202 MOBILITY Practice Questions

When a patient uses a cane to ambulate, the patient will hold the cane on the? A. Weak side B. Strong side C. It does not matter. The patient should choose what side is the most comfortable for them.

B. The patient will hold the cane on the strong side (non-injured side).

Which patients below are at risk for developing osteoarthritis? Select-all-that-apply: A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.

A and C. The risk factors for developing OA include: older age, being overweight (BMI >25), repeated injuries to the weight bearing joints, genetics. Option B is at risk for osteoporosis, and option D is at risk for gout.

A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply: A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day

A, C, D. These options are signs and symptoms found with rheumatoid arthritis NOT osteoarthritis. In OA: morning stiffness is LESS than 30 minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at the end of the day compared to the beginning due to overuse of the joints.

In neurogenic shock, a patient will experience a decrease in tissue perfusion. This deprives the cells of oxygen that make up the tissues and organs. Select all the mechanisms, in regards to pathophysiology, of why this is occurring: A. Loss of vasomotor tone B. Increase systemic vascular resistance C. Decrease in cardiac preload D. Increase in cardiac afterload E. Decrease in venous blood return to the heart F. Venous blood pooling in the extremities

A, C, E, and F. Massive vasodilation is occurring in the body and this is due to the loss of vasomotor tone (remember the sympathetic nervous system loses its ability to stimulate nerves that regular the diameter of vessels....so vessels are relaxed). This will DECREASE (NOT increase) systemic vascular resistance (which will decrease cardiac afterload) and the blood pressure will fall. Furthermore, there is pooling of venous blood in the extremities because there isn't any pressure to push it back to the heart. This will cause a decrease in venous blood return to the heart. When this occurs it will decrease cardiac preload (the amount the ventricle stretch at the end of diastole). All of this together will decrease the amount of blood the heart can pump per minute....hence the cardiac output and shock will occur.

A patient is receiving treatment for a complete spinal cord injury at T4. As the nurse you know to educate the patient on the signs and symptoms of autonomic dysreflexia. What signs and symptoms will you educate the patient about? Select all that apply: A. Headache B. Low blood glucose C. Sweating D. Flushed below site of injury E. Pale and cool above site of injury F. Hypertension G. Slow heart rate H. Stuffy nose

A, C, F, G and H. All of these are signs and symptoms of autonomic dysreflexia. The patient will have flushing above site of injury due to vasodilation from parasympathetic activity, BUT will be pale and cool below site of injury due to vasoconstriction occurring below the site of injury for the sympathetic response reflex.

You're developing a nursing plan of care for a patient with neurogenic shock. As the nurse, you know that due to venous blood pooling from vasodilation a deep vein thrombosis can occur in this type of shock. A patient goal is that the patient will be free from the development of a deep vein thrombosis. Select all the nursing interventions below that can help the patient meet this goal: A. Perform range of motion exercises daily. B. Place a pillow underneath the patient knees as needed. C. Administer anticoagulants as scheduled per physician's order. D. Apply compression stockings daily.

A, C, and D. Option B would impede blood flow and increase the risk of a DVT. The other options would help prevent a DVT.

You receive a patient in the ER who has sustained a cervical spinal cord injury. You know this patient is at risk for neurogenic shock. What hallmark signs and symptoms, if experienced by this patient, would indicate the patient is experiencing neurogenic shock? Select all that apply: A. Blood pressure 69/38 B. Heart rate 170 bpm C. Blood pressure 250/120 D. Heart rate 29 E. Warm and dry extremities F. Cool and clammy extremities G. Temperature 104.9 'F H. Temperature 95 'F

A, D, E, and H. Hallmark signs and symptoms of neurogenic shock are: hypotension, bradycardia, hypothermia, warm/dry extremities (this is due to the vasodilation and blood pooling and will be found in the extremities).

During an outpatient visit you are assessing the patient's understanding about the signs and symptoms associated with osteoporosis. Select all of the signs and symptoms stated by the patient that are correct: A. Dowager's Hump B. Loss of 0.5 inches in height compared to young adult height C. Swelling and warmth at the bone site D. Some patients are asymptomatic E. Fractures most commonly in the hips, wrist, and spine

A, D, and E. Option B is wrong because there is normally a loss of 2-3 inches in height compared to the patient's height in young adulthood. Option C is wrong because the bone site will not present as warm or swollen (most patients are asymptomatic).

Which statements are TRUE about autonomic dysreflexia? Select all that apply: A. "Autonomic dysreflexia is an exaggerated reflex response by the parasympathetic nervous system that results in severe hypertension due to a spinal cord injury." B. "Autonomic dysreflexia causes a slow heart rate and severe hypertension." C. "Autonomic dysreflexia is less likely to occur in a patient who has experienced a lumbar injury." D. "The first-line of treatment for autonomic dysreflexia is an antihypertensive medication."

A. "Autonomic dysreflexia is an exaggerated reflex response by the parasympathetic nervous system that results in severe hypertension due to a spinal cord injury." B. "Autonomic dysreflexia causes a slow heart rate and severe hypertension." C. "Autonomic dysreflexia is less likely to occur in a patient who has experienced a lumbar injury." D. "The first-line of treatment for autonomic dysreflexia is an antihypertensive medication."

A 63 year old patient has severe osteoarthritis in the right knee. The patient is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the patient. Which statement made by the patient is correct about this procedure? A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." B. "A knee osteotomy is also called a total knee replacement." C. "A knee osteotomy is commonly performed for patients who have osteoarthritis in both knees." D. "This procedure will realign the unaffected knee and help alleviate the amount of weight experienced on the right knee."

A. A knee osteotomy is NOT known as a total knee replacement. A knee osteotomy can be used as an alternative for a total knee replacement but is not the same thing. In addition, a knee osteotomy is performed when there is OA on only one side of the knee.

A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication: A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes. B. right after breakfast and to lay the patient flat (as tolerated) for 30 minutes. C. with food but to avoid giving this medication with dairy products. D. on an empty stomach with a full glass of juice or milk.

A. Alendronate (Fosamax) is a bisphosphonate which is known for causing GI upset, especially inflammation of the esophagus. These medications should be taken with a full glass of water in morning on empty stomach with NO other medication. The patient should sit up for 30 minutes (60 minutes with Boniva) after taking the medication, and not eat anything for 1 hour after taking (helps the body absorb more of the medicine.)

Your patient is scheduled for a DEXA scan this morning. The patient is having heartburn and requests a PRN medication to help with relief. Which medications can the patient NOT have at this time? A. Calcium Carbonate B. Bismuth Salicylate C. Milk of Magnesia d. Famotidine

A. Before a DEXA scan, which is a bone density test, the patient should not take any type of calcium supplements (calcium carbonate (TUMs) or vitamins containing calcium.

Your patient is 2 hours post-op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care? A. Gently moving the cast with the fingertips of the hands every 2 hours to help with drying. B. Positioning the cast at heart level with pillows. C. Checking the color and temperature of the right foot. D. Using a hair dryer on the cool setting to help with drying.

A. The cast should always be moved with the palms of the hands (NOT finger tips) during the drying period to prevent dent formation because this can cause the development of ulcers under the skin where the dents develop.

What is the BEST position for a patient experiencing autonomic dysreflexia? A. High Fowler's with legs lowered B. Low Fowler's with legs lowered C. Semi-Fowler's with legs at heart level D. Prone

A. The patient should be in high Fowler's (90 degrees) with the legs lowered. This will allow gravity to cause blood to pool in the lower extremities and help decrease blood pressure.

Your patient attempts to sit down in the bedside chair after ambulating in the hallway with crutches. What finding requires you to re-educate the patient on how to sit down in the chair correctly while using crutches? A. The patient places both crutches on the non-injured side before sitting down in the chair. B. The patient backs up to the chair's seat until he feels it with his non-injured leg and stops. C. The patient keeps the injured leg extended out in front of him while sitting down. D. The patient holds both crutches on one side and reaches for the hand grips on the crutches and places weight on them while sitting down.

A. This requires re-education because the patient should place both crutches on the INJURED SIDE (NOT the non-injured side) before sitting down in the chair. The crutches will help provide weight support to the injured side while sitting down.

Which assessment finding found while assessing a patient with a fracture who has traction requires immediate intervention? A. The weights are freely hanging on the floor. B. Pin sites are free from drainage. C. Patient uses the overhead trapeze bar to move around in the bed. D. Patient's extremities have a capillary refill of less than 2 seconds.

A. Weights used for traction should freely hang but NOT on the floor. All the other options are expected findings.

Parathyroid hormone plays an important role in bone health. When the parathyroid gland secretes PTH (parathyroid hormone) it causes: A. the body to increase the calcium levels by stimulating the osteoclast activity B. the body to decrease the calcium levels by inhibiting osteoclast activity C. the body to increase the calcium levels by stimulating osteoblast activity D. the body to decrease the calcium levels by inhibiting osteoblast activity.

A. When the calcium levels are low this stimulates the parathyroid gland to secrete PTH, which stimulates osteoCLAST activity. Remember osteoCLASTS break down the bone matrix within the spongy bone. This will cause calcium to enter the blood stream, hence increasing calcium levels.

Which demonstration by the patient below shows that the patient knows how to properly ambulate a cane? A. The patient holds the cane on the strong side and moves the cane and weak side forward together, and then moves the strong side. B. The patient holds the cane on the strong side and moves the cane forward, then moves the weak side, and then moves the strong side. C. The patient holds the cane on the weak side and moves the cane forward, then moves the weak side, and then moves the strong side. D. The patient holds the cane on the weak side and moves the cane and weak side forward together, and then moves the strong side.

A: The patient holds the cane on the strong side and moves the cane and weak side forward TOGETHER, and then moves strong side.

You're working on a neuro unit. Which of your patients below are at risk for developing neurogenic shock? Select all that apply. A. A 36-year-old with a spinal cord injury at L4. B. A 42-year-old who has spinal anesthesia. C. A 25-year-old with a spinal cord injury above T6. D. A 55-year-old patient who is reporting seeing green halos while taking Digoxin.

B and C. Any patient who has had a cervical or upper thoracic (above T6) spinal cord injury, receiving spinal anesthesia, or taking drugs that affect the autonomic or sympathetic nervous system is at risk for developing neurogenic shock.

Your patient is using a cane for the first time. Before using the cane, you assess that the cane properly fits the patient. Which findings below demonstrate the cane properly fits the patient? Select all that apply: A. The arm that is holding the cane is flexed at about a 40 degree angle. B. The top of the cane is at the level of the greater trochanter. C. When the patient dangles their arms, the top of the cane is even with the crease of the wrist closest to the hand. D. There is a 1.5 inch gap between the top of the cane and the axillae.

B and C. Option B and C are correct because these are the two methods used to determine a proper fit for a cane. Option A is wrong because the arm holding the cane should be flexed at about 15-30 degree angle (NOT 40 degree angle). Option D is wrong because proper measurement of a cane has nothing to do with the axillae region (this is applicable only for crutches).

Your patient will be using crutches for mobility. After educating the patient on how to adjust the crutches to fit correctly, you assess how well the patient understood the instructions. What findings demonstrate that the crutches were adjusted correctly by the patient? Select all that apply: A. The hand grips of the crutches are even with the mid-forearm. When the patient grips the hand grips of the crutches the elbow bends at about 30 degrees. C. The patient has a 2-3 finger width distance between the axillae and crutch rest pad. D. The patient places weight on the axillae rather than the hands while ambulating.

B and C. Properly fitted crutches should be a 2-3 finger width (about 1-1.5 inches) distance between the axillae (armpit area) and the crutch rest pads during ambulation. This prevents damaging the nerves that are located in the axillae during ambulation. In addition, when the patient grips the hand grips of the crutches the elbow should slightly bend at about 30 degrees. Option A is wrong because the hand grips of the crutches should be even with the hip line (not the mid-forearm), and option D is wrong because the patient should place weight on the HANDS while ambulating NOT the axillae area (this can cause nerve damage)

You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply: A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage

B and C. The joint space would be DECREASED not increased in OA. In addition, an x-ray cannot show hyaline cartilage...therefore, the cartilage cannot be assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

You're providing an in-service to a group of new nurse graduates on the causes of autonomic dysreflexia. Select all the most common causes you will discuss during the in-service: A. Hypoglycemia B. Distended bladder C. Sacral pressure injury D. Fecal impaction E. Urinary tract infection

B, C, D, and E. Anything that can cause an irritating stimulus below the site of the spinal injury (T6 or higher) can lead to autonomic dysreflexia, which causes an exaggerated sympathetic reflex response and the parasympathetic system is unable to oppose it. This will lead to severe hypertension. The most common cause of AD is a bladder issue (full/distended bladder, urinary tract infection etc). Other common causes are due to a bowel issue like fecal impaction or skin break down (pressure injury/ulcer, cut, infection etc.).

A patient with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient: A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E. Walking

B, C, E. The patient wants to perform exercises that are low impact like: walking, water aerobics, stationary bike riding along with strengthen training (lifting weights: helps strengthen muscles around the joint), ROM: improves the mobility of the joint and decreases stiffness. It is important patients with OA avoid high impact exercises that will increase stress on weight bearing joints such as running/jogging, jump rope, tennis, or any type of exercise with both feet off the ground.

Select all the signs and symptoms that will present in compartment syndrome? A. Capillary refill less than 2 seconds B. Pallor C. Pain relief with medication D. Feeling of tingling in the extremity E. Affected extremity feels cooler to the touch than the unaffected extremity

B, D, and E. These symptoms may present with compartment syndrome. Option A and C are normal findings. Remember in compartment syndrome nerve and blood vessel function is being compromised, so expect signs and symptoms that occur when these structures are affected.

Your patient in neurogenic shock is not responding to IV fluids. The patient is started on vasopressors. What option below, if found in your patient, would indicate the medication is working? A. Decreased CVP (central venous pressure) B. Mean arterial pressure (MAP) 90 mmHg C. Serum lactate 6 mmol/L D. Blood pH 7.20

B. A MAP of 85-90 mmHg will help maintain tissue perfusion and indicates the vasopressor is working to maintain tissue perfusion. It does this by causing vasoconstriction. Options A, C, and D would indicate tissue perfusion is decreased.

During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as: A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas

B. Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) is called Heberden's Node. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) it is called Bouchard's Node.

A patient in neurogenic shock is ordered intravenous fluids due to severe hypotension. During administration of the fluids the nurse will monitor the patient closely and immediately report? A. Increase in blood pressure B. High central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP) C. Urinary output of 300 mL in the past 5 hours D. Mean arterial pressure (MAP) 85 mmHg

B. Option B would indicate the patient is in fluid volume overload. Remember that patients in neurogenic shock usually have a normal blood volume. If fluids are ordered to help increase the blood pressure, they should be used with extreme caution because fluid overload can occur. An increase in the CVP and PAWP would indicate this. These pressures show the filling pressure in the heart.

Which patient below is at MOST risk for developing a condition called autonomic dysreflexia? A. A 24-year-old male patient with a traumatic brain injury. B. A 15-year-old female patient with a spinal cord injury at C7. C. A 35-year-old male patient with a spinal cord injury at L6. D. A 42-year-old male patient recovering from a hemorrhagic stroke.

B. Patients who are at MOST risk for developing autonomic dysreflexia are patients who've experienced a spinal cord injury at T6 or higher...this includes C7. L6 is below T6, and traumatic brain injury and hemorrhagic stroke does not increase a patient risk of AD.

In autonomic dysreflexia, the nurse would expect what finding below the site of the spinal cord injury? A. Flushed lower body B. Pale and cool lower extremities C. Low blood pressure D. Absent reflexes

B. The lower extremities would be cool and pale due to vasconstriction caused by the exaggerated reflex response of the sympathetic nervous system from an irritating stimulus. The sympathetic reflex can NOT be unopposed by the parasympathetic nervous system due to the spinal injury, which is blocking the nerve impulse. The areas found ABOVE the site of injury would be flushed due to vasodilation from parasympathetic stimulation.

A patient needs to go up the stairs while using crutches. What finding by the nurse demonstrates the patient understands how to ambulate upstairs with crutches? A. The patient moves the crutches forward up the step, then the injured and non-injured leg. B. The patient moves the non-injured leg forward onto the step and then the moves the injured leg and crutches up. C. The patient moves the injured leg forward onto the steps, then moves the crutches, and then moves the non-injured leg. D. The patient moves the crutches and non-injured leg forward to the step together, and then the non-injured leg.

B. The patient will move the non-injured leg forward onto the step and then will move the injured leg and crutches up.

A 42-year-old male patient is admitted with a spinal cord injury. The patient is experiencing severe hypotension and bradycardia. The patient is diagnosed with neurogenic shock. Why is hypotension occurring in this patient with neurogenic shock? A. The patient has an increased systemic vascular resistance. This increases preload and decreases afterload, which will cause severe hypotension. B. The patient's autonomic nervous system has lost the ability to regulate the diameter of the blood vessels and vasodilation is occurring. C. The patient's parasympathetic nervous system is being unopposed by the sympathetic nervous system, which leads to severe hypotension. D. The increase in capillary permeability has depleted the fluid volume in the intravascular system, which has led to severe hypotension.

B. The sympathetic nervous system (which is a division of the autonomic nervous system) is unable to stimulate the nerves that regulate the diameter of the blood vessels (there's a loss of vasomotor tone). So, now the vessels are relaxed and this causes massive vasodilation. Systemic vascular resistance will decrease and hypotension will occur.

While your patient is ambulating with crutches he moves both crutches forward along with the injured leg and then moves the non-injured forward. When you document you will note that the patient used what type of gait while ambulating with crutches? A. Two-point gait B. Three-point gait C. Four-point gait D. Swing-to-gait

B. This describes the three-point gait while using crutches.

A 5 year old has a fracture of the right upper arm. The x-ray showed that one side of the bone is bent while the other is broken. This known as a __________ fracture? A. Spiral B. Greenstick C. Oblique D. Transverse

B. This is a greenstick fracture. These types of fractures are more common in the pediatric population because their bones tend to be more flexible and the periosteum is stronger than an adult.

A patient will be using a walker for the first time. You adjust the walker to fit the patient. Which finding below demonstrates that the walker properly fits the patient? A. There is a 2-3 finger width distance between the hand grips of the walker and the wrists. B. The elbows bend at about a 15-30 degree angle when the patient holds onto the hand grips of the walker. C. The patient's back is mid-line with the crossbar of the walker. D. The crossbar of the walker is even with the greater trochanter.

B. When a patient holds the hand grips of the walker, the elbows should slightly bend at a 15-30 degree angle.

While going down the stairs with crutches the patient will move the crutches down onto the step followed by? A. moving the non-injured leg down onto the step. B. moving the injured leg down onto the step. C. moving both legs down onto the step.

B. When going down the stairs with crutches, the patient will move the crutches down first onto the step followed by moving the INJURED leg and then the patient will move the non-injured leg down.

As the nurse, how would you correctly demonstrate to the patient the proper gait while using a walker? A. Hold onto the walker's hand grips, take a step forward with the strong side, then move walker forward, and then take a step with the weak side. B. Hold onto the walker's hand grips, move walker forward, then take a step forward with the weak side, and then take a step forward with the strong side. C. Hold onto the walker's hand grips, move walker forward, then take a step forward with the strong side, and then take a step forward with the weak side. D. Hold onto the walker's hand grips, take a step forward with the weak side, then move walker forward, and then take a step with the strong side.

B: The correct gait with a walker is to: Hold onto the walker's hand grips, move walker forward, then take a step forward with the weak side, and then take a step forward with the strong side.

During discharge teaching to a patient at risk for developing osteoporosis, you discuss the types of exercise the patient should perform. Which type of exercise is not the best to perform to prevent osteoporosis? A. Tennis B. Weight-lifting C. Walking D. Hiking

C. Low-impact exercises are not as beneficial in building bone mass as compared to weight-bearing exercises such as tennis, lifting weights, and hiking etc. The patient should perform exercises that put stress on the bones against gravity, which will help increase bone strength and build muscle.

A 55-year-old female arrives to the ER with a right leg fracture. An x-ray is performed and shows a closed tibia fracture. A closed reduction is performed and a cast is put in place. The patient is ordered Morphine 2 mg IV every 4-6 hours as needed for pain. The patient calls on the call light to tell you the pain medication is not working and that it even hurts to slightly stretch the leg. What is your response to this statement by the patient? Select all that apply: A. Reassure the patient that this is normal after a bone fracture, and reposition the cast. B. Re-adjust the cast to ensure it fits snugly against the fracture. C. Perform neurovascular checks. D. Elevate the leg above heart level. E. Loosen and remove restrictive items. F. Notify the physician.

C,E,F

After taking all the necessary steps for a patient who has developed autonomic dysreflexia, what should the nurse assess FIRST as a possible cause of this condition? A. Skin break down B. Blood glucose C. Possible bladder irritant D. Last bowel movement

C. A bladder issue is usually the most common cause of AD. If this isn't the issue the nurse should assess the bowel and then the skin for break down.

Which patient below is NOT at risk for osteoporosis? A. A 50 year old female whose last menstrual period was 7 years ago. B. A 45 year old male patient who has been taking glucocorticoids for the last 6 months. C. A 30 year old male who drinks alcohol occasionally and has a BMI of 28. D. A 35 year old female who has a history of seizures and takes Dilantin regularly.

C. All these patients are at risk for osteoporosis except the patient in option C. Remember the risk factors include: older age (45+), being a woman, Caucasian or Asian, post-menopause, glucocorticoids therapy, anticonvulsants (Dilantin), REGULAR alcohol usage, smoking, sedentary lifestyle, BMI <19, family history. Option C is not at risk.

A patient with neurogenic shock is experiencing a heart rate of 30 bpm. What medication does the nurse anticipate will be ordered by the physician STAT? A. Adenosine B. Warfarin C. Atropine D. Norepinephrine

C. Atropine will quickly increase the heart rate and block the effects of the parasympathetic system on the body. Remember bradycardia occurs in neurogenic shock because the sympathetic nervous system (which increases the heart rate) loses its ability to stimulate nerves. The sympathetic and parasympathetic systems are, in a way, balancing each other out when it comes to the heart rate. The sympathetic system increases it, while the parasympathetic decreases it. If the sympathetic system isn't working the way it should, it can NOT oppose the parasympathetic system....which will take over and lead to bradycardia.

You're performing a head-to-toe assessment on a patient with a spinal cord injury at T6. The patient is restless, sweaty, and extremely flushed. You assess the patient's blood pressure and heart rate. The patient's blood pressure is 140/98 and heart rate is 52. You look at the patient's chart and find that their baseline blood pressure is 106/76 and heart rate is 72. What action should the nurse take FIRST? A. Reassess the patient's blood pressure. B. Check the patient's blood glucose. C. Position the patient at 90 degrees and lower the legs. D. Provide cooling blankets for the patient.

C. Based on the patient findings and how the patient has a spinal cord injury at T6, they are experiencing autonomic dysreflexia. Patients with this condition may have a blood pressure that is 20-40 mmHg higher than their baseline and may experience bradycardia (heart rate less than 60). The FIRST action the nurse should take when AD is suspected is to position the patient at 90 degree (high Fowler's) and lower the legs. This will allow gravity to cause the blood to pool in the lower extremities and help decrease the blood pressure. Then the nurse should try to find the cause of the autonomic dysreflexia, which could be a full bladder, impacted bowel, or skin break down.

Bones play an important role in the body. Which of the following in NOT a function performed by the bones? A. Provide protection and support for the organs. B. Give the body shape. C. Secrete the hormone calcitonin and store blood cells. D. Store calcium and phosphorus.

C. Bones (specifically bone marrow) are responsible for red blood cell, platelet, and white blood cell production. In addition, it stores blood cells and minerals, such as calcium and phosphorous. Calcitonin is secreted by the thyroid gland NOT the bones. However, calcitonin causes osteoclast activity to be inhibited, but is not secreted by the bone.

A patient is taking Calcitonin for osteoporosis. The patient should be monitored for? A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia

C. Calcitonin is made from salmon calcitonin and acts like the hormone calcitonin which is produced naturally by the thyroid gland. It decreases osteoclast activity, which can decrease calcium levels. Therefore, the patient is at risk HYPOcalcemia.

A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA? A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

C. Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.

You're providing care to a patient experiencing neurogenic shock due to an injury at T4. As the nurse, you know which of the following is a patient safety priority? A. Keeping the head of the bed greater than 45 degrees at all times. B. Repositioning the patient every thirty minutes. C. Keeping the patient's spine immobilized. D. Avoiding log-rolling the patient during transport.

C. It is very important when a patient has a spinal cord injury to keep the spine protected. The nurse wants to prevent further damage or perfusion issues to the spinal cord. Therefore, the patient's spine should be immobilized. Example: usage of cervical collar, log-rolling, usage of a backboard.

A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication? A. Compartment Syndrome B. Osteomyelitis C. Fat embolism D. Hypovolemia

C. Patients who experience a fracture of the long bones (such as the femur) are at risk for a fat embolism. The patient will become confused and restless along with an abnormal respiratory status.

Your patient is prescribed to use crutches for ambulation. The patient can bear partial weight and needs to be taught how to use the two-point gait while using crutches. Which description below best describes this type of gait with crutches? A. The patient moves both crutches forward and then moves both legs forward to the same point as the crutches. B. The patient moves the right crutch (injured side), then moves the left foot (non-injured side), then moves the left crutch (non-injured side), and then moves the right foot (injured side). C. The patient moves both the right crutch (injured side) and left foot (non-injured side) forward together, and then moves the left crutch (non-injured side) and right foot (injured side) forward together. D. The patient moves both crutches and injured leg forward together, and then moves the non-injured leg forward.

C. The two-point gait is where the patient moves both the right crutch (injured side) and left foot (non-injured side) forward TOGETHER, and then moves the left crutch (non-injured side) and right foot (injured side) forward TOGETHER.

While using crutches the patient moves both crutches forward and then moves both legs forward past the placement of the crutches. This is known as the: A. Two-point gait B. Swing-to-gait C. Swing-through-gait D. Three-point gait

C. This description is known as the swing-through-gait. The key word to let you know it is the swing-through-gait is that the patient moves both legs PAST the placement of the crutches. It would have been the swing-to-gait if both legs moved forward to the same point as the crutch placement.

Your patient, who has a spinal cord injury at T3, states they are experiencing a throbbing headache. What is your NEXT nursing action? A. Perform a bladder scan B. Perform a rectal digital examination C. Assess the patient's blood pressure D. Administer a PRN medication to alleviate pain and provide a dark, calm environment.

C. This is the nurse's NEXT action. The patient is at risk for developing autonomic dysreflexia because of their spinal cord injury at T3 (remember patients who have a SCI at T6 or higher are at MOST risk). If a patient with this type of injury states they have a headache, the nurse should NEXT assess the patient's blood pressure. If it is elevated, the nurse would take measures to check the bladder (a bladder issue is the most common cause of AD), bowel, and skin for breakdown.

The physician orders Nitropaste for a patient who has developed autonomic dysreflexia. Which finding would require the nurse to hold the ordered dose of Nitropaste and notify the physician? A. The patient's blood pressure is 130/80. B. The patient reports a throbbing headache. C. The patient's lower extremities are pale and cool. D. The patient states they took Sildenafil 12 hours ago.

D. A patient should not receive a dose of Nitropaste if they have taken a phosphodiesterase inhibitor within the past 24 hours (Sildenafil or Tadalafil). This will cause major vasodilation and severe hypotension that will not respond to medication. Another medication should be used. All the other findings are expected with autonomic dysreflexia.

________ are found within the spongy bone and are responsible for building up the bone matrix. While ________, which are also found in the spongy bone, breakdown the bone matrix. A. Osteocytes, osteoclasts B. Osteoclasts, osteoblasts C. Osteocytes, osteoblasts D. Osteoblasts, osteoclasts

D. OsteoBLASTS are found within the spongy bone and are responsible for building up the bone matrix, while osteoCLASTS, which are also found in the spongy bone as well, breakdown the bone matrix.

While the patient ambulates in the hallway with a walker, the nurse will make it priority to? A. stand on the patient's strong side. B. stand behind the patient. C. stand in front of the patient. D. stand on the patient's weak side.

D. The nurse should stand on the patient's weak side while the patient ambulates with a walker.

he nurse is about to assess for bowel impaction in a patient who has developed autonomic dysreflexia. The nurse makes it priority to? A. Avoid using lubricants B. Stimulate the bowel with rectal manipulation C. Slowly administer a saline solution prior to assessment D. Instill an anesthetic jelly prior to assessment

D. To avoid increasing autonomic dysreflexia symptoms by increasing the sympathetic reflex due to an irritating stimulus, the nurse should instill an anesthetic jelly before assessing the rectum for hardened stool. This is also important prior to catheterization to check the bladder for urine.

You're caring for a patient who has a health history of severe osteoporosis. On assessment you note the patient has severe kyphosis of the upper back. Which nursing diagnosis takes priority for this patient's care? A. Risk for skin breakdown B. Knowledge deficient regarding disease process C. Limited mobility D. Risk for falls

D. When assessing the options you want to select the option that is a priority for this patient and risk for falls is the priority. The patient is at risk for falls due to severe kyphosis, which is common in severe osteoporosis (also called Dowager's Hump). This deformity of the spine limits mobility and increases the chances of falls In addition, it is important the nurse takes precautions in preventing falls because the patient will most likely experience a fracture due to severe osteoporosis.

True or False: The parasympathetic nervous system loses the ability to stimulate nerve impulses in patients who are experiencing neurogenic shock. This leads to hemodynamic changes.

FALSE....the statement should say: The sympathetic (NOT parasympathetic) nervous system loses the ability to stimulate nerve impulses in patients who are experiencing neurogenic shock. This leads to hemodynamic changes.

True or False: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the compact bone.

FALSE: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the SPONGY (not compact) bone. The compact bone is the outside part of the bone, and the spongy bone is found inside the compact bone. It contains a matrix of pore-like components such as protein and minerals...this starts to thin and becomes more porous in osteoporosis.

6 P's of Compartment Syndrome

Pain (early sign) Paresthesia (can be an early sign too) Pallor Paralysis Poikilothermia Pulselessness (late sign)

You're caring for a patient who has experienced a fracture to the right arm that is represented in Figure 3. What nursing intervention will you take with this type of fracture? A. Cover the fracture with a sterile dressing B. Place the arm below the heart level. C. Attempt bone reduction by manually readjusting the bone. D. Place a tight compression bandage over the fracture.

The answer is A. Figure 3 represents a compound fracture (also called an open fracture). Due to the nature of this fracture, the patient is at major risk for infection because the skin is no longer intact. Therefore, the nurse should cover the fracture site with a sterile dressing. NEVER attempt a bone reduction. In addition, avoid a tight compression bandage due to the development of ischemia. Instead, you would want to immobilize the extremities and splint it.

A 85 year old patient has an accidental fall while going to the bathroom without assistance. It appears the patient has sustained a bone fracture to the left leg. The leg's shape is deformed and the patient is unable to move it. The patient is alert and oriented but in pain. What will you do FIRST after confirming the patient is safe and stable? A. Apply an ice pack covered with a towel to the site. B. Immobilize the fracture with a splint. C. Administer pain medication. D. Elevate the extremity above heart level.

The answer is B. After confirming the patient is safe and stable, the nurse would immobilize the fracture with a splinting device. This will prevent the accidental movement of the extremity by the patient. Immobilization is important because it prevents further pain or bleeding along with more damage that can occur to the surrounding tissues. In addition, if a bone is not immobilized but moved after it has been fractured this can affect the healing process.

Figure 3 represents what type of bone fracture: This a fractured bone that breaks through the skin. A. Closed Fracture B. Compound Fracture C. Greenstick Fracture D. Transverse Fracture

The answer is B. This is known as a compound fracture (also called an open fracture).

Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the physician immediately? A. "It is really itchy inside my cast!" B. "My pain is so severe that it hurts to stretch or elevate my arm." C. "I can feel my fingers and move them." D. "I've been using ice packs to reduce swelling.""

The answer is B. This statement is very concerning and may represent a condition called compartment syndrome. Compartment syndrome is where the nerves and blood vessels are becoming compromised due to increasing pressure in the compartments within the fascia (remember fascia doesn't expand, so if there is building pressure within the compartments of muscle from bleeding etc. it will compromise circulation and nerve function). Remember to monitor the 6 P's. (pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia)

Figure 1 represents what type of bone fracture: This is a fracture that is slanted across the bone shaft.* A. Transverse Fracture B. Spiral Fracture C. Oblique Fracture D. Compound Fracture

The answer is C. This is known as an oblique fracture.

What is a late sign of compartment syndrome? A. Paralysis B. Pain C. Parethesia D. Pulselessness

The answer is D. Pulselessness is a late sign of compartment syndrome.

Figure 2 represents what type of bone fracture: The fractured bone is broken into many fragments (3 or more). A. Open Fracture B. Greenstick Fracture C. Oblique Fracture D. Comminuted Fracture

The answer is D. This is known as a comminuted fracture