Exam #9

What assessment findings of the leg are consistent with a fracture of the femoral neck? A) Shortened, adducted, and externally rotated B) Shortened, abducted, and internally rotated C) Adducted and internally rotated D) Abducted and externally rotated

A) Shortened, adducted, and externally rotated With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? A) A bone biopsy B) Demineralization of the bone C) Increased and decreased areas of bone metabolism D) Elevated levels of alkaline phosphatase

A) A bone biopsy A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? A) Bisphosphonates B) Calcitonin C) Selective estrogen receptor modulators D) Anabolic agents

A) Bisophosphonates

To help assess a client's cerebral function, a nurse should ask: A) "Have you noticed a change in your memory?" B) "Have you noticed a change in your muscle strength?" C) "Have you had any problems with coordination?" D) "Have you had any problems with your eyes?"

A) Have you noticed a change in your memory? To assess cerebral function, the nurse should ask about the client's level of consciousness, orientation, memory, and other aspects of mental status. Questions about muscle strength help evaluate the client's motor system. Questions about coordination help her assess cerebellar function. Questions about eyesight help the nurse evaluate the cranial nerves associated with vision.

A nurse is aware that the strength and integrity of an individual's bones is dependent on a delicate balance between bone formation and bone resorption. Bone resorption is a primary function of: A) Osteoclasts B) Lamellae C) Osteocytes D) The endosteum

A) Osteoclasts Osteoclasts are multinuclear cells involved in dissolving and resorbing bone. Osteocytes are mature bone cells involved in bone maintenance. Lamellae are circles of mineralized bone matrix, and the endosteum is a thin, vascular membrane that covers the marrow cavity of long bones and the spaces in cancellous bone.

Which of the following is a hallmark of spinal metastases? A) Pain B) Nausea C) Fatigue D) Change in level of consciousness (LOC)

A) Pain

Which type of fracture is one in which the skin or mucous membrane extends to the fractured bone? A) Compound B) Complete C) Incomplete D) Simple

A) Compound A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin.

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate? A) A bone densitometry B) A bone scan C) An arthrocentesis D) An arthroscopy

D) An arthroscopy An arthroscopy is the internal inspection of the joint using an arthroscope. The physician can inspect the joint for injury or deterioration and can also complete therapeutic procedures such as removing bit of torn or floating cartilage. A bone densitometry estimates bone density. A bone scan is used to detect metastatic bone lesions, fractures, or inflammatory disorders. An arthrocentesis is the aspiration of synovial fluid. An arthrocentesis may be completed during an arthroscopy.

synarthrodial joint A)Between the vertebrae B) In the fingers C)At the hip D) Skull at the temporal and occipital bones

D) skull at the temporal and occipital point ( Immovable joint)

Hallux Vagus

bunion, abnormal enlargement of the joint at the base of the great toe

Kyphosis

increased forward curvature of the thoracic spine (osteoporosis)

A rapid, jerky, involuntary, and purposeless movement of the extremities or facial muscles is A) Akathisia B) Chorea C) Dyskinesia D) Paresthesia

B) Chorea

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures? A) Paresthesia and ischemia B) Hemorrhage and shock C)Paralytic ileus and a lacerated urethra D)Thrombophlebitis and infection

B) Hemorrhage and shock Hemorrhage and shock are two of the most serious consequences that may occur in a pelvic fracture

The nurse is caring for an older woman with a hip fracture. The nurse recognizes that an incorrect risk factor for hip fracture is: A) Anemia B) Muscular agility C) Female gender D) Osteoporosis

B) Muscular agility Muscular agility decreases the risk for hip fracture. The other choices are all risk factors for hip fracture.

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for? A) Lack of sleep and appetite B) Serous drainage C) Signs of depression D) Signs of shock

B) serous drainage When the client undergoes an invasive knee joint examination, the nurse should inspect the knee area for swelling, bleeding, and serous drainage. An invasive joint examination does not cause lack of sleep or appetite, depression, or shock. The client may be in shock due to the injury itself.

Which is a circulatory indicator of peripheral neurovascular dysfunction? A) Weakness B) Paresthesia C) Cool skin D) Paralysis

C) Cool skin Indicators of peripheral neurovascular dysfunction related to circulation include pale, cyanotic, or mottled skin with a cool temperature. The capillary refill is more than 3 seconds. Weakness and paralysis are related to motion. Paresthesia is related to sensation.

Dupuytren contracture causes flexion of which area(s)? A) Thumb B) Index and middle fingers C) Fourth and fifth fingers D) Ring finger

C) Fourth and fifth fingers Dupuytren contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger.

Which cells are involved in bone resorption? A) Chondrocytes B) Osteoblasts C) Osteoclasts D) Osteocytes

C) Osteoclasts

Ligament

Connects bone to bone

If a client has a lower motor neuron lesion, the nurse would expect the client to exhibit A) hyperactive reflexes. B) no muscle atrophy. C) muscle spasticity. D) decreased muscle tone.

D) Decreased muscle tone A client with a lower motor neuron lesion would be expected to have decreased muscle tone. Those with upper motor neuron lesions would have hyperactive reflexes, no muscle atrophy, and muscle spasticity.

A client is admitted to the hospital for a fracture of the right femur. Which clinical manifestation supports the diagnosis? A) Swelling of the right leg B) Pain in the right thigh C) Hematoma over the right trochanter D) Right leg shorter than left

D) Right leg shorter than left A fractured lower extremity is often shorter than the unaffected one.

When learning about the nervous system, students learn that which nervous system regulates the expenditure of energy? A) Parasympathetic B) Central C) Peripheral D) Sympathetic

D) Sympathetic Sympathetic Nervous System: This division of the autonomic nervous system regulates the expenditure of energy.

Lorodosis

Exaggerated curvature or the lumbar spine (Pregnancy)

osteocalcin

bone turnover

arthoscopy after surgery

wrap the joint in compression dressing

Tendon

Connects muscle to bone

scoloisis

Lateral curving of the spine (Congenital or idiopathic)

Paget's disease

bowing of the legs, skull, femur, tibia, pelvic bone, humerus, scapula, and vertebrae

Endosteum

covers the marrow cavity of long bones

Ganglion

cystic tumor of a tendon

flat bones

These bones are thin, flat, and curved. They form the ribs, breastbone, and skull.

The anatomy instructor is discussing the central nervous system. A student asks where the cerebral cortex is located. What should the anatomy instructor answer? A) "It is located on the surface of the cerebrum." B) "It is located in the center of the cerebellum." C) "It is located at the base of the brain." D) "It is located between the left and right hemispheres of the brain."

A) It is located on the surface of the cerebrum The cerebral cortex is the surface of the cerebrum. It contains motor neurons, which are responsible for movement, and sensory neurons, which receive impulses from peripheral sensory neurons located throughout the body.

Which occurs when reflexes are hyperactive when the foot is abruptly dorsiflexed? A) Ataxia B) Clonus C) Rigidity D) Flaccidity

B) Clonus Clonus occurs when the foot is abruptly dorsiflexed. It continues to "beat" two or three times before it settles into a position of rest. Sustained clonus always indicates the present of central nervous system disease and requires further evaluation. Ataxia is incoordination of voluntary muscle action. Rigidity is an increase in muscle tone at rest characterized by increased resistance to passive movement. Flaccid posturing is usually the result of lower brain stem dysfunction; the client has no motor function, is limp, and lacks motor tone.

A patient has suffered cerebellar trauma after falling off of a ladder. The patient has been stabilized and is now receiving care on a neurological unit. When planning this patient's care, what nursing diagnosis is most likely to result from an injury to this part of the brain? A) Risk for aspiration B) Risk for falls C) Risk for ineffective thermoregulation D) Risk for ineffective breathing pattern

B) Risk for falls The cerebellum is largely responsible for coordination of all movement. Injury thus results in a significant risk for falls. The cerebellum does not coordinate thermoregulation, swallowing, or respiration.

The nurse teaches the client diagnosed with Huntington disease that it is transmitted as which type of genetic disorder? A) X-linked B) Autosomal recessive C) Autosomal dominant D) Non -repeated HTT gene

C) Autosomal dominant Huntington disease is transmitted as an autosomal dominant genetic disorder. It is a genetic mutation , caused by the presences of a repeat of the ( Huntington gene) HTT gene. This disease is a chronic, progressive, hereditary disorder of the nervous system and results in progressive involuntary choreiform movements and dementia.

The nurse is discussing conservative management of tendonitis with a patient. Which of the following is likely the most effective approach to managing tendonitis? A) Weight reduction B) Stress reduction C) Intermittent application of ice and heat D) Range-of-motion (ROM) exercise of the affected joint

C) Intermittent application of ice and heat. Conservative management of tendonitis includes rest of the extremity, intermittent ice and heat to the joint, and nonsteroidal anti-inflammatory drugs to control the inflammation and pain. Weight reduction, stress reduction, and ROM exercises are not part of conservative management of tendonitis.

The nurse is caring for a patient with an upper motor neuron lesion. What clinical manifestations would the nurse expect this patient to exhibit? A) Decreased muscle tone B) Flaccid paralysis C) Loss of voluntary control D) Slow reflexes

C) Loss of voluntary control Upper motor neuron lesions do not cause muscle atrophy, flaccid paralysis, or slow reflexes. Upper motor neuron lesions do cause loss of voluntary control.

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? A) Avascular necrosis B) Fat embolism C) Osteomyelitis D) Compartment syndrome

C) Osteomyelitis Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection.

A nurse is providing education about migraine headaches to a community group. The cause of migraines has not been clearly demonstrated, but is related to vascular disturbances. A member of the group asks about familial tendencies. The nurse's correct reply will be which of the following? A) "There is a very weak familial tendency." B) "No familial tendency has been demonstrated." C) "There is a strong familial tendency." D) "Only secondary migraine headaches show a familial tendency."

C) There is a strong familiar tendency Migraine headaches have a strong familial tendency. Migraines are primary headaches, not secondary headaches.

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? A) Hammer toe B) Mallet toe C) Hallux valgus D) Bunion

A) Hammer toe Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

A client who was trapped inside a car for hours after a head-on collision is rushed to the emergency department with multiple injuries. During the neurologic examination, the client responds to painful stimuli with decerebrate posturing. This finding indicates damage to which part of the brain? A) Diencephalon B) Medulla C) Midbrain D) Cortex

C) Midbrain Damage to the midbrain causes decerebrate posturing that's characterized by abnormal extension in response to painful stimuli. With damage to the diencephalon or cortex, abnormal flexion (decorticate posturing) occurs when a painful stimulus is applied. Damage to the medulla results in flaccidity.

A client who was found unconscious at home is brought to the hospital by a rescue squad. In the intensive care unit, the nurse checks the client's oculocephalic (doll's eye) response by: A) introducing ice water into the external auditory canal. B) touching the cornea with a wisp of cotton. C) turning the client's head suddenly while holding the eyelids open. D) shining a bright light into the pupil.

C) Turning the client's head suddenly while holding the eyelids open. To elicit the oculocephalic response, which detects cranial nerve compression, the nurse turns the client's head suddenly while holding the eyelids open. Normally, the eyes move from side to side when the head is turned; in an abnormal response, the eyes remain fixed. The nurse introduces ice water into the external auditory canal when testing the oculovestibular response; normally, the client's eyes deviate to the side of ice water introduction. The nurse touches the client's cornea with a wisp of cotton to elicit the corneal reflex response, which reveals brain stem function; blinking is the normal response. Shining a bright light into the client's pupil helps evaluate brain stem and cranial nerve III function; normally, the client's pupil responds by constricting.

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury? A) Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly. B) Apply heat to the affected area every night. C) Apply a cold pack to the affected area every night. D) Assist with a gradual introduction of activity.

D) Assist with a gradual introduction of activity. A gradual introduction of activity assists the client with a knee injury to ambulate without causing any further injury. Using NSAIDs or applying ice during the first 48 hours helps ease the pain and the inflammation. The application of heat at a later stage improves the blood circulation. However, the regular use of NSAIDs, cold packs, or heat does not help the client progress without causing any further injury.

A blow with a sharp object has resulted in an injury to a patient's skull and the tissues surrounding his brain. What term is used to describe the fibrous connective tissue that hugs the brain closely and extends into every fold of the brain's surface? A) Dura mater B) Arachnoid C) Fascia D) Pia mater

D) Pia mater The meninges are a term used to describe the fibrous connective tissue that covers the brain and spinal cord. The meninges have three layers: the dura mater, arachnoid, and pia mater. The pia mater is the innermost membrane that hugs the brain closely and extends into every fold of the brain's surface. The dura mater is the outermost layer and covers the brain and spinal cord. The arachnoid is the middle membrane and is responsible for the production of cerebrospinal fluid.

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment? A) Nonunion B) Delayed union C) Malunion D) Subluxation

A) Nonunion Nonunion results from failure of the ends of a fractured bone to unite in normal alignment. Delayed union occurs when there is prolonged healing for union of the fracture. In malunion, there is flawed union of fractured bone. Subluxation is a partial dislocation of the articulating surfaces.

Which of the following is a brain tumor arising from the supporting structures? A) Meningiomas B) Astrocytomas C) Medulloblastoma D)Glioblastoma multiforme

A) Meningiomas Brain tumors arising from the supporting structures include meningiomas, neuromas, and pituitary adenomas. Intracerebral tumors include astrocytomas, medulloblastoma, and glioblastoma multiforme

Which of the following is a brain tumor arising from the supporting structures? A) Meningiomas B) Astrocytomas C) Medulloblastoma D) Glioblastoma multiforme

A) Meningiomas Brain tumors arising from the supporting structures include meningiomas, neuromas, and pituitary adenomas. Intracerebral tumors include astrocytomas, medulloblastoma, and glioblastoma multiforme.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? A) Compound B) Greenstick C) Oblique D) Spiral

A) compound A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

The nurse is caring for a pregnant patient with pregnancy-induced hypertension. When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as? A) Positive Babinski reflex B) Clonus C) Hypertrophy D) Ankle reflex

B) Clonus The nurse may elicit muscle clonus (rhythmic contractions of a muscle) in the ankle or wrist by sudden, forceful, sustained dorsiflexion of the foot or extension of the wrist.

A comatose client is being cared for by a critical care nurse who documents that the client responds only to very painful stimuli by fragmentary, delayed reflex withdrawal. The nurse knows that reflexes in the body are centered where? A) In the pons B) In the medulla oblongata C)In the spinal cord D) In the midbrain

C) In the spinal cord The spinal cord functions as a passageway for ascending sensory and descending motor neurons. Its two main functions are to provide centers for reflex action and to serve as a pathway for impulses to and from the brain. Reflex centers are not in the pons, the medulla, or the midbrain.

A nurse assesses a patient who has been diagnosed with having a pituitary adenoma that is pressing on the third ventricle. The nurse looks for the associated sign/symptom. What is that sign/symptom? A) Disruption in sleep patterns B) Unusual sensitivity to heat and cold C) Visual disturbances D) Increased intracranial pressure

D) Increased intracranial pressure All the choices are signs and symptoms that can occur with an adenoma, depending on whether the pressure is exerted on the hypothalamus, the third ventricle, or the optic nerves, chiasm, or tracts. Increased intracranial pressure occurs when the third ventricle is affected.

Which neurons transmit impulses from the CNS? A) Sensory B) Neurilemma C) Dendrites D) Motor

D) Motor

A client undergoes a scheduled electroencephalogram (EEG). Which of the following post-procedure activities should the nurse carry out for the client? A) Allow the client to rest and shampoo the client's hair. B) Provide the client with adequate caffeine-rich drinks. C) Measure the level of consciousness (LOC) of the client. D) Measure the heart and the pulse rate.

A) Allow the client to rest and shampoo the client's hair. After an EEG, the nurse should ensure rest for the sleep-deprived client and shampoo the client's hair to remove the glue used to affix electrodes to the scalp. The client is advised not to take sedative drugs and caffeine-related drinks before the EEG, and there is no reason to provide the client with them after the test. The nurse should not measure the LOC, the heart rate, or the pulse rate of the client unless advised by the physician.

To assess a client's cranial nerve function, a nurse should assess: A) hand grip. B) orientation to person, time, and place. C) arm drifting. D) gag reflex.

D) Gag reflex The gag reflex is governed by the glossopharyngeal nerve, one of the cranial nerves. Hand grip and arm drifting are part of motor function assessment. Orientation is an assessment parameter related to a mental status examination.

The nurse recognizes that proper positioning of an amputated lower extremity for the prevention of contractures is: A) Extension B) Flexion C) External rotation D) Abduction

A) Extension

The nurse is caring for a comatose client. The nurse knows she should assess the client's motor response. Which method may the nurse use to assess the motor response? A) observing the reaction of pupils to light B) observing the client's response to painful stimulus C) using the Romberg test D) assessing the client's sensitivity to temperature, touch, and pain

B) Observing the clients response to painful stimuli The nurse evaluates motor response in a comatose or unconscious client by administering a painful stimulus. This action helps determine if the client makes an appropriate response by reaching toward or withdrawing from the stimulus. The Romberg test is used to assess equilibrium in a noncomatose client. Pupils are examined for their reaction to light to assess sensitivity in the third cranial (oculomotor) nerve. Sensitivity to temperature, touch, and pain is a test to assess the sensory function of the client and not motor response.

The nurse is performing a detailed mental status assessment of an older adult patient who has a diagnosis of mild Alzheimer's disease. What assessment most accurately gauges the patient's abstract reasoning? A) "What city and state are we in right now?" B) "What would you do if you found a stamped envelope on the street?" C) "If you divide 16 by four and then double it, what do you get?" D) "How do you believe that Alzheimer's disease is affecting you?"

B) What would you do if you found a stamped envelope on the street? Abstract reasoning is often assessed by presenting a scenario that requires the patient to weigh various options in an effort to craft a plausible response. Orientation to place and math ability do not necessarily indicate normal abstract reasoning ability. Asking about the patient's diagnosis may indicate the presence or absence of insight.

A client suspected of having a distortion of cerebral arteries and veins is scheduled for a cerebral angiography. What would the nurse tell the client about the upcoming test? A) That sedatives, coffee, tea, and soft drinks that contain caffeine will be withheld for at least 8 hours before the test to avoid affecting the diagnostic findings. B) The client will have to stay in a dark quiet room. C) Contrast will be given and a rapid sequence of radiographs will be taken. D) The client will have to shampoo his or her hair.

C) Contrast will be given and a rapid sequence of radiographs will be taken. A radiopaque dye is injected into the right or left carotid artery, the brachial artery, or the femoral artery. A rapid sequence of radiographs is taken as the dye circulates through the cerebral arteries and veins. For cerebral angiography options A, B, and D do not apply.