exam 4

Which musculoskeletal disorder is the dorsiflexion of any metatarsophalangeal (MTP) joint that has plantar flexion of the proximal interphalangeal joint next to it?

hammertoe

Which condition may increase the risk for developing acute carpal tunnel syndrome (CTS)? Select all that apply.

hand burns; colles' fracture of the wrist

neurologic symptoms

headache photophobia indications of increased ICP nuchal rigidity positive kernigs, brudzinskis signs decreased mental status focal neurologic deficits

Which clinical sign of complex regional pain syndrome (CRPS) does the nurse know to be a manifestation of the sensory perception abnormalities seen in this syndrome?

intense burning pain

priority of care

interventions and support (patient and caregiver)

Arrange in the correct order the process of sequestrum formation as it occurs in osteomyelitis.

invasion of pathogenic microorganisms stimulation of antiflammatory response vascular thrombosis release of exudate into the bone tissue ischemia of bone tissue sequestrum formation

Arrange in the correct order the process of sequestrum formation as it occurs in osteomyelitis.

invasion of pathogenic microorganisms, stimulation of antiflammatory response, vascular thrombosis, release of exudate into the bone tissue, ischemia of bone tissue, and sequestrum formation

A chemical sympathetic nerve block may be used to manage complex regional pain syndrome (CRPS). Which drug, administered intravenously, is used to block sympathetic nerve receptors?

phentolamine

photophobia and phonophobia

photophobia- sensitivity to light phonophobia- sensitivity to noise

Which statements are true regarding the various types of casting materials for immobilization? Select all that apply.

plaster is not commonly used for casting; fiberglass can dry and become rigid in minutes

Which is a priority problem for the older adult patient diagnosed with bone cancer?

potential for injury related to weakness and drug therapy

Which long-term drug therapy increases the risk of developing ischemic bone necrosis?

prednisone

Parkinsons disease

progressive neurodegenerative disorder

what may also be used if there is close contact with meningitis-infected patient?

prophylaxis treatment

The nurse anticipates providing collaborative care for a patient with a traumatic amputation of the right hand with which health care team members? Select all that apply.

psychologist; physical therapist; occupational therapist

what are some drug therapies?

psychotropic meds help with safety

Which assessment findings are consistent with cluster headaches? Select all that apply.

ptosis and rhinorrhea Ptosis and rhinorrhea are assessment findings consistent with cluster headaches. Aphasia, drowsiness, and flashing lights are findings consistent with the prodromal phase of a migraine headache

Which part of the pelvis is non-weight-bearing?

pubic rami

What is the generic name for the bisphosphonate drug zoledronic acid?

reclast

migraine headache

recurrent, espisodic attacks of head pain

what does drug therapy do>

reduces signs and symtoms and increased mobility and self-care abilities

when dopamine levels are decreased, a person loses the ability to do what?

refine voluntary movement

The nurse is caring for a patient with hypertrophic ungual labium. The nurse prepares to teach the patient about treatment for the condition. Which actions will the nurse include? Select all that apply.

removing the necrotic nail; taking antibiotics for secondary infections

status epilepticus

repeated seizures that last more than 5 minutes or repeated seizures over course of 30 minutes

what are some nonpharmacologic ways?

repetition reminders schecule reminence therapy doll therapy validation therapy

home care management

respite care - short stay admission caring for caregiver - support groups

do not want...

restrains

secondary seizures

result form an underlying brain lesion, most commonlyl a tumor, trauma, or metabolic or other disorders

what to look for in the physical assessment?

rigidity assessment facial expression emotional changes bowel and bladder changes

Which condition may be detected by using the drop arm test?

rotator cuff injury

abortive therapies alleviates pain during...

the aura phase or soon after the start

For drug therapy, evaluate what?

the most current blood level of medication, if appropriate

The patient's blood test shows a count of 12,000 white blood cells (WBCs) per microliter. Which finding does the nurse suspect is causing this laboratory value?

the patient has an inflamed ingrown toe nail

The nurse is reviewing the risk factors for Dupuytren contracture with a patient. Which finding causes the nurse to believe the patient may be at risk for developing this condition?

the patient has diabetes

what should you maintain?

therapeutic blood levels for maximal effectiveness

Which is true of partial-thickness rotator cuff tears?

they are more painful than full-thickness tears

the nurse is taking the history of an adult female patient. which factor places the patient at risk for osteoporosis

working at a desk and playing the piano for a hobby

The nurse meets with a patient who reports having a ganglion. Which part of the body will the nurse inspect?

wrist

The nurse is providing postoperative care to a patient immediately following an osteotomy for the correction of hammertoe. What information does the nurse tell the patient?

you can put all of your weight on your foot in a few weeks

The nurse is assessing a patient with a hallux valgus deformity. What term is used to refer to an enlargement of the first metatarsal head commonly seen with this kind of deformity?

bunions

How is the Tinel sign diagnostic test for carpal tunnel syndrome (CTS) performed?

by tapping lightly over the area of the median nerve in the wrist

A nurse assesses a client who has a history of migraines. Which clinical manifestation should the nurse identify as an early sign of a migraine with aura? a. Vertigo b. Lethargy c. Visual disturbances d. Numbness of the tongue

c

A nurse assesses a client with Alzheimer's disease who is recently admitted to the hospital. Which psychosocial assessment should the nurse complete? a. Assess religious and spiritual needs while in the hospital. b. Identify the client's ability to perform self-care activities. c. Evaluate the client's reaction to a change of environment. d. Ask the client about relationships with family members.

c

The nursing instructor is teaching a group of nursing students about ganglions. Which statement made by a student indicates the need for further instruction?

"Activity should be avoided for 24 hours after surgery of a large ganglion cyst."

A patient who is an avid runner has suffered a muscle strain. Which management advice given by the nurse is most helpful to the patient?

"Alternate heat and cold on the ankle, stay off it, and take a nonsteroidal antiinflammatory drug (NSAID) for the pain."

The nurse is teaching a patient with bunions on both feet about bone resection and fusion. Which statement made by the patient indicates that more teaching is needed?

"Healing time will take two weeks for each foot

The nurse provides teaching to a patient who has a callus. Which statement made by the patient indicates proper learning?

"I should be sure to pad that part of my foot so it doesn't have too much pressure on it."

A patient is recovering from an above-knee amputation resulting from peripheral vascular disease. Which statement indicates that the patient is coping well after the procedure?

"It will take me some time to get used to this"

The nurse is educating a patient who is scheduled for endoscopic carpal tunnel release (ECTR) surgery for carpal tunnel syndrome (CTS). Which statement made by the patient shows understanding of the procedure?

"This surgery will require a small incision, but the pain might be worse than it would be with open surgery."

The nurse is caring for a preoperative patient who is about to undergo a partial fasciectomy to treat Dupuytren contracture. The nurse ensures that the patient understands the procedure. Which statement made by the patient causes the nurse to do additional teaching?

"This surgery will tighten the fascia in my hand."

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan?

"Wear helmets when riding a motorcycle."

When performing a physical assessment, the nurse notices the patient has an ingrown toenail. What does the nurse advise the patient? Select all that apply.

"When you do not trim your nails the right way, you can get a secondary infection." "Sometimes with ingrown toenails, the necrotic nail will have to be removed surgically." "It is important for you to trim your nails properly so that you do not get chronic hypertrophy of the nail lip."

The nurse is providing postoperative care to a patient immediately following an osteotomy for the correction of hammertoe. What information does the nurse tell the patient?

"You can put all of your weight on your foot in a few weeks."

The nurse provides a patient with information about how to prevent osteomalacia. Which statement made by the patient indicates the need for further teaching?

"i should exclude chicken and swordfish from my diet"

Medications for Thrombocytopenia:

-Oral glucocorticoids such as prednisone to suppress the autoimmune response -Immunosuppressive drugs such as azathioprine, cyclophosphamide, and cyclosporine

Manifestations of TTP:

-Purpura and petichiae -Neuro symptoms: headache, seizures, and altered consciousness (due to clotting)

Treatment of DIC:

-Treat the underlying disorder -Prevent further bleeding or massive thrombosis

what are the priority collaborative problems for patients with alzheimers disease?

-decreased memory and cognition related to neuronal degeneration in the brain -potential for injury or accident related to wandering or inability to ambulate independently -potential for prolonged progression of disability and the patients increasing care needs

A 35-year-old lady complains of bruises on her legs, arms, and thighs and has heavy menstrual bleeding. While taking the medical history of patient, the nurse finds that the patient had a history of frequent nose and gum bleeding. A complete blood count revealed the platelet count to be 10,000 mm3. What should be the immediate intervention given to the patient? 1 Transfusing platelets 2 Providing low dosage of chemotherapy 3 Providing intravascular immunoglobulin and intravascular anti-rho 4 Providing corticosteroid therapy for inhibiting antiplatelet antibodies

1

A diagnosis of autoimmune thrombocytopenic purpura is made after detection of what finding in the blood? 1 Antiplatelet antibodies 2 Elevated platelet counts 3 Elevated red blood cells 4 Low hemoglobin and hematocrit

1

Which time frame accurately describes the typical duration of a cluster headache?

1-2 hours Cluster headaches are brief, lasting 30 minutes to 2 hours, and are classified as the most common chronic short-duration headache with pain lasting less than 4 hours. Time frames of longer than 4 hours would not describe a cluster headache.

Arrange the following nursing actions pertaining to the emergency care of a patient who experiences a fracture in the correct sequence.

1. Assess airway, breathing, and circulation 2. Render cardiopulmonary resuscitation (CPR), if necessary 3. Control bleeding by direct pressure 4. Manage pain

What are the 2 main types of Partial Seizures

1. Complex-partial 2. Simple-partial

What are the 5 types of Generalized Seizures?

1. Tonic-clonic 2. Tonic 3. Clonic 4. Myoclonic 5. Atonic

What are 3 surgical interventions

1. Vagal Nerve Stimulation 2. Craniotomy 3. Corpus Callotomy

stages?

1:mild to 5:severe

What trigger is suspected in the production of autoimmune antibodies in autoimmune thrombocytopenic purpura? 1 Age 2 Virus 3 Alcohol 4 Family histor

2

What trigger is suspected in the production of autoimmune antibodies in autoimmune thrombocytopenic purpura? 1 Age 2 Virus 3 Alcohol 4 Family history

2

Which intervention most effectively protects a patient with thrombocytopenia? 1 Avoiding the use of dentures 2 Encouraging the use of an electric shaver 3 Taking rectal temperatures 4 Using warm compresses on trauma sites

2

Which laboratory parameter helps to differentiate between classic hemophilia and Christmas disease? 1 Platelet count 2 Coagulation factor 3 Prothrombin time 4 Partial prothromboplastin time

2

Which statement indicates a failure of blood clotting due to hemophilia? 1 The production of platelets from the bone marrow is inadequate. 2 Formation of the fibrin mesh is inadequate to stop the bleeding. 3 Constriction of the blood vessels does not take place to stop the bleeding. 4 Formation of the platelet plug takes place properly to stop the bleeding

2

The 24 yo female client is diagnosed with ITP. Which question would be important for the nurse to ask during the admission interview? 1. "Do you become SOB during activity?" 2. "How heavy are your menstrual periods?" 3. "Do you have a history of deep vein thrombosis?" 4. "How often do you have migraine headaches?"

2. "How heavy are your menstrual periods?"

The nurse is providing teaching for female patient diagnosed with hemophilia A. What statement by the patient indicates a need for further teaching? 1 "There's a high chance I could pass hemophilia on to my children." 2 "I will need to have infusions of factor VIII for the rest of my life." 3 "I will be able to use steroids to help my body create the clotting factors." 4 "If I notice any swelling in my joints, I should contact my health care provider."

3

The nurse uses the 0-to-5 scale for grading muscle strength of a patient around the knee joint. If the patient can complete range of motion (ROM) against gravity but only without any resistance, what rating does this signify?

3

What medication is used to prevent the destruction of antibody-coated platelets in a patient with idiopathic thrombocytopenia purpura? 1 Rituximab 2 Corticosteroids 3 IV immunoglobulin 4 Platelet transfusion

3

What risk factors are associated with higher incidence of development of heparin-induced thrombocytopenia in patients? 1 Male patients 2 Pre-surgical thromboprophylaxis 3 Exposure to unfractionated heparin 4 Use of heparin longer than 1 mont

3

What treatment does the nurse expect a patient diagnosed with hemophilia to receive? 1 Rituximab 2 Corticosteroids 3 Synthetic factor VIII 4 Packed red blood cells

3

Which abnormal laboratory value indicates hemophilia? 1 Increased platelet count 2 Decreased platelet count 3 Increased partial thromboplastin time 4 Increased time for platelet plug formation

3

Which blood product may be administered to a patient diagnosed with thrombotic thrombocytopenic purpura? 1 Albumin 2 Platelets 3 Fresh frozen plasma 4 Packed red blood cells

3

Which drug has a recombinant antihemophilic factor? 1 Advate 2 Alphanate 3 Helixate FS 4 Monarc-M

3

Which platelet disorder involves the failure of blood to clot after a trauma, in spite of having the ability to form blood clots? 1 Hemophilia 2 Heparin-induced thrombocytopenia 3 Thrombotic thrombocytopenic purpura 4 Autoimmune thrombocytopenic purpur

3

For rotator cuff injuries, providers generally take a conservative approach. If a patient has a partial-thickness tear, how much time is allowed for conservative treatment before surgical repair?

3 to 6 months

What is the normal range for PTT?

32-39 seconds

A 70-year-old patient has an infected tibial fracture. What is the estimated healing time?

90 days

Which individual has the highest chance of developing carpal tunnel syndrome (CTS)?

A 60-year-old female

A patient presents with pain in the front of the knee. The patient reports being an avid runner. What will the nurse be most likely to suggest?

A brace and nonsteroidal antiinflammatory drugs (NSAIDs)

Describe Absence Seizure

A brief sudden lapse in attention. (most common in children)

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?

A hematoma forms at the site of the fracture

A client with myasthenia gravis has become increasingly weaker. The HCP prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis). An injection of edrophonium is administered. What finding would indicate that the client is having a cholinergic crisis?

A temporary worsening of the condition

Which medication does the nurse expect to be ordered for the patient experiencing a mild migraine?

Acetaminophen or ibuprofen For mild migraines, acetaminophen or ibuprofen is the expected first-line treatment. Ergotamine derivatives and triptan preparations (e.g., almotriptan, eletriptan) are reserved for more severe migraine headaches. Beta blockers like propranolol and timolol are used for preventive therapy.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed.

Acetylcysteine (Mucomyst)

A primary health care provider advises a patient to avoid wearing high heels. Which traumatic condition does the nurse suspect in the patient?

Achilles tendinopathy

Which condition can manifest in a patient undergoing fluoroquinolone therapy?

Achilles tendinopathy

A patient who recently suffered a broken tibia presents with edema, a great deal of pain, pale skin, and a weakened pulse. Upon palpation, the area is noted to be tense. What is most likely the concern?

Acute compartment syndrome

The nurse is caring for a patient with a tibial fracture. For which complication common in a fracture of this type should the nurse monitor the patient?

Acute compartment syndrome (ACS)

A client has a neurological deficit involving the limbic system On assessment, which finding is specific to this type of deficit?

Affect is flat, with periods of emotional lability

The nurse is assessing the skeletal system of an African-American patient. What must the nurse know to assess the patient correctly?

African Americans have a decreased incidence of osteoporosis.

What is the goal of abortive therapy in migraine headaches?

Alleviating pain during the aura phase The goal of abortive therapy in migraine headaches is to alleviate pain during the aura phase. Abortive therapy is not meant to identify triggers, prevent reoccurrence, or decrease pain during the second phase.

The nurse refers a patient with an amputation and the patient's family to which community resource?

Amputee Coalition of America (ACA)

Body temperature of 102°F (Older adults may not have an extreme temperature elevation because of lower core body temperature and a compromised immune system that occurs with normal aging. Acute osteomyelitis is characterized by severe throbbing pain, swelling, and erythema of the affected region.)

An 80-year-old patient suffering from severe pain in the lower jaw is diagnosed with acute osteomyelitis. Which symptom may be least likely to be found?

. Which priority assessment confirms a diagnosis of meningitis?

Analysis of cerebrospinal fluid The most significant laboratory test used in the diagnosis of meningitis is the analysis of cerebrospinal fluid. A CT scan or nuclear imaging may also be conducted, but are not the priority in all cases. WBC counts provide data regarding etiology, but are not diagnostic

What does AED stand for?

Antiepileptic Drugs ( AED's).

What are the important aspects of emergency care in a patient who has a sports-related injury? Select all that apply.

Application of ice intermittently for 24 to 48 hours; Immobilization of the joint until spinal cord injury is ascertained; Assessment of the neurovascular status in the area distal to the injury

A 67-year-old patient is diagnosed with plantar fasciitis. What conservative management does the nurse suggest? Select all that apply.

Apply an ice pack to the site. Strap the affected foot. Wear shoes with good support.

Which part of the body is affected by plantar fasciitis?

Arch of the foot

The nurse is creating a nursing plan for management of a pelvic fracture. For which complications will the nurse monitor this patient? Select all that apply.

Arterial bleeding Blood volume loss Abdominal rigidity Blood in urine and stool

A patient with an osteoporotic vertebral fracture is prescribed raloxifene. What should the nurse include in the assessment of this patient?

Assess for a history of venous thromboembolism.

A patient has undergone arthroscopy of the knee. What care should the nurse provide to the patient after the procedure?

Assess neurovascular status of the extremity every hour.

A patient has had reconstructive surgery for scoliosis. What postoperative interventions does the nurse perform? Select all that apply

Assess respiratory status and encourage the use of incentive spirometry Teach the patient to log roll Collaborate with the case manager for continued patient care

What is the first step in emergency care of a patient with an extremity fracture?

Assess the patient's airway, breathing, and circulation.

The nurse is caring for a patient immediately following a bunionectomy. What is the nurse's priority action?

Assessing the patient's neurovascular status

medication for tonic-clonic seizure activity

Ativan diazepam diastat IV dilantin

Which Seizure is most resistant to drug therapy?

Atonic.

What lifestyle changes can help reduce the incidence of Seizures?

Balanced diet, proper rest and stress-reduction techniques.

What type of AED's are CNS Depressants?

Benzodiazepines.

Which class of drugs would be administered to a patient experiencing a constant, dull, and burning phantom limb pain (PLP)?

Beta blockers

After dental work, a female patient taking medications for osteoporosis reports pain, bleeding gums, and halitosis. Upon examination, the bone is found to be exposed. Which medication is the cause for this condition?

Bisphosphosphonates

Breast CA Lung CA Prostate CA Kidney CA

Bone seeking cancers are?

A mother arrives at an ED with her 5-year old and states that the child fell off a bunk bed. A head injury is suspected, and the nurse checks the child's airway status and assess the child for early and late signs of ICP. Which is the late sign of increased ICP?

Bradycardia

What signs and symptoms are indicative of an absence seizure? Select all that apply

Brief, blank staring episodes Involuntary picking at clothes An absence seizure is characterized by brief episodes of loss of consciousness or blank staring, as if the person is daydreaming. It may be accompanied by involuntary movements, such as lip smacking and picking at clothes, of which the patient is unaware. Rigidity of the muscles and quick, jerky movements of the extremities indicate a tonic-clonic seizure. In an atonic seizure, there is a sudden loss of muscle tone.

A 15-year-old boy has Becker muscular dystrophy. If the boy's maternal grandmother is unaffected, who else in the family might be affected by this disease? Select all that apply.

Brother Maternal grandfather

The nurse admits an older adult patient who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the patient will be placed in which type of traction?

Buck's traction

The nurse is assessing a patient with a hallux valgus deformity. What term is used to refer to an enlargement of the first metatarsal head commonly seen with this kind of deformity?

Bunion

How is the Tinel sign diagnostic test for carpal tunnel syndrome (CTS) performed?

By tapping lightly over the area of the median nerve in the wrist

A nurse is caring for a client who has idiopathic thrombocytopenic purpura (ITP). The nurse should notify the provider and report possible small-vessel clotting when which of the following is assessed? A. Petechiae on the upper chest B. Hypotension C. Cyanotic nail beds D. Severe headache

C. Cyanotic nail beds Rationale: Cyanotic nail beds indicate microvascular clotting is occurring and should be immediately reported to avoid ischemic loss of the fingers or toes

Lab assessement of meningitis

CSF analysis - lumbar puncture CT scan blood cultures counterimmunoelectrophoresis polymerase chain reaction CBC x rays to determine presence of infection

What are some typical diagnostic testing for seizures

CT, MRI, EEG, PET scan.

What is a SE of Dilantin?

Can increase a persons appetite.

A nurse is monitoring the blood pressure of a patient with gout. Upon inflating the cuff, the patient experiences pain and numbness in the wrist. Which musculoskeletal injury does the nurse suspect in the patient?

Carpal tunnel syndrome (CTS)

The patient presents with wrist pain that is worse at night and has started to radiate to the shoulder and neck. An x-ray reveals no damage to any bones in the wrist. The Phalen maneuver is positive. The patient works as a data manager and exercises three days a week roller blading. What is the most likely diagnosis?

Carpal tunnel syndrome (CTS)

Which group has the least risk of developing osteomalacia?

Caucasian population

which group has the least risk of developing osteomalacia

Caucasian population

A patient with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first?

Check the dorsalis pedis pulse

Which food is commonly thought to be a trigger for causing migraine headaches?

Chocolate Chocolate contains tyramine, which may trigger migraine attacks. Eggs, shellfish, and yogurt are not on the list of foods that may trigger a migraine.

What other things should be avoided when taking AED's?

Citrus fruits, alcohol and excessive fatigue.

What three clotting factor deficiencies account for most hemophilia disorders?

Clotting factors 8, 9, 11

A patient reports a history of wrist pain after an attempt to break a fall by landing on the heel of the hand with an extended wrist. Which type of fracture should the nurse suspect?

Colles' fracture

Which seizure classification is commonly associated with older adults and are difficult to Dx and why?

Complex-partial, difficult to Dx because symptoms appear similar to dementia, psychosis, or other neurological behaviors.

The nurse is assessing the adaptation of a client to changes in functional status after a stroke (brain attack). Which observation indicates to the nurse that the client is adapting most successfully?

Consistently uses adaptive equipment in dressing self.

Which category of osteomyelitis is related to a bone infection that is caused by a skin infection of the adjacent tissues?

Contiguous

What is the other name for Paget's disease?

Correct3 Osteitis deformans

What is the medical term for the bone disease caused by reduced blood flow to the bones in the joints?

Correct3 Osteonecrosis

What are the common symptoms of meningitis? Select all that apply.

Cranial nerve dysfunction Tachycardia Photophobia Some common symptoms of meningitis are photophobia, tachycardia, and cranial nerve dysfunction, especially CN III, IV, VI, VII, and VIII. Tongue or lip biting and the presence of cyanosis and salivation symptoms are mainly observed in patients with seizures.

An 80-year-old patient with uncontrolled hypertension reports pain in the right foot and is diagnosed with a hallux valgus deformity. What is the most appropriate treatment?

Custom-made shoes

A male patient is diagnosed with Becker muscular dystrophy. Who in the patient's next generation may be affected by this disease?

Daughter's sons

In a client with ITP, would their Hemoglobin increase or decrease?

Decrease

Is hemoglobin increased or decreased in DIC?

Decreased

In a patient with bacterial meningitis, the nurse expects cerebrospinal fluid (CSF) analysis to include which results? Select all that apply.

Decreased glucose level Increased protein level Increased white blood cell (WBC) count Cloudy CSF appearance Patients with bacterial meningitis show decreased glucose levels, increased protein levels, and increased WBC counts. CSF in a patient with bacterial meningitis is cloudy in color, and the RBC count would be normal. CSF pressure is elevated in bacterial meningitis.

In a patient with compartment syndrome, what is the physiologic change that causes pallor?

Decreased oxygen to tissues

Care of the older adult may be affected by which physiologic change in the musculoskeletal system?

Decreased range of motion (ROM)

Arrange the sequence of events, in their order of their occurrence, pertaining to the biochemical theory for fat embolism.

Degradation of fat emboli into free fatty acids Capillary leakage Lipid and platelet aggregation Clot formation

What conditions should women diagnosed with migraines be assessed for?

Depressive disorder Depressive disorder is found more frequently in women diagnosed with migraines. Migraines do not make women more susceptible to hypotension, brain tumors, or multiple sclerosis.

Which is one of the causes of secondary osteoporosis?

Diabetes mellitus

A disruption of hemostasis characterized by widespread intravascular clotting and bleeding is known as what coagulation disorder?

Disseminated Intravascular Coagulation (DIC)

What is a hammertoe?

Dorsiflexion of the metatarsophalangeal joint with plantar flexion of the proximal interphalangeal joint next to it

What complication of osteoporosis can cause a patient to lose up to 3 inches of height in 20 years?

Dowager's hump

Upon performing a physical examination of a patient, the nurse observes that the ring finger and the little finger are bent toward the palm and cannot be extended. What condition does this finding indicate?

Dupuytren's contracture

Which is a deformity of the hand?

Dupuytren's contracture

. The primary health care provider performed vagal nerve stimulation for a patient with partial seizures. Which complications should the nurse anticipate in the patient? Select all that apply.

Dyspnea, neck pain, dysphagia Vagal nerve stimulation is performed by stimulating the vagus nerve with electric impulses to treat simple, complex, or partial seizures. Dyspnea (shortness of breath), neck pain, and dysphagia (difficulty in swallowing) are common complications of vagal nerve stimulation. Vomiting and headache are not related to vagal nerve stimulation.

How is endoscopic carpal tunnel release (ECTR) different from open carpal tunnel release (OCTR)? Select all that apply.

ECTR is less costly than OCTR. ECTR is less invasive than OCTR. ECTR is associated with a longer period of postoperative numbness than is OCTR.

Which teaching about prevention of carpal tunnel syndrome (CTS) will the nurse provide to other health care employees? Select all that apply.

Employees should be provided with specially designed wrist rest devices. Employees should be provided with geometrically designed computer keyboards. Employees should be provided with chairs at a height that facilitates good posture.

To prevent thrombophlebitis in the immediate postoperative period, which action is most important for a nurse to include in the client's plan of care?

Encourage early mobility.

How do you identify Benzodiazepines?

End in (PAM)... Clonazepam (Klonopin) , Diazepam (Valium), Lorazepam (Ativan).

A patient is in traction after a major leg injury. What nursing care is necessary for the patient? Select all that apply.

Ensure the weights are freely hanging at all times Inspect the traction equipment every 8 to 12 hours

The nurse is providing care to a patient who has been experiencing a seizure for more than 5 minutes. Which is the priority nursing intervention?

Establishment of a patent airway Convulsive status epilepticus must be treated promptly and aggressively. The priority nursing intervention is to establish a patent airway. Intubation by an anesthesia provider or respiratory therapist may be necessary. Oxygen should be administered as indicated by the patient's condition. If not already in place, intravenous access should be established with a large-bore catheter and 0.9% sodium chloride should be started. The health care provider or Rapid Response Team should be notified immediately after an effort is made to establish an airway. The patient is usually transferred to the intensive care unit for continuous monitoring and management.

Which factors should the nurse include when conducting the initial assessment of a patient suspected of seizures? Select all that apply.

Excessive fatigue Increased physical activity Alcohol and caffeine consumption Excessive fatigue can result in mental and physical illness and may cause seizures. Increased physical activity can increase stress levels in the body and may lead to seizures. Excessive alcohol consumption can alter neurological functions. Caffeine may alter the brain's electrical signals and cause seizures. The excessive intake of carbohydrate-rich foods does not increase the risk for seizures. A patient's occupation or workplace environment would not increase the risk for seizures.

A school-aged child has a cast applied to a fractured wrist. What action should the nurse take to hasten drying of the cast?

Expose the casted extremity.

The nurse is caring for a patient with an open wound from chronic osteomyelitis. How does the nurse ensure that this patient receives increased tissue perfusion?

Exposing the affected area to a high concentration of oxygen.

Hemophilia C is treated by giving

FFP

When bleeding is the major manifestation of DIC how would you treat it?

FFP and platelet concentrates are given to restore clotting factors and platelets

Hemophilia A is deficient of which clotting factor?

Factor 8 (carried by von Willebrand)

Which clotting factor deficit occurs in Hemophilia B?

Factor 9

T/F: Treatment cures DIC

False

A 30-year-old patient suffers a pelvic fracture. His partial oxygen concentration (PaO 2) drops to 70 mm Hg. There is an increase in the erythrocyte sedimentation rate (ESR) and serum lipid levels. The serum calcium level drops to 7 mg/dL. Which complication should the nurse suspect?

Fat embolism syndrome (FES)

How many types of generalized Seizures are there?

Five.

The nurse is evaluating the neurological signs of a client in spinal shock following spinal cord injury. Which observation indicates that spinal shock persists

Flaccid paralysis

What is another term used for Partial Seizures

Focal or Local Seizures. ( in one part of the cerebral hemisphere)

A patient has a Buck extension traction. What type of injury does the patient most likely to have?

Fracture of the hip before surgery

Which type of fracture is most commonly complicated by delayed union because of poor perfusion?

Fractures of the tibia and fibula

A surgical repair was done shortly after injury in a patient with a rotator cuff injury using arthroscopy. What could a presurgical magnetic resonance imaging (MRI) of the shoulder reveal?

Full-thickness tear

What Neurotransmitter is considered Inhibitory?

GABA. (not enough can cause seizure)

Which statement is true regarding a ganglion cyst? Select all that apply.

Ganglion cysts can rapidly disappear and recur. Treatment includes the aspiration of cystic fluid with a fine needle. Ganglion cysts form due to the degeneration of synovium surrounding the tendon

Which statement is true regarding a ganglion cyst? Select all that apply.

Ganglion cysts can rapidly disappear and recur. Treatment includes the aspiration of cystic fluid with a fine needle. Ganglion cysts form due to the degeneration of synovium surrounding the tendon.

Which statement is true regarding a ganglion cyst? Select all that apply.

Ganglion cysts can rapidly disappear and recur. Treatment includes the aspiration of cystic fluid with a fine needle. Ganglion cysts form due to the degeneration of synovium surrounding the tendon.

What assessment finding typically indicates there is a fracture of the hip?

Groin pain

The nurse is caring for a patient diagnosed with partial seizures after encephalitis, who is to receive carbamazepine. The nurse plans to monitor the patient for which adverse effects? Select all that apply.

Headaches, dizziness, and diplopia; Headaches, dizziness, and diplopia are adverse effects of carbamazepine because this drug affects the central nervous system. Carbamazepine does not cause alopecia and does not increase blood glucose; divalproex and valproic acid may cause alopecia.

What autonomic changes can occur during a Simple-partial Seizure

Heart rate, skin flushing and epigastric discomfort.

Factor 8 concentrate or cryoprecipitate is given to treat which type of hemophilia?

Hemophilia A

A patient with history of cold sores is diagnosed with encephalitis. Which virus may be responsible for this condition?

Herpes simplex virus Patients with history of cold sores are very often infected with herpes simplex virus. Arbovirus can be transmitted to humans through the bite of an infected mosquito or tick. Echovirus is the common entero virus associated with encephalitis that causes mumps and chickenpox. West Nile virus is spread rapidly and is a serious illness with no common symptoms such as fever and body ache.

Which topics are included in patient teaching following a leg amputation? Select all that apply.

How to wrap the limb Range-of-motion exercises How to turn independently if possible Exercises to prepare the limb for prosthesis How to inspect the area for signs of inflammation or skin breakdown

The nurse is instructing a client with Parkinson's disease about preventing falls. Which client statement reflects a need for further teaching?

I don't need to use my walker to get to the bathroom

The nurse has completed discharge instructions for a client with application of a halo device. Which statement indicates that the client needs further clarification of the instructions?

I will drive only during the daytime

A patient with bone cancer is scheduled for a right upper extremity amputation. Which statement by the patient's husband indicates an effective coping strategy?

I'll have to find ways to help my wife focus on positive aspects of her body

The nurse enters a client's room and finds the client on the floor crying for help. It is obvious to the nurse that the client has sustained a hip fracture. Which action should the nurse take first?

Immobilize the affected extremity.

A type of primary thrombocytopenia that is an autoimmune disorder in which platelet destruction is accelerated

Immune Thrombocytopenic Purpura also known as Idiopathic Thrombocytopenic Purpura (ITP)

Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the client for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect?

Impaired voluntary movements

What is the pathophysiology of osteoporosis?

Increased osteoclastic activity over osteoblastic activity

What consequence of excessive wrist extension may result in carpal tunnel syndrome?

Increased pressure in the lower portion of the carpal tunnel

What is the indication for use of Phenytoin (Dialantin) and a nursing intervention?

Indication: All except abscence, myoclonic, and atonic. Go to for Status Epilepticus! NI: Monitor for gastric distress, gingival hyperplasia, anemia, ataxia, nystagmus. Labs: CBC

What is the indication for use of Divalproex (Depakote) and a nursing intervention?

Indication: All types of seizures NI: monitor for hair loss, tremor, increased liver enzymes, bruising and N/V. Lab: CBC, PT, PTT and AST.

What is the indication for use of Gabapebtin (Neurontin) and a nursing intervention?

Indication: Partial seizures NI: Watch for increased appetite and weight gain; monitor for ataxia, irritability, dizziness and fatigue.

What is the indication for use of Carbamazepine (Tegretol) and a nursing Intervention?

Indication: Partial/ Generalized tonic-clonic Seizures NI: Monitor for HA; dizziness; N/V; blurred vision Lab: CBC

What are typical SE of AED's?

Influence the CNS and GI, gingival hyperplasia and drowsiness.

In a client who has DIC, they are most at risk for

Internal and external bleeding as well as damage to the organs resulting from ischemia caused by microclqots

A patient has been admitted with new-onset status epilepticus. Which seizure precautions does the nurse put in place? Select all that apply.

Intravenous access Suction equipment at the bedside Side rails up Intravenous access is needed to administer medications. Suctioning equipment should be available to suction secretions and facilitate an open airway during a seizure. Raised, padded side rails may be used to protect the patient from falling out of bed during a seizure. Bite blocks or padded tongue blades should not be used because the patient's jaw may clench, causing teeth to break and possibly obstructing the airway. Continuous sedation is a medical intervention and not a seizure precaution.

How is Dowager's hump formed?

Kyphosis of the spine

Describe Tonic Seizure

Lasting from 30 seconds to several minutes, abrupt increase in muscle tone and LOC.

Describe Atonic (akinetic) Seziure

Lasting seconds with sudden loss of muscle tone followed by confusion.

Describe Clonic Seizure

Lasts several minutes and causes muscle contraction and relaxation.

What would the platelet count be in someone with thrombocytopenia?

Less than 100,000 per mL of blood

The nurse is teaching the importance of nutrition to a 74-year-old patient who is lactose-intolerant and at risk for osteoporosis. What nutritional considerations does the nurse teach? Select all that apply.

Limit consumption of carbonated beverages. Avoid excessive intake of alcohol and caffeine. Drink fruit juices fortified with calcium

A client with a spinal cord injury is prone to experiencing autonomic dysreflexia. The nurse should avoid which measure to minimize the risk of occurrence?

Limiting bladder catheterization to once every 12 hours

What statements about amputation are correct? Select all that apply.

Lisfranc and Chopart amputations are types of midfoot amputations. In a Syme amputation, most of the foot is removed but the ankle remains. Lower extremity amputations are more common than upper extremity amputations.

Where are clotting factors and plasma proteins produced?

Liver

What is thrombopoietin produced by?

Liver, kidney, smooth muscle, bone marrow

laboratory and imaging assessment

MRI, K+, etc All of the electrolytes that can affect cognition

The nurse is planning care for a child with acute bacterial meningitis. Based on the mode of transmission of this infection, which precautionary intervention should be included in the plan of care?

Maintain respiratory isolation precautions for at least 24 hours after the initiation of antibiotics

A client is scheduled for a lumbar puncture. What nursing care should be implemented after the procedure?

Maintaining the client in the supine position for several hours

Hemophilia C occurs in which gender(s)?

Males and females

A 70-year-old male patient who underwent an open reduction internal fixation (ORIF) surgery experiences a seizure after 24 hours. Which drug can cause seizures related to its toxic metabolites?

Meperidine

An older adult patient is undergoing treatment for a fracture. Which pain medication must be avoided in this patient?

Meperidine

Which disorders causing seizures are NOT considered Epilepsy

Metabolic disorders, Alcohol withdrawl, electrolyte imbalance, high fever, stroke, head injury etc...

The nurse is teaching a patient ways to increase vitamin D in the diet using natural foods (unfortified). Which food choices indicate the patient understands the teaching? Select all that apply.

Milk eggs tofu liver

The nurse is caring for a client with severe back pain. Codeine sulfate has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication?

Monitor bowel activity

A client with osteoporosis is prescribed raloxifene. What should the nurse monitor in the client?

Monitor liver function tests

8. Which vector is responsible for the transmission of West Nile virus?

Mosquito West Nile virus infection is caused by the bite of an infected mosquito. Flea, tick, or spider bites do not transmit West Nile virus.

Which finding in the incidence of bacterial meningitis is the most common?

Most cases have occurred in densely populated areas People who live in densely populated areas are at greatest risk for outbreaks of bacterial meningitis. Occurrences on college campuses are decreasing due to vaccination requirements. Men and women are affected equally. Children under 12 are not affected in greater numbers than adults.

Which procedure does the nurse anticipate for the patient with suspected muscular dystrophy?

Muscle biopsy

Which statement about the human muscular system is accurate?

Muscle is surrounded by fascia.

Describe Primary Epilepsy or Idiopathic Epilepsy

No specific cause or identifiable brain lesion, liked closely to Genetic factors.

A patient who has repeated tonic-clonic seizures has received one dose of lorazepam, and the patient is now having a seizure that has lasted 5 minutes. What is the nurse's next action?

Notify the Rapid Response Team A seizure lasting more than 5 minutes indicates status epilepticus and is a medical emergency. The nurse should notify the Rapid Response Team because intubation may be necessary. Administering oxygen, requesting an order for rectal gel, and documenting the seizure should be performed only after notifying the Rapid Response Team.

A patient with a rotator cuff injury has undergone surgery. During analgesia, the peripheral nerve was blocked. What complication may be seen in the patient?

Numbing feeling of the arm

A nurse is assessing a client with a cast to the extremity. Which assessment finding is the priority?

Numbness

A patient has undergone a below-knee amputation of the right leg as a result of severe peripheral vascular disease. In the postoperative care teaching, the nurse instructs the patient to notify the health care provider if which change occurs?

Observation of a large amount of serosanguineous or bloody drainage

Describe Unclassified or Idiopathic Seizures

Occur for no known reason and do not fit in the Generalized or Partial Classifications.

A diabetic patient is admitted to the health care facility with a foot ulcer. The nurse teaches wound care to the patient and the caregiver to prevent the risk for which condition?

Osteomyelitis

Which condition is the biggest risk factor for hip fracture?

Osteoporosis

What is Gingival Hyperplasia?

Over growth of Gums.

. What nursing intervention is priority for a patient experiencing a migraine headache?

Pain management Pain management is a priority intervention when caring for a patient with a migraine headache. Reduction of stimuli is important, but pain reduction is more important. Determining the trigger is important, but not the priority. Prevention of further headaches is not important at this time.

Which is a positive finding of the Phalen's maneuver?

Paresthesia of the palmar side of the thumb, index finger, middle finger, and half of the ring finger

A patient reports pain around the knee with stiffness when it is flexed. Which type of musculoskeletal trauma does the nurse suspect in the patient?

Patellofemoral pain syndrome

The serum calcium level of a patient with a femoral fracture is 12 mg/dL. What type of fracture does the nurse suspect that the patient has?

Pathologic fracture

What are some characteristics of Complex-partial seizures

Patient is unaware of environment and may wonder at the start of the seizure.

Describe Simple-partial Seizures

Patient remains conscious, Aura occurs before the seizure and may have unusual movement and autonomic changes.

Which body part has an amphiarthrodial joint?

Pelvis

A client with a distal femoral shaft fracture is at risk for developing a fat embolus. The nurse knows to watch for what distinguishing sign that is unique to a fat embolus?

Petechiae

What is another term used for Absence Seizures

Petit Mal Seizures. (most common in children)

A patient who has severe peripheral vascular disease resulting in an above-the-knee amputation two months ago describes intense burning pain, numbness and tingling. The patient reports the symptoms worsen with exhaustion and stress. What is the patient most likely experiencing?

Phantom limb pain

A chemical sympathetic nerve block may be used to manage complex regional pain syndrome (CRPS). Which drug, administered intravenously, is used to block sympathetic nerve receptors?

Phentolamine

Which AED is typically the drug of choice?

Phenytoin (Dilantin).

A patient with encephalitis has high fever, nausea and vomiting, and neck stiffness. Which other clinical manifestations should the nurse anticipate in the patient? Select all that apply.

Photophobia and phonophobia Decreased level of consciousness Change in mental status Changes in mental status are more extensive in encephalitis patients and may include acute confusion, irritability, personality, and behavioral changes. In patients with encephalitis, photophobia (light sensitivity) and phonophobia (sound sensitivity) occur as a result of facial weakness and nystagmus. Decreased level of consciousness may be seen as a result of mental changes. Decreased pain sensation and mild muscle weakness are not clinical manifestations of encephalitis

What is the key feature of TTP?

Platelet aggregation

Which is a priority problem for the older adult patient diagnosed with bone cancer?

Potential for injury related to weakness and drug therapy

In all types of hemophilia what is the primary focus of treatment?

Preventing and/or treating bleeding by replacing deficient clotting factors

A regimen of rest, exercise, and physical therapy is prescribed for a client with rheumatoid arthritis. What should the nurse teach the client is the intended purpose of the regimen?

Preventing the crippling effects of the disease

Which type of Epilepsy is successfully treated through drug therapy

Primary Epilepsy.

In DIC, Coagulation studies show __________ PT, PTT, and thrombin time

Prolonged

In vW disease, bleeding time is _______ and coagulation time is _______

Prolonged

The nurse is assessing a patient to evaluate the movements of the wrist. What movement does the nurse assess?

Pronation and supination

A child is diagnosed with Reye's syndrome. The nurse develops a nursing care plan for the child and should include which intervention in the plan?

Providing a quiet atmosphere with dimmed lighting

The client with Guillain-Barre syndrome has ascending paralysis and is intubated and receiving mechanical ventilation. Which strategy should the nurse incorporate in the plan of care to help the client cope with this illness?

Providing information, giving positive feedback, and encouraging relaxation

A patient with a migraine headache is prescribed a drug that acts by reducing the hyper excitability of neurons and interferes with vasodilation. What further assessment should be made by the nurse considering this drug's adverse effect?

Pulse Rate The calcium channel and beta blockers act by reducing the activity of hyper-excitable neurons and by interfering with vasodilation in a patient with migraine. Both these drug categories may lower blood pressure and decrease the pulse rate. The other assessments such as estimating body temperature, leukocyte count, and erythrocyte count may not be made by considering this drug's side effects.

A patient has recently undergone surgery to treat osteomyelitis. What are the signs of neurovascular compromise after the surgery? Select all that apply.

Pulselessness Paresis or paralysis Paresthesia Uncontrollable pain

A client who is recuperating from a spinal cord injury at the T4 level wants to use a wheelchair. What should the nurse teach the client to do in preparation for this activity?

Push-ups to strengthen arm muscles

A patient with a history of epilepsy has been taking an antiepileptic drug (AED) for several years. The patient's admission lab work reveals elevated levels of the drug, even though the patient reports taking the prescribed amount. The patient takes no other medications. Which action by the nurse is correct?

Question the patient about dietary intake of citrus. Citrus fruits, especially grapefruit, can interfere with the metabolism of AEDs, leading to increased serum drug levels. The initial action should be to perform a dietary history. It may be necessary to perform a pill count to evaluate compliance, but the dietary history should be done first. Liver and renal function tests may be necessary if other causes of elevated drug levels are not identified. It is not necessary to notify the Rapid Response Team.

The nurse is caring for a patient who is experiencing a tonic-clonic seizure. Which actions should the nurse perform? Select all that apply.

Refrain from placing anything in the patient's mouth. Record the time the seizure began. Suction the airway as needed. Protect the patient from injury The nurse should protect the patient from injury by moving objects away from the patient. The airway should be suctioned as needed to maintain an open airway. The nurse should never attempt to place anything in the patient's mouth. The nurse should document the time the seizure began and ended. The nurse should turn the patient to the side to prevent aspiration and should never attempt to restrain the patient in any way.

A client with a fractured tibia and fibula is to be discharged from the emergency department with a right leg cast and crutches. In addition to the technical aspects of crutch walking, the nurse should teach the client to do what?

Remove loose rugs from the environment.

An infant with a diagnosis of hydrocephalus is scheduled for surgery. Which is the priority nursing intervention in the preoperative period?

Reposition the infant frequently

The nurse is caring for a client who begins to experience seizure activity while in bed. What action by the nurse is contraindicated?

Restraining the clients limb

The nurse is reviewing the record of a child with increased ICP and notes that the child has exhibited signs of decerebrate posturing. On assessment of the child, the nurse expects to note which characteristics of this type of posturing?

Rigid extension and pronation of the arms and legs

Which type of traction is used to correct bone deformities of the lower extremities?

Russell's traction

Which statement is true regarding the types of traction used for musculoskeletal trauma of the lower extremities?

Russell's traction is used for fractures of the hip.

What is the indication for use of Valproate (Depakote) and a nursing intervention?

SAME AS DIVALPROEX (DEPAKOTE)! Indication: All types of seizures NI: monitor for hair loss, tremor, increased liver enzymes, bruising and N/V. Lab: CBC, PT, PTT and AST.

Which joint in the client's body is an example of a gliding joint?

Sacroiliac

The nurse assessing a patient for spinal alignment observes a lateral curve of the spine. How does the nurse document this finding?

Scoliosis

Define Status Epilepticus

Seizure lasting longer than 5 minutes, a medical emergency!!!

The most common cause of DIC

Sepsis

The nurse suspects that a patient may have plantar fasciitis if the patient has which assessment finding?

Severe pain in the arch of the foot, especially when getting out of bed

A client is taking the prescribed dose of phenytoin (Dilantin) to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this lab result?

Slurred speech

Which individual is at risk of developing carpal tunnel syndrome?

Software engineer

Due to the autoantibodies, which organ reacts to the platelets as being foreign and begins to destroy them after only 1-3 days of circulation?

Spleen

Organ responsible for platelet destruction and antibody production

Spleen

If a patient with ITP relapses when glucocorticoids are discontinued what is the treatment of choice?

Splenectomy

What is the excessive stretching of a ligament?

Sprain

The nurse is caring for a marathon runner with plantar fasciitis. What conservative management method does the nurse suggest?

Strap the affected foot

The nurse develops a plan of care for a child ay risk for tonic-clonic seizures. In the plan of care. the nurse identifies seizure precautions and documents that which items need to be placed at the child's bedside?

Suctioning equipment and oxygen

1. A patient is prescribed dihydroergotamine for relief of a migraine headache. What medications should the nurse assess the patient for prior to giving this medication?

Sumatriptan Patients taking dihydroergotamine should not take it within 24 hours of taking a triptan drug, such as Sumatriptan. Ibuprofen, verapamil, and propranolol will not affect the administration of dihydroergotamine.

For the patient taking beta blockers or calcium channel blockers for migraine headache management, which teaching point should the nurse include in the treatment plan?

Take your pulse rate daily and report bradycardia. Calcium channel blockers and beta blockers can slow the heart rate significantly. The patient should monitor his or her pulse rate daily. The drugs do not cause muscle pain, nor do they deplete potassium, so there is no need to increase potassium intake or report muscle pain. Fluid does not need to be restricted to a level of less than 500 mL per day.

The nurse is teaching a client with myasthenia gravis about the prevention of myasthenic and cholinergic crisis. Which client activity suggest that teaching is most effective?

Taking medications as sheduled

Which intervention does the nurse suggest to a patient with a leg amputation to help cope with loss of the limb?

Talking with an amputee close to the patient's age who has had the same type of amputation

The nurse is assessing a patient who is reporting pain under the arch of the foot when getting out of bed in the morning. The nurse suspects the patient may have plantar fasciitis. What information does the nurse give to the patient to help manage the onset of the condition?

Telling the patient to manage his or her weight

The nurse is assessing a patient diagnosed with acute osteomyelitis. What features of this disorder does the nurse expect to find? Select all that apply.

Temperature above 101° F Swelling around the affected area Erythema around the affected area Pulsating pain that worsens with movement

What lobe of the brain is typically affected by Complex-partial seizures

Temporal lobe.

A 5-year-old child is given fluoroquinolones. Which potential adverse effect unique to pediatric clients should the nurse anticipate?

Tendon rupture

Which drug may cause tooth and bone anomalies as a teratogenic effect?

Tetracycline

The nurse notes documentation that a child with meningitis is exhibiting a positive Kernig's sign. Which observation is characteristic of this sign?

The child is not able to extend the leg when the thigh is flexed anteriorly at the hip

The nurse is preparing a patient with osteosarcoma for a nuclear bone scan. What information about this test should be taught to the patient?

The isotope is excreted through the intestinal tract.

Which aspect of a musculoskeletal assessment will the physical therapist and the nurse plan to collaborate on?

The need for ambulatory devices

The nurse is caring for a patient with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which patient statement indicates effective coping after the procedure?

The nurse is caring for a patient with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which patient statement indicates effective coping after the procedure?

Take the medication early in the morning with 8 ounces of water. Remain upright for 30 minutes after taking the medication. Discontinue the medication if chest discomfort develops (The nurse should instruct the patient to take alendronate on an empty stomach and with a full glass of water. The patient must remain upright for 30 to 60 minutes, either sitting or standing, to prevent esophagitis. The nurse should also advise the patient to discontinue the medication if chest discomfort occurs as a symptom of esophageal irritation. Dizziness and leg cramping are side effects of Forteo, a parathyroid hormone preparation. Alendronate is taken either daily or weekly, depending on the dose. Patients taking alendronate need not have liver function tests but must have an oral assessment and preventive dentistry before beginning the therapy.)

The nurse is caring for a patient with osteoporosis who has been prescribed alendronate. What does the nurse teach the patient about taking this drug?

The patient's blood test shows a count of 12,000 white blood cells (WBCs) per microliter. Which finding does the nurse suspect is causing this laboratory value?

The patient has an inflamed ingrown toe nail.

Why would the platelet count in TTP show a decrease?

The platelets are being used to form clots

Which characteristic accurately describes the occurrence of status epilepticus?

The seizure lasts longer than 5 minutes Status epilepticus is a medical emergency and is a prolonged seizure lasting longer than 5 minutes or repeated seizures over the course of 30 minutes. Status epilepticus seizures are not preceded by an aura; this type of seizure is manifested by bilateral symptoms. The patient will remain unconscious during this type of seizure

Why is carpal tunnel syndrome (CTS) beginning to be found in much younger patients than previously?

The use of handheld mobile devices has increased among children.

The home health nurse visits a client who is taking phenytoin for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan?

There is the potential of decreased effectiveness of birth control pills while taking phenytoin

Which is true of partial-thickness rotator cuff tears?

They are more painful than full-thickness tears.

What are the risk factors for primary osteoporosis? Select all that apply.

Thin build with low body weight Parental history of osteoporosis Chronic low calcium and vitamin D intake

Why should you educate the client with DIC to avoid the Valsalva maneuver?

This could cause cerebral hemorrhage

This is a rare thrombocytopenic disorder in which thrombi occlude arterioles and capillaries of the microcirculation

Thrombotic Thrombocytopenic Purpura (TTP)

The nurse is developing a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply.

Time the seizure, stay with the child, move furniture away from the child.

A patient experiences paresthesia when the primary health care provider slightly taps over the median nerve on the wrist. Which finding is observed in the patient?

Tinel's sign

The client arrives at the ED complaining of back spasms. The client states, "I have been taking 2-3 aspirins every 4 hours for the last week, and it hasn't helped my back." Since aspirin intoxication is suspected, the nurse should assess the client for which manifestation?

Tinnitus

A patient experiences frequent headaches, and the nurse suggests that the patient maintain a headache diary. What is the primary purpose the nurse would recommend keeping a headache diary? Select all that apply.

To determine the effectiveness of the prescribed drugs To assess headache symptoms and identify the type of headache To identify the presence of any unusual changes associated with the headache Headache diaries or journals allow the patient to document each headache to help the healthcare provider determine the type of headache on the basis of the patient's symptoms, determine the effectiveness of prescribed drugs, and identify any unusual changes associated with the headaches. A headache diary is not intended as a creative release or to take the patient's mind off the headache symptoms.

A client newly diagnosed with type 1 diabetes is taught to exercise on a regular basis. What is the primary reason for instruction on exercise?

To improve the cellular uptake of glucose

The nurse is caring for a patient with encephalitis who is currently immobile and stuporous. Of the nursing interventions that must be implemented for the patient, which one can the nurse delegate to unlicensed assistive personnel (UAP)?

Turning, coughing, and deep-breathing The UAP could perform turning, coughing, and aid in deep-breathing because this is within the UAP scope of practice. A nurse must perform tracheal suctioning, assessment of neurologic status, and Glasgow Coma Scale assessment.

Epilepsy

Two or more seizures experienced by a person.

A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery?

Use a pillow to keep the legs abducted.

Which statement about the blood supply and nerve fibers of bone is accurate?

Very few nerve fibers are connected to the bone.

Clotting factors require ________ for synthesis and activation

Vitamin K

What is the antidote for warfarin (Coumadin)?

Vitamin K

This disease is considered the most common hereditary bleeding disorder and can occur is both males and females

Von Willebrand's Disease

A client with trigeminal neuralgia is being treated with carbamazepine (Tegretol), 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication?

WBC count, 3000 cells/mm

The nurse is preparing a patient who underwent vertebroplasty for discharge. What measures should the patient take after discharge? Select all that apply.

Walking the next day after discharge Monitoring of the puncture site for infection

Which anticoagulant medication is contraindicated with Dilantin (AED)?

Warfarin (coumadin).

What teaching does the nurse provide to a patient who had outpatient surgery for hallux valgus?

Wear an orthopedic boot or shoe

What teaching does the nurse provide to a patient who had outpatient surgery for hallux valgus?

Wear an orthopedic boot or shoe.

Estrogen agonist/antagonist therapy ( increase bone density and are used to treat and prevent osteoporosis)

What are common treatments for osteomalacia/osteoporosis?

Crohn's disease Hypophosphatemia Chronic kidney disease Barbiturate therapy (Osteomalacia is a bone disorder related to vitamin D deficiency. Crohn's disease causes decreased vitamin and mineral absorption that can lead to osteomalacia. Hypophosphatemia stimulates calcium movement from bone and prevents calcium uptake in the bone which can result in osteomalacia. Chronic kidney disease interferes with the synthesis of calcitriol, the most active metabolite of vitamin D, and can cause osteomalacia. Osteomalacia can be an adverse effect of barbiturate therapy.)

What are the common causes of osteomalacia?

Long-term corticosteroid drug therapy

What are the risk factors for SECONDARY osteoporosis?

Heparin Furosemide Cyclosporine Aluminum/magnesium antacid (Long-term drug therapy with heparin, loop diuretics such as furosemide, immunosuppressants such as cyclosporine, and aluminum-based antacids like Mylanta may cause secondary osteoporosis. Ergocalciferol is an active form of vitamin D that is administered along with calcium for the treatment of osteoporosis. Bisphosphonates such as alendronate are also commonly used in the treatment of osteoporosis as they slow down bone resorption by binding with crystal elements in spongy, trabecular bone tissue)

Which long-term drug therapies may cause secondary osteoporosis? Select all that apply.

High alcohol intake (High alcohol intake is a risk factor for both osteoporosis and osteomalacia. A history of smoking is a risk factor for osteoporosis only. Inadequate exposure to sunlight and homelessness are risk factors for osteomalacia only.)

Which risk factor is shared by patients who have osteoporosis or osteomalacia?

Endochondroma (Endochondroma, or chondroma, is a benign tumor arising from cartilage. This type of tumor primarily affects the hands and the feet. Osteochondroma is a benign tumor but arises from both bone and cartilage. Osteosarcoma is a malignant bone tumor. Giant cell tumor is a benign tumor of the bone.)

Which term describes a benign tumor arising from cartilage?

Why should a DIC client not take NSAIDS?

Will increase bleeding

The nurse is taking the history of an adult female patient. Which factor places the patient at risk for osteoporosis?

Working at a desk and playing the piano for a hobby

How is Classic Hemophilia transmitted?

X-linked recessive disorder from mother to sons (transmitted by females)

Can discontinuing AED's lead to a recurrence of Seizures?

Yes.

Is Epilepsy considered a chronic disorder?

Yes.

The hallux valgus deformity can cause what other condition?

bunions

Which syndrome may result in the compression of the median nerve?

carpal tunnel syndrome (CTS)

general symptom?

fever

Which statement is true regarding a ganglion cyst? Select all that apply.

ganglion cysts can rapidly disappear and recur, treatment includes the aspiration of cystic fluid with a fine needle, and ganglion cysts form due to the degeneration of synovium surrounding the tendon

and help prevent what?

injuries or accidnets prevent elder abuse

tonic-clonic seizure

involve both cerebral hemispheres

What are the major concerns related to pelvic fractures? Select all that apply.

venous oozing; arterial bleeding; hypovolemic shock

Which procedure to treat a vertebral compression fracture involves injecting bone cement through the skin directly into the fracture site, allowing the patient to go home the next day?

vertebroplasty

2 types

viral bacterial

what may be subsidized?

vocational rehabilitation

vW Disease is caused by a deficit or defective ______ factor

von Willebrand factor (protein that mediates platelet adhesion)

Which lifestyle change would benefit a patient who has osteoporosis?

walking

What is the appropriate minimum weight of the pulling force in skeletal traction?

15 pounds

Radiographic assessment of a patient with femoral fracture reveals spotty and diffuse osteoporosis. The patient gives a history of excessive sweating, intense burning pain, and edema. Which side effect of fractures does the nurse suspect?

Complex regional pain syndrome (CRPS)

Which complication resulting from a fracture might necessitate the use of an implanted device to block pain perception?

Complex regional pain syndrome (CRPS)

Which statement by a nursing student about the health economics associated with osteoporosis indicates a need for further teaching by the nursing instructor?

"Peripheral quantitative ultrasound (pQUS) is rarely used as a screening tool for osteoporosis detection because of its high cost."

Manifestations of ITP:

-Insidious onset -Petechiae and purport develop on the anterior chest, arms, neck, and oral mucous membranes -Bruising -Spontaneous epistaxis and gum bleeding -Hematuria and excess menstrual bleeding -Weight loss -Fever -Headache -Tachycardia -Hypotension -Diaphoresis

A healthcare provider prescribes a diagnostic workup for a client who may have myasthenia gravis. What is the initial nursing objective for the client during the diagnostic phase?

"The client will maintain present muscle strength."

Manifestations of Chronic DIC:

-May be asymptomatic -Peripheral cyanosis -Thrombosis -Pre-gangrenous changes in the fingers and toes, nose, and genitalia

Manifestations of DIC:

-Oozing to frank hemorrhage from every body orfice (especially oozing from punctures/ IV catheter sites) -Acute risk of bleeding out is high

Manifestations of Hemophilia:

-Hemarthrosis -Easy bruising and cutaneous hematoma formation with minor trauma -Bleeding from gums -Prolonged bleeding -Spontaneous hematuria or epistaxis -Pain or paralysis due to the pressure of hematoma on nerves -Intracranial hemorrhaging

The nurse is caring for the following clients. Which client should the nurse assess first? 1. Client whose PTT is 38 seconds 2. Client whose Hgb is 14 and Hct is 45% 3. Client whose platelet count is 75,000 per cubic millimeter of blood 4. Client whose RBC count is 4.8

3. Client whose platelet count is 75,000 per cubic millimeter of blood Rationale: A platelet count less than 100,000 indicates thrombocytopenia

A nurse is assessing a client and suspects the client is experiencing DIC. Which of the following physical findings should the nurse anticipate? 1. Bradycardia 2. Hypertension 3. Epistaxis 4. Xerostomia

3. Epistaxis Why 1 and 2 are wrong: 1. Tachycardia is a finding of DIC 2. Hypotension is a finding of DIC

The client is diagnosed with hemophilia. Which safety precaution should the nurse encourage? 1. Wear helmets and pads during contact sports 2. Take antibiotics prior to any dental work 3. Keep clotting factor VIII on hand at all times 4. Use ibuprofen, an NSAID, for pain

3. Keep clotting factor VIII on hand at all times

Which situation might cause the nurse to think that the client has von Willebrand's disease? 1. The client has had unexplained episodes of hematemesis 2. The client has microscopic blood in the urine 3. The client has prolonged bleeding following surgery 4. The female client developed abruptio placentae

3. The client has prolonged bleeding following surgery

The nurse is caring for a patient diagnosed with septic shock. The patient develops bleeding from puncture sites after a blood draw. What complications does the nurse suspect? 1 Hemophilia A 2 Hemophilia B 3 Von Willebrand's disease 4 Disseminated intravascular coagulation

4

What disorder is classified by less than 150,000 platelets per microliter? 1 Leukemia 2 Hemophilia 3 Leukocytopenia 4 Thrombocytopenia

4

The novice nurse is learning about interventions for carpal tunnel syndrome (CTS). Which statement indicates a need for further education?

"An occupational therapist (OT) will fit a brace with the wrist in neutral position or slight flexion."

A patient with a history of tuberculosis is hospitalized for generalized seizures and prescribed primidone. Which question should the nurse ask prior to administering the drug to ensure safety?

"Are you taking isoniazid?" Primidone is a GABA receptor agonist and prescribed to patients with generalized seizures. This drug has the potential to interact with isoniazid and may produce undesirable effects in the patient. Therefore, the nurse should consult the primary health care provider prior to administering primidone. The other drugs used to treat tuberculosis such as rifampin, ethambutol, and pyrazinamide do not interact with primidone.

What disorder is classified by less than 150,000 platelets per microliter? Incorrect 1 Leukemia 2 Hemophilia 3 Leukocytopenia Correct 4 Thrombocytopenia

4

A woman fractured her left tibia and fibula one week ago and has a cast in place. She is taking acetaminophen (Tylenol) with codeine for pain and an oral contraceptive. She began experiencing left calf pain 3 days ago and began having shortness of breath and chest pain 15 minutes ago. When the shortness of breath and chest pain increase, she calls the emergency department and communicates this information to the triage nurse. What is the triage nurse's best response?

"Give me your name and address. I am sending an ambulance to your home. You need emergency care."

The nurse is teaching a patient with bunions on both feet about bone resection and fusion. Which statement made by the patient indicates that more teaching is needed?

"Healing time will take two weeks for each foot."

A nursing student is studying the skeletal system. Which statement indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system?

"Hematopoiesis occurs in the red marrow, which is where blood cells are produced."

The nurse teaches techniques to prevent fractures to a patient who has decreased bone density. Which statement made by the patient indicates effective learning?

"I should use a walking stick."

A female patient with newly diagnosed migraines is being discharged with a prescription for sumatriptan. Which comment by the patient indicates an understanding of the nurse's discharge instructions?

"I must report any chest pain right away." Chest pain must be reported immediately with the use of sumatriptan. Sumatriptan must be taken as soon as migraine symptoms appear. Remind the patient to use contraception (birth control) while taking the drug because it may not be safe for women who are pregnant. Triptans should not be taken with selective serotonin reuptake inhibitors (SSRIs) or St. John's wort, an herb used commonly for depression.

The nurse completes a teaching session on safe drug administration for a patient with Paget's disease taking oral bisphosphonates. Which patient statement indicates a need for further teaching?

"I should go to sleep immediately after taking the drug."

The nurse assesses a middle-aged female patient. Which statement made by the patient causes the nurse to teach the patient about preventing hallux valgus?

"I wear high heels to work every day."

The nurse is teaching a patient about levetiracetam as an adjunctive therapy to treat partial seizures. Which statement by the patient indicates a need for further teaching?

"If I have trouble with coordination, I should stop taking this immediately." Patients should be taught to avoid stopping antiepileptic drugs (AEDs) abruptly because of the risk of status epilepticus. Side effects should be reported, but the drug should not be stopped without discussing this with the provider. Hair loss and tremors are characteristic of divalproex. Patients with seizure disorders should wear medical alert bracelets and carry IDs in case of emergency. Regular renal function tests should be performed on patients taking levetiracetam.

The nurse manager is observing a nurse caring for a patient after surgery for carpal tunnel release. Which statement made by the nurse requires correction?

"It's important for you to keep your fingers as still as possible the first day after surgery."

The nurse is taking the medical history of a patient. Which patient statements indicate a likelihood of carpal tunnel syndrome (CTS)? Select all that apply.

"My wrist and fingers feel numb." "I have severe pain in my wrist at night." "I don't have much sensation around my wrist."

The nurse is caring for a marathon runner with plantar fasciitis. What conservative management method does the nurse suggest?

"Strap the affected foot."

A 67-year-old patient is diagnosed with plantar fasciitis. What conservative management does the nurse suggest? Select all that apply.

"Strap the affected foot." "Apply an ice pack to the site." "Wear shoes with good support."

A patient who has severe migraine headaches will begin taking a triptan medication to treat this disorder. What does the nurse include when teaching the patient about this medication?

"Take it when symptoms first develop or during an aura.' Triptans are used as abortive therapy for migraine headaches and should be used as soon as symptoms develop. They are not used as needed during a migraine and are not taken prophylactically.

The nurse instructor is teaching nursing students about the structure of a bone. What statement made by a student indicates a need for further instruction?

"The haversian canals run horizontally within the cortical bone."

Which instruction should the nurse provide to the patient and care givers to protect them from West Nile virus? Select all that apply.

"Use an insect repellent when outdoors." "Check window and door screens for holes that may need repair." "Limit time outside between dusk and dawn when mosquitoes are rampant." West Nile virus may cause encephalitis and is spread through mosquitoes. To protect from mosquitoes, use insect repellents when outdoors. Check window and door screens properly and repair any holes to prevent mosquitoes from entering the home. Mosquitoes are out between dusk and dawn so limiting outdoor time during that period will help prevent mosquito bites. Protective clothing, long sleeves, and pants should be worn to protect from mosquito bites. Hot tubs and pools should be clean and properly chlorinated.

A patient has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this patient's teaching plan?

"Use pain medication as prescribed to control pain."

The nurse is teaching a young patient about ways to prevent osteoporosis in later adulthood. Which information does the nurse provide?

"limit the consumption of carbonated beverages"

How to Diagnose Thrombocytopenia:

-CBC -Measure antinuclear antibodies (ANA) for autoantibodies -Serologic studies -Bone marrow examination

Thrombocytopenia results from

-Decreased production of platelets -Increased sequestration -Accelerated destruction of platelets

Risk factors for ITP include

-Females (ages 20-40) -Autoimmune disorder -Recent virus (children only)

What lab result would the nurse expect to find in a patient diagnosed with hemophilia A? 1 Clumping of platelets 2 Prolonged bleeding time 3 Shortened prothrombin time (PT) 4 Prolonged activated partial thromboplastin time (aPTT)

4

A patient diagnosed with acute liver failure should be assessed for what coagulation disorder? 1 Hemophilia 2 Heparin-induced thrombocytopenia 3 Idiopathic thrombocytopenic purpura (ITP) 4 Thrombotic thrombocytopenic purpura (TTP

1

A patient diagnosed with idiopathic thrombocytopenic purpura is scheduled for a splenectomy. What interventions are priority? 1 Vaccinations two weeks prior to surgery 2 Antibiotic therapy one week prior to surgery 3 Platelet counts 7 to 10 days prior to surgery 4 Hemoglobin and hematocrit levels 5 days prior to surgery

1

The nurse is caring for a patient diagnosed with autoimmune idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 6,000/mm3. What treatment should be administered first? 1 Platelets 2 Rituximab 3 Azathioprine 4 Dexamethason

1

The nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 38,000/mm3. What treatment does the nurse anticipate for this patient? 1 Corticosteroids 2 Platelet transfusion 3 Fresh frozen plasma 4 Haemophilus influenza vaccine

1

The nurse is caring for four patients. Which patient should the nurse assess first? 1 A patient diagnosed with hemophilia who is complaining of knee pain 2 A patient diagnosed with heparin-induced thrombocytopenia (HIT) who received argatroban 3 A patient diagnosed with idiopathic thrombocytopenic purpura (ITP) with platelet count of 9,000 mm3 4 A patient diagnosed with thrombotic thrombocytopenic purpura (TTP) who has just completed an infusion of fresh frozen plasma

1

What percentage of patients diagnosed with hemophilia account for the form of hemophilia called "Christmas disease"? 1 20% 2 30% 3 50% 4 80%

1

Which antihemophilic drug is obtained from animal serum? 1 Hyate: C 2 Koate-DIV 3 Hemofil-M 4 Monarc-M

1

Which clotting disorder may be caused by X-linked inheritance? 1 Hemophilia A 2 Hemophilia C 3 Von Willebrand disease 4 Heparin-induced thrombocytopenia

1

Which nursing intervention is priority when caring for a patient diagnosed with thrombotic thrombocytopenia purpura? 1 Assessing for headache and confusion 2 Ensuring the patient is on strict bedrest 3 Monitoring platelet count every four hours 4 Using a soft-bristled toothbrush after flossing

1

Which patient is at increased risk for development of hemophilia? 1 The son of the woman who is a carrier 2 The son of the father who has hemophilia 3 The daughter of a woman who is a carrier 4 The daughter of a father who has hemophilia

1

he nurse is caring for a patient diagnosed with idiopathic thrombocytopenic purpura (ITP). The patient's platelet count is 38,000/mm3. What treatment does the nurse anticipate for this patient? 1 Corticosteroids 2 Platelet transfusion 3 Fresh frozen plasma 4 Haemophilus influenza vaccine

1

What statement by a patient diagnosed with hemophilia indicates a need for further teaching? 1 "I will avoid bending over at the waist." 2 "I am using an electric shaver now." 3 "I was taking a stool softener every day." 4 "I have been flossing my teeth once a day

4

What statement by a patient diagnosed with hemophilia indicates a need for further teaching? 1 "I will avoid bending over at the waist." 2 "I am using an electric shaver now." 3 "I was taking a stool softener every day." 4 "I have been flossing my teeth once a day.

4

Which nursing interventions should the nurse implement when caring for a client diagnosed with hemophilia A? Select all that apply 1. Instruct the client to use a razor blade to shave 2. Avoid administering enemas to the client 3. Encourage participation in non contact sports 4. Teach the client how to apply direct pressure if bleeding occurs 5. Explain the importance of not flossing the gums

2. Avoid administering enemas to the client 3. Encourage participation in non contact sports 4. Teach the client how to apply direct pressure if bleeding occurs

Which clotting factor is deficient in patients with hemophilia B? 1 Thrombin 2 Fibrinogen 3 Prothrombin 4 Plasma thromboplastin

4

Which disorder causes antiplatelet antibody formation even when platelet production is normal? 1 Hemophilia 2 Heparin-induced thrombocytopenia 3 Thrombotic thrombocytopenic purpura 4 Autoimmune thrombocytopenic purpura

4

Potentially fatal bleeding occurs when the platelet count is less than

10,000/mL

What are causes of platelet disorders? Select all that apply. 1 Inherited 2 Autoimmune 3 Drug 4 Injury 5 Depletion of clotting factors

123

A patient is being treated for thrombotic thrombocytopenic purpura. What does the nurse anticipate administering to reduce the clumping of the platelets? Select all that apply. 1 Aspirin 2 Heparin 3 Ibuprofen 4 Alprostadil 5 Immunosuppressants

14

When hemorrhage occurs:

1. Endothelial damage, tissue factors, or toxins stimulate the clotting cascade 2. Excess thrombin overwhelms naturally occurring coagulants 3. Widespread clotting occurs within the microvasculature 4. Thrombi and emboli impair tissue perfusion, leading to ischemia, infarction and necrosis 5. Clotting factors and platelets are consumed faster than they can be replaced 6. Clotting activates fibrinolytic process that begins to break down clots 7. Fibrin degradation products are released and contribute to bleeding 8. Clotting factors are depleted, clots are unable to form, and hemorrhage occurs

Which sign/symptom should the nurse expect to assess in the client diagnosed with hemophilia A? 1. Epistaxis 2. Petechiae 3. Subcutaneous emphysema 4. Intermittent claudication

1. Epistaxis

What are the 3 broad categories of Seizures?

1. Generalized 2. Partial 3. Unclassified

A nurse is caring for a client who has DIC. Which of the following medications should the nurse anticipate administering to the client? 1. Heparin 2. Vitamin K 3. Antibiotic 4. Antilipemic

1. Heparin

The client is admitted with full-thickness burns and may be developing DIC. Which signs/symptoms would support the diagnosis of DIC? 1. Oozing blood from the IV catheter site 2. Sudden onset of chest pain and frothy sputum 3. Foul-smelling, concentrated urine 4. A reddened, inflamed central line catheter site

1. Oozing blood from the IV catheter site

Which sign would the nurse expect to assess in the client diagnosed with ITP? 1. Petechiae on the anterior chest, arms, and neck 2. Capillary refill of less than 3 seconds 3. An enlarged spleen 4. Pulse oximeter reading of 95%

1. Petechiae on the anterior chest, arms, and neck

A nurse is caring for a client who has DIC. Which of the following indicates that the client's clotting factors are becoming depleted? Select all that apply 1. Platelets 100,000 2. Fibrinogen levels 97 mg/dL 3. Fibrin degradation products 4.3 mcg/mL 4. D-dimer 179 ng/mL 5. Sedimentation rate 38 mm/hr

1. Platelets 100,000 2. Fibrinogen levels 97 mg/dL Rationale: 1. Platelet levels are decreased in DIC, increasing the clotting time and raising the risk for fatal hemorrhage. 2. Fibrinogen levels are decreased causing clotting factors to become depleted.

What are the 3 terms for before, during and after a seizure

1. Preictal 2. Intraictal 3. Postictal

What are the 2 types of Epilepsy

1. Primary 2. Secondary

The nurse is administrating platelets to a patient with DIC. What is the intended effect of this treatment? 1. Replace depleted cells 2. Restore tissue oxygenation 3. Promote intravascular clotting 4. Replace specific clotting factors

1. Replace depleted cells

The client's CBC indicates an RBC 6.0, Hgb 14.2, Hct 42%, and platelets 69,000. Which intervention should the nurse implement? 1. Teach the client to use a soft-bristle toothbrush 2. Monitor the client for elevated temperature 3. Check the client's BP 4. Hold venipuncture sites for 1 minute

1. Teach the client to use a soft-bristle toothbrush Rationale: A low platelet count indicates thrombocytopenia

A patient diagnosed with idiopathic thrombocytopenic purpura has received teaching about the diagnosis. What statement by the patient indicates a need for further teaching? 1 "My body is destroying my own platelets." 2 "I should not have major issues with clotting." 3 "My body makes a normal amount of platelets." 4 "I may have developed this after a viral infection.

2

A patient diagnosed with idiopathic thrombocytopenic purpura has received teaching about the diagnosis. What statement by the patient indicates a need for further teaching? 1 "My body is destroying my own platelets." 2 "I should not have major issues with clotting." 3 "My body makes a normal amount of platelets." 4 "I may have developed this after a viral infection."

2

A patient diagnosed with septic shock should be assessed for which complication? 1 Hemophilia A 2 Disseminated intravascular coagulation 3 Idiopathic thrombocytopenic purpura (ITP) 4 Thrombotic thrombocytopenic purpura (TTP

2

A patient diagnosed with septic shock should be assessed for which complication? 1 Hemophilia A 2 Disseminated intravascular coagulation 3 Idiopathic thrombocytopenic purpura (ITP) 4 Thrombotic thrombocytopenic purpura (TTP)

2

The nurse is providing teaching to a patient scheduled for a splenectomy secondary to idiopathic thrombocytopenic purpura (ITP). What teaching is priority? 1 Risk for injury 2 Risk for infection 3 Risk for impaired tissue integrity 4 Risk for altered body temperatur

2

The nurse is using a common scale to grade a patient's muscle strength. The patient is able to complete range of motion (ROM) with gravity eliminated. Which grade does the nurse document in this patient's record?

2

Which laboratory result would the nurse expect in the client diagnosed with DIC? 1. A decreased prothrombin time (PT) 2. A low fibrinogen level 3. An increased platelet count 4. An increased WBC count

2. A low fibrinogen level

The client with hemophilia A is experiencing hemarthrosis. Which intervention should the nurse recommend to the client? 1. Alternate aspirin and acetaminophen to help with the pain 2. Apply cold pack for 24-48 hours to the affected area 3. Perform active ROM exercise on the extremity 4. Put the affected extremity in the dependent position

2. Apply cold pack for 24-48 hours to the affected area Rationale: Hemarthrosis is bleeding into the joint. Applying ice to the area can cause vasoconstriction, which can help decrease bleeding

A patient whose husband has hemophilia asks if her newborn baby girl could have the disease. What information should the nurse use when responding to this patient? 1. Hemophilia is an autosomal dominant disorder; therefore, her daughter has a 50% chance of having this disorder 2. The most common forms of hemophilia are transmitted as sex-linked recessive disorders; her daughter is at risk for carrying the defective gene 3. Although hemophilia is genetically transmitted, its pattern of inheritance is unknown, and her daughter will need to be tested for the defective gene 4. Because hemophilia is a sex-linked recessive disorder carried on the Y chromosome, her daughter has no risk of having or carrying the disease

2. The most common forms of hemophilia are transmitted as sex-linked recessive disorders; her daughter is at risk for carrying the defective gene

What findings are consistent with a diagnosis of von Willebrand's disease? Select all that apply. 1 Pyuria 2 Epistaxis 3 Peripheral edema 4 Profound hematuria 5 Petechiae on the chest and arms

24

What findings are consistent with a diagnosis of idiopathic thrombocytopenia purpura (ITP)? Select all that apply. 1 Low fibrin levels 2 Low platelet count 3 Decrease in factor IX 4 Antiplatelet antibodies 5 High megakaryocyte count

245

Where are the level defects that cause coagulation disorders? Select all that apply. 1 Bladder 2 Platelet 3 Kidneys 4 Vascular 5 Clotting facto

245

Which collaborative treatment would the nurse anticipate for the client diagnosed with DIC? 1. Administer oral anticoagulants 2. Prepare for plasmapheresis 3. Administer frozen plasma 4. Calculate the intake and output

3. Administer frozen plasma

The UAP asks the primary nurse, "How does someone get hemophilia A?" Which statement would be the primary nurse's best response? 1. "It is an inherited X-linked recessive disorder" 2. "There is a deficiency of the clotting factor VIII" 3. "The person is born with hemophilia A" 4. "The mother carries the gene and gives it to the son"

4. "The mother carries the gene and gives it to the son"

Which client would be most at risk for developing DIC? 1. 35 yo pregnant client with placenta previa 2. 42 yo client with pulmonary embolus 3. 60 yo client receiving hemodialysis 3 days a week 4. 78 yo client diagnosed with septicemia

4. 78 yo client diagnosed with septicemia Rationale: Sepsis is the most common cause of DIC

The nurse writes a diagnosis of "potential for fluid volume deficit related to bleeding" for a client diagnosed with DIC. Which would be an appropriate goal for this client? 1. The client's clot formations will resolve in two days 2. The saturation of the client's dressings will be documented 3. The client will use lemon-glycerin swabs for oral care 4. The client's urine output will be >30 mL per hour

4. The client's urine output will be >30 mL per hour

The parent of a child recently diagnosed with cerebral palsy ask the nurse about the disorder. The nurse bases the response on the understanding that cerebral palsy is which type of condition?

A chronic disability characterized by impaired muscle movement and posture

Why would a coagulation study in DIC show a low fibrinogen level?

A low fibrinogen level is due to the depletion of clotting factors As the fibrinogen level falls, the risk of bleeding increases

The nurse is caring for a patient who is scheduled to undergo a procedure to remove a ganglion cyst in the wrist. What does the nurse tell the patient about the procedure?

A needle will be used to aspirate the fluid.

Assess for a history of venous thromboembolism. (Raloxifene is an estrogen agonist and is often used in the treatment of osteoporotic vertebral fracture. This drug is not given to patients with a history of venous thromboembolism (VTE) because it increases the risk of VTE in the first 4 months of therapy. Patients taking bisphosphonates are at risk for jaw necrosis. Liver functions tests are monitored for raloxifene (Evista), not the CBC. Drowsiness, agitation, and anxiety are some of the central nervous system side effects of risedronate, a biphosphonate.)

A patient with an osteoporotic vertebral fracture is prescribed raloxifene. What does the nurse include in the assessment of this patient?

Take prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) after meals or with food

A patient diagnosed with a benign bone tumor is being discharged. What does the nurse teach the patient about self-management?

Paresis of right lower extremity (Paresis indicates a neurovascular compromise that must be reported immediately to the surgeon. The patient undergoing a sequestrectomy experiences increased swelling after the procedure; the affected extremity should be elevated to increase venous return and thus control swelling. Palpable pulses of 1+ to 2+ bilaterally are a sign of adequate blood flow. Pain on movement of the right lower extremity is an expected finding.)

A patient has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon?

Pulselessness Paresis or paralysis Paresthesia Uncontrollable pain (pulselessness, paresis or paralysis presented as weakness or inability to move, and paresthesia presented as an abnormal tingling sensation. In addition, the patient may also experience uncontrollable pain. Purulent discharge indicates infection rather than neurovascular compromise. Pallor, rather than erythema, is a sign of neurovascular compromise.)

A patient has recently undergone surgery to treat osteomyelitis. What are the signs of neurovascular compromise after the surgery?

Take the medication early in the morning with 8 ounces of water (The patient who is prescribed alendronate must take the medication on an empty stomach with 8 ounces of water and wait for 30 to 60 minutes in an upright position, either sitting or standing, before eating or drinking. BPs are associated with esophageal ulcers, especially if the tablet is not swallowed completely. The medication is taken either daily or weekly depending on the dose. Patients with poor renal function, hypocalcemia, or gastroesophageal reflux disease (GERD) must not take BPs. Patients receiving BP therapy by IV need not have a liver function test before starting the medication; however, they must have an oral assessment and preventive dentistry before beginning therapy because this therapy is associated with jaw osteonecrosis.)

A patient is prescribed the bisphosphonate (BP) alendronate for osteoporosis. What does the nurse teach the patient?

Enlargement of bones with a radiolucent, punched-out appearance (When seen on an x-ray, Paget's disease presents with an enlarged bone that has a radiolucent, punched-out appearance. Smooth, uniform periosteal bone appearance on x-ray is seen in benign bone tumors. Poor demonstration of bone margins on x-ray is usually observed in cancerous bone tumors. The classic diagnostic finding on an x-ray specific for osteomalacia is the presence of Looser's zones. These appear as radiolucent bands which represent stress fractures that have not mineralized.)

A patient is suspected of having Paget's disease. What x-ray finding is suggestive of the disorder?

Which patient is at the highest risk for a fatigue fracture?

A patient who runs every day

To evaluate for secondary osteoporosis (Secondary osteoporosis may result from certain medical conditions, medications, or lifestyle behavior such as prolonged immobilization. Primary osteoporosis occurs due to age-related or idiopathic factors. Osteomyelitis is infection of the bone characterized by infective manifestations such as fever, pus, discharge, and sinus tract formation. Primary and secondary osteomyelitis have similar symptoms.)

A patient whose fracture of the right ulnar bone was immobilized in a cast for nearly 8 weeks reports swelling and pain in the right forearm. Why would the patient be advised to undergo bone mineral density (BMD) test and erythrocyte sedimentation rate (ESR)?

The nurse is evaluating the status of a client who had a craniotomy 3 days ago. Which assessment finding would indicate that the client is developing meningitis as a complication of surgery?

A positive Brudzinski's sign

What do you want to monitor closely specifically when administering Benzodiazepines?

ABC's. (CNS Depressants)

what are the neurotransmitters involved in PD?

ACh and dopamine

What are typical causes for Status Epilepticus?

AED withdrawl, ETOH, head trauma, infection.

care coordination and transition management- compliance with what?

AED's

A nurse delegates care for a client with Parkinson disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care? a. "Allow the client to be as independent as possible with activities." b. "Assist the client with frequent and meticulous oral care." c. "Assess the client's ability to eat and swallow before each meal." d. "Schedule appointments early in the morning to ensure rest in the afternoon."

ANS: A Clients with Parkinson disease do not move as quickly and can have functional problems. The client should be encouraged to be as independent as possible and provided time to perform activities without rushing. Although oral care is important for all clients, instructing the UAP to provide frequent and meticulous oral is not a priority for this client. This statement would be a priority if the client was immune-compromised or NPO. The nurse should assess the client's ability to eat and swallow; this should not be delegated. Appointments and activities should not be scheduled early in the morning because this may cause the client to be rushed and discourage the client from wanting to participate in activities of daily living.

A nurse obtains a focused health history for a client who is suspected of having bacterial meningitis. Which question should the nurse ask? a. "Do you live in a crowded residence?" b. "When was your last tetanus vaccination?" c. "Have you had any viral infections recently?" d. "Have you traveled out of the country in the last month?"

ANS: A Meningococcal meningitis tends to occur in multiple outbreaks. It is most likely to occur in areas of high-density population, such as college dormitories, prisons, and military barracks. A tetanus vaccination would not place the client at increased risk for meningitis or protect the client from meningitis. A viral infection would not lead to bacterial meningitis but could lead to viral meningitis. Simply knowing if the client traveled out of the country does not provide enough information. The nurse should ask about travel to specific countries in which the disease is common, for example, sub-Saharan Africa.

A nurse witnesses a client with late-stage Alzheimer's disease eat breakfast. Afterward the client states, "I am hungry and want breakfast." How should the nurse respond? a. "I see you are still hungry. I will get you some toast." b. "You ate your breakfast 30 minutes ago." c. "It appears you are confused this morning." d. "Your family will be here soon. Let's get you dressed."

ANS: A Use of validation therapy with clients who have Alzheimer's disease involves acknowledgment of the client's feelings and concerns. This technique has proved more effective in later stages of the disease, when using reality orientation only increases agitation. Telling the client that he or she already ate breakfast may agitate the client. The other statements do not validate the client's concerns.

A nurse assesses clients on a medical-surgical unit. Which clients should the nurse identify as at risk for secondary seizures? (Select all that apply.) a. A 26-year-old woman with a left temporal brain tumor b. A 38-year-old male client in an alcohol withdrawal program c. A 42-year-old football player with a traumatic brain injury d. A 66-year-old female client with multiple sclerosis e. A 72-year-old man with chronic obstructive pulmonary disease

ANS: A, B, C Clients at risk for secondary seizures include those with a brain lesion from a tumor or trauma, and those who are experiencing a metabolic disorder, acute alcohol withdrawal, electrolyte disturbances, and high fever. Clients with a history of stroke, heart disease, and substance abuse are also at risk. Clients with multiple sclerosis or chronic obstructive pulmonary disease are not at risk for secondary seizures.

A nurse assesses a client who is experiencing a cluster headache. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a. Ipsilateral tearing of the eye b. Miosis c. Abrupt loss of consciousness d. Neck and shoulder tenderness e. Nasal congestion f. Exophthalmos

ANS: A, B, E Cluster headache is usually accompanied by ipsilateral tearing, miosis, rhinorrhea or nasal congestion, ptosis, eyelid edema, and facial sweating. Abrupt loss of consciousness, neck and shoulder tenderness, and exophthalmos are not associated with cluster headaches.

A nurse is caring for a client with meningitis. Which laboratory values should the nurse monitor to identify potential complications of this disorder? (Select all that apply.) a. Sodium level b. Liver enzymes c. Clotting factors d. Cardiac enzymes e. Creatinine level

ANS: A, C Inflammation associated with meningitis can stimulate the hypothalamus and result in excessive production of antidiuretic hormone. The nurse should monitor sodium levels for early identification of syndrome of inappropriate antidiuretic hormone. A systemic inflammatory response (SIR) can also occur with meningitis. A SIR can result in a coagulopathy that leads to disseminated intravascular coagulation. The nurse should monitor clotting factors to identify this complication. The other laboratory values are not specific to complications of meningitis.

A nurse evaluates the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which fluid results alerts the nurse to possible viral meningitis? (Select all that apply.) a. Clear b. Cloudy c. Increased protein level d. Normal glucose level e. Bacterial organisms present f. Increased white blood cells

ANS: A, C, D In viral meningitis, CSF fluid is clear, protein levels are slightly increased, and glucose levels are normal. Viral meningitis does not cause cloudiness or increased turbidity of CSF. In bacterial meningitis, the presence of bacteria and white blood cells causes the fluid to be cloudy.

A nurse plans care for a client with epilepsy who is admitted to the hospital. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Have suction equipment at the bedside. b. Place a padded tongue blade at the bedside. c. Permit only clear oral fluids. d. Keep bed rails up at all times. e. Maintain the client on strict bedrest. f. Ensure that the client has IV access.

ANS: A, D, F Oxygen and suctioning equipment with an airway must be readily available. The bed rails should be up at all times while the client is in the bed to prevent injury from a fall if the client has a seizure. If the client does not have an IV access, insert a saline lock, especially for those clients who are at significant risk for generalized tonic-clonic seizures. The saline lock provides ready access if IV drug therapy must be given to stop the seizure. Padded tongue blades may pose a danger to the client during a seizure and should not be used. Dietary restrictions and strict bedrest are not interventions associated with epilepsy. The client should be encouraged to eat a well-balanced diet and ambulate while in the hospital.

A nurse assesses a client after administering prescribed levetiracetam (Keppra). Which laboratory tests should the nurse monitor for potential adverse effects of this medication? a. Serum electrolyte levels b. Kidney function tests c. Complete blood cell count d. Antinuclear antibodies

ANS: B Adverse effects of levetiracetam include coordination problems and renal toxicity. The other laboratory tests are not affected by levetiracetam.

A nurse assesses a client with Huntington disease. Which motor changes should the nurse monitor for in this client? a. Shuffling gait b. Jerky hand movements c. Continuous chewing motions d. Tremors of the hands

ANS: B An imbalance between excitatory and inhibitory neurotransmitters leads to uninhibited motor movements, such as brisk, jerky, purposeless movements of the hands, face, tongue, and legs. Shuffling gait, continuous chewing motions, and tremors are associated with Parkinson disease.

A nurse is teaching a client who experiences migraine headaches and is prescribed a beta blocker. Which statement should the nurse include in this client's teaching? a. "Take this drug only when you have prodromal symptoms indicating the onset of a migraine headache." b. "Take this drug as ordered, even when feeling well, to prevent vascular changes associated with migraine headaches." c. "This drug will relieve the pain during the aura phase soon after a headache has started." d. "This medication will have no effect on your heart rate or blood pressure because you are taking it for migraines."

ANS: B Beta blockers are prescribed as prophylactic treatment to prevent the vascular changes that initiate migraine headaches. Heart rate and blood pressure will also be affected, and the client should monitor these side effects. The other responses do not discuss appropriate uses of the medication.

A nurse cares for a client who is experiencing status epilepticus. Which prescribed medication should the nurse prepare to administer? a. Atenolol (Tenormin) b. Lorazepam (Ativan) c. Phenytoin (Dilantin) d. Lisinopril (Prinivil)

ANS: B Initially, intravenous lorazepam is administered to stop motor movements. This is followed by the administration of phenytoin. Atenolol, a beta blocker, and lisinopril, an angiotensin-converting enzyme inhibitor, are not administered for seizure activity. These medications are typically administered for hypertension and heart failure.

A nurse assesses a client with a history of epilepsy who experiences stiffening of the muscles of the arms and legs, followed by an immediate loss of consciousness and jerking of all extremities. How should the nurse document this activity? a. Atonic seizure b. Tonic-clonic seizure c. Myoclonic seizure d. Absence seizure

ANS: B Seizure activity that begins with stiffening of the arms and legs, followed by loss of consciousness and jerking of all extremities, is characteristic of a tonic-clonic seizure. An atonic seizure presents as a sudden loss of muscle tone followed by postictal confusion. A myoclonic seizure presents with a brief jerking or stiffening of extremities that may occur singly or in groups. Absence seizures present with automatisms, and the client is unaware of his or her environment.

A nurse cares for a client with advanced Alzheimer's disease. The client's caregiver states, "She is always wandering off. What can I do to manage this restless behavior?" How should the nurse respond? a. "This is a sign of fatigue. The client would benefit from a daily nap." b. "Engage the client in scheduled activities throughout the day." c. "It sounds like this is difficult for you. I will consult the social worker." d. "The provider can prescribe a mild sedative for restlessness."

ANS: B Several strategies may be used to cope with restlessness and wandering. One strategy is to engage the client in structured activities. Another is to take the client for frequent walks. Daily naps and a mild sedative will not be as effective in the management of restless behavior. Consulting the social worker does not address the caregiver's concern.

A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex) for migraine headaches. Which condition should alert the nurse to hold the medication and contact the health care provider? a. Bronchial asthma b. Prinzmetal's angina c. Diabetes mellitus d. Chronic kidney disease

ANS: B Sumatriptan succinate effectively reduces pain and other associated symptoms of migraine headache by binding to serotonin receptors and triggering cranial vasoconstriction. Vasoconstrictive effects are not confined to the cranium and can cause coronary vasospasm in clients with Prinzmetal's angina. The other conditions would not affect the client's treatment.

A nurse witnesses a client begin to experience a tonic-clonic seizure and loss of consciousness. Which action should the nurse take? a. Start fluids via a large-bore catheter. b. Turn the client's head to the side. c. Administer IV push diazepam. d. Prepare to intubate the client.

ANS: B The nurse should turn the client's head to the side to prevent aspiration and allow drainage of secretions. Anticonvulsants are administered on a routine basis if a seizure is sustained. If the seizure is sustained (status epilepticus), the client must be intubated and should be administered oxygen, 0.9% sodium chloride, and IV push lorazepam or diazepam.

A nurse assesses a client who has encephalitis. Which manifestations should the nurse recognize as signs of increased intracranial pressure (ICP), a complication of encephalitis? (Select all that apply.) a. Photophobia b. Dilated pupils c. Headache d. Widened pulse pressure e. Bradycardia

ANS: B, D, E Increased ICP is a complication of encephalitis. The nurse should monitor for signs of increased ICP, including dilated pupils, widened pulse pressure, bradycardia, irregular respirations, and less responsive pupils. Photophobia and headache are not related to increased ICP.

A nurse is teaching a client who has chronic headaches. Which statements about headache triggers should the nurse include in this client's plan of care? (Select all that apply.) a. "Increase your intake of caffeinated beverages." b. "Incorporate physical exercise into your daily routine." c. "Avoid all alcoholic beverages." d. "Participate in a smoking cessation program." e. "Increase your intake of fruits and vegetables."

ANS: B, D, E Triggers for headaches include caffeine, smoking, and ingestion of pickled foods, so these factors should be avoided. Clients are taught to eat a balanced diet and to get adequate exercise and rest. Alcohol does not trigger chronic headaches but can enhance headaches during the headache period.

A nurse assesses a client who is experiencing an absence seizure. For which clinical manifestations should the nurse assess? (Select all that apply.) a. Intermittent rigidity b. Lip smacking c. Sudden loss of muscle tone d. Brief jerking of the extremities e. Picking at clothing f. Patting of the hand on the leg

ANS: B, E, F Automatisms are characteristic of absence seizures. These behaviors consist of lip smacking, picking at clothing, and patting. Rigidity of muscles is associated with the tonic phase of a seizure, and jerking of the extremities is associated with the clonic phase of a seizure. Loss of muscle tone occurs with atonic seizures.

A nurse assesses a client with Alzheimer's disease who is recently admitted to the hospital. Which psychosocial assessment should the nurse complete? a. Assess religious and spiritual needs while in the hospital. b. Identify the client's ability to perform self-care activities. c. Evaluate the client's reaction to a change of environment. d. Ask the client about relationships with family members.

ANS: C As Alzheimer's disease progresses, the client experiences changes in emotional and behavioral affect. The nurse should be alert to the client's reaction to a change in environment, such as being hospitalized, because the client may exhibit an exaggerated response, such as aggression, to the event. The other assessments should be completed but are not as important as assessing the client's reaction to environmental change.

A nurse is teaching a client with chronic migraine headaches. Which statement related to complementary therapy should the nurse include in this client's teaching? a. "Place a warm compress on your forehead at the onset of the headache." b. "Wear dark sunglasses when you are in brightly lit spaces." c. "Lie down in a darkened room when you experience a headache." d. "Set your alarm to ensure you do not sleep longer than 6 hours at one time."

ANS: C At the onset of a migraine attack, the client may be able to alleviate pain by lying down and darkening the room. He or she may want both eyes covered and a cool cloth on the forehead. If the client falls asleep, he or she should remain undisturbed until awakening. The other options are not recognized therapies for migraines.

A nurse delegates care for a client with early-stage Alzheimer's disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care? a. "If she is confused, play along and pretend that everything is okay." b. "Remove the clock from her room so that she doesn't get confused." c. "Reorient the client to the day, time, and environment with each contact." d. "Use validation therapy to recognize and acknowledge the client's concerns."

ANS: C Clients who have early-stage Alzheimer's disease should be reoriented frequently to person, place, and time. The UAP should reorient the client and not encourage the client's delusions. The room should have a clock and white board with the current date written on it. Validation therapy is used with late-stage Alzheimer's disease.

A nurse prepares to discharge a client with Alzheimer's disease. Which statement should the nurse include in the discharge teaching for this client's caregiver? a. "Allow the client to rest most of the day." b. "Place a padded throw rug at the bedside." c. "Install deadbolt locks on all outside doors." d. "Provide a high-calorie and high-protein diet."

ANS: C Clients with Alzheimer's disease have a tendency to wander, especially at night. If possible, alarms should be installed on all outside doors to alert family members if the client leaves. At a minimum, all outside doors should have deadbolt locks installed to prevent the client from going outdoors unsupervised. The client should be allowed to exercise within his or her limits. Throw rugs are a slip and fall hazard and should be removed. The client should eat a well-balanced diet. There is no need for a high-calorie or high-protein diet.

A nurse is teaching the daughter of a client who has Alzheimer's disease. The daughter asks, "Will the medication my mother is taking improve her dementia?" How should the nurse respond? a. "It will allow your mother to live independently for several more years." b. "It is used to halt the advancement of Alzheimer's disease but will not cure it." c. "It will not improve her dementia but can help control emotional responses." d. "It is used to improve short-term memory but will not improve problem solving."

ANS: C Drug therapy is not effective for treating dementia or halting the advancement of Alzheimer's disease. However, certain drugs may help suppress emotional disturbances and psychiatric manifestations. Medication therapy may not allow the client to safely live independently.

A nurse assesses a client who has a history of migraines. Which clinical manifestation should the nurse identify as an early sign of a migraine with aura? a. Vertigo b. Lethargy c. Visual disturbances d. Numbness of the tongue

ANS: C Early warning of impending migraine with aura usually consists of visual changes, flashing lights, or diplopia. The other manifestations are not associated with an impending migraine with aura.

After teaching the wife of a client who has Parkinson disease, the nurse assesses the wife's understanding. Which statement by the client's wife indicates she correctly understands changes associated with this disease? a. "His masklike face makes it difficult to communicate, so I will use a white board." b. "He should not socialize outside of the house due to uncontrollable drooling." c. "This disease is associated with anxiety causing increased perspiration." d. "He may have trouble chewing, so I will offer bite-sized portions."

ANS: D Because chewing and swallowing can be problematic, small frequent meals and a supplement are better for meeting the client's nutritional needs. A masklike face and drooling are common in clients with Parkinson disease. The client should be encouraged to continue to socialize and communicate as normally as possible. The wife should understand that the client's masklike face can be misinterpreted and additional time may be needed for the client to communicate with her or others. Excessive perspiration is also common in clients with Parkinson disease and is associated with the autonomic nervous system's response.

A nurse assesses a client who is recovering from the implantation of a vagal nerve stimulation device. For which clinical manifestations should the nurse assess as common complications of this procedure? (Select all that apply.) a. Bleeding b. Infection c. Hoarseness d. Dysphagia e. Seizures

ANS: C, D Complications of surgery to implant a vagal nerve stimulation device include hoarseness (most common), dyspnea, neck pain, and dysphagia. The device is tunneled under the skin with an electrode connected to the vagus nerve to control simple or complex partial seizures. Bleeding is not a common complication of this procedure, and infection would not occur during the recovery period.

After teaching a client who is diagnosed with new-onset status epilepticus and prescribed phenytoin (Dilantin), the nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching? a. "To prevent complications, I will drink at least 2 liters of water daily." b. "This medication will stop me from getting an aura before a seizure." c. "I will not drive a motor vehicle while taking this medication." d. "Even when my seizures stop, I will continue to take this drug."

ANS: D Discontinuing antiepileptic drugs can lead to the recurrence of seizures or status epilepticus. The client does not need to drink more water and can drive while taking this medication. The medication will not stop an aura before a seizure.

A nurse plans care for a client with Parkinson disease. Which intervention should the nurse include in this client's plan of care? a. Ambulate the client in the hallway twice a day. b. Ensure a fluid intake of at least 3 liters per day. c. Teach the client pursed-lip breathing techniques. d. Keep the head of the bed at 30 degrees or greater

ANS: D Elevation of the head of the bed will help prevent aspiration. The other options will not prevent aspiration, which is the greatest respiratory complication of Parkinson disease, nor do these interventions address any of the complications of Parkinson disease. Ambulation in the hallway is usually implemented to prevent venous thrombosis. Increased fluid intake flushes out toxins from the client's blood. Pursed-lip breathing increases exhalation of carbon dioxide.

After teaching a client newly diagnosed with epilepsy, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I will wear my medical alert bracelet at all times." b. "While taking my epilepsy medications, I will not drink any alcoholic beverages." c. "I will tell my doctor about my prescription and over-the-counter medications." d. "If I am nauseated, I will not take my epilepsy medication."

ANS: D The nurse must emphasize that antiepileptic drugs must be taken even if the client is nauseous. Discontinuing the medication can predispose the client to seizure activity and status epilepticus. The client should not drink alcohol while taking seizure medications. The client should wear a medical alert bracelet and should make the doctor aware of all medications to prevent complications of polypharmacy.

A nurse cares for a client who has been diagnosed with the Huntington gene but has no symptoms. The client asks for options related to family planning. What is the nurse's best response? a. "Most clients with the Huntington gene do not pass on Huntington disease to their children." b. "I understand that they can diagnose this disease in embryos. Therefore, you could select a healthy embryo from your fertilized eggs for implantation to avoid passing on Huntington disease." c. "The need for family planning is limited because one of the hallmarks of Huntington disease is infertility." d. "Tell me more specifically what information you need about family planning so that I can direct you to the right information or health care provider."

ANS: D The presence of the Huntington gene means that the trait will be passed on to all offspring of the affected person. Understanding options for contraception and conception (e.g., surrogacy options) and implications for children may require the expertise of a genetic counselor or a reproductive specialist. The other statements are not accurate.

The parents of a young child report that their child sometimes stares blankly into space for just a few seconds and then gets very tired. The nurse anticipates that the child will be assessed for which seizure disorder?

Absence Absence seizures are more common in children and consist of brief (often just seconds) periods of loss of consciousness and blank staring, as though he or she is daydreaming. Myoclonic seizures are characterized by brief jerking or stiffening of the extremities, which may occur singly or in groups. Partial seizures are most often seen in adults. Tonic seizures are characterized by an abrupt increase in muscle tone, loss of consciousness, and autonomic changes lasting from 30 seconds to several minutes.

A nurse prepares to provide perineal care to a client with meningococcal meningitis. Which personal protective equipment should the nurse wear? (Select all that apply.) a. Particulate respirator b. Isolation gown c. Shoe covers d. Surgical mask e. Gloves

ANS: D, E Meningeal meningitis is spread via saliva and droplets, and Droplet Precautions are necessary. Caregivers should wear a surgical mask when within 6 feet of the client and should continue to use Standard Precautions, including gloves. A particulate respirator, an isolation gown, and shoe covers are not necessary for Droplet Precautions.

Epilepsy is thought to be caused by what?

Abnormal electrical neuron activity or imbalance of neurotransmitters especially GABA, or combo of both.

Seizure

Abnormal sudden, excessive, uncontrolled electrical discharge of neurons within the brain that may result in a change in LOC, motor sensory ability/behavior.

Which seizure type is characterized as a generalized seizure?

Absence Absence seizures, characterized by very brief loss of consciousness with automatisms, are classified as generalized seizures, along with tonic and clonic seizures. Complex partial seizures and focal seizures are classified as partial seizures. Idiopathic seizures are also categorized as "unclassified" seizures.

A 65-year-old female patient has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the patient?

Antalgic gait

What is aother type of medication that is contraindicated with use of Dilantin?

Any TB medication.

. Which seizure is known as psychomotor seizure?

Complex partial seizure Complex partial seizures most often involve neurological changes in parts of the brain such as the temporal lobe. These are psychomotor seizures or temporal lobe seizures. Atonic, tonic-clonic, and simple partial seizures are not associated with neurological changes in the temporal lobe.

A hospitalized patient remains conscious throughout the entire episode of a seizure but feels an unusual sensation of "déjà vu" before the seizure begins. Autonomic changes such as increased heart rate, skin flushing, and epigastric discomfort are also observed. Which drug treatment would the nurse expect to be prescribed?

Carbamazepine The patient's signs and symptoms are consistent with simple partial seizures. Carbamazepine is prescribed for this condition. It acts by stabilizing the inactivated state of voltage-gated sodium channels. Diazepam, clonazepam, and ethosuximide are not prescribed for partial seizures. Diazepam is indicated for status epilepticus. Clonazepam is prescribed to patients with absence, myoclonic, and akinetic seizures. Ethosuximide treats patients with absence seizure.

Patients with what types of seizures are ideal candidates for vagal nerve stimulation? Select all that apply.

Complex partial seizures Simple partial seizure Vagal nerve stimulation surgery is effective in patients with complex partial and simple partial seizures with improved quality of life and fewer seizures. Patients with generalized seizures such as tonic-clonic, myoclonic, and unclassified seizures are not ideal candidates for vagus nerve stimulation because it can result in severe neurologic deficits.

A patient receiving sumatriptan for migraine headaches is experiencing adverse effects after taking the drug. Which adverse effect is of greatest concern to the nurse?

Chest tightness Triptan drugs are contraindicated in patients with coronary artery disease because they can cause arterial narrowing. Patients taking triptan drugs should report angina or chest discomfort to prevent cardiac injury associated with myocardial ischemia. Skin flushing, tingling feelings, and a warm sensation are common adverse effects with triptan medications and are not indications to avoid using this group of drugs.

A lumbar puncture is performed on a child suspected to have bacterial meningitis, and CSF is obtained for analysis. The nurse reviews the results of the CSF analysis and determines that which results would verify the diagnosis?

Cloudy CSF, elevated protein, and decreased glucose levels

What is the purpose of vagal nerve stimulation (VNS) in the treatment of seizures?

Controls the occurrence of simple or complex partial seizures The purpose of VNS is to control continuous simple or complex partial seizures. Patients with generalized seizures are not candidates for this surgery because VNS may result in severe neurologic deficits. VNS can decrease the occurrence of seizures, but does not eliminate seizures entirely. VNS can also reduce the intensity and duration of seizures. VNS is not used in the management of status epilepticus.

what is the most common assessment finding associated with osteoporosis

bone fractures

Drug therapy

broad-spectrum antibiotic hyperosmolar agents anticonvulsants steroids

An enlarged first metatarsal head is known as what?

bunion

The hallux valgus deformity can cause what other condition?

bunion

What is an early manifestation of fat embolism syndrome?

Low arterial oxygen

When assessing a female patient, the nurse learns that the patient has several risk factors for osteoporosis. Which risk factor will be the priority for patient teaching?

Low calcium intake

rigidity can lead to difficulties in what?

chewing and swallowing and can lead to inadequate nutrition

A client has a diagnosis of multiple sclerosis and is currently in remission. The client is a parent of two active preschoolers. What should the nurse encourage the client to do?

Develop a flexible schedule for completion of routine daily activities.

Which complication of fractures can be treated with minimally invasive surgical sympathectomy?

complex regional pain syndrome

Which Benzodiazepine has a long half-life?

Diazepam ( Valium).

A client with trigeminal neuralgia tells the nurse that acetaminophen is taken daily for the relief of generalized discomfort. Which laboratory value would indicate toxicity associated with the medication?

Direct bilirubin level of 2 mg/dl

A patient is hospitalized for a seizure lasting 4 minutes. It began with arm muscles stiffening and immediate loss of consciousness, followed by rhythmic jerking of all extremities. The patient subsequently developed tongue biting and urinary incontinence. Which prescribed medication requires the patient to undergo periodic liver enzyme testing?

Divalproex The symptoms signify that the patient may have sustained an epileptic tonic-clonic seizure. Divalproex will help control seizure activity, but it increases the liver enzymes. Therefore, liver enzyme testing is performed for patients taking divalproex medication. Primidone, phenobarbital, and carbamazepine do not cause an increase in liver enzymes, so the patient would not require liver enzyme testing.

The nurse is teaching the importance of nutrition to a 74-year-old patient who is lactose-intolerant and at risk for osteoporosis. What nutritional considerations does the nurse teach? Select all that apply.

Drink fruit juices fortified with calcium. Limit consumption of carbonated beverages. Avoid excessive intake of alcohol and caffeine.

Which is the most commonly used screening and diagnostic tool for measuring bone mineral density?

Dual x-ray absorpitometry

Which disorder affects the hand or part of the hand?

Dupuytren contracture

The nurse is admitting a client with Guillain-Barre syndrome to the nursing unit. The client has ascending paralysis to the level of the waist. Knowing the complications of the disorder, the nurse should bring which most essential items to the client's room?

Electrocardiographic monitoring electrodes and intubation tray

The nurse is instituting seizure precautions for a client who is being admitted from the emergency department. Which measures should the nurse include in planning for the client's safety? Select all the apply.

Padding the side rails of the bed, placing an airway at the bedside, placing oxygen and suction equipment at the bedside, having intravenous equipment ready for insertion of an IV catheter

Non-weight bearing with crutches has been prescribed for a client with a leg injury. The nurse provides teaching before ambulation is begun. To facilitate walking with crutches, what is the most important activity the nurse should teach the client?

Exercise the triceps, finger flexors, and elbow extensors.

A client is recovering from a head injury is participating in care. The nurse determines that the client understands measures to prevent elevations in ICPif the nurse observes the client doing which activity?

Exhaling during repositioning

A nurse provides discharge teaching to a client who had a total hip replacement. The client states that the plan is to go swimming at the community pool the day after discharge. How should the nurse respond?

Explain that the incision should not be immersed in water until it has healed.

While evaluating the stance of a patient, the nurse observes a bow-legged deformity. How does the nurse document this condition?

Genu varum

A client has clear fluid leaking from the nose following a basilar skull fracture. Which finding would alert the nurse that CSF is present?

Fluid separates into concentric rings and tests positive for glucose

This type of Hemophilia is deficient of Factor 11 and is commonly seen in Jewish people

Hemophilia C

Which is the most effective way for a college student to minimize the risk for bacterial meningitis?

Get the meningococcal vaccine Individuals aged 16-21 years have the highest rates of meningococcal infection and should be immunized against the virus. Adults are advised to get an initial or booster vaccine if living in a shared residence (residence hall, military barracks, group home), traveling or residing in countries in which the disease is common, or are immunocompromised due to a damaged or surgically removed spleen or a serum complement deficiency. Avoiding large crowds is helpful, but is not practical for a college student. Taking a daily vitamin is helpful, but is not the best way to safeguard against bacterial meningitis. Taking prophylactic antibiotics is inappropriate because it leads to antibiotic-resistant strains of microorganisms.

How do you treat Hemophilia B?

Give Factor 9 concentrate

What Neurotransmitter is considered Excitatory?

Glutamate. (too much can cause seizure)

The nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions?

Good oral hygiene is needed, including brushing and flossing

What is another term used for Tonic-clonic seizures?

Grand Mal Seizures.

The nurse is providing medication instructions for a patient for whom phenytoin has been ordered for treatment of epilepsy. The nurse instructs the patient to avoid which beverage?

Grapefruit Grapefruit juice can interfere with the metabolism of phenytoin. Apple juice, grape juice, and milk do not interact with phenytoin.

Which occupational activity predisposes a person to carpal tunnel syndrome (CTS)?

Grasping during wrist flexion

A group of hereditary clotting factor disorders that lead to persistent and sometimes severe bleeding

Hemophilia

The most common type of hemophilia

Hemophilia A (classic hemophilia)

This type of Hemophilia is known as the christmas disease

Hemophilia B

Activated PTT time is prolonged in which hemophilia?

Hemophilia C

An older adult patient has multiple tibial and fibular fractures of the left lower extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this patient?

Patient-controlled analgesia (PCA) with morphine

The nurse has given suggestions to a client with trigeminal neuralgia about strategies to minimize episodes of pain. The nurse determines that the client needs further teaching if the client make which statement;

I'll try to eat my food either very warm or very cold.

Which drug is a bisphosphonate that is approved by the Food and Drug Administration (FDA) and is commonly used for the prevention and treatment of osteoporosis?

Ibandronate

In ITP, the proteins on the platelet cell membrane stimulate autoantibody production. These are usually what antibodies?

IgG

Which physiologic change related to compartment syndrome is responsible for symptoms of flexed posture and unequal pulses in a patient?

Increased production of lactic acid

A nurse is caring for a group of clients with myasthenia gravis, Guillain-Barré syndrome, and amyotrophic lateral sclerosis (ALS). Which information should the nurse consider when planning care for this group of clients?

Increased risk for respiratory complications

The nurse is caring for the client with increased intracranial pressure. The nurse would note which trend in vital signs if the intracranial pressure is rising?

Increasing temperature, decreasing pulse, decreasing respirations, increasing blood pressure

What is the indication for use of Clonazepam (Klonopin) and a nursing intervention?

Indication: Abscence/ myoclonic/ akinetic seizures NI: Monitor liver function

What is the indication for use of Diazepam (Valium)/ Lorazepam ( Ativan) and a nursing intervention?

Indication: Status Epilepticus NI: Monitor ABC's

What is the indication for use of Phenobarbital (Barbita, Luminal) and a nursing intervention?

Indications: Generalized tonic-clonic/ partial seizures NI: monitor for drowsiness, impaired cognition, sleep disturbances and depression. * less desirable then other AED's, overdose may be fatal.

What interventions may be utilized to manage a patient with chronic osteomyelitis? Select all that apply.

Irrigating wounds through the window of a cast Exposing the affected area to hyperbaric oxygen therapy Packing the wound with bone cement bead impregnated with antibiotic

The nurse instructor is educating nursing students about compartment syndrome. What statement made by a nursing student indicates a need for further instruction?

It causes an absence of pulses

A patient who loses consciousness for 2 minutes with the occurrence of automatisms in an epilepsy attack is receiving valproic acid. Why would lamotrigine be contraindicated in this patient?

It may cause a life-threatening rash. Lamotrigine is prescribed to patients with partial epileptic seizures. It acts by blocking sodium channels. When lamotrigine is given concurrently with valproic acid, it may result in a life-threatening rash. Liver failure, hypernatremia, and kidney damage are not associated with the administration of lamotrigine along with valproic acid.

What is true regarding the Canadian Centre for Occupational Health and Safety with respect to health care organizations?

It requires work settings to have joint health and safety committees in which employees are actively involved in setting safety standards.

Define Clonic or Rhythmic Jerking

Jerking of all extremities followed by biting the tongue and possible incontinence.

Describe Complex-partial Seizures

LOC " black out" for 1-3 minutes.

Define syncope

LOC.

Describe Myoclonic Seizure

Lasting for seconds, asymmetrical or symmetrical contractions causing a brief jerking or stiffening of extremities singly or in groups.

What statements about amputation are correct? Select all that apply.

Lisfranc and Chopart amputations are types of midfoot amputations; In a Syme amputation, most of the foot is removed but the ankle remains; lower extremity amputations are more common than upper extremity amputations

How do you treat chronic DIC?

Long-term Heparin therapy via IV

Which Benzodiazepine has a short half-life?

Lorazepam ( Ativan).

Which Benzodiazepine is typically the drug of choice?

Lorazepam (ativan).

Define Amnesia

Loss of memory.

A nurse notices the lateral drift of the greater toe at the first metatarsophalangeal joint. What would be the expected diagnosis by the primary health care provider?

hallux vagus

What intervention is most commonly used to treat strains?

Muscle relaxants

Which protein is released when a bone is broken down?

N-telopeptide

The nurse us assessing the motor function of an unconscious client. The nurse should plan to use which technique to test the client's peripheral response to pain?

Nail bed pressure

The nurse plans to refer a patient diagnosed with osteoporosis to which community resource?

National Osteoporosis Foundation

What is the priority assessment for a patient with bacterial meningitis?

Neurological assessment The most important thing to monitor in patients with meningitis is neurologic status. Blood pressure, temperature, and muscle function are important, but not as high a priority as neurologic assessment.

The nurse is caring for a patient with a tibial fracture. For which complication common in a fracture of this type should the nurse monitor the patient?

acute compartment syndrome (ACS)

A patient with a history of simple partial seizures begins to have involuntary movement of the right leg after reporting an unusual smell. Which action by the nurse is correct?

Observe the seizure and document observations. The patient is having a simple partial seizure which usually does not require intervention. The nurse should remain at the bedside and document observations about the seizure activity and the length of time the seizure lasts. Even with complex or generalized seizures, cyanosis is usually self-limiting and does not require oxygen. The nurse should never attempt to restrain seizure movements because this could cause injury. It is not necessary to turn the patient on the side unless a more complex seizure develops and the risk of airway obstruction and aspiration increases.

Which nursing action is appropriate when a patient requests spiritual guidance during a preoperative assessment?

Offer assistance to arrange for a hospital chaplain to talk with the patient before surgery

what are some well established risk factors?

age gender genetics

What interventions may be utilized to manage a patient with chronic osteomyelitis? Select all that apply.

Packing the wound with bone cement bead impregnated with antibiotic Irrigating wounds through the window of a cast Exposing the affected area to hyperbaric oxygen therapy

A patient is diagnosed with Morton's neuroma. How might a patient describe the pain associated with a Morton's neuroma? Select all that apply.

Pain is acute pain is in the web space pain is burning in nature

The nurse is caring for a patient with prostate cancer who has bone metastasis. The nurse anticipates that the health care provider will prescribe which medication?

Pamidronate

What are the risk factors for primary osteoporosis? Select all that apply.

Parental history of osteoporosis Thin build with low body weight Chronic low calcium and vitamin D intake

A patient has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to contact the surgeon immediately?

Paresis of right lower extremity

A patient has recently undergone surgery to treat osteomyelitis. What are the signs of neurovascular compromise after the surgery? Select all that apply.

Paresthesia Pulselessness Uncontrollable pain Paresis or paralysis

After dental work, a female patient taking medications for osteoporosis reports pain, bleeding gums, and halitosis. Upon examination, the bone is found to be exposed. Which medication is the cause for this condition?

bisphosphosphonates

Which foot disorder is one of the most common causes of heel pain?

Plantar fascitis

What is the primary treatment for acute TTP?

Plasmapheresis or plasma exchange therapy. The patient's plasma is removed and replaced with FFP to remove autoantibodies, immune complexes, and toxins

Which statements are true regarding the various types of casting materials for immobilization? Select all that apply.

Plaster is not commonly used for casting. Fiberglass can dry and become rigid in minutes.

Thrombocytes are responsible for

Platelet production

Acute bleeding related to thrombocytopenia can be treated by?

Platelet transfusion

The nurse refers a patient with an amputation and the patient's family to which community resource?

amputee coalition of America

Cluster headaches are brief, lasting 30 minutes to 2 hours, and are classified as the most common chronic short-duration headache with pain lasting less than 4 hours. Time frames of longer than 4 hours would not describe a cluster headache.

Prodrome phase The prodrome phase of a migraine headache is when the patient develops an aura and experiences visual disturbances such as flashing lights and double vision, along with numbness or tingling of the lips. The second phase of the migraine is accompanied with nausea and vomiting; the third phase is when the throbbing pain begins to dull. The termination phase is when the intensity of the headache decreases.

what is used to diagnose meningitis?

analysis of the CSF

most seizures can be completely or almost completely controlled through the admin of

antiepileptic drugs

The client is admitted to the hospital with a diagnosis of Guillain-Barré syndrome. Which past medical history finding makes the client most at risk for this disease?

Respiratory or gastrointestinal infection during the previous month

Describe Secondary Epilepsy

Result from an underlying brain lesion, most commonly tumor or trauma.

A patient has a callus of the foot. What treatment does the nurse anticipate for this patient?

application of padding and lanolin cream

The nurse observes that a patient has an ingrown toenail that is hindering the patient's ambulation. What treatments does the nurse suggest for this patient? Select all that apply.

Soaking the foot in warm water Applying antibiotic ointment

The nurse observes that a patient has an ingrown toenail that is hindering the patient's ambulation. What treatments does the nurse suggest for this patient? Select all that apply.

Soaking the foot in warm water applying antibiotic ointment

The nurse is completing an admission assessment on a patient scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider?

Warm, red, and swollen knee

The nurse is assigned to care for an 8-year old child with a diagnosis of a basilar skull fracture. The nurse reviews the HCPs prescription and show contact the HCP to question which prescription?

Suction as needed

The nurse is caring for a patient during an episode of complete partial seizure. Which action made by the nurse would be beneficial in providing safe and effective care to this patient?

Suctioning oral secretion Suctioning the oral secretions will help to maintain the patient's airway. The nurse should refrain from stopping the patient's movements altogether, but should try to guide the patient's movements instead. The nurse should not force anything into the patient's mouth during a seizure episode because it may lead to aspiration. The patient should be turned to the side to keep the airways clear, but should not be placed in the supine position.

A client with severe varicose veins has surgery that involves ligation, dissection, and removal of incompetent vessels. In which position should the nurse place the client after surgery?

Supine with the legs elevated at a 15-degree angle

what is now being used to treat seizures?

THC

The nurse has instructed the family of a client with stroke (brain attack) who has homonymous hemianopsia about measures to help the client overcome the deficit. Which statement suggests that the family understands the measures to use when caring for the client?

We need to remind him to turn his head to scan the lost visual field.

Which finding helps in assessing the motor changes of a patient with carpal tunnel syndrome (CTS)?

muscle weakness

A client sustains a fractured right femur after an automobile accident and is admitted to the hospital's emergency department. Which assessment is the priority?

Take the client's pedal pulse in the affected extremity.

Which instructions would the nurse give to a patient with osteoporosis who has been prescribed alendronate? Select all that apply.

Take the medication early in the morning with 8 ounces of water. Remain upright for 30 minutes after taking the medication. Discontinue the medication if chest discomfort develops

For the patient taking beta blockers or calcium channel blockers for migraine headache management, which teaching point should the nurse include in the treatment plan?

Take your pulse rate daily and report bradycardia." Calcium channel blockers and beta blockers can slow the heart rate significantly. The patient should monitor his or her pulse rate daily. The drugs do not cause muscle pain, nor do they deplete potassium, so there is no need to increase potassium intake or report muscle pain. Fluid does not need to be restricted to a level of less than 500 mL per day.

Why is carpal tunnel syndrome (CTS) beginning to be found in much younger patients than previously?

`the use of handheld mobile devices has increased among children

A patient's short-leg cast has been removed. What should the nurse teach the patient about caring for the extremity after cast removal?

apply elastic bandages around the extremity

A nurse delegates care for a client with Parkinson disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care? a. "Allow the client to be as independent as possible with activities." b. "Assist the client with frequent and meticulous oral care." c. "Assess the client's ability to eat and swallow before each meal." d. "Schedule appointments early in the morning to ensure rest in the afternoon."

a

A nurse obtains a focused health history for a client who is suspected of having bacterial meningitis. Which question should the nurse ask? a. "Do you live in a crowded residence?" b. "When was your last tetanus vaccination?" c. "Have you had any viral infections recently?" d. "Have you traveled out of the country in the last month?"

a

The nurse is assigned to care for a client with complete right-sided hemiparesis. Which characteristics are associated with this condition? Select all that apply.

The client is aphasic, the client has weakness in the face and tongue, the client has weakness on the right side of the body

A patient with a torn meniscus has undergone a meniscectomy. What intervention will prevent swelling? Select all that apply.

apply ice elevate the leg with one or two pillows

Nephrolithiasis (The formation of nephroliths (stones) in the kidney is called nephrolithiasis. It is characterized by severe, intermittent pain from the flank to the groin in the right side and is caused by calcium supplementation. Diverticulitis is the inflammation of diverticulum, especially in the colon, and is manifested as a similar pain, but on the left side. Appendicitis and pyelonephritis are associated with inflammation and are not a cause for pain in the flank to the groin. )

The medical history of a patient reporting severe intermittent pain from the flank to the groin on the right side shows that the patient is osteoporotic and is on calcium supplements. Which condition should the nurse anticipate?

"I should go to sleep immediately after taking the drug." (Oral bisphosphonates can cause stomach upset, inflammation, and erosions of the esophagus. This can be prevented by remaining upright for 30 to 60 minutes after taking the medication. Oral hygiene should be maintained as long as the drug is taken. Patients taking bisphosphonates are more prone to develop osteonecrosis of the jaw, so invasive surgical procedures are to be avoided. The drug should be stopped 3 months prior to any invasive dental treatment to prevent complications.)

The nurse completes a teaching session on safe drug administration for a patient with Paget's disease taking oral bisphosphonates. Which patient statement indicates a need for further teaching?

Temperature above 101° F Swelling around the affected area Erythema around the affected area Pulsating pain that worsens with movement

The nurse is assessing a patient diagnosed with ACUTE osteomyelitis. What features of this disorder does the nurse expect to find? Select all that apply.

Ulceration of the skin resulting in a sinus tract Drainage from the affected area

The nurse is assessing a patient diagnosed with CHRONIC osteomyelitis. What features of this disorder does the nurse expect to find?

Hypophosphatemia Looser's lines or zones Unsteady gait (Osteomalacia is loss of bone related to vitamin D deficiency, which can lead to bone softening and inadequate deposits of calcium and phosphorus in the bone matrix; this may cause hypophosphatemia. Looser's lines or zones (radiolucent bands) represent stress fractures and are a classic diagnostic finding of osteomalacia. Muscle weakness in the lower extremities may cause waddling and an unsteady gait.)

The nurse is assessing a patient with osteomalacia. Which findings does the nurse expect to observe?

Hyperparathyroidism and hyperuricemia

The nurse is assessing a patient with pagets disease. Which findings does the nurse expect to observe?

Perform range of motion exercises and gentle stretching

The nurse is caring for a patient with Paget's disease. What interventions does the nurse suggest to the patient to promote bone health?

ergocalciferol (Osteomalacia is loss of bone related to vitamin D deficiency. The major treatment for osteomalacia is vitamin D in an active form such as ergocalciferol.)

The nurse is caring for an older adult patient diagnosed with osteomalacia. The nurse anticipates that the health care provider will request which medication?

Improve the quality of life and promote pain relief

The nurse is developing a plan of care for a patient with metastatic bone cancer. What is an appropriate goal of treatment to include in the plan of care for this patient?

"Take calcium citrate with food." (Calcium supplements can cause gastric upset; taking calcium citrate with food can minimize gastric upset. Calcium citrate should be taken with 6-8 ounces of water, not carbonated beverages. One-third of the daily dose is best taken at bedtime. MOM is not indicated and actually may lead to decreased absorption of calcium citrate.)

The nurse is instructing a patient who has been prescribed calcium citrate. Which instruction does the nurse include?

It affects women twice as often as it affects men. (Osteitis deformans, or Paget's disease, is a chronic metabolic disorder of the bone. Men are affected twice as often as women. It may present as low back pain and sciatic nerve pain due to nerve impingement in the lumbosacral area of the vertebral column. Paget's disease may cause secondary hyperparathyroidism that leads to increased levels of serum and urinary calcium. This in turn results in calcium deposits as renal or urinary calculi. Bones affected by Paget's disease may rarely develop malignant changes such as osteogenic sarcoma. Paget's disease is characterized by rapid bone destruction (osteoclastic activity) followed by bone regeneration (osteoblastic activity).)

The nurse is teaching a group of nursing students about osteitis deformans. What statement made by a student nurse indicates the need for further instruction?

Milk eggs tofu liver

The nurse is teaching a patient ways to increase vitamin D in the diet using natural foods (unfortified). Which food choices indicate the patient understands the teaching?

An 80-year-old patient experiencing severe pain in the lower jaw is diagnosed with acute osteomyelitis. Which symptom may be least likely found?

body temperature of 102 F

Paget's disease (The most common site of occurrence of Paget's disease is the region of hips and pelvis. The localized flushing and warmth is due to increased blood flow due to the formation of highly vascular, structurally weak bone. Paget's disease is characterized by elevated levels of serum ALP and urinary hydroxyproline. In osteoporosis, the ALP levels are not elevated. In osteomalacia and osteopetrosis, there is no hyper-perfusion (flushing of blood) in the region of pathology.)

The nurse observes warm and flushed skin over the pelvic region of a patient reporting pain in the pelvic region. The lab investigations reveal elevated serum alkaline phosphatase (ALP), serum uric acid, and urinary hydroxyproline levels. What does the nurse infer about the diagnosis?

The nurse is reviewing the risk factors for Dupuytren contracture with a patient. Which finding causes the nurse to believe the patient may be at risk for developing this condition?

The patient has diabetes.

The nurse is assessing a patient with scoliosis. What does the degree of curvature of the spine in scoliosis signify? Select all that apply.

The spine is unstable if the curvature is over 50 degrees Cardiopulmonary function is compromised if curvature is more than 60 degrees Patients are prescribed exercises if curvature is less than 50 degrees

Increased uric acid levels Increased alkaline phosphatase levels Increased urinary hydroxyproline levels

The x-ray of a patient shows a radiolucent appearance of bones in the pelvic region. Which other findings would confirm the diagnosis of Paget's disease?

Which are benefits of external fixation of an open fracture when compared to other surgical techniques? Select all that apply.

There is minimal blood loss compared with internal fixation. It carries a low risk for the development of pin-site infection. The device maintains alignment in closed fractures that will not maintain position in a cast. The device allows early ambulation and exercise of the affected body part while relieving pain.

Which are benefits of external fixation of an open fracture when compared to other surgical techniques? Select all that apply.

There is minimal blood loss compared with internal fixation. It carries a low risk for the development of pin-site infection. The device maintains alignment in closed fractures that will not maintain position in a cast. The device allows early ambulation and exercise of the affected body part while relieving pain.

A patient whose fracture of the right ulnar bone was immobilized in a cast for nearly 8 weeks reports swelling and pain in the right forearm. Why would the patient be advised to undergo bone mineral density (BMD) test?

To evaluate for secondary osteoporosis

As part of the treatment plan for a patient with decreased bone density, the nurse administers zoledronic acid. The nurse infuses the medication slowly over 20 minutes. Why is the medication given slowly?

To prevent atrial fibrillation

During a seizure episode, a patient experiences rigidity of the muscles and an immediate loss of consciousness that lasts for several minutes. Which type of seizure did the patient have?

Tonic seizure Rigidity of the muscles and an immediate loss of consciousness for several minutes occur in tonic seizures. Clonic seizures last for several minutes and causes muscle contraction and relaxation. In an atonic seizure, the patient has a sudden loss of muscle tone, lasting for seconds, followed by confusion after the seizure. Complex partial seizures may cause a loss of consciousness or a black out for one to three minutes.

The nurse uses different noninvasive techniques to assess the viability of a patient's limb. What statement about these techniques is accurate?

Transcutaneous oxygen pressure is reliable for predicting healing.

Meperidine hydrochloride (Demerol) has been prescribed for a client to treat pain. What are side/adverse effects of this medication? Select all that apply.

Tremors, drowsiness, hypotension

T/F: Classic Hemophilia and Christmas Disease are both clinically identical

True

T/F: In DIC, clotting and anticlotting mechanisms occur at the same time

True

A nurse witnesses a client with late-stage Alzheimer's disease eat breakfast. Afterward the client states, "I am hungry and want breakfast." How should the nurse respond? a. "I see you are still hungry. I will get you some toast." b. "You ate your breakfast 30 minutes ago." c. "It appears you are confused this morning." d. "Your family will be here soon. Let's get you dressed."

a

Which individual has the highest chance of developing carpal tunnel syndrome (CTS)?

a 60-year-old female

Which patient is at the highest risk for a fatigue fracture?

a patient who runs every day

Thin build with low body weight Parental history of osteoporosis Chronic low calcium and vitamin D intake

What are the risk factors for PRIMARY osteoporosis? Select all that apply.

can cause bone infection leading to osteomyelitis

What disease can pseudomonas aeruginosa lead to?

When can you use Heparin to treat DIC?

When bleeding is not controlled by plasma and platelets

Caucasian population (Caucasians are white skinned European-Americans. Due to less melanin content of the skin, the conversion of previtamin D to vitamin D in the presence of sunlight is more robust. People with lactose intolerance or those following a strict vegan diet who do not consume dairy products may develop osteomalacia. Long-term hospitalized individuals are not exposed to sunlight and are at risk of developing osteomalacia.)

Which group has the least risk of developing osteomalacia?

Calcitriol (Calcidiol is converted to the metabolite calcitriol in the kidneys, where the calcitriol directly regulates the calcium levels in circulation. Calcitriol promotes absorption of dietary calcium from the gastrointestinal tract, increasing renal tubular reabsorption. Cholecalciferol is converted to calcidiol in the liver. Vitamin D has two important groups, vitamin D2, called ergocalciferol, and vitamin D3, known as cholecalciferol.)

Which is the hormonally active metabolite of vitamin D that directly regulates serum calcium levels?

Instructing the patient to brush teeth after every meal (Proper dental hygiene helps prevent periodontal infection, which can be a causative factor in osteomyelitis of the facial bone. Long-term IV catheters can be a primary source of infection, so dressing changes are done using sterile technique. All patients undergoing hemodialysis require careful sterile technique before needle cannulation. Standard Precautions should be used for all patients.)

Which nursing intervention helps to prevent the incidence of osteomyelitis for a patient receiving hemodialysis?

A nurse assesses clients on a medical-surgical unit. Which clients should the nurse identify as at risk for secondary seizures? (Select all that apply.) a. A 26-year-old woman with a left temporal brain tumor b. A 38-year-old male client in an alcohol withdrawal program c. A 42-year-old football player with a traumatic brain injury d. A 66-year-old female client with multiple sclerosis e. A 72-year-old man with chronic obstructive pulmonary disease

a,b,c

A nurse assesses a client who is experiencing a cluster headache. Which clinical manifestations should the nurse expect to find? (Select all that apply.) a. Ipsilateral tearing of the eye b. Miosis c. Abrupt loss of consciousness d. Neck and shoulder tenderness e. Nasal congestion f. Exophthalmos

a,b,e

A nurse is caring for a client with meningitis. Which laboratory values should the nurse monitor to identify potential complications of this disorder? (Select all that apply.) a. Sodium level b. Liver enzymes c. Clotting factors d. Cardiac enzymes e. Creatinine level

a,c

A nurse evaluates the results of diagnostic tests on a client's cerebrospinal fluid (CSF). Which fluid results alerts the nurse to possible viral meningitis? (Select all that apply.) a. Clear b. Cloudy c. Increased protein level d. Normal glucose level e. Bacterial organisms present f. Increased white blood cells

a,c,d

A nurse plans care for a client with epilepsy who is admitted to the hospital. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Have suction equipment at the bedside. b. Place a padded tongue blade at the bedside. c. Permit only clear oral fluids. d. Keep bed rails up at all times. e. Maintain the client on strict bedrest. f. Ensure that the client has IV access.

a,d,f

A nurse assesses a client who has encephalitis. Which manifestations should the nurse recognize as signs of increased intracranial pressure (ICP), a complication of encephalitis? (Select all that apply.) a. Photophobia b. Dilated pupils c. Headache d. Widened pulse pressure e. Bradycardia

b,d,e

seizure

abnormal, sudden, excessive, uncontrolled electrical discharge of neurons resulting in alteration in consciousness, motor or sensory ability, or behavior

what are some types of therapies used?

abortive and preventive therapy

A patient with a pelvic fracture is advised to undergo external fixation. Which part of the pelvis might have been involved in the fracture?

acetabulum

A primary health care provider advises a patient to avoid wearing high heels. Which traumatic condition does the nurse suspect in the patient?

achilles tendinopathy

Which condition is effectively treated with rest, ice, compression, and elevation (RICE)?

achilles tendinopathy

A patient who recently suffered a broken tibia presents with edema, a great deal of pain, pale skin, and a weakened pulse. Upon palpation, the area is noted to be tense. What is most likely the concern?

acute compartment syndrome

Which bone fracture complication is also known as ischemia-edema cycle?

acute compartment syndrome

A basketball player falls, landing on the outstretched right hand. The player reports feeling a popping sensation upon impact, and now the area of the injury is bruised and swollen. Based on this information, what does the team medical staff most likely direct the player to do in the first 48 hours following the injury?

apply ice and use compression

The nurse observes that a patient has an ingrown toenail that is hindering the patient's ambulation. What treatments does the nurse suggest for this patient? Select all that apply.

applying antibiotic ointment, and soaking the foot in warm water

The nurse is caring for a patient who underwent kyphoplasty. Which nursing intervention is beneficial to the patient?

applying ice pack to the insertion site

Which part of the body is affected by plantar fasciitis?

arch of the foot

The nurse is creating a nursing plan for management of a pelvic fracture. For which complications will the nurse monitor this patient? Select all that apply.

arterial bleeding; blood volume loss; abdominal rigidity; blood in urine and stool

A patient has undergone surgery on a lower extremity for a primary bone tumor. What intervention does the nurse perform for this patient?

assess neurovascular status of the extremity every 1 to 2 hours after the surgery

The nurse prepares to perform a neurovascular assessment on a patient with closed multiple fractures of the right humerus. Which technique does the nurse use?

assess sensation of the right upper extremity

A patient's left arm is placed in a plaster cast. Which assessment does the nurse perform before the patient is discharged?

assess that the cast is dry

What is the first step in emergency care of a patient with an extremity fracture?

assessing the patient's airway, breathing, and circulation

what can it be accompanied by?

associated symptoms - nausea, sensitivity to light or sound, or head movement

A nurse assesses a client after administering prescribed levetiracetam (Keppra). Which laboratory tests should the nurse monitor for potential adverse effects of this medication? a. Serum electrolyte levels b. Kidney function tests c. Complete blood cell count d. Antinuclear antibodies

b

A nurse assesses a client with Huntington disease. Which motor changes should the nurse monitor for in this client? a. Shuffling gait b. Jerky hand movements c. Continuous chewing motions d. Tremors of the hands

b

A nurse assesses a client with a history of epilepsy who experiences stiffening of the muscles of the arms and legs, followed by an immediate loss of consciousness and jerking of all extremities. How should the nurse document this activity? a. Atonic seizure b. Tonic-clonic seizure c. Myoclonic seizure d. Absence seizure

b

A nurse cares for a client who has been diagnosed with the Huntington gene but has no symptoms. The client asks for options related to family planning. What is the nurse's best response? a. "Most clients with the Huntington gene do not pass on Huntington disease to their children." b. "I understand that they can diagnose this disease in embryos. Therefore, you could select a healthy embryo from your fertilized eggs for implantation to avoid passing on Huntington disease." c. "The need for family planning is limited because one of the hallmarks of Huntington disease is infertility." d. "Tell me more specifically what information you need about family planning so that I can direct you to the right information or health care provider."

b

A nurse cares for a client who is experiencing status epilepticus. Which prescribed medication should the nurse prepare to administer? a. Atenolol (Tenormin) b. Lorazepam (Ativan) c. Phenytoin (Dilantin) d. Lisinopril (Prinivil)

b

A nurse cares for a client with advanced Alzheimer's disease. The client's caregiver states, "She is always wandering off. What can I do to manage this restless behavior?" How should the nurse respond? a. "This is a sign of fatigue. The client would benefit from a daily nap." b. "Engage the client in scheduled activities throughout the day." c. "It sounds like this is difficult for you. I will consult the social worker." d. "The provider can prescribe a mild sedative for restlessness."

b

A nurse is teaching a client who experiences migraine headaches and is prescribed a beta blocker. Which statement should the nurse include in this client's teaching? a. "Take this drug only when you have prodromal symptoms indicating the onset of a migraine headache." b. "Take this drug as ordered, even when feeling well, to prevent vascular changes associated with migraine headaches." c. "This drug will relieve the pain during the aura phase soon after a headache has started." d. "This medication will have no effect on your heart rate or blood pressure because you are taking it for migraines."

b

A nurse obtains a health history on a client prior to administering prescribed sumatriptan succinate (Imitrex) for migraine headaches. Which condition should alert the nurse to hold the medication and contact the health care provider? a. Bronchial asthma b. Prinzmetal's angina c. Diabetes mellitus d. Chronic kidney disease

b

A nurse witnesses a client begin to experience a tonic-clonic seizure and loss of consciousness. Which action should the nurse take? a. Start fluids via a large-bore catheter. b. Turn the client's head to the side. c. Administer IV push diazepam. d. Prepare to intubate the client.

b

A nurse is teaching a client who has chronic headaches. Which statements about headache triggers should the nurse include in this client's plan of care? (Select all that apply.) a. "Increase your intake of caffeinated beverages." b. "Incorporate physical exercise into your daily routine." c. "Avoid all alcoholic beverages." d. "Participate in a smoking cessation program." e. "Increase your intake of fruits and vegetables."

b,d,e

A nurse assesses a client who is experiencing an absence seizure. For which clinical manifestations should the nurse assess? (Select all that apply.) a. Intermittent rigidity b. Lip smacking c. Sudden loss of muscle tone d. Brief jerking of the extremities e. Picking at clothing f. Patting of the hand on the leg

b,e,f

An 80-year-old patient experiencing severe pain in the lower jaw is diagnosed with acute osteomyelitis. Which symptom may be least likely found?

body temperature of 102 degrees F

What is the most common assessment finding associated with osteoporosis?

bone fractures

A nurse delegates care for a client with early-stage Alzheimer's disease to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating this client's care? a. "If she is confused, play along and pretend that everything is okay." b. "Remove the clock from her room so that she doesn't get confused." c. "Reorient the client to the day, time, and environment with each contact." d. "Use validation therapy to recognize and acknowledge the client's concerns."

c

A nurse is teaching a client with chronic migraine headaches. Which statement related to complementary therapy should the nurse include in this client's teaching? a. "Place a warm compress on your forehead at the onset of the headache." b. "Wear dark sunglasses when you are in brightly lit spaces." c. "Lie down in a darkened room when you experience a headache." d. "Set your alarm to ensure you do not sleep longer than 6 hours at one time."

c

A nurse is teaching the daughter of a client who has Alzheimer's disease. The daughter asks, "Will the medication my mother is taking improve her dementia?" How should the nurse respond? a. "It will allow your mother to live independently for several more years." b. "It is used to halt the advancement of Alzheimer's disease but will not cure it." c. "It will not improve her dementia but can help control emotional responses." d. "It is used to improve short-term memory but will not improve problem solving."

c

A nurse prepares to discharge a client with Alzheimer's disease. Which statement should the nurse include in the discharge teaching for this client's caregiver? a. "Allow the client to rest most of the day." b. "Place a padded throw rug at the bedside." c. "Install deadbolt locks on all outside doors." d. "Provide a high-calorie and high-protein diet."

c

A nurse assesses a client who is recovering from the implantation of a vagal nerve stimulation device. For which clinical manifestations should the nurse assess as common complications of this procedure? (Select all that apply.) a. Bleeding b. Infection c. Hoarseness d. Dysphagia e. Seizures

c,d

triad of dominant inheritance or huntingtons disease

choreiform movements (rapid, jerky movements) dementia

example of drug therapy used for PD?

cinemet - replacement of dopamine

priority concepts in this chapter are

cognition mobility

rigidity assessment

cogwheel, plastic, lead pipe

interrelated concept

comfort

what are some other therapies used for migraines?

complementary adn alternative therapies such as yoga, meditation, massage, exercise, biofeedback, ice, darkened room, relaxation

A 73-year-old patient is being discharged after falling and fracturing the radius and ulna. What can the nurse tell the patient regarding the length of healing time?

complete healing may last three months or longer

A nurse is assessing a perimenopausal patient's musculoskeletal system. The nutrition history is especially important because women generally do not get enough of which nutrient in their diet?

calcium

The patient has a flat, poorly defined mass on the sole of the foot. What does this patient most likely have?

callus

A nurse is monitoring the blood pressure of a patient with gout. Upon inflating the cuff, the patient experiences pain and numbness in the wrist. Which musculoskeletal injury does the nurse suspect in the patient?

carpal tunnel syndrome (CTS)

A patient who had an open reduction of the ankle complains of intense, burning pain. The primary health care provider instructs the nurse to intravenously administer phentolamine. What condition is the health care team likely treating?

complex regional pain syndrome (CRPS)

The nurse is caring for a patient after a fracture. Which complication of fractures manifests as a clinical triad of sensory perception abnormalities, motor dysfunction such as paresis and muscle spasm, and autonomic nervous system abnormalities?

complex regional pain syndrome (CRPS)

Which complication resulting from a fracture might necessitate the use of an implanted device to block pain perception?

complex regional pain syndrome (CRPS)

Which type of fracture extends through the skin?

compound

Which category of osteomyelitis is related to a bone infection that is caused by a skin infection of the adjacent tissues?

contiguous

What is a Dupuytren's contracture?

contracture of the hand due to palmar fibromatosis

A nurse is providing care for a newly admitted patient diagnosed with progressive muscular dystrophy. Which laboratory test does the nurse expect to be elevated?

creatinine kinase

An 80-year-old patient with uncontrolled hypertension reports pain in the right foot and is diagnosed with a hallux valgus deformity. What is the most appropriate treatment?

custom-made shoes

A nurse plans care for a client with Parkinson disease. Which intervention should the nurse include in this client's plan of care? a. Ambulate the client in the hallway twice a day. b. Ensure a fluid intake of at least 3 liters per day. c. Teach the client pursed-lip breathing techniques. d. Keep the head of the bed at 30 degrees or greater.

d

After teaching a client newly diagnosed with epilepsy, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I will wear my medical alert bracelet at all times." b. "While taking my epilepsy medications, I will not drink any alcoholic beverages." c. "I will tell my doctor about my prescription and over-the-counter medications." d. "If I am nauseated, I will not take my epilepsy medication."

d

After teaching a client who is diagnosed with new-onset status epilepticus and prescribed phenytoin (Dilantin), the nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching? a. "To prevent complications, I will drink at least 2 liters of water daily." b. "This medication will stop me from getting an aura before a seizure." c. "I will not drive a motor vehicle while taking this medication." d. "Even when my seizures stop, I will continue to take this drug."

d

After teaching the wife of a client who has Parkinson disease, the nurse assesses the wife's understanding. Which statement by the client's wife indicates she correctly understands changes associated with this disease? a. "His masklike face makes it difficult to communicate, so I will use a white board." b. "He should not socialize outside of the house due to uncontrollable drooling." c. "This disease is associated with anxiety causing increased perspiration." d. "He may have trouble chewing, so I will offer bite-sized portions."

d

A nurse prepares to provide perineal care to a client with meningococcal meningitis. Which personal protective equipment should the nurse wear? (Select all that apply.) a. Particulate respirator b. Isolation gown c. Shoe covers d. Surgical mask e. Gloves

d,e

Which are initial nursing interventions for a patient with a distal radius fracture? Select all that apply.

elevate, immobilize, remove any jewelry on the affected side; perform a neurovascular assessment on the upper extremity

self-management education

emphasize mobility

Which term describes a benign tumor arising from cartilage?

endochondroma

A patient has a short-leg cast following a fracture of the ankle. What does the nurse teach the patient about managing the fracture?

elevate the affected leg on several pillows

priority collaborative problems with PD include

decreased mobility (and possible self-care deficit) related to muscle rigidity, tremors, and postural instability potential for decreased self-esteem related to impaired cognition, tremors, and self-care deficit

In a patient with compartment syndrome, what is the physiologic change that causes pallor?

decreased oxygen to tissues

Alzheimers is the most common type of what?

dementia

patients can also develop emotional changes such as...

depression, irritability, pessimism, fear, and insecurity

Which is one of the causes of secondary osteoporosis?

diabetes mellitus

A patient with plantar fasciitis reports increasing pain. Inflammation is observed during the patient's physical assessment of the foot. According to the patient and the medical record, the patient has tried treating the condition with nonsteroidal antiinflammatory drugs and steroids, but all measures have been unsuccessful. The patient does not want endoscopic surgery to remove the inflamed tissue. What else can the nurse suggest to the patient for possible relief and comfort? Select all that apply.

doing stretching exercises, resting and icing the foot, and wearing shoes with orthodotics

if you have bacterial meningitis, what are the precautions?

droplet precautions and standard precautions

be aware of what?

drug-drug, drug-food interactions

Which is the most commonly used screening and diagnostic tool for measuring bone mineral density?

dual x-ray absorptiometry

Which disorder affects the hand or part of the hand?

dupuytren contracture

Upon performing a physical examination of a patient, the nurse observes that the ring finger and the little finger are bent toward the palm and cannot be extended. What condition does this finding indicate?

dupuytrens contracture

The nurse is caring for a patient with complex regional pain syndrome (CRPS). Which clinical sign of CRPS is a manifestation of autonomic nervous system dysfunction seen in this complication?

edema

A patient who underwent therapy for carpal tunnel syndrome (CTS) reports prolonged periods of pain and numbness. Which therapeutic procedure is associated with recovery from this procedure?

endoscopic carpal tunnel release (ECTR)

The nurse is caring for a patient with Buck's traction. What care should the nurse provide for this patient?

ensure the weights are freely hanging at all times

A patient is in traction after a major leg injury. What nursing care is necessary for the patient? Select all that appl

ensure the weights are freely hanging at all times; inspect the traction equipment every 8-12 hours

although the cause is unknown, it may be due to...

environmental and genetic factors

what are the main priorities

establish airway ABG's IV push lorazepam, diazepam rectal diazepam loading dose IV phenytoin

what is needed to decrease risks?

evaluation of employment safety

how can you promote this?

exercise programs physical therapy drug therapy surgical management

The nurse is caring for a patient with an open wound from chronic osteomyelitis. How does the nurse ensure that this patient receives increased tissue perfusion?

exposing the affected area to a high concentration of oxygen

what are some known risk factors?

exposure to pesticides, herbicides, industrial chemical, and metals, age over 40, reduced estrogen levels

what are some symptoms common with seizures?

eyes roll back drool urine/bowel incontinence sweat diaphoretic

A 40-year-old patient who is 36 hours into recovering from a fractured pelvis begins experiencing hypoxemia, dyspnea, and tachypnea. For which complication should the nurse first assess the patient?

fat embolism

When differentiating between fat embolism and blood clot embolism, which statement is true?

fat embolism is more likely to occur with fractures of the long bones

A 30-year-old patient suffers a pelvic fracture. His partial oxygen concentration (PaO 2) drops to 70 mm Hg. There is an increase in the erythrocyte sedimentation rate (ESR) and serum lipid levels. The serum calcium level drops to 7 mg/dL. Which complication should the nurse suspect?

fat embolism syndrome (FES)

Athletes are likely to experience which type of fracture?

fatigue

Which is a key feature of acute osteomyelitis?

fever

which is a key feature of acute osteomyelitis

fever

Which stage of bone healing occurs in a patient 3 days to 2 weeks after a fracture?

fibrocartilage formation

symptoms?

flu-like, fever, headache

Which part of the body does the hallux valgus deformity affect?

foot

A nurse is preparing a presentation on carpal tunnel syndrome (CTS) to be given to a group of employees in an office. Which statement does the nurse need to revise before finalizing the presentation?

for the most appropriate positioning, set the height of your chair 30 in away from the floor

seizure precautions

for those who have had one or more seizures have 02 suctioning IV access siderails up at all times

and never do what?

force anything into the patients mouth

What complication of osteomyelitis is the most likely to occur?

formation of bone abscesses

A patient has a fractured tibia. Arrange the stages of bone healing in the order they occur.

formation of hematoma; formation of fibrocartilage; formation of callus; resorption of callus; consolidation and remodeling

Which fingers are affected by Dupuytren contracture?

fourth and fifth fingers

A patient has a Buck extension traction. What type of injury does the patient most likely to have?

fracture of the hip before surgery

Which musculoskeletal trauma occurs after minimal trauma to a bone that has been weakened due to disease?

fragility fracture

What causes corns?

friction

what causes corns?

friction

A surgical repair was done shortly after injury in a patient with a rotator cuff injury using arthroscopy. What could a presurgical magnetic resonance imaging (MRI) of the shoulder reveal?

full-thickness tear

The nurse meets with a patient who reports having a ganglion. Which part of the body will the nurse inspect?

ganglion

What is a round, benign cyst that is often found on the wrist?

ganglion

Which term is used to describe a round, benign cyst, often found on a wrist or foot joint or tendon?

ganglion

Seizures

generalized - entire brain partial - only one side of the brain unclassified

The nurse is discussing treatment options with a patient who has a bunion. The patient is not a candidate for surgery. What does the nurse discuss with the patient?

getting custom shoes made to fit the deformity

The nurse plans to use which tool to measure joint range of motion (ROM)?

goniometer

Which occupational activity predisposes a person to carpal tunnel syndrome (CTS)?

grasping during wrist flexion

bacterial

highly contagious, high mortality rate for the first 24 hours

care coordination and transition management

home care preparation self-management education health care resources

Which topics are included in patient teaching following a leg amputation? Select all that apply.

how to wrap the limb; range-of-motion exercises; how to turn independently if possible; exercises to prepare the limb for prosthesis; how to inspect the area for signs of inflammation or skin breakdown

Which term is related to the presence of excess serum calcium?

hypercalcemia

The nurse is educating a group of people at a community center about emergency care for physical trauma. What should the nurse teach this group? Select all that apply.

immobilize the extremity; cut the clothing over the affected area; call 911 then assess for airway, breathing, and circulation

The nurse is developing a plan of care for a patient with metastatic bone cancer. What is an appropriate goal of treatment to include in the plan of care for this patient?

improve the quality of life and promote pain relief

anomia

inabaility to find words

prosopagnosia

inability to recognize oneself and other familiar faces

aphasia

inability to speak or understnad

apraxia

inability to use words or objects correctly

Which type of fracture does not divide the bone into two portions because the break is through only part of the bone?

incomplete

bowel and bladder changes

incontinent - q2h

what may occur with meningitis?

increased ICP as a result of blockage of the flow of CSF, change in cerebral blood flow, or thrombus ormation

Which physiologic change related to compartment syndrome is responsible for symptoms of flexed posture and unequal pulses in a patient?

increased production of lactic acid

A student nurse is caring for an older adult who is recovering from hip replacement. The patient has recently spiked a high temperature and appears confused. For which complication should the nurse assess this patient?

infection

meningitis

infection of the brain

encephalitis

infection of the brain caused by herpes simplex virus

Which complications can result from a fracture? Select all that apply.

infection; hemorrhage; crush syndrome; acute compartment syndrome

encephalitis

inflammtion of the brain tissue and often the surrounding meninges, affecting the cerebrum, the brainstem, adn the cerebellum

Which nursing intervention helps prevent the incidence of osteomyelitis in a patient receiving hemodialysis?

instructing the client to brush teeth after every meal

The nurse uses a hand brace to immobilize the wrist of a patient who has undergone surgery for carpal tunnel syndrome. What should the nurse explain to the patient about the hand brace?

it helps to provide relief from pain

The nurse manager is observing a nurse caring for a patient after surgery for carpal tunnel release. Which statement made by the nurse requires correction?

it's important for you to keep your fingers as still as possible the first day after surgery

An older adult patient has had a right open reduction and internal fixation (ORIF) of a fractured hip. Which intervention does the nurse implement for this patient?

keep the patient's heels off the bed at all times

How is Dowager's hump formed?

kyphosis of the spine

When checking a patient with fractures, a wound, and extensive soft tissue damage for signs of infection, which results indicate that there is no infection present? Select all that apply.

lack of fever, negative wound culture, no increase in white blood cell count

Describe Tonic-Clonic Seizure

lasting 2-5 minutes, LOC and immediate stiffening or rigidity of muscles (arms & legs).

The nurse is assessing a patient with Ewing's sarcoma. Which finding does the nurse expect to observe?

leukocytosis

A patient with myoclonic seizures is receiving clonazepam therapy. Which parameters should the nurse monitor in this patient for safe and effective care?

liver enzyme Clonazepam medication causes a decrease in the liver's function, so liver enzymes should be monitored. Oxcarbazepine, which is the preferred drug for partial seizures, may cause hyponatremia. Therefore, sodium levels should be monitored in patients who are on oxcarbazepine. Clorazepate may cause changes in a patient's blood pressure, so, BP should be monitored in patients taking this drug. Leucopenia is an adverse effect of carbamazepine. Therefore, CBC should be monitored in the patient who is on this drug.

Which is a key feature of acute osteomyelitis?

localized pain

major drugs used for status epilepticus

lorazepam and diazepam

What is the major concern related to pelvic injury?

loss of blood volume

agnosia

loss of sensory comprehension

What is an early manifestation of fat embolism syndrome?

low arterial oxygen

you need to what to the environment?

make it safe well lit non-skid strips rubber stops on socks hand rails rugs

and what else may be used?

mannitol 20%

Carpal tunnel syndrome (CTS) occurs when which nerve in the wrist is compressed?

median

while symptoms of dementia can vary greatly, at least 2 of the following cognitive functions must be significantly impaired to be considered dementia

memory communication and language attention span or ability to focus and pay attention reasoning and judgement visual perception

you want to manage what?

memory and cognitive dysfunctiono

signs and symptoms?

memory loss inability to perform ADL's. communicate, feed themselves, control bowel and bladder, recognize others

An older adult patient is undergoing treatment for a fracture. Which pain medication must be avoided in this patient?

meperidine

seizures may result from what?

metabolic disorders - diabetes acute alcohol withdrawal electrolyte disturbances heart disease high fever - common in pediatric population stroke - due to absence of O2 substance abuse

The nurse is teaching a patient ways to increase vitamin D in the diet using natural foods (unfortified). Which food choices indicate the patient understands the teaching? Select all that apply.

milk tofu eggs liver

The nurse is teaching a patient ways to increase vitamin D in the diet using natural foods (unfortified). Which food choices indicate the patient understands the teaching? Select all that apply.

milk, tofu, eggs, and liver

diagnostic testing

mini-mental health assessment

what should you try to maintain?

mobility

what do you want to promote?

mobility and self-esteem independence

A patient has undergone a kyphoplasty. What discharge teaching should the nurse provide to the patient and family?

monitor the puncture site for infection

The brain is part off the CNS system that functions as the bodys center for controlling..

movement, sensation, and cognition

What intervention is most commonly used to treat strains?

muscle relaxant

The nurse is taking the medical history of a patient. Which patient statements indicate a likelihood of carpal tunnel syndrome (CTS)? Select all that apply.

my wrist and fingers feel numb; i have severe pain in my wrist at night; i don't have much sensation around my wrist

Which complication is associated with compartment syndrome?

myoglobinuria renal failure

The nurse plans to refer a patient diagnosed with osteoporosis to which community resource?

national osteoporosis foundation

GI symptoms

nausea and vomiting

lab and imaging?

no specific diagnostic tests

In Hemophilia A, bleeding time is ______ and coagulation time is _______

normal; prolonged

viral

not a specific causative agent, not contagous

what are some meds commonly used for migraines?

nubain and Vistaril nonsteriodals imatrex, propranolol

A patient with a rotator cuff injury has undergone surgery. During analgesia, the peripheral nerve was blocked. What complication may be seen in the patient?

numbing feeling of the arm

make sure to..

observe and document

To which resource should the nurse refer the patient to for upper extremity rehabilitation after trauma?

occupational therapy

Which nursing action is appropriate when a patient requests spiritual guidance during a preoperative assessment?

offer assistance to arrange for a hospital chaplain to talk with the patient before surgery

After rotator cuff surgery, when are pendulum exercises typically started?

on the third postoperative day

Which type of trauma increases a patient's risk for hospital-acquired infection?

open fracture

Which type of trauma increases a patient's risk for hospital-acquired infection?

open fractures

What manifestation is usually seen in fat embolism but not in blood clot embolism?

petechiae

A patient who has severe peripheral vascular disease resulting in an above-the-knee amputation two months ago describes intense burning pain, numbness and tingling. The patient reports the symptoms worsen with exhaustion and stress. What is the patient most likely experiencing?

phantom limb pain

Sensation that is felt in an amputated part immediately after surgery is known as which of the following?

phantom limb pain

Which medical term refers to bone infection caused by bacteria, viruses, or fungi?

osteomyelitis

A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the patient for which potential complications? Select all that apply.

osteomyelitis; fat embolism syndrome (FES); acute compartment syndrome (ACS)

What is the medical term for the bone disease caused by reduced blood flow to the bones in the joints?

osteonecrosis

Which chronic metabolic disease causes decreased bone density and possible fracture?

osteoporosis

Which condition is the biggest risk factor for hip fracture?

osteoporosis

seizure precautions

oxygen suction equipment airway IV access side rails up and padded

what should never be used?

padded tongue blades

what si the priority of care ?

pain management

Which motor clinical manifestation may be seen in a patient with complex regional pain syndrome (CRPS)?

paresis

The serum calcium level of a patient with a femoral fracture is 12 mg/dL. What type of fracture does the nurse suspect that the patient has?

pathologic fracture

priority can be...

patient safety

Which type of traction is used for strain or sprain in the lower back?

pelvic belt

A doctor is performing a closed reduction on a simple fracture. During the procedure, the nurse notices that the patient's end-tidal carbon dioxide levels falls to 30 mm Hg, and the respiratory rate calls to 10 breaths/minute. What is the best response?

rub the patient's sternum and encourage breathing

Which statement is true regarding the types of traction used for musculoskeletal trauma of the lower extremities?

russell's traction is used for fractures of the hip

health care resources

safe return program

what is the priority interprofessional care?

safety

what are the priorities when dealing with seizures?

safety airway look at clock to report how long lasted full body? one side? protect from injury

epilepsy

seizure disorder where pts have recurrent seizures

what are some physical manifestations of neurologic impairmennt that tend to occur late in the disease process?

seizures, tremors, ataxia

How is a partial-thickness tear generally manifested in a patient with a rotator cuff injury?

severe pain

what happens to the brain?

shrinks in size dead space around the brain into the skull

what position?

side lying position

what to document and report?

side/adverse effects

incidence and prevalence

significantly increases after 65 years of age

In which positions can the nurse assess a patient with a shoulder or upper arm fracture? Select all that apply.

sitting standing

In which positions can the nurse assess a patient with a shoulder or upper arm fracture? Select all that apply.

sitting, standing

When using a hand brace to treat carpal tunnel syndrome (CTS), the occupational therapist (OT) will often put the wrist in which position?

slight extension

bradykinesia

slow movement/no movement

Which type of fracture may occur when a person attempts to break a fall by landing on the heel of the hand when the wrist is flexed?

smith fracture

what can help assist with medication costs?

social service resources

Which fracture is most likely to be treated with implantation of a genetically engineered substance?

spine

A patient with bone cancer is most susceptible to what type of fracture?

spontaneous fracture

What is the excessive stretching of a ligament?

sprain

PD is separated into stages

stage 1 is mild progressing to stage 5 which is completely dependent

In which stage of bone healing is callus formed?

stage 3

In which stage of bone healing is callus formed?

stage three

Physical assessment

stages changes in cognition changes in behavior and personality changes in self-management skills

surgical management for PD?

stereotactic pallidotomy deep brain stimulation - for severe cases

What is the excessive stretching of a muscle or tendon?

strain

A patient is being educated on the prevention of carpal tunnel syndrome (CTS). What is a measure the nurse can suggest to help prevent CTS?

stretching the fingers periodically

Alzheimer's Disease pathophysiology

structural changes in the brain

Define Aura

sudden smell, noise, pain or any unusual sensation before seizure takes place.

What might be the consequence of early ambulation of a patient who underwent open reduction internal fixation (ORIF) surgery?

surgical site healing

emphasize to patients the importance off what?

taking their antiseizure meds as prescribed

The nurse is educating a patient who is scheduled for endoscopic carpal tunnel release (ECTR) surgery for carpal tunnel syndrome (CTS). Which statement made by the patient shows understanding of the procedure?

this surgery will require a small incision, but the pain might be worse than it would be with open surgery

The nurse is caring for a preoperative patient who is about to undergo a partial fasciectomy to treat Dupuytren contracture. The nurse ensures that the patient understands the procedure. Which statement made by the patient causes the nurse to do additional teaching?

this surgery will tighten the fascia in my hand

A patient sustains a tibial fracture, and a cast is applied. The primary health care provider advises that a window is cut on the cast. What is the objective of this action?

to inspect the skin

As part of the treatment plan for a patient with decreased bone density, the nurse administers zoledronic acid. The nurse infuses the medication slowly over 20 minutes. Why is the medication given slowly?

to prevent atrial fibrillation

what is the goal?

to treat with antiviral meds and resume function

Where does the nurse expect to find a conical mass, or corn, on the patient's body?

toe

what are the 4 cardinal symptoms?

tremors muscle rigidity postural instability bradykinesia

some patients have what...

triggers - caffeine, red wine, MSG

medication depends on what?

type of seizure

what does seizure management depend on?

type of seizure

Which finding does the nurse expect to observe in a patient with suspected common chronic osteomyelitis?

ulceration of skin

Which finding does the nurse expect to observe in a patient with suspected common chronic osteomyelitis?

ulceration of the skin

a patient is diagnosed with chronic osteomyelitis. What feature does the nurse expect to assess in the patient?

ulceration resulting in the sinus tract

what is the cause?

unknown

A patient is examined in a sitting or standing position for what type of fracture?

upper arm

A patient has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this patient's teaching plan?

use pain medication as prescribed to control pain

A patient has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement?

use strict aseptic technique when cleaning the site

reminiscence therapy

use this rather than reality orientation, acknowledge the patients feelings and concerns

deep brain stimulation

used for severe cases,

Cryoprecipitate and DDAVP can be used to treat

vW disease

surgical management for status epilepticus?

vagal nerve stimulation conventional surgical procedures anterior temporal lobe resection partial corpus callostomy

both calcium channel blockers and beta blockers are used in teh treatment of migraines by interfering with

vasodilation, which is a contributing cause of migraine pain

In a client who has vW disease, why would there be reduced levels of Factor 8?

von Willebrand factor carries Factor 8

Which is the best way to decrease the risk for osteoporosis in a patient who has just been diagnosed with the disease

walk for 30 minutes three times a week

do not administer what together?

warfarin and phenytoin

Which group of patients is most likely to experience carpal tunnel syndrome (CTS)?

women over 50