NU272 Mobility
Which individual is most likely to be diagnosed with a central vestibular disorder? A man who states that he feels carsick whenever he rides in the back seat of a vehicle A man who got up quickly from his bed and sustained an injury after he "blacked out". A woman who suffered a loss of consciousness after being struck on the head during a soccer game A woman who has ongoing difficulty balancing herself when walking
A woman who has ongoing difficulty balancing herself when walking Explanation: Central vestibular disorders are marked by a sensation of motion that interferes with balance, but that is mild and constant and chronic in duration. It should be differentiated from postural hypotension, loss of balance from a head injury, or motion sickness.
Which current multiple sclerosis drug treatments are designed to slow the progress of myelin degeneration? Immunomodulators Anticonvulsants Antibiotics Antidepressants
Immunomodulators Explanation: Immunomodulators reduce inflammation and improve nerve conduction, thus improving outcomes of disease.
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply ice packs for the first 24 to 48 hours, then apply heat packs." "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." "Apply heat packs for the first 24 to 48 hours."
"Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.
A nurse is caring for a 13-year-old boy with Duchenne muscular dystrophy. He says he feels isolated and that there is no one who understands the challenges of his disease. How should the nurse respond? "There are many things that you can do like crafts, computers or art." "There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." "You have to go to a support group; it will be very helpful." "You need to remain as active as possible and have a positive attitude."
"There are a lot of kids with the same type of muscular dystrophy you have at the MDA support group." Explanation: The best response would be to remind the boy that there are many children with muscular dystrophy that could be found at the local support group. Teenagers do not like to be told that they "have" to do anything. Telling the boy that he needs to be active or simply suggesting activities does not address his concerns.
Following genetic testing and a thorough history from the child's mother and father, a 5 month-old boy has been diagnosed with osteogenesis imperfecta. What teaching point should the care team provide to the mother and father? "You'll need to commit to calcium supplementation for the duration of his development." "His hips are extremely susceptible to dislocation, so rough play is out of the question." "His skeleton is prone to breakage and we'll begin hormone therapy to treat this." "You'll need to be very careful to avoid causing fractures to his fragile bones."
"You'll need to be very careful to avoid causing fractures to his fragile bones." Explanation: There is no definitive treatment for correction of the defective collagen synthesis that is characteristic of osteogenesis imperfecta, and prevention and treatment of fractures is important. Hip dislocation is not a common manifestation, and neither hormone therapy nor calcium supplements are useful in treatment.
Which individual demonstrates a health problem with his or her axial skeleton? A 79-year-old female who has undergone hemiarthroplasty (hip replacement surgery). A 30-year-old pregnant woman who has a separated pubic symphysis. A 21-year-old male who fractured his humerus while snowboarding. A 40-year-old man who has a contusion to the left temporal bone of his skull following a motor vehicle accident.
A 40-year-old man who has a contusion to the left temporal bone of his skull following a motor vehicle accident. Explanation: The skull is considered to be part of the axial skeleton, while the arm, hips, and pelvis are components of the appendicular skeleton.
Peripheral nerve disorders are not uncommon. What is an example of a fairly common mononeuropathy? Guillain-Barré syndrome Carpal tunnel syndrome Myasthenia gravis Phalen maneuver
Carpal tunnel syndrome Explanation: The most common clinical presentation is slowly progressive weakness and atrophy in distal muscles of one upper extremity.
A child has been diagnosed with myopathic neuromuscular scoliosis. What other concurrent diagnosis may the child have? Huntington disease Down syndrome Cerebral palsy Epilepsy
Cerebral palsy Explanation: Neuromuscular scoliosis develops from neuropathic or myopathic disease. It is seen with cerebral palsy, myelodysplasia, and poliomyelitis. It is not linked to Huntington disease, epilepsy, or Down syndrome.
What is the term for a rhythmic contraction of a muscle? Clonus Atrophy Crepitus Hypertrophy
Clonus Explanation: Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkage-like decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.
After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do? Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Tell the client that this noncompliance will be reported to the health care provider. Document the client's refusal to ambulate. Do nothing because the client has the ultimate right to determine the degree of participation.
Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Explanation: The nurse should discuss the care plan and its rationale with the client. Calling the health care provider to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, the nurse should first discuss the care plan with the client.
Which is the most commonly seen adverse side effect of typical antipsychotics? Auditory and visual hallucinations Accidental overdosage as a result of the narrow therapeutic range Extrapyramidal symptoms and tardive dyskinesia Serotonin syndrome
Extrapyramidal symptoms and tardive dyskinesia Explanation: The greatest hazard of typical antipsychotics involves adverse effects, such as extrapyramidal symptoms (EPSs) and tardive dyskinesia. Risk of EPSs and other movement disorders is highest for clients who use older, high-potency neuroleptics, such as haloperidol or perphenazine, for long periods.
A female tennis player has suffered an injury to her shoulder that has affected her bursae in the joint. Which consequence would be most expected from this aspect of her injury? Increased friction on the tendons of the shoulder joint. Loss of connection between the humerus bone and biceps muscle. Direct contact between the humerus and scapula bones. Fusing of the head of the humerus with the glenoid capsule of the scapula.
Increased friction on the tendons of the shoulder joint. Explanation: The primary role of bursae is the reduction of friction on tendons. Damage to the bursae would not result in bone-to-bone contact, fusing of the joint, or separation between normally connected muscle and bone.
Which of the following is the most common site of joint effusion? Elbow Knee Hip Shoulder
Knee Explanation: The most common site for joint effusion is the knee. If inflammation or fluid is suspected in a joint, consultation with a provider is indicated. The elbow, hip, and shoulder are not the most common site of joint effusion.
Which therapeutic exercise is done by the nurse without assistance from the client? Resistive Isometric Active Passive
Passive Explanation: Passive therapeutic exercise is carried out by the therapist or the nurse without assistance from the client. Active therapeutic exercises are accomplished by the client without assistance. Resistive exercise is carried out by the client working against resistance produced by either manual or mechanical means. Isometric exercise is described as alternately contracting and relaxing a muscle while keeping the part in a fixed position.
Muscle spindles and Golgi tendon organs are two types of sensory receptors that provide information to the central nervous system (CNS). This information is relayed to the thalamus and sensory cortex and is experienced as: Somesthesia Gustation Proprioception Accommodation
Proprioception Explanation: Specialized sensory nerve terminals in the skeletal muscles (muscle spindles) and tendons (Golgi tendon organs) relay information about muscle stretch and joint tension to the CNS. This information is relayed to the thalamus and sensory cortex and is experienced as proprioception, the sense of body movement and position. The other functions are not mediated by these receptors.
Which principle applies to the client in traction? Knots in the ropes should touch the pulley. Skeletal traction is never interrupted. Weights are removed routinely. Weights should rest on the bed.
Skeletal traction is never interrupted. Explanation: Skeletal traction is applied directly to the bone and is never interrupted. To be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.
What information should be included in the teaching plan of care for the parents of a child diagnosed with Tay-Sachs disease? The disorder involves tissue hyperplasia. Symptoms are often noted at birth. The primary organ affected is the heart. The disorder involves accumulation of abnormal lipids.
The disorder involves accumulation of abnormal lipids. Explanation: In Tay-Sachs disease, a genetic disorder, abnormal lipids accumulate in the brain and other tissues, causing motor and mental deterioration beginning at approximately 6 months of age, followed by death at 2 to 5 years of age.
The nurse is working in the rehabilitative setting caring for tetraplegia and paraplegia clients. When instructing family members on the difference between the sites of impairment, which location differentiates the two disorders? The first lumbar vertebrae The first thoracic vertebrae The seventh thoracic vertebrae The second cervical vertebrae
The first thoracic vertebrae Explanation: Tetraplegia is the impairment of all extremities and the trunk when there is a spinal injury at or above the first thoracic vertebrae. Paraplegia is the impairment of all extremities below the first thoracic vertebrae.
Following a spinal cord injury suffered in a motor vehicle accident, a 22-year-old male has lost fine motor function of his finger and thumb, but is still able to perform gross motor movements of his hand and arm. Which component of his "white matter" has most likely been damaged? The outer layer (neolayer) The inner layer (archilayer) The middle layer (paleolayer) The reticular formation
The outer layer (neolayer) Explanation: Fine manipulation skills are the domain of the outer, or neolayer, of the tract systems. The inner and middle layers and the reticular formation are not noted to be responsible for these functions.
A client is having difficulty with balance. The nurse understands that the area of the ear that impacts balance is: Malleus Cochlea Tympanic membrane Vestibular apparatus
Vestibular apparatus Explanation: The vestibular system maintains and assists recovery of stable body and head position and balance through control of postural reflexes. The vestibular system includes the three semicircular canals.
A client recovering from surgery to repair a fracture of the tibia and fibula of the left leg is reporting increased pain at the site. What sign must the nurse be alert to that would indicate compromised circulation to the leg? increased edema in the toes of the affected leg purulent drainage from the incision site a temperature of 101.3 °F (38.5 °C) a foul odor emitting from the affected leg
increased edema in the toes of the affected leg Explanation: Constriction of circulation decreases venous return and increases pressure within the vessels. The increased pressure in the venous side of the capillary prevents reabsorption of fluid from the interstitial spaces, causing edema. Foul odor, increased body temperature, and purulent drainage from the incision site indicate the presence of an infection.
A 12-year-old boy taken to the emergency department after a soccer injury cries out, "Look, my leg is bigger now!" How will the nurse respond to the boy? "No need to worry. Soccer is a dangerous sport." "Swelling is a normal response from your body to prepare for healing." "Let me look at that. We may need to have the doctor examine you." "Yes. it is supposed to. This is a good thing."
"Swelling is a normal response from your body to prepare for healing." Explanation: Inflammation is a defensive reaction after injury that helps to prepare the site for repair. At the age of 12 years, children should be given age-appropriate responses for better understanding of what is happening to them. The correct choice is the best therapeutic communication response.
The nurse is taking the history of a 4-year-old boy. His mother mentions that he seems weaker and unable to keep up with his 6-year-old sister on the playground. Which question should the nurse ask to elicit the most helpful information? "Would you please describe the weakness you are seeing in your son?" "Has he achieved his developmental milestones on time?" "Has his pace of achieving milestones diminished?" "Do you think he is simply fatigued?"
"Would you please describe the weakness you are seeing in your son?" Explanation: The nurse needs to obtain a clear description of weakness. This open-ended question would most likely elicit specific examples of weakness and shed light on whether the boy is simply fatigued. The other questions would most likely elicit a yes or no answer rather than any specific details about his weakness or development.
Which of the following biologically active vitamin functions to increase the amount of calcium in the blood? C D E A
D Explanation: Biologically active vitamin D (Calcitrol) functions to increase the amount of calcium in the blood by promoting absorption of calcium from the gastrointestinal tract.Osteosarcoma Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor that normally requires surgery and chemotherapy. Exostosis and osteochondroma are synonymous terms for types of benign neoplasms that often require no treatment. Enchondroma is also benign and may self-resolve.
A female client is prescribed centrally acting anticholinergics for her Parkinson's disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter's request? Evaluate the client for adverse reactions from the centrally acting anticholinergics Increase the centrally active anticholinergics to decrease the client's symptoms Immediately discontinue the centrally acting anticholinergic medication Admit the client to the hospital for a psychological evaluation
Evaluate the client for adverse reactions from the centrally acting anticholinergics Explanation: When centrally active anticholinergics are given for Parkinson's disease, agitation, mental confusion, hallucinations, and psychosis may occur.
Which of the following describes a muscle that is limp and without tone? Paralysis Spastic Atonic Flaccid
Flaccid Explanation: A muscle that is limp and without tone is described as flaccid. A muscle with greater-than-normal tone is described as spastic. In conditions characterized by lower neuron destruction, denervated muscle becomes atonic (soft and flabby) and atrophies. A person with muscle paralysis has a loss of movement and possibly nerve damage.
The nurse is conducting a physical examination of a 10-year-old boy with a suspected neuromuscular disorder. Which finding is a sign of Duchenne muscular dystrophy? appearance of smaller than normal calf muscles indications of hydrocephalus Gowers sign lordosis
Gowers sign Explanation: A sign of Duchenne muscular dystrophy (DMD) is Gowers sign, or the inability of the child to rise from the floor in the standard fashion because of weakness. Signs of hydrocephalus are not typically associated with DMD. Kyphosis and scoliosis occur more frequently than lordosis. A child with DMD has an enlarged appearance to their calf muscles due to pseudohypertrophy of the calves.
A client presents with sudden onset of deep, localized pain and swelling in the proximal femur while undergoing diagnostic workup for suspected lung cancer. The nurse suspects the client may have developed which type of neoplasm of the skeletal system? Enchondroma Exostosis Osteochondroma Osteosarcoma
Osteosarcoma Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor that normally requires surgery and chemotherapy. Exostosis and osteochondroma are synonymous terms for types of benign neoplasms that often require no treatment. Enchondroma is also benign and may self-resolve.
The nurse positions the client in the lithotomy position in preparation for Perineal surgery Pelvic surgery Abdominal surgery Renal surgery
Perineal surgery Explanation: The client undergoing perineal surgery will be placed in the lithotomy position.
A 67-year-old client diagnosed with myasthenia gravis will likely display which clinical manifestations as a result of autoantibodies ultimately blocking the action of acetylcholine, resulting in destruction of the receptors? Weakness of the eye muscles, difficulty in swallowing and slurred speech, impaired gait. Tremor of hands/arms, rigidity of the arms, shuffling gait. Short-term memory lapses, problems with orientation, a lack of drive or initiative. Facial droop, slurred speech, weakness on one side of the body.
Weakness of the eye muscles, difficulty in swallowing and slurred speech, impaired gait. Explanation: Myasthenia gravis ultimately results in destruction of receptors in the neuromuscular junction, leading to a decrease in neuromuscular function. Tremor of hands/arms, rigidity of the arms, and shuffling gait are signs/symptoms of Parkinson's disease. Short-term memory lapses, problems with orientation, and a lack of drive or initiative are signs/symptoms of Huntington disease. Facial droop, slurred speech, and weakness on one side of the body are classic signs/symptoms of CVA.
Which intervention would be least effective in caring for a woman who is in the transition phase of labor? encouraging the woman to ambulate providing one-to-one support urging her to focus on one contraction at a time having the client breathe with contractions
encouraging the woman to ambulate Explanation: Although ambulating is beneficial during early and possibly even active labor, the strong and frequent contractions experienced and the urge to bear down may make ambulating quite difficult. During transition, women should continue to breathe with contractions and focus on one contraction at a time. Providing one-to-one support at this time helps the woman cope with the events of this phase, as well as help her maintain a sense of control over the situation.
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I need to remember not to cross my legs. It's such a habit." "I'll need to keep several pillows between my legs at night." "The occupational therapist is showing me how to use a sock puller to help me get dressed." "I don't know if I'll be able to get off that low toilet seat at home by myself."
"I don't know if I'll be able to get off that low toilet seat at home by myself." Explanation: The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.
The nurse is instructing a client's family members on the most incapacitating symptom of Ménière's disease. Which nursing instruction associated with the symptom is most helpful? Ensure low lighting in the room. Sit in front of the client when speaking. Keep a bucket beside the bed. Assist the client when ambulating.
Assist the client when ambulating. Explanation: The most incapacitating symptom of Ménière's disease is vertigo. When the client is experiencing vertigo or dizziness, the gate is unsteady. Having a person assist the client when ambulating is most helpful in preventing falls. Keeping a bucket at the bedside is helpful if the client is experiencing nausea. Photophobia is not a main symptom of Ménière's disease. If the client experiences hearing loss, being able to see the client's lips may be helpful.
A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect? Inability to flex index and middle fingers Tenderness in the affected wrist Pain radiating down the dorsal surface of the forearm A decrease in grasp strength
Inability to flex index and middle fingers Explanation: Clients with carpal tunnel syndrome describe pain or burning in one or both hands, which may radiate to the forearm and shoulder in severe cases. The pain tends to be more prominent at night and early in the morning. Shaking the hands may reduce the pain by promoting movement of edematous fluid from the carpal canal. Sensation may be lost or reduced in the thumb, index, middle, and a portion of the ring finger. The client may be unable to flex the index and middle fingers to make a fist. Flexion of the wrist usually causes immediate pain and numbness. In epicondylitis, clients report pain radiating down the dorsal surface of the forearm and a weak grasp. Clients with ganglion cysts experience pain and tenderness in the affected area.
Reflexes are basically "hard-wired" into the CNS. Anatomically, the basis of a reflex is an afferent neuron that synapses directly with an effector neuron to cause muscle movement. Sometimes the afferent neuron synapses with what intermediary between the afferent and effector neurons? Suprasegmental effectors Intersegmental effectors Interneuron Neurotransmitter
Interneuron Explanation: The anatomic basis of a reflex consists of an afferent neuron, which synapses either directly with an effector neuron that innervates a muscle or with an interneuron that synapses with an effector neuron.
A client has tendonitis. What will the nurse teach the client about this disorder? It is caused by overuse. It is caused when tendons rupture It is caused by ligaments rubbing on tendons. It is caused by a bone fracture.
It is caused by overuse. Explanation: Tendons have an outer connective tissue tube that is attached to the structures surrounding the tendon and an inner sheath that encloses the tendon. The space between the inner and outer sheath is filled with a fluid. Overuse of the tendon can result in tendonitis or inflammation of the tendon.
Which statements describe open reduction of a fracture? Select all that apply. The bone is surgically exposed and realigned. It is performed in the operating room. The client usually receives general or spinal anesthetic. The bone is restored to its normal position by external manipulation.
It is performed in the operating room. The bone is surgically exposed and realigned. The client usually receives general or spinal anesthetic. Explanation: Statements describing open reduction are the following: It is performed in the operating room, the bone is surgically exposed and realigned, and the client usually receives general or spinal anesthetic. The bone is restored to its normal position by external manipulation with closed reduction.
A client presents with sudden onset of deep, localized pain and swelling in the proximal femur while undergoing diagnostic workup for suspected lung cancer. The nurse suspects the client may have developed which type of neoplasm of the skeletal system? Osteosarcoma Osteochondroma Enchondroma Exostosis
Osteosarcoma Explanation: Osteosarcoma is an aggressive and highly malignant bone tumor that normally requires surgery and chemotherapy. Exostosis and osteochondroma are synonymous terms for types of benign neoplasms that often require no treatment. Enchondroma is also benign and may self-resolve.
Each joint capsule has tendons and ligaments. What are the tendons and ligaments of the joint capsule sensitive to? Position and elevating Position and lowering Position and turning Position and movement
Position and movement Explanation: The tendons and ligaments of the joint capsule are sensitive to position and movement, particularly stretching and twisting.
A client is asked to stand with feet together, eyes open, and hands by the sides. Then the client is asked to close the eyes while the nurse observes for a full minute. What assessment is the nurse performing? Segmental reflex Posture Crossed-extensor reflex Proprioception
Proprioception Explanation: Information from the sensory afferents is relayed to the cerebellum and cerebral cortex and is experienced as proprioception (the sense of body movement and position independent of vision). The knee-jerk reflex is a form of stretch reflex. The crossed-extensor reflex serves to integrate motor movements so they function in a coordinated manner.
Which is an accurately phrased risk nursing diagnosis? Risk for Fluid Volume Excess related to increased oral intake as evidenced by consuming 3 L of soda Risk for Falls related to altered mobility Risk for Pain After Surgery Risk for Impaired Coping as evidenced by client crying
Risk for Falls related to altered mobility Explanation: Risk for Falls related to altered mobility is an accurately phrased risk nursing diagnosis. It is a two-part statement that contains the diagnostic statement (Risk for Falls) and risk factors (altered mobility).Two of the options (Risk for Impaired Coping and Risk for Fluid Volume Excess) incorrectly pair actual presenting manifestations, also called defining characteristics (client crying, consuming 3 L of soda), with a risk statement. Another option (Risk for Pain After Surgery) does not include a risk factor.
The nurse is caring for an 80-year-old client who was admitted to the hospital in a confused and dehydrated state. After the client got out of bed and fell, restraints were applied. She began to fight and was rapidly becoming exhausted. She has black-and-blue marks on her wrists from the restraints. What would be the most appropriate nursing intervention for this client? Sedate her with sleeping pills and leave the restraints on. Leave the restraints on and talk with her, explaining that she must calm down. Talk with the client's family about taking her home because she is out of control. Take the restraints off, stay with her, and talk gently to her.
Take the restraints off, stay with her, and talk gently to her. Explanation: Physical restraints increase the possibility of the occurrence of falls, skin breakdown and contractures, incontinence, depression, delirium, anxiety, aspiration respiratory difficulties, and even death. The best action in this situation is for the nurse to remove the restraint, stay with the client and gently talk to her. Sedating her with sleeping pills is a chemical form of restraint. Leaving the restraints on the client to talk to her is going to cause further agitation and bruising of her wrists. The client's condition—not confusion and agitation—dictates when the client is discharged.
A client had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated?
The left leg is internally rotated. Explanation: The nurse must monitor the client for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity. The length of the leg with a dislocated prosthesis may be shorter. The client's discomfort will not indicate a dislocation. Diminished peripheral pulse of the affected extremity would be a indication of circulation issues.
The LPN assists the RN while performing the Ortolani maneuver on a newborn. When asked by the mother the reason for this maneuver, which is the best response from the nurse? shoulder movement clavicles for dislocation spinal column movement hip for dislocation
hip for dislocation Explanation: Ortolani maneuver is used to assess the possibility of a dislocated hip in an infant. Ortolani maneuver does not assess for spinal column movement, shoulder movement, nor does it assess the clavicles for dislocation. There is no specific movement to assess for spinal column movement, shoulder movement, or clavicle dislocation.
A daughter is concerned because her elderly parent has been diagnosed with osteomalacia. The daughter asks the nurse why this happened. The best response would be that: intestinal absorption slows as natural aging occurs. her parent is not using any sunscreens to help with absorption. her parent is consuming a diet high in calcium. there is an absorption of too much vitamin D.
intestinal absorption slows as natural aging occurs. Explanation: The incidence of osteomalacia is high among older adults because of diets deficient in calcium and vitamin D, a problem often compounded by the intestinal malabsorption that accompanies with aging. Melanin is extremely efficient in absorbing UVB radiation; thus, decreased skin pigmentation markedly reduces vitamin D synthesis, as does the use of sunscreens. Osteomalacia also may occur in persons on long-term treatment with medications such as anticonvulsants (e.g., phenytoin, carbamazepine, valproate) that decrease the activation of vitamin D in the liver.
The family of an older adult client is concerned about injuries from falls. The nurse providing discharge teaching would best minimize this risk by encouraging the family to perform which intervention? Cover the kitchen's tiled floor with several scatter rugs. Keep walkways free of clutter since alteration in vision happens with aging. Discourage the client from wearing rubber-soled shoes. Place exposed extension cords under decorative carpet runners.
Keep walkways free of clutter since alteration in vision happens with aging. Explanation: Older adults are at risk for falls related to environmental hazards, such as scatter rugs, loose or loosely covered cords, and cluttered walkways. The use of rubber-soled shoes is appropriate. Other fall prevention in older adults focuses on strength/balance exercises and vitamin D supplements to improve bone health.
A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait? Difficulty putting weight on soles of feet and tends to walk on tiptoes Takes large, exaggerated strides and swings arms/hands wildly Hyperactive leg motions like he just can't stand still Slow to start walking and has difficulty when asked to "stop" suddenly
Slow to start walking and has difficulty when asked to "stop" suddenly Explanation: The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.
During a crime scene investigation, the coroner confirms that rigor mortis has set in. This helps to confirm an approximate time of death. The forensic nurse can explain this process (rigor mortis) to a group of students based on the fact that: at death, the body is unable to complete the actin/myosin cycle and release the coupling between the myosin and actin, creating a state of muscular contraction. the myosin head catalyzes the breakdown of ATP to provide the energy need so that a cross-bridge can be formed. troponin is being prevented from forming a cross-bridge between the actin and myosin. when activated by ATP, cross-bridges become attached to the actin filament.
at death, the body is unable to complete the actin/myosin cycle and release the coupling between the myosin and actin, creating a state of muscular contraction. Explanation: As the muscle begins to degenerate after death, the sarcoplasmic cisternae release their calcium ions, which enable the myosin heads to combine with their sites on the actin molecule. As ATP supplies diminish, no energy source is available to start the normal interaction between actin and myosin; therefore, the muscle is in a state of rigor until further degeneration destroys the cross-bridges between actin and myosin.
