RPN Integrated Post Test II (A):

When planning care for the client, the PN expects that she will need more time and assistance with activities of daily living a. in the early morning. b. at noontime. – at this time the patient must have performed som ...

When planning care for the client, the PN expects that she will need more time and assistance with activities of daily living a. in the early morning. b. at noontime. – at this time the patient must have performed some physical activities that makes muscles more relax c. in late afternoon. – same with option B d. before bedtime. – this is usually rest period Answer: A - People with rheumatoid arthritis are more stiff and uncomfortable in the early morning hours after being inactive during the hours of sleep. Therefore, it is best to allow extra time and distribute selfcare activities over later hours of the day. 2. Which nursing recommendation has the greatest potential for helping the client maintain her ability to care for herself? a. Move to a warm climate.- warm or heat may cause fatigue b. Buy clothes that are easy to pull or slip on. c. Enroll in an aerobic exercise class. – the patient has some stiffness which may cause some difficulty in carrying out ADLs d. Sleep on a waterbed.—the patient needs firm mattress Answer: B - Hand deformity and muscle atrophy make it difficult to perform fine motor movement with the fingers. Purchasing clothes that are pulled on or slipped on enables the client with rheumatoid arthritis to maintain a degree of independence. It is important for the person with arthritis to maintain joint mobility through exercise. Aerobic exercise, however, is unrealistic because it is likely to be too strenuous. Clients with rheumatoid arthritis are often anemic and tire easily. Sleeping on a waterbed or moving to a warm climate has little to no affect on the disease process. 3. During an acute episode of rheumatoid arthritis, the physician asks the PN to apply a splint to each of the client’s hands. The nurse most accurately explains to the client that the primary purpose of the splints is to a. rest the affected joints. b. cure her joint disease. –there’s no known cure for arthritis c. improve her hand strength. –splints may actually cause weakness due to immobility (it’s actually to relive pain or discomforts by immobilizing the painful joints) d. increase her range of motion. – splints immobilize the joints Answer: A - During an acute attack, splints are used primarily to keep the inflamed joints somewhat inactive. Resting the part suppresses additional stress on the diseased joints. The acute inflammation subsides with a combination of drug therapy and the body’s natural healing processes. A certain amount of strength and joint flexibility is preserved by limiting the damage during the acute attack but these choices are not the most appropriate ones. Splinting the affected fingers will not cure the disease. 4. The client tells the PN that when she is at home she takes 400 mg of Ibuprofen (Motrin) four times a day. To determine if a side effect is occurring, which question is most appropriate to ask a client who takes nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen (Motrin)? a. “Have you noticed any hand tremors?” – NSAIDs don’t usually cause tremors b. “Are you urinating more frequently?” – NSAIDs do not cause diuresis c. “Has your interest in food changed?” – NSAIDs have no known effect on the appetite d. “What color are your stools?” Answer: D - Gastrointestinal side effects and the potential for bleeding are common among clients who take nonsteroidal anti-inflammatory drugs (NSAIDs). By asking the client to identify the color of his stools, the nurse is assessing if the drug is causing gastrointestinal bleeding. NSAIDs are not known to cause increased urination or hand tremors. NSAIDs may or may not affect appetite depending on the amount of GI upset. 5. Which item is best for preventing external rotation of the operative leg when caring for the client with the total hip replacement? a. A footboard –this prevents foot drop b. A trochanter roll c. A turning sheet –this help move the patient d. A foam mattress – this prevent pressure on bony prominences Answer: B – trochanter roll is a rolled towel or blanket or anything placed on the side of the affected leg to prevent external rotation 6. The PN caring for the client after the total hip replacement provides discharge teaching instructions regarding positions she must temporarily avoid. Which client statement indicates that she has a correct understanding of the restrictions she must follow? a. The client says she should not cross her legs. (rule of thumb: maximum hip extension and abduction) b. The client says she should not point her toes.- this has nothing to do with hip replacement c. The client says she should not lay flat in bed. d. The client says she should not stand upright. – the patient is allowed to stand straight (this promotes hip extension) Answer: A- A client with a total hip replacement is instructed to avoid crossing the legs. Crossing the legs places the hip in a position of adduction and flexion. These two positions can displace the prosthetic device. Pointing the toes as in plantar flexion or dorsiflexion will not impair the surgical procedure. Laying flat and standing upright are not harmful. 7. When planning the client’s discharge, post hip replacement, it is essential that the PN help the client obtain which item for his home care? a. A wheelchair –sitting in a regular chair (wheelchair) promotes flexion of hip; chair that promotes extension of hip is recommended (bar stool type or firm chair with feet flat on the ground) b. A hospital bed – this has nothing to do with hip replacement c. A raised toilet seat d. A mechanical lift –this is for the patient who cannot transfer from bed to chair Answer: C - Postoperatively and for an extended time afterward, a client with a total hip replacement must avoid flexing the hip more than 90 degrees. This necessitates using a raised toilet seat. The client does not need a wheelchair and can ambulate using a walker. The client can continue to use his own bed at home. The client is taught techniques for transferring from bed to a chair. Therefore, a mechanical lift is unnecessary. 8. Mrs. J. November is newly admitted to the long-term care facility. While the PN is helping her unpack her belongings, she suddenly burst out to crying. What is the PN’s best response? a. “Please don’t cry. Everyone is happy here.” b. “I see that you’re upset. It must be very hard for you to be here.” c. “It is alright to be in the hospital, Mrs. November.” –this is a false reassurance d. “I know how difficult it is for you to be here in the hospital.” – you may not know unless you went through the same experience Answer: B – this is a therapeutic response – called reflecting 9. One of the persons in a group of lactating young mothers in a post-partum class started saying that the only way to have her old jeans she used to wear before pregnancy to fit again is to go back smoking and start dieting. What will the PN discuss in this group? a. The influences of diet on breastfeeding. –the issue is smoking and diet b. The influences of smoking and eating habits on breastfeeding. c. The influence of breastfeeding on lactation.- this is not the issue d. The effect of exercise on weight loss. – smoking, breastfeeding and diet are the issues Answer: B- smoking is contraindicated to mothers who are breastfeeding 10. A patient drank 7 ½ oz of orange juice, 6 oz of tea, and 8 oz of eggnog. The calculated intake would be: a. 515 ml b. 585 ml c. 625 ml d. 645 ml Answer: D - 1 ounce = 30 ml; 7.5 oz + 6 oz + 8 oz X 30 ml = 635 ml