patho ch.47 &49 study guide

Which disorders place a client at increased risk for secondary osteoporosis? Select all that apply.

Long-term corticosteroid use Hyperparathyroidism.

To maintain adequate serum calcium levels, what does parathyroid hormone reduce?

serum phosphate levels (calcium and phosphate oppose each other)

The practitioner expects to see which lab result in a client with a recent femur fracture?

Increased alkaline phosphatase p 1179 osteoblast secrete alkaline phosphatase, increased activity of osteoblast increased serum AP

A physiotherapist is aware of the benefits of minimizing bed rest and is teaching a cardiac client's daughter about the rationale for early mobilization. Which teaching point would the physiotherapist be unable to justify during his teaching?

"A bedridden person's heart beats faster and can cause an increase in blood pressure."

An adult with flat feet is complaining about pain. Which statements will best help this client? Select all that apply.

"Be fitted for good shoes with arch supports." "Surgery may be needed if symptoms do not decrease." "Losing weight may ease the pain."

What questions should the nurse ask a 55-year-old woman to ascertain her risk for osteoporosis? Select all that apply.

"Do you have a family history of osteoporosis?" "What medications do you take on a regular basis?" "Do you smoke?" "Do you sit most of the day?"

A parent asks the nurse, "What is femoral anteversion? I was told my daughter has this." What is the best response by the nurse?

"How old is your daughter?"

A parent complains of her son being "pigeon-toed." How should the nurse respond to this parent?

"Your son should be evaluated to determine what type of abnormality he has."

While trying to explain the role of vitamin D in clients who are experiencing calcium and phosphate deprivation, the instructor correlates these electrolyte imbalances with an increase in which metabolite?

1,25- (OH)2D3

In which client would the nurse expect to find woven bone scaffolding in place to facilitate healing? Select all that apply.

22 year old with fracture 55 year old under chemo for prostate CA w/ bone metastasis -tumor (found in fetus, fracture and tumors)

The nurse is caring for clients with chronic metabolic disorders. For which of the following clients should the nurse advocate the monitoring of vitamin D levels? Select all that apply.

A 27-year-old who has had resection of the small bowel (source vit d) A 47-year-old with cirrhosis of the liver (vit D activation) A 60-year-old with advanced chronic kidney disease (vit D activation)

While educating the client starting bisphosphonates for osteoporosis, the client asks, "So what adverse reaction can this drug cause?" Which response by the nurse is most accurate?

A hip fracture

Which statements are true regarding a synarthrosis?

Little movement or no movement, connected by hyaline cartilage like in skull sutures can expand a little for baby brain growth

Which clients are at increased risk for development of osteoporosis? Select all that apply.

A postmenopausal 65-year-old woman A 20-year-old female with hyperthyroidism A client with Cushing syndrome A client with adult onset diabetes mellitus. A young adult who has alcoholism

The nurse knows that an individual diagnosed with chronic fatigue syndrome (CFS) may complain of which clinical manifestation listed below?

A) Achy joints and muscles and low-grade temperature over the past few weeks

The nurse knows that which client might experience fatigue relative to either physiologic, psychological, and/or pathologic aspects? Select all that apply.

A) An elderly client on tranquilizers for sleep in the noisy nursing home environment B) An adult who performs manual outdoor labor as a roofer C) An adolescent client with a diagnosis of leukemia on a chemotherapy regimen

A nursing instructor is teaching about osteoporosis and correctly lists which of these to be risk factors? Select all that apply.

Age Gender Genetics Activity Nutrition

Which clients are at risk for developing osteomalacia ? Select all that apply.

An elderly female who "can't stand to drink milk" and refuses calcium supplements since she has a history of kidney stones A person who lives in a colder region of the northwest who doesn't get out much during the winter months for fear of falling A female client whose father had a genetic predisposition to primary hyperparathyroidism resulting in increased calcium resorption from the bone

An adult client with a diagnosis of diabetes mellitus performing isometric exercise to help control his blood glucose level will gain which benefit?

An increase in his basal metabolic level

A client is experiencing pain in the knee and is diagnosed with inflammatory joint disease. In order to confirm the diagnosis, the nurse will anticipate teaching the client about which procedure?

Aspiration of synovial fluid

Which organs are involved in the conversion and activation of vitamin D into its physiologically active form? Select all that apply

Liver and kidneys (skin and intestines are the source but don't convert)

Scoliosis is an abnormal curvature of the spine. Why is it first noticed?

Because of the deformity it causes.

The health care provider has evaluated a client diagnosed with osteoporosis and determined that pharmacologic therapy will benefit the client. Select the medication options that the provider may prescribe. Select all that apply.

Bisphosphonates Selective estrogen receptor modulators (SERMs), Calcitonin, RANKL inhibitor danosumab, Recombinant parathyroid hormone

Which test should be included when screening a client for potential causes of rickets?

Blood cultures

A nurse is describing the structure of bone to a client. The nurse will explain that one-third of the dry weight of bone is composed of which organic substances?

Bone cells, blood vessels and nerves

A client is suspected of having osteomalacia based on clinical manifestations and lab/diagnostic work-up (low calcium levels, transverse lines on X-ray). The nurse would expect the client to have which clinical manifestations? Select all that apply.

Bone pain. Muscle weakness.

Which of the following serves as a communicating channel for the exchange of nutrients and metabolites between the osteocytes and the blood vessels on the surface of the bone layer?

Canaliculi

A client reports a feeling of chronic fatigue to the nurse. Which conditions in the client's history could contribute to this manifestation? Select all that apply.

Cancer Diabetes mellitus Hypertension Obesity

The nurse is caring for several clients who have chronic fatigue. Which intervention is the appropriate match for the cause of the clients' fatigue?

Clients with end-stage renal disease receiving erythropoietin

Which disorder places a client at increased risk for secondary osteoporosis? Select all that apply.

Long-term corticosteroid use Hyperparathyroidism.

Which type of materials are not included in a cancellous bone?

Compact, cartilaginous and densely calcified

Hormones involved in bone formation?

Cortisol and growth hormone

The nurse is performing an assessment on a 12-month-old infant and notices an outward bowing of the knees when the medial malleoli of the ankles are touching. What action should the nurse take at this time?

Document the findings

Which client reports would support a diagnosis of a torn ligament?

Extreme pain and swelling

A basketball player fell awkwardly, which resulted in a tear to the anterior cruciate ligament (ACL). The school nurses will anticipate the player to exhibit which clinical manifestations? Select all that apply.

Extreme pain and swelling of knee

The nurse is planning care for a client with hyperparathyroidism. Which interventions should the nurse include in the plan of care? Select all that apply.

Fall prevention, monitor urine output, neuro assessment

When reviewing the history of clients scheduled for clinical visits today, which client(s) should the provider consider at risk for possible osteopenia? Select all that apply.

Female, 40-years old, laboratory value abnormal with high calcium level, low vitamin D level Client with a recent history of malignant myeloma currently under treatment

Which are efficient dietary ways to aid in intestinal absorption of calcium? Select all that apply.

Fish and irradiated milk

A nurse is conducting parent education on complications associated with childhood obesity. Which musculoskeletal developmental disorder associated with obesity would the nurse include in this education?

Genu valgum

When performing a musculoskeletal assessment on a young boy, the nurse notices that the boy has decreased space between the knees so that the medial malleoli cannot be brought together. The nurse documents this as:

Genu valgum

Which information should the nurse teach the parent of a child diagnosed with osteogenesis imperfecta? Select all that apply.

Hearing loss is very common." "Your child will need to be protected from trauma." "This is a hereditary disease." "This is a disease characterized by defective collagen."

When assessing a client diagnosed with Paget disease focused in the skull, the nurse should anticipate which findings? Select all that apply.

Hearing loss, Intermittent tinnitus, Headaches, Vertigo

The nurse is caring for a client who has been prescribed calcitonin. The current serum calcium level is 6.4 mg/dL (1.6 mmol/L). What is the nurse's best action

Hold calcitonin until speaking with dr. calcium should be 9-11, already low, calcitonin will make it even lower.

What diagnostic/lab testing helps to confirm the diagnosis of Paget's disease? Select all that apply.

Increased serum alkaline phosphatase Bone deformities Bone scans Changes noted on x-ray

Which symptoms does the nurse identify as supporting a diagnosis of chronic fatigue syndrome (CFS) when assessing a client with fatigue? Select all that apply.

Increasing fatigue that is not due to ongoing exertion Short-term memory loss and short attention span Tender lymph nodes in neck and axillae

Parathyroid hormone functions to maintain serum calcium levels. How does it fulfill this function? Select all that apply.

Initiates calcium release from bone Enhances intestinal absorption of calcium Activates conservation of calcium by the kidney

Which characteristic most accurately applies to compact (cortical) bone?

It is found along lines of stress on long bones

Which statements are true regarding red bone marrow? Select all that apply

It is the primary type of bone marrow found in infants. It is primarily present in the vertebrae, ribs, and sternum. It is the site of blood cell formation.

Which joint is classified as a being a syndesmosis?

Joints between the vertebrae

An instructor is explaining the role of synovial fluid. Which functions are included in the role of synovial fluid? Select all that apply

Lubricate joint, brings oxygen to chondrocytes in joint, brings macrophages to phagocytize debris in joint, brings nutrients

While studying bones in pathophysiology class, the nursing students learn that the harversian canals contain which anatomical feature?

Lymphatics- blood vessels, lymph and nerves in the bone

When explaining to a class of nursing students the effects of dysregulation of the RANKL/RANK/OPG pathway, the instructor emphasizes that this plays a prominent role in the pathogenesis of which bone diseases? Select all that apply.

Neoplasia of the bone Osteoporosis

Which bone cell is responsible for continual replacement of worn out bone tissue?

Osteoprogenitor

What type of cells are in the growth plate?

Osteoprogenitors

Which hormones or ion concentrations influence the regulation of vitamin D activity? Select all that apply.

PTH prolactin potassium

The client experiences a twisting knee injury. Which type of pain would the provider expect the client to have?

Pain that is experienced as hip pain

The nursing instructor is teaching about osteoporosis and informs the class that certain groups of children are also at a higher risk for decreased bone mass. Which group of children are at risk for developing osteoporosis? Check all that apply.

Premature infants Children on corticosteroids Infants with a low birth weight Children with cystic fibrosis

Synovial membranes can form sacs, called bursae. What is the function of bursae?

Prevents friction on a tendon (where tendon joins muscle to bone)

When vitamin D is metabolized, it breaks down into various metabolites. 1,25(OH)2D3 is the most potent of the vitamin D metabolites. What is the function of this metabolite of vitamin D?

Promotes PTH action of resorption of calcium and phosphate from bone

Which statement most accurately describes cartilage?

Pure cartilage is pearly white.

While lifting weights during football season, a player hears a loud "pop." This is primarily associated with a loss of which function?

Reflexive proprioception

Which would be considered the primary goal of treatment for an adult with "flat feet"?

Relief of fatigue

A client with end stage chronic kidney disease is diagnosed with secondary hyperparathyroidism. Which dietary intervention should the nurse include in the plan of care?

Restrict food high in phosphates

When assessing an 8-year-old child who is diagnosed with genu valgum, the nurse will educate the family about treatments to prevent which risk factor associated with this diagnosis (if left untreated)?

Rheumatoid arthritis

The nurse concludes that the participants of a community education class on prevention of osteoporosis are understanding the information when they identify which cause as a potential risk factor? Select all that apply.

Smoking High-protein diet Alcoholism Excessive caffeine intake

A client is being investigated for chronic fatigue syndrome. What findings should the nurse assess for to confirm/support this diagnosis? Select all that apply?

Sore throat Muscle aches Sore joints Low-grade fever

A clinic nurse plans care for a newly diagnosed client with osteoarthritis. The nurse should provide educational materials about which topics? Select all that apply.

Splints to protect and rest the involved joint Use of heat and cold when appropriate for muscle spasms and pain How to use a cane or walker if hip/knees joints are involved

The student is studying bones of the head and their connection joints to surrounding bones of the head. Which term is used for the nonmovable joints that join these bones?

Synostoses

The nurse notices that a child appears to have flatfoot and determines that additional assessment is needed. Which assessment finding would meet criteria for flatfoot?

Talus points medially

The infant child of a family who has recently immigrated to the United States from South Asia has been diagnosed with rickets. Bone density scanning would yield which characterization of the infant's bones?

The child's bones are far softer than those of healthy children.

What part of the bone assists in protecting the long bone?

The compact bone

A child's history and a subsequent physical document that the child has a grade I metatarsus adductus deformity. When assessing the child, the nurse anticipates finding which result?

The foot can be manipulated into a straight position

A nurse is providing a client with preoperative education. The nurse knows that which teaching point should be included in the instruction regarding deep breathing and coughing exercises?

The resistance of your bed limits your lung expansion.

Which statements are true regarding the skeletal system? Select all that apply.

There is a type of skeleton referred to as appendicular. The skeletal system includes both bone and cartilage tissue. Cartilage is prevalent in both prenatal and postnatal life. The skull is considered a part of the axial skeleton.

A client newly diagnosed with rheumatoid arthritis is crying and tells the nurse she does not know how to manage the disease. Select the most important information for the nurse to provide. Select all that apply.

Treatment goals, education, posture, physical rest, therapeutic use of heat and cold

A client with a history of osteoarthritis in his hip, which he refers to as "bad hip," is also complaining of knee pain. The physiologic principle behind this would include the fact that

all joints of an extremity are innervated by the same peripheral nerves as they travel down the limb.

A long bone, such as the humerus of the upper arm, has a membrane that lines the spaces of spongy bone and is composed mainly of:

an endosteum composed of osteogenic cells (bone-generating)

Rheumatic disorders attack the joints of the body. Which joints are most frequently attacked by rheumatic disorders

diarthrodial

Select the correct statements that describe the function of PTH (parathyroid hormone). Select all that apply.

prevents serum calcium from decreasing and phosphate from increasing above normal Maintains serum calcium by bone resorption Maintained by serum levels of ionized calcium

In the adult, haematopoietically active bone marrow is located in which anatomical bones?

ribs

A 7-year-old child has been diagnosed with renal failure due to autoimmune glomerulonephritis. Knowing the potential complications of this disease, the nurse should closely monitor the client for signs and symptoms of:

rickets

A client presented to the emergency department after getting "hit in the head with a baseball" while watching his grandson play. An x-ray of the head reveals poor quality of bone. The ED physician suspects the client has Paget disease. Which signs/symptoms help confirm this diagnosis? Select all that apply.

• "I've had a lot of headaches lately." • "Every now and then, I get a ringing in my ears." • "I have gotten dizzy and had to sit down while shopping."

Which assessment findings assist in diagnosing Legg-Calvé-Perthes disease? Select all that apply.

• Pain in the thigh • Pain in the knee • Difficulty walking • Limpness