Nclex 42

Dupuytren's contracture causes flexion of which area(s)?

Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

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 interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.

The nurse is educating a patient on home care following a ganglion cyst removal of the right wrist. Which of the following statements made by the patient demonstrates that the nurse's teaching has been effective?

The first dressing change is done by the surgeon at a scheduled follow-up appointment. If the hand becomes cool and numb, the patient needs to call the surgeon as soon as possible. The surgeon should be notified immediately if redness and purulent drainage develop. Medication should only be used as prescribed. The use of heat may increase swelling, which may increase pain.

Which of the following terms refers to disease of a nerve root?

When the patient reports radiating pain down the leg, he or she is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation.

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing?

In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective?

Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting.

Morton's neuroma is exhibited by which clinical manifestations?

Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.

Which is a risk-lowering strategy for osteoporosis?

Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

Most cases of osteomyelitis are caused by which of the following microorganisms?

Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species are frequently found in osteomyelitis, but they do not cause the majority of bone infections. Pseudomonas species are frequently found in osteomyelitis, but they do not cause most bone infections. While E. coli is frequently found in osteomyelitis, it does not cause the majority of bone infections.

A patient with a musculoskeletal injury is instructed to increase dietary calcium. Which of the following statements by the nurse is appropriate?

Vitamin D is needed for the absorption of calcium. Although fruits containing vitamin C will assist in the absorption of calcium, noncitrus fruits are of little benefit for calcium absorption. Increasing phosphorus s in the diet can cause calcium to be lost from the bone, decreasing bone density. Red meat does not facilitate calcium absorption.

The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following?

Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. In flatfoot, the patient demonstrates a diminished longitudinal arch of the foot.

Which should be included in the teaching plan for a patient diagnosed with plantar fasciitis?

Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (e.g., heel cups, arch supports), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs.

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing bone mass density (BMD)?

Miacalcin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Evista reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Forteo has been recently approved by the FDA for the treatment of osteoporosis. Vitamin D increases the absorption of calcium.

A physician prescribes raloxifene (Evista) to a hospitalized patient. The patient's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which of the following actions by the nurse demonstrates safe nursing care?

Raloxifene (Evista) is contraindicated in patients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene (Evista) can be given without regard to food or time of day. Raloxifene (Evista) is a selective estrogen receptor modulation (SERM) medication. Sitting upright for 30-60 minutes is for the classification of bisphosphonates.

The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which of the following statements?

The only accurate statement is related to getting an adequate amount of exposure to sunshine. Aerobic exercise, such as swimming, does not prevent osteoporosis. The exercise needs to be weight bearing. A diet low in calcium and high in phosphorus will increase the risk of osteoporosis. Estrogen deficiency is linked to decreased bone mass.

A patient has been prescribed alendronate (Fosamax) for the prevention of osteoporosis. Which of the following is the highest priority nursing intervention associated with the administration of the medication?

While all interventions are appropriate, the highest priority is having the patient sit upright for 60 minutes following the administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The patient should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and Fosamax is link to a complication of osteonecrosis.

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given?

Alendronate (Fosamax) is a bisphosphonate medication. Raloxifene (Evista) is a selective estrogen receptor modulator. Terparatide (Forteo) is an anabolic agent, and denosumab (Prolia) is a monoclonal antibody agent.

Which common problem of the upper extremity results from entrapment of the median nerve at the wrist?

Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren's contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.

Which is a deformity in which the great toe deviates laterally?

Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia.

Which of the following is a metabolic bone disease that is characterized by inadequate mineralization of bone?

Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from extension of soft tissue infection, direct bone contamination, or hematogenous spread. Osteoarthritis (OA), also known as degenerative joint disease, is the most common and frequently disabling of the joint disorders. OA affects the articular cartilage, subchondral bone, and synovium.

A patient who had hospitalized with acute osteomyelitis is being discharged home. The patient states, "I'm not sure I will be able to manage the IV at home."

Osteomyelitis is treated with long-term IV antibiotics. For this reason, patients usually require IV therapy in the home environment. By saying, "don't worry," the nurse is dismissing the patient's concerns and providing nontherapeutic communication. The patient will require home IV therapy, so it is inappropriate to state that the IV will be removed. Not all patients will need or can afford a home health nurse to administer the IV therapy. The concern the patient has might be a small concern that education by the nurse may solve or it may be the need for emotional support. The nurse needs to assess the patient's concerns related to caring for the IV.

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders?

Paget's disease results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. A ganglion is a collection of neurological gelatinous material. Osteomyelitis is an infection of bone that comes from the extension of a soft tissue infection, direct bone contamination, or hematogenous spread.

A nurse is educating a patient diagnosed with osteomalacia. Which of the following statements by the nurse is appropriate?

The patient may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The patient needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The patient is at risk for pathological fractures and therefore should not engage in vigorous exercise.