Surgery/ acute pain
A postoperative client reports pain rated 8/10. Which action should the nurse take first?
Assess the client's pain characteristics, location, and vital signs before administering pain medication.
Rationale:
Pain should be assessed before intervention so the nurse can determine the appropriate treatment and evaluate for complications.
Which type of arthritis is an autoimmune inflammatory disorder that commonly causes symmetrical joint involvement?
Rheumatoid arthritis.
Rationale:
RA is an autoimmune disorder that causes systemic inflammation and commonly affects joints symmetrically.
A client with a fractured leg suddenly reports severe pain that is not relieved by prescribed medication. The extremity is tense and swollen. What complication should the nurse suspect?
Compartment syndrome.
Rationale:
Severe, increasing pain that is disproportionate to the injury and swelling/tense tissue are early warning signs of compartment syndrome.
Which medication is commonly given to a client experiencing angina to decrease myocardial oxygen demand and improve coronary blood flow?
Nitroglycerin.
Rationale:
Nitroglycerin causes vasodilation and decreases cardiac workload, helping relieve anginal chest pain.
Which finding is most characteristic of peripheral arterial disease?
A. Warm skin
B. Diminished peripheral pulses
C. Significant dependent edema
D. Brown pigmentation around the ankles
B. Diminished peripheral pulses
Rationale:
Arterial disease decreases blood flow to the extremities, causing weak or absent pulses, cool skin, and delayed capillary refill.
Which medication is an opioid analgesic commonly used to treat moderate to severe acute pain?
A. Acetaminophen
B. Morphine
C. Ibuprofen
D. Celecoxib
B. Morphine
Rationale:
Morphine is an opioid analgesic used for moderate to severe pain. The nurse should monitor respiratory rate, sedation, blood pressure, and pain relief.
Which medication may be used as a disease-modifying antirheumatic drug for rheumatoid arthritis?
A. Methotrexate
B. Acetaminophen
C. Furosemide
D. Nitroglycerin
A. Methotrexate
Rationale:
Methotrexate is a DMARD commonly used to slow disease progression in rheumatoid arthritis.
Which finding is an early sign of a fat embolism after a long-bone fracture?
A. Bradycardia
B. Sudden respiratory distress
C. Increased appetite
D. Hypertension only
B. Sudden respiratory distress
Rationale:
Fat embolism can occur after long-bone fractures. Early findings include respiratory distress, hypoxemia, neurologic changes, and petechiae.
A client taking nitroglycerin reports a headache after taking the medication. What should the nurse explain?
Headache can occur because nitroglycerin causes vasodilation.
Rationale:
Headache is a common expected effect of nitroglycerin. The nurse should also monitor blood pressure.
A client with peripheral arterial disease reports leg pain while walking that improves with rest. What is this called?
Intermittent claudication.
Rationale:
Intermittent claudication is ischemic muscle pain caused by inadequate arterial blood flow during activity.
A client receiving IV morphine has a respiratory rate of 8/min and is difficult to arouse. What is the nurse's priority action?
Hold the opioid and immediately assess/support the client's airway and breathing.
Rationale:
Respiratory depression is a serious adverse effect of opioids. Airway and breathing are the priority.
A client with osteoarthritis asks why exercise is recommended when the joints already hurt. What is the nurse's best response?
Regular, appropriate exercise helps maintain joint mobility, muscle strength, and function.
Rationale:
OA management includes activity and exercise to maintain mobility and strength while avoiding excessive stress on affected joints.
A client with a cast reports numbness and tingling in the affected extremity. What should the nurse do?
Assess circulation, sensation, movement, pulses, and capillary refill and notify the provider of concerning findings.
Rationale:
Numbness and tingling may indicate impaired neurovascular function or increasing pressure.
Which medication class is commonly used as first-line therapy for hypertension and can cause a persistent dry cough?
A. ACE inhibitors
B. Loop diuretics
C. Opioids
D. Antacids
A. ACE inhibitors
Rationale:
ACE inhibitors such as lisinopril can cause a persistent dry cough. They can also cause hyperkalemia and angioedema.
Which assessment finding is more consistent with chronic venous insufficiency?
A. Cool, pale extremity
B. Diminished pulses
C. Dependent edema
D. Pain relieved by dangling the leg
C. Dependent edema.
Rationale:
Venous insufficiency causes venous pooling and commonly results in edema, especially when the extremity is dependent.
A client is 8 hours postoperative. Which finding requires the nurse's immediate attention?
A. Pain rated 6/10
B. Temperature of 100.2°F
C. Oxygen saturation of 89%
D. Mild incisional discomfort
C. Oxygen saturation of 89%
Rationale:
Hypoxemia can indicate a serious respiratory complication. Airway and breathing take priority.
A client receiving treatment for osteomyelitis has a temperature of 102.4°F and increasing pain at the affected site. What should the nurse do?
Assess the client for worsening infection and notify the healthcare provider.
Rationale:
Osteomyelitis is a bone infection. Fever and increasing localized pain can indicate persistent or worsening infection.
Which intervention is most important for preventing complications after an amputation?
A. Keep the client on complete bed rest
B. Encourage early mobility and prescribed exercises
C. Keep the residual limb dependent at all times
D. Avoid physical therapy
B. Encourage early mobility and prescribed exercises.
Rationale:
Early mobility helps prevent complications such as contractures, DVT, and loss of function.
A client taking lisinopril develops swelling of the lips and tongue. What is the priority action?
Hold the medication and immediately assess the airway and notify the healthcare provider.
Rationale:
Lip and tongue swelling can indicate angioedema, which can rapidly become life-threatening due to airway obstruction.
A client with heart failure is prescribed furosemide. Which laboratory value should the nurse monitor closely?
A. Potassium
B. Hemoglobin
C. Platelets
D. Bilirubin
A. Potassium
Rationale:
Furosemide is a loop diuretic that can cause potassium loss and hypokalemia.
A postoperative client suddenly develops chest pain, shortness of breath, and tachycardia. What complication should the nurse suspect?
Pulmonary embolism.
Rationale:
Sudden dyspnea, chest pain, tachycardia, and decreased oxygen saturation are concerning for pulmonary embolism. This requires immediate assessment and intervention.
A client taking a medication for osteoporosis asks what lifestyle measures can help reduce fracture risk. Which response is appropriate?
Weight-bearing exercise, adequate calcium and vitamin D, fall prevention, and avoidance of smoking can help reduce fracture risk.
Rationale:
Osteoporosis management focuses on maintaining bone strength and preventing falls and fractures.
A postoperative fracture client develops sudden shortness of breath, confusion, and a petechial rash on the chest. What should the nurse do first?
Assess airway and oxygenation and provide oxygen as prescribed while obtaining immediate medical assistance.
Rationale:
These findings are highly concerning for fat embolism syndrome, which can cause acute respiratory and neurologic deterioration.
A client with heart failure has crackles, shortness of breath, and a rapid weight gain over several days. What does this most likely indicate?
Fluid volume overload.
Rationale:
Rapid weight gain, crackles, and dyspnea are common signs of worsening fluid retention in heart failure.
The nurse receives report on four clients. Which client should be assessed first?
A. Client with chronic PVD reporting mild leg discomfort
B. Client with osteoarthritis requesting pain medication
C. Client with heart failure who has new severe shortness of breath and crackles
D. Client with osteoporosis asking about calcium supplements
C. Client with heart failure who has new severe shortness of breath and crackles.
Rationale:
New severe dyspnea and crackles can indicate acute pulmonary edema from worsening heart failure. Airway and breathing take priority.