Patho Exam 5- Ch 16,48,50
Which of the following clients' signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult A) has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days. B) has experienced a sudden loss of balance and slurred speech. C) has vomited and complained of a severe headache. D) states that his left arm and leg are numb, and gait is consequently unsteady.
A A cardinal trait of the manifestations of stroke is that the onset is sudden, and a gradual onset of symptoms over 2 days would suggest an alternative etiology. Ataxia, slurred speech, and unilateral numbness are associated with stroke, with sudden vomiting and headache being particularly indicative of a hemorrhagic CVA.
Following a collision while mountain biking, the diagnostic workup of a 22-year-old male has indicated the presence of an acute subdural hematoma. Which of the following pathophysiological processes most likely underlies his diagnosis? A) Blood has accumulated between the man's dura and subarachnoid space. B) Vessels have burst between the client's skull and his dura. C) A traumatic lesion in the frontal or temporal lobe has resulted in increased ICP. D) Blood has displaced CSF in the ventricl
A A subdural hematoma develops in the area between the dura and the arachnoid space, while epidural hematomas exist between the skull and dura. Intracerebral hematomas are located most often in the frontal or temporal lobe, and the ventricles are not directly involved in a subdural hematoma.
Following a motorcycle accident that resulted in bilateral femoral fractures, a 42- year-old male has been receiving skeletal traction for the past 8 days. His care providers would recognize that which of the following risks is paramount? A) Risk of thromboemboli B) Risk of compartment syndrome C) Risk of permanent muscle atrophy D) Risk of decreased bone density and increased future fracture risk
A For individuals with lower limb injuries, there is a high risk of venous thromboemboli. Compartment syndrome normally manifests within 64 hours of injury, and muscle atrophy is not likely to be permanent. His injury and recovery are not likely to result in long-standing decreased bone density.
A new patient arrives at the clinic. The physician is suspecting that the patient may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and a history of pleural effusions. The nurse should anticipate which of the following diagnostic test will be a priority to facilitate with the diagnosis? A) Anti-DNA antibody test B) Routine hemoglobin C) C-reactive protein D) B-cell lymphocytes
A Ninety-five percent of people with untreated SLE have high ANA levels. However, ANA is not specific for SLE. The anti-DNA antibody test is more specific for the diagnosis of SLE. Hemoglobin may be low if the patient has severe anemia, but it is not specific for SLE. C-reactive protein will show an inflammatory response but again not specific for SLE.
A 51-year-old male with a history of hypertension has received a kidney transplant. The client's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long-term steroid therapy. Which of the following teaching points should the physician emphasize? A) "One of the risks that these steroids bring is the possibility that part of a bone might die." B) "Steroids will help your body to not reject your new kidney, but they bring a risk o
A Osteonecrosis is strongly associated with steroid therapy. Osteomyelitis, decreased bone density, and compartment syndrome are not associated with steroid therapy.
A 13-year-old girl and her father come in to the local health clinic hoping to see an orthopedic doctor about the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, and the daughter concurs, but with further discussion, it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny and had been keeping her awake at night for a week or so before the game. Which of the following might be the cause of the
A Osteosarcoma is the most common bone tumor in children and the third most common cancer in children and adolescents; they most commonly arise in the vicinity of knee. The primary clinical feature of osteosarcoma is deep localized pain with nighttime awakening and swelling in the affected bone. Because the pain is often of sudden onset, patients and their families often associate the symptoms with recent trauma. The skin overlying the tumor may be warm, shiny, and stretched, with prominent superficial veins. The range of motion of the adjacent joint may be restricted. The four most common types of benign bone tumors are osteoma, chondroma, osteochondroma, and giant cell tumor; pain is a feature common to almost all malignant tumors but may or may not occur with benign tumors; pain that persists at night and is not relieved by rest suggests malignancy.
Which of the following individuals is most likely to develop a form of reactive arthritis? A) A 24-year-old male who completed treatment for a chlamydial infection 1 year ago B) A 46-year-old female who has a long-standing diagnosis of systemic lupus erythematosus C) A 3-year-old girl who was born with a 20-degree congenital scoliosis D) A 79-year-old male who had a total hip replacement 2 months prior
A Reactive arthritis and Reiter syndrome, in particular, are precipitated by time-distant bacterial infections; Chlamydia trachomatis is frequently implicated. SLE, scoliosis, and hip fractures and/or surgery are not noted risk factors for the health problem.
Which of the following pathophysiological phenomena would be most indicative of ankylosing spondylitis? A) Loss of motion in the spinal column and eventual kyphosis B) A progressive loss of range of motion in the knee and hip joints C) A facial "butterfly rash" and multiorgan involvement D) Decreased bone density in long bones
A The characteristic trait of ankylosing spondylitis is progressive loss of the spinal ROM and eventual kyphosis. Synovial joint involvement is not associated with the disease, and a butterfly rash and multisystem involvement are associated with SLE. Decreased bone density does not normally accompany ankylosing spondylitis.
A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate? A) "Your prognosis will depend on whether we can surgically resect your tumor." B) "Our treatment plan will depend on whether your tumor is malignant or benign." C) "This is likely a result of a combination of heredity and lifestyle." D) "The major risk that you face is metastases to your lungs, liver,
A The prognosis of people with pilocytic astrocytomas is influenced primarily by their location. The prognosis is usually better for people with surgically resectable tumors, such as those located in the cerebellar cortex, than for people with less accessible tumors, such as those involving the hypothalamus or brain stem. Because of infiltration of brain tissue that prevents total resection, surgery rarely cures brain tumors. The binary of malignant and benign is not used to characterize brain tumors, and the etiology and substantive risk factors are largely unknown. Brain tumors rarely metastasize outside the CNS.
Which of the following diagnostic findings is likely to result in the most serious brain insult? A) Mean arterial pressure (MAP) that equals intracranial pressure (ICP) B) Moderate decrease in brain tissue volume secondary to a brain tumor removal C) Increased ICP accompanied by hyperventilation D) High intracellular concentration of glutamate
A When the pressure in the cranial cavity approaches or exceeds the MAP, tissue perfusion becomes inadequate; cellular hypoxia results; and neuronal death may occur. Displacement of CSF and blood can partially compensate for decreased brain tissue volume. Hyperventilation partially mitigates, rather than exacerbates, increase in ICP. Glutamate is normally in far higher concentrations intracellularly than extracellularly.
The parents of an active 9-year-old are leaving the emergency department (ED) following cast placement for their son's lower extremity as a result of a fall in soccer. The nurse should emphasize that assessment of the cast is important and that they should bring their son back to the ED if they note which of the following signs and symptoms? Select all that apply. A) Cold, pale toes on the side with the cast. B) Patient complaining of tingling and numbness in the casted leg. C) Swelling in the
A,B If the circulation becomes inadequate (on a casted extremity), the parts that are exposed at the distal end of the cast (i.e., the toes with a leg cast and the fingers with an arm cast) usually become cold and cyanotic or pale. An increase in pain may occur initially, followed by paresthesia (tingling or abnormal sensation) or anesthesia as the sensory neurons that supply the area are affected. There is a decrease in amplitude of the pulse in areas where the arteries can be palpated. Bruising in the lower foot and toes would be considered normal following this type of fracture. Blood tends to pull in the lower tissues.
A 22-year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a severe meniscus injury. Which of the following consequences should the woman expect over the course of recovery? Select all that apply. A) Decreased lubrication in the knee joint B) Decreased stability of the knee C) Reduced shock absorption capacity D) Presence of infectious microorganisms in the synovial capsule E) Rapid restoration of the cartilage cells in the meniscus
A,B,C Meniscal injuries have consequences for the lubricating and shock absorption capacities of the meniscus and would involve decreased range of motion. An infectious process is unlikely due to the internal nature of meniscal injuries, and healing is typically very slow.
A physician is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which of the following aspects of the physician's assessment and the client's history would be considered potentially indicative of SLE? Select all that apply. A) The client has a "butterfly rash" on her nose and cheeks. B) She complains of intermittent joint pain. C) The woman states that she has numerous environmental allergies. D) The client has been h
A,B,D,E A butterfly rash, joint pain, pleural effusion, and low levels of blood cellular components are all associated with SLE. Environmental allergies are not noted to be risk factors or associated symptoms of the disease.
A brain tumor causing clinical manifestations of headache, nausea, projectile vomiting, and mental changes is likely located in which parts of the brain? Select all that apply. A) Intra-axially B) Extra-axially C) Brain stem D) Temporal lobe E) Frontal lobe
A,B,E Tumors within the intracranial (intra-axially) cavity are fixed and cause s/s of increased ICP like headache, nausea, vomiting, mental changes, papilledema, visual disturbances, and alterations in sensory and motor function. Outside the brain tissue (extra-axially), but within the cranium, tumors may reach large sizes without producing s/s. After they reach a sufficient size, s/s of increased ICP appear. Temporal lobe tumors often produce seizures as their first symptom. Brain stem tumors commonly produce upper/lower motor neuron s/s such as weakness of facial muscles and ocular palsies. Frontal lobe tumors also grow to a large size and cause s/s of increased ICP.
While speaking to a senior citizen club about osteoarthritis (OA), which of the following facts are accurate to share? Select all that apply. A) By the time you are in your 70s, about 85% of adults will have some form of OA B) Men usually get OA in their hands, whereas women get OA primarily in their hips C) Obesity in women has been correlated to having OA in the knees D) Heredity does not play a significant role in the development of OA
A,C Eighty-five percent of people with OA are in their 70s. Men are affected more commonly at a younger age. Heredity influences the occurrence of hand OA in the DIP joint. Hand OA is more likely to affect white women, whereas knee OA is more common in black women. Obesity is a particular risk factor for OA of the knee in women.
When educating the patient with ankylosing spondylitis, the nurse should emphasize which of the following treatment interventions? Select all that apply. A) Encourage sleeping supine on an extra firm mattress if possible. B) Prop self up in bed with extra pillows if having respiratory congestion. C) Try using the heating pad prior to exercise to help stretching and improve movement. D) Wear a knee immobilizer while biking to facilitate ability to exercise for longer periods. E) Modify diet to i
A,C Treatment of ankylosing spondylitis is directed at controlling pain and maintaining mobility by suppressing inflammation. Proper posture and position are important. This includes sleeping in a supine position on a firm mattress using one small pillow. Therapeutic exercises are important. Heat applications or a shower or bath may be beneficial before exercise to improve ease of movement. Swimming is an excellent exercise. Immobilizing joints is not recommended. Maintaining ideal weight reduces the stress on weight-bearing joints. However, dietary changes are usually very individualized.
A 20-year-old has been admitted to a rehabilitation center after hospital treatment for an ischemic stroke. Which of the following aspects of the client's history would be considered to have contributed to his stroke? Select all that apply. The client A) is an African American male. B) takes iron supplements for the treatment of chronic anemia. C) blood pressure has historically been in the range of 150s/90s. D) was diagnosed with type 2 diabetes 8 years ago. E) takes corticosteroids for the
A,C,D African American race, male gender, hypertension, and diabetes are all well- documented risk factors for stroke. Anemia, autoimmune disorders like rheumatoid arthritis, and the use of corticosteroids are not noted to predispose to stroke.
A patient has been admitted with a fractured pelvis that occurred in an auto accident just a few hours ago. The nurse notices a slight change in behavior. Which of the following clinical manifestations would lead the nurse to suspect that the patient has fat emboli that has migrated? Select all that apply. A) Complaints of substernal chest pain B) Complaints of pain in the lower abdomen and back C) Pulse rate 120 with temperature of 99.7°F D) Profuse diaphoresis with pallor noted E) Urine out
A,C,D Initial symptoms of FES are a subtle change in behavior and signs of disorientation resulting from emboli in the cerebral circulation combined with respiratory depression. There may be complaints of substernal chest pain and dyspnea accompanied by tachycardia and low-grade fever. Diaphoresis, pallor, and cyanosis become evident as respiratory function deteriorates. It would be expected that the patient have lower abdominal and back pain since they have a pelvic fracture. The normal urine output is a minimum of 30 mL/hour.
Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? A) "Your daughter has lost all her cognitive functions as well as all her basic reflexes." B) "Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change." C) "If you or the c
B A continuation of the sleep-wake cycle can exist in a persistent vegetative state. Reflexes often remain, as does spontaneous eye opening. Aspects of brain function beyond those governing consciousness are affected.
Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture? A) A 20-year-old football player who had an opposing player fall laterally on his leg B) An 8-year-old boy who fell out of a tree and on to his arm C) An 81-year-old woman with a history of osteoporosis who stumbled and fell on her hip D) A 32-year-old woman who fell awkwardly on her arm while skiing B
B A greenstick fracture is seen almost exclusively in children under age 10.
A 64-year-old man was diagnosed 19 months ago with bilateral osteoarthritis (OA) in his knees, and has come to his family physician for a checkup. The client and his physician are discussing the effects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which of the following statements by the client would necessitate further teaching? A) "I'm really trying to lose weight, and I've been able to lose 15 lb this year so far." B
D Analgesics are a common and appropriate treatment for OA, and it would be unnecessary and inappropriate to forego pain control in order to maximize pain signals from affected joints. Weight loss, the use of assistive devices, and muscle- strengthening exercises are appropriate treatments for OA.
A 26-year-old female is resting after a one-minute episode during which she lost consciousness while her muscles contracted and extremities extended. This was followed by rhythmic contraction and relaxation of her extremities. On regaining consciousness, she found herself to have been incontinent of urine. What has the woman most likely experienced? A) A myoclonic seizure B) A tonic-clonic seizure C) An absence seizure D) A complex partial seizure
B A tonic-clonic seizure often begins with tonic contraction of the muscles with extension of the extremities and immediate loss of consciousness. Incontinence of the bladder and bowel is common. Cyanosis may occur from contraction of airway and respiratory muscles. The tonic phase is followed by the clonic phase, which involves rhythmic bilateral contraction and relaxation of the extremities. A myoclonic seizure involves bilateral jerking of muscles, generalized or confined to the face, trunk, or one or more extremities. Absence seizures are nonconvulsive, and complex partial seizures are accompanied by automatisms.
The nurse knows that which of the following patients listed below is at high risk for developing a hip fracture? A) A 77-year-old male who runs marathons and maintains a BMI of 25. B) An 82-year-old female with macular degeneration and uses a walker to go to the bathroom. C) A 64-year-old male with uncontrolled diabetes and chronic kidney disease on dialysis. D) A 73-year-old nursing home patient with long-term continence issues but able to walk the hallways for exercise.
B Hip fracture is a major public health problem in the Western world. The incidence of hip fractures increases with age. The incidence is also higher in white women compared with nonwhite women. Risk factors for hip fracture include low BMI, tall body structure, use of benzodiazepines, lack of exercise, previous injury to lower body extremity, vision problems, and confusion.
Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis? A) A 55-year-old female who is in renal failure secondary to poorly controlled type 1 diabetes B) A 79-year-old man who is immunocompromised following a bone marrow transplant C) A 30-year-old man who has undergone open reduction and internal fixation of his fractured tibia D) A 68-year-old woman who had a laminectomy 4 days prior for treatment of her chronic back pain
B Older age and immunocompromised status are noted risk factors for the development of tuberculosis osteomyelitis. Postsurgical status and diabetes are not noted to be strongly associated with the pathology.
A 17-year-old male has been diagnosed with osteosarcoma of the upper tibia following several months of leg pain. Which of the following statements by the client demonstrates that he has an accurate understanding of his diagnosis? A) "I guess it's good that at least my tumor's a benign type." B) "I'm really nervous about having to get surgery and chemo." C) "I'm gaining hope from the fact that it's really rare for someone to die from this." D) "It still feels surreal that I'm goin
B Osteosarcomas are malignant bone tumors that are treatable by surgery and chemotherapy. Survival is in the range of 55% to 70%, so death is not uncommon. Amputation is sometimes necessary but is certainly not an inevitability.
Although the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82-year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem? A) Extended periods of walking cause pain that extends from her ankles, knees, and sciatic nerve. B) The woman complains of aching and morning stiffness in her neck, shoulder, and pelvis. C) Range of motion in the woman's wrists and ankl
B Polymyalgia rheumatica is an inflammatory condition of unknown origin characterized by aching and morning stiffness in the cervical regions and shoulder and pelvic girdle areas. Lower limb pain, wrist and ankle stiffness, and pain in the joints of the foot would not be as clearly suggestive of polymyalgia rheumatica.
A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light. She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment? A) Delirium B) Coma C) Brain death D) Vegetative state
B The continuum of loss of consciousness is marked by the degree of client's responsiveness to stimuli, in addition to the preservation of brain stem reflexes. Since this client still exhibits a pain response (the extended arms and legs indicate decerebrate posturing), even though her pupils are not responsive to light, she has sustained sufficient brain function that she fails to qualify as being brain dead or in a vegetative state.
Due to her progressing osteoarthritis (OA), an 80-year-old woman is no longer able to perform her activities of daily living without assistance. Which of the following phenomena most likely underlies the woman's situation? A) Inappropriate T-cell-mediated immune responses have resulted in articular cartilage degeneration. B) Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself. C) Excessive collagen deposits have accum
B The joint changes associated with osteoarthritis, which include a progressive loss of articular cartilage and synovitis, result from the inflammation caused when cartilage attempts to repair itself, creating osteophytes or spurs. These changes are accompanied by joint pain, stiffness, limitation of motion, and in some cases by joint instability and deformity. Immune etiology is more associated with rheumatoid arthritis, and collagen deposits are characteristic of scleroderma. Bones do not tend to fuse in the pathogenesis of OA.
A 9-year-old boy has been brought to the emergency department by his father who is concerned by his son's recent fever, stiff neck, pain, and nausea. Examination reveals a petechial rash. Which of the following assessment questions by the emergency room physician is most appropriate? A) "Is your son currently taking any medications?" B) "Has your son had any sinus or ear infections in the last little while?" C) "Does your son have a history of cancer?" D) "Was your son born with a
B The most common symptoms of acute bacterial meningitis are fever and chills; headache; stiff neck; back, abdominal, and extremity pains; and nausea and vomiting. Risk factors associated with contracting meningitis include otitis media and sinusitis or mastoiditis. Particular medications, a history of neoplasm, and hematopoietic problems would be unlikely to relate directly to his symptoms of meningitis.
While reviewing the following diagnostic findings on a group of patients with joint complaints, which finding would be a priority for further investigation and possible medical intervention? A) A male client has elevated levels of serum uric acid but lacks symptoms. B) Synovial fluid aspiration indicates the presence of monosodium urate crystals. C) A man reveals that he eats organ meat two to three times weekly. D) A 55-year-old male reveals that it takes a day or two for oral colchicines to
B The presence of crystalline deposits in synovial fluid confirms a diagnosis of gout and would necessitate further investigation and/or treatment. Hyperuricemia is not necessarily indicative of gout, and while diet can contribute to gout, this would not necessarily require modification in the absence of gout. Oral colchicine often takes 48 hours to take effect during an acute attack of gout.
A 41-year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would most likely lead clinicians to this conclusion? A) A visible hematoma is present on the anterior portion of the knee. B) The woman experiences intermittent, painful locking of her joint. C) Computed tomography indicates a complete tear of her knee ligament. D) An x-ray shows that her femoral head and tibia are no longer articulated.
B The symptoms of loose bodies are painful catching and locking of the joint. The loose body repeatedly gets caught in the crevice of a joint, pinching the underlying healthy cartilage. A tear of her ligament, a hematoma, or a lack of articulation is not as closely associated with the presence of loose bodies in a joint.
Following an injury where a child hit his head from a fall, the CT scan reveals a contusion that the doctor classifies as a moderate brain injury. Which of the following manifestations will the nurse more than likely assess on this child that support this diagnosis? Select all that apply. A) Coma with total paralysis B) Periods of unconsciousness C) Aphasia at times D) Nuchal rigidity E) Weakness or slight paralysis affecting one side of the body
B,C,E Moderate brain injury is characterized by a period of unconsciousness and may be associated with focal manifestations such as hemiparesis (weakness or slight paralysis affecting one side of the body), aphasia, and cranial nerve palsy. Coma with total paralysis is seen in severe brain injury. Nuchal rigidity is a classic sign of meningitis.
A male patient in his 50s has just been diagnosed with hyperuricemia. He has had multiple flare-ups of his first metatarsophalangeal joint pain and swelling. The pain is so severe that he cannot sleep with any covers/sheets over his feet at night. The nurse should anticipate that the patient will likely be prescribed: Select all that apply. A) Tylenol (acetaminophen) for the pain. B) allopurinol (Zyloprim) to decrease uric acid levels. C) calcium carbonate used to increase the intake of calcium
B,D Treatment of hyperuricemia is aimed at maintaining normal uric acid levels and is lifelong. One method is to reduce hyperuricemia through the use of allopurinol. Allopurinol inhibits xanthine oxidase, an enzyme needed for the conversion of hypoxanthine to xanthine and xanthine to uric acid as does a newer medication, Febuxostat. The uricosuric drugs (sulfinpyrazone) prevent tubular reabsorption of urate and increase its excretion in the urine. NSAIDs, not Tylenol, are usually prescribed for the pain. Calcium does not play a factor in gout. Sevelamer (Renagel), to reduce the absorption of Phosphate, is primarily used in renal failure patients.
A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a "coup" injury. How will the nurse explain this to the family so they can understand? A) "It's like squeezing an orange so tight that the juice runs out of the top." B) "Your son has a huge laceration inside his brain where the bat hit his skull." C) "Your son has a contusion of the brain at the site where the bat hit his head." D) "When th
C A direct contusion of the brain at the site of external force is referred to as a coup injury. Contrecoup injury (answer choice D) is the rebound injury on the opposite side of the brain. Answer choice B relates to lacerations that are usually not caused by a direct blow to the head. However, depending on how hard the head was hit with a bat, a hematoma could form as the brain strikes the rough surface of the cranial vault.
A 16-year-old boy has been diagnosed with ankylosing spondylitis. Which of the following etiologies is responsible for his health problem? A) Infection B) Friction between bones C) Immune response D) Inappropriate bone remodeling
C Ankylosing spondylitis is thought to have an etiology that suggests an immune response. Physical wear and tear, infection, and inappropriate remodeling are not considered primarily responsible for the disease.
When trying to explain to a patient diagnosed with a benign bone tumor, the nurse should emphasize the fact that benign tumors primarily A) grow rapidly and can spread to the surrounding tissue. B) cause growth of other tumors as they spread their cancer cells into the bloodstream. C) tend to grow very slowly without destroying the supporting tissue. D) occur as a result of tumors in other areas of the body metastasizing into the bone.
C Benign tumors, such as osteochondromas, tend to grow rather slowly and usually do not destroy the supporting or surrounding tissue or spread to other parts of the body (metastasize). Malignant tumors tend to grow rapidly, destroy supporting or surrounding tissue, or spread to other parts of the body through the bloodstream or lymphatics.
A patient asks the nurse why his hip fracture (head of the femur) bone has died (osteonecrosis). The nurse responds based on which of the following pathophysiological principles? A) All fractured bones interrupt blood supply and thereby results in death of the bone no matter where it is located. B) Most of the time when the head of the femur breaks, the entire neck region is disconnected to the rest of the bone so the blood vessels are severed. C) Since the head of the femur has only limited co
C Bone has a rich blood supply that varies from site to site. The flow in the medullary portion of bone originates in nutrient vessels from an interconnecting plexus that supplies the marrow, trabecular bone, and endosteal half of the cortex. Some bony sites, such as the head of the femur, have only limited collateral circulation, so that interruption of the flow, such as with a hip fracture, can cause necrosis of a substantial portion of medullary and cortical bone and irreversible damage. Not all fractures interrupt blood supply to the bone. It is not common for the entire head of the femur to break off leaving the area with no blood supply.
A 56-year-old male is obese and has poorly controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which of the following statements best captures what is likely occurring? A) The client is possibly experiencing direct penetration osteomyelitis in which microorganisms ha
C Diabetes is strongly associated with vascular insufficiency; this process is more likely than infection from the bloodstream, and his situation is not indicative of direct penetration osteomyelitis. Decreased immune status is not directly responsible for his problem.
A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations? A) Rocky Mountain spotted fever B) Lyme disease C) Encephalitis D) Spinal infection
C Encephalitis represents a generalized infection of the parenchyma of the brain or spinal cord. A virus, such as West Nile virus, usually causes encephalitis although it may be caused by bacteria, fungi, and other organisms. Encephalitis is characterized by fever, headache, and nuchal rigidity. However, more often, people also experience neurologic disturbances, such as lethargy, disorientation, seizures, focal paralysis, delirium, and coma. Rocky Mountain spotted fever (answer choice A) is a tick-borne disease caused by the bacterium Rickettsia rickettsii and usually begins with a sudden onset of fever and headache. A rash may occur 2 to 5 days after fever onset. Lyme disease (answer choice B) is also a tick-borne disease. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. As the disease progresses, the patient develops bouts of severe joint pain and swelling of the joint. Neurological problems may occur for weeks, months, or ev
A public health nurse is conducting a health promotion teaching session at a seniors' drop-in center. Which of the following teaching points about hip fractures in older adults is most justified? A) "Current treatment options for hip fractures in older adults mean that surgery is no longer a common necessity." B) "Because of their generally higher body mass, men are particularly susceptible to breaking a hip in a fall." C) "Most hip fractures are actually a break at the very top of th
C Fractures to the femoral head are the most common etiology of hip fractures in the older adult. Surgery is commonly required, and incidence is higher in women than in men. There are numerous risk factors for hip fracture beyond genetic factors, many of which are modifiable.
Which of the following individuals would most likely experience global ischemia to his or her brain? A) A male client who has just had an ischemic stroke confirmed by CT of his head B) A woman who has been admitted to the emergency department with a suspected intracranial bleed C) A man who has entered cardiogenic shock following a severe myocardial infarction D) A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heat
C Global ischemia is associated with a cessation of blood flow to the entire brain, as often occurs during cardiac arrest or myocardial infarction. Ischemic stroke and intracranial bleeding are likely to cause focal ischemia; carbon monoxide toxicity is associated with hypoxia.
A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms? A) Increased tissue perfusion at the site of the malformation B) Hydrocephalus and protein in the cerebral spinal fluid C) High pressure and local hemorrhage of the venous system D
C In arteriovenous malformations, a tangle of arteries and veins acts as a bypass between the cerebral arterial and venous circulation, in place of the normal capillary bed. However, the capillaries are necessary to attenuate the high arterial blood pressure before this volume drains to the venous system. As a result, the venous channels experience high pressure, making them to hemorrhage and rupture more likely; the lack of perfusion of surrounding tissue causes neurologic deficits such as learning disorders. Headaches are severe, and people with the disorder may describe them as throbbing (synchronous with their heartbeat). Increased tissue perfusion means that more oxygenated blood is brought to the area, which is not the case. The elevated arterial and venous pressures divert blood away from the surrounding tissue, impairing tissue perfusion. Answer choice B is incorrect since arteriovenous malformation is associated with blood vessels and not the fluid within the ventricles of the
The physician is considering prescribing an anti-tumor necrosis factor (TNF) like infliximab for a rheumatoid arthritis patient. Which of the following statements is accurate about the advantages of using a TNF inhibitor? A) "Since TNF inhibitors have few side effects, these drugs will fit well into your regimen." B) "Your disease-modifying antirheumatic drug (DMARD) methotrexate has more cardiovascular side effects than TNF inhibitors." C) "TNF inhibitors help slow the disease progre
C Second-line antirheumatic drugs include anti-TNF drugs such as etanercept, infliximab, and adalimumab. These drugs are biologic response-modifying agents or TNF inhibitors that block TNF-a, one of the key proinflammatory cytokines in RA. Anti- TNF-a agents have shown significant efficacy although they do have some potential adverse side effects. Evidence indicates that CV side effects are not different for TNF inhibitors than for DMARDs. The TNF inhibitor agents also have been shown to inhibit radiologic disease progression and improve functional outcomes.
Which of the following clients may be experiencing a sensory focal seizure that has sent an abnormal cortical discharge to the autonomic nervous system (ANS)? A) A 44-year old patient complaining of constant movement and pain in the legs that gets worse when he tries to sleep B) An 85-year-old patient experiencing drooping of the right side of the face and numbness in the right arm and leg C) A 56-year-old complaining of tingling sensations and has both an elevated pulse and BP D) A 22-year-old
C Sensory symptoms correlate with the location of seizure activity on the contralateral side of the brain and may involve somatic sensory disturbance (tingling). With abnormal cortical discharge stimulating ANS, tachycardia, diaphoresis, hypo- or hypertension, or papillary changes may be evident. Distracter A is associated with restless legs syndrome (RLS). Distracter B is associated with stroke (CVA). Distracter D is associated with meningitis.
A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs A) are an accumulation of small deficits that may eventually equal the effects of a full CVA. B) are a relatively benign sign that necessitates monitoring but not treatment. C) resolve rapidly but may place the client at an increased risk for stroke. D) are caused by smal
C TIAs can be considered a warning sign for future strokes. They are not hemorrhagic in nature, and their effects are not normally cumulative. They may require treatment medically or surgically.
Following prosthetic joint replacement of the knee, the patient continues to complain of pain and discomfort above what would be expected. There is poor incisional healing. The clinic nurse is concerned when she sees that the incision is still draining after 3 weeks post-op. The nurse suspects a prosthetic joint infection. The nurse should anticipate the physician will prescribe A) complete bed rest with immobilization of the knee. B) high doses of nonsteroidal anti-inflammatory drugs. C) anti
C Treatment includes the use of antibiotics and selective use of surgical interventions. Antimicrobial agents are usually used prophylactically in persons undergoing bone surgery. For persons with osteomyelitis, early antimicrobial treatment, before there is extensive destruction of bone, produces the best results. Bed rest is not encouraged. The patient may be given NSAIDs for pain, but usually he or she will require a more potent pain killer. Wound irrigations are usually performed in OR rather than at bedside for infected prosthetic joints.
A 44-year-old woman who has a long-standing diagnosis of SLE has been able to control her symptoms with lifestyle modifications for several years, but has presented to her care provider due to recent exacerbation. Which of the following pharmacological treatment options is her care provider most likely to rule out first? A) Nonsteroidal anti-inflammatory drugs B) Corticosteroids C) Antiplatelet aggregators D) Immunosuppressive drugs
C While NSAIDs, corticosteroids, and immunosuppressives are all noted treatment options for SLE, antiplatelet aggregators are unlikely to address the etiology or signs and symptoms of the disease. A new drug that has shown positive effects in decreasing inflammatory exacerbations for people with SLE is Belimumab, which is a monoclonal antibody that inhibits B-lymphocyte stimulator.
A 68-year-old woman has had her mobility and quality of life severely affected by rheumatoid arthritis (RA). Place the following pathophysiological events involved in her health problem in the correct order that they most likely occurred. Use all the options. A) Inflammatory response B) Interaction between rheumatoid factor (RF) and IgG C) T-cell-mediated immune response D) Pannus invasion E) Destruction of articular cartilage
C,B,A,D,E RA is thought to begin with a T-cell-mediated immune response that precipitates interaction between IgG and RF that constitutes an immune response. Pannus invasion is one consequence of this interaction, the ultimate result of which is destruction of cartilage.
Following a car accident of a male teenager who did not have his seatbelt on, he arrived in the emergency department with a traumatic brain injury. He has severe cerebral edema following emergent craniotomy. Throughout the night, the nurse has been monitoring and reporting changes in his assessment. Which of the following assessments correspond to a supratentorial herniation that has progressed to include midbrain involvement? Select all that apply. A) Clouding of consciousness B) Decorticate p
C,D,E With midbrain involvement, pupils are fixed and midsized (5 mm in diameter), and reflex adduction of the eyes is impaired; pain elicits decerebrate posturing; and respirations change from Cheyne-Stokes respiration to neurogenic hyperventilation. Cloudiness of consciousness occurs in early diencephalic stages. Decorticate posturing with pain occurs in the diencephalic stage.
Following a progressive onset of fatigue, aching, and joint stiffness over the last 2 years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which of the following teaching points should his primary care physician include during the office visit in which this diagnosis is communicated to the client? A) "The symptoms you've been experiencing are the result of damage inside your joints, but I'll start you medications that will reverse this damage." B) "It's im
D Current treatment guidelines for RA involve early and aggressive pharmacological treatment, including NSAIDs and corticosteroids. Damage cannot be reversed, and while therapeutic exercise plays a role in treatment, rest is also important.
While being tackled, a 20-year-old football player puts out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment?
D Damage to the ligament structures is associated with sprains, and an incomplete tear would be indicative of a mild to moderate (grade 1 or 2) sprain. A strain is associated most commonly with overuse, and severe sprain would involve total disruption of the
When working with a patient with diffuse scleroderma who is exhibiting a "stone face" expression, the nurse should consider which of the following to be a priority nursing diagnosis for this patient? A) Ineffective tissue perfusion related to tightening of the facial skin B) Activity intolerance related to muscle tightening in lower extremities C) Oral mucous membrane, impaired due to restricted motion of the mouth D) Aspiration, risk related to swallowing impairments
D Diffuse scleroderma is characterized by severe and progressive disease of the skin and the early onset of organ involvement. The typical person has a "stone facies" due to tightening of the facial skin with restricted motion of the mouth. Involvement of the esophagus leads to hypomotility and difficulty in swallowing. The other NANDAs would be of lower priority if at all given the assessment data presented.
A nurse is providing care for a client who has had a cast applied to her fractured arm 6 hours prior. The client is now complaining of severe pain that she describes as "even worse than when I broke my arm." What would be the nurse's best course of action? A) Administration of analgesics and teaching the client about the normal course of pain after a fracture B) Teaching the client simple range of motion exercises to promote circulation and perfusion C) Taking the client's temperature due t
D Severe pain in the site of a fracture that is out of proportion to the original injury is a hallmark of compartment syndrome. Assessment of sensory and motor function would be an appropriate first action. Analgesia alone and exercises would be insufficient to diagnose or address compartment syndrome, and infection would be an unlikely etiology of sudden pain after cast application.
The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? A) Stat administration of tissue plasminogen activator (tPA) B) Administration of a diuretic such as mannitol to reduce cerebral edema and ICP C) Monitoring in the ICU for signs and symptoms of cerebral insult D) Craniotomy and clipping of the affected vessel
D Surgery for treatment of aneurysmal subarachnoid hemorrhage involves craniotomy and inserting a specially designed silver clip that is tightened around the neck of the aneurysm. Administration of tPA would exacerbate bleeding, and a diuretic would not address the issue of bleeding. Monitoring alone would be an insufficient response given the severity of the problem.
An 8-year-old child has just been diagnosed with systemic lupus erythematosus (SLE). The parents wonder what the child's prognosis is going to be. Which of the following findings would be considered a good prognostic indicator of the extent/seriousness of the disease? A) Complaints of arthralgias and arthritis in joints with movement B) Ligaments and tendons hurt during passive ROM C) Has a rash on the nose and cheeks D) Swelling in the face and eyes and rust/blood-colored urine
D The clinical manifestations of SLE in children reflect the extent and severity of systemic involvement. The best prognostic indicator in children is the extent of renal involvement, which is more common and more severe in children than in adults with SLE. Edema and rusty or bloody urine are classic signs of glomerulonephritis. It is expected that people/children with SLE have arthralgias/arthritis in joints, sore ligaments and tendons, as well as integumentary signs and symptoms like a rash on the nose and cheeks (butterfly rash).
A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary care physician's office with chronic hip pain. She reports that as part of her commitment to her recovery, she began exercising regularly about a year earlier. After a month or two, her hip began to hurt when she ran on the treadmill. She stretches, has had a physical trainer check her form to ensure that it is correct, and rests adequately between each workout. Six months ago, the pain began waking
D The symptoms associated with osteonecrosis are varied and depend on the extent of infarction. Typically, subchondral infarcts cause chronic pain that is initially associated with activity, but that gradually becomes more progressive until it is experienced at rest. Osteonecrosis is a common complicating disorder of Legg-Calvé- Perthes disease, slipped capital epiphysis, sickle cell disease, steroid therapy, alcohol abuse, and hip trauma, fracture, or surgery. In adults, hematogenous osteomyelitis is seen most commonly in debilitated patients; in those with a history of chronic skin infections, chronic urinary tract infections, and intravenous drug use; and in those who are immunologically suppressed. Osteomyelitis with vascular insufficiency is characterized by local cellulitis with inflammation and necrosis. Local symptoms of tuberculosis of the bone include pain, immobility, and muscle atrophy; joint swelling, mild fever, and leukocytosis also may occur.
A patient in the intensive care unit who has a brain tumor has experienced a sharp decline. The care team suspects that water and protein have crossed the blood-brain barrier and been transferred from the vascular space into the client's interstitial space. Which of the following diagnoses best captures this pathophysiology? A) Focal hypoxia B) Cytotoxic edema C) Hydrocephalus D) Vasogenic edema
D Vasogenic edema occurs with conditions that impair the function of the blood-brain barrier and allow transfer of water and protein from the vascular into the interstitial space. It occurs in conditions such as tumors, prolonged ischemia, hemorrhage, brain injury, and infectious processes. Focal hypoxia is associated with localized delivery of blood with inadequate oxygen, and cytotoxic edema is an absolute increase in intracellular fluid. Hydrocephalus is an abnormal increase in CSF volume in any part or all of the ventricular system.
A 56-year-old female with a diagnosis of breast cancer has developed bone metastases, which her oncologist would like to treat with radiation therapy. What is her physician's most likely primary goal in the treatment plan of the metastases? A) Thorough elimination of neoplastic cells in the bone structure B) Preservation of normal weight bearing and range of motion C) Ensuring vascular supply to the bone is not affected D) Prevention of pathologic fractures
D While care providers would certainly try to maintain blood supply and mobility, the primary goal in the treatment of bone metastases is to prevent pathologic fractures. Complete elimination of neoplastic cells is not commonly attainable with radiation treatment.
