Question 1
NUR Alteration Mobility/Immunity Exam. What is the most common cause of fat embolism syndrome?
- A crush injury to a large bone
- Fracture of a long bone or pelvis
- Infection of a bone marrow site
- Recent surgical intervention on a joint
Question 2
The nurse is assessing a client with a suspected fat embolism. Which clinical manifestation is a classic sign of this condition?
- Petechiae on the chest and neck
- Decreased level of consciousness
- Sudden onset of shortness of breath
- High fever and chills
Question 3
Which of the following laboratory findings would the nurse expect to see in a client with a fat embolism?
- Decreased PaO2 level
- Increased serum calcium
- Decreased erythrocyte sedimentation rate (ESR)
- Decreased serum lipids
Question 4
Match the assessment finding to the most likely condition:
- Potassium level of 5.8, calcium level of 7.5, and phosphate of 1.5: Crush Injury
- ABG analysis shows metabolic acidosis with lactic acidosis: Crush Injury
- Inability to move right leg with parasthesias and absent pulses: Crush Injury
- Decreased PaO2 level, increased serum lipids and ESR: Fat Embolism Syndrome
- Decreased LOC, agitation, and nonpalpable petechiae rash on chest and neck: Fat Embolism Syndrome
Question 5
After reviewing the assessment data, the nurse determines the client is experiencing:
- Acute compartment syndrome as evidenced by pain, pulselessness, and paralysis of the right leg.
- The client is also experiencing rhabdomyolysis as evidenced by dark, brown urine and myoglobinuria.
Question 6
Determine if the following interventions are Appropriate or Not Appropriate for this client:
- Prepare for surgical decompressive fasciotomy: Appropriate
- Administration of diuretic therapy: Appropriate
- Prepare for application of skeletal traction: Not Appropriate
- Administration of aggressive IV fluid therapy: Appropriate
- Administration of IV narcotic pain medications via PCA: Appropriate
Question 7
Select five (5) appropriate nursing actions for the client post-fasciotomy:
- Implement infection prevention measures and carry out ordered wound care
- Draw and monitor basic metabolic panel, serum CK, and ABGs
- Monitor frequent intake and output and daily weights
- Establish large bore IV access and administer ordered IV fluids
- Assess hourly pedal and posterior tibial pulses and capillary refill
- Administer thrombolytics
- Perform pin site care
Question 8
Determine if these findings indicate the client’s condition has Improved or Declined:
- Pain absent in right lower extremity, skin color pale and dusky, pulses greatly diminished: Declined
- 250 mL of clear, straw-colored urine over the last two hours: Improved
- Potassium 4.9, Calcium 8.5, Phosphate 3.0, Creatinine Kinase 175: Improved
- Lung sounds coarse, SpO2 90% on 5L nasal cannula, temperature 96.5: Declined
- ABG results: pH 7.36, PaCO2 40, HCO3 27, lactate 6.5: Improved
Question 9
Which medication should the nurse question for a client with a Creatinine of 4.5 and BUN of 55?
- Hydrocodone Bitartrate and Acetaminophen Oral Solution
- 0.9% Normal Saline
- Morphine Sulfate PCA
- IV Furosemide
Question 10
Which statements demonstrate the client’s understanding of the advantages of external fixation?
- “It stabilizes the fracture during healing.”
- “There is minimal blood loss compared to open surgery.” NUR Alteration Mobility/Immunity Exam.
- “It allows for early ambulation and exercise.”
- “It helps maintain bone alignment.”
- “It decreases the risk of infection.”
- “It increases blood supply to the bone.”
Question 11
Which dietary choice best demonstrates the nutrition needed to assist in healing a fractured femur?
- Roast beef, broccoli, milk, and a vitamin C supplement
- Hamburger, fries, and a chocolate shake
- Garden salad with Italian dressing and iced tea
- Baked chicken, white rice, and apple juice
Question 12
Which nursing actions indicate appropriate care for a client in Buck’s traction?
- Assess client for pain and medicate as needed
- Monitor peripheral pulses bilaterally
- Examine skin under the traction splint
- Instruct unlicensed personnel to assess for skin breakdown
- Release traction once a shift
- Position weights to rest on the foot of the bed
Question 13
Which assessment findings should the nurse expect in a client with a hip fracture?
- Groin pain and muscle spasms
- External rotation of the affected leg
- Shortening of the affected extremity
- Internal rotation of the affected leg
- Lengthening of the affected extremity
Question 14
Which postoperative hip precautions should the nurse reinforce? NUR Alteration Mobility/Immunity Exam.
- Use an elevated toilet seat
- Place an abduction pillow between the legs while turning
- Avoid flexing the hip more than 90 degrees
- Cross legs at the ankles when sitting
- Sit in a low, soft recliner for comfort
Question 14
A nurse is caring for a client who received the benzodiazepine medication diazepam as moderate sedation for closed reduction of a fractured ulna and radius. The client’s respirations are now 6 per minute, and the nurse plans to administer which reversal agent?
- Naloxone
- N-Acetylcysteine
- Flumazenil
- Protamine sulfate
Question 15
The nurse is caring for a client with multiple fractures to the left leg and external fixation device in place. Which assessment finding is priority and requires immediate intervention by the nurse?
- Client complains of pain in the left leg that measures a 6 out of 10
- Client is dyspneic with altered level of consciousness (LOC) and red/purple spots on the chest
- Client complains that the cast is too tight, capillary refill < 3 seconds with 2+ pedal pulse
- Client’s most distal pin site is mildly red, edematous, and tender to the touch
Question 16
The nurse is caring for a client with multiple fractures to the left leg and external fixation device in place. Which assessment finding is priority and requires immediate intervention? 88% on room air. The nurse reviews the following orders and understands which order takes priority?
- Administer normal saline 0.9% IV infusion at 50mL an hour
- Type and cross and transfuse 2 units of packed red blood cells
- Administer morphine 4mg IV PRN every 4 hours for pain > 5/10
- Strict bedrest in supine position with pelvic immobilization
Question 17
The nurse is caring for a client with multiple fractures to the left leg and external fixation device in place. Which assessment finding is priority and requires immediate intervention? Which statement by the client indicates a need for further instruction regarding activity?
- “I can walk on the leg until it begins to hurt.”
- “I may have pain if I put weight on that leg.”
- “I need to cover the dressing when I shower.”
- “I will limit standing until the doctor sees me again.”
Question 18
The nurse is caring for a client admitted to the intensive care unit with pelvic and femur fractures with orders for a fentanyl patient-controlled analgesia (PCA) pump. What is an appropriate nursing intervention?
- Have non-rebreather mask and promethazine readily available
- Have nasal cannula and flumazenil readily available
- Have bag-valve-mask and naloxone readily available
- Have intubation kit set up and naloxone readily available
Question 26
A healthcare provider prescribes amphotericin B $0.5\text{ mg/kg}$ IV to a client who weighs $120\text{ lbs}$. The drug label states to reconstitute $50\text{ mg}$ with $10\text{ mL}$ of sterile water for a concentration of $5\text{ mg/mL}$. How many $mL$ will the nurse administer? (Round to the nearest tenth).
- 2.5 mL
- 2.7 mL
- 5.4 mL
- 12.0 mL
Question 27
Complete the following sentence by choosing from the lists of options.
The nurse is assessing a client three weeks after hematopoietic stem cell transplant (HSCT) and determines blistering rash and nausea and vomiting indicate the client is experiencing an adverse outcome from the procedure. The nurse identifies Graft-versus-Host Disease as the issue causing the client’s symptoms. The nurse understands treatment includes immunosuppression with tacrolimus and prednisone to reduce symptoms.
- Options for Assessment: blistering rash, nausea and vomiting, fever, hypotension
- Options for Issue: Graft-versus-Host Disease, Sinusoidal Obstruction Syndrome, Graft Failure
- Options for Treatment: tacrolimus, prednisone, epoetin alpha, calcium gluconate NUR Alteration Mobility/Immunity Exam.
Question 28
The nurse is caring for a client with HIV-related dementia. Which communication technique should the nurse use?
- Abstract questions
- Multiple questions at a time
- Brief, direct statements
- Detailed, long explanations NUR Alteration Mobility/Immunity Exam.
Question 32
The nurse is prioritizing care for four clients. Which client should the nurse see first?
- Client with hemolytic anemia experiencing jaundice
- Client with DiGeorge syndrome refusing a calcium supplement
- Client with AIDS receiving IV fluids for dehydration
- Client postoperative lung transplant with blistering rash on palms of the hands
Question 33
A client with AIDS presents with shortness of breath, a dry cough, weight loss, and a low-grade fever. Which action is the priority for the nurse?
- Administer oxygen via nasal cannula
- Obtain sputum specimen for culture and sensitivity
- Start an IV infusion of normal saline
- Provide a high-calorie nutritional supplement
Question 34
The nurse is providing discharge teaching for a client with AIDS and Human Papilloma Virus (HPV). Which information should the nurse include?
- HPV is rarely found in the rectal or perineal area
- Antiretroviral therapy (ART) should be stopped during HPV treatment
- Stress the importance of getting a PAP smear every six months
- Wear tight-fitting clothing to keep the area dry
Question 35
The nurse is providing discharge teaching to a client with DiGeorge Syndrome. Which instruction should the nurse include? NUR Alteration Mobility/Immunity Exam.
- “Avoid all contact with people who have active infections.”
- “Limit your intake of dairy products.”
- “Take a daily calcium supplement and vitamin D.”
- “You will need to receive live vaccines every year.”
Question 36
Complete the following sentence by choosing from the lists of options.
The nurse caring for a client with severe combined immunodeficiency (SCID) recognizes the client is at greatest risk for infection of the respiratory and gastrointestinal systems. NUR Alteration Mobility/Immunity Exam.
- Options for Risk: infection, hemorrhage, organ rejection
- Options for Systems: respiratory, gastrointestinal, integumentary, neurological
Question 37
The nurse is assessing a client with hemolytic anemia who reports activity intolerance. Which finding is the priority to report to the healthcare provider?
- Jaundice of the sclera
- Tachycardia at 102 beats/min
- S3 heart sound heard upon auscultation of the heart
- Hemoglobin level of 10 g/dL
Question 38
A client recently diagnosed with AIDS tells the nurse, “I am so afraid of dying.” Which response by the nurse is therapeutic?
- “You may live for several more years with new treatments.”
- “Everyone dies eventually; it is a part of life.”
- “Tell me your concerns regarding death.”
- “Why are you so focused on dying right now?” NUR Alteration Mobility/Immunity Exam.
Question 39
The nurse is providing dietary education to a client undergoing immunosuppression therapy. Which foods should the client be instructed to avoid? (Select all that apply.)
- Sashimi (raw sushi) from the hibachi restaurant
- Uncooked oysters from a seafood restaurant
- Rare steak from an open grill
- Raw vegetables bought at a farmers market
- Pasteurized milk from the grocery store NUR Alteration Mobility/Immunity Exam.
Question 40
The nurse is reviewing orders for a client with severe combined immunodeficiency (SCID). Which order should the nurse question?
- Intravenous immunoglobulin (IVIG) administration
- Attenuated nasal flu mist
- Total parenteral nutrition (TPN)
- Inactivated Hepatitis B vaccine
Question 41
The nurse is educating a client who is post-hematopoietic stem cell transplant (HSCT) about their immunization schedule. When should the nurse instruct the client to receive the Hib vaccine?
- Immediately upon discharge
- 6 to 12 months post-transplant
- 2 years post-transplant
- Only if they were never vaccinated as a child
Question 42
A client 10 days after HSCT presents with ascites, jaundice, and right upper quadrant (RUQ) pain. Which complication does the nurse suspect?
- Acute Graft-versus-Host Disease
- Sinusoidal Obstruction Syndrome (SOS)
- Engraftment Syndrome
- Cytomegalovirus (CMV) infection
