Nursing 1128 and 1424 Test 1 (SAC Nursing)

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

Alkaline phosphatase Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.

Which term refers to fixation or immobility of a joint?

Ankylosis Ankylosis may result from disease or scarring due to trauma. Hemarthrosis refers to bleeding into a joint. Diarthrodial refers to a joint with two freely moving parts. Arthroplasty refers to replacement of a joint.

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Hypovolemic Hypovolemic shock resulting from hemorrhage is more frequently noted in trauma patients with pelvic fractures and in patients with a displaced or open femoral fracture in which the femoral artery is torn by bone fragments.

A home care nurse assesses for disease complications in a client with bone cancer . Which laboratory value may indicate the presence of a disease complication?

Calcium level of 2.9mmol/L In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 0.53mmol/L) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.

Which of the following classifications are considered antiarthritic drugs? Select all that apply.

-Anti-inflammatory -Disease-modifying antirheumatics (DMARDs) -Glucocorticoids

A patient shows the nurse a round, firm nodule on the wrist. The pain is described as aching, with some weakness of the fingers. What treatment does the nurse anticipate assisting with? (Select all that apply.)

-Corticosteroid injections -Surgical excision -Aspiration of the cyst

Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome?

Acute respiratory distress syndrome Acute pulmonary edema and acute respiratory distress syndrome are the most common causes of death.

Which of the following procedures involves a surgical fusion of the joint?

Arthrodesis

To confirm a diagnosis of low back pain, which of the following diagnostic procedures would be ordered to rule out the presence of a tumor?

Bone Scan

Which is a hallmark sign of compartment syndrome?

Pain A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion.

What intravenous anesthetic administered by the anesthesiologist has a powerful respiratory depressant effect sufficient to cause apnea and cardiovascular depression?

Pentothal Thiopental sodium (Pentothal) is an intravenous anesthetic agent that in large doses may cause apnea and cardiovascular depression.

A patient is undergoing a perineal surgical procedure. Which of the following actions by the nurse is appropriate?

Place the patient in lithotomy position. The lithotomy position is used for nearly all perineal, rectal, and vaginal surgeries. The Trendelenburg position is usually used for surgery on the lower abdomen and pelvis. Sims' or lateral position is used for renal surgery. The dorsal recumbent position is the usual position for surgical procedures.

A client is scheduled for surgery to fuse a joint. The nurse identifies this as which of the following?

Arthrodesis An arthrodesis is a surgical procedure to fuse a joint. An osteotomy involves cutting and removing a wedge of the bone to change alignment. An arthroplasty is a total reconstruction or replacement of a joint with an artificial joint. Open reduction internal fixation is accomplished with wire, nails, plate and/or an intramedullary rod to hold bone fragments in place until healing is complete.

A nurse is reviewing the intraoperative record of a patient who has just returned from surgery. The patient received general anesthesia with intravenous agents. Which of the following would the nurse identify as a nondepolarizing muscle relaxant?

Atracurium Atracurium is a nondepolarizing muscle relaxant. Succinylcholine is a depolarizing muscle relaxant. Fentanyl and sufentail are opioid analgesic agents.

The nurse recognizes that the client with osteomyelitis is at risk for:

Bone abscess formation Bone abscess formation is a potential complication of osteomyelitis.

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication?

Colchicine The physician usually orders colchicine for a client experiencing an acute gout attack. This drug decreases leukocyte motility, phagocytosis, and lactic acid production, thereby reducing urate crystal deposits and relieving inflammation. Allopurinol is used to decrease uric acid production in clients with chronic gout. Although corticosteroids are ordered to treat gout, the nurse wouldn't give them because they must be administered interarticularly to this client. Propoxyphene, an opioid, may be used to treat osteoarthritis.

Which assessment findings would the nurse expect to find in the client with osteomyelitis?

Column B Osteomyelitis is characterized by elevated white blood cell count and erythrocyte sedimentation rate.

A patient was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the patient is complaining of pain with inspiration. What is the anticipated treatment for this patient?

Coughing and deep breathing with pillow splinting Because these fractures cause pain with respiratory effort, the patient tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the patient cough and take deep breaths and use an incentive spirometer

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location?

Distal femur around the knee Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites.

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse?

Ensure that a large tourniquet is in the room. The client with an amputation is at risk for hemorrhage. A tourniquet should be placed in plain sight for use if the client hemorrhages.

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. Which of the following might be prescribed?

Etanercept Etanercept is an example of a tumor necrosis factor (TNF)-alpha inhibitor used to treat rheumatoid arthritis. Diclofenac and indomethacin are nonsteroidal anti-inflammatory drugs (NSAIDs). Celecoxib is a cyclooxygenase-2 (COX-2) inhibitor.

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:

Femoral neck A fracture of the neck of the femur may damage the vascular system and the bone will become ischemic. Therefore, a vascular necrosis is common.

A college student is admitted to the emergency room to be evaluated for aseptic meningitis. The nurse knows that the most serious infecting organism (34% mortality rate) is:

Streptococcus pneumoniae Septic meningitis is caused by bacteria; commonly Streptococcus pneumoniae and Neisseria meningitidis. For patients over 50, additional causative organisms include Listeria monocytogenes and aerobic gram-negative bacilli. Haemophilus influenzae is still a concern for those not immunized for H. influenzae.

Which newer pharmacological therapy, used to treat osteoarthritis, is thought to prevent the loss of cartilage and repair chondral defects, as well as have some anti-inflammatory effects?

Viscosupplementation Viscosupplementation, the intra-articular injection of hyaluronates, is thought to prevent the loss of cartilage and repair chondral defects. It may also have some anti-inflammatory effects. Glucosamine and chondroitin are thought to improve tissue function and retard breakdown of cartilage. Capsaicin is a topical analgesic.

A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis?

Bone pain and tenderness Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. As a result, the skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures.

Nursing assessment for tinnitus, gastric intolerance, and bleeding is important for patient who take which class of medications for a rheumatic disease?

Salicylates

Which of the following are routes of administration for Calcitonin? Select all that apply.

-Nasal spray -Subcutaneous -Intramuscular injection

A patient, with a history of peptic ulcer disease is diagnosed with RA. The nurse practitioner prescribes an anti-inflammatory drug that also protects the stomach lining. Which of the following is that medication?

COX-2 inhibitor (Celebrex) A new class of second-generation NSAID, the cyclooxygenase-2 (COX-2) inhibitors, have been shown to inhibit inflammatory processes, but does not inhibit the protective prostaglandin synthesis in the GI tract. Therefore, patients who are at increased risk for gastrointestinal complications, especially GI bleeding, have been managed effectively with COX-2 inhibitors.

The nurse is educating a patient about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms they should report. Which COX-2 inhibitor is the nurse educating the patient about?

Celecoxib (Celebrex) The COX-2 inhibitor celecoxib (Celebrex) is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.

What medication should the nurse prepare to administer in the event the patient has malignant hyperthermia?

Dantrolene sodium (Dantrium) Anesthesia and surgery should be postponed. However, if end-tidal carbon dioxide (CO2) monitoring and dantrolene sodium (Dantrium) are available and the anesthesiologist is experienced in managing malignant hyperthermia, the surgery may continue using a different anesthetic agent

A nurse practitioner was asked to explain to a patient the age-related process of bone loss that results in osteoporosis. Which of the following is the best statement the nurse should use?

Decreased estrogen inhibits bone breakdown. Osteoporosis is characterized by decreased estrogen, calcitonin, and vitamin D use; the parathyroid hormone increases with age, causing increased bone turnover and resorption.

Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)?

Electromyogram An electromyogram and nerve conduction studies are used to evaluate spinal nerve toot disorders (radiculopathies) for patients with low back pain. A bone scan may disclose information about infections, tumors, and bone marrow abnormalities. A computed tomography scan is useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral disks. Magnetic resonance imaging permits visualization of the nature and location of spinal pathology.

Identify descriptors of the pathophysiologic process seen in osteomalacia. Select all that apply.

-There is a deficiency of activated vitamin D (calcitriol). - Calcium and phosphate are not moved to the bones. -The bone mass is structurally weaker, and bone deformities occur.

A patient visits an orthopedic specialist because of pain that he feels beginning in his low back and radiating behind his right thigh and down below his right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between these intervertebral disks:

L4, L5, and S1 The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.

A client has meningitis and cultures are being done to determine the cause. Which of the following is most likely to be identified as the causative factor?

Streptococcus pneumoniae The bacteria Steptococcus pneumoniae and Nesseria meningitides are responsible for 80% of cases of meningitis in adults.

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density?

Compression fractures In osteoporosis, loss of bone substance exceeds bone formation. The total bone mass and density is reduced, resulting in bones that become progressively porous, brittle, and fragile. Compression fractures of the vertebrae are common. Diabetes, hypertension, and cardiac disease may occur in response to the aging process but are not the result of osteoporosis.

Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply.

-Muscle weakness -Anorexia and constipation -Shortened QT interval -Lack of muscle coordination

Which of the following refers to fixation of a joint?

Ankylosis Fixation of a joint, called ankylosis, eliminates friction, but at the drastic cost of immobility. Inflammation is manifested in the joints as synovitis. Pannus has a destructive effect on the adjacent cartilage and bone. Articulations are joints.

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?

Raloxifene (Evista) An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a biphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent.

A client with a musculoskeletal injury is instructed to alter the diet. The objective of altering the diet is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which food item should the nurse encourage the client to include in the diet?

Vitamin D-fortified milk The nurse should advise the client to include dietary sources of vitamin D, such as fatty fish, vitamin D-fortified milk, and cereals. These foods protect against bone loss and decrease the risk of fracture by facilitating the absorption of calcium from food and supplements. Red meat, bananas, and green vegetables do not facilitate calcium absorption from food and supplements.