Adult Health - Exam 3

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

Which assessment finding would the nurse expect to find in a client with acute osteomyelitis? A. leukocytosis and localized bone pain B. leukopenia and elevated sedimentation rate C. leukopenia and elevated fever D. petechia over the chest and abnormal ABG levels

A. leukocytosis and localized bone pain (p. 1105)

The nurse identifies a nursing diagnosis of Imbalanced nutrition: less than body requirements for a terminally ill client who is near the end of life. Which of the following would the nurse expect to include in the client's plan of care?

Advise the family to have fruit juices readily available at the client's bedside.

A client states, "My children still need me. Why did I get cancer? I am only 30." This client is exhibiting which stage according to Kübler-Ross?

Anger

What are the nursing interventions for a patient who has just undergone an arthrography?

Apply a compression elastic bandage, rest the joint for 12 hours, and provide analgesia/ice as appropriate

Which of the following nursing actions is most important in caring for the client following an arthrogram?

Apply ice to the joint

In this diagnostic procedure, a joint is aspirated and the synovial fluid is examined.

Arthrocentesis

What is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip or wrist?

Arthrography

Which Diagnostic Procedures may use Contrast Dye?

Arthrography, Bone Scan, CT's

What food can the nurse suggest to the client at risk for osteoporosis?

Broccoli - high in Calcium

What should the nurse assess when monitoring for neurovascular status changes?

CSM: circulation, sensation, movement

What are the major hormonal regulators of calcium homeostasis?

Calcitonin, parathormone, thryoid hormone, cortisol, growth hormone, sex hormones, Vitamin D

A pregnant woman admits to the clinic complaining of pain, intermittent numbness, and paresthesia in her fingers. What might the nurse suspect is the concern?

Carpal Tunnel Syndrome

Which group is at the greatest risk for osteoporosis?

Caucasian women

Which population of people is most at risk for osteoporosis

Caucasian women over the age of 65

A nursing instructor is discussing the causes of the increasing number of people with chronic conditions. The nurse correctly identifies what cause for this trend?

Early detection and treatment of diseases

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours

What is a sign of impending death?

Fluid accumulation in the pulmonary circulation

What is an appropriate method of assessing the dying client?

Focus on the client's basic needs.

What nursing interventions will a nurse perform to transfer heat and improve circulation in a dying client?

Gently massage the arms and legs.

A 78-year-old client is in the emergency department following involvement in a motor-vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?

Immobilization

Which deformity causes a exaggerated curvature of the lumbar spine?

Lordosis

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

Lower lumbar

What nursing interventions will encourage the dying client to continue verbalizing?

Nod and use responsive comments such as "Yes."

An instructor is describing the process of bone development. What would the instructor describe as being responsible for the process of ossification?

Osteoblasts

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?

Osteoblasts

Which cells are involved in bone resorption?

Osteoclasts

Each bone is comprised of cells, protein matrix, and mineral deposits. Which type of bone cell is not only a mature bone cell; it is involved in maintaining bone tissue.

Osteocytes

Which tumor is the most common and most fatal primary malignant bone tumor?

Osteogenic sarcoma (osteosarcoma)

There are thousands of components of the musculoskeletal system which facilitate mobility and independent function. What is the function of skeletal muscle?

Promoting movement of skeletal bone

Which action is most important for the nurse to include in the teaching plan for a client who has undergone arthrography?

Report joint crackling or clicking noises occurring after the second day

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

Which laboratory study indicates the rate of bone turnover?

Serum osteocalcin

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

Staphylococcus aureus

A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"?

Stretched or pulled beyond capacity

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations?

Surgical debridement

The family of a terminally ill client tells the nurse that the client has been breathing irregularly and, at times, it appears that he is not breathing at all. The client's daughter states, "He moans when he breathes. Is he in pain?" What response by the nurse would be most appropriate?

The moaning you hear is from air moving over very relaxed vocal cords

Which sign may be helpful in identifying carpal tunnel syndrome?

Tinel's

In spite of administering the prescribed pain medication, a dying patient is still in pain due to fear and anxiety. What nursing interventions should a nurse use to potentiate the effects of pain medication?

Using imagery, humor, and progressive relaxation

What should the nurse report so that the team can consider alternative nutritional and fluid administration routes for a dying client?

Weight loss and inadequate food intake

What is the difference between an arthrography and arthroscopy?

an arthrography uses contrast agent and X-rays to detect joint tears. An Arthroscopy uses a scope in the joint to visualize the join, synovium, and articular surfaces

What are risk factors for contrast dyes?

asthma, allergy, diabetes, renal insufficiency, and cardiac disease

What should the nurse monitor in a patient who has recently had a bone biopsy?

edema, bleeding, pain, infection

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement.

What treatment interventions would a nurse provide to a patient who is suffering from bursitis?

rest, intermittent ice and heat to the joint, NSAIDs. (Arthroscopic Synovectomy may be considered if shoulder pain and weakness persist)

During a muscle strength assessment, a nurse may elicit muscle clonus. What is this?

rhythmic contractions of a muscle in the ankle or wrist

A patient admits to the ER with chills, fever, and painful joints. They have a history of IV drug abuse. What does the nurse suspect as the cause?

septic (infectious) arthritis

When a nurse assesses an injury, what should the nurse look for?

size, shape, and symmetry (the three S's), edema, ecchymosis, tenderness, abnormal joint motion, pain

What is a fasciotomy?

surgical procedure in which skin is opened and allows pressure to be relieved and circulation restored (emergency compartment syndrome)

Why might a bone scan be ordered?

to detect metastatic and primary bone tumors, osteomyeletis, fractures, or aseptic necrosis

Why would an Arthrography be ordered?

to identify acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist.

Why would heat therapy be used to treat a joint?

to promote circulation and healing (should be used intermittently)

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

Administering large doses of I.V. antibiotics as ordered

This stage of bone healing is characterized by the infiltration of capillaries into the hematoma caused by fracture. A callus is formed, and cell proliferation and differentiation occurs

Angiogenesis

Emergency medical technicians transport a client to the emergency department. They tell the nurse, "He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he's comatose. We intubated him and he's maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag." What intervention by the nurse has the highest priority?

Assessing the left leg- circulation

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following? A. Dislocation B. Sprain C. Strain D. Contusion

B. Sprain = injury to ligaments

What is used to refer to the period of time during which mourning a loss takes place?

Bereavement

Delayed wound healing, inadequate nutrition, infection, and hypercalcemia are all potential complications of which musculoskeletal disorder?

Bone cancer

Which of the following is a term used to describe a soft tissue injury produced by a blunt force?

Contusion

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

Ergonomic changes can be incorporated into your workday to reduce stress on your wrist.

What chronic illness accounts for the largest percentage of adults in the United States?

Hypercholesterolemia

What is the term that refers to individual, family, group, and cultural expressions of grief and associated behaviors?

Mourning

A client is scheduled to undergo an electromyography. The nurse understands that this test is performed to evaluate what?

Muscle Weakness

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications?

Osteomyelitis

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

You will receive IV antibiotics for 3 to 6 weeks

What is a nursing intervention for promoting self-care in the dying client?

Assist with personal hygiene.

Which of the following solutions may be the most effective in cleansing pin sites?

Chlorhexidine

A nurse is providing care to a client experiencing symptoms associated with terminal illness. What would be most appropriate to use as a means for managing the client's symptoms?

Client's goals

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?

Complaints of numbness and tingling in toes of affected leg

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves what part of the body?

Tendon

At what T Score is osteoporosis defined?

at least 2.5 Standard Deviations below the young adult mean value on the BMD scan

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

Bone fracture

Which of the following would be a circulatory indicator of peripheral neurovascular dysfunction?

Cool skin

A 39-year-old client has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicated intact but malpositioned bones, what would you expect the physician to diagnose?

Dislocation

What disorder results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)