Theories and Concepts 1 Exam 4
is a procedure that allows direct visualization of a joint through the use of a fiberoptic endoscope.
arthroscopy
Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy?
aspirin
The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response?
decrease in estrogen
hinge joint
elbow and knee
A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?
nervousness, diaphoresis, confusion
Red bone marrow produces which of the following? Select all that apply.
platelets, RBCs, WBCs
The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?
quads
Which term refers to the shaft of the long bone?
diaphysis
The elbow and the knee are examples of joints.
diarthrosis
Not a risk for osteoporosis
white male
A client newly diagnosed with diabetes mellitus asks why he needs ketone testing when the disease affects his blood glucose levels. How should the nurse respond?
"Ketones will tell us if your body is using other tissues for energy."
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
"Test your blood glucose every 4 hours."
The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given?
Alendronate
A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. What procedure will the nurse prepare the client for?
Arthrogram
A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory finding should the nurse expect in this client?
Blood glucose level 1,100 mg/dl
Adequate intake of vitamin _________ is essential for absorption of calcium from the gastrointestinal track and for bone mineralization.
D
Which of the following is the priority nursing diagnosis for the client preparing for a bone marrow biopsy?
Deficient knowledge: procedure
After a person experiences a closure of the epiphyses, which statement is true?
No further increase in bone length occurs
A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint?
Skull at the temporal and occipital bones
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?
Use the large muscles of the leg when lifting items.
The nurse is teaching a client about self-administration of insulin and about mixing regular and neutral protamine Hagedorn (NPH) insulin. Which information is important to include in the teaching plan?
When mixing insulin, the regular insulin is drawn up into the syringe first.
Which of the following is the first-line medication that would be used to treat and prevent osteoporosis?
biphosphates
What is the term for a rhythmic contraction of a muscle?
clonus
NPH is an example of which type of insulin?
intermediate
A client with diabetes is receiving an oral antidiabetic agent that acts to help the tissues use available insulin more efficiently. Which of the following agents would the nurse expect to administer?
metformin
A nurse knows to assess a patient with type 1 diabetes for postprandial hyperglycemia. The nurse knows that glycosuria is present when the serum glucose level exceeds:
180 mg/dl
A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored?
Serial x-rays will be taken.
The most common causative organism of osteomyelitis is .
Staphylococcus Aureus
The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?
Tear in the joint capsule
A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?
The recommended daily allowance of calcium may be found in a wide variety of foods.
Which intervention is essential when performing dressing changes on a client with a diabetic foot ulcer?
Using sterile technique during the dressing change
Which statement describes paresthesia?
abnormal sensations
The three main clinical features of diabetic ketoacidosis are hyperglycemia, dehydration with electrolyte loss, and
acidosis
When reviewing the history of a client with a ganglion cyst, which factor would the nurse identify as most likely contributing to the client's current condition?
age below 50 years
A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?
albumin
The nurse is performing a musculoskeletal assessment of a client in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the client's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to
atrophy of right calf muscle.
Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?
compartment syndrome
A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?
elbow
Osteoblasts aid in bone remodeling by dissolving and reabsorbing bone.
false
A nurse is teaching a client with type 1 diabetes how to treat adverse reactions to insulin. To reverse hypoglycemia, the client ideally should ingest an oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the nurse should advise the client to keep which alternate treatment on hand?
glucagon
An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?
osteoblasts
The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply.
pacemaker, jewelry, hearing aid
A health care provider diagnoses primary osteoporosis in a client who has lost bone mass. For which client is primary osteoporosis most common?
postmenopause
A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?
regular
A client has Paget's disease. An appropriate nursing diagnosis for this client is:
risk for falls
A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. At about 4:30 p.m., the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms?
serum glucose level of 52 mg/dl
Fracture pain, frequently described as sharp and piercing, is usually relieved by immobilization.
true
Osteoporosis frequently results in compression fractures of the spine, fractures of the neck or intertrochanteric region of the femur, and Colles fractures of the wrist.
true
Osteosarcoma is the most common, and most often fatal, primary malignant bone tumor.
true
Which nerve is assessed when the nurse asks the client to spread all fingers?
ulnar
Which instruction about insulin administration should a nurse give to a client?
"Always follow the same order when drawing the different insulins into the syringe."
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?
"I should use my heating pad this evening to reduce some of the pain in my knee."
The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?
"I will avoid prolonged sitting or walking."
A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?
"Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."
On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?
"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
The nurse is preparing the client for computed tomography. Which information should be given by the nurse?
"You must remain very still during the procedure."
A 16-year-old client newly diagnosed with type 1 diabetes has a very low body weight despite eating regular meals. The client is upset because friends frequently state, "You look anorexic." Which statement by the nurse would be the best response to help this client understand the cause of weight loss due to this condition?
"Your body is using protein and fat for energy instead of glucose."
A client with osteoporosis is prescribed calcitonin 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?
0.5
An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting:
10 to 15 g of a simple carbohydrate
The American Dietetic Association recommends that for all levels of caloric intake, the percentage of calories from carbohydrates should not exceed
60%
Which statement is true regarding gestational diabetes?
A glucose challenge test should be performed between 24 and 28 weeks.
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?
Alkaline phosphatase
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?
Arthroscopy
A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?
Chlorpheniramine
A client comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the health care provider orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the client about?
Duloxetine
After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching?
I might need insulin later on but probably not as much or as often
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
Initiating weight-bearing exercise routines
A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?
Ossification and calcification
Common deformities of the spine include , an increased forward curvature of the thoracic spine that causes a bowing or rounding of the back and leads to a hunchback or slouching posture.
kyphosis
A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?
Insulin is absorbed more rapidly at abdominal injection sites than at other sites
Proliferative retinopathy, a diabetic microvascular disease, represents the greatest threat to vision; it is characterized by the proliferation of new blood vessels growing from the retina into the vitreous.
true
When mixing short-acting and longer-acting insulin, the ADA recommended procedure is that the regular insulin be drawn up first.
true
A client diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. What is the best response by the nurse?
"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."
Which should be included in the teaching plan for a client diagnosed with plantar fasciitis?
Management of plantar fasciitis includes stretching exercises
A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?
3-6 weeks
A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks?
L4, L5, and S1
A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?
Temporomandibular disorder
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?
Surgical debridement
Morton neuroma is exhibited by which clinical manifestation?
Swelling of the third (lateral) branch of the median plantar nerve
What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years?
decreased height
A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?
electromyography
The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?
lordosis
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?
lower lumbar
The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client
places the load close to the body
Which of the following is the final stage of fracture repair?
remodeling
Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?
risk for infection
The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?
The fracture is on the diaphysis.
A client has type 1 diabetes. Her husband finds her unconscious at home and administers glucagon, 0.5 mg subcutaneously. She awakens in 5 minutes. Why should her husband offer her a complex carbohydrate snack as soon as possible?
To restore liver glycogen and prevent secondary hypoglycemia
When administering insulin to a client with type 1 diabetes, which of the following would be most important for the nurse to keep in mind?
accuracy of the dosage
_____________ are administered on arising in the morning with a full glass of water on an empty stomach, and the patient must stay upright for 30 to 60 minutes.
bisphosphonates
__________ is an inflammation of a fluid-filled sac in the joint.
bursitis
A male client, aged 42 years, is diagnosed with diabetes mellitus. He visits the gym regularly and is a vegetarian. Which of the following factors is important when assessing the client?
client's consumption of carbohydrates
A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?
coma, anxiety, confusion, headache, and cool, moist skin
The ______________ phenomenon is an example of morning hyperglycemia that is characterized by a relatively normal blood glucose level until approximately 3:00 AM when blood glucose levels begin to rise.
dawn
Which type of insulin acts most quickly?
lispro
A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy?
100 units of regular insulin in normal saline solution
A health care provider prescribes short-acting insulin for a patient, instructing the patient to take the insulin 20 to 30 minutes before a meal. The nurse explains to the patient that Humulin-R taken at 6:30 AM will reach peak effectiveness by:
8:30AM
Which of the following is a characteristic of diabetic ketoacidosis (DKA)? Select all that apply.
more common in type 1 diabetes rapid onset elevated BUN and creatinine
A patient who is diagnosed with type 1 diabetes would be expected to:
need exogenous insulin
The most prevalent bone disease in the world is .
osteoporosis
The nurse is preparing to administer intermediate-acting insulin to a patient with diabetes. Which insulin will the nurse administer?
NPH
A nurse is caring for an older woman with a hip fracture. What are appropriate risk factors for the nurse to consider related to the client's hip fracture? Select all that apply.
Presence of anemia Female gender Osteoporosis
The nurse is assessing the client for scoliosis. What will the nurse have the client do to perform the assessment?
Stand behind the client and ask the client to bend forward at the waist.
A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication?
The short-acting insulin is withdrawn before the intermediate-acting insulin.
The nurse is performing a neurological assessment. What will this assessment include?
ask the client to plantar flex the toes
Which hormone inhibits bone resorption and increases the deposit of calcium in the bone?
calcitonin
Which assessment finding is most important in determining nursing care for a client with diabetes mellitus?
fruity breath
Predicting bone fracture risk related to osteoporosis is only achieved through dual-energy x-ray absorptiometry (DXA) of the wrist.
false
Regular insulin is a rapidly acting insulin that has a duration of 4 to 6 hours
false
The nurse should recommend short periods of bed rest, in a prone position, for patients experiencing back pain resulting from a compression fracture.
false
Type 1 diabetes, which affects approximately 95% of people with the disease, is characterized by insulin resistance and impaired insulin secretion.`
false
A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:
glycosylated hemoglobin level
A client with type 1 diabetes asks the nurse about taking an oral antidiabetic agent. The nurse explains that these medications are effective only if the client:
has type 2 diabetes
The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include?
increase frequency of glucose self-monitoring
A client with type 1 diabetes is admitted to an acute care facility with diabetic ketoacidosis. To correct this acute diabetic emergency, which measure should the health care team take first?
intiate fluid replacement therapy
_____________ muscle contraction is characterized by shortening of the muscle without an increase in tension within the muscle.
isotonic
A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odored breath. What could be the cause of the client's current serious condition?
ketoacidosis
The nurse is conducting a musculoskeletal assessment of a client in a nursing home. The client is unable to dorsiflex the right foot or extend the toes. The nurse evaluates this finding as an injury to which nerve?
peroneal
A client has been recently diagnosed with type 2 diabetes, and reports continued weight loss despite increased hunger and food consumption. This condition is called:
polyphagia
Classic clinical manifestations of diabetes include polyuria, polydipsia, and .
polyphagia
Lispro (Humalog) is an example of which type of insulin?
rapid-acting
What is the only insulin that can be given intravenously?
regular
A client with diabetes mellitus must learn how to self-administer insulin. The physician has ordered 10 units of U-100 regular insulin and 35 units of U-100 isophane insulin suspension (NPH) to be taken before breakfast. When teaching the client how to select and rotate insulin injection sites, the nurse should provide which instruction?
rotate injection sites within the same anatomical region, not among different regions
Low back pain that radiates down the leg suggests the presence of nerve root involvement known as .
sciatica
The diabetic client asks the nurse why shoes and socks are removed at each office visit. Which assessment finding is most significant in determining the protocol for inspection of feet?
sensory nephropathy
A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?
sweating, tremors, tachycardia
A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which structure?
tendon
A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What effect do these findings have on his need for insulin?
they increase the need for insulin
Latent autoimmune diabetes of adults (LADA) is a subtype of diabetes in which progression of autoimmune beta cell destruction in the pancreas is slower than in types 1 and 2 diabetes.
true
Muscle tone can be assessed by palpating the muscle while passively moving the relaxed extremity.
true
Normal synovial fluid obtained during arthrocentesis is clear, pale, straw colored, and scanty in volume.
true
Nursing interventions for a patient undergoing foot surgery include a neurovascular assessment every 1 to 2 hours for the first 24 hours.
true
Symptoms of plantar fasciitis include acute heel pain experienced in the morning upon arising.
true
A client with type 2 diabetes asks the nurse why he can't have a pancreatic transplant. Which of the following would the nurse include as a possible reason?
Underlying problem of insulin resistance
