- (Topic 2)
An 83-year-old client has been hospitalized following a fall in his home. He has developed a possible fecal impaction. Which of the following assessment findings would be most indicative of a fecal impaction?

1. A. Boardlike, rigid abdomen
2. B. Loss of the urge to defecate
3. C. Liquid stool
4. D. Abdominal pain

Correct Answer: C
(A) A boardlike, rigid abdomen would point to a perforated bowel, not a fecal impaction. (B) When a client is fecally impacted, a common symptom is the urge to defecate but the inability to do so. (C) When an impaction is present, only liquid stool will be able to pass around the impacted site. (D) Abdominal pain without distention is not a sign of a fecal impaction.

- (Topic 6)
On the third postpartum day, a client complains of extremely tender breasts. On palpation, the nurse notes a very firm, shiny appearance to the breasts and some milk leakage. She is bottle feeding. The nurse should initially recommend to her to:

1. A. Take 2 ibuprofen (Motrin) tablets by mouth now because the baby will be returning for feeding in 20 minutes
2. B. Allow the infant to breast-feed at the next feeding time to empty the breasts
3. C. Apply ice packs to the breasts and wear a supportive, well-fitting bra
4. D. Take a warm shower and express milk from both breasts until empty

Correct Answer: C
(A) Judicious use of analgesics is appropriate with breast engorgement; however, mechanical suppression would be the initial recommendation. (B) Breast-feeding every 112–3 hours will reduce and/or prevent breast engorgement. Breast-feeding will promote milk production, which will compound the distention and stasis of the venous circulation of engorgement in a bottlefeeding mother. (C) Ice packs reduce milk flow while the snug, supportive bra provides mechanical suppression and decreases pulling on Cooper??s ligament. In addition, breast binders or ace bandages may be used for some women. (D) Warmth promotes milk production and may stimulate the let-down reflex. These measures would contribute to the venous congestion of engorgement.

- (Topic 4)
A male client had a right below-the-knee amputation 4 days ago. His incision is healing well. He has gotten out of bed several times and sat at the side of the bed. Each time after returning to bed, he has experienced pain as if it were located in his right foot. Which nursing measure indicates the nurse has a thorough understanding of phantom pain and its management?

1. A. Phantom pain is entirely in the client??s min
2. B. The client should be instructed that the pain is psychological and should not be treated.
3. C. The basis for phantom pain may occur because the nerves still carry pain sensation to the brain even though the limb has been amputate
4. D. The pain is real, intense, and should be treated.
5. E. The cause of phantom pain is unknow
6. F. The nurse should provide the client with support, promote sleep, and handle the injured limb smoothly and gently.
7. G. Phantom pain is caused by trauma, spasms, and edema at the incisional sit
8. H. It will decrease when postoperative edema decrease
9. I. It should be treated with nonnarcotic medication whenever possible.

Correct Answer: B
(A) This statement is entirely false. (B) Phantom pain may be caused by nerves continuing to carry sensation to the brain even though the limb is removed. It is real, intense, and should be treated as ordinary pain would. (C) Although the cause of phantom pain is still unknown, thesemeasures may promote the relief of any type of pain, not just phantom pain. (D) Phantom pain is not caused by trauma, spasms, and edema and will not be relieved by decreasing edema.

- (Topic 2)
A 16-year-old client comes to the prenatal clinic for her monthly appointment. She has gained 14 lb from her 7th to 8th month; her face and hands indicate edema. She is diagnosed as having PIH and referred to the high-risk prenatal clinic. The client??s weight increase is most likely due to:

1. A. Overeating and subsequent obesity
2. B. Obesity prior to conception
3. C. Hypertension due to kidney lesions
4. D. Fluid retention

Correct Answer: D
(A) Overeating can lead to obesity, but not to edema. (B) There is no indication of obesity prior to pregnancy. PIH is more prevalent in the underweight than in the obese in this age group. (C) Hypertension can be due to kidney lesions, but it would have been apparent earlier in the pregnancy. (D) The weight gain in PIH is due to the retention of sodium ions and fluid and is one of the three cardinal symptoms of PIH.

- (Topic 2)
A 54-year-old client is admitted to the hospital with a possible gastric ulcer. He is a heavy smoker. When discussing his smoking habits with him, the nurse should advise him to:

1. A. Smoke low-tar, filtered cigarettes
2. B. Smoke cigars instead
3. C. Smoke only right after meals
4. D. Chew gum instead

Correct Answer: C
(A, B, D) Cigarettes, cigars, and chewing gum would stimulate gastric acid secretion. (C) Smoking on a full stomach minimizes effect of nicotine on gastric acid.