N3 mobility

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? "I will lie prone with my legs slightly elevated." "I will bend at the waist when I am lifting objects from the floor." "I will avoid prolonged sitting or walking." "Instead of turning around to grasp an object, I will twist at the waist."

"I will avoid prolonged sitting or walking." Explanation: The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods.

The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain? "I have soreness and aching like cramps in both of my arms." "The pain feels deep in my legs and keeps me awake at night." "The pain feels tender, hurts, and is worse when I move." "The pain is sharp in my arms but is relieved by not moving."

"The pain feels deep in my legs and keeps me awake at night." Explanation: Bone pain is typically described as a dull, deep ache that is "boring" in nature. This pain is not typically related to movement and may interfere with sleep. Muscular pain is described as soreness or aching and is referred to as "muscle cramps." Joint pain is felt around or in the joint and typically worsens with movement. Fracture pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

An elderly female client who has dizziness and osteoporosis fell at home and fractured her hip. She underwent surgical intervention for repair of the fractured hip and is now being discharged to a subacute care facility. In the comeback phase of the Trajectory Model of Chronic Illness, the nurse Acknowledges the client's achievement when she walks to the bedside commode with her walker Discontinues the intravenous needle and changes the surgical dressing prior to discharge from the hospital Teaches the client about osteoporosis Assesses postural blood pressures

Acknowledges the client's achievement when she walks to the bedside commode with her walker Explanation: In the comeback phase of the Trajectory Model of Chronic Illness, the nurse provides positive reinforcement for goals identified and accomplished by the client. This would be acknowledging the client's achievement when she ambulates to the bedside commode with her walker.

The nurse is discussing nutritional needs for a postmenopausal patient. What dietary increase should the nurse recommend to the patient? Calcium Iron Salt Vitamin K

Calcium Explanation: Postmenopausal women should be encouraged to observe recommended calcium and vitamin D intake, including calcium supplements, if indicated, to slow the process of osteoporosis. Iron and vitamin K need not be increased unless there are signs of deficiency. Salt should be eaten in moderation, not increased, to prevent hypertension.

A client is undergoing testing to confirm a diagnosis of myasthenia gravis. The nurse explains that a diagnosis is made if muscle function improves after the client receives an IV injection of a medication. What is the medication the nurse tells the client he'll receive during this test? Cyclosporine (Sandimmune) Edrophonium (Tensilon) Immunoglobulin G (Iveegam EN) Azathioprine (Imuran)

Edrophonium (Tensilon) Explanation: The most useful and reliable diagnostic test for myasthenia gravis is the edrophonium (Tensilon) test. Within 30 to 60 seconds after injection of edrophonium, most clients with myasthenia gravis will demonstrate a marked improvement in muscle tone that lasts about 4 to 5 minutes. Cyclosporine, an immunosuppressant, is used to treat myasthenia gravis, not to diagnose it. Immunoglobulin G is used during acute relapses of the disorder. Azathioprine is an immunosuppressant that's sometimes used to control myasthenia gravis symptoms.

A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively? Help the client assume a more comfortable position. Administer hydrocodone (Vicodin) as ordered. Provide teaching on nonpharmacologic measures to control pain. Notify the physician of the client's pain.

Help the client assume a more comfortable position. Explanation: The nurse should first help the client assume a more comfortable position. After doing so, the nurse may administer pain medication as ordered. Next, the nurse should assess the client's knowledge of nonpharmacologic measures to relieve pain and provide teaching as necessary. If the client's pain isn't relieved after taking these actions, the nurse should notify the physician of the client's pain issues.

A nurse is assessing a client for potential problems related to function and mobility. Which of the following would alert the nurse to identify a potential problem related to function or movement? Uses the handrail on one side to go down the stairs Lifts one leg by raising it off the ground Holds onto the furniture when walking in the house Keeps the head erect while combing the hair

Holds onto the furniture when walking in the house Explanation: Holding onto the furniture or other objects in the room when ambulating suggests difficulty with movement. Using both hands on a handrail while going down stairs, lifting one leg by using the other leg as support, or tilting the head to reach the back of the side while combing would suggest problems with function and mobility.

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? Keep the knees together at all times Never cross the affected leg when seated Avoid placing a pillow between the legs when sleeping Bend forward only when seated in a chair

Never cross the affected leg when seated Explanation: Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The client should be taught to keep the knees apart at all times, to put a pillow between the legs when sleeping, and to avoid bending forward when seated in a chair.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis? Risk for infection Chronic pain Deficient knowledge: procedure Activity intolerance

Risk for infection Explanation: The priority nursing diagnosis following an arthrocentesis is risk for infection. The client may experience acute pain. The client needs adequate information before experiencing the procedure. Activity intolerance would not be an expected nursing diagnosis.

Which is an inaccurate principle of traction? The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely. The client must be in good alignment in the center of the bed. Skeletal traction is interrupted to turn and reposition the client.

Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be? The patient will have unilateral resting tremors and then will have a period of no tremors present. The patient will have a slow, shuffling gait and then will be able to move at a faster pace. The patient will have a period when medication with levodopa will be unnecessary. The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication.

The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication. Explanation: The patient may experience an on-off syndrome in which sudden periods of near immobility ("off effect") are followed by a sudden return of effectiveness of the medication ("on effect"). Changing the drug dosing regimen or switching to other drugs may be helpful in minimizing the on-off syndrome.

Which statement describes external fixation? The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. The bone is restored to its normal position by external manipulation. The bone is surgically exposed and realigned.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. Explanation: In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.

An elderly client with chronic osteoarthritis has difficulty ambulating and is seeking a prescription for a walker. How should the nurse categorize the client's disability? developmental acquired age-associated sensory

acquired Explanation: Acquired disabilities may be progression of a chronic disorder, such as arthritis. Developmental disabilities are those disabilities that occur any time from birth to 22 years and may result in impairment of physical or mental health, cognition, speech, language, or self-care. Sensory disabilities affect hearing or vision. Age-related disabilities are conditions from age, not a chronic disease.

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse. Complete the following sentence by choosing from the lists of options. Based on the nursing assessment, the priority action the nurse should take is to notify the orthopedic health care provider immediately and prepare the client for bivalving of the cast

correct answer

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? "You would have to stay here much longer because it takes a cast longer to dry." "A splint is applied when more swelling is expected at the site of injury." "It is best if an orthopedic doctor applies the cast." "Not all fractures require a cast."

"A splint is applied when more swelling is expected at the site of injury." Explanation: Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will swell as part of the inflammation process. The client would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied.

A 78-year-old client is undergoing surgery to repair a right hip fracture. What nursing action is appropriate during the intraoperative phase? Discuss with the anesthesiologist the need for higher doses of anesthetic agents. Withhold pain medication due to decreased renal function. Appropriately position the client using adequate padding and support. Maintain an operating room temperature of 18°C to prevent hypothermia.

Adequate padding and support should be used to prevent positioning injuries. Older adults have lower bone mass, which increases the risk of intraoperative positioning injuries. Pain medication can still be used, just in smaller doses, due to decreased liver and kidney function. For the same reason, lower doses of anesthetic agents are used with older adults. The operating room is usually maintained from 20°C to 24°C; 18°C is lower than the recommended temperature and can promote hypothermia in an older adult who already has impaired thermoregulation and is prone to hypothermia.

x A nurse is assessing a client who will be discharged home after rehabilitation for a stroke. The nurse is questioning the client about his instrumental activities of daily living (IADLs). Which of the following would the nurse address? Bathing Grooming Dressing Cooking

Cooking Explanation: Instrumental activities of daily living (IADLs) include cooking, cleaning, shopping, doing laundry, managing personal finances, developing social and recreational skills, and handling emergencies. Bathing, grooming, and dressing are activities of daily living (ADLs).

The nurse is performing an assessment for a patient in the clinic with Parkinson's disease. The nurse determines that the patient's voice has changed since the last visit and is now more difficult to understand. How should the nurse document this finding? Dysphagia Dysphonia Hypokinesia Micrographia

Dysphonia Explanation: Dysphonia (voice impairment or altered voice production) may occur as a result of weakness and incoordination of the muscles responsible for speech.

Which of the following describes a muscle that is limp and without tone? Flaccid Spastic Atonic Paralysis

Flaccid Explanation: A muscle that is limp and without tone is described as flaccid. A muscle with greater-than-normal tone is described as spastic. In conditions characterized by lower neuron destruction, denervated muscle becomes atonic (soft and flabby) and atrophies. A person with muscle paralysis has a loss of movement and possibly nerve damage.

The nursing instructor gives their students an assignment of making a plan of care for a client with Huntington's disease. What would be important for the students to include in the teaching portion of the care plan? How to exercise How to perform household tasks How to take a bath How to facilitate tasks such as using both hands to hold a drinking glass

How to facilitate tasks such as using both hands to hold a drinking glass Explanation: The nurse demonstrates how to facilitate tasks such as using both hands to hold a drinking glass, using a straw to drink, and wearing slip-on shoes. The teaching portion of the care plan would not include how to exercise, perform household tasks, or take a bath.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? Keep the cast clean and dry. Position the client on the affected side. Promote elimination with a regular bedpan. Keep the legs in abduction.

Keep the cast clean and dry. Explanation: Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.

A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client? Laser therapy Ultrasound therapy Open nerve release Injection of lidocaine

Open nerve release Explanation: Evidence-based treatment of acute carpal tunnel syndrome includes the application of splints to prevent hyperextension and prolonged flexion of the wrist. Should this treatment fail, open nerve release is a common surgical management option. A variety of treatments may be tried by the client, however, they may fail to improve the condition. These treatments include laser therapy, ultrasound therapy, and the injection of substances such as lidocaine. Though these can be used, surgery to release nerves is the best option.

A nurse is performing passive range of motion to a client's upper extremities. The nurse touches the client's thumb to each fingertip on the same hand. The nurse is performing which of the following? Adduction Pronation Opposition Dorsiflexion

Opposition Explanation: Opposition involves touching the thumb to each fingertip on the same hand. Adduction would involve moving the arm away from the midline of the body. Pronation involves rotating the forearm so that the palm of the hand is down. Dorsiflexion involves movement that flexes or bends the hand back toward the body.

Which serum level indicates the rate of bone turnover? Osteocalcin Myoglobin Creatinine kinase Aspartate aminotransferase

Osteocalcin Explanation: Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Serum myoglobin is assessed to evaluate muscle trauma. Serum enzyme levels of creatinine kinase and aspartate aminotransferase become elevated with muscle damage.

The nurse is providing care for a 90-year-old client whose severe cognitive and mobility deficits result in the nursing diagnosis of risk for impaired skin integrity due to lack of mobility. When planning relevant assessments, the nurse should prioritize inspection of what area? The client's elbows The soles of the client's feet The client's heels The client's knees

The client's heels Explanation: Full inspection of the client's skin is necessary, but the sacrum and the heels are the most susceptible areas for skin breakdown due to shear and friction.

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg? Within 30 minutes, then every 1 to 2 hours Within 30 minutes, then every 4 hours Within 30 minutes, then every 8 hours Within 30 minutes, then every shift

Within 30 minutes, then every 1 to 2 hours Explanation: After skin traction is applied, the nurse assesses circulation of the foot or hand within 15 to 30 minutes and then every 1 to 2 hours.

The nurse working in the emergency department receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the epiphysis. lordosis. scoliosis. diaphysis.

diaphysis. Explanation: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? detection of systemic complications strategies for remaining active disease-modifying antirheumatic drug therapy prevention of joint deformity

strategies for remaining active Explanation: The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

"Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "A foul smell from the cast is normal."

"Keep your right leg elevated above heart level." Explanation: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? Meniscography Bone densitometry Arthrography EMG

Arthrography Explanation: Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. Meniscography is a distractor for this question. Bone densitometry is used to estimate bone mineral density. An EMG provides information about the electrical potential of the muscles and nerves leading to them.

Which of the following brain structures is responsible for equilibrium? Cerebellum Brainstem Thalamus Hypothalamus

Cerebellum Explanation: Body balance is maintained by the cooperation of the muscles and joints of the body (proprioceptive system), the eyes (visual system), and the labyrinth (vestibular system). These areas send information about equilibrium, or balance, to the brain (cerebellar system) for coordination and perception in the cerebral cortex. The brainstem, thalamus, and hypothalamus do not function in equilibrium.

Which cleansing solution is the most effective for use in completing pin site care? Betadine Chlorhexidine Hydrogen peroxide Alcohol

Chlorhexidine Explanation: Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.

A female client who is diagnosed with a malignant tumor in her bladder is advised to undergo cystectomy followed by a urinary diversion procedure. Which of the following would be most important for the nurse to assess preoperatively? Client's manual dexterity and vision History of allergy to iodine and seafood Dietary habits involving cholesterol-laden food Menstrual history

Client's manual dexterity and vision Explanation: It is essential to assess manual dexterity, vision, and level of understanding of a client who undergoes a urinary diversion procedure because this information will determine the client's ability to manage stoma care and self-catheterization following the urinary diversion procedure. The client's history of allergy to iodine and seafood, dietary habits related to high cholesterol intake, and menstrual history are not important factors for this situation.

x Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? Callus Hammertoe Hallux valgus Dupuytren's contracture

Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Elevate the affected extremity and use cold applications. Breathe deeply and cough every 2 hours until ambulation is possible. Do ROM exercises as indicated. Apply antiembolism stockings as indicated.

Elevate the affected extremity and use cold applications. Explanation: Elevating the affected extremity and using cold applications reduce swelling. Deep breathing and coughing helps with maintenance of effective respiratory rate and depth. ROM exercises maintain full ROM of unaffected joints. Antiembolism stockings help prevent deep vein thrombosis (DVT).

A nurse asks a client who had abdominal surgery 1 day ago if he has moved his bowels since surgery. The client states, "I haven't moved my bowels, but I am passing gas." How should the nurse intervene? Apply moist heat to the client's abdomen. Encourage the client to ambulate as soon as possible after surgery. Administer a tap water enema. Notify the physician.

Encourage the client to ambulate as soon as possible after surgery. Explanation: The nurse should encourage the client to ambulate as soon as possible after surgery. Ambulating stimulates peristalsis, which helps the bowels to move. It isn't appropriate to apply heat to a surgical wound. Moreover, heat application can't be initiated without a health care provider's order. A tap water enema is typically administered as a last resort after other methods fail. A health care provider's order is needed with a tap water enema as well. Notifying the health care provider isn't necessary at this point because the client is exhibiting bowel function by passing flatus.

A client with a fractured ulna has a plaster cast applied to the forearm. Which action(s) will the nurse take when caring for the client and cast? Select all that apply. Ensure a free flow of air around the cast. Apply a dry towel over the cast until it is dry. Test cast dryness with the palm of the hand. Determine the cast is dry when it is white and shiny. Position the cast on a plastic pillow to dry.

Ensure a free flow of air around the cast.Test cast dryness with the palm of the hand. Determine the cast is dry when it is white and shiny. Casts made of plaster of Paris are less costly and achieve a better mold than fiberglass casts; however, they are heavy, not water resistant, and can take up to 24 to 72 hours to dry post-application. A free flow of air around the cast is needed for it to dry. Testing the cast for dryness can be done by using the palm of the hand. A plaster cast is dry when it is white and shiny in appearance. The cast should not be covered while it is drying because the heat generated by the chemical reaction cannot escape. A freshly applied cast should be handled as little as possible to prevent denting and cracking. The wet plaster cast should be handled by only the palms so that indentations in the cast may be prevented; indentations can result in areas of pressure on the skin. If elevation is requested to reduce swelling, a cloth-covered pillow is preferred to one covered in plastic, which could retain heat and prevent drying.

A client with chronic kidney disease reports generalized bone pain and tenderness. Which assessment finding would alert the nurse to an increased potential for the development of spontaneous bone fractures? Elevated serum creatinine Hyperkalemia Hyperphosphatemia Elevated urea and nitrogen

Hyperphosphatemia Explanation: Osteodystrophy is a condition in which the bone becomes demineralized due to hypocalcemia and hyperphosphatemia. In an effort to raise blood calcium levels, the parathyroid glands secrete more parathormone. Elevated creatinine, urea, nitrogen, and potassium levels are expected in chronic renal failure and do not contribute to bone fractures.

Which intervention should the nurse implement with the client who has undergone a hip replacement? Instruct the client to avoid internal rotation of the leg. Place the client in high Fowler's position for meals. Have the client bend forward to rise from the chair. Adduct the legs by placing a pillow between the legs.

Instruct the client to avoid internal rotation of the leg. Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.

According to the 2013 OASIS data study, which client would be at greatest risk for re-hospitalization? Female client with mild cognitive decline Male client who requires assistance to ambulate Female client with a live-in caregiver Male client with controlled congestive heart failure

Male client who requires assistance to ambulate Explanation: According to the 2013 OASIS data study, the client at greatest risk for re-hospitalization is the male client who requires assistance to ambulate. According to the study, factors that increased the likelihood of re-hospitalization included: male gender, mid-level cognitive impairment, decreased ability to perform ADLs, or support deficits (psychosocial, financial, environmental).

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? Methotrexate Celecoxib Methylprednisolone Mercaptopurine azathioprine

Methotrexate Explanation: Methotrexate is a DMARD that reduces the amount of joint damage and slows the damage to other tissues as well. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). Methylprednisolone is a steroid to reduce pain and inflammation and slow joint destruction. Mercaptopurine azathioprine is a cytotoxic drug.

A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. What is the supportive goal for the client diagnosed with muscular dystrophy? Client will be free of respiratory complications. Minimized functional deterioration in the client. Genetic testing will identify specific gene mutations. Client will complete end-of-life decisions.

Minimized functional deterioration in the client. Explanation: The goal of supportive management is to keep the client active and functioning as normally as possible and to minimize functional deterioration. Client will have respiratory complications at times, but this is not the target of the supportive goal. Gene mutations are useful, but not a generalized goal for clients. Clients with muscular dystrophy should make end-of-life decisions, but this is not the client's supportive goal.

Which of the following is considered a central nervous system (CNS) disorder? Multiple sclerosis Guillain-Barré Myasthenia gravis Bell's palsy

Multiple sclerosis Explanation: Multiple sclerosis is an immune-mediated, progressive demyelinating disease of the CNS. Guillain-Barré, myasthenia gravis, and Bell's palsy are peripheral nervous system disorders.

A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury? Numbness and burning of the foot Pallor to the dorsal surface of the foot Visible cyanosis in the toes Inadequate capillary refill to the toes

Numbness and burning of the foot Explanation: Peroneal nerve injury may result in numbness, tingling, and burning in the feet. Cyanosis, pallor, and decreased capillary refill are signs of inadequate circulation.

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? Gastrocnemius Latissimus dorsi Quadriceps Rectus abdominis

Quadriceps Explanation: The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (Fig. 42-3).

A patient diagnosed with MS 2 years ago has been admitted to the hospital with another relapse. The previous relapse was followed by a complete recovery with the exception of occasional vertigo. What type of MS does the nurse recognize this patient most likely has? Benign Primary progressive Relapsing-remitting (RR) Disabling

Relapsing-remitting (RR) Explanation: Approximately 85% of patients with MS have a relapsing-remitting (RR) course. With each relapse, recovery is usually complete; however, residual deficits may occur and accumulate over time, contributing to functional decline.

Which of the following is the final stage of fracture repair? Remodeling Cartilage calcification Cartilage removal Angiogenesis

Remodeling Explanation: The final stage of fracture repair consists of remodeling the new bone into its former structural arrangement. During cartilage calcification, enzymes within the matrix vesicles prepare the cartilage for calcium release and deposit. Cartilage removal occurs when the calcified cartilage is invaded by blood vessels and becomes reabsorbed by chondroblasts and osteoclasts. Angiogenesis occurs when new capillaries infiltrate the hematoma, and fibroblasts from the periosteum, endosteum, and bone marrow produce a bridge between the fractured bones.

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? Rotator cuff tears Epicondylitis Heterotopic ossification Acute compartment syndrome

Rotator cuff tears Explanation: Key assessment findings related to rotator cuff tears include acromioclavicular joint pain, limited range of motion, and muscle weakness. Epicondylitis (tennis elbow) is manifested by pain that usually radiates down the extensor surface of the forearm and generally is relieved with rest and avoidance of the aggravating activity. Heterotopic ossification is the abnormal formation of bone, near bones or in muscle, in response to soft tissue trauma after blunt trauma, fracture, or total joint replacement. Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur.