HESI Adaptive Quizzing - Musculoskeletal
The patient asks the nurse which foods are good sources of calcium. Which food does the nurse recommend? a) Milk b) Carrot c) Lettuce d) Potatoes
a) Milk Milk is a good source of calcium. Carrots, potatoes, and lettuce are poor sources of calcium.
The nurse is admitting a patient to the clinic that is suspected of having osteomalacia. Which diagnostic test should the nurse prepare the patient for to confirm the diagnosis? a) X-ray b) Quantitative ultrasound (QUS) c) Magnetic resonance imaging (MRI) scan d) Dual-energy x-ray absorptiometry (DXA
a) X-ray X-rays reveal ribbons of bone decalcification, confirming the presence of the disease. QUS and DXA are used to measure the bone mineral density in patients with osteoporosis. An MRI scan is not required, because x-rays detect the bone defects.
A patient is being treated for a spinal vertebral fracture due to osteoporosis. Which condition poses a risk to the patient? a) Loss of hearing b) Enlarged and thickened skull c) Second vertebral fracture within 18 months d) Wedging and fractures of the vertebrae over time
d) Wedging and fractures of the vertebrae over time Wedging and fractures gradually reduce the height of patients with osteoporosis, resulting in a hunched-back look. Patients with Paget's disease have a risk of loss of hearing due to an enlarged and thickened skull. A patient with osteoporosis who has a spinal vertebral fracture is at a risk of another fracture in a year's time.
The registered nurse teaches a student nurse about care of a patient with a fracture of the humerus, compartment syndrome, and a plaster cast in place. The student nurse provides discharge education to the patient. Which statement made by the student nurse needs correction? a) "Elevate the extremity above the heart level." b) "Use a hair dryer on a low setting to dry the cast thoroughly." c) "Avoid covering the cast with plastic for extended periods of time." d) "Control the itching sensation by using a hair dryer on a cool setting at the site of itching."
a) "Elevate the extremity above the heart level." Elevation of the extremity above the heart level is contraindicated for patients with compartment syndrome, which is a painful condition that occurs when the pressure within the muscle increases to dangerous levels. If the cast gets wet by mistake, it should be dried thoroughly using a hair dryer on the low setting. Itching is a common sensation experienced by patients and can be controlled by using a hair dryer on the cool setting instead of using hard objects to scratch the area. The patient should not cover the cast with plastic for prolonged periods.
The nurse provides education to a patient that recently underwent acromioplasty about the postoperative plan of care. Which statement made by the patient indicates the need for further teaching? a) "Weight lifting will be permitted in 7 to 10 days." b) "Physical therapy will start one day after surgery." c) "The shoulder will be immobilized for a short time." d) "Pendulum exercises will be started one day after surgery."
a) "Weight lifting will be permitted in 7 to 10 days." Acromioplasty is the surgical removal of the acromion, which relieves rotator cuff compression during the movement. Weight lifting is usually restricted until the patient fully recovers. Physical therapy is initiated from the first postoperative day to facilitate recovery without any complications. Pendulum exercises begin on the first postoperative day. The shoulder is immobilized with a sling for a short time.
During a health screening event, which assessment finding would alert the nurse to the possible presence of osteoporosis? a) A measurable loss of height b) The presence of bowed legs c) Poor appetite and aversion to dairy products d) Development of unstable, wide-gait ambulation
a) A measurable loss of height A gradual but measurable loss of height and the development of kyphosis or "dowager's hump" are indicative of the presence of osteoporosis, in which the rate of bone resorption is greater than bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis, but are not indicative of osteoporosis. A wide gait is used to support balance and does not indicate osteoporosis.
The nurse is teaching a group of elderly patients about techniques for preventing musculoskeletal problems. The nurse prioritizes which teaching points for these patients? Select all that apply. a) Avoid excessive weight gain. b) Remove throw rugs in the home. c) Start non-weight-bearing exercises. d) Change positions and rise to standing slowly. e) Use steps instead of ramps when ambulating.
a) Avoid excessive weight gain. b) Remove throw rugs in the home. d) Change positions and rise to standing slowly. Throw rugs in the home can create an unsafe environment for ambulation, causing potential falls, so the patient should remove them. It is important to change positions slowly to prevent dizziness that could cause the patient to faint or fall. Excessive weight gain can contribute to osteoarthritis and bone injury. Weight-bearing exercise is encouraged to strengthen the bones, rather than non-weight bearing exercise. The use of ramps would be preferred over steps to prevent falls.
The nurse is caring for a patient on systemic hydrocortisone for the treatment of arthritis. For which parameters should the nurse monitor in the patient? Select all that apply. a) Body weight b) Renal function c) Blood pressure d) Potassium level e) Hepatic function
a) Body weight c) Blood pressure d) Potassium level Corticosteroids like hydrocortisone cause various fluid electrolyte imbalances such as sodium retention, fluid retention, congestive heart failure in susceptible patients, potassium loss, calcium loss, and hypertension, and should be monitored. Furthermore, corticosteroids cause weight gain, which may worsen the joint condition. Monitoring hepatic function and renal function is not required.
A patient is suspected of having systemic lupus erythematosus. What indication does the nurse have when assessing this patient that is a classic feature of this disease? a) Butterfly rash b) Telangiectasia c) Bull's eye rash d) Kyphotic posture
a) Butterfly rash Butterfly rash over the cheeks and bridge of the nose is a characteristic feature of systemic lupus erythematosus. Telangiectasia is a feature of scleroderma. Bull's eye rash is seen in Lyme disease. Kyphotic posture is seen in advanced ankylosing spondylitis.
A patient with morbid obesity with a history of hyperlipidemia comes in to the clinic stating that he or she has muscular weakness in the pelvic region and difficulty walking. What laboratory findings does the nurse expect to see? a) Calcium 7.0 mg/dL b) Phosphorus 5.5 mg/dL c) Alkaline phosphatase 12 U/L d) 25-hydroxy vitamin D 80 ng/mL
a) Calcium 7.0 mg/dL A morbidly obese patient with a history of hyperlipidemia is at high risk for the development of osteomalacia, and muscular weakness in the pelvic region and difficulty walking are clinical manifestations of osteomalacia. Patients with osteomalacia have a decreased serum calcium level (<8.5 mg/dL). A patient with osteomalacia will have a decreased phosphorus level (<2.5 mg/dL), an elevated alkaline phosphatase level (>125 U/L), and a decreased 25-hydroxyvitamin D level (<30 ng/mL).
The nurse is caring for a patient with systemic lupus erythematosus (SLE). Which cardiopulmonary manifestations should the nurse closely monitor for? Select all that apply a) Cough b) Tachypnea c) Hypotension d) Dysrhythmias e) Hypocholesterolemia
a) Cough b) Tachypnea d) Dysrhythmias Cough and tachypnea suggest lung disease in a patient with SLE. Dysrhythmias may also occur due to fibrosis of the sinoatrial and atrioventricular nodes. Other cardiopulmonary changes seen in patients with SLE include hypertension and hypercholesterolemia.
The nurse is preparing a patient for serum analysis of uric acid levels. Which condition does the nurse anticipate in the patient? a) Gout b) Scleroderma c) Osteoarthritis d) Rheumatoid arthritis
a) Gout Gout is characterized by increased levels of uric acid in blood. Serum uric acid analysis is used in the diagnosis of gout. Scleroderma is associated with inflammatory changes in the skin, blood vessels, and internal organs. A skin or visceral biopsy is required to rule out scleroderma. Osteoarthritis is associated with inflammation of the minor joints and a physical exam, radiologic analysis like computerized tomography (CT) and x-ray scan will help in the diagnosis. Rheumatoid arthritis is associated with inflammation of the weight bearing joints and can be ruled out by performing serology tests such as rheumatoid factor and C-reactive protein.
The nurse is caring for a patient with mucocutaneous lesions, urethritis, and conjunctivitis. Which drug therapy does the nurse expect the primary health care provider to prescribe for the patient? Select all that apply. a) Ibuprofen b) Infliximab c) Nifedipine d) Pregabalin e) Methotrexate f) Sulfasalazine
a) Ibuprofen e) Methotrexate f) Sulfasalazine Mucocutaneous lesions, urethritis, and conjunctivitis are the clinical signs of reactive arthritis. Methotrexate is used in the treatment of mucocutaneous lesions. Sulfasalazine is used to treat chronic inflammation. Nonsteroidal antiinflammatory drugs such as Ibuprofen are given in the initial stages of reactive arthritis. Pregabalin is used to treat anxiety or peripheral neuropathic pain. This medication is not indicated for a patient with mucocutaneous lesions, urethritis, and conjunctivitis. Nifedipine is a vasodilator that helps decrease arterial blood pressure. Infliximab is a tissue necrotic factor (TNF) inhibitor used in the treatment of patients with ankylosing spondylitis (AS).
A patient experiences delayed bone healing. What function does the nurse identify as helpful by electrical bone growth stimulation? a) Increases the calcium uptake of bones b) Deactivates intracellular calcium stores c) Decreases the calcium uptake of the bone d) Decreases the production of bone growth factors
a) Increases the calcium uptake of bones Electrical bone growth stimulation is used to facilitate the healing process for certain types of fractures. This includes those with delayed bone healing by increasing the calcium uptake of the bone. Electrical bone growth stimulation helps in activating the intracellular calcium stores and does not decrease the calcium uptake of the bone. Electrical bone growth stimulation leads to an increase in the production of bone growth factors.
What is a meniscus injury? a) Injury to fibrocartilage of the knee b) Injury to the ligament by deceleration forces c) Injury resulting in tearing or stretching of a ligament d) Injury within the muscle or tendinoligamentous structures
a) Injury to fibrocartilage of the knee A meniscus injury refers to injury to the fibrocartilage of the knee that is characterized by popping, clicking, and tearing sensations with effusion and swelling. The traumatic tearing of ligaments by excessive deceleration forces together with pivoting or rotating positions of the knee or leg is an anterior cruciate ligament tear. Tearing or stretching of ligaments as a result of excessive inversion, eversion, shearing, or torque applied to a joint is described as ligament injury. Injury to the muscle or tendinoligamentous structures around the shoulder is called a rotator cuff tear.
A bandage has been applied on the ankle of a patient for a sprain. The patient states the ankle is swollen, numb, and painful. What is the priority action by the nurse? a) Loosen the bandage. b) Check for Homan's sign. c) Have the patient ambulate. d) Administer an antibiotic for cellulitis.
a) Loosen the bandage The patient's signs and symptoms indicate that the bandage is too tight. In such cases, the bandage can be left in place for 30 minutes and then removed for 15 minutes. However, some elastic wraps are left on during training, athletic, and occupational activities. Although assessing for thrombophlebitis, deep vein thrombosis, and cellulitis can all cause pain and swelling, the differential diagnosis in this instance points to bandage tightness as the likeliest cause. Ambulation will increase the pain and swelling until the bandage is loosened.
While assessing a patient, the nurse notes red spots on the hands, forearms, palms, face, and lips. Which condition does the nurse suspect? a) Scleroderma b) Lyme disease c) Psoriatic arthritis d) Systemic lupus erythematosus
a) Scleroderma Red spots on the hands, forearms, palms, face, and lips, known as telangiectasia, are found in patients with scleroderma. In Lyme disease, there is a bull's eye lesion at the site of the tick bite. In psoriatic arthritis, there are red, irritated, scaly patches that involve the joints. In systemic lupus erythematosus, there is a typical butterfly rash over the cheeks and bridge of the nose.
A patient experiences inflammation and pain in the muscles, tendons, and nerves of the neck and spine due to repetitive strain injury (RSI). What ergonomic instructions should the nurse provide to the patient? Select all that apply. a) Take hourly stretch breaks while working at your desk." b) "Apply moist, warm, heat to the affected area regularly." c) "Perform strengthening and conditioning exercises regularly." d) "Keep your hips and knees flexed to 90 degrees with the feet flat while sitting." e) "Keep your wrist straight when typing and keep the top of the computer monitor level with your forehead."
a) Take hourly stretch breaks while working at your desk." d) "Keep your hips and knees flexed to 90 degrees with the feet flat while sitting." e) "Keep your wrist straight when typing and keep the top of the computer monitor level with your forehead." Ergonomic considerations for patients include taking hourly stretch breaks, keeping the hips and knees flexed at 90 degrees, keeping the feet flat on the floor to reduce strain on the soft tissue, keeping the wrist straight when typing, and keeping the top of the computer monitor even with the forehead to reduce strain of muscles and ligaments. Strengthening and conditioning exercises may reduce sprain and strain risk. Warm, moist heat application is used to help patients with a sprain after 48 hours of injury.
Which athlete is least likely to experience a meniscus injury, according to the nurse who is assisting in conducting sports physicals? a) swimmer b) A soccer player c) A football player d) A basketball player
a) swimmer A meniscus injury may be manifested as a popping, clicking, tearing sensation with effusion and swelling. Swimmers have repeated overhead arm movements and are not likely to suffer from this condition. Athletes who play basketball, soccer, and football have a higher risk of knee injury than swimmers.
When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which statement? a) "I should take the naproxen as prescribed to help control the pain." b) "I should try to stay standing all day to keep my joints from becoming stiff." c) "I can use a cane if I find it helpful in relieving the pressure on my back and hip." d) "A warm shower in the morning will help relieve the stiffness I have when I get up."
b) "I should try to stay standing all day to keep my joints from becoming stiff." It is important to maintain a balance between rest and activity to prevent overstressing the joints with OA. Naproxen may be used for moderate to severe OA pain. Using a cane and warm shower to help relieve pain and morning stiffness are helpful.
A patient bitten by a tick suspects that they may have contracted Lyme disease but does not want to seek treatment at this time. What should the nurse inform the patient is important to prevent and why early intervention is important? a) Sterility b) Arthritis c) Renal failure d) Lung abscess
b) Arthritis If Lyme disease goes untreated, arthritis pain and swelling in large joints; neurologic problems such as headaches, temporary facial paralysis, and poor motor coordination; and cardiac abnormalities may arise late in the disease's course. Sterility, renal failure, and lung abscesses are not complications of Lyme disease.
A patient sustained a fall one week ago without a fracture and reports pain in the right hip, which increases in intensity with activity. The patient has a fever and the site of injury is swollen and tender to the touch. Which diagnostic tests would help determine the cause of the patient's condition? Select all that apply. a) X-ray of the hip b) Bone tissue biopsy c) White blood cell count d) Radionuclide bone scans e) Magnetic resonance imaging
b) Bone tissue biopsy d) Radionuclide bone scans e) Magnetic resonance imaging Osteomyelitis and its causative organisms are best determined through a bone tissue biopsy, which involves the excision of a small amount of tissue from the affected area. Radionuclide bone scans may be helpful in indicating the area of infection. Magnetic resonance imaging may help to identify the extent of infection in the hip bone. X-ray of the hip may not show the osteomyelitic changes immediately; it could be evident only after 10 days or a few weeks. The white blood cell count may be elevated due to infection, but the test is very nonspecific.
The public health nurse is planning to provide community education to increase the number of people who seek health care promptly after a tick bite. What information should the nurse provide when teaching people who are at risk for a tick bite? a) Antibiotics will prevent Lyme disease if taken for 10 days. b) Check for an enlarging reddened area with a clear center. c) Surveillance is necessary during the summer months only. d) The best therapy for the acute illness is an intravenous (IV) antibiotic.
b) Check for an enlarging reddened area with a clear center. Following a tick bite, the expanding "bull's eye rash" is the most characteristic symptom, which usually occurs in 3 to 30 days. There also may be flu-like symptoms and migrating joint and muscle pain. Active lesions are treated with oral antibiotics for two to three weeks and doxycycline is effective in preventing Lyme disease when given within three days after the bite of a deer tick. IV therapy is used with neurologic or cardiac complications. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors.
A patient's x-ray exam reveals that there is no evidence of callus formation after the second week of treatment for a bone fracture. What does the nurse infer related to healing of the fracture? a) It is healing normally. b) It is failing to heal despite treatment. c) It is healing at a slower rate than expected. d) It is healing in an abnormal position in relation to midline of structure.
b) It is failing to heal despite treatment. During the second week of treatment after a bone fracture, an x-ray is performed to check for the presence of callus formation. Callus formation indicates that the healing process of the bone has started. Absence of callus formation indicates failure of the healing process in spite of treatment. When the fracture healing progress is slower than expected over time, it indicates a delayed union of the fractured bone. The fracture is not healing normally. When the fracture heals in an abnormal position in relation to the midline of the structure, it indicates angulation.
A varus deformity (bowlegged) is a result of what type of arthritis? a) Heberden's nodes b) Medial joint arthritis c) Lateral joint arthritis d) Advanced hip osteoarthritis
b) Medial joint arthritis A varus deformity is a result of osteoarthritis in the medial joints. Heberden's nodes occur on the distal interphalangeal (DIP) joints due to osteophyte formation and loss of joint space. In advanced hip arthritis, one of the patient's legs may become shorter as the joint space narrows. A valgus deformity (knock-knee appearance) is a result of lateral joint arthritis.
Which assistive device should be included in the plan of care for a patient with tendonitis who has a recurrence of symptoms? a) Walker b) Orthosis c) Crutches d) Gait belts
b) Orthosis Tendonitis may be described as the inflammation of a tendon due to overuse or incorrect use. An orthosis is a protective brace used in the treatment of recurrence of symptoms. Walkers, crutches, and gait belts can aid in walking but do not prevent recurrence of symptoms.
Bone remodeling is consistent in reducing fractures unless the patient has which condition? a) Cancer b) Osteoporosis c) Osteomyelitis d) Osteochondroma
b) Osteoporosis Bone remodeling is not consistent in patients with osteoporosis, since bone loss exceeds building of bone with osteoclasts. Cancer does not cause bone remodeling to occur, but cancer treatment may alter the rate of osteoclasts. Osteomyelitis is an infection of the bone and does not affect remodeling. Osteochondroma is a common benign bone tumor, an overgrowth of cartilage and bone near the end of the growth plate, and does not affect remodeling.
The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis (OA). Which finding should the nurse expect to be present on assessment of the patient's knees? a) Ulnar drift b) Pain with joint movement c) Reddened, swollen affected joints d) Stiffness that increases with movement
b) Pain with joint movement OA is characterized predominantly by joint pain upon movement and is a classic feature of the disease. Ulnar drift occurs with rheumatoid arthritis (RA), not osteoarthritis. Not all joints are reddened or swollen. Stiffness decreases with movement.
While assessing a patient with dermatomyositis, the nurse notes that the patient has an erythematous scaling rash on the buttocks. What condition is indicated by the assessment findings as recognized by the nurse? a) Heliotrope b) Poikiloderma c) Calcinosis cutis d) Gottron's papule
b) Poikiloderma An erythematous scaling rash on the buttocks of a patient with dermatomyositis (DM) indicates poikiloderma. Heliotrope is an erythematous symmetric rash found around the eyes of patients with DM. Calcinosis cutis are calcium nodules which may develop throughout the skin in long-standing DM. Gottron's papules are also found in patients with DM. These are violet or erythematous papules and small plaques that develop over the distal interphalangeal or metacarpophalangeal areas, and at the elbow or knee joints.
When caring for a patient with systemic lupus erythematosus, the nurse recognizes which major and serious complication of the disorder? a) Dysphagia b) Renal failure c) Peripheral neuropathies d) Multiple open skin lesions
b) Renal failure The multisystem nature of systemic lupus erythematosus (SLE) places the patient at risk for multiple complications and is ultimately fatal. Renal failure is one of the major and serious complications of SLE. Although dysphagia, peripheral neuropathies, and multiple open skin lesions may be present in the patient with SLE, they are not consistently present and are not as serious as renal failure.
A patient, hospitalized with osteomyelitis, has a prescription for bed rest. The nurse would place the highest priority on which intervention? a) Offer the patient a urinal every hour. b) Reposition the patient every two hours. c) Provide activities to prevent restlessness. d) Ambulate the patient to the bathroom every three hours.
b) Reposition the patient every two hours. The patient is at risk for atelectasis of the lungs and skin breakdown from the prescribed bed rest. For this reason, the nurse should change the patient's position frequently to promote lung expansion and prevent pressure ulcers. If the patient is on bed rest, he or she should not ambulate to the bathroom. The patient should be offered a urinal every two hours and should be provided with activities to complete while on bed rest; however, these are not the nursing priorities.
A patient with extensive muscle atrophy and joint deformity has rheumatoid arthritis. Which stage of rheumatoid arthritis does the nurse determine the patient is experiencing? a) Early stage b) Severe stage c) Terminal stage d) Moderate stage
b) Severe stage The severe stage of rheumatoid arthritis is characterized by extensive muscle atrophy, and joint deformities such as subluxation, ulnar deviation, and osteoporosis. The early stage of rheumatoid arthritis is characterized by possible x-ray evidence of osteoporosis, but no destructive changes on x-ray. The terminal stage of rheumatoid arthritis is characterized by fibrous or bony ankylosis and adjacent muscle trophy. A patient with moderate rheumatoid arthritis will experience adjacent muscle atrophy, possible presence of extraarticular lesions, and osteoporosis with or without bone destruction.
A patient with a history of a cervical injury frequently works at a desk and uses a computer. The patient reports a recurrence of pain and stiffness in the neck. Which action may be the cause of the symptoms? a) The patient takes hourly stretch breaks. b) The patient elevates the wrist when typing. c) The patient keeps the top of the computer monitor even with the forehead. d) The patient keeps the hips and knees flexed to 90 degrees with feet flat while sitting.
b) The patient elevates the wrist when typing The patient with a cervical injury who frequently works at a desk and uses the computer may suffer from a repetitive strain injury from repetitive movements and awkward positions of the wrist. Taking hourly stretch breaks helps in promoting circulation. The computer monitor's top should be kept even with the forehead to keep the neck muscles from straining. The hips and knees should be kept flexed at 90 degrees with the feet flat.
The nurse is creating a plan of care for a patient with osteoarthritis. What would the nurse plan as an appropriate short-term goal for this patient? a) The patient will limit physical activity in the morning. b) The patient will participate in physical therapy activities. c) The patient will eliminate the use of narcotic analgesics if diarrhea develops. d) The patient will limit pain medications to nonnarcotic drugs to prevent addiction.
b) The patient will participate in physical therapy activities. Because pain and discomfort are major clinical manifestations of osteoarthritis, relief measures are the first priority. Relief can be achieved with physical therapy and other pain-management measures. Limitation of physical therapy, elimination of pain medication, and limitation of pain medication to nonnarcotic drugs are all incorrect goals for a patient with osteoarthritis. The patient needs to stay physically active and use narcotic or nonnarcotic analgesics, depending on the level of pain.
A patient with osteomyelitis in the left femur has been receiving gentamicin therapy for two weeks. During a follow up visit, which patient statement indicates that the treatment should be discontinued? a) "I don't have a fever now." b) "I have severe pain in my left leg." c) "I have a ringing sensation in my ear." d) "The pus from the wound has stopped draining."
c) "I have a ringing sensation in my ear." A ringing sensation in the ear indicates ototoxicity due to the gentamicin. The treatment should be stopped to prevent worsening of the complication. Absence of fever may indicate that the infection has been reduced, but treatment should not be stopped. Severe pain in the leg is a manifestation of osteomyelitis and does not indicate that the treatment should be stopped. Absence of pus indicates effectiveness of treatment, but does not mean that the treatment should be stopped.
A patient with a tumor in the left leg states there is severe pain at the site of the tumor. The patient states, "Why is there so much pain?" What is the best response by the nurse? a) "This is a side effect of radiation therapy." b) "The pain medication must not be working." c) "The tumor may be pressing on nerves near the bone." d) "If one does not get enough exercise, the leg will stiffen up."
c) "The tumor may be pressing on nerves near the bone." When the tumor presses on nerves or other organs, it causes severe pain. The question does not discuss any medications or doses that would be given for pain. Radiation therapy actually is used to help decrease the pain. Exercising will actually help decrease the pain as well.
What is the best intervention to prevent infection in a patient who has sustained an acute knee injury and has an open wound? a) Applying an ice pack b) Administer analgesics c) Administering tetanus prophylaxis d) Immobilizing the affected extremity
c) Administering tetanus prophylaxis Tetanus prophylaxis is administered when the patient has an open wound and an increased risk of infection. Application of ice may help relieve pain. Analgesics may help to relieve pain. Immobilizing the extremity helps in providing comfort.
A patient was started on hydralazine for hypertension after a recent hospitalization. The patient is accompanied by a parent who has systemic lupus erythematosus (SLE). What is the best intervention by the nurse? a) Alert the healthcare provider to screen for SLE. b) Tell the patient to immediately discontinue taking the hydralazine. c) Alert the healthcare provider to the medication and family history. d) Educate the patient that family history of SLE does not increase risk for this disease.
c) Alert the healthcare provider to the medication and family history. Many drugs may trigger SLE, the most common being procainamide, hydralazine, and quinidine. While the exact etiology of the disease is unknown, there is a high prevalence of SLE among family members, and a genetic link is suspected. Therefore, the nurse should alert the physician to these factors. The patient should not be told that family history does not increase risk, as this is incorrect. Hydralazine is a medication that treats hypertension, and patients should not stop or change medications without consulting their physicians. There is no specific screening tool for this disease that would be done on an annual basis.
A patient with osteoporosis has been on bed rest for one month after a complicated surgery. What is the patient at risk for after returning to daily activities? a) Pneumonia b) Depression c) Bone fracture d) Pressure ulcer
c) Bone fracture The patient is at risk for bone fractures due to immobility after prolonged bed rest. Pneumonia, pressure ulcers, and depression are problems associated with continued bed rest; they are not risks for after the patient has returned to daily activities.
Which assessment finding would alert the nurse to the presence of osteoarthritis in a patient admitted to the hospital after a fall? a) Swan neck deformities b) A measurable loss of height c) Crepitus with knee movement d) Joint stiffness that is worse in the morning
c) Crepitus with knee movement Crepitus over joints is suggestive of osteoarthritis. A gradual but measurable loss of height and the development of kyphosis, or "dowager's hump," is indicative of the presence of osteoporosis; a swan neck deformity and stiffness that is worse in the morning occur with rheumatoid arthritis.
Which is a common site of bursitis? a) Back b) Thighs c) Elbows d) Abdomen
c) Elbows Bursitis is the inflammation of the bursae. These are located at sites of friction such as between tendons and bones and near the joints. The most common sites of bursitis occurrence include the elbows, shoulders, and greater trochanters of the hip. The back, thighs, and abdomen are less likely to be affected.
A patient is hospitalized with severe bleeding in the leg. An x-ray exam of the leg reveals that the periosteum is intact across the fracture and that the bone is still in alignment. What type of fracture does the patient have? a) Oblique fracture b) Pathologic fracture c) Greenstick fracture d) Comminuted fracture
c) Greenstick fracture A nondisplacement fracture in which the periosteum is intact across the fracture and the bone is still in alignment is classified as a greenstick fracture. In an oblique fracture, the line of the fracture extends in an oblique direction. A pathologic fracture is a spontaneous fracture at the site of a bone disease. Displaced fractures are usually comminuted fractures in which there are more than two bone fragments with the smaller fragments floating or oblique.
The nurse is performing an assessment for a patient with osteoarthritis (OA). When observing small nodules on the distal interphalangeal joints of the fingers, how does the nurse document these nodules? a) Lymph nodes b) Bouchard's nodes c) Heberden's nodes d) Non-Hodgkin's lymphoma
c) Herberden's nodes Patients with OA may develop small hard, round nodules on the distal interphalangeal joints (near the tips of the fingers or toes) called Herberden's nodes. Lymph nodes are found throughout the body and play a role in the body's immune response. Bouchard's nodes occur with OA at the proximal interphalangeal joints. Non-Hodgkin's lymphoma is a cancer that begins in lymph cells.
The nurse is caring for a patient with a dislocated hip. The nurse knows that this type of injury is associated most commonly with what? a) Fall from a high place b) Osteoporosis of the hip c) Motor vehicle collisions d) Pathologic fractures of the hip
c) Motor vehicle collisions The hip is the most common dislocation of the lower extremity and generally is associated with motor vehicle collisions. Falls from a high place generally result in a fracture. Osteoporosis of the hip joint is more likely to result in a fracture and not dislocation. Pathologic fractures secondary to a history of cancer are not associated with hip dislocations.
The nurse is assessing a patient who is taking alendronate for osteoporosis. What should the nurse inform the patient to be aware of when taking this medication? a) Helps replace low calcium levels b) Can lead to uncontrolled weight gain c) Must be taken with a full glass of water d) Is always given after primary treatment with estrogen therapy
c) Must be taken with a full glass of water Gastritis is a common side effect of this drug, so the patient has to be instructed to take the medication with a full glass of water. Alendronate does not have any effect on blood calcium levels. Anorexia and weight loss, not weight gain, are associated with this drug. Estrogen therapy is no longer given as primary treatment for menopausal symptoms because of an increased risk of heart disease, and of breast and uterine cancer.
The nurse is educating a patient with systemic lupus erythematosus (SLE) about precipitating factors of the disease. Which precipitating factors should the nurse be sure to include when discussing them? a) Azathioprine, hydralazine, and procainamide b) Procainamide, chloroquine, and sun exposure c) Sun exposure, hydralazine, and oral contraceptives d) Cyclophosphamide, oral contraceptives, and azathioprine
c) Sun exposure, hydralazine, and oral contraceptives In SLE patients, the onset or exacerbation of disease symptoms sometimes occurs due to sun exposure. SLE may also be precipitated or aggravated by certain drugs, such as hydralazine and oral contraceptives. Azathioprine is used as a treatment drug in SLE. Procainamide can also precipitate SLE. However, chloroquine is used to treat fatigue and moderate skin and joint problems in patients with SLE. Cyclophosphamide and azathioprine are used to treat SLE.
A 30-year-old female patient with severe rheumatoid arthritis (RA) is prescribed methotrexate for disease management. What should the nurse instruct the patient to do? a) Avoid use of contraceptives as this increases the risk for deep vein thrombosis. b) Expect an orange-yellow urine discoloration during treatment with methotrexate. c) Use effective contraception during and three months after treatment with methotrexate. d) Decrease fluid intake to reduce the risk of edema-related side effects with methotrexate.
c) Use effective contraception during and three months after treatment with methotrexate. A female of childbearing age prescribed methotrexate should use effective conception during and three months after treatment due to drug-related teratogenic effects. Contraceptives should not be avoided since methotrexate has been linked to teratogenic effects. Sulfasalazine, not methotrexate, may cause an orange discoloration of the urine. The patient should be advised to stay well hydrated while taking methotrexate; the patient should not be told to decrease fluid intake.
The nurse is planning health promotion teaching for a patient with asthma, low back pain from a herniated lumbar disc, and hypertension. The nurse determines which exercise would be best to include in an individualized exercise plan for the patient? a) Tennis b) Running c) Walking d) Weightlifting
c) Walking The patient would benefit from an aerobic exercise that takes into account the patient's health status and fits the patient's lifestyle. The best exercise of those listed is walking, which builds strength in the back and leg muscles and is an aerobic exercise as well. Running, weightlifting, and tennis may result in improper body mechanics, too much stress on the body, and increased low back pain. Running also may result in asthma exacerbation.
A nurse applies an elastic bandage to a patient's knee and provides discharge instructions after teaching the patient how to reapply the bandage. Which statement made by the patient indicates the need for further teaching? a) "I will leave it in place for prolonged periods." b) "I will wrap it starting from distal to proximal end." c) "I will wrap it tightly but ensure that there is no numbness." d) "I will leave it in place for 30 minutes and then remove it for 15 minutes."
d) "I will leave it in place for 30 minutes and then remove it for 15 minutes." The elastic bandage should not be wrapped for prolonged periods, because it may irritate the area and cut off circulation. The bandage should not be wrapped too tightly, because it may interfere with the blood supply and cause numbness. The ideal way of wrapping the bandage is to start from the proximal end and progress to the distal area. The bandage should be wrapped for 30 minutes and removed for 15 minutes.
A patient with systemic lupus erythematosus (SLE) has persistent proteinuria, for which the healthcare provider prescribed both oral steroids and a cytotoxic agent. When the patient asks why two medications are necessary, what is the nurse's best response? a) "Oral steroids are likely a mistake; take only the cytotoxic agent." b) "Both agents combined will help slow the progression of further kidney damage." c) "Oral steroids must be used to decrease inflammation in the kidney and reverse damage." d) "Oral steroids are used in the initial treatment period while the cytotoxic agent takes effect."
d) "Oral steroids are used in the initial treatment period while the cytotoxic agent takes effect." The primary goal of treatment for SLE with renal involvement is to slow the progression of renal damage by treating the underlying disease, which is usually accomplished with oral steroids, cytotoxic agents, and immunosuppressive agents. Corticosteroids are common until cytotoxins or immunosuppressants take effect. Oral steroids are unlikely to reverse damage already done in the kidney but can slow further progression. Corticosteroid use should be limited as much as possible and is usually only in the initial phase of this treatment. Patients should be educated to take all medications as prescribed; the nurse should not tell the patient this is a mistake without consulting the prescribing provider.
A patient has been diagnosed with chronic fatigue syndrome (CFS) and asks the nurse what can be done to control the symptoms of the syndrome. What education can the nurse provide to help the patient with control of symptoms? a) "Stay on complete bed rest." b) "Avoid dark-colored fruits and vegetables in your diet." c) "Eat a proper diet which is rich in fats and carbohydrates." d) "Take an antiinflammatory drug if you have pain or fever."
d) "Take an antiinflammatory drug if you have pain or fever." The nurse should teach the patient to take nonsteroidal antiinflammatory drugs (NSAIDS) if there is pain or fever. Complete bed rest is not advised, because it may have the psychologic effect of the patient of becoming disabled. Dark-colored fruits and vegetables rich in antioxidants form an essential part of the treatment of chronic fatigue syndrome. A diet rich in fat and carbohydrates is not required. Instead, the diet should be balanced and high in fiber content.
A patient with intervertebral disc damage caused by lumbar spinal stenosis is undergoing treatment and reports bladder incontinence and constant back pain. The nurse prepares the patient for what outpatient procedure? a) A laminectomy b) A radiofrequency discal nucleoplasty c) An intradiscal electrothermoplasty (IDET) d) An interspinous process decompression system
d) An interspinous process decompression system Surgery is indicated because of the bladder incontinence, and an interspinous process decompression system (X-stop) is an outpatient technique used in patients with constant pain caused by lumbar spinal stenosis. Laminectomy requires a minimal hospital stay after completion. An IDET is not specifically for patients with lumbar spinal stenosis or constant pain. Radiofrequency discal nucleoplasty (coblation nucleoplasty) is not specifically for patients with lumbar spinal stenosis, and pain relief varies
A patient tests positive for Lachman's test and is unable to perform physical activities due to pain in the knees. What coexisting condition may be diagnosed, as per the nurse's suspicion? a) Bursitis b) Fracture c) Rotator cuff injury d) Collateral ligament injuries
d) Collateral ligament injuries A positive Lachman's test may indicate an anterior cruciate ligament (ACL) tear in the knee. The coexisting condition that might be diagnosed includes collateral ligament injuries. Bursitis involves the inflammation of the bursae. Fracture is the disruption in bone structure's continuity. Rotator cuff injury causes disruption of shoulder joint movement.
The nurse reviews the results of a magnetic resonance image (MRI) study that was performed on a patient with a severe shoulder injury. Which MRI finding has the potential risk of dislocation? a) Tearing of the ligaments around the shoulder joint b) Mild tears within the muscles around the shoulder joint c) Severe tearing within the muscles around the shoulder joint d) Deformation injury to the humerus around the shoulder joint
d) Deformation injury to the humerus around the shoulder joint The patient with a dislocation may have deformation injury to the humerus around the shoulder joint. Tearing of ligaments in the shoulder may not indicate a dislocation. Mild tears in the shoulder muscles may not indicate dislocation. Severe tearing in the shoulder muscles may not indicate dislocation.
The nurse is caring for a patient in the postoperative phase of spinal surgery. What nursing action is most appropriate when turning a patient? a) Malignant b) Inflammatory c) Immunologic d) Degenerative
d) Degenerative Osteoarthritis occurs commonly after years of stress, or "wear and tear," on weight-bearing joints. This degenerative process causes hypertrophic changes in the joints. Malignant refers to a growth process that is resistant to treatment, such as that seen in cancer. Inflammatory is the term given to a nonspecific immune response that occurs in reaction to any type of bodily injury. Immunologic refers to the immune system, which protects us from or resists disease or infection as a result of the development of antibodies or cell-mediated immunity.
The nurse is reinforcing health teaching about osteoporosis with a patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient? a) Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. b) With a family history of osteoporosis, there is no way to prevent or slow bone resorption. c) Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. d) Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
d) Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements or foods high in calcium, and engages in regular weight-bearing exercise. Even if the patient has a family history of osteoporosis, there are methods to prevent and slow bone resorption. Corticosteroids interfere with bone metabolism and would not be effective. Estrogen therapy is no longer used to prevent osteoporosis, because of the associated increased risk of heart disease and breast and uterine cancer.
A patient with osteoarthritis (OA) is prescribed sulfasalazine and reports an orange discoloration of the urine. What is the most appropriate action for the nurse to take? a) Advise the patient to decrease fluid intake to help the urine return to normal color. b) Report the urine discoloration to the prescriber immediately since there could be liver impairment. c) Report the urine discoloration to the prescriber immediately since orange-colored urine could indicate renal impairment. d) Inform the patient that orange discoloration of the urine often occurs with sulfasalazine, and there is no need for concern.
d) Inform the patient that orange discoloration of the urine often occurs with sulfasalazine, and there is no need for concern. The nurse should inform the patient that orange-yellow discoloration of the urine often occurs with sulfasalazine, and there is no need for concern. The nurse should advise the patient to take sulfasalazine with food and 8 oz of water rather than decreasing his or her fluid intake. Orange-colored urine does not mean the patient has liver or renal impairment; it is a normal side effect of sulfasalazine.
A patient with hypertension is admitted to the nursing unit with osteomyelitis. Which symptom will the nurse most likely find on physical examination? a) Hypotension b) Abdominal pain c) Nausea and vomiting d) Limited range of motion of the extremity
d) Limited range of motion Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or extension of nearby infection. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and redness and limited movement of the affected extremity. Nausea, vomiting, and abdominal pain are not associated with osteomyelitis. If the infection leads to bacteremia, the patient may become hypotensive, indicating septic shock.
The nurse is caring for a patient who is prescribed a muscle relaxant for acute low back pain. What should the nurse teach the patient about managing low back problems? a) Sleep in prone position. b) Maintain complete bed rest. c) Use a soft comfortable mattress. d) Place a foot on a stool during prolonged standing
d) Place a foot on a stool during prolonged standing The nurse should tell the patient to place a foot on a stool during prolonged standing to avoid straining the lower back. The patient should avoid complete bed rest; it is better for the patient to continue daily activities. The patient should be asked to sleep in supine or side-lying positions with knees and hips flexed to prevent unnecessary pressure on support muscles, ligaments, and lumbosacral joints. A firm mattress or a bed board is recommended instead of a soft mattress.
What is the best intervention for a patient with an anterior cruciate ligament (ACL) injury who evidences tight and painful effusion? a) Applying ice b) Elevating the knee c) Administering aspirin d) Preparing for aspiration
d) Preparing for aspiration The anterior cruciate ligament injury may involve a tear from the bone attachments that form the knee. The patient may report a tight and painful effusion, and a joint aspiration may be needed. Application of ice interferes with transmission of pain impulses and may not help in joint effusion. Elevation of the knee relieves edema. Nonsteroidal antiinflammatory drugs (NSAIDs) such as aspirin may relieve the pain at the injury site, but may not relieve effusion.
A patient receiving long-term nonsteroidal antiinflammatory drug (NSAID) therapy for osteoarthritis develops gastrointestinal bleeding and erosion. What should be the first intervention? a) Dietary modifications b) Administration of antacids c) Switch to low-dose therapy d) Proton pump inhibitor therapy
d) Proton pump inhibitor therapy The major side effects of nonsteroidal antiinflammatory agents are gastrointestinal bleeding and ulceration, which are to be monitored during the course of the treatment. The coadministration of a proton pump inhibitor helps to treat this condition. Low-dose therapy will still be irritating to the gastric mucosa. Antacids only decrease the irritation by increasing the pH of the stomach and do not treat the bleeding. Dietary modifications are necessary to help heal the eroded surface but are not the first intervention.
A nurse is assessing the recent health history of a patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which activity pattern? a) Bed rest with bathroom privileges b) Daily high-impact aerobic exercise c) Frequent rest periods with minimal exercise d) Regular exercise program that involves walking
d) Regular exercise program that involves walking A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with osteoarthritis. A balance of rest and activity is needed. High-impact aerobic exercises would cause stress to affected joints and further damage.
The nurse is obtaining a health history and performing a physical assessment for a patient with gout. What indication does the nurse have that the patient has developed a complication from gout? a) The patient has a gastric ulcer b) The patient has a pulmonary embolus c) The patient has developed renal calculi d) The laboratory studies determine the patient has cirrhosis
d) The laboratory studies determine the patient has cirrhosis Uric acid, an end product of purine metabolism, may exceed the kidneys' excretion capacity, resulting in the formation of a uric acid renal calculus. Gout and increased serum uric acid level do not cause cirrhosis, gastric ulcer, or pulmonary emboli.
A patient with osteoarthritis has been prescribed treatment with celecoxib. What is the reason to justify this pharmacologic therapy? a) The patient is taking warfarin. b) The patient has hyperchlorhydria. c) The patient has severe disease condition. d) The patient does not tolerate traditional nonsteroidal antiinflammatory agents (NSAIDs).
d) The patient does not tolerate traditional nonsteroidal antiinflammatory agents (NSAIDs). Celecoxib is a selective cyclooxygenase-2 (COX-2) inhibitor and is devoid of the side effects of conventional NSAIDs. However, its use is limited to selected cases in which the side effects outweigh the benefits or when conventional therapy is not tolerated. Its use can be justified in a patient having severe gastrointestinal disturbances due to conventional therapy. The use of celecoxib should be carefully administered concomitantly with warfarin, because it potentiates the anticoagulant effect of warfarin. The medication is also indicated for use in mild disease conditions. Patients with hyperchlorhydria can take NSAIDs and do not need celecoxib.
A patient with a fracture of the femur has the extremity in skeletal traction and is encouraged to use an overhead trapeze apparatus. The nurse explains that the primary purpose of the overhead trapeze is what? a) To assist with leg exercises b) To enhance breathing and lung expansion c) To promote circulation throughout the body d) To facilitate independent movement while the patient is in bed
d) To facilitate independent movement while the patient is in bed An overhead trapeze will facilitate independent movement in bed. It also maintains range of motion of the upper extremities and strengthens the biceps. Assisting with stump exercises, enhancing breathing and lung expansion, and promoting circulation throughout the body are secondary benefits to using an overhead trapeze but are not the primary purpose.
A patient with osteoarthritis (OA) is prescribed ibuprofen 800mg every eight hours for pain. What is an important nursing instruction when teaching the patient about safe drug administration? a) Take ibuprofen on an empty stomach. b) Expect the stool to appear dark and tarry. c) Do not take ibuprofen with milk products. d) Try to take ibuprofen with a meal or a snack.
d) Try to take ibuprofen with a meal or a snack. Ibuprofen is irritating to the stomach lining and should not be be taken on an empty stomach. Patients should be taught to take ibuprofen with food, milk, or antacids (if prescribed) to reduce the risk of gastrointestinal bleeding. Taking ibuprofen on an empty stomach raises the risk of irritation. The patient should not be told to expect dark, tarry stools; ibuprofen should be stopped immediately and the prescriber notified if signs of bleeding occur (e.g., tarry stools, bruising, and petechiae). The patient may take ibuprofen with milk products.
