A nurse is caring for a client with a new diagnosis of pagets disease. the nurse anticipates

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What is the first line treatment for Paget disease quizlet?
What is most helpful to the doctor in determining a patient's likely diagnosis?
When a client has a superficial tumor involving only 1 vocal cord which surgery would the nurse anticipate?

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Exam III

Question	Answer
The nurse anticipates that a client with degenerative joint disease would probably reveal that the pain is	worse at the end of the day.
The client who has osteoarthritis describes a grating sound in the hip. The nurse explains that this bothersome manifestation is related to	Joint destruction. With degenerative joint disease, crepitus (sound of bone ends rubbing together) indicates fractures or joint destruction
A client enters the emergency department with an injured right knee after falling at home. When the client proudly reports that he immediately put a hot compress on the injury, the nurse’s best response is	“Let me exchange the hot compress for a cold one. Heat may cause more bleeding and discomfort.”
A client who has undergone repair of the anterior cruciate ligament complains that the use of the continuous passive motion (CPM) machine causes pain and asks how long he is expected to use the machine. The nurse’s most appropriate response would be	“I will give you pain medication to make you comfortable, since you should use the machine at least 8 hours out of 24.”
When performing a musculoskeletal assessment on a client who complains of muscle weakness with cramping, the nurse should be sure to assess for	ingestion of a potassium-wasting diuretic.
When a 24-year-old male client describes painful walking from heel pain, the nurse identifies the probable cause contributing to his problem as being	jogging on weekends. Achilles tendon damage can arise from improperly landing on the heels while jogging.
The school nurse assesses a 13-year-old client and finds lateral thoracic spine curvature with a raised shoulder and hip. The nurse records these findings as	Scoliosis it is an obvious lateral deformity of the spine with an associated raised shoulder and hip.
The client who had a recent cerebrovascular accident (CVA) can perform full range of motion (ROM) against gravity and resistance with the L arm & only with the elbow joint supported with the R arm. The nurse would grade the client’s muscle strength as	left arm: 5; right arm: 2.
A client describes ripping sounds in his knee during a fall while skiing. The nurse explains to the client that the diagnostic test that will provide the best data is a(n)	Arthrogram An arthrogram is a radiographic examination of soft tissue joint structures. It is used to diagnose trauma to joint capsules or supporting ligaments, especially involving the shoulder, wrist, hip, ankle, or knee.
The nurse assisting with an arthrocentesis assesses the fluid withdrawn from the joint as normal because it is	straw colored
When a client scheduled for arthroscopic examination of his knee asks about his level of activity following the procedure, the nurse responds	“You will be allowed to walk, but avoid strenuous activity for a few days.”
The nurse designing a teaching plan for a clilent who had arthrocentesis of the left knee includes the advice to	maintain a compression bandage A compression bandage is applied after arthrocentesis, and the client should be advised to rest the joint for 8 hours.
The nurse preparing a client for indium imaging explains that this test is being done to diagnose	bone infection Radiologic imaging using indium as a tracer is performed to detect bone infection.
The nurse explaining the benefits of bone density studies would stress that routine x-ray films will not show evidence of osteoporosis until there has been bone loss of	30% to 50%. Methods to measure bone density are performed to diagnose osteoporosis because the condition is not evident in x-ray studies until 30% to 50% of bone mass is lost.
The nurse counseling a client with osteoporosis identifies one of the medications that may have contributed to the condition as	Prednisone Osteoporosis can result from underlying conditions, such as hyperparathyroidism, thyrotoxicosis, anorexia, & Cushing’s, & from use of medications such as thyroid hormone, anticonvulsants, furosemide, & corticosteroids (e.g., prednisone).
A client with osteoporosis complains that avoidance of coffee in the client’s new diet will be very difficult. To offset coffee consumption, the nurse might suggest that for every cup of coffee consumed, the client should	take 40 mg of over-the-counter calcium
The client who is receiving Evista, a selective estrogen receptor modulator (SERM), asks the nurse why this particular drug is better than her previous drug protocol of both estrogen and progesterone. The nurse’s most accurate response is	“Evista prevents bone loss and reduces the risk of fractures
The nurse instructing a client on considerations regarding the medication calcium carbonate would include in the teaching plan that the client	Take with food All Ca Supplements should be taken with food
The nurse assesses in a new client one of the most common manifestations of osteoporosis, which is	kyphosis
Paget’s disease, a bone disorder, is characterized by	increased bone tissue breakdown followed by abnormal bone formation
On admission assessment of a client with Paget’s disease, the nurse would anticipate the complaint of	continuous bone pain
The nurse discussing treatment options with a client with Paget’s disease will focus on the the most common remedy, which is	NSAIDS
When counseling a client who is a strict vegetarian, the nurse would caution that this diet puts the client at risk for	osteomalacia
The client with osteomalacia is depressed and anxious about the outcome of the illness. The most beneficial nursing response would be	“Vitamin D will stimulate healing, and afterward a low maintenance dose with adequate calcium and protein will improve the condition.”
On admitting a client with acute osteomyelitis, the nurse will most likely find on initial assessment the client’s complaint of	localized pain & redness
After surgical débridement of diseased bone, a client with acute osteomyelitis asks how long antibiotics will be administered. The nurse should respond that the antibiotic protocol will be	parenteral antibiotics for 4 to 8 weeks, then oral agents for 4 to 8 weeks.
The nurse recognizes the significant laboratory finding helpful in confirming the diagnosis of a bone tumor as	elevated serum alkaline phosphatase.
The nurse explains that the most common early manifestation of a primary bone tumor is	fracture in the area
When informed that his metastatic bone tumor will be treated by radiation, a client asks the nurse what benefit can be expected. The nurse’s most helpful response is that radiation	can improve bone strength
The nurse teaching a class on osteoarthritis (OA) stresses that this disorder is best described as	degeneration of articular cartilage in synovial joints.
As a beneficial exercise program, the nurse teaching a group of clients with osteoarthritis would suggest	regular daily, low-impact exercise program.
The nurse ensures postoperative positioning for a client who has a total hip arthroplasty is	side-lying position on unaffected side with operated side extended.
The nurse confirms that the first choice for pain control in a client with OA is	Acetaminophen
The client returns from surgery for a THA with a Hemovac in place. The nurse assesses the first 6 hours drainage as 350 ml. The nurse should	notify the physician of the amount of drainage The expected amount of drainage is usually less than 200 ml in the first 8 hours
The nurse setting up the continuous passive motion (CPM) machine for a client after total knee arthoplasty will ensure that	CPM will be initiated at 0 degrees of extension and 20 degrees of flexion.
The nurse is transferring a client with a noncemented total knee arthroplasty (TKA) from bed to walker. Before the client uses the walker, the nurse will assist the client to	push off of bed using the arms and gain balance on one foot.
The nurse explains to a client with delayed union of a fractured femur that treatment for this complication is based on	finding & correcting the cause
A client who has had left hip surgery complains of tingling and increasing pain. The nurse assesses weakness and diminished pulses in the left foot and suspects the client has	compartment syndrome
In the emergent care of a client with a pelvic fracture, the nurse must be especially alert for indications of the complication of	hypovolemic shock Pelvic fractures can result in hemorrhage into the pelvic cavity. The pelvic cavity can hold as much as 4 liters of blood.
The nurse explains to a 7-year-old client with a mid-shaft fracture that healing time for this type of fracture is longer because	a bone’s blood supply is less at mid-shaft than at the ends.
The nurse assesses an 85-year-old client who has fallen and finds crepitus and swelling below the right elbow. The nurse interprets these findings as	a closed fracture
The nurse instructs a 52-year-old client who is considering running as an exercise that to prevent injuries, it is important before running to	perform static stretching exercises for 10 minutes.
When a 20-year-old athlete with a third-degree sprain of the left knee asks about the probable treatment, the nurse’s most informative reply would be	“Surgery is usually required to repair the tear, followed by application of a cast or splint.”
When a 68-year-old client with a new full-leg cast exhibits bilateral pedal edema, the nurse would assess for the etiologic factor of	cardiovascular disease
The assessment that would alert the nurse to the possibility of cast syndrome in a client with a spica cast is	abdominal distention.
During the first 24 to 48 hours after application of a cast for Colles’ fracture, the nurse positions the extremity to	elevate the arm on pillows with fingers higher than the elbow.
The principal concept that a nurse would include in a teaching plan regarding partial weight-bearing is that the client should	use a walker or crutches and bear 30% to 50% of weight on the affected limb
The type of traction that a nurse would apply intermittently is	chin halter
A victim of a motorcycle accident has a compound fracture to the left femur with an associated wound of 8 cm. The nurse’s assessment records this injury as	class III
The complaint of proximal thigh pain in an older client who has fallen leads the nurse to suspect a hip fracture and that the location of the fracture is	subtrochanteric.
The nurse in the emergency department caring for a client with an anterior dislocation of the knee should have as a priority the assessment of	capillary refill of the toes.
The nurse would explain to a client that when a major burn occurs, the body’s initial systemic responses include	increased capillary permeability, decreased cardiac output, and oliguria.
The nurse would perform close respiratory assessment for a client with inhalation injuries because lung tissue injury due to inhalation of smoke is caused by	chemical action on lung tissues
The nurse is caring for a client with burns covering the entire surface of both arms and the anterior trunk. Using the rule of nines, the nurse would estimate the percentage of burn surface area to be	36%
When caring for a severely burned client, the nurse notes that the client’s urine is dark brown. The nurse would	ensure that intravenous (IV) fluid is maintained at the prescribed rate
A 200-pound client is receiving fluid replacement after 35% of the client’s body was burned 12 hours ago. The nurse would evaluate the fluid resuscitation as adequate when the minimum urine output is maintained at	45 cc/hr. (.5 cc/kg/hr is accepted minimum urine output)
The nurse would assess that the client at highest risk for burns sustained from clothing ignition during meal preparation is	a 75-year-old adult.
The nurse teaching a class on burn injury prevention would stress that the leading cause of fire deaths is	cigarettes igniting furniture.
The nurse would assess that the client with a “major burn” is	a 60-year-old with a 20% burn The classification of major burns follows: persons over age 40 with a 20% burn, persons under 40 with a 25% burn, children under 10 with a 20% burn.
When admitting a client who has sustained a burn injury, the nurse would inoculate against tetanus if the client has	been inoculated in the last 6 years.
The nurse caring for a burn client would monitor the client’s stools for occult blood as assessment for development of	stress ulcers
The nurse caring for a client with burns over 40% of the body notes a hematocrit of 55% at 12 hours after the injury. The nurse would explain that this finding is related to	a decrease in the intravascular fluid
A client’s burn wound is being treated with enzymatic débridement. At this time the nurse would assess the client for	bleeding from the burn wound.
To reduce contractures of the knee in a client with extensive burns of the knee and mid-leg, the nurse would position the client with the knee	extended
A burn client is receiving 5% mafenide acetate for a burn wound. The nurse would observe the client for clinical manifestations of	fungal infection
To minimize hypertrophic scarring of a client’s burn wound, the nurse would anticipate	application of continuous pressure with elastic wraps
A burn victim in the emergency department who was trapped in a closet during a fire becomes agitated & has a rapid deterioration in LOC. The nurse would anticipate that the laboratory report will support the neurologic changes & show an increase in	COHb. Carbon dioxide binds to the hemoglobin and forms COHb in a client who has sustained smoke inhalation
A client with pulmonary disease appears more comfortable after respiratory therapy but still feels short of breath. To measure the client’s respiratory improvement, the nurse would use	The Visual Analogue Scale
Evaluating the respiratory status of a 59-year-old man with vague complaints of respiratory problems, the nurse would know the assessment that is normal is	the absence of sputum production after coughing
When a 49-year-old client tells the nurse he has smoked half a pack of unfiltered cigarettes a day since he was 19 years old, the nurse would record the pack-years as	15
The nurse preparing to assess a client for the presence of clubbing would instruct the client to	place the nails of the ring fingers together.
The nurse who is assessing several clients with respiratory problems would expect that increased tactile fremitus will most likely be demonstrated by the client with	pneumonia
When the nurse hears a high, hollow, drum-like sound while percussing the right chest of a young man with a right pneumothorax; the nurse would record this finding as	tympany
The nurse clinician performing percussion of the chest on a client assesses a low-pitched, hollow sound over the middle lobe. The nurse would record this finding as	normal resonance Resonant sounds are low-pitched, hollow sounds heard over normal lung tissue.
The nurse performing a physical examination on a 25-year-old, 90-pound, anorexic client notes hyperresonance during percussion of the chest. The nurse would anticipate that the client will need	routine respiratory care for this normal finding Hyperresonant sounds are normally heard in children and very thin adults
The nurse auscultating over a client’s trachea would expect to hear the breath sound characteristic of this location, which is	bronchial
The nurse auscultating the chest of a client with chronic bronchitis would expect to hear the characteristic adventitious breath sound of	rhonchi on expiration Rhonchi (gurgles) result when air passes through fluid-filled narrow passages. Diseases with excess mucus production (e.g., bronchitis) are associated with rhonchi on expiration
The nurse reviews the results of the arterial carbon dioxide tension (PaCO2) of a client with asthma to obtain information relative to the	effectiveness of alveolar ventilation.
The group of medications that the nurse would instruct a client to withhold in the 6 hours before pulmonary function studies is	bronchodilators.
To best prepare a client scheduled for measurement of lung volumes with body plethysmography, the nurse would	note that the client will be placed in an airtight, box-like device.
The nurse is assessing breath sounds with the diaphragm of the stethoscope and hears rhonchi on expiration in both lower lobes. The nurse would reassess	after the client has coughed Rhonchi are usually heard on expiration and may clear with a cough.
The nurse would question the accuracy of a pulse oximetry evaluation in a client who is	experiencing hypotension.
The nurse would explain to a client that the most helpful test in the evaluation of a possible pulmonary embolus is	ventilation-perfusion scan.
The nurse preparing a client for pulmonary angiography would include information about	no exposure to radiation.
the nurse would explain to a client that a contraindication for fluoroscopy is	pregnancy
The nurse would identify that the client at highest risk for development of laryngeal cancer is	a 70-year-old man with a 40-year history of alcohol use and heavy smoking.
In the preoperative teaching plan for a client scheduled for total laryngectomy and radical neck resection, the nurse would give highest priority to	the client not being able to speak normally again.
The observation that would require an immediate nursing intervention for a client recently returned to the unit following partial laryngectomy is	pulsations of the tracheostomy tube.
In planning postoperative nursing care for a client who has undergone radical neck dissection and total laryngectomy, the nurse would give priority to the fact that	there is a radical change in appearance as a result of this type of surgery.
For a client who has a posterior nasal plug and anterior nasal packing in place to control an episode of severe epistaxis, the priority assessment for the nurse would be assessing for	presence of hypoxia.
For client returning to the nursing unit after a Caldwell-Luc procedure, the nurse would plan care based on the knowledge that	the client will be unable to breathe through the nose.
The measure that would best aid the nurse in removing heavy, tenacious secretions during suctioning is	instilling sterile saline directly into the trachea.
A client has a fenestrated tracheostomy tube in place. A tracheostomy plug will be used to allow the client to talk. The intervention by the nurse that would be essential before inserting the plug is	deflating the cuff on the tracheostomy tube.
In the event of deterioration in a client’s respiratory status and a Jackson metal tracheostomy tube being used, the nurse would note the limitation that the tube	has no respirator adapter.
A client is trying unsuccessfully to clear the airway with a cough. The measure the nurse would suggest to help the client cough more effectively is	place a clean finger over the tracheostomy tube and cough.
When the nurse prepares to suction an unconscious client’s tracheostomy, the initial action would be	suction with the cuff inflated The tracheostomy should be suctioned first with the cuff inflated to prevent aspiration of the secretions accumulated on top of the cuff.
Noting the need to use 8 ml rather than 5 ml to inflate the tracheostomy cuff sufficiently, the nurse would	notify the physician to have an x-ray film obtained for tracheal dilation
A client receives a beta-adrenergic bronchodilator and supplemental oxygen when entering the ED for treatment of asthma, but the client’s condition remains unchanged. The nurse would anticipate that the client	will receive intravenous (IV) steroids.
In developing a long-range plan for a client with chronic bronchitis, the nurse would consider the possibility that the client may develop the common cardiovascular change of	enlargement of the right ventricle.
The nurse would prepare a client with emphysema who has a ruptured emphysematous bleb for	chest tube insertion
The nurse is assessing the partial thromboplastin time (PTT) for a client taking heparin for the resolution of a pulmary embolus. If the INR of the client is 1.2, the nurse would be	aware that the physician will need to be notified to increase the heparin. The optimal INR ratio for heparin therapy is 2.5 to 3. A reading of 1.2 indicates that the clotting time is still too fast for effective anticoagulant therapy.
The nurse notes that a client in a long-term care facility has become increasingly confused in the last few days. The resident’s vital signs are temperature 97.7° F, pulse 80, repirations 20, and blood pressure 90/62. The nurse would suspect	pneumonia
The nurse would record a Mantoux as “positive” when the induration at 48 hours is 5 cm in a client who is	HIV positive.
The nurse has made the nursing diagnosis Ineffective Breathing Pattern related to tachypnea secondary to chest pain for a client with pneumonia. After administration of an analgesic, the nurse would	auscultate the client’s chest.
The nurse notes intermittent bubbling in the water-seal chamber of a chest tube in place for a client with pneumothorax. The nurse’s most appropriate action is to	encourage respiratory exercises.
The nurse would explain that the client’s diagnosis of interstitial pneumonia means	there is an inflammatory response in the tissue surrounding the air space.
In the nursing care of a client recently intubated and placed on mechanical ventilation, the nursing action that would take highest priority is	monitoring blood pressure frequently.
The nurse monitoring a client with adult respiratory distress syndrome (ARDS) would closely assess for	PE
When a client is admitted to the ED with tension pneumothorax and mediastinal shift following an automobile accident, the nurse would know that the client will exhibit	severe hypotension
The nurse would explain that the use of positive end-expiratory pressure (PEEP) assists the client on mechanical ventilation by	keeping the alveoli open.
As part of the immediate care plan for a client with pulmonary edema and a nursing diagnosis of Impaired Gas Exchange, the nurse would	administer oxygen as ordered using a high-flow rebreather bag.
When the ED nurse receives a radio call from an ambulance transporting a client who sustained chest trauma and has a severe flail chest, the nurse would set up the treatment area with	intubation tray.
A client’s ventilator alarm begins to ring. The nurse enters the room and notes that the “low expired minute volume” alarm is sounding. After quickly determining that the client is in no acute distress, the nurse would	look for a leak or disconnection in the system.

What is the first line treatment for Paget disease quizlet?

Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone. Bisphosphonates are typically given by injection into a vein, but they can also be taken by mouth.

What is most helpful to the doctor in determining a patient's likely diagnosis?

Clinical History and Interview Acquiring a clinical history and interviewing a patient provides important information for determining a diagnosis and also establishes a solid foundation for the relationship between a clinician and the patient.

When a client has a superficial tumor involving only 1 vocal cord which surgery would the nurse anticipate?

For small cancers of the vocal cords, the surgeon might be able to remove the cancer by taking out only one side of the larynx (one vocal cord) and leaving the other behind. This is called a hemilaryngectomy.

A nurse is caring for a client with a new diagnosis of pagets disease. the nurse anticipates

Exam III

What is the first line treatment for Paget disease quizlet?

What is most helpful to the doctor in determining a patient's likely diagnosis?

When a client has a superficial tumor involving only 1 vocal cord which surgery would the nurse anticipate?

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