cartilage develops D. Irregular joint motion, stiffness, and pain - ANSWER✔✔C. Fragile, soft, dull joint cartilage develops A. Exacerbation of abdominal tissue growth D. Irregular joint motion, stiffness, and pain B. Bony articular surfaces in joint exposed A precipitating factor, such as trauma to the spine, leads to the development of OA by damaging the cartilage. Joint destruction begins with the development of dull, soft, less elastic, and more fragile cartilage. Because the body is unable to repair the cartilage fast enough, the cartilage develops fissures and erosion and, in so doing, becomes thinner, leading to the
formation of osteophytes and cartilage at the joint margins. The formation of abnormal tissue leads to abnormal joint movement. Pain and stiffness increase as the bony surfaces of the joint are exposed. Ch. 65 Pre-Assessment # The nurse is assessing a patient who is complaining of joint pain and stiffness. Which assessment does not differentiate between osteoarthritis (OA) and rheumatoid arthritis (RA)? A. Symmetry of joint effect B. Duration of joint stiffness C. Space between the bones D. Erythrocyte sedimentation rate - ANSWER✔✔C. Space between the bones Both OA and RA manifest with narrowed joint spaces so this is not a valid assessment to help differentiate between the two disorders. The remaining options are patient assessments that facilitate differentiation of OA and RA because symmetric joints are affected in RA but not in OA; stiffness resolves in less than 30 minutes with OA but not RA; and a patient with RA, but not OA, is likely to have elevated erythrocyte sedimentation levels indicating inflammation. Ch. 65 Pre-Assessment # A 75-year-old female patient complains about morning stiffness and increasing joint pain in her right hip. What is the best initial drug therapy for her?
A. aspirin B. naproxen (Aleve) C. ibuprofen (Motrin) D. acetaminophen (Tylenol) - ANSWER✔✔D. acetaminophen (Tylenol) For patients with osteoarthritis who have mild to moderate pain, the initial drug of choice is acetaminophen. Ch. 65 Pre-Assessment # Which of the following laboratory values would probably be found in a patient with osteoarthritis (OA)? A. Decreased RBCs B. Increased WBCs C. Clear yellow synovial fluid D. Increased C-reactive protein E. Increased erythrocyte sedimentation rate - ANSWER✔✔C. Clear yellow synovial fluid Normally there are no laboratory abnormalities or biomarkers for OA. Clear yellow fluid is normal synovial fluid.
Ch. 65 Pre-Assessment # A patient who has ankylosing spondylitis (AS) asks the nurse for help in choosing suitable activities for maintaining good posture. Which exercise should the nurse advise the patient to avoid? A. Do stomach crunching B. Stand on a single leg C. Face wall and push off D. Stretch the lower back - ANSWER✔✔A. Do stomach crunching The nurse advises a patient who has AS to avoid stomach crunches because they involve spinal flexion, which over the long term can aggravate pulmonary complications by decreasing the thoracic cage. The help strengthen the same muscles, the nurse encourages exercises to strengthen the upper and lower back such as leg lifts in the prone position because in the prone position the back is supported to prevent flexion. The remaining options can be suitable exercises for this patient, standing on one leg promotes core strength, pushing off a wall strengthens back muscles, and stretching the lower back helps maintain joint flexibility. Ch. 65 Pre-Assessment # The incidence of Lyme disease is very high in a Pennsylvania county, so the public health nurse provides community education to increase the number of patients who seek health care
promptly after a tick bite. Which information should the nurse provide in community teaching people who are at risk for a tick bite? A. The best therapy for the acute illness is an IV antibiotic. B. Check for an enlarging reddened area with a clear center. C. Antibiotics will prevent Lyme disease if taken for 10 days. D. Surveillance is necessary during the summer months only. - ANSWER✔✔B. Check for an enlarging reddened area with a clear center. Following a tick bite, individuals should mark the area with a pen and watch for a reddened lesion that enlarges within 2 to 30 days after the bite, develops a clear center, has a bright red border, and is accompanied by flu-like symptoms and migrating joint and muscle pain. When Lyme disease is confirmed, oral doxycycline (Vibramycin) can be effective if started within 3 days of the bite, and 2 to 3 weeks of antibiotic therapy is usually effective. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors. Ch. 65 Pre-Assessment # In comparing connective tissue disorders, which disorder is most likely to result in patient injury, affect pulmonary function, and increase the patient's risk of infection as a result of the indicated drug therapy? A. Polymyositis (PN)
B. Sjogren's Syndrome (SS) C. Systemic sclerosis (scleroderma) D. Systemic lupus erythematousus (SLE) - ANSWER✔✔A. Polymyositis (PN) PN is an inflammatory disease of striated muscle, resulting in muscle weakness that increases the patient's risk of falls and injury. In addition, most patients with PN develop interstitial lung disease, which can impair pulmonary function. The risk of infection increases during therapy with corticosteroids because these drugs suppress the immune response to potential pathogens. Ch. 65 Pre-Assessment # Patients who have which of this following connective disorders are least likely to experience significant pain because of the primary pathophysiologic process of this disorder? A. FIbromyalgia B. Lyme disease C. Sjogren's syndrome (SS) D. Systemic lupus erythematousus (SLE) - ANSWER✔✔C. Sjogren's syndrome (SS) Patients who have SS are least likely to require pain management from the pathophysiologic result of the disorder because the result is dryness. Fibromyalgia causes generalized musculoskeletal, nonarticular pain. Lyme disease is characterized my migrating joint pain, and SLE can result in polyarthalgia.
Ch. 65 Pre-Assessment # A patient who is receiving methotrexate for lung cancer has a serum uric acid of 8 mg/dL and develops excruciating pain in the great toe. What should be used to minimize the effects of the patient's metabolic problem and prevent nephrotoxicity? A. IV fluids B. colchicine C. naproxen (Naprosyn)
D. probenecid (Benemid) - ANSWER✔✔A. IV fluids Administering IV fluids to a patient who has hyperuricemia from chemotherapy dilutes the serum concentration of uric acid, helps prevent uric acid crystal formation, and helps preserve renal function. This is a very important goal for the nurse because methotrexate can cause renal dysfunction. Ch. 65 Pre-Assessment # The home care nurse visits an elderly patient diagnosed with Parkinson's disease who fell while ambulating. What observation is of most concern to the nurse? A. Stooped posture with a shuffling gait and slow movements. B. 2 × 6 cm contusion located on the right thigh C. Left leg externally rotated and shorter than the right leg. D. Mild pain and minimal swelling of the right ankle and foot. - ANSWER✔✔C. Left leg externally rotated and shorter than the right leg. Rationale: Clinical manifestations of a hip fracture include external rotation, muscle spasm, shortening of the affected extremity, and severe pain and tenderness in the region of the fracture site. Expected clinical manifestations of Parkinson's disease include a stooped posture, shuffling gait, and slow movements. A contusion is a soft tissue injury. Mild pain and minimal swelling may occur with a sprain or strain.
Evolve Ch. 63 # A patient with a fracture of the proximal left tibia in a long leg cast complains of severe pain distal to the fracture site and paresthesia. The toes on the left foot are pale and cool. Which action should the nurse take? A. Elevate the left leg above the level of the heart. B. Administer prescribed morphine sulfate intravenously. C. Notify the health care provider immediately. D. Apply ice packs to the left proximal tibia over the cast. - ANSWER✔✔C. Notify the health care provider immediately. Rationale: Clinical manifestations of compartment syndrome include paresthesia; pain distal to the injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compartment; pressure increases in the compartment; pallor, coolness, and loss of normal color of the extremity; paralysis or loss of function; and pulselessness or diminished/absent peripheral pulses. Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications of impending compartment syndrome. Pulselessness and paralysis (in particular) are later signs of compartment syndrome. Notify the health care provider immediately of a patient's changing condition. Because elevation of the extremity may lower venous pressure and slow arterial perfusion, the extremity should not be elevated above heart level. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. Evolve Ch. 63 #
The nurse performs discharge teaching for a patient after a left hip arthroplasty (posterior approach). Which statement, if made by the patient to the nurse, indicates teaching is successful? A. "Driving a car should not be attempted for 2 to 3 weeks." B. "Leg raising exercises will need to be done for several months." C. "My blood will be tested while taking enoxaparin (Lovenox)." D. "There will not be any restrictions on hip and leg movements." - ANSWER✔✔B. "Leg raising exercises will need to be done for several months." Rationale: Exercises designed to restore strength and muscle tone will be done for months after surgery; the exercises will include leg raises in supine and prone positions. Driving a car is not allowed for 4 to 6 weeks. In posterior approach hip arthroplasties, extremes of internal rotation and 90-degree flexion of the hip must be avoided for 4 to 6 weeks postoperatively. The knees must be kept apart; the patient should never cross the legs or twist to reach behind. To prevent thromboembolism, enoxaparin is administered subcutaneously and can be given at home. Enoxaparin does not require monitoring of the patient's coagulation status. Evolve Ch. 63 # A patient has a cast applied to the right upper extremity for a Colles' fracture. Which action, if taken by the nurse, is the most appropriate?
A. Apply heating pad to reduce muscle spasms and pain. B. Elevate the right arm on two pillows for 24 hours. C. Limit movement of the thumb and fingers on the right hand. D. Place arm in a sling to prevent movement of the right shoulder. - ANSWER✔✔B. Elevate the right arm on two pillows for 24 hours. Rationale: The cast should be supported on pillows during the drying period to prevent denting and flattening of the cast. The casted extremity should be elevated at or above heart level to reduce swelling or inflammation. Ice should be applied for first 24 to 36 hr to reduce swelling or inflammation. Active movement of the thumb and fingers should be encouraged to reduce edema and increase venous return. A sling may be used to support and protect the extremity but the patient should perform active movements of the shoulder to prevent stiffness or contracture. Evolve Ch. 63 # A patient has an amputation of the left leg below the knee. Which intervention should the nurse include in the plan of care for this patient? A. Elevate the residual limb on a pillow for 4 to 5 days after surgery. B. Lay prone with hip extended for 30 minutes four times per day. C. Dangle the residual limb for 20 to 30 minutes every 6 hours. D. Sit in a chair for 1 to 2 hours three times each day. - ANSWER✔✔B. Lay prone with hip extended for 30 minutes four times per day.
Rationale: To prevent hip flexion contractures, patients should lie on their abdomen for 30 minutes three or four times each day and position the hip in extension while prone. Patients should avoid sitting in a chair for more than 1 hour with hips flexed or having pillows under the surgical extremity. The patient should avoid dangling the residual limb over the bedside to minimize edema. Evolve Ch. 63 # The nurse suspects an ankle sprain when a patient at the urgent care center relates a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track. c. dropping a 10 lb. weight on his lower leg at the health club. d. twisting his ankle while running bases during a baseball game. - ANSWER✔✔d. twisting his ankle while running bases during a baseball game. Rationale: A sprain is an injury to the ligamentous structures surrounding a joint, and a wrenching or twisting motion usually causes it. Most sprains occur in the ankle and knee joints. Ch. 63 Bridge to NCLEX Examination #
The nurse explains to a patient with a distal tibial fracture who is returning for a 3-week checkup that healing is indicated by a. formation of callus. b. complete bony union. c. hematoma at fracture site. d. presence of granulation tissue. - ANSWER✔✔a. formation of callus. Rationale: Bone goes through a remarkable reparative process of self-healing (i.e., union) that occurs in stages. The third stage is callus formation. As minerals (i.e., calcium, phosphorus, and magnesium) and new bone matrix are deposited in the osteoid, an unorganized network of bone is formed that is woven about the fracture parts. Callus is primarily composed of cartilage, osteoblasts, calcium, and phosphorus. It usually appears by the end of the second week after injury. Evidence of callus formation can be verified on radiographs. Ch. 63 Bridge to NCLEX Examination # In assessing the joints of a patient with rheumatoid arthritis, the nurse understands that the joints are damaged by (select all that apply) a. bony ankylosis following inflammation of the joints. b. the deterioration of cartilage by proteolytic enzymes. c. the development of Heberden's nodes in the joint capsule.
d. increased cartilage and bony growth at the joint margins. e. invasion of pannus into the joint causing a loss of cartilage. - ANSWER✔✔a. bony ankylosis following inflammation of the joints. e. invasion of pannus into the joint causing a loss of cartilage. Ch. 65 Bridge to NCLEX Examination # Assessment data in the patient with osteoarthritis commonly include a. gradual weight loss. b. elevated WBC count. c. joint pain that worsens with use. d. straw-colored synovial fluid. - ANSWER✔✔c. joint pain that worsens with use. Ch. 65 Bridge to NCLEX Examination # Teach the patient with ankylosing spondylitis the importance of a. regular exercise and maintaining proper posture. b. continuing with physical activity during flare-ups. c. avoiding extremes in environmental temperatures.
d. applying cool compresses for relief of local symptoms. - ANSWER✔✔a. regular exercise and maintaining proper posture. Ch. 65 Bridge to NCLEX Examination # When administering medications to the patient with gout, the nurse would recognize which of the following as a treatment for chronic disease? a. Colchicine b. Febuxostat c. Sulfasalazine d. Cyclosporine - ANSWER✔✔b. Febuxostat Ch. 65 Bridge to NCLEX Examination # In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG. b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer. c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles.
d. the production of a variety of autoantibodies directed against components of the cell nucleus. - ANSWER✔✔d. the production of a variety of autoantibodies directed against components of the cell nucleus. Ch. 65 Bridge to NCLEX Examination #5 When caring for a patient with systemic sclerosis, the nurse knows it is important to instruct the patient to (select all that apply) a. avoiding the consumption of high-purine foods. b. strategies for good dental hygiene and mouth care. c. protecting the extremities from hot and cold temperatures. d. maintaining joint function and preserving muscle strength. e. performing mouth excursion (yawning) exercises on a daily basis. - ANSWER✔✔b. strategies for good dental hygiene and mouth care. c. protecting the extremities from hot and cold temperatures. d. maintaining joint function and preserving muscle strength. e. performing mouth excursion (yawning) exercises on a daily basis. Ch. 65 Bridge to NCLEX Examination #6
In teaching a patient with chronic fatigue syndrome (CFS) about this disorder, the nurse understands that a. palpating tender points is an indicator of CFS severity. b. may symptoms are similar to fibromyalgia syndrome. c. definitive treatment includes low-dose hydrocortisone. d. CFS is characterized by progressive memory impairment. - ANSWER✔✔b. may symptoms are similar to fibromyalgia syndrome. Ch. 65 Bridge to NCLEX Examination #7 The nurse teaches a community group how to prevent food poisoning. The nurse determines that teaching is successful if a community member makes which statement? a. "Ground beef is safe to eat if cooked until it is brown." b. "Pasteurized juices and cider are safe to drink." c. "Fresh fruits are safe and do not need to be washed before eating." d. "Alfalfa sprouts are safe if rinsed before eating." - ANSWER✔✔b. "Pasteurized juices and cider are safe to drink." Rationale: Drink only pasteurized milk, juice, or cider. Ground beef should be cooked thoroughly; browned meat can still harbor live bacteria. Cook ground beef until a thermometer reads at least 160° F; if a thermometer is unavailable, decrease risk of illness by cooking the
ground beef until there is no pink color in the middle. Fruits and vegetables should be washed thoroughly, especially those that will not be cooked. Persons who are immunocompromised or elderly should avoid eating alfalfa sprouts until the safety of the sprouts can be ensured. Evolve Ch. 42 #1 The nurse receives an order for a parenteral dose of promethazine (Phenergan) and prepares to administer the medication to a patient. Which action is most important for the nurse to take? a. Administer the medication subcutaneously for fast absorption. b. Administer the medication into an arterial line to prevent extravasation. c. Administer the medication deep into the muscle to prevent tissue damage. d. Administer the medication with 0.5 mL of lidocaine to decrease injection pain. - ANSWER✔✔c. Administer the medication deep into the muscle to prevent tissue damage. Rationale: Promethazine (Phenergan) is an antihistamine administered for nausea and vomiting. This medication should not be administered into an artery or under the skin because of the risk of severe tissue injury, including gangrene. When administered intravenously, a risk factor is that it can leach out from the vein and cause serious damage to surrounding tissue. Deep muscle injection is the preferred route of injection administration for this drug. Evolve Ch. 42 #2 Which of the following patients would be at highest risk for developing oral candidiasis?
a. A 22-year-old patient who smokes eight cigarettes per day b. A 74-year-old patient who has vitamin B and C deficiencies c. A 58-year-old patient who is receiving amphotericin B d. A 32-year-old patient who is receiving ciprofloxacin (Cipro) - ANSWER✔✔d. A 32-year-old patient who is receiving ciprofloxacin (Cipro) Rationale: Oral candidiasis is caused by prolonged antibiotic treatment (e.g., ciprofloxacin) or high doses of corticosteroids. Use of tobacco products leads to stomatitis. Vitamin B and C deficiencies may lead to Vincent's infection. Amphotericin B is used to treat candidiasis. Evolve Ch. 42 #3 An elderly female patient has gastroesophageal reflux disease (GERD). Which over-the- counter medications, if taken long term by the patient, should the nurse question? a. Sucralfate (Carafate) b. Omeprazole (Prilosec) c. Cimetidine (Tagamet) d. Metoclopramide (Reglan) - ANSWER✔✔b. Omeprazole (Prilosec)
Rationale: There is a potential link between proton pump inhibitors (PPIs) (such as omeprazole) use and bone metabolism. Long-term use or high doses of PPIs may increase the risk of fractures of the hip, wrist, and spine; lower doses or shorter duration of therapy should be considered. Evolve Ch. 42 #4 The nurse cares for a patient with nausea and vomiting. Which action would be an appropriate nursing intervention? a. Offer the patient a herbal supplement such as ginseng. b. Discontinue any medications that may cause nausea or vomiting. c. Apply a cool washcloth to the forehead and provide mouth care. d. Have the patient walk in the hallway to promote peristalsis. - ANSWER✔✔c. Apply a cool washcloth to the forehead and provide mouth care. Rationale: Cleansing the face and hands with a cool washcloth and providing mouth care are appropriate interventions for nausea and vomiting. Ginseng is not used to treat nausea and vomiting. Medications may be temporarily withheld until the acute phase is over, but the medications should not be discontinued without consultation with the health care provider. Unnecessary activity should be avoided; the patient should rest in a quiet environment. Awarded 1.0 points out of 1.0 possible points. Evolve Ch. 42 #5