NUR2120 CH 38-44

A nurse is caring for a client with deteriorating neurologic status. The nurse is performing an assessment at the beginning of the shift that reveals a falling blood pressure and heart rate, and the client makes no motor response to stimuli. Which documentation of neuromuscular status is most appropriate? (CH43) A) Abnormal posture B) Flaccidity C) Weak muscular tone D) Decorticate posturing

B) Flaccidity The nurse would document flaccidity when the client makes no motor response to stimuli. Abnormal posturing and weak motor tone would be documented specifically as the nurse would assess. Decorticate posturing is when a client is stiff with bent arms and clenched fists with legs straight out.

kyphosis (CH40)

forward curvature of the thoracic spine

Hallmark of spinal metastasis (CH44)

Pain

The older client asks the nurse how best to maintain strong muscles. What is the nurse's best response? (CH40) A) "Weight-resistance exercises can strengthen muscles." B) Cardio-training is the best way to build muscle." C) "Weight-bearing exercises can strengthen muscles." D) "Range of motion exercises build muscle mass."

A) Weight- resistance exercises can strengthen muscles." Weight-resistance exercises maintain and strengthen muscles. Cardio-training is important for heart health and weight maintenance/reduction. Weight-bearing exercises maintain bone mass. Range of motion exercises are essential for joint mobility.

Lorodosis (CH40)

exaggerated curvature of the lumbar spine

Diaphysis (Ch40)

shaft of a long bone

A client is scheduled for an EEG after having a seizure for the first time. Client preparation for this test should include which instruction? (CH43) A) "Don't eat anything for 12 hours before the test." B) "Don't shampoo your hair for 24 hours before the test." C) "Avoid stimulants and alcohol for 24 to 48 hours before the test." D) "Avoid thinking about personal matters for 12 hours before the test."

C) "Avoid stimulants and alcohol for 24 to 48 hours before the test." For 24 to 48 hours before an EEG, the client should avoid coffee, cola, tea, alcohol, and cigarettes because these may interfere with the accuracy of test results. (For the same reason, the client also should avoid antidepressants, sedatives, and anticonvulsants.) To avoid a reduced serum glucose level, which may alter test results, the client should eat normal meals before the test. The hair should be washed before an EEG because the electrodes must be applied to a clean scalp. The client's thoughts don't affect the test results.

Which of the following neurotransmitters are deficient in myasthenia gravis? (CH43) A) Acetylcholine B) GABA C) Dopamine D) Serotonin

A) Acetycholine A decrease in the amount of acetylcholine causes myasthenia gravis. A decrease of serotonin leads to depression. Parkinson's disease is caused by a depletion of dopamine. Decreased levels of GABA may cause seizures.

Which term refers to the inability to recognize objects through a particular sensory system? (CH43) A) Agnosia B) Dementia C) Ataxia D) Aphasia

A) Agnosia Agnosia may be visual, auditory, or tactile. Dementia refers to organic loss of intellectual function. Ataxia refers to the inability to coordinate muscle movements. Aphasia refers to loss of the ability to express oneself or to understand language.

What is the most common type of brain neoplasm? (CH44) A) Glioma B) Angioma C) Meningioma D) Neuroma

A) Giloma

Cranial nerve IX is also known as which of the following? (CH43) A) Glossopharyngeal B) Vagus C) Spinal accessory D) Hypoglossal

A) Glossopharyngeal

Which is the leading cause of disability and pain in the elderly? (CH39) A) Osteoarthritis (OA) B) Rheumatoid arthritis (RA) C) Systemic lupus erythematosus (SLE) D) Scleroderma

A) OA Osteoarthritis is the leading cause of disability and pain in the elderly. RA, SLE, and scleroderma are not leading causes of disability and pain in the elderly.

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification? (CH40) A) Osteoblasts B) Cortical bone C) Osteoclasts D) Cancellous bone

A) Osteoblasts Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. Cortical bone is dense hard bone found in the long shafts; cancellous bone is spongy bone found in the irregular rounded edges of bone.

A nurse suspects that a client has Huntington disease based on which assessment finding? (CH44) A) Slurred speech B) Disorganized gait C) Chorea D) Dementia

C) Chorea The most prominent clincial features of Huntington disease include chorea, intellectual decline, and often emotional disturbance. As the disease progresses, speech becomes slurred, gait becomes disorganized, and cognitive function is altered with dementia.

Colles fracture occurs in which area? (CH42) A) Elbow B) Humeral shaft C) Clavicle D) Distal radius

D) Distal radius A Colles fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand.

Which of the following procedures involves a surgical fusion of the joint? (CH39) A) Arthrodesis B) Synovectomy C) Tenorrhaphy D) Osteotomy

A) Arthroodesis An arthrodesis is a surgical fusion of the joint. Synovectomy is the excision of the synovial membrane. Tenorrhaphy is the suturing of a tendon. An osteotomy alters the distribution of the weight within the joint.

Which type of fracture is one in which the skin or mucous membrane extends to the fractured bone? (CH42) A) Compound B) Complete C) Incomplete D) Simple

A) Compound A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin.

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? (CH39) A) Facial erythema, pericarditis, pleuritis, fever, and weight loss B) Photosensitivity, polyarthralgia, and painful mucous membrane ulcers C) Weight gain, hypervigilance, hypothermia, and edema of the legs D) Hypothermia, weight gain, lethargy, and edema of the arms

A) Facial erythema, pericarditis, pleuritis, fever, and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, (the classic butterfly rash). SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

Following a transsphenoidal hypophysectomy, a nurse should assess a client for which condition? (CH44) A) Hypocortisolism B) Hypoglycemia C) Hyperglycemia D) Hypercalcemia

A) Hypocortisolism Although steroids should be given during surgery to prevent hypocortisolism, the nurse should assess the client for it. Abrupt withdrawal of endogenous cortisol may lead to severe adrenal insufficiency. Signs of hypocortisolism include vomiting, increased weakness, dehydration, and hypotension. After the corticotropin-secreting tumor is removed, the client shouldn't be at risk for hyperglycemia. Calcium imbalance and hypoglycemia shouldn't occur in this situation.

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not include when teaching the client and family information about managing the disease? (CH39) A) If you have problems with a medication, you may stop it until your next physician visit. B) Avoid sunlight and ultraviolet radiation. C) Pace activities. D) Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.

A) If you have problems with a medication, you may stop it until your next physician visit. Take medications exactly as directed and do not stop the medication if symptoms are relieved unless advised to do so by the physician. Sunlight tends to exacerbate the disease. Because fatigue is a major issue, allow for adequate rest, along with regular activity to promote mobility and prevent joint stiffness. Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing.

The nurse in an allergy clinic is assessing a new patient. The nurse is aware that histamine plays an important role in the immune response and that the effects of histamine can manifest in assessment findings. What response can occur as a result of histamine release? (CH38) A) Constriction of small venules B) Contraction of bronchial smooth muscle C) Dilation of large blood vessels D) Decrease secretion of gastric and mucosal cells

B) Constriction of bronchial smooth muscle Histamine's effects during the immune response include contraction of bronchial smooth muscle, resulting in wheezing and bronchospasm; an increase in secretion of gastric and mucosal cells; dilation of small venules; and constriction of large blood vessels.

Which cerebral lobes is the largest and controls abstract thought? (CH43) A) Temporal B) Frontal C) Parietal D) Occipital

B) Frontal The frontal lobe also controls information storage or memory and motor function. The temporal lobe contains the auditory receptive area. The parietal lobe contains the primary sensory cortex, which analyzes sensory information and relays interpretation to the thalamus and other cortical areas. The occipital lobe is responsible for visual interpretation.

The sympathetic and parasympathetic nervous systems have a direct effect on the circulatory system. Stimulation of the parasympathetic nervous system (PNS) causes which of the following? (CH43) A) Blood vessels in the heart muscle to dilate B) Heartbeat to decrease C) Blood pressure to increase D) Blood vessels in the skeletal muscles to dilate

B) Heartbeat to decrease The parasympathetic nervous system has a constricting effect on the blood vessels in the heart and skeletal muscles; the heartbeat and blood pressure will decrease.

A patient has just returned to the unit from the PACU after surgery for a tumor within the spine. The patient complains of pain. When positioning the patient for comfort and to reduce injury to the surgical site, the nurse will position the patient in what position? (CH44) A) In the lithotomy position B) In a flat side-lying position C) In the Trendelenburg position D) In the reverse Trendelenburg position

B) In a flat side-lying position After spinal surgery, the bed is usually kept flat initially. The side-lying position is usually the most comfortable because this position imposes the least pressure on the surgical site. The lithotomy position, the Trendelenburg position, and the reverse Trendelenburg position are inappropriate for this patient.

The nurse working in an allergy clinic is preparing to administer skin testing to a client. Which route is the safest for the nurse to use to administer the solution? (CH38) A) Intramuscular B) Intradermal C) Subcutaneous D) Intravenous

B) Intradermal The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.

A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored? (Ch40) A) The plate will be removed to determine if the bone is growing back. B) Serial x-rays will be taken. C) An arthroscopy will be performed. D) The bone will heal on its own without intervention.

B) Serial x-rays will be taken. Serial x-rays are used to monitor the progress of bone healing. The plate need not be disturbed. An arthroscopy is used to visualize joints. While the bone will heal without interference, monitoring of bone healing is needed to ensure further adjustments are not necessary.

Dupuytren contracture causes flexion of which area(s)? (CH41) A) Thumb B) Index and middle fingers C)Fourth and fifth fingers D) Ring finger

C) Fourth and fifth fingers

A nurse is assisting during a lumbar puncture. How should the nurse position the client for this procedure? (CH43) A) Prone, with the head turned to the right B) Supine, with the knees raised toward the chest C) Lateral recumbent, with chin resting on flexed knees D) Lateral, with right leg flexed

C) Lateral recumbent, with chin resting on flexed knees To maximize the space between the vertebrae, the client is placed in a lateral recumbent position with knees flexed toward the chin. The needle is inserted between L4 and L5. The other positions wouldn't allow as much space between L4 and L5.

While reviewing the nursing documentation on a patient on the neurological unit, the nurse notes that the patient complained of a headache several times over the previous shift. How can the nurse differentiate between a headache that is caused by a brain tumor and a headache that is caused by meningitis or encephalitis? (CH44) A) Assess the patient's carotid pulses bilaterally. B) Assess the patient's orientation to person, place, and time. C) Assess the active and passive range of motion of the patient's neck. D) Assess for the presence of a fever.

D) Assess for the presence of a fever.

A client is weak and drowsy after a lumbar puncture. The nurse caring for the client knows that what priority nursing intervention should be provided after a lumbar puncture? (CH43) A) Administer antihistamines to the client. B) Provide adequate caffeine-rich drinks to the client. C) Assess the level of consciousness (LOC) and the pupil response of the client. D) Position the client flat for at least 3 hours.

D) Position the client flat for at least 3 hours A client who has undergone a lumbar puncture should be positioned flat for at least 3 hours and given adequate fluids. These measures help restore the cerebrospinal fluid volume extracted from the client and are priority activities. The client is administered antihistamines to manage any allergic reactions that may occur from the test. The nurse should assess the LOC or the pupil response of the client after a lumbar puncture. Parenteral administration of caffeine sodium benzoate may offset cerebral vasodilation.

Which medication classification should be avoided in the treatment of brain tumors? (CH44) A) Anticoagulants B) Osmotic diuretics C) Corticosteroids D) Anticonvulsants

A) Anticoagulants Anticoagulants usually are not prescribed because of the risk for central nervous system (CNS) hemorrhage; however, prophylactic therapy with low-molecular-weight heparin is under investigation. Osmotic diuretics, corticosteroids, and anticonvulsants are utilized in the treatment of brain tumors.

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is? (CH39) A) Sicca syndrome B) Episcleritis C) Glaucoma D) Cataracts

A) Sicca syndrome Sicca syndrome is a condition of dry eyes and dry mouth that can result from infiltration of the lacrimal and salivary glands with lymphocytes. Episcleritis is an inflammatory condition of the connective tissue between the sclera and conjunctiva. Glaucoma results from increased intraocular pressure, and cataracts are a clouding of the lens in the eye.

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? (CH38) A) "It means you are very sensitive to something inside of yourself." B) "It is a hyperimmune response to something in the environment that is usually harmless." C) "It is a muted response to something in the environment." D) "It is a harmless reaction to something in the environment."

B) "It is a hyperimmune response to something in the environment that is usually harmless." An allergic disorder is characterized by a hyperimmune response to weak antigens that usually are harmless. The antigens that can cause an allergic response are called allergens.

The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid? (CH38) A) cromolyn sodium B) fluticasone C) zileuton D) fexofenadine

B) fluticasone Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

The nurse is assessing the throat of a client with throat pain. In asking the client to stick out the tongue, the nurse is also assessing which cranial nerve?(CH43) A) Cranial nerve I B) Cranial nerve V C) Cranial nerve XI D) Cranial nerve XII

D) Cranial nerve XII Assessment of the movement of the tongue is cranial nerve XII . Cranial nerve I is the olfactory nerve. Cranial nerve V is the trigeminal nerve responsible for sensation to the face and chewing. Cranial nerve XI is the spinal or accessory nerve responsible for head and shoulder and shoulder movement.

A client is actively hallucinating during an assessment. The nurse would be correct in documenting the hallucination as a disturbance in (CH43) A) thought content. B) motor ability. C) intellectual function. D) emotional status.

A) Thought content Hallucinations are disturbances of thought content. They are not disturbances in motor ability, intellectual function, or emotional status.

A nurse is reviewing how to use an epinephrine auto-injector with a child and parents. The nurse determines that the teaching was successful when the child and parents state that after injection they will hold the pen in place for approximately: (CH38) A) 5 seconds. B) 10 seconds. C) 30 seconds. D) 60 seconds.

B) 10 seconds Once the device is inserted, the client should hold device firmly against the thigh for approximately 10 seconds.

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes? (CH40) A) Radial B) Peroneal C) Median D) Ulnar

B) Peroneal The motor function of the peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses sensory function. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger. Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation.

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? (CH41) A) "I will lie prone with my legs slightly elevated." B) "I will bend at the waist when I am lifting objects from the floor." C) "I will avoid prolonged sitting or walking." D) "Instead of turning around to grasp an object, I will twist at the waist."

C) "I will avoid prolonged sitting or walking." 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.

A nurse notes on the electronic medical record of a post-lumbar puncture patient an abnormal CSF value. Which of the following is the minimal level that is an abnormal value? (CH43) A) 140 mm H2O B) 160 mm H2O C) 190 mm H2O D) 210 mm H2O

D) 210 mm H2O CSF pressure with the patient in a lateral recumbent position is normally 70 to 200 mm H2O. Pressures of more than 200 mm H2O are considered abnormal.

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity? (CH42) A) Impaired skin integrity related to effects of the injury B) Anticipatory grieving related to the loss of a limb C) Disturbed body image related to changes in the structure of a body part D) Risk for injury related to amputation

D) Risk for injury related to amputation

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? (CH41) A) Wound packing B) Wound irrigation C) Vitamin supplements D) Surgical debridement

D) Surgical debridement In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement.

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? (CH41) A) Bind the toes so that they will straighten. B) Do active range of motion on the toes. C) Have surgery to fix them. D) Wear properly fitting shoes.

D) Wear properly fitting shoes. Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist

transsphenoidal adenohypophysectomy (CH44)

Surgery involving the pituitary gland, most commonly performed to remove a pituitary tumor. The physician enters from the inner aspect of the upper lip through the sphenoid sinus.

Scoliosis (Ch40)

abnormal lateral curvature of the spine

diarthrosis joint (ch40)

freely movable- elbow, shoulder, ankle

Ataxia (CH43)

the loss of full control of bodily movements

A patient arrives to have an MRI done in the outpatient department. What information provided by the patient warrants further assessment to prevent complications related to the MRI? (CH43) A) "I am trying to quit smoking and have a patch on." B) "I have been trying to get an appointment for so long." C) "I have not had anything to eat or drink since 3 hours ago." D) "My legs go numb sometimes when I sit too long."

A) "I am trying to quit smoking and have a patch on." Before the patient enters the room where the MRI is to be performed, all metal objects and credit cards (the magnetic field can erase them) must be removed. This includes medication patches that have a metal backing and metallic lead wires; these can cause burns if not removed (Bremner, 2005).

The nurse is conducting a musculoskeletal assessment on a client documented to have rheumatoid arthritis. Which would the nurse anticipate finding when inspecting the client's fingers? (CH40) A) Soft, subcutaneous nodules along the tendons B) Hard nodules adjacent to the joints C) Hard nodules of bony overgrowth D) Soft nodules along the palmar surface

A) Soft, subcutaneous nodules along the tendons The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. The nodules of gout are hard and lie within and immediately adjacent to the joint capsule itself. Osteoarthritic nodules are hard and painless and represent bony overgrowth that results from destruction of the cartilaginous surface of bone within the joint capsule.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time? (CH42) A) 2 to 4 weeks B) 6 to 8 weeks C) 10 to 12 weeks D) 14 to 16 weeks

B) 6 to 8 weeks Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? (CH41) A) "This condition is associated with various sports." B) "Surgery is the only sure way to manage this condition." C) "Using arm splints will prevent hyperflexion of the wrist." D) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

D) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.

As part of the assessment process for a patient suspected of having gout, the nurse evaluated his serum uric acid levels. Select the value that is considered above the saturation point for crystal formation. (CH39) a. 3.2 mg/dL b. 4.3 mg/dL c. 5.4 mg/dL d. 6.8 mg/dL

D) 6.8 mg/dL The biologic value of 6.8 mg/dL or 408 ?mol/L, is a level of serum uric acid above the saturation point for crystal formation.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? (CH40) A) Growth hormone B) Vitamin D C) Sex hormones D) Calcitonin

D) Calcitonin Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.

The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout? (CH39) A) penicillamine B) methotrexate C) prednisone D) colchicine

D) Colchincine Colchicine is prescribed for the treatment of an acute attack of gout.

A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? (CH41) A) C3, C4, and L1 B) L1, L2, and L4 C) L2, L3, and L5 D) L4, L5, and S1

D) L4, L5, and S1 The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.

What intervention will best help a client with ankylosing spondylitis (AS)? (CH39) A) Have the client do range-of-motion exercises. B) Immobilize the client in traction. C) Teach the client about surgery. D) Teach the client to use a walker or cane.

D) Teach the client to use a walker or a cane. Ankylosing spondylitis (AS) affects the cartilaginous joints of the spine and can lead to decreased mobility and stability. Assisting the client to use a walker or cane will help prevent injury from falls. Range-of-motion exercises and traction will not help the client. The hallmark of the condition is back pain and sometimes fractures.

A client is diagnosed with atopic dermatitis and asks the nurse why the skin is so dry and itchy. What is the nurse's best response? (CH38) A) Large amounts of histamine in the skin B) Changes in lipid content C) Decrease in serum IgE levels D) Increased basophils

B) Changes in lipid content Excessive dryness and resultant itching of the skin with atopic dermatitis are related to changes in the lipid content, sebaceous gland activity, and sweating. Pruritus and hyperirritability of the skin are related to the large amounts of histamine in the skin. Overall, atopic dermatitis involves significant elevations of serum IgE and peripheral eosinophilia.

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? (CH41) A) Magnesium level B) Potassium level C) Alkaline phosphatase D) Troponin levels

C) Alkaline phosphatase Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.

Which factor inhibits fracture healing? (CH42) A) Vitamin D B) Exercise C) Local malignancy D) Maximum bone fragment contact

C) Local malignancy Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.

The nurse educator is teaching nursing students about various types of brain tumors. The instructor recognizes that teaching has been effective when students correctly identify a client whose lab work indicates excessively high levels of thyroid stimulating hormone would most likely be diagnosed with which type of tumor? (CH44) A) Angioma B) Neuroma C) Pituitary adenoma D) Glioblastoma

C) Pituitary adenoma Pituitary adenomas can increased production of several hormones including TSH, ACTH, growth hormone and prolactin. Excessive hormone production is not characteristic of the brain tumors identified in the alternate options.

After a person experiences a closure of the epiphyses, which statement is true? (Ch40) A) The bone grows in length but not thickness. B) The bone increases in thickness and is remodeled. C) Both bone length and thickness continue to increase. D) No further increase in bone length occurs.

D) No further increase in bone length occurs. After closure of the epiphyses, no further increase in bone length can occur. The other options are inappropriate and not related to closure of the epiphyses.

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose? (CH42) A) dislocation B) strain C) sprain D) fracture

A) Dislocation In joint dislocation, radiographic films show intact yet malpositioned bones. Arthrography or arthroscopy may reveal damage to other structures in the joint capsule. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. Sprains are injuries to the ligaments surrounding a joint. A fracture is a break in the continuity of a bone.

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? (Ch42) A) Ability to stretch arm over the head B) Difficulty lying on affected side C) Pain worse in the morning D) Minimal pain with movement

B) Difficulty lying on affected side Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side.

The human body is designed to protect its vital parts. The nurse is aware that a fracture of what type of bone may interfere with the protection of vital organs? (Ch40) A) Long bones B) Short bones C) Flat bones D) Irregular bones

C) Flat bones Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones my lead to puncturing of the vital organs or may interfere with the protection of the vital organs.

Which term refers to the failure of fragments of a fractured bone to heal together? (CH42) A) Dislocation B) Subluxation C) Nonunion D) Malunion

C) Nonunion When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? (CH41) A) Sleep on the stomach to alleviate pressure on the back. B) A soft mattress is most supportive by conforming to the body. C) Avoid twisting and flexion activities. D) Use the large muscles of the leg when lifting items.

D) Use the large muscles of the leg when lifting items. The large muscles of the leg should be used when lifting.

A patient has just had an arthroscopy. What is a nursing intervention that is necessary for the nurse to implement following an arthroscopy? (CH40) A) Wrap the joint in compression dressing. B) Flex and lower the joint. C) Extend and lower the joint. D) Apply heat.

A) Wrap the joint in compression dressing. Interventions to take following an arthroscopy include wrapping the joint in a compression dressing, extending and elevating the joint, and applying ice or cold packs.

Which may occur if a client experiences compartment syndrome in an upper extremity? (CH42) A) Whiplash injury B) Volkmann's contracture C) Callus D) Subluxation

B) Volkmann's contracture If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

A patient comes to the emergency department with severe pain in the face that was stimulated by brushing the teeth. What cranial nerve does the nurse understand can cause this type of pain? (CH43) A) III B) IV C) V D) VI

C) V The trigeminal nerve (cranial nerve V) innervates the forehead, cheeks, and jaw, so pain in the face elicited when brushing the teeth would most likely involve this nerve.

The nurse is performing a neurologic assessment on a client diagnosed with a stroke and cannot elicit a gag reflex. This deficit is related to which of the following cranial nerves? (CH43) A) VIII B) X C) III D) VII

C) X CN X is the vagus nerve and has to do with the gag reflex, laryngeal hoarseness, swallowing ability, and the symmetrical rise of the uvula and soft palate. CN VII is the facial nerve and has to do with symmetry of facial movements and the ability to discriminate between the tastes of sugar and salt. The inability to close one eyelid indicates impairment of this nerve. CN VIII is the acoustic nerve. It has to do with hearing, air and bone conduction, and balance. CN III is the oculomotor nerve and has to do with pupillary response, conjugate movements, and nystagmus

The nurse teaches the client that corticosteroids will be used to treat his brain tumor to (CH44) A) prevent extension of the tumor. B) facilitate regeneration of neurons. C) reduce cerebral edema. D) identify the precise location of the tumor.

C) reduce cerebral edema. Corticosteroids may be used before and after treatment to reduce cerebral edema and to promote a smoother, more rapid recovery. Corticosteroids do not prevent extension of the tumor or facilitate regeneration of neurons. Stereotactic procedures identify the precise location of the tumor.

A nurse helps a patient recently diagnosed with a pituitary adenoma understand that: (Ch44) A) The cause is directly related to prior exposure to radiation. B) Most tumors are malignant (>90%). C) Transcranial surgery is usually necessary to remove the tumor. D) Most tumors produce too much of one or more hormones.

D) Most tumors produce too much of one or more hormones. The majority of these tumors are benign. In rare cases, they may be malignant. Functioning tumors produce hormones, frequently in excessive amounts, resulting in conditions such as hyperthyroidism, Cushing's syndrome, and gigantism or acromegaly.

A client is diagnosed with a brain angioma. When teaching the client about the risks associated with this type of brain tumor, the nurse would educate about signs and symptoms associated with which condition? (Ch44) A) Hemorrhagic stroke B) Thyroid disorders C) Hearing loss D) Visual loss

A) Hemorrhagic stroke Brain angiomas (masses composed largely of abnormal blood vessels) are found either in the brain or on its surface. Because the walls of the blood vessels in angiomas are thin, affected clients are at risk for hemorrhagic stroke. Pituitary adenomas that produce hormones can lead to endocrine disorders, such as thyroid disorders. In addition, they can exert pressure on the optic nerves and optic chiasm, leading to vision loss. Acoustic neuromas are associated with hearing loss.

A nurse is providing an educational class to a group of older adults at a community senior center. The topic of the class is nutrition. The nurse informs the group that their recommended adequate intake (RAI) level of calcium daily is what? (CH41) A) 1,000 mg B) 1,100 mg C) 1,200 mg D) 1,300 mg

C) 1,200 mg The RAI level of calcium for adults 51 years of age and older is 1,200 mg/day. The RAI level of calcium for ages 9 to 19 years of age is 1,300 mg/day. The RAI level for adults 19 to 50 years of age is 1,000 mg/day.

A client with a cerebellar brain tumor is admitted to an acute care facility. The nurse formulates a nursing diagnosis of Risk for injury. Which "related-to" phrase should the nurse add to complete the nursing diagnosis statement? (CH44) A) Related to visual field deficits B) Related to difficulty swallowing C) Related to impaired balance D) Related to psychomotor seizures

C) Related to impaired balance A client with a cerebellar brain tumor may suffer injury from impaired balance as well as disturbed gait and incoordination. Visual field deficits, difficulty swallowing, and psychomotor seizures may result from dysfunction of the pituitary gland, pons, occipital lobe, parietal lobe, or temporal lobe — not from a cerebellar brain tumor. Difficulty swallowing suggests medullary dysfunction. Psychomotor seizures suggest temporal lobe dysfunction.

Which statement indicates appropriate nursing intervention for a client with post-polio syndrome? (CH44) A) Administer antiretroviral agents B) Plan activities for evening hours rather than morning hours C) Avoid the use of heat applications in the treatment of muscle and joint pain D) Provide care aimed at slowing the loss of strength and maintaining overall well-being.

D) Provide care aimed at slowing the loss of strength and maintaining overall well-being. No specific medical or surgical treatment is available for this syndrome and therefore nursing plays a pivotal role in the team approach to assisting clients and families in dealing with the symptoms of progressive loss of muscle strength and significant fatigue. Nursing interventions are aimed at slowing the loss of strength and maintaining the physical, psychological and social well-being of the client. Clients need to plan and coordinate activities to conserve energy and reduce fatigue. Important activities should be planned for the morning as fatigue often increases in the afternoon and evening. Pain in muscles and joints may be a problem. Nonpharmacologic techniques, such as the application of heat and cold, are most appropriate because these clients tend to have strong reactions to medications.

Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? (CH39) A) Rheumatoid arthritis B) Systemic lupus erythematosus C) Polymyalgia rheumatic D) Scleroderma

D) Scleroderma Scleroderma occurs initially in the skin but also occurs in blood vessels, major organs, and body systems, potentially resulting in death. Rheumatoid arthritis results from an autoimmune response in the synovial tissue, with damage taking place in body joints. SLE is an immunoregulatory disturbance that results in increased autoantibody production. In polymyalgia rheumatic, immunoglobulin is deposited in the walls of inflamed temporal arteries.

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? (CH41) A) Open reduction B) Needle aspiration C) Arthroplasty D) Arthroscopy

D) arthroscopy Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.

The anatomy instructor is discussing the central nervous system. A student asks where the cerebral cortex is located. What should the anatomy instructor answer? (CH43) A) "It is located on the surface of the cerebrum." B) "It is located in the center of the cerebellum." C) "It is located at the base of the brain." D) "It is located between the left and right hemispheres of the brain."

A) "It is located on the surface of the cerebrum." The cerebral cortex is the surface of the cerebrum. It contains motor neurons, which are responsible for movement, and sensory neurons, which receive impulses from peripheral sensory neurons located throughout the body.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? (CH42) A) As soon as tolerated, after a reasonable period of immobilization B) In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments C) In about 4 to 5 weeks, after new bone is well established D) In 2 to 3 months, after normal activities are resumed

A) As soon as tolerated, after a reasonable period of immobilization Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer (NAON, 2007).

A patient has had rheumatoid arthritis for over 10 years, and the health care provider has now ordered cyclophosphamide (Cytoxan) for treatment of the disease. The nurse must be alert to what side effects of this medication when administering an immunosuppressant? (Ch39) A) Infection B) Nystagmus C) Muscle rigidity D) Hyperthermia

A) Infection When administering immunosuppressant agents, such as Cytoxan, the nurse should be alert to manifestations of bone marrow suppression. Clinical manifestations of infection would be an important assessment for this patient. Nystagmus is a clinical manifestation of multiple sclerosis. Muscle rigidity occurs in Parkinson's disease. Hyperthermia does not occur as a common manifestation when receiving immunosuppressant agents.

A clinic nurse has been charged with the responsibility of teaching avoidance strategies to an adult patient who has allergic rhinitis. What measure should the nurse recommend to this patient? (CH38) A) "Make sure that there are never air drafts in your home." B) "Avoid the use of air conditioning whenever possible." C) "If possible, make sure that no one smokes tobacco in your home." D) "Keep your windows open to ensure adequate air circulation."

C) "If possible, make sure that no one smokes tobacco in your home." Avoidance strategies for allergic rhinitis include maintaining a smoke-free home, keeping windows closed during peak times, and using air conditioning whenever possible. Air drafts do not necessarily exacerbate allergies.

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? (CH41) A) "You will need to decrease the amount of dairy products you consume." B) "You will need to avoid foods high in phosphorus and vitamin D." C) "You may need to be evaluated for an underlying cause, such as renal failure." D) "You will need to engage in vigorous exercise three times a week for 30 minutes."

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

Which client is most likely to develop systemic lupus erythematosus (SLE)? (CH39) A) A 25-year-old white male B) A 25-year-old Jewish female C) A 27-year-old black female D) A 35-year-old Hispanic male

C) A 27-year- old black female SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more black women than white women; its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women.

A 30-year-old primiparous woman has been admitted in early labor. The obstetrical nurse has read on the patient's prenatal record that she has a history of seizures. The nurse should understand that seizures most often occur as a result of: (Ch43) A) Benign spinal cord lesions B) Cranial nerve deficits C) Abnormal activity in the cerebral cortex D) Faulty integration of sensory impulses by the thalamus

C) Abnormal activity in the cerebral cortex Seizures are the result of abnormal paroxysmal discharges in the cerebral cortex, which then manifest as an alteration in sensation, behavior, movement, perception, or consciousness. Spinal cord lesions, cranial nerve deficits, and dysfunction of the thalamus are not common causes of seizures.

Which term refers to fixation or immobility of a joint? (CH39) A) Hemarthrosis B) Diarthrodial C) Arthroplasty D) Ankylosis

D) Ankylosis Ankylosis may result from disease or scarring due to trauma. Hemarthrosis refers to bleeding into a joint. Diarthrodial refers to a joint with two freely moving parts. Arthroplasty refers to replacement of a joint.

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? (CH39) A) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." B) "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." C) "OA affects joints on both sides of the body. RA is usually unilateral." D) "OA is more common in women. RA is more common in men."

A) "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.

The nurse is providing health education to a client recently diagnosed with a brain tumor. During the appointment, the client states, "I'm really worried that I will have a seizure while I am at work or with my kids. Should I be concerned about this?" How should the nurse respond? (CH44) A) "There is a risk for seizures in people who have this diagnosis. What have you already discussed with your primary health care provider regarding management of seizures?" B) "60% of people with brain tumors have seizures. There is a strong chance you will have a seizure at some point and should keep a seizure kit close by." C) "Seizures are genetic neurological conditions. Do you have anyone in your family with a seizure disorder? If so, this increases the likelihood you will have one." D) "It is not within my scope to discuss this aspect of your care with you. You should talk to your treating primary health care provider about this and discuss options.

A) "There is a risk for seizures in people who have this diagnosis. What have you already discussed with your primary health care provider regarding management of seizures?" In this case, the client is verbalizing a valid concern about management of the potential manifestation of the brain tumor. The nurse should engage the client by providing fact-based information about the probability of seizures caused by effects of brain tumors. The nurse should further engage in the discussion by evaluating the client's existing understanding of the seizures related to brain tumors and the associated management of this problem. The open-ended manner in which the nurse has asked the question in the correct answer option allows the client to reveal any knowledge deficits or gaps in understanding of the condition. Telling the client there is a strong chance that he or she will have a seizure is countertherapeutic and would serve to increase the client's anxiety. The nurse's aim should be to reduce the client's anxiety related to the diagnosis. Telling the client that seizures are a genetic neurological condition is out of context in this situation. The client is worried about having a seizure because he or she has a brain tumor. The nurse should address the concern in the correct context. The nurse is incorrect when stating having this discussion is not within the nurse's scope of practice. The client's verbalized concern presents an opportunity for the nurse to evaluate the client's understanding of the treatment and management of the condition. The nurse should refer the client back to the primary health care provider if there are any aspects of the client's health history that are unclear.

The nurse is assessing a client's perneal nerve. What technique will the nurse use? (CH40) A) Prick the skin mid-way between the great and second toe. B) Ask the client to plantar flex the toes. C) Ask the client to invert and evert the foot. D) Prick the medial surface of the sole.

A) Prick the skin mid-way between the great and second toe. To assess the peroneal nerve, the nurse would prick the skin mid-way between the great and second toe.

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as? (CH39) A) Swan neck deformity B) Boutonnière deformity C) Ulnar deviation D) Rheumatoid nodules

A) Swan neck deformity A swan neck deformity is a hyperextension of the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. A Boutonnière deformity is a persistent flexion of the proximal interphalangeal joint with hyperextension of the distal interphalangeal joint. Ulnar deviation is when the fingers are deviating laterally toward the ulna. A rheumatoid nodule is a subcutaneous nodule.

Extensive diagnostic testing has resulted in a patient's diagnosis of a benign brain tumor. When providing care for this patient, the nurse should be cognizant of which of the following characteristics of benign brain tumors? (CH44) A) Benign brain tumors constitute a risk factor for possible metastasis. B) Benign brain tumors can slowly grow into an area of vital brain function. C) Benign brain tumors have no physiological effect but should be closely monitored. D) Benign brain tumors typically become malignant within 1 to 2 years.

B) Benign brain tumors can slowly grow into an area of vital brain function. Benign tumors are slow growing but can occur in a vital area, where they can grow large enough to cause serious effects. They do not necessarily develop to malignancy, and they are not primarily understood as simply a risk factor for further cancer.

The nurse reviews the patient's drug regimen for treatment of a brain tumor. She explains to the patient why one of the following drugs would not be prescribed, even though it might have therapeutic benefits. Which drug would not be prescribed for this patient? (Ch44) A) Paclitaxel B) Coumadin C) Decadron D) Dilantin

B) Coumadin Although deep vein thrombosis and pulmonary embolism occur in about 15% of patients and cause significant morbidity, anticoagulants are not prescribed due to the risk for CNS hemorrhage.

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following? (CH44) A) Edema associated with the tumor B) Irritation of the meduallary vagal centers C) Compression of surrounding structures D) Distortion of pain-sensitive structures

B) Irritation of the meduallary vagal centers Vomiting associated with a brain tumor is usually the result of irritation of the vagal centers in the medulla. Edema secondary to the tumor or distortion of the pain-sensitive structures is thought to be the cause of the headache associated with brain tumors. Compression of the surrounding structures results in the signs and symptoms of increased intracranial pressure.

A patient has suffered cerebellar trauma after falling off of a ladder. The patient has been stabilized and is now receiving care on a neurological unit. When planning this patient's care, what nursing diagnosis is most likely to result from an injury to this part of the brain? (CH43) A) Risk for aspiration B) Risk for falls C) Risk for ineffective thermoregulation D) Risk for ineffective breathing pattern

B) Risk for falls The cerebellum is largely responsible for coordination of all movement. Injury thus results in a significant risk for falls. The cerebellum does not coordinate thermoregulation, swallowing, or respiration.

The nurse is doing an initial assessment on a patient recently admitted to the unit with a diagnosis of cerebrovascular accident (CVA). The patient has difficulty copying a figure that the nurse has drawn. The nurse uses this technique to assess for what type of aphasia? (CH43) A) Auditory-receptive B) Visual-receptive C) Expressive speaking D) Expressive writing

B) Visual receptive Difficulty copying a figure that the nurse has drawn would be considered visual-receptive aphasia. Expressive aphasia is the inability to express oneself, often associated with damage to the left frontal lobe area. Receptive aphasia is the inability to understand what someone else is saying; it is often associated with damage to the temporal lobe area

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? (CH39) A) Increased red blood cell count B) Increased C4 complement C) Elevated erythrocyte sedimentation rate D) Increased albumin levels

C) Elevated erythrocyte sedimentation rate. The erythrocyte sedimentation rate (ESR) may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. Red blood cell count and C4 complement component are decreased. Serum protein electrophoresis may disclose increased levels of gamma and alpha globulin but decreased albumin.

The nurse is teaching a group of health care workers about latex allergies. What reaction will the nurse teach the workers to be most concerned about with laryngeal edema? (CH38) A) irritant contact B) allergic contact C) IgE-mediated hypersensitivity D) IgG antibodies

C) IgE-mediated hypersensitivity A type I, IgE-mediated hypersensitivity can cause severe reaction symptoms such as laryngeal edema and bronchospasm. Irritant and allergic contact dermatitis result in more localized skin reactions. IgG antibodies are important in fighting viral and bacterial infections.

The nurse who is employed in a neurologist's office is performing a history and assessment on a client experiencing hearing difficulty. The nurse is most correct to gather equipment to assess the function of cranial nerve: (CH43) A) II B) VI C) VIII D) XI

C) VIII There are 12 pairs of cranial nerves. Cranial nerve VIII is the vestibulocochlear or auditory nerve responsible for hearing and balance. Cranial nerve II is the optic nerve. Cranial nerve VI is the abducens nerve responsible for eye movement. Cranial nerve XI is the accessory nerve and is involved with head and shoulder movement.

The nurse is discussing an older adult's risk for skeletal fractures with a group of students assigned to the clinical area. Which of the following would the nurse most likely explain as the underlying reason for the increased risk? (CH40) A) Collagen formation decreases. B) Aging leads to a deficiency of calcium. C) No bone reformation occurs in the older adult. D) Bone resorption is more rapid than bone formation.

D) Bone resorption is more rapid than bone formation. Older adults are more prone to skeletal fractures because bone resorption is more rapid than bone formation. Collagen formation increases resulting in fibrosis and loss of strength and flexibility. Increased risk for skeletal fractures is not always due to a calcium deficiency. The process of bone reformation does not stop with age. Age-related declines of estrogen and testosterone production cause bone loss. After age 35 years, people generally experience a loss of bone mass.

To assess a client's cranial nerve function, a nurse should assess: (CH43) A) hand grip. B) orientation to person, time, and place. C) arm drifting. D) gag reflex.

D) gag reflex The gag reflex is governed by the glossopharyngeal nerve, one of the cranial nerves. Hand grip and arm drifting are part of motor function assessment. Orientation is an assessment parameter related to a mental status examination.

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration? (Ch40) A) A serum calcium test B) An electromyography C) An arthroscopy D) A magnetic resonance imaging (MRI)

B) An electromyography An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. A serum calcium test evaluates the calcium in the blood. An arthroscopy assesses changes in the joint. An MRI identifies abnormalities in the targeted area.

The nurse understands that bone maintenance requires a balance between forming and dissolving bone. What is a correct statement about the function of osteoblasts? (CH40) A) They are multinuclear cells involved in resorbing bone. B) They secrete a matrix that consists of collagen. C) They are located in shallow lacunae (small pits in bones). D) They are nourished by capillaries that are part of the Haversian system.

B) They secrete a matrix that consists of collagen. Osteoblasts function in bone formation by secreting bone matrix, which consists of collagen and ground substances that provide a framework for inorganic mineral salts to be deposited. The other choices are characteristic of osteoclasts.

A client is waiting in a triage area to learn the medical status of family members following a motor vehicle accident. The client is pacing, taking deep breaths, and handwringing. Considering the effects in the body systems, the nurse anticipates that the liver will: (Ch43) A) cease function and shunt blood to the heart and lungs. B) convert glycogen to glucose for immediate use. C) produce a toxic byproduct in relation to stress. D) maintain a basal rate of functioning.

B) convert glycogen to glucose for immediate use. When the body is under stress, the sympathetic nervous system is activated readying the body for action. The effect of the body is to mobilize stored glycogen to glucose to provide additional energy for body action.

The nurses instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? (CH42) A) Do not flex the hip more than 30 degrees. B) Do not flex the hip more than 60 degrees. C) Do not flex the hip more than 90 degrees. D) Do not flex the hip more than 120 degrees.

C) Do not flex hip more than 90 degrees. Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture. By telling the patient to not to cross their legs, the leg stays in a the abducted position allowing for the hip to heal in the proper position. Having someone assist with the shoes does not allow for the hip to flex more than 90 degrees.

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? (CH41) A) Gastrocnemius B) Latissimus dorsi C) Quadriceps D) Rectus abdominis

C) Quadriceps 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).

The nurse is admitting a patient to the unit who is diagnosed with a lower motor neuron lesion. What clinical manifestations would this patient most likely exhibit? (CH43) A) Increased muscle tone B) No muscle atrophy C) Hyperactive and abnormal reflexes D) Absent or decreased reflexes

D) Absent or decreased reflexes Lower motor neuron lesions cause flaccid muscle paralysis, muscle atrophy, decreased muscle tone, and loss of voluntary control.

A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include? (CH39) A) tender to the touch B) reddened C) nonmovable D) located over bony prominence

D) located over bony prominence Rheumatoid nodules usually are nontender, movable, and evident over bony prominences, such as the elbow or the base of the spine. The nodules are not reddened.

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client? (CH42) A) Disseminated intravascular coagulation B) Compartment syndrome C) Carpal tunnel syndrome D) Fat embolism syndrome

B) Compartment syndrome The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a client with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation. A client with a dislocation does not experience an increased risk of complications such as disseminated intravascular coagulation, carpal tunnel syndrome, or fat embolism syndrome.

A nursing educator is talking with nurses about the effects of the aging process and neurologic changes. What would the educator identify as a normal neurological change that accompanies the aging process? (CH43) A) Hyperactive deep tendon reflexes B) Reduction in cerebral blood flow (CBF) C) Increased cerebral metabolism D) Hypersensitivity to painful stimuli

B) Reduction in cerebral blood flow (CBF) Reduction in CBF is a change that occurs in the normal aging process. Deep tendon reflexes can be decreased or in some cases absent. Cerebral metabolism decreases as the patient advances in age. Reaction to painful stimuli may be decreased with age. Because pain is an important warning signal, caution must be used when hot or cold packs are applied.

A patient is recovering in the hospital following a total hip replacement that was performed 2 days ago. In an effort to prevent the common complications associated with the surgical procedure, the nurse should implement which of the following interventions, as ordered? (CH42) A) Passive range-of-motion (ROM) exercises with the affected leg B) Provision of a low-fiber, high-calorie diet C) Application of sequential compression devices D) Intermittent urinary catheterization to prevent urinary retention

C) Application of sequential compression devices The risk of venous thromboembolism is particularly great after reconstructive hip surgery. The nurse encourages the patient to consume adequate amounts of fluids, to perform ankle and foot exercises hourly while awake, and to use elastic stockings and sequential compression devices as prescribed. Passive ROM is not performed due to the high risk of injury. A low-fiber diet is not indicated, and intermittent catheterization is not used as a preventative measure.

A 67-year-old woman with a history of osteoarthritis has been admitted to the postsurgical unit from the PACU following a bunionectomy. Which of the following nursing actions should the nurse integrate into this patient's immediate care? (CH41) A) Maintain the patient's foot in a dependent position. B) Apply ice to the affected foot on a schedule of 1 hour on and 1 hour off. C) Keep the patient's foot elevated above the level of her heart. D) Change the patient's surgical dressing and irrigate the surgical site every 6 hours.

C) Keep the patients foot elevated above the level of her heart. Post bunionectomy, the patient may have intense throbbing pain at the operative site, requiring liberal doses of analgesic medication. The foot is elevated to the level of the heart to decrease edema and pain. The application of ice for a 1-hour period is likely to cause skin breakdown. It is unnecessary to perform frequent irrigation or dressing changes.

A client has undergone a lumbar puncture as part of a neurological assessment. The client is put under the care of a nurse after the procedure. Which important postprocedure nursing intervention should be performed to ensure the client's maximum comfort? (CH43) A) Administer antihistamines according to the physician's prescription B) Keep the room brightly lit and play soothing music in the background C) Help the client take a brisk walk around the testing area D) Encourage the client to drink liberal amounts of fluids

D) Encourage the client to drink liberal amounts of fluids The nurse should encourage the client to take liberal fluids and should inspect the injection site for swelling or hematoma. These measures help restore the volume of cerebrospinal fluid extracted. The client is administered antihistamines before a test only if he or she is allergic to contrast dye and contrast dye will be used. The room of the client who has undergone a lumbar puncture should be kept dark and quiet. The client should be encouraged to rest, because sensory stimulation tends to magnify discomfort.

Two days after surgery to amputate the left lower leg, a client reports pain in the missing extremity. Which action by the nurse is most appropriate? (CH42) A) Administer medication, as ordered, for the reported discomfort. B) Contact the health care provider. C) Initiate a consult with a psychologist. D) Do nothing because it isn't possible to have pain in a missing limb.

A) Administer medication, as ordered, for the reported discomfort. The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pain is a normal occurrence after an amputation. It should be treated with medication. The nurse doesn't need to contact the health care provider at this time. Consultation with the psychologist isn't indicated, and the nurse shouldn't take this action without consulting the health care provider.

Choose the correct statement about the endosteum, a significant component of the skeletal system: (CH40) A) Covers the marrow cavity of long bones B) Supports the attachment of tendons to bones C) Contains blood vessels and lymphatics D) Facilitates bone growth

A) Covers the marrow cavity of long bones The endosteum is a thin vascular membrane that covers the marrow cavity of long bones and the spaces in cancellous bone. Osteoclasts are located near the endosteum.

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? (Ch41) A) Hammer toe B) Mallet toe C) Hallux valgus D) Bunion

A) Hammer toe Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk? (CH42) A) Infection B) Malunion C) Complex regional pain syndrome D) Depression

A) Infection This client is at the highest risk for infection because of the open fracture that was obtained while horseback riding. Infection that enters the body and affects the bone can lead to osteomyelitis. The treatment may involve long-term antibiotics and may even result in death. The client is still at risk for malunion, but this risk is slight because the bone can be visualized (either through the wound or surgical intervention) and returned to anatomical position. The other options are possible consequences of this type of injury but do not represent the most serious complication.

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? (CH41) A) Changing the dressing B) Applying a cock-up splint and immobilization C) Having the patient exercise the fingers to avoid future contractures D) Performing hourly neurovascular assessments for the first 24 hours

D) Performing hourly neurovascular assessments for the first 24 hours Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion.

A female patient tells the nurse that she has pain and numbness to her thumb, first, and second finger of her right hand. The nurse discovers that the patient is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the patient could possibly have what? (CH41) A) Carpal tunnel syndrome B) Tendinitis C) Impingement syndrome D) Dupuytren's contracture

A) Carpal tunnel syndrome Carpal tunnel syndrome may be manifested by numbness, pain, paresthesia, and weakness along the median nerve. Tendonitis is inflammation of muscle tendons. Impingement syndrome is a general term that describes all lesions that involve the rotator cuff of the shoulder. Dupuytren's contracture is a slowly progressive contracture of the palmar fascia.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? (CH42) A) Compound B) Greenstick C) Oblique D) Spiral

A) Compound A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate? (CH40) A) Muscle weakness B) Muscle composition C) Bone density D) Metastatic bone lesions

A) Muscle weakness Electromyography tests the electric potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, disability, and to differentiate muscle and nerve problems. A bone biopsy is done to identify bone composition. Bone densitometry is done to evaluate bone density. A bone scan would be appropriate to detect metastatic bone lesions.

The nurse is performing a neurological assessment of a client who has sustained damage to the frontal cortex. Which of the following deficits will the nurse look for during assessment? (CH43) A) The inability to tell how a mouse and a cat are alike B) The inability to maintain steady balance for the Romberg test C) Absence of movement below the waist D) Intentional tremors

A) The inability to tell how a mouse and a cat are alike The client with damage to the fronal cortex will display a deficit in intellectual functioning. Questions designed to assess this capacity might include the ability to recognize similarities: for example, how are a mouse and dog or pen and pencil alike? The Romberg test assesses balance, which has to do with the cerebellar and basal ganglia influence on the motor system. Absence of movement below the waist suggests a deficit with the spinal cord. Intentional tremors have to do with deficits of the motor system.

A 77-year-old man is recovering in the hospital after a recent femoral fracture and has rung his call light. The nurse has entered the room to find the patient in distress, clutching his chest while struggling to say, "I can't breathe." The nurse should take prompt action based on the knowledge that this patient may be experiencing what complication of lower extremity fractures? (CH42) A) Thromboembolism B) Unstable angina C) Acute respiratory distress syndrome (ARDS) D) Ischemic stroke

A) Thromboembolism Venous thromboemboli, including deep vein thrombosis (DVT) and pulmonary emboli (PE), are associated with reduced skeletal muscle contractions and bed rest. Patients with fractures of the lower extremities and pelvis are at high risk for venous thromboemboli. The most frequent signs are sudden onset shortness of breath, restlessness, increased respiratory rate, tachycardia, chest pain, and low-grade temperature. Angina, ARDS and stroke are not common complications of skeletal fractures.

A nurse leader is coordinating care for a group of medical-surgical patients. What patient should the nurse recognize as being at the highest risk for the development of osteomyelitis? (Ch41) A) A middle-aged adult who takes ibuprofen daily for rheumatoid arthritis B) An elderly patient with an infected pressure ulcer in the sacral area C) A 19-year-old football player who had orthopedic surgery 6 weeks prior D) An older adult patient with a diagnosis of chronic heart failure (CHF)

B) An elderly patient with an infected pressure ulcer in the sacral area Patients who are at high risk of osteomyelitis include those who are poorly nourished, elderly, and obese. The elderly patient with an infected sacral pressure ulcer is at the greatest risk for the development of osteomyelitis, as this patient has two risk factors: age and the presence of a soft-tissue infection that has the potential to extend into the bone. The patient with rheumatoid arthritis has one risk factor, the arthritis. The adult with CHF has no identifiable risk factors. The patient 6 weeks postsurgery is beyond the window of time for the development of a postoperative surgical wound infection.

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? (CH39) A) Acupuncture B) An exercise routine that includes range-of-motion (ROM) exercises C) Heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) D) Cold therapy

B) An exercise routine that includes range-of-motion (ROM) exercises Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain. Acupuncture may help relieve the client's pain; however, it isn't within the scope of practice for physical and occupational therapists. Heat therapy may help the client, but it's coupled with NSAIDs in this option, which goes against the client's wishes. Cold therapy aggravates joint stiffness and causes pain.

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction? (CH42) A) Apply heat to the fracture site. B) Apply ice to the fracture site. C) Perform ankle dorsiflexion three times per day. D) Use crutches for 1 week.

B) Apply ice to the fracture site. Applying ice to the injury site soon after an injury causes vasoconstriction, helping to relieve or prevent swelling and bleeding. Applying heat to the fracture site may increase swelling and bleeding. Ankle dorsiflexion has no therapeutic use after a toe fracture. It's unlikely the client would need crutches after a toe fracture.

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? (CH41) A) Potassium level of 6.3 mEq/L B) Calcium level of 11.6 mg/dl C) Sodium level of 110 mEq/L D) Magnesium level of 0.9 mg/dl

B) Calcium level of 11.6 mg/dl In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client? (CH42) A) With the affected hip flexed acutely B) With the leg on the affected side abducted C) With the leg on the affected side adducted D) With the affected hip rotated externally

B) With the leg on the affected side abducted The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.