Med/Surg Test 4 NCLEX

In assessing the joints of a pt with osteoarthritis, the nurse understands that Bouchard's nodes a. are often red, swollen, and tender b. indicate osteophyte formation at the PIP joints c. are the result of panes formation at the DJP joints d. occurs from deterioration of cartilage by proteolytic enzymes

b. indicate osteophyte formation at the PIP joints Rationale: Bouchard's nodes are bony deformities of the proximal interphalangeal joints that indicate osteophyte formation and loss of joint space in osteoarthritis.

The nurse determines that teaching about management of osteoarthritis of the feet and hands has been effective when the patient says which of the following? a. "I can use heat to relieve the stiffness when I wake up in the morning." b. "I should exercise my hands every day, especially if they are painful and inflamed." c. "I should avoid the use of glucosamine as it has been shown to have no therapeutic value." d. "I will be careful to avoid crowds and people with infections."

a. "I can use heat to relieve the stiffness when I wake up in the morning."

Which persons are at high risk for chronic low back pain? (SATA) a. 63 yr old man who is a long-distance truck driver b. 30 yr old nurse who works on an orthopedic unit and smokes c. 55 yr old construction worker who is 6ft 2in and weighs 250 lbs d. 44 yr old female chef with prior compression fracture of the spine e. 28 yr old female yoga instructor who is 5ft 6in and weighs 130 lbs

a. 63 yr old man who is a long-distance truck driver b. 30 yr old nurse who works on an orthopedic unit and smokes c. 55 yr old construction worker who is 6ft 2in and weighs 250 lbs d. 44 yr old female chef with prior compression fracture of the spine Rationale: Causes of chronic low back pain include (1) degenerative conditions, such as arthritis or disc disease; (2) osteoporosis; (3) weakness from the scar tissue of prior injury; and (4) chronic strain on lower back muscles from obesity, pregnancy, or jobs that require repetitive heavy lifting, vibration, and prolonged sitting. Health care personnel are at high risk for low back pain. Lifting and moving patients, excessive time being stooped over or leaning forward, and frequent twisting can cause low back pain.

The nurse is providing discharge teaching to a patient who had a myelogram. What would the nurse include in the teaching plan? a. Report a HA that is worse when sitting or standing b. Remain flat in bed for 24-48 hr to prevent pain c. Decrease fluid intake for a4-8 hrs to prevent nausea d. Take acetaminophen to prevent fever

a. Report a HA that is worse when sitting or standing

You are providing discharge education for a pt with SEID. What should be included regarding activity and diet? a. avoid total rest and balanced diet of fiber and dark-colored veggies b. sign up local gym which includes a strenuous activity program c. total rest minimize pain and joint aches d. to minimize severe fatigue-total rest and brain fog-total rest

a. avoid total rest and balanced diet of fiber and dark-colored veggies

A pt with a pelvic fracture should be monitored for a. change in urine output b. petechiae on the abdomen c. a palpable lump in the buttock d. sudden increase in blood pressure

a. change in urine output Rationale: Pelvic fractures may cause serious intraabdominal injury, such as hemorrhage, and laceration of the urethra, bladder, or colon. Patients may survive the initial pelvic injury, only to die of sepsis, FES, or VTE. Because a pelvic fracture can damage other organs, assess bowel and urinary elimination and distal neurovascular status.

The increased risk for falls in the older adult is likely due to (SATA) a. changes in balance b. decrease in bone mass c. loss of ligament elasticity d. erosion of articular cartilage e. decrease in muscle mass and strength

a. changes in balance b. decrease in bone mass c. loss of ligament elasticity e. decrease in muscle mass and strength Rationale: Aging can cause changes in a person's sense of balance, making the person unsteady, and proprioception may be altered. The risk for falls also increases in older adults partly because of a loss of muscle strength, loss of ligament elasticity, and decrease in bone density.

A pt with a torn ligament in the knee asks what the ligament does. The nurse's response is based on the knowledge that ligaments a. connect bone to bone b. provide strength to muscle c. lubricate joints with synovial fluid d. relieve friction between moving parts

a. connect bone to bone Rationale: Ligaments are composed of dense, fibrous connective tissue that contains bundles of closely packed collagen fibers arranged in the same plane for additional strength. They connect bone to bone providing stability for joints.

The nurse is obtaining a health history of a patient with a fracture. Which condition poses the most concern related to the musculoskeletal system? a. diabetes b. HTN c. chronic bronchitis d. nephrotic syndrome

a. diabetes Rationale: Certain illnesses are known to affect the musculoskeletal system directly or indirectly. These diseases include tuberculosis, poliomyelitis, diabetes, parathyroid problems, hemophilia, rickets, soft tissue infection, and neuromuscular disabilities.

While performing passive ROM for a pt, the nurse puts the elbow joint through the movements of (SATA) a. flexion and extension b. inversion and eversion c. pronation and supination d. flexion, extension, abduction, and adduction e. pronation, supination, rotation, and circumduction

a. flexion and extension c. pronation and supination Rationale: Movements that occur at the elbow include pronation, supination, flexion, and extension.

A pt with a humeral fracture is returning for a 4 wk check-up. The nurse explains that initial evidence of healing on x-ray is indicated by: a. formation of callus b. complete bony union c. hematoma at the fracture site d. presence of granulation tissue

a. formation of callus Rationale: Bone goes through a remarkable healing process (e.g., union) that occurs in stages. The third stage is callus formation. As minerals (e.g., calcium, phosphorus, and magnesium) and new bone matrix are deposited in the osteoid, an unorganized network of bone is formed that is woven about the fracture parts. Callus is composed primarily of cartilage, osteoblasts, calcium, and phosphorus. It usually appears by the end of the second week after injury. Evidence of callus formation can be verified on x-rays.

The nurse teaching the pt with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contracture b. clot formation at the incision c. skin irritation and breakdown d. increased risk for wound dehiscence

a. hip flexion contracture Rationale: Flexion contractures may delay the rehabilitation process after amputation. The most common and debilitating contracture is hip flexion. To prevent flexion contractures, the patient should avoid sitting in a chair for more than 1 hour with hips flexed or with pillows under the surgical extremity. Unless specifically contraindicated, help the patient lie on the abdomen for 30 minutes 3 or 4 times each day and position the hip in extension while prone.

A pt who has had surgical correction of bilateral hallux values is being discharged from the same-day surgery unit. The nurse will teach the pt to a. rest frequently with the feet elevated b. wear shoes continually except when bathing c. soak the feet in warm water several times a day d. expect the feet to be numb for the next few days

a. rest frequently with the feet elevated Rational: After surgical correction of bilateralparag hallux valgus, the feet should be elevated with the heel off the bed to reduce discomfort and decrease edema.

Teach the pt with fibromyalgia the importance of limiting intake of which foods? (SATA) a. sugar b. alcohol c. caffeine d. red meat e. root vegetables

a. sugar b. alcohol c. caffeine Rationale: Dietitians often urge patients with fibromyalgia to limit their intake of sugar, caffeine, and alcohol because these substances have been shown to be muscle irritants.

When administering medications to the patient with chronic gout, the nurse recognizes which drug is used as a treatment for chronic disease? a. Colchicine b. Allopurinol c. Sulfasalazine d. Cyclosporine

b. Allopurinol Rationale: Febuxostat (Uloric), a selective inhibitor of xanthine oxidase, is given for long- term management of hyperuricemia in persons with chronic gout. An acute episode of gout is treated with colchicine and NSAIDs.

A plaster splint is applied with an elastic bandage to the leg of a patient hospitalized with a fractured tibia in preparation for open reduction and internal fixation of the fracture. The patient complains of increasing pain in the affected leg and foot that is not relieved by loosening of the elastic bandage. The most appropriate action by the nurse is to a. Elevate the leg on two pillows. b. Perform neurovascular assessment of the foot. c.Notify the health care provider. d.Apply ice over the fracture site.

b. Perform neurovascular assessment of the foot.

A pt with osteosarcoma of the humerus shows understanding of his tx options when he states a. I accept that I have to lose my arm with surgery b. The chemotherapy before surgery will shrink the tumor c. This tumor is related to the melanoma I had 3 yr ago d. I'm glad they can take out the cancer with such a small scar.

b. The chemotherapy before surgery will shrink the tumor Rationale: A patient with osteosarcoma usually has preoperative chemotherapy to decrease tumor size. This increases the chance that limb-salvage procedures, including wide surgical resection of the tumor, can be done. Osteosarcoma is an extremely aggressive primary bone tumor that rapidly metastasizes to distant sites.

A pt with RA has articular involvement. The nurse recognizes these characteristic changes include (SATA) a. bamboo-shaped fingers b. metatarsal head dislocation in feet c. noninflammatory pain in large joints d. asymmetric involvement of small joints e. morning stiffness lasting 60 minutes or more

b. metatarsal head dislocation in feet e. morning stiffness lasting 60 minutes or more Rationale: Morning stiffness may last from 60 minutes to several hours or more, depending on disease activity. Metatarsal head dislocation and subluxation in the feet may cause pain and walking disability. Joint symptoms occur symmetrically and often affect the small joints of the hands (proximal interphalangeal [PIP] and metacarpophalangeal [MCP] joints) and feet (metatarsophalangeal [MTP] joints). Larger peripheral joints such as the wrists, elbows, shoulders, knees, hips, ankles, and jaw may be involved. Rheumatoid arthritis is an inflammatory disorder. In early disease, the fingers may become spindle-shaped from synovial hypertrophy and thickening of the joint capsule.

A client recovering from a limb amputation complains of pain of the amputated limb. This type of pain is a. residual pain b. phantom pain c. chronic pain d. neuropathic pain

b. phantom pain

The nurse should teach the patient with ankylosing spondylitis the importance of a. avoiding extremes in environmental temperatures b. regularly exercising and maintaining proper posture c. Maintaining pt's usually physical activity during flares d. applying hot and cool compresses for relief of local symptoms

b. regularly exercising and maintaining proper posture Rationale: Patients with AS should exercise after pain and stiffness are managed. Teach the patient with AS about regular exercise and attention to posture, local moist-heat applications, and knowledgeable use of drugs. Postural control is important for minimizing spinal deformity. Proper positioning at rest is essential. Postural training emphasizes avoiding spinal flexion (e.g., leaning over a desk), heavy lifting, and prolonged walking, standing, or sitting. Exercise should include back, neck, and chest stretches. Discourage excessive physical exertion during periods of active flare-up of the disease. The mattress should be firm. The patient should sleep on the back with a flat pillow, avoiding positions that encourage flexion deformity.

A pt with osteoarthritis is scheduled for total hip arthroplasty. The nurse explains the purpose of this procedure is to (SATA) a. fuse the joint b. replace the joint c. prevent further damage d. improve or maintain ROM e. decrease the amount of destruction in the joint

b. replace the joint d. improve or maintain ROM Rationale: Arthroplasty is the reconstruction or replacement of a joint. This surgical procedure is done to relieve pain, improve or maintain range of motion, and correct deformity. Total hip arthroplasty (THA) provides significant pain relief and improved function for a patient with osteoarthritis (OA).

What is most important to include in the teaching plan for a pt with osteopenia? a. lose weight b. stop smoking c. eat a high-protein diet d. start swimming for exercise

b. stop smoking Rationale: Patients with osteopenia should be taught to quit smoking to decrease bone loss.

A pt with osteomyelitis undergoes surgical debridement with implantation of antibiotic beads. When the patient asks why the beads are used, the nurse answers (SATA) a. oral or IV antibiotics are not effective in most cases of bone infection b. the beads are an adjunct to debridement and antibiotics for deep infections c. the beads are used to deliver antibiotics directly to the site of the infection d. this is the safest method to deliver long-term antibiotic therapy for bone infection e. ischemia and bone death related to osteomyelitis are impenetrable to IV antibiotics

b. the beads are an adjunct to debridement and antibiotics for deep infections c. the beads are used to deliver antibiotics directly to the site of the infection Rationale: Treatment of chronic osteomyelitis includes surgical removal of the poorly perfused tissue and dead bone in addition to the extended use of IV and oral antibiotics. Antibiotic acrylic bead chains may be placed during surgery to help fight the infection.

In caring for a pt after a spinal fusion, the nurse would report which finding to the health care provider? a. the pt has a single episode of emesis b. the pt is unable to move the lower extremities c. the pt is nauseated and has not voided in 4 hrs d. the pt reports of pain at the bone graft site

b. the pt is unable to move the lower extremities Rationale: After spinal fusion surgery, the nurse should frequently monitor peripheral neurovascular condition. Movement of the arms and legs and assessment of sensation should be no worse in comparison with the preoperative status. These assessments are repeated at least every 2 to 4 hours during the first 48 hours after surgery, and findings are compared with the preoperative assessment. The nurse should immediately report any new muscle weakness to the HCP and record this in the patient's medical record.

An abnormal assessment finding of the musculoskeletal system is a. equal leg length bilaterally b. ulnar deviation and subluxation c. full ROM in all joints d. muscle strength 5/5 in all muscles

b. ulnar deviation and subluxation Rationale: Normal physical assessment findings of the musculoskeletal system include normal and full range of motion; equal leg length bilaterally, and muscle strength score of 5/5. Ulnar deviation and subluxation are associated with rheumatoid arthritis

In teaching a pt with Sjogren's syndrome about drug therapy for this disorder, the nurse includes instruction about the use of which drug? a. Pregabalin (Lyrica) b. Etanercept (Enbrel) c. Cyclosporine (Restasis) d. Cyclobenzaprine (Flexeril)

c. Cyclosporine (Restasis) Rationale: Cyclosporine (Restasis) ophthalmic drops can be used to treat the chronic dry eye associated with Sjögren's syndrome.

A pt is scheduled for a bone scan. The nurse explains that this dx test involves a. incision or puncture of the joint capsule b. insertion of small needles into certain muscles c. administration of a radioisotope before the procedure d. placement of skin electrons to record muscle activity

c. administration of a radioisotope before the procedure Rationale: Bone scan involves injection of radioisotope (usually technetium [Tc]-99m) that is taken up by bone. Uniform uptake of the isotope is normal. Increased uptake is seen in osteomyelitis, primary and metastatic bone cancer, and certain fractures. Decreased uptake is seen in areas of avascular necrosis.

Etanercept (Enbrel) is prescribed for a pt with stage II RA. The nurse determines that the medication is effective if what is observed? a. increased serum immunoglobulin G b. decreased lymphocyte count c. decreased C-reactive protein (CRP) d. absence of Rh factor in the blood

c. decreased C-reactive protein (CRP)

The nurse suspects a neuromuscular problem based on assessment of a. exaggerated strength with movement b. increased redness and heat below the injury c. decreased sensation distal to the fracture site d. a purulent drainage at the site of an open fracture

c. decreased sensation distal to the fracture site Rationale: Musculoskeletal injuries can cause changes in the neurovascular condition of an injured extremity. The neurovascular assessment consists of peripheral vascular evaluation (e.g., color, temperature, capillary refill, peripheral pulses, and edema) and peripheral neurologic evaluation (e.g., sensation and motor function). Paresthesia and partial or full loss of sensation (paresis or paralysis) may be a sign of neurovascular damage. Pallor, a cool-to-cold extremity, or a delay in capillary refill time below the injury occur with arterial insufficiency. A decreased or absent pulse distal to the injury can indicate vascular dysfunction and insufficiency.

A pt with comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the pt is unable to tolerate prolonged immobilization b. the pt cannot tolerations the surgery for a closed reduction c. other nonsurgical methods cannot achieve adequate alignment d. a temporary scat would be too unstable to provide normal mobility

c. other nonsurgical methods cannot achieve adequate alignment Rationale: A comminuted fracture has more than 2 bone fragments. Open reduction with internal fixation (ORIF) is indicated for a comminuted fracture. It is used to realign and maintain bony fragments. Other nonsurgical methods can fail to obtain satisfactory reduction. Internal fixation reduces the hospital stay and complications associated with prolonged bed rest.

The nurse should teach the patient with ankylosing spondylitis the importance of a. maintaining pt's usual physical activity during flares b. applying hot and cool compresses for relief of local symptoms c. regularly exercising and maintaining proper posture d. avoiding extremes in environmental temperatures

c. regularly exercising and maintaining proper posture

When grading muscle strength, the nurse records a score of 3/5 which indicates a. no detection of muscular contraction. b. a barely detectable flicker of contraction. c. active movement against full resistance without fatigue. d. active movement against gravity but not against resistance.

d. active movement against gravity but not against resistance. Rationale: Muscle strength score of 3 indicates active movement only against gravity and not against resistance (Table 61.4).

A pt is scheduled for total ankle replacement. The nurse should tell the pt that after surgery he should avoid a. lifting heavy objects b. sleeping on the back c. abduction exercises of the affected ankle d. bearing weight on the affected ankle for 6 weeks

d. bearing weight on the affected ankle for 6 weeks Rationale: After total ankle arthroplasty (TAA), the patient may not bear weight for 6 weeks and must elevate the extremity to reduce edema. The patient must follow strategies to prevent postoperative infection and maintain immobilization as directed by the provider.

The nurse is caring for a 74-yr-old woman. What would be a normal age-related finding? a. spinal crepitation b. back pain c. kyphosis d. loss of height

d. loss of height

The bone cells that fx in the formation of new bone tissue are called a. osteoids b. osteocytes c. osteoclasts d. osteoblasts

d. osteoblasts Rationale: Osteoblasts are the main cells that form new bone.

A pt with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse notifies the provider of possible early compartment syndrome when the patient has a. increasing edema of the limb b. muscle spasms of the lower arm c. bounding pulse at the fracture site d. pain when passively extending the fingers

d. pain when passively extending the fingers Rationale: One or more of these characteristics occur with early compartment syndrome: (1) paresthesia (e.g., numbness and tingling sensation); (2) pain distal to the injury that is not relieved by opioid analgesics and is increased on passive stretch of muscle; (3) increased pressure in the compartment; and (4) pallor, coolness, and loss of normal color of the extremity. Paralysis (or loss of function) and pulselessness (or decreased or absent peripheral pulses) are late signs of compartment syndrome. The examination also includes assessment of peripheral edema, especially pitting edema, which may occur with severe injury.

A pt with suspected disc herniation has acute pain and muscle spasms. The nurse's responsibility is to a. encourage total bed rest for several days b. teach principles of back strengthening exercises c. stress the importance of straight-leg raises to decrease pain d. promote use of cold and hot compresses and pain medication

d. promote use of cold and hot compresses and pain medication Rationale: If acute pain and muscle spasms are not severe, the patient may be treated as an outpatient with NSAIDs and muscle relaxants (e.g., cyclobenzaprine). Massage and back manipulation, acupuncture, and application of cold and hot compresses may help some patients. A brief period (1 to 2 days) of rest at home may be needed for some people; most patients do better if they continue their regular activities. Prolonged bed rest should be avoided. All patients should refrain from activities that worsen the pain, including lifting, bending, twisting, and prolonged sitting.

A pt is undergoing dx testing for symptoms of polyarthralgia, fatigue, and hair loss. Lab results include the presence of anti-DNA, antinuclear antibodies, and anti-Smith in the blood. The nurse recognizes that these findings are most likely to be related to which dx? a. chronic fatigue syndrome b. RA c. systemic sclerosis d. systemic lupus erythematosus

d. systemic lupus erythematosus

In teaching a pt with systemic lupus erythemetosus about the disorder, the nurse knows the pathophysiology includes a. circulating immune complies formed fro, IgG autoantibodies reacting with IgG b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles d. the production of variety of autoantibodies directed against components of the cell nucleus

d. the production of variety of autoantibodies directed against components of the cell nucleus Rationale: SLE is marked by production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions (antinuclear antibodies [ANA]) are typically directed against constituents of the cell nucleus, especially DNA.

The nurse suspects an ankle sprain when a pt at the urgent care center describes a. being hit by another soccer player during a game b. having ankle pain after sprinting around the track c. dropping a 10lb weight on his lower leg at the health club d. twisting his ankle while running bases during a baseball game

d. twisting his ankle while running bases during a baseball game Rationale: A sprain is an injury to the ligaments surrounding a joint. It is usually caused by a wrenching or twisting motion. Most sprains occur in the ankle and knee joints.