Quiz 1: Eye & Vision Disorders 9.

A patient has had cataract extractions and the nurse

1. The nurse is collecting the history of a client is providing discharge instructions. What should the
diagnosed with a cataract and is performing a focused nurse encourage the patient to do at home?
assessment. Which finding should the nurse anticipate? a. Maintain bed rest for 1 week.
a. A burning sensation and the sensation of an b. Lie on the stomach while sleeping.
object in the eye c. Avoid bending the head below the waist.
b. Blurred or cloudy vision d. Lift weights to increase muscle strength.
c. Inability to produce sufficient tears
d. A swollen lacrimal caruncle 10. The nurse is establishing a visual test using the
Snellen chart for a client experiencing visual changes. At
2. Chemical burns of the eye are immediately treated by: which distance should the nurse instruct the client to
a. Administering local aesthetics and antibacterial stand?
drops for 24 to 36 hours. a. A 10-foot distance
b. Applying hot compresses at 15-minute intervals. b. A 20-foot distance
c. Flushing the lids, conjunctiva, and cornea with c. A 30-foot distance
tap water or normal saline. d. A 40-foot distance
d. Cleansing the conjunctiva with a small
cotton-tipped applicator. 11. A client has developed diabetic retinopathy and is
seeing the physician regularly to prevent further loss of
3. A young baseball player was fielding a ground ball sight. From where do the nerve cells of the retina
when it bounced and struck the player in the left eye, extend?
leaving a large ecchymosis and edema. In client a. optic nerve
education, after applying an ice pack, the nurse explains b. trochlear nerve
the functions of the various structures of the eye. What c. nerve
glands, contained in the eyelids, produce tears? d. trigeminal nerve
a. lacrimal
b. sebaceous 12. A patient is suspected of having glaucoma. What
c. sweat reading of OP would demonstrate an increase resulting
d. olfactory from optic nerve damage?
a. 0 to 5 mm Hg
4. Which of the following eye disorders is caused by an b. 6 to 10 mm Hg
elevated intraocular pressure (10P)? c. 11 to 20 mm Hg
a. Glaucoma d. 21 mm Hg or higher
b. Cataracts
c. Hyperopia 13. When obtaining the health history from a client with
d. Myopia retinal detachment, a nurse expects the client to report:
a. light flashes and floaters in front of the eye. b.
5. A client presents at the ED after receiving a chemical b. a recent driving accident while changing lanes.
burn to the eye. What would be the nurse's initial c. headaches, nausea, and redness of the eyes.
intervention for this client? d. frequent episodes of double vision.
a. Generously flush the affected eye with a dilute
antibiotic solution. 14. The client with chronic open-angle glaucoma is
b. Generously flush the affected eye with normal receiving timolol eye drops. Which evaluation finding
saline or water. would indicate to the nurse the trealment is working?
c. Apply a patch to the affected eye. a. Intraocular pressure 15 mm Hg
d. Apply direct pressure to the affected eye. b. Reduced peripheral vision.
c. Halos around lights
6. The school nurse is testing the kindergarten class with d. Decrease in nausea and vomiting.
the Snellen chart. What is the nurse testing the children
for? 15. A nurse is teaching a client about medications for
a. Near vision glaucoma. What is the main marker of glaucoma control
b. Visual acuity with medication?
c. Hearing a. Changing the opacity of the lens
d. Color vision b. Lowering intraocular pressure to target pressure.
c. Reducing the appearance of optic nerve head
7. A nurse is assessing a pediatric client in a public d. Increasing the visual field
health clinic. The parent states that the client has been
sneezing and rubbing the eyes. The nurses observes the 16. A nurse notices that a client's left upper eyelid is
client's eyes and documents objective symptoms of drooping. The nurse has observed:
watery and red eyes. When reporting to the physician a. ptosis
the assessment findings, which word is appropriate? b. proptosis
a. Signs and symptoms of conjunctivitis c. Ptolemy
b. Signs and symptoms of ptosis d. nystagmus
c. Signs and symptoms of nystagmus
d. Signs and symptoms of proptosis 17. The nurse is assisting the eye surgeon in completing
an examination of the eye. Which piece of equipment
8. An older adult patient has noticed a significant amount would the nurse provide to the physician to examine the
of vision loss in the last few years. What does the nurse optic disc under magnification?
recognize as the most common cause of visual loss in a. Retinoscope
older adults? b. Ophthalmoscope
a. Macular degeneration c. Tonometer
b. Ocular trauma d. Amsler grid
c. Retinal vascular disease
d. Uveitis
18. Which term refers to the absence of the natural lens? d. Phacoemulsification
a. Aphakia
b. Scotoma 27. A client complains to the nurse about having difficulty
c. Keratoconus seeing to read, but reports no difficulty with driving. What
d. Hyphema test would the nurse prepare for the physician to
administer to this client?
19. A client is ready to be discharged home after a a. Rosenbaum
cataract extraction with intraocular lens implant and the b. Ishihara
nurse is reviewing signs and symptoms that need to be c. Snellen
reported to the ophthalmologist immediately. Which of d. Jobst
the client's statements best demonstrates an adequate
understanding? 28. A client in the emergency room was involved in a
a. "I need to call the doctor if I get nauseated." motor vehicle accident which caused blunt facial trauma,
b. "I need to call the doctor if I have a light morning especially to the orbit of the skull. Which bones are in
discharge." danger of fracture in this type of injury? Select all that
c. "I need to call the doctor if I get a scratchy apply.
feeling." a. Lacrimal
d. "I need to call the doctor if I see flashing lights." b. Ethmoid
c. Mastoid
20. The nurse is performing an assessment of the visual d. Stapes
fields for a patient with glaucoma. When assessing the e. Frontal
visual fields in acute glaucoma, what would the nurse
expect to find? 29. A patient is suspected of having retinal detachment.
a. Clear cornea The nurse would expect to prepare the patient for which
b. Constricted pupil of the following? Select all that apply.
c. Marked blurring of vision a. Visual acuity testing
d. Watery ocular discharge b. Slit lamp biomicroscopy.
c. Fluorescein angiography
21. The nurse should monitor for which manifestation in d. Amsler grid testing
a client who has had LASIK surgery? e. Tonometry
a. Excessive tearing
b. Halos and glare 30. The nurse is educating a patient with glaucoma
c. Cataract formation about medications. What medications will the nurse
d. Stye formation educate the patient about that decrease aqueous
production? Select all that apply.
22. The nurse asks a client to follow the movement of a a. Alpha-adrenergic agonists
pencil up, down, right, left, and both ways diagonally. b. Carbonic anhydrase inhibitors
The nurse is assessing which of the following? c. Beta-blockers
a. Pupillary reaction d. Miotics
b. Extraocular muscle function e. Calcium channel blockers
c. Eyelid drooping
d. Eyeball oscillation movements 31. A client is examined due to recent vision changes
and is diagnosed with myopia. What is the cause of this
23. A client is color blind. The nurse understands that client's vision change?
this client has a problem with: a. elongated eyeballs
a. rods b. shortened eyeballs
b. lens c. irregularly shaped corneas
c. cones d. unequal curvatures in the cornea
d. aqueous humor
32. A client has received a diagnosis of hyperopia and is
24. A nurse is performing an eye examination. Which wondering if there is a physical condition that has
question would not be included in the examination? caused these vision changes. In explaining hyperopia,
a. "Are you able to raise both eyebrows?" what does the nurse indicate is the cause of this client's
b. Have you experienced blurred, double, or vision changes?
distorted vision?" a. eyeballs that are shorter than normal
c. "Do any family members have any eye b. irregularly shaped corneas
conditions?" c. unequal curvatures in the cornea
d. "What medications are you taking?" d. eyeballs that are longer than normal

25. The nurse is giving a visual field examination to a 33. A client is scheduled to undergo surgery to remove a
55-year-old male client. The client asks what this test is cataract in the left eye using phacoemulsification. When
for. What would be the nurse's best answer? phacoemulsification is used, a:
a. "This test measures visual acuity." a. small portion of the anterior capsule is removed.
b. "This test measures how well your eyes move." Ultrasound is emitted through a probe, and
c. "This test is to see how well your eyes are suction is used to extract the lens.
aging." b. longer incision is made, and a laser is used to
d. "This test measures peripheral vision and eradicale the cataract. Suction is then used to
detects gaps in the visual field." extract the lens.
c. longer incision is made, and the lens is extracted
26. Which of the following surgical procedures involves in one piece.
taking a piece of silicone plastic or sponge and sewing it d. small incision is made, a laser is used to
onto the sclera at the site of a retinal tear? eradicate the cataract, and the lens is extracted
a. Scleral buckle in one piece.
b. Pars plana vitrectomy
c. Pneumatic retinopexy
34. Which of the following is the overall aim of glaucoma e. Faded areas appear on the page.
treatment?
a. Prevent optic nerve damage 42. The patient with glaucoma is usually started on the
b. Optimize the patient's remaining vision lowest dose of medication. Which of the following is the
c. Reverse optic nerve damage preferred initial topical medication?
d. Reattach the retina a. Bela-blockers
b. Prostaglandins
35. The nurse recognizes the following as marker(s) of c. Carbonic anhydrase inhibitors
medication effectiveness in glaucoma control except: d. Alpha-agonists
a. Lowering intraocular pressure to the target
pressure 43. A client comes to the clinic for a routine examination.
b. Stable appearance of the optic nerve head A her obtaining the ocular history, which of the following
c. Visual field would the nurse do next?
d. Opacity of the lens a. Examine the external eye.
b. Test the client's visual acuity.
36. Which is an accurate statement regarding refractive c. Perform direct ophthalmoscopy.
surgery? d. Prepare the client for a slit-lamp examination.
a. Refractive surgery will alter the normal aging of
the eye. 44. Which of the following would be an inaccurate
b. Refractive surgery may be performed on all clinical manifestation of a retinal detachment?
clients, even if they have underlying health a. Pain
conditions. b. Sudden onset of a greater number of floaters
c. Refractive surgery may be performed on clients c. Cobwebs
with an abnormal corneal structure as long as d. Bright flashing lights
they have a stable refractive error.
d. Refractive surgery is an elective cosmetic 45. Which is the most common cause of visual loss in
surgery performed to reshape the cornea. people older than 60 years of age?
a. Glaucoma
37. Which would be an advanced stage finding in a client b. Macular degeneration
with wet macular degeneration? c. Cataracts
a. inability to see images by looking at them d. Retinal detachment
directly.
b. blurred vision when reading or doing close-up 46. The nurse is caring for a client with increased fluid
work. accumulation in the eye. When assessing the client,
c. diminished perception of color which structure within the eye is noted to drain fluid from
d. distortion of vision the anterior chamber?
a. Fovea centralis
38. The nurse is preparing to assess a client's eyes and b. Canthus
vision. For which reason will the nurse ask the client to c. Canal of Schlemm
move the eyes through all fields of gaze? d. Choroid
a. Assess visual acuity.
b. Determine the status of central vision. 47. Which of the following medication classifications
c. Measure the degree of peripheral vision. increases aqueous fluid outflow in the patient with
d. Evaluate the status of cranial nerves IlI, IV, and glaucoma?
VI. a. Cholinergics
b. Beta blockers
39. A diabetic patient is scheduled for surgery for repair c. Alpha-adrenergic agonists.
of a detached retina that was caused by proliferative d. Carbonic anhydrase inhibitors
retinopathy. 'I'he nurse prepared the patient for surgery,
aware that the type of detachment is most likely 48. Which part of the retina is responsible for central
classified as which of the following? vision?
a. Rhegmatogenous a. Macula
b. Traction b. Optic disk
c. Exudative c. Sclera
d. Traction combined with rhegmatogenous d. Fundus

40. A patient is being seen in the ophthalmology clinic 49. A client comes to the eye clinic for a routine
for a suspected detached retina. What clinical check-up. The client tells the nurse he thinks he is color
manifestations does the nurse recognize as significant blind. What screening test does the nurse know will be
for a retinal detachment? Select all that apply. performed on this client to assess for color blindness?
a. A visual field of floating particles a. Rosenbaum
b. A definite area of blank vision b. Jaeger
c. Momentary flashes of light c. Ishihara
d. Pain d. Snellen
e. Halos around the eyes
50. A client is having a routine eye examination. The
41. The nurse practitioner conducts a vision test on a procedure being performed is done by using an
78-year-old woman. Based on the findings, the nurse instrument to indent or flatten the surface of the cyc. This
concludes that the patient has age-related macular is known as _____ and it is routinely done to test for
degeneration (AMD). What are the signs/symptoms _____.
consistent with this diagnosis? Select all that apply. a. tonometry; intraocular pressure
a. When reading, words are missing letters. b. retinoscopy; detached
b. Straight lines on a paper appear wavy. c. retina tonometry; macular degeneration
c. Changes occur in distinguishing color. d. retinoscopy; cataracts
d. There is increased sensitivity to glare.
Quiz 2: Hearing Disorder c. Closing the eyes when lying down during an
1. The nurse is performing an assessment of a patient's episode of vertigo
ears. When looking at the tympanic membrane, the d. Performing self-care activities when the vertigo
nurse observes a healthy membrane. What should the first starts
appearance be?
a. Pearly gray and translucent 8. The nurse is caring for an 86-year-old client with
b. White and cloudy hearing impairment. The nurse is preparing to educate
c. Pink with white exudate the client on the diagnosis and discharge plan. What
d. Dark yellow with cerumen action(s) should the nurse take when talking with the
client? Select all that apply.
2. A patient has been treated for external otitis for the a. Always face the client when talking.
second time during the summer months. What education b. Ensure adequate lighting by standing in front of
can be provided for the patient to reduce the risk of an uncovered window.
developing this problem? Select all that apply. c. Provide written instructions and information.
a. Do not clean the external canal with d. Speak in a loud, high-pitched tone.
cotton-tipped applicators. e. Written material is written to an eighth-grade
b. Irrigate the ears daily with a warm saline reading level.
solution.
c. Avoid getting the ear wet when swimming or 9. Which of the following medications may be used in the
showering. treatment of motion sickness?
d. Use an antiseptic otic preparation after a. Dimenhydrinate (Dramamine)
swimming, unless there is a history of tympanic b. Peroxide in glycerol (Debrox)
membrane perforation. c. Intravenous Diazepam (Valium)
e. Ensure that cerumen is absent from the external d. Furosemide (Lasix)
canal by irrigating once a week after instilling
mineral oil. 10. A client with Meniere's disease has a nursing
diagnosis of risk for injury related to gait disturbances
3. The nurse is talking with a patient diagnosed with and vertigo. Which of the following would be most
Ménière's disease about the patient's symptoms. What appropriate to include in this client's plan of care?
symptom does the patient inform the nurse is the most a. Moving the head from side-to-side when vertigo
troublesome? occurs
a. Nausea b. Sitting down at the first sign of feeling dizzy
b. Tinnitus c. Closing the eyes when lying down during an
c. Diarrhea episode of vertigo
d. Vertigo d. Performing self-care activities when the vertigo
first starts
4. Some clients with acoustic neuromas have vertigo.
What is a priority nursing action for clients with vertigo? 11. Which symptom is related to vertigo?
a. Protect the client from injury a. Loss of consciousness
b. Provide small meals of tepid food. b. Spinning sensation
c. Mobilize the client at every opportunity. c. Fainting
d. Provide ice to the affected ear. d. Syncope

5. A nurse needs to change a dressing on an abdominal 12. Which instruction regarding swimming should the
wound for a patient who is hearing-impaired and whose nurse give to the client who is recovering from otitis
speech is difficult to understand. Which of the following externs?
is the best approach for the nurse? a. Wear a scarf
a. Write down the steps of the procedure for the b. Avoid cold water
patient to read before beginning the treatment. c. Avoid swimming for 7-10 days
b. Change the dressing while the patient is reading d. Insert a loose cotton pledget in the external ear
the steps of the treatment because distraction
decreases anxiety. 13. What information would be important to ask the
c. Use nonverbal signals of agreement (head family members to help you care for your client?
nodding), even if unsure, to instill confidence a. How the client lost their hearing
and trust. b. What allergies the client has
d. Minimize misunderstandings by completing the c. The client's preferred method of communication
patient's sentences (fill-in-the-blanks) to d. How much the client weighs
decrease the patient's embarrassment.
14. Which manifestation is the most problematic for the
6. The nurse is planning the care of a client with a client diagnosed with Ménière disease?
diagnosis of vertigo. What nursing diagnosis risk should a. Tinnitus
the nurse prioritize in this client's care? b. Diaphoresis
a. Risk for disturbed sensory perception c. Vertigo
b. Risk for unilateral neglect d. Hearing loss
c. Risk for falls
d. Risk for ineffective health maintenance 15. The nurse is developing a plan of care for a client
with Meniere's disease and identifies a nursing diagnosis
7. A client with Meniere's disease has a nursing of excess fluid volume related to fluid retention in the
diagnosis of risk for injury related to gait disturbances inner ear. Which intervention would be most appropriate
and vertigo. Which of the following would be most to include in the plan of care?
appropriate to include in this client's plan of care? a. Limit foods that are high in sodium.
a. Moving the head from side-to-side when vertigo b. Encourage intake of caffeinated fluids.
occurs c. Administer prescribed antihistamine.
b. Sitting down at the first sign of feeling dizzy d. Restrict high-potassium foods.
16. Which phrase defines ossiculoplasty? 25. Nursing assessment of hearing loss in an older adult
a. Surgical reconstruction of the middle ear bones client includes evaluation of age-related changes, as
b. Surgical repair of the eardrums well as a history of current illnesses and medications.
c. Incision into the tympanic membrane Which of the following factors are associated with
d. Incision into the eardrum ototoxic effects? Select all that apply.
a. Coronary artery disease
17. Which of the following is an involuntary rhythmic b. Diabetes mellitus
movement of the eyes that is also associated with c. Loop diuretics (e.g., Lasix)
vestibular dysfunction? d. Asthma
a. Nystagmus e. Gentamicin
b. Vertigo
c. Tinnitus 26. Which statement describes benign paroxysmal
d. Presbycusis positional vertigo (BPPV)?
a. The vertigo is usually accompanied by nausea
18. A client presents to the ED reporting a sudden onset and vomiting; generally, however, hearing is not
of incapacitating vertigo, with nausea and vomiting and impaired.
tinnitus. The client mentions to the nurse experiencing a b. The onset of BPPV is gradual.
sudden hearing loss. What would the nurse suspect the c. BPPV is caused by tympanic membrane
client's diagnosis will be? infection.
a. Ossiculitis d. BPPV is stimulated by the use of certain
b. Ménière disease
c. Ototoxicity 27. A client is diagnosed with benign paroxysmal
d. Labyrinthitis positional vertigo. Which information will the nurse
provide about a step in canalith repositioning?
19. Which term refers to surgical repair of the tympanic a. Shaking the head to the left and right
membrane? b. Rapidly changing positions from sitting to supine
a. Tympanotomy c. Rotating the head to the left, right, up, and down
b. Myringotomy d. Moving the head left to right in the prone
c. Ossiculoplasty position
d. Tympanoplasty
28. An older adult with a recent history of mixed hearing
20. A client comes to the walk-in clinic reporting feeling a loss has been diagnosed with a cholesteatoma. What
"bug in my ear." What action should be taken when there should this client be taught about this diagnosis? Select
is an insect in the ear? all that apply.
a. Instillation of mineral oil a. Cholesteatomas are benign and self-limiting,
b. Instillation of carbamide peroxide and hearing loss will resolve spontaneously.
c. Instillation of hot water b. Cholesteatomas are usually the result of
d. Use of a small forceps metastasis from a distant tumor site.
c. Cholesteatomas are often the result of chronic
21. Which is a correct rationale for encouraging a client otitis media.
with otitis externa to eat soft foods? d. Cholesteatomas, if left untreated, result in
a. Chewy foods, such as red meat, may react with intractable neuropathic pain.
prescribed analgesics and antibiotics. e. Cholesteatomas usually must be removed
b. Chewing may cause discomfort. surgically.
c. Chewing may lead to further complications, such
as otitis media. 29. The nurse is instructing a patient with Ménière's
d. Chewing may cause excessive drainage. disease on dietary management to include as an adjunct
to other more traditional therapies. The nurse would
22. The nurse is performing a Weber test on a client. include which of the following? Select all that apply.
During this test, where should the nurse place the tuning a. Limit foods high in salt and sugar.
fork? b. Avoid aspirin and aspirin products.
a. On the mastoid process behind the ear c. Avoid coffee, tea, and soft drinks.
b. In the midline of the client's skull or in the center d. Avoid high-fiber foods.
of the forehead
c. Near the external meatus of each ear d. 30. What is located in the cochlea of the inner ear?
d. Under the bridge of the nose a. Semicircular canals
b. Labyrinth
23. The nurse is caring for a patient with Ménière's c. Vestibulocochlear nerve
disease who is hospitalized with severe vertigo. What d. Organ of Corti
medication does the nurse anticipate administering to
shorten the attack?
a. Meclizine (Antivert)
b. Furosemide (Lasix
c. Cortisporin otic solution
d. Gentamicin (Garamycin) intravenously

24. Hearing aids help patients by ______?

a. Making the sounds louder
b. Improving discrimination of words
c. Improving understanding of speech
d. Improving communication skills
Quiz 3: Musculoskeletal Disorders 8. Localized rapid bone turnover, most commonly
1. The nurse is caring for the client with chronic affecting the skull, femur, tibia, pelvic bones, and
osteomyelitis of the jaw with a draining wound. Which vertebrae, is characterized by which bone disorder?
client goal is a priority for the client? Select all that apply. a. Osteomalacia
a. The client will experience a tolerable level of b. Osteoporosis
pain. c. Osteomyelitis
b. The client will demonstrate wound care. d. Osteitis deformans
c. The client will maintain adequate nutritional
intake. 9. A provider prescribes a subcutaneous anabolic agent
d. The client will remain free from injury. for an older adult client to prevent fractures associated
e. The client will maintain effective airway with osteoporosis. What is the most likely prescribed
clearance. drug?
a. Alendronic acid
2. A nurse is performing discharge teaching for an b. Raloxifene
elderly client diagnosed with osteoporosis. Which c. Calcitonin
statement about home safety should the nurse include? d. Teriparatide
a. "Most falls among the elderly ocour outside the
home. Clients should confine themselves to their 10. An older adult fernale has a bone density test that
homes as much as practical." reveals severe osteoporosis. What does the nurse
b. "Most accidental injuries among the elderly are understand can be a problem for this client due to the
automobile-related. Elderly clients should have decrease in bone mass and density?
vision testing every 6 months while they're still a. Diabetes
driving." b. Compression fractures
c. "Because of the increase in home burglaries c. Hypertension
involving the elderly, these clients should have d. Cardiac disease
burglar bars on every window in the home."
d. "Most falls among the elderly occur in the home. 11. Which common problem of the upper extremity
These clients should remove throw rugs and results from entrapment of the median nerve at the
install bathroom grab bars wrist?
a. Ganglion
3. The nurse provides teaching to a client with b. Dupuytren's contracture
osteoarthritis (OA). Which statements) indicate that c. Bursitis
teaching about pain management and functional ability d. Carpal tunnel syndrome
were effective? Select all that apply.
a. "I will spend more time resting 12. Which aspect should a nurse include in the teaching
b. "I will need to lose some weight." plan for a client with osteomalacia?
c. "I will avoid using a cane to walk." a. Avoid dairy products
d. "I will take the pain medication after exercising." b. Include calcium, phosphorus, and vitamin D
e. "I will increase the amount of walking I do every supplements
day." c. Avoid green, leafy vegetables
d. Avoid any activity or exercise
4. A nurse is teaching a client with osteoporosis about
dietary selections. What client statement indicates the 13. A patient stepped on an acorn while walking barefoot
teaching was effective? in the backyard and developed an infection progressing
a. "I will decrease my intake of red meat." to osteomyelitis. What microorganism does the nurse
b. "I will decrease my intake of popcorn, nuts, and understand is most often the cause of the development
seeds." of osteomyelitis?
c. "I will eat more fruits to increase my potassium a. Proteus
intake." b. Salmonella
d. "I will eat more dairy products to increase my c. Pseudomonas
calcium intake." d. S. aureus

5. A health care provider diagnoses primary 14. Which classic symptom will the nurse assess for to
osteoporosis in a client who has lost bone mass. For detect the development of plantar fasciitis?
which client is primary osteoporosis most common? a. Shortened height
a. elderly man b. Morning heel pain
b. young child c. Elevated temperature
c. young menstruating woman d. Shortening of affected leg
d. elderly postmenopausal woman
15. A client is diagnosed with carpal tunnel syndrome.
6. Lifestyle risk factors for osteoporosis include: Which assessment findings would the nurse expect?
a. lack of aerobic exercise. a. Pain radiating down the dorsal surface of the
b. a low-protein, high-fat diet. forearm
c. an estrogen deficiency or menopause. b. Tenderness in the affected wrist
d. lack of exposure to sunshine. c. Inability to flex index and middle fingers
d. A decrease in grasp strength
7. The nurse is providing teaching to a client with a mild
case of bunions. Which suggestion would be most 16. The nurse teaches the client with a high risk for
important for the nurse to give this client? osteoporosis about risk-lowering strategies, including
a. Avoid strenuous exercise which action?
b. Avoid foot creamts, a. Increase fiber in the diet
c. Don proper footwear. b. Walk or perform weight-bearing exercises
d. Regularly use analgesics. c. Reduce stress
d. Decrease the intake of vitamins A and D
17. A nurse is providing care for a client who has a
recent diagnosis of Paget disease. When planning this 25. A client with diabetes is attending a class on the
client's nursing care, what should interventions address? prevention of associated diseases. What action should
Select all that apply. the nurse teach the client to reduce the risk of
a. Impaired physical mobility osteomyelitis?
b. Acute pain a. Increase calcium and vitamin intake.
c. Disturbed auditory sensory perception b. Monitor and control blood glucose levels
d. Risk for injury c. Exercise 3 to 4 times weekly for at least 30
e. Risk for unstable blood glucose minutes.
d. Take corticosteroids as ordered.
18. The nurse is gathering a health history for a client
with osteoarthritis. What clinical manifestation will the 26. A nurse is performing foot care for a client with
nurse expect to find? chronic osteomyelitis and the client asks the nurse about
a. small joint involvement the next treatment What is the specific treatment for a
b. joint pain that increases with rest client with chronic osteomyelitis?
c. subcutaneous nodules a. Aggressive physical therapy
d. early morning stiffness b. Drainage of localized foci of infection
c. Continued aseptic wound treatment
19. A patient shows the nurse a round, firm nodule on d. Surgical removal o the sequestrum
the wrist. The pain is described as aching, with some
weakness of the fingers What treatment does the nurse 27. A client is scheduled for surgery to fuse a joint. The
anticipate assisting with? (Select all that apply.) nurse identifies this as which of the following?
a. Educating the patient on the use of gabapentin a. Osteotomy
b. Active range-of-motion exercises b. Arthrodesis
c. Corticosteroid injections c. Arthroplasty
d. Surgical excision d. Open reduction internal fixation
e. Aspiration of the cyst
28. ​The nurse is assessing the feet of a patient and
20. The health care provider has preseribed plicamycin observes an overgrowth of the horny layer of the
to control serum calcium levels in a client with Paget's epidermis. What does the nurse recognizde this
disease. The dose prescribed is 25 micrograms per kg. condition as?
The client weighs 132 Ibs. How many milligrams will the a. Bunion
nurse expect the client to receive? b. Clawfoot
a. 1.5 c. Corn
b. 1500 d. Hammer toe
c. 15
d. 150 29. A nurse is discussing conservative management of
tendonitis with a client. What is the nurse's best
21. The client has just been diagnosed with recommendation?
osteomyelitis. What are possible causes of a. Weight reduction
osteomyelitis? Select all that apply. b. Use of oral opioid analgesics
a. Trauma, such as penetrating wounds or c. Intermittent application of ice and heat
compound fractures d. Passive range of motion exercises
b. Vascular insufficiency in clients with diabetes or
peripheral vascular disease
c. Surgical contamination, such as pin sites of 30. An older adult client sought care for the treatment of
skeletal traction a swollen, painful knee joint. Diagnostic imaging and
d. Progressive osteoporosis culturing of synovial fluid resulted in a diagnosis of septic
arthritis. The nurse should prioritize what aspect of care?
22. Which of the following is the first-line medication that a. Administration of oral and V corticosteroids as
would be used to treat and prevent osteoporosis? prescribed
a. Bisphosphonates b. Prevention of falls and pathologic fractures
b. Calcitonin c. Maintenance of adequate serum levels of Vit. D
c. Selective estrogen receptor modulators d. Intravenous administration of antibiotics
d. Anabolic agents
31. Which medication directly inhibits osteoclasts,
23. A nurse is caring for a client with Paget disease and thereby reducing bone loss and increasing BMD?
is reviewing the client's most recent laboratory values. a. Calcitonin (Miacalcin)
Which of the following values are most characteristic of b. Raloxifene (Evista)
Paget disease? c. Teriparatide (Forteo)
a. An elevated level of parathyroid hormone and d. Vitamin D
low calcitonin levels
b. A low serum alkaline phosphatase level and a 32. A healthcare provider asks a nurse to test a client for
low serum calcium level Tinel's sign to diagnose carpal tunnel syndrome. What
c. An elevated serum alkaline phosphatase level should the nurse do to perform this assessment?
and a normal serum calcium level a. Have the client make a fist and open the hand
d. An elevated calcitonin level and low levels of against
parathyroid hormone b. resistance.
c. Have the client stretch the fingers around a ball
24. In which deformity does the great toe deviate and squeeze with force
laterally? d. Have the client hold the palm of the hand up
a. Hammertoe while the nurse percusses over the median
b. Pes cavus nerve.
c. Hallux valgus e. Have the client pronate the hand while the nurse
d. Plantar fasciitis palpates the radial nerve.
33. A nurse is teaching a client about preventing 40. A client with osteoporosis is prescribed calcitonin
osteoporosis. Which teaching point is correct? 100 unites subcutaneously. The medication is available
a. Obtaining an X-ray of the bones every 3 years is 200 units per ml. How many mililiters will the nurse
recommended to detect bone loss. administer to the client?
b. To prevent fractures, the client should avoid a. 0.5
strenuous exercise. b. 2
c. The recommended daily allowance of calcium c. 1
may be found in a wide variety of foods. d. 1.5
d. Obtaining the recommended daily allowance of
calcium requires taking a calcium supplement. 41. A client is complaining of severe pain in the left great
toe. What lab studies that the nurse reviews indicate that
34. A client with Paget's disease comes to the hospital the client may have gout?
and reports difficulty urinating. The emergency a. Elevated white blood count
department health care provider consults urology. What b. Elevated uric acid levels
should the nurse suspect is the most likely cause of the c. Decreased hemoglobin and hematocrit
client's urination problem? d. Increased AST and ALT
a. Renal calculi
b. Urinary tract infection (UTI) 42. A client is experiencing an acute attack of gout.
c. Benign prostatic hyperplasia Which medications will the nurse anticipate being
d. Dehydration prescribed for this client? Select all that apply.
a. Colchicine
35. Which group is at the greatest risk for osteoporosis? b. Allopurinol
a. Men c. Febuxostat
b. European American women d. Prednisone
c. Asian American women e. Ibuprofen
d. African American Women
43. A nurse should advise a client with gout to avoid which
36. A client with carpal tunnel syndrome has had limited foods?
improvement with the use of a wrist splint. The nurse a. Bread and cereal
knows that which procedure will show the greatest b. Fruits and juices
improvement in treatment for this client? c. Organ meats and scallops
a. Laser therapy d. Nuts and peanut butter
b. Ultrasound therapy
c. Open nerve release 44. A client is diagnosed with primary hyperuricemia.
d. Injection of lidocaine Which information in the client's health history will the
nurse use to substantiate this diagnosis? Select all that
37. During a routine physical examination on an older apply.
female client, a nurse notes that the client is 5 feet, ⅜ a. Takes 20 mg of furosemide daily
inches (1.6) tall. The client states. “How is that possible? b. Being treated for psoriasis
I was always 5 feet and ½? (1.7m) tall.” which statement c. Has daily intake of shellfish
is the best response by the nurse? d. Takes 81 mg of aspirin every day
a. After age 40, height may show a gradual e. Has a family history of hyperuricemia
decrease as a result of spinal compression"
b. "After menopause, the body's bone density 45. The nurse is preparing to assess a client
declines, resulting in a gradual loss of height." experiencing symptoms of gout. Which findings indicate
c. "There may be some slight discrepancy between to the nurse that the client is experiencing gout
the measuring tools used." syndrome? Select all that apply.
d. "The posture begins to stoop after middle age." a. Tophi
b. Uric acid urinary calculi
38. A nurse is teaching a client who was recently c. Lower extremity wounds
diagnosed with carpal tunnel syndrome. Which d. Severe articular inflammation
statement should the nurse include? e. Lack of hair over the lower extremities
a. "This condition is associated with various
sports." 46. As part of the assessment process for a client
b. "Surgery is the only sure way to manage this suspected of having gout, the nurse evaluated the
condition." client's serum uric acid levels. Select the value that is
c. "Using arm splints will prevent hyperflexion of considered above the saturation point for crystal
the wrist." formation.
d. "Ergonomic changes can be incorporated into a. 3.2 mg/dL (0.19mmol/L)
your workday to reduce stress on your wrist." b. 4.0 mg/dL (0.24 mmol/L)
c. 5.4 mg/dL (0.32 mmol/L)
39. A client with diabetes has been diagnosed with d. 6.8 mg/dL (0.40 mmol/L)
osteomyelitis. The nurse observes that the client’s right
foot is pale and mottled, cool to touch, with a capillary 47. A client asks the nurse what the difference is
refill of greater than 3 seconds. The nurse should between osteoarthritis (OA) and rheumatoid arthritis
suspect what type of osteomyelitis? (RA). Which response is correct?
a. Hematogenous osteomyelitis a. "OA is a noninflammatory joint disease. RA is
b. Osteomyelitis with vascular insufficiency characterized by inflamed, swollen joints."
c. Contiguous-focus osteomyelitis b. "OA and RA are very similar. OA affects the
d. Osteomyelitis with muscular deterioration smaller joints and RA affects the larger,
weight-bearing joints."
c. "OA affects joints on both sides of the body. RA
is usually unilateral."
d. "OA is more common in women. RA is more
common in men."
48. The nurse is completing a health history with a client
in a clinic. What assessment finding best correlates with
a diagnosis of osteoarthritis?
a. joint stiffness that increases with activity
b. erythema and edema over the affected joint
c. anorexia and weight loss
d. fever and malaise

49. A client is taking ibuprofen for the treatment of

osteoarthritis. What education will the nurse give the
client about the medication?
a. Take the medication on an empty stomach in
order to increase effectiveness.
b. Since the medication is able to be obtained over
the counter, it has few side effects.
c. Take the medication with food to avoid stomach
upset.
d. Inform the health care provider if there is ringing
in the ears.

50. A client arrives at the clinic with reports of pain in the

left great toe. The nurse assesses a swollen, warm,
erythematous left great toe. What disorder will the nurse
relate the client symptoms to?
a. Rheumatoid arthritis
b. Osteoarthritis
c. Fibromyalgia
d. Gout
Quiz 4: Musculoskeletal Trauma Part 1 8. A client sustains an injury to the left ankle in a fall.
1. Emergency medical technicians transport a client to There was immediate swelling and pain from the injury,
the emergency department and inform the nurse that the and the client was taken to the local emergency
client fell from a two-story building. The comatose client department. What initial test does the nurse anticipate
has a large contusion on the left side of the chest, a the physician will order to rule out a fracture?
hematoma in the left parietal area, and a compound a. Arthrography
fracture of the left femur. The client was intubated and is b. Arthroscopy
maintaining an. arterial oxygen saturation of 92% by c. X-ray
pulse oximeter with a manual-resuscitation bag. Which d. Computerized tomography (CT scan)
intervention by the nurse has the highest priority?
a. Assessing the left leg 9. Which is one of the most common causes of death in
b. Assessing the pupils clients diagnosed with fat emboli syndrome?
c. Placing the client in Trendelenburg's position a. Myocardial infarction
b. Stroke
2. Which nursing diagnosis is the most appropriate for a c. Acute respiratory distress syndrome
client with a strained ankle? d. Pulmonary embolism
a. Impaired skin integrity
b. Impaired physical mobility 10. A client arrives in the emergency room complaining
c. Risk for deficient fluid volume of severe pain in her left hip after falling out of the bed.
d. Disturbed body image What indication upon assessment does the nurse
recognize as a dislocated left hip? Select all that apply.
3. A client sprains an ankle while playing tennis and is a. The left leg is shorter than the right. b?
brought to the emergency department. What is the b. Limited range of motion of the left hip.
priority action by the nurse? c. The skin over the left hip is warm.
a. Heat, compression, analgesics, and exercise d. The skin of the lower left leg is pale.
b. Rest, heat, compression, and elevation e. The client is able to bend the knee but not move
c. Rest, ice, compression, and elevation toes.
d. Exercise, ice, compression, and elevation
11. A nurse is writing a care plan for a client admitted to the
4. A client who has fractured the radial head asks the emergency department (ED) with an open fracture. The nurse
nurse about factors that will promote bone healing. will assign priority to what nursing diagnosis for a client with an
Which statement should the nurse include when open fracture of the radius?
responding to the client? Select all that apply. a. Risk for infection
a. "Immobilization of the fracture will promote b. Risk for ineffective role performance
healing by maximizing contact of bone c. Risk for perioperative positioning injury
fragments." d. Risk for powerlessness
b. "Fractured bones require a good blood supply
and adequate nutrition for healing." 12. An x-ray demonstrates a fracture in which the
c. "Weight bearing stimulates healing of the long r fragments of bone are driven inward. This type of
bones of the leg, if the fracture is stabilized. fracture is referred to as?
d. "Adults heal faster than children because adult a. depressed.
bodies are physiologically more mature." b. compound.
e. "Corticosteroids will decrease the bone and soft c. comminuted
tissue inflammation associated with the d. impacted.
fracture."
13. Which type of fracture occurs when a bone fragment
5. A nurse is inspecting the area of contusion and notes is driven into another bone fragment?
numerous areas of bruising. How would the nurse a. Impacted
document this finding? b. Oblique
a. Whiplash injury c. Spiral
b. Callus d. Transverse
c. Ecchymosis
d. Palsy 14. Which type of fracture produces several bone
fragments?
6. Which term refers to a blunt force injury to soft tissue? a. Comminuted
a. Contusion b. Open
b. Dislocation c. Oblique
c. Strain d. Incomplete
d. Stain.
15. Which factor may contribute to compartment
7. A client has a fractured femur and is being seen in the syndrome?
emergency department. The nurse assessing the area a. Hemorrhage
notices there is a grating sound that is suspected to be b. Macular lesion
bone ends moving over one another. This sound is c. Venous thromboembolus
called: d. Disuse syndrome
a. crepitus.
b. false motion. 16. A classic indicator of edema and alveolar
c. spasm. hemorrhage associated with Fat Embolism Syndrome is:
d. Deformity. a. Tachycardia.
b. Hyperventilation.
c. Crackles and wheezes.
d. Tachypnea.
17. If a dislocation is not treated promptly, tissue death 25. A client with metastatic bone cancer sustained a left
due to anoxia can occur. This would be documented as hip fracture without injury. What type of fracture does the
which of the following? nurse understand occurs without trauma or fall?
a. Avascular necrosis (AVN) a. Impacted fracture
b. Subluxation b. Transverse fracture
c. Heterotopic ossification c. Compound fracture
d. Osteomyelitis d. Pathologic fracture

18. A 75-year-old client had surgery for a left hip fracture 26. A client has sustained a right tibial fracture and has
yesterday. When completing the plan of care, the nurse just had a cast applied. Which instruction should the
should include assessment for which complications? nurse provide in client cast care?
Select all that apply. a. "Cover the cast with a blanket until the cast
a. Pneumonia dries."
b. Necrosis of the humerus b. "Keep your right leg elevated above heart level."
c. Skin breakdown c. "Use a knitting needle to scratch itches inside
d. Sepsis the cast."
e. Delirium d. "A foul smell from the cast is normal."

19. When caring for a client with a fracture, what 27. A patient sustained an open fracture of the femur 24
assessment would take priority? hours ago. While assessing the patient, the nurse
a. Neurovascular compromise observes the patient is having difficulty breathing, and
b. Hormonal imbalances oxygen saturation decreases to 88% from a previous
c. Cardiac problems 99%. What does the nurse understand is likely occurring
d. Altered kidney function with this patient?
a. Spontaneous pneumothorax
20. A client with a fracture develops compartment b. Cardiac tamponade
syndrome that requires surgical intervention. What c. Pneumonia
treatment will the nurse would most likely prepare the d. Fat emboli
client for?
a. Bone graft
b. Joint replacement
Heart rate 116 bpm
c. Fasciotomy
d. Amputation
Respiratory raite 32/min
21. A client has been in a motor vehicle collision.
pH 7.60
Radiographs indicate a fractured humerus; the client is
awaiting the casting of the upper extremity and
CO2 30 mmHG
admission to the orthopedic unit. What is the primary
treatment for musculoskeletal trauma?
HCO2 24 mEq/L
a. immobilization
b. surgical repair Pao 55 mmHG
c. external rotation
d. enhancing complications
28. Which assessment findings would the nurse expect
22. A client is brought to the emergency department to find in the postoperative client experiencing fat
after injuring the right arm in a bicycle accident. The embolism
orthopedic surgeon tells the nurse that the client has a a. Column A
greenstick fracture of the arm. What does this mean? b. Column B
a. The fracture line extends through the entire c. Column C
bone substance. d. Column D
b. The fracture results from an underlying bone
disorder. 29. Which factor inhibits fracture healing?
c. Bone fragments are separated at the fracture a. Increased vitamin D and calcium in the diet
line. b. Age of 35 years
d. One side of the bone is broken and the other c. History of diabetes
side is bent. d. Immobilization of the fracture

23. Elderly clients who fall are most at risk for which 30. A client sustains an injury to the ligaments
injuries? surrounding a joint. What will the nurse identify this injury
a. Wrist fractures as?
b. Humerus fractures a. Strain
c. Pelvic fractures b. Contusion
d. Cervical spine fractures c. Sprain
d. Fracture
24. A client sustains a fractured right humerus in an
automobile accident. The arm is edematous, the client 31. A client has been diagnosed with a muscle strain.
states not being able to move or feel the fingers, and the What does the physician mean by the term "strain"?
nurse does not feel a pulse. What condition should the a. stretched or pulled beyond its capacity
nurse be concerned about that requires emergency b. injury resulting from a blow or blunt trauma
measures? c. injuries to ligaments surrounding a joint
a. Compartment syndrome d. subluxation of a joint
b. Dislocation
c. Muscle spasms 32. A client is recovering from a-below-the-knee
d. Subluxation traumatic amputation and is 72 hours post surgery.
Which actions will the nurse take to promote healing of a. Nonunion
the wound? Select all, that apply. b. Delayed union
a. Measure the residual limb every 8 to 12 hours.- c. Malunion
b. Elevate the residual limb on a pillow when d. Subluxation
seated.
c. Assess neurovascular function of the residual 39. Which client(s) is most likely to have compartment
limb. syndrome after sustaining a fracture? Select all that
d. Apply an elastic compression bandage over the apply.
wound site. a. The client with elevated pressure within the
e. Remind to place the residual limb in a muscles
dependent position when sitting. b. The client with hemorrhage in the site of injury
c. The client with a plaster cast applied
immediately after injury
d. The client who sustained a clavicle fracture
e. The client using ice to control pain in the
33. A client has presented to the emergency department extremity
with an injury to the wrist. The client is diagnosed with a
third-degree strain. Why would the health care provider 40. A client has delayed bone healing in a fractured right
prescribe an x-ray of the wrist? humerus. What should the nurse prepare the client for
a. Nerve damage is associated with third-degree that promotes bone growth?
strains. a. Electrical stimulation
b. Compartment syndrome is associated with b. Administration of low-dose heparin
third-degree strains. c. Joint fusion
c. Avulsion fractures are associated with d. Administration of antibiotics
third-degree strains.
d. Greenstick fractures are associated with 41. A nurse in a busy emergency department provides
third-degree strains. care for many clients who present with contusions,
strains, or sprains. What are treatment modalities that
34. A client with a right below-the-knee amputation is are common to all of these musculoskeletal injuries?
being transferred from the postanesthesia care unit to a Select all that apply.
medical-surgical unit. What is the highest priority nursing a. Massage
intervention by the receiving nurse? b. Applying ice
a. Ensure that a large tourniquet is in the room. c. Compression dressings
b. Document the receiving report from the d. Resting the affected extremity
transferring nurse. e. Corticosteroids
c. Delegate the gathering of enough pillows for f. Elevating the injured limb
proper positioning and comfort.
d. Review the physician's orders for type and 42. Pulselessness, a very late sign of compartment
frequency of pain medication syndrome, may signify
a. Venous congestion
35. A nurse's assessment of a client's knee reveals b. Nerve involvement
edema, tenderness, muscle spasms, and ecchymosis. c. Diminished arterial perfusion
The client states that 2 days ago the client ran in a d. Lack of distal tissue perfusion
long-distance race and now it "really hurts to stand up."
The nurse should plan care based on the belief that the 43. A client is brought in by ambulance to the emergency
client has experienced what injury? department after being involved in a motorcycle
a. A first-degree strain accident. The client has an open fracture on his tibia.
b. A second-degree strain The wound is highly contaminated and there is extensive
c. A first-degree sprain soft- tissue damage. How would this client's fracture
d. A second-degree sprain likely be graded?
a. Grade I
36. A patient sustains an open fracture of the left arm b. Grade II
after an accident at the roller skating rink. What does c. Grade III
emergency management of this fracture involve? (Select d. Grade IV
all that apply.)
a. Covering the area with a clean dressing if the 44. Which is a hallmark sign of compartment syndrome?
fracture is open a. Motor weakness
b. Immobilizing the affected site b. Edema
c. Splinting the injured limb c. Pain
d. Asking the patient if he or she is able to move d. Weeping skin surfaces
the arm
e. Wrapping the arm in an ace bandage 45. A client was fitted with an arm cast after fracturing
the humerus. Twelve hours after the application of the
37. A client is hospitalized for open reduction of a cast, the client tells the nurse that the injured arm hurts.
fractured femur. During the postoperative assessment, Analgesics do not relieve the pain. What would be the
the nurse notes that the client is restless and observes most appropriate nursing action?
petechiae on the client's chest. Which nursing action is a. Prepare the client for opening or bivalving of the
indicated first? cast.
a. Elevate the affected extremity. b. Obtain a prescription for a different analgesic.
b. Contact the nursing supervisor. c. Encourage the client to wiggle and move the
c. Administer oxygen. fingers.
d. Contact the health care provider. d. Petal the edges of the client's cast.

38. Which of the following describes failure of the ends 46. Colles fracture occurs in which area?
of a fractured bone to unite in normal alignment? a. Elbow
 b. Humeral shaft
c. Clavicle
d. Distal radius

47. Radiographic evaluation of a client's fracture reveals

that a bone fragment has been driven into another bone
fragment. The nurse identifies this as which type of
fracture?
a. Comminuted
b. Compression
c. Impacted
d. Greenstick

48. Which of the following disorders results in

widespread hemorrhage and microthrombosis with
ischemia?
a. Disseminated intravascular coagulation (DIC)
b. Avascular necrosis (AVN)
c. Complex regional pain syndrome (CRPS)
d. Fat embolism syndrome (FES)

49. A client was playing softball and was hit in the right
ankle by the ball sustaining a contusion. What is the first
action taken to help alleviate pain and swelling?
a. Apply heat to the ankle.
b. Apply a cold pack to the ankle.
c. Administer ibuprofen (Advil).
d. Ask the client to walk to stretch the ligaments.

50. Which nursing diagnosis is a priority for a client with

a traumatically amputated lower extremity?
a. Impaired skin integrity related to effects of the
injury.
b. Anticipatory grieving related to the loss of a limb.
c. Disturbed body image related to changes in the
structure of a body part.
d. Risk for injury related to amputation.
Quiz 5: Renal Disorders 8. A client with a history of chronic renal failure receives
1. Based on her knowledge of the primary cause of hemodialysis treatments three times per week through
end-stage renal disease, the nurse knows to assess the an arteriovenous (AV) fistula in the left arm. Which
most important indicator. What is that indicator? intervention should the nurse include in the care plan?
a. Blood pressure a. Keep the AV fistula site dry.
b. Serum glucose b. Keep the AV fistula wrapped in gauze.
c. Urine protein c. Take the client's blood pressure in the left arm
d. pH and HCO3 d. Assess the AV fistula for a bruit and thrill.

2. A client has a decreased secretion of erythropoietin 9. A 15-year-old is admitted to the renal unit with a
from the kidncys due to end-stage kidney disease. The diagnosis of postinfectious glomerular disease. The
nurse explains that the decrease in erythropoietin will nurse should recognize that this form of kidney disease
have what effect? may have been precipitated by what event?
a. Aneria from the decrease in maturation of RBCs a. Psychosocial stress
b. Decrease in blood sugar levels due to alteration b. Hypersensitivity to an immunization
in insulin levels c. Menarche
c. Increase in blood sugar levels due to alteration d. Streptococcal infection
in insulin levels
d. Development of male sex characteristics 10. The nurse is caring for a client with acute glomerular
inflammation. When assessing for the characteristic
3. The nurse is reviewing a patient's laboratory results. signs and symptoms of this health problem, the nurse
What findings does the nurse assess that are consistent should include which assessments? Select all that apply
with acute glomerulonephritis? Select all that apply. a. Percuss for paint in the right lower abdominal
a. RBCs in the urine quadrant.
b. Proteinuria b. Assess for the presence of peripheral edema.
c. Polyuria c. Auscultate the client's apical heart rate for
d. Hemoglobin of 12.8 g/dL dysrhythmias.
e. WBC casts in the urine d. Assess the client's BP.
e. Assess the client's orientation and judgment.
4. During hemodialysis, toxins and wastes in the blood
are removed by which of the following? 11. The nurse notes that a patient who is retaining fluid
a. Diffusion had a 1-kg weight gain. The nurse knows that this is
b. Ultrafiltration equivalent to about how many mL?
c. Osmosis a. 250 ml.
d. Filtration b. 500 ml.
c. 750 mL
5. A client with end-stage kidney disease is scheduled to d. 1.000 mL
begin hemodialysis. The nurse is working with the client
to adapt the client's diet to maximize the therapeutic 12. A client is admitted for treatment of chronic renal
effect and minimize the risks of complications. The failure (ERF). The nurse knows that this disorder
client's diet should include which or the following increases the client's risk of
modifications? Select all that apply. a. water and sodium retention secondary to a
a. Decreased protein intake severe decrease in the glomerular filtration rate.
b. Decreased sodium intake b. a decreased serum phosphate level secondary
c. increased potassium intake to kidney failure.
d. Fluid restriction c. an increased serum calcium level secondary to
e. Vitamin D supplementation kidney failure.
d. metabolic alkalosis secondary to retention of
6. A client with chromic renal failure comes to the clinic hydroge ions.
for a visit. During the visit, he complains of pruritus.
Which suggestion by the nurse would be most 13. A nurse is providing education to the family of a
appropriate? client beginning peritoncal dialysis. The family ask
a. "Try washing clothes with a strong detergent to questions concerning catheter structure, placement and
ensure that all impurities are gone." stabilization. Which information will the nurse provide
b. "When you shower, use really warm water and about the cuffs? Select all that apply.
an antibacterial soap. a. The cuffs are constructed of Dacron polyester
c. Keep your showers brief, patting your skin dry material.
after showering." b. The cuffs will help stabilize the catheter.
d. Liberally apply alcohol to the areas of your skin c. The cuffs prevent the dialysate from leaking.
where you itch the most." d. The cuffs provide a barrier against
microorganisms.
7. The nurse cares for a client with a right-arm e. The cuffs will absorb the dialysate.
arteriovenous fistula (AVF) for hemodialysis treatments.
Which nursing action is contraindicated? 14. The nurse recognires which condition as an
a. Obtaining blood samples from the left arm integumentary manifestation of chronic renal failure?
b. Palpating the fistula for a "thrill" a. Asterixis
c. Obtaining a blood pressure reading from the b. Gray-bronze skin color
right arm c. Tremors
d. Placing the client's watch on the left wrist d. Seizures
15. The nurse weighs a patient daily and measures 23. What is a hallmark of the diagnosis of nephrotic
urinary output every hour. The nurse notices a weight syndrome?
gain of 1.5 kg in a 74-kg patient over 48 hours. The a. Hyponatremia
nurse is aware that this weight gain is equivalent to the b. Proteinuria
retention of. c. Hyperalbuminemia
a. 500 mL of fluid d. Hypokalemia
b. 1.000 ml. of fluid
c. 1.500 ml of fluid d. 24. The nurse is caring for a client who has undergone a
d. 2.000 mL of fluid nephrectomy Which assessment finding is most uportant
in determining nursing care for the client?
16. A client with chronic renal failure (CRF) is admitted a. Unine outout of 35 to 40 ml/hour
to the urology unit. Which diagnostic test results are b. Pain of 3 out of 10. 1 hour after analgesic
consistent with CRF? administration
a. Increased pH with decreased hydrogen ions c. SpO2 at 90% with fine crackles in the lung
b. Increased serum levels of potassium, bases
magnesium, and calcium d. Blood tinged drainage in Jackson-Prat drainage
c. Blood urea nitrogen (BUN) 100 mg/dL and tube
serum creatinine 6.5 mg/dL
d. Uric acid analysis 3.5 mg/dL and 25. The nurse is planning client teaching for a client with
phenolsulfonate (PSP) excretion 75% end-stage kidney disease who is scheduled for the
creation of a fistula. The nurse should teach the client
17. After teaching a group of students about how to what information about the fistula?
perform peritoneal dialysis, which statement would a. A vein and an artery in vour arm will be attached
indicate to the instructor that the students needs surgicaly
additional teaching? b. "The arm should be immobilized for 4 to 6 days."
a. “It is important to use strict aseptic technique” c. One needle will be inserted into the fistula for
b. “It is appropriate to warm the dialysate in a each dialysis treatment n
microwave.” d. "The fistula can be used 5 to 7 days after the
c. “The infusion clamp should be open during .. surgery for dialysis treatment n
d. “The effluent should be allowed to drain by..
26. Sevelamer hydrochloride (Renagel) has been
18. Hyperkalemia is a serious side effect of acute renal prescribed for a client with chronic renal failure. The
failure. Identify the electrocardiogram (ECG) tracing that physician has prescribed Renagel 800 mg orally three
is diagnostic for hyperkalemia. times per day with meals to (reat the client's
a. Tall, peaked T waves hyperphosphatemia. The medication is available in 400
b. Shortened QRS complex mg tablets. How many tablets per day will the nurse
c. Multiple spiked P waves administer to the client?
d. Prolonged STI segment a. 6
b. 2
19. A history of infection specifically caused by group A c. 3
beta-hemolytic streptococci is associated with which d. 4
disorder?
a. Acute renal failure 27. A client with chronic kidney disease is completing an
b. Acute glomerulonephritis exchange during peritoneal dialysis. The nurse observes
c. Chronic renal failure that the peritoneal fluid is draining slowly and that the
d. Nephrotic syndrome client's abdomen is increasing. in girth. What is the
nurse's most appropriate action?
20. When caring for the patient with acute a. Advance the catheter 2 to 4 cm further into
glomerulonephritis, which of the following assessment peritoneal cavity.
findings should the nurse anticipate? b. Reposition the client to facilitate drainage.
a. Cola-colored urine c. Aspirate from the catheter using a 60-mL
b. Left upper quadrant pain syringe.
c. Pyuria d. Infuse 50 mL of additional dialysate.
d. Low blood pressure
28. Which of the following is the most sensitive indicator
21. A patient has stage 3 chronic kidney failure. What of renal function in terms of influential factors & GFR?
would the nurse expect the patient's glomerular filtration a. Serum creatinine
rate (GFR) to be? b. Blood urea nitrogen (BUN)
a. A GFR of 90 mL/min/1.73 m2 c. Creatinine clearance
b. A GFR of 30-59 ml./min/1. 73 m2 d. Potassium
c. AGFR of 120 mL/min/1.73 m2
d. AGFR of 85 mL/min/1.73 m2 29. A child is brought into the clinic with symptoms of
edema and dark brown rusty urine. Which nursing
22. A client with chronic kidney disease weighs 209 lbs assessment finding would best assist in determining the
(95 kg) and is prescribed 1.2 grams of protein per kg per cause of this problem
day. Which amount of protein will the client ingest per a. Sore throat 2 weeks ago.
day? b. Red blood cells in the urine
a. 114 c. Elevation of blood pressure
b. 79 d. Protein elevation in the urine
c. 2
d. 6
30. A client with end stage renal disease (ESKD) is 38. A client with chronic renal failure (CRE) has
being treated for a fight ankle fracture unrelated to a fall. developed faulty red blood cell (RBC) production. The
The client's lab values show high phosphate levels, low nurse should monitor this client for:
calcium levels, and low vitamin D. levels. What is the a. Nausea and vomiting
most likely reason for this client's fracture? b. dyspnea and cyanosis.
a. Osteoporosis c. fatigue and weakness.
b. Codman triangle d. thrush and circumoral pallor.
c. Hypertrophic osteoarthropathy
d. Renal osteodystrophy 39. A client, aged 75, is diagnosed with a renal disease
and administered nephrotoxic drugs in normal doses.
31. Acute dialysis is indicated during which situation? The nurse is aware that it is important to observe the
a. Dehydration client closely for as; changes in renal slatus, Which of
b. Impending pulmonary edema the following measures nit a nurse determine a change
c. Metabolic alkalosis in renal status?
d. Hypokalemia a. Observing the client's fluid intake.
b. Checking for a thrill or a bruit daily.
32. A client is experiencing a decreasing glomerular c. Observing the client's urinary output.
filtration. What laboratory valucs should the nurse expect d. Observing the skin color and nail beds.
to follow the change Select all that apply.
a. Serum creatinine increases 40. The nurse is caring for a client receiving
b. Blood urea nitrogen (BUN) increases hemodialysis three times weekly. The client has had
c. Creatinine clearance decreases surgery to form an arteriovenous fistula What is most
d. Hypokalemia important for the nurse to be aware of when providing
e. Hypophosphatemia care for this client?
a. Using a stethoscope for auscultating the fistula
33. A client on the medical unit has a documented is contraindicated.
history of polycystic kidney disease (PKD). What b. The client feels best immediately after the
principle should guide the nurse's care of this client? dialysis.
a. The disease is self-limiting and cysts usually c. Taking a BP reading on the affected ann can
resolve spontaneously in the fifth or sixth damage the fistula.
decade of life. d. The client should not feel pain during dialysis
b. The client's disease is incurable and the nurse's
interventions will be supportive.
c. The client will eventually require surgical
removal of his or her renal cysts.
d. The client is likely to respond favorably to
lithotripsy treatment of the cysts.

34. At the and of five peritoneal exchanges, a patient's

fluid loss was 500 mL. How much is this loss equal to?
a. 0.5 lb
b. 1 lb
c. 1.5 lb
d. 2 lb

35. The nurse is visiting the home of a client who is

receiving at hock peritoneal dialysis therapy. Which
finding indicates to the nurse that the client is deycloping
peritonitis?
a. Low back pain
b. Bloody effluent
c. Cloudy dialysate effluent
d. Report of pronounced hunger

36. Patient education regarding a fistulae or graft which

is the following? Select all that apply.
a. Check daily for thrill and bruit.
b. Avoid compression of the site.
c. No IV or blood pressure taken on extremity with
dialysis access.
d. No tight clothing.
e. Cleanse site BID

37. The nurse cares for a client with end-stage kidney

disease (ESKD) Which acid-base imbalance is
associated with this disorder?
a. H 7.47, PaCO2 45, HCO3 33-
b. pH 7.31, PaCO2 48, HCO3 24-
c. pH 7.20, PaCO2 36, HCO3 14-
d. pH 7.50, PaCO2 29, HCO3 22-
Quiz 6: Urologic Disorders 9. Which of the following is classified as a upper urinary
1. Which finding is an early indicator of bladder cancer? tract infection (UTI) Select all that apply,
a. Painless hematuria a. Acute pyelonephritis
b. Decasional polyuria b. Renal abscess
c. Nocturia c. Cystitis
d. Dysuria d. Urethritis
e. Prostatitis
2. The nurse is preparing to assess a client's new stoma.
Which finding would the nurse include in the 10. A patient comes to the clinic suspecting a possible
documentation of a healthy stoma? UTI was symptoms of a UTI would the murse recognize
a. Pain from the data gathered?
b. Pink color a. Rebound tenderness at McRarney's pers
c. Black color b. An output of 200ml, with each voiding
d. Dry in appearance c. Cloudy urine
d. Urine with a specific gravity of 1.005-1.072
3. W bat is true about extracorporeal shock wave
lithotripsy (ESWL)? Select all that apply. 11. The nurse is educating a patient with urolithiasis
a. Stones are shattered into smaller particles that about preventive measures to avoid another occurrence.
are passed from the urinary tract. What should the patients be encouraged to do?
b. ESWL is a high-energy blast of pressure. a. Increase fluid intake so that the patient can
c. ESWL is a ureteroscopic approach. excrete 2,500 to 4,000 mL every day, which will
d. ESWL is done while the patient is undergoing a help prevent additional stone formation.
percutaneous nephrolithotomy. b. Participate in strenuous exercises so that the
tone of smooth muscle in the urinary tract can
4. The nurse who teaches a client about preventing be strengthened to help propel calculi.
recurrent urinary tract infections would include which c. Add calcium supplements to the diet to replace
statement? losses to renal calculi.
a. Take tub baths instead of showers. d. Limit voiding to every 6 10 8 hours so that
b. Void immediately after sexual intercourse. increased
c. Increase intake of coffee, tea, and colas:
d. Void every 5 hours during the day. 12. Which type of medication may be used to inhibit
bladder contraction in a client with incontinence?
5. The núrse is caring for a client with incontinence. a. Anticholinergic agent
Which criteria will the nurse instruct the client to track b. Estrogen hormone
when logging self-care activities? Select all that apply. c. Tricyclic antidepressants.
a. Frequency of voiding d. Over-the-counter decongestant
b. Episodes of incontinence
c. Use of protective clothing 13. A client undergoes surgery to remove a malignant
d. Changes in bladder function tumor, followed. by a urinary diversion procedure. Which
e. Timing of pelvic floor muscle exercises postoperative procedure should the nurse perform?
a. Determine the client's ability to manage stoma
6. A female client is undergoing a bladder training b. Show photographs and drawings of the
program as treatment for urinary incontinence. Which placement of the stoma
technique would be the most appropriate for the nurse to c. Maintain skin and stoma integrity
suggest? d. Suggest a visit to a local ostomy group
a. Performing Kegel exercises
b. Reducing fluid intake 14. Examination of a client's bladder stones reveal that
c. Attempting to hold the urine for five minutes until they are, primarily composed of uric acid. The nurse
the sensation is felt would expeof to provide the client with which type of
d. Taking warn sitz baths diet?
a. Low oxalate
7. A client seeks medical attention for a new onset of b. Low purine
acute pain in the groin. Which additional finding(s) c. High protein
indicates to the nurse that the client is experiencing d. High sodium
ureteral colic? Select all that apply.
a. Hematuria 15. A client undergoes extracorporeal shock wave
b. Left shoulder pain lithotripsy. Before discharge, the nurse should provide
c. Bruising around the umbilicus which instruction?
d. pain in midepigastric region a. Take your temperature every 4 hours."
e. Absent urine despite the urge to void b. "Increase your fluid intake to 2 to 3 L per day."
c. "Apply an antibacterial dressing to the incision
8. A client is prescribed amitriptyline (an antidepressant) daily."
for incontinence. The nurse understands that this drug is d. "Be aware that your urine will be cherry-red for 5
an effective treatment because it: to 7 days."
a. increases contraction of the detrusor muscle.
b. increases bladder neck resistance. 16. the nurse is assisting in the development of a
c. reduces bladder spasticity. protocol for bladder retraining following removal of an
d. decreases involuntary bladder contractions. indwelling catheter. which should the nurse include?
a. Encourage voiding immediately after catheter
removal
b. Avoid drinking fluids for 6 hours
c. Perform straight catheterization every 4 hours
d. Implement a 2-to-3 hour voiding schedule
17. A group of students are reviewing information about 24. The nurse is caring for a client who is scheduled for
disorders of the bladder and urethra. The students the creation of an ileal conduit. Which statement by the
demonstrate understanding of the material when they client provides evidence that client teaching was
identify which of the following as a voiding dysfunction? effective?
a. Cystitis a. "I will not need to worry about being incontinent
b. Bladder stones of urine."
c. Urinary retention b. "My urine will be eliminated through a stoma."
d. Urethral structure c. "My urine will be eliminated with my feces."
d. "A catheter will drain urine directly from my
18. Which term refers to inflammation of the renal kidney
pelvis?
a. Pyelonephritis 25. A client comes to the emergency department
b. Cystitis complaining of a sudden onset of sharp, severe flank
c. Urethritis pain. During the physical examination, the client
d. Interstitial nephritis indicates that the pain, which comes in waves, travels to
the suprapubic region. He states, “I can even feel the
19. An older adult client is being evaluated for suspected pain at the tip of my penis." Which of the following would
pyelonephritis and is ordered kidney, ureter, and bladder the nurse suspect?
(KUB) X-ray. The nurse understands the significance of a. Acute glomerulonephritis
this order is related to which rationale? b. Ureteral stricture.
a. Shows damage to the kidneys c. Urinary calculi
b. If risk for chronic pyelonephritis is likely d. Renal cell carcinoma
c. Reveals causative microorganisms
d. Detects calculi, cysts, or tumors 26. The nurse is employed in a urologist's office. Which
classification of medication is anticipated for clients
20. Which type of incontinence refers to the involuntary having difficulty with urinary incontinence?
loss of urine due to extrinsic medical factors, particularly a. Anticholinergic
medications? b. Diuretics
a. Reflex c. Anticonvulsant
b. iatrogenic d. Cholinergic
c. Overflow
d. Urge 27. The nurse advises a patient with renal stones to
avoid eating shellfish, asparagus, and organ meats. She
21. A client comes to the clinic for a follow-up visit. emphasizes these food because she knows that his
During the interview, the client states, "Sometimes when renal stones are composed of which o the following
have to urinate, I can't control it and do not reach the substances?
bathroom in time." The nurse suspects that the client is a. Calcium
experiencing which type of incontinence? b. Uric acid
a. Stress c. Struvite
b. Urge d. Cystine
c. Overflow
d. Functional 28. The nurse is caring for a postoperative client who
has a Kock pouch. Nursing assessment findings reveal
22. The nurse is caring for a client who has undergone abdominal pain, absence of bowel sounds, fever,
creation of a urinary diversion. Forty-eight hours tachycardia, and tachypnea. The nurse suspects which
postoperatively, the nurse's assessment reveals that the of the following?
stoma is a dark purplish color. What is the nurse's most a. Stoma ischemia
appropriate response? b. Postoperative pneumonia
a. Document the presence of a healthy stoma. c. Stoma retraction
b. Assess the client for further signs and symptoms d. Peritonitis
of infection.
c. Inform the primary care provider that the 29. Which of the following is a cause of a calcium renal
vascular supply may be compromised. stone?
d. Liaise with the wound-ostomy-continence a. Excessive intake of vitamin D
(WOC) nurse because the ostomy appliance b. Gout
around the stoma may be too loose c. Neurogenic bladder
d. Foreign bodies
23. The Furse has been asked to provide heatth
information to a female patient diagnosed with a urinary 30. What condition or laboratory result supports of
tract infection. What appropriate instructions will the pyelonephritis?
nurse provide? Select all that apply. a. Myoglobinaria
a. Cleanse around the perineum and urethral b. Ketonuria
meatus after each bowel movement to reduce c. Pyuria
pathogens. d. Low white blood cell (WBC) count
b. Drink caffeinated beverages twice a day to
increase urination.
c. Drink liberal amounts of fluid to flush out
bacteria.
d. Void every 2-3 hours to prevent overdistention of
the bladder
e. Bathe in warm water to soak the affected area