gg gg gg gg gg gg gg gg
1.ggA ggnurse ggis ggreviewing ggthe ggcause ggof gggout ggwith gga gggroup ggof ggnurses. ggWhich ggof ggthe ggfollowing ggstatements
ggshould ggthe ggnurse ggmake?
A. "Uric ggacid gglevels ggdrop ggand ggcalcium ggforms ggprecipitate."
Rationale:ggWith gggout, ggclients gghave gghyperuricemia, ggrather ggthan gga ggreduction ggin gguric ggacid.
B. "Tophi ggform ggin ggthe ggkidneys ggand ggthey ggimpair ggthe ggexcretion ggof gguric ggacid."
Rationale:ggTophi, ggor ggdeposits ggin ggtissues ggnear gga ggjoint, ggdevelop ggin ggchronic, gglate-stage gggout. ggThey ggare
ggnot ggpart ggof ggthe ggprimary ggdisease ggprocess.
C. "The ggintra-articular ggdeposition ggof ggurate ggcrystals ggcauses gginflammation."
Rationale: ggGout, ggor gggouty ggarthritis, ggdevelops ggwhen ggurate ggcrystals ggdeposit ggin ggjoints ggand ggtissues ggand
ggcause gginflammation ggand ggpain.
D. "Articular ggcartilage ggthins, ggleading ggto ggsplitting ggand ggfragmentation."
Rationale: ggGout ggdoes ggnot ggthin ggand ggfragment ggcartilage.
2.ggA ggnurse ggis ggteaching gga gggroup ggof ggclients ggabout ggosteoarthritis. ggWhich ggof ggthe ggfollowing ggrecommendations
ggshould ggthe ggnurse gginclude ggin ggthe ggteaching?
A. Use ggEchinacea ggto ggmanage ggjoint ggpain.
Rationale: ggThe ggnurse ggmay gginclude ggthe gguse ggof ggcomplementary ggand ggalternative ggtherapies ggin ggthe
ggteaching.
However, ggEchinacea ggis ggused ggfor ggthe ggtreatment ggof ggthe ggcommon ggcold, ggnot ggosteoarthritis.
ggAlternative ggtherapies ggthat ggare ggused ggfor ggosteoarthritis gginclude ggglucosamine, ggchondroitin, ggand
ggtopical ggcapsaicin.
B. Apply ggice ggto ggthe ggjoint ggbefore ggexercising.
Rationale:ggThe ggnurse ggshould ggrecommend ggthat ggthe ggclients ggbegin ggexercising ggimmediately
ggfollowing ggthe ggapplication ggof ggheat. ggThis ggreduces ggpain ggand ggimproves ggmobility,
ggallowing ggfor ggincreased ggrange-of-motion ggduring ggexercises. ggCold ggapplication ggmay
ggbe ggapplied ggfollowing ggexercise ggto ggdecrease ggdiscomfort ggand gginflammation.
C. Maintain gga ggrecommended ggbody ggweight.
Rationale: ggObesity ggis gga ggrisk ggfactor ggfor ggthe ggdevelopment ggof ggosteoarthritis. ggMaintenance ggof ggan ggideal
ggweight ggis ggone ggway gga ggclient ggcan ggprevent ggadded ggwear ggand ggtear ggon ggjoints ggand
ggpromote ggoverall ggjoint gghealth.
D. Reduce ggthe ggamount ggof ggpurine ggin ggthe ggdiet.
Rationale: ggThe ggnurse ggshould ggrecognize ggthat gglimiting ggpurine ggin ggthe ggdiet, ggwhich ggis ggoften ggfound ggin
ggorgan ggmeats, ggis ggrecommended ggfor ggclients ggwho gghave gggout.
3.ggA ggnurse ggis ggcaring ggfor gga ggclient ggwho gghas gghad gga ggmyocardial gginfarction. ggUpon gghis ggfirst ggvisit ggto ggcardiac
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, rehabilitation, gghe ggtells ggthe ggnurse ggthat gghe ggdoesn't ggunderstand ggwhy gghe ggneeds ggto ggbe ggthere ggbecause ggthere
gg
is ggnothing ggmore ggto ggdo, ggas ggthe
gg
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, damage ggis ggdone. ggWhich ggof ggthe ggfollowing ggis ggthe ggcorrect ggnursing ggresponse?
A. "Cardiac ggrehabilitation ggcannot ggundo ggthe ggdamage ggto ggyour ggheart ggbut ggit ggcan gghelp ggyou ggget ggback ggto
ggyour ggprevious gglevel ggof ggactivity ggsafely."
Rationale: ggWith ggthis ggresponse, ggthe ggnurse gguses ggthe ggtherapeutic ggcommunication ggtechnique ggof
ggpresenting ggreality ggby ggindicating ggher ggperception ggof ggthe ggsituation ggfor ggthe ggclient.
B. "It’s ggnot ggunusual ggto ggfeel ggthat ggway ggat ggfirst, ggbut ggonce ggyou gglearn ggthe ggroutine, ggyou’ll ggenjoy ggit."
Rationale:ggWith ggthis ggresponse, ggthe ggnurse ggillustrates ggthe ggnontherapeutic ggcommunication ggtechnique ggof
gggiving ggreassurance, ggthus ggdiscouraging ggthe ggclient ggfrom ggfurther ggcommunication.
C. "Exercise ggis gggood ggfor ggyou ggand gggood ggfor ggyour ggheart."
Rationale:ggWith ggthis ggresponse, ggthe ggnurse ggillustrates ggthe ggnontherapeutic ggcommunication ggtechniques ggof
ggdisagreeing ggand gggiving ggadvice.
D. "Your ggdoctor ggis ggthe ggexpert gghere, ggand ggI’m ggsure gghe ggwould ggonly ggrecommend ggwhat ggis ggbest ggfor ggyou."
Rationale:ggWith ggthis ggresponse, ggthe ggnurse ggillustrates ggthe ggnontherapeutic ggcommunication ggtechnique ggof
ggdefending.
4.ggA ggnurse ggis ggcaring ggfor gga ggclient ggwho gghas ggheart ggfailure ggand gga ggpotassium gglevel ggof gg2.4 ggmEq/L. ggThe ggnurse
ggshould ggidentify ggwhich ggof ggthe ggfollowing ggmedications ggas ggthe ggcause ggof ggthe ggclient’s gglow ggpotassium gglevel?
A. Furosemide
Rationale: ggFurosemide ggis gga ggloop gg(high-ceiling) ggdiuretic ggthat gginhibits ggthe ggreabsorption ggof ggsodium
ggand ggchloride ggand ggresults ggin ggdiuresis, ggwhich ggdecreases ggpotassium ggthrough ggexcretion
ggin ggthe ggdistal ggnephrons.
Hypokalemia ggis ggan ggadverse ggeffect ggof ggfurosemide.
B. Nitroglycerin
Rationale: ggA ggpotassium gglevel ggof gg2.4 ggmEq/L ggis ggnot ggan ggadverse ggeffect ggof ggnitroglycerin. ggNitroglycerin
ggis gga ggvasodilator ggmedication ggto ggtreat ggangina.
C. Metoprolol
Rationale: ggA ggpotassium gglevel ggof gg2.4 ggmEq/L ggis ggnot ggan ggadverse ggeffect ggof ggmetoprolol.
ggMetoprolol ggis gga ggbeta-blocker ggthat ggslows ggthe ggheart ggrate ggand ggimproves
ggcontractility ggof ggthe ggheart ggmuscle.
D. Spironolactone
Rationale: ggSpironolactone ggis gga ggpotassium-sparing ggdiuretic ggmedication; ggtherefore, gghyperkalemia ggis
ggan ggadverse ggeffect ggof ggthis ggmedication.
5. ggA ggnurse ggis ggcaring ggfor gga ggclient ggwho ggis ggpostoperative ggfollowing ggan ggopen ggreduction gginternal ggfixation gg(ORIF)
ggof gga ggfemur ggfracture. ggWhich ggof ggthe ggfollowing ggparameters ggshould ggthe ggnurse gginclude ggin ggthe ggevaluation ggof
ggthe ggneurovascular ggstatus ggof ggthe ggclient's ggaffected ggextremity? gg(Select ggall ggthat ggapply.)
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, A. Color
B. Temperature
C. Ecchymosis
D. Skin ggintegrity
E. Sensation
Rationale: ggColor ggis ggcorrect. ggClients ggwho gghave ggsustained ggtrauma ggto ggan ggextremity, ggsuch ggas gga
ggfracture, ggare ggat ggincreased ggrisk ggfor ggneurovascular ggcompromise. ggThe ggnurse ggshould
ggcheck ggthe ggcolor ggof ggthe ggclient's ggaffected ggextremity ggas ggpart ggof ggthis ggassessment. ggThe
ggnurse ggshould ggidentify ggpallor ggor ggcyanosis ggof ggthe ggextremity ggas ggan ggindication ggof
ggperipheral ggneurovascular ggdysfunction ggand ggshould ggnotify ggthe ggprovider.Temperature ggis
ggcorrect. ggClients ggwho gghave ggsustained ggtrauma ggto ggan ggextremity, ggsuch ggas gga ggfracture, ggare
ggat ggincreased ggrisk ggfor ggneurovascular ggcompromise. ggThe ggnurse ggshould ggmonitor ggthe
ggtemperature ggof ggthe ggextremity ggas gga ggpart ggof ggthis ggassessment ggand ggidentify ggskin ggthat ggis
ggcool ggor ggcold ggto ggthe ggtouch ggas gghaving ggdecreased ggperfusion ggto ggthe ggtissues ggof ggthe
ggextremity, ggwhich ggis ggan ggindication ggof ggperipheral ggneurovascular ggdysfunction. ggThe ggnurse
ggshould ggreport ggskin ggthat ggis ggcool ggto ggthe ggtouch ggto ggthe ggprovider.Ecchymosis ggis ggincorrect.
ggEcchymosis, ggor ggbruising, ggis ggan ggexpected ggfinding ggwith ggleg gginjuries ggand ggis ggnot gga
ggcomponent ggof gga ggneurovascular ggcheck.Skin ggintegrity ggis ggincorrect. ggWhile ggthe ggnurse
ggshould ggassess ggthe ggincision ggof gga ggclient ggwho ggis ggpostoperative ggfollowing ggan ggopen
ggreduction g g and gginternal ggfixation ggof ggthe ggfemur, ggit ggis ggnot gga ggcomponent ggof gga
ggneurovascular ggcheck.Sensation ggis ggcorrect. ggClients ggwho gghave ggsustained ggtrauma ggto ggan
ggextremity, ggsuch ggas gga ggfracture, ggare ggat ggincreased ggrisk ggfor ggneurovascular ggcompromise.
ggThe ggnurse ggshould ggassess ggthe ggclient's ggextremity ggfor ggnumbness ggor ggtingling. ggThe ggnurse
ggshould ggrecognize ggdiminished ggpain ggor ggparesthesia ggas ggan ggindication ggof ggdamage ggto ggthe
ggnerves ggor ggperipheral ggneurovascular ggdysfunction ggand ggshould ggreport ggit ggto ggthe ggprovider.
6.ggA ggnurse ggis ggmonitoring gga ggclient ggfollowing gga ggthoracentesis. ggThe ggnurse ggshould ggidentify ggwhich ggof ggthe
ggfollowing ggmanifestations ggas gga ggcomplication ggand ggcontact ggthe ggprovider ggimmediately?
A. Serosanguineous ggdrainage ggfrom ggthe ggpuncture ggsite
Rationale: ggA ggsmall ggamount ggof ggserosanguineous ggdrainage ggat ggthe ggpuncture ggsite ggis ggexpected ggafter gga
ggthoracentesis.
B. Discomfort ggat ggthe ggpuncture ggsite
Rationale: ggMild ggdiscomfort ggat ggthe ggpuncture ggsite ggis ggexpected ggafter gga ggthoracentesis.
C. Increased ggheart ggrate
Rationale: ggClients ggare ggat ggrisk ggfor ggdeveloping ggpulmonary ggedema ggor ggcardiovascular ggdistress ggdue
ggmediastinal ggcontent ggshift ggafter ggthe ggaspiration ggof gga gglarge ggamount ggof ggfluid ggfrom ggthe
ggclient's ggpleural ggspace.
Therefore, ggthe ggclient ggmay ggexperience ggan ggincrease ggin ggheart ggand ggrespiratory ggrate,
ggalong ggwith ggcoughing ggwith ggblood-tinged ggfrothy ggsputum, ggand ggtightness ggin ggthe ggchest.
ggThese ggfindings ggrequire ggnotification ggof ggthe ggprovider ggimmediately.
D. Decreased ggtemperature
Rationale: ggInfection ggis ggpossible ggafter ggany gginvasive ggprocedure; gghowever, ggit ggtakes ggtime ggto ggdevelop
ggand ggincreases ggthe ggbody ggtemperature.
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