Test 3 Review

Which patients below are at risk for developing osteoarthritis? Select-all-that-apply:* A. A 65 year old male with a BMI of 35. B. A 59 year old female with a history of taking long term doses of corticosteroids. C. A 55 year old male with a history of repeated right knee injuries. D. A 60 year old female with high uric acid levels.

The answers are A and C. The risk factors for developing OA include: older age, being overweight (BMI >25), repeated injuries to the weight bearing joints, genetics. Option B is at risk for osteoporosis, and option D is at risk for gout.

A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply. Vitamin B12 Potassium Calcitonin Calcium Vitamin D

A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12 and potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient.

True or False: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the compact bone.*

The answer is FALSE: Osteoporosis is a disease process that results in the thinning of the matrix of pore-like structures within the SPONGY (not compact) bone. The compact bone is the outside part of the bone, and the spongy bone is found inside the compact bone. It contains a matrix of pore-like components such as protein and minerals...this starts to thin and becomes more porous in osteoporosis.

You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply: A. Increased joint space B. Osteophytes C. Sclerosis of the bone D. Abnormal sites of hyaline cartilage

The answers are B and C. The joint space would be DECREASED not increased in OA. In addition, an x-ray cannot show hyaline cartilage...therefore, the cartilage cannot be assessed on an x-ray. The radiologist would be looking for osteophytes (bone spurs), sclerosis of the bone (abnormal hardening of the bones), and decreased joint space.

True or False: Osteoarthritis develops due to the deterioration of the synovium within the joint that can lead to complete bone fusion.*

The answer is FALSE: Osteoarthritis is the most common type of arthritis that develops due to the deterioration of the HYALINE CARTILAGE (not synovium) of the bone. This can lead to bone break down, sclerosis of the bone, and osteophytes formation (bone spurs).

During an outpatient visit you are assessing the patient's understanding about the signs and symptoms associated with osteoporosis. Select all of the signs and symptoms stated by the patient that are correct:* A. Dowager's Hump B. Loss of 0.5 inches in height compared to young adult height C. Swelling and warmth at the bone site D. Some patients are asymptomatic E. Fractures most commonly in the hips, wrist, and spine

The answers are A, D, and E. Option B is wrong because there is normally a loss of 2-3 inches in height compared to the patient's height in young adulthood. Option C is wrong because the bone site will not present as warm or swollen (most patients are asymptomatic).

What are three common activity level recommendations for postop appendectomy pts?

1. Resume normal activity in 2-4 weeks 2. No heavy lifting for 6 weeks 3. No driving for 2 weeks (medication use, seatbelt pressure on abdomen)

A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? Remove all small rugs from the home Participatie in weight-bearing exercises Classify medications Increase calcium and vitamin D in the diet

A client with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the client, but the risk for injury from a fall and potential for a fracture makes safety in the home environment a priority.

Identify the correct sequence in how rheumatoid arthritis develops: A. Development of pannus, synovitis, ankylosis B. Anklyosis, development of pannus, synovitis C. Synovitis, development of pannus, anklyosis D. Synovitis, anklyosis, development of pannus

The answer is C. The body attacks (specifically the WBCs) the synovium of the joint. The synovium becomes inflamed and this process is called synovitis. The inflammation of the synovium leads to thickening and the formation of a pannus, which is a layer of vascular fibrous tissue. The pannus will grow so large it will damage the bone and cartilage within the joint. The space in between the joints will disappear and anklyosis will develop, which is the fusion of the bone.

You're caring for a patient who has a health history of severe osteoporosis. On assessment you note the patient has severe kyphosis of the upper back. Which nursing diagnosis takes priority for this patient's care?* A. Risk for skin breakdown B. Knowledge deficient regarding disease process C. Limited mobility D. Risk for falls

The answer is D. When assessing the options you want to select the option that is a priority for this patient and risk for falls is the priority. The patient is at risk for falls due to severe kyphosis, which is common in severe osteoporosis (also called Dowager's Hump). This deformity of the spine limits mobility and increases the chances of falls In addition, it is important the nurse takes precautions in preventing falls because the patient will most likely experience a fracture due to severe osteoporosis.

During a home health visit you are helping a patient with gout identify foods in their pantry they should avoid eating. Select all the foods below the patient should avoid:* A. Sardines B. Whole wheat bread C. Sweetbreads D. Crackers E. Craft beer F. Bananas

The answers are A, C, and E. A patient with gout should avoid foods high in PURINES. These include most red meats, organ meats (liver, kidneys, sweetbreads), alcohol (especially beer).

A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication? Ensure adequate intake of vitamin D in the diet Assess for the use of corticosteroids Encourage the client to get yearly dental exams Have the client sit upright for at least 30 minutes following administration

While all interventions are appropriate, the highest priority is having the client sit upright for 60 minutes following administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The client should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and alendronate is link to a complication of osteonecrosis.

Parathyroid hormone plays an important role in bone health. When the parathyroid gland secretes PTH (parathyroid hormone) it causes:* A. the body to increase the calcium levels by stimulating the osteoclast activity. B. the body to decrease the calcium levels by inhibiting osteoclast activity. C. the body to increase the calcium levels by stimulating osteoblast activity. D. the body to decrease the calcium levels by inhibiting osteoblast activity.

The answer is A. When the calcium levels are low this stimulates the parathyroid gland to secrete PTH, which stimulates osteoCLAST activity. Remember osteoCLASTS break down the bone matrix within the spongy bone. This will cause calcium to enter the blood stream, hence increasing calcium levels.

A patient is post-op from surgery. The patient has a history of gout. While performing a head-to-toe assessment, you assess the patient for signs and symptoms of gout. As the nurse, you know that gout tends to start at what site?* A. Elbow B. Big toe C. Thumb or index finger D. Knees

The answer is B. Most patients tend to have an acute attack of gout that begins in the big toe. Remember that patients who have a history of gout or who are experiencing a hospitalization (due to the physical stress on the body) are at risk for an acute gout attack. Therefore, the nurse should assess the patient for this during the head-to-toe assessment.

During the 1000 medication pass, your patient reports to you that he is having muscle pain and tingling in his fingers and toes. You note that the patient also has a grayish color to his lips. You immediately notify the doctor. In addition, you would hold which medication that is scheduled to be administered at 1000?* A. Ibuprofen B. Prednisone C. Colchicine D. Aspirin

The answer is C. The signs and symptoms presenting in this patient are classic signs of Colchicine toxicity. Therefore, the nurse should not administer Colchicine. This medication can also cause GI upset and neutropenia

It is important a patient with gout avoid medications that can increase uric acid levels. Which medication below is NOT known to increase uric acid levels?* A. Aspirin B. Niacin C. Cyclosporine D. Tylenol

The answer is D. Options A, B, and C increase uric acid. Option D does not.

During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as:* A. Bouchard's Nodes B. Heberden's Nodes C. Neurofibromatosis D. Dermatofibromas

The answer is B. Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) is called Heberden's Node. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) it is called Bouchard's Node.

You are providing education to a patient, who was recently diagnosed with rheumatoid arthritis, about physical exercise. Which statement made by the patient is correct? A. "It is best I try to incorporate a moderate level of high impact exercises weekly into my routine, such as running and aerobics." B. "I will be sure to rest joints that are experiencing a flare-up, but I will try to maintain a weekly regime of range of motion exercises along with walking and riding a stationary bike." C. "It is important I perform range of motion exercises during joint flare-ups and incorporate low-impact exercises into my daily routine." D. "Physical exercise should be limited to only range of motion exercises to prevent further joint damage."

The answer is B. During flare-ups of RA the patient should rest the joint. However, it is important the patient performs range of motion exercises along with LOW-IMPACT exercise weekly (such as stationary bike riding, walking, water aerobics etc.). This will help with increasing the patient's energy level along with muscle strength and maintain joint health.

Identify which patient below is at MOST risk for developing gout:* A. A 56 year old male who reports consuming foods low in purines. B. A 45 year old male with a BMI of 40 who reports taking hydrochlorothiazide and aspirin. C. A 39 year old female hospitalized with bulimia that has a BMI of 24. D. A 27 year old female with ulcerative colitis.

The answer is B. Gout is due to high levels of uric acid in the blood. This can either be due to the kidney's inability to excrete uric acid out of the body or the body is producing too much uric acid. Some causes that can lead to increased uric acid levels include: being overweight (BMI >25 is considered overweight), usage of aspirin or diuretics (thiazides (hydrochlorothiazide) or loop), HIGH consumption of purines, dehydration, renal problems. Option B is the only patient MOST at risk for developing gout.

You're providing education to a group of nursing students about the care of a patient with appendicitis. Which statement by a nursing student requires re-education about your teaching? "After an appendectomy the patient may have a nasogastric tube to remove stomach fluids and swallowed air." "Non-pharmacological techniques for a patient with appendicitis include application of heat to the abdomen and the side-lying position." "The nurse should monitor the patient for signs and symptoms of peritonitis which includes increased heart rate, respirations, temperature, abdominal distention, and intense abdominal pain." "It is normal for some patients to have shoulder pain after a laparoscopic appendectomy."

The answer is B. This statement by the nursing student requires re-education because heat should NEVER be applied to abdomen if appendicitis is suspected or known. Heat application can increase the risk of appendix perforation. Ice application is recommended, if warranted. However, the side-lying position can help relieve the patient's pain and is recommended. All the other options are correct.

A 75 year old male is admitted for chronic renal failure. You note that the patient has white/yellowish nodules on the helix of the ear and fingers. The patient reports they are not painful. As you document your nursing assessment findings, you will document this finding as?* A. Nodosa B. Keloid C. Dermoid D. Tophi

The answer is D. Tophi are white/yellowish nodules that are urate crystals. They start to form together in large masses and can be found under the skin (helix ears, elbows, fingers, toes etc.), joints, bursae, bones, which can lead to bone deformity and joint damage. Patients with chronic renal failure are at risk for chronic gout due to the kidney's inability to remove uric acid remove the body.

A client presents in the emergency department with complaints of cough, headache, and generalized aches and pains. Upon assessment, the nurse documents a temperature of 102.5°F (39.2°C) and redness on the arms, legs, and upper chest. She also notes that the client takes eight different medications each day. What nursing diagnosis is the priority for this client? Impaired physical mobility Impaired tissue integrity Impaired thermoregulation Ineffective therapeutic regimen management

The client is showing signs of Stevens-Johnson Syndrome (SJS), which is triggered by a reaction to medications. Signs and symptoms of SJS include conjunctival burning, fever, cough, sore throat, headache, aches and pains, and erythema and mucous membranes. As the disease progresses, large portions of the epidermis are shed, exposing the dermis and causing tender skin and a weeping surface. Keeping the tissue intact is the main priority for this client. Although Impaired physical mobility, Impaired thermoregulation, and Ineffective therapeutic regimen management apply to this client, these nursing diagnoses are lower priorities than Impaired tissue integrity.

What are the five diagnostic tools for appendicitis?

1. CT Scan (Preferred) 2. Ultrasound (Preferred for children and pregnant women) 3. Urinalysis (To rule out UTI) 4. Abdominal X-Ray 5. Pelvic Exam

What are some of the non-super obvious clinical manifestations of appendicitis?

1. Pain aggravated by walking or moving 2. Coated tongue and bad breath 3. Constipation OR Diarrhea 4. Fever 5. Rovsing's 6. Psoas 7. Obturator

What are the four major complications of appendicitis?

1. Peritonitis - ISOTONIC FLUIDS pushed to combat hypovolemia\ 2. Paralytic Ileus - absent or high pitched bowel sounds; distended abdomen 3. Pyelophlebitis - rare, but lethal inflammation of portal venous system 4. Abcess Formation - Collection of purulent tissue surrounded by inflamed tissues; tx = antibiotics, maybe a drain, then appendectomy

Which of the following are routes of administration for Calcitonin? Select all that apply. Nasal spray Subcutaneous Intramuscular injection Intravenous Oral

Calcitonin is administered by nasal spray or by subcutaneous or intramuscular injections.

Which of the following type of fracture is associated with osteoporosis? Compression Stress Oblique Simple

Compression fractures are caused by compression of vertebrae and are associated frequently with osteoporosis. Stress fractures occur with repeated bone trauma from athletic activities, most frequently involving the tibia and metatarsals. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees. A simple fracture (closed fracture) is one that does not cause a break in the skin.

Each bone is composed of cells, protein matrix, and mineral deposits. Which type of bone cell works to repair a bone fracture? osteocytes osteoblasts osteoclasts osteomytes

During times of rapid bone growth or bone injury, osteocytes function as osteoblasts to form new bone.

A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until his femur can be rodded in surgery. For what early complications should the nurse monitor this client? Select all that apply. Systemic infection Complex regional pain syndrome Deep vein thrombosis Compartment syndrome Fat embolism

Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and complex regional pain syndrome are later complications of fractures.

A patient newly diagnosed with osteoarthritis asks about the medication treatments for their condition. Which medication is NOT typically prescribed for OA?* A. NSAIDs B. Topical Creams C. Oral corticosteroids D. Acetaminophen (Tylenol)

The answer is C. Intra-articular corticosteroids (an injection in the joint) are commonly prescribed rather than oral corticosteroids. Remember OA in within the joint...not systemic so oral corticosteroids are not as effective. All the other medications listed are prescribed in OA.

To confirm a diagnosis of low back pain, which of the following diagnostic procedures would be ordered to rule out the presence of a tumor? Bone scan Computed tomography Magnetic resonance imaging Electromyogram

A bone scan is the preferred diagnostic procedure to disclose tumors in a patient with low back pain.

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

Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply. Pneumonia Necrosis of the humerus Skin breakdown Sepsis Delirium

Complications in clients with hip fractures are often related to the client's age. During the first 24 to 48 hours following surgery for hip fracture, atelectasis or pneumonia can develop as a result of the anesthesia. Thromboemboli are possible, as is sepsis. Elderly clients are also at risk for delirium in hospital settings because of the stress of the trauma, unfamiliar surroundings, sleep deprivation, and medications. An elderly client with decreased mobility is at risk for skin breakdown. Necrosis is a potential complication of the surgery, but the complication would be with the femur, not the humerus.

A client has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care?

Constipation is a problem related to immobility and medications used to treat vertebral fractures. The client's risks of aspiration, dysphagia, and decreased cardiac output are not necessarily heightened.

1. True or False: The appendix is found on the left lower side of the abdomen and is connected to the cecum of the large intestine.

False. The appendix is found on the RIGHT (not left) lower side of the abdomen and is connected to the cecum of the large intestine.

True or False: Rheumatoid arthritis tends to affect women more than men and people who are over the age of 60.

False: Yes, RA tends to affect women more than men BUT it can affect all ages...most commonly 20-60 years old.

Which of the following assessment findings indicate to the nurse that a client may have peripheral neurovascular dysfunction? Absence of feeling Capillary refill of 4 to 5 seconds Cool skin Pain Redness of the skin Weakness in motion

Indicators of peripheral neurovascular dysfunction include pale, cyanotic or mottled skin with a cool temperature, capillary refill greater than 3 seconds, weakness or paralysis with motion, and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling.

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.) Checking the urine for hematuria Palpating peripheral pulses in both lower extremities Testing the stool for occult blood Assessing level of consciousness Assessing pupillary response

In pelvic fracture, the nurse should palpate the peripheral pulses, especially the dorsalis pedis pulses of both lower extremities; absence of a pulse may indicate a tear in the iliac artery or one of its branches. To assess for urinary tract injury, the patient's urine is analyzed for blood.

A nurse practitioner was asked to explain to a patient the age-related process of bone loss that results in osteoporosis. Which of the following is the best statement the nurse should use? Decreased estrogen inhibits bone breakdown. Increased calcitonin enhances bone resorption. Increased vitamin D use interferes with calcium use. Decreased parathyroid hormone increases bone resorption.

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

Your patient is scheduled for a DEXA scan this morning. The patient is having heartburn and requests a PRN medication to help with relief. Which medications can the patient NOT have at this time?* A. Calcium Carbonate B. Bismuth Salicylate C. Milk of Magnesia D. Famotidine

The answer is A. Before a DEXA scan, which is a bone density test, the patient should not take any type of calcium supplements (calcium carbonate (TUMs) or vitamins containing calcium.

You're providing care to a patient with severe rheumatoid arthritis. While performing the head-to-toe nursing assessment, you note the patient's overall skin color to be pale and the patient looks exhausted. You ask the patient how she is feeling, and she says "I'm so tired. I can't even get out of this bed without getting short of breath." Which finding on the patient's morning lab work may confirm a complication that can be experienced with rheumatoid arthritis? A. Potassium 3.2 mEq/L B. Hemoglobin 7 g/dL C. Sodium 135 mEq/L D. WBC count 6,500

The answer is B. Patients with RA can experience anemia. A hemoglobin level can be helpful in diagnosing anemia (a normal level in females is 12 to 15.5 g/dL). The patient's signs and symptoms above are classic findings in anemia.

Which patient below is NOT at risk for osteoporosis?* A. A 50 year old female whose last menstrual period was 7 years ago. B. A 45 year old male patient who has been taking glucocorticoids for the last 6 months. C. A 30 year old male who drinks alcohol occasionally and has a BMI of 28. D. A 35 year old female who has a history of seizures and takes Dilantin regularly.

The answer is: C. All these patients are at risk for osteoporosis except the patient in option C. Remember the risk factors include: older age (45+), being a woman, Caucasian or Asian, post-menopause, glucocorticoids therapy, anticonvulsants (Dilantin), REGULAR alcohol usage, smoking, sedentary lifestyle, BMI <19, family history. Option C is not at risk.

A nurse is explaining a client's decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? Select all that apply. Thyroid hormone Growth hormone Estrogen Vitamin B12 Luteinizing hormone

The balance between bone resorption and formation is influenced by the following factors: physical activity; dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone. Luteinizing hormone and vitamin B12 do not play a role in bone formation or resorption.

A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage? A. Hydroxychloroquine (Plaquenil) B. Lefluomide (Arava) C. Sulfasalazine (Azulfidine) D. Methylprednisolone (Medrol)

The answer is A. This medication is a DMARD and can cause retinal damage. Therefore, the patient should be monitored for vision changes.

During discharge teaching to a patient at risk for developing osteoporosis, you discuss the types of exercise the patient should perform. Which type of exercise is not the best to perform to prevent osteoporosis?* A. Tennis B. Weight-lifting C. Walking D. Hiking

The answer is C. Low-impact exercises are not as beneficial in building bone mass as compared to weight-bearing exercises such as tennis, lifting weights, and hiking etc. The patient should perform exercises that put stress on the bones against gravity, which will help increase bone strength and build muscle.

A 58 year old female is experiencing a flare-up with rheumatoid arthritis. While assisting the patient with her morning routine, the patient verbalizes a pain rating of 7 on 1-10 scale in the right and left wrist along with severe stiffness. You note the wrist joints to be red, warm, and swollen. What nonpharmalogical nursing interventions can you provide to this patient to help alleviate pain and stiffness? Select-all-that-apply: A. Exercise the affected joints B. Assist the patient with a warm shower or bath C. Perform deep massage therapy to the wrist joints D. Assist the patient with applying wrist splints

The answers are B and D. During flare-ups of RA the joint should be rested (not exercised) and should not be deep massaged because this can further damage the joint (in addition cause the patient more pain). Heat therapy, like a warm shower or bath, will help alleviate the stiffness. Furthermore, cold therapy can be used to reduce the inflammation along with splinting the affected joints to protect and rest them.

A patient with osteoarthritis has finished their first physical therapy session. As the nurse you want to evaluate the patient's understanding of the type of exercises they should be performing regularly at home as self-management. Select all the appropriate types of exercise stated by the patient:* A. Jogging B. Water aerobics C. Weight Lifting D. Tennis E. Walking

The answers are B, C, E. The patient wants to perform exercises that are low impact like: walking, water aerobics, stationary bike riding along with strengthen training (lifting weights: helps strengthen muscles around the joint), ROM: improves the mobility of the joint and decreases stiffness. It is important patients with OA avoid high impact exercises that will increase stress on weight bearing joints such as running/jogging, jump rope, tennis, or any type of exercise with both feet off the ground.

2. Select all the following options that are NOT causes of appendicitis: Fecalith Routine usage of NSAIDs Infection due to Helicobacter pylori Lymph node enlargement due to viral or bacterial infection Diet low in fiber

The answers are: B, C, and E. These options are NOT causes of appendicitis. Routine usage of NSAIDS and infection due H. pylori are causes of peptic ulcers. While a diet low in fiber is thought to be the cause of diverticulosis. Fecalith and lymph node enlargement due to viral or bacterial infection (such as mononucleosis etc.) can cause appendicitis.

A physician prescribes raloxifene to a hospitalized client. The client's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which action by the nurse demonstrates safe nursing care? Administering the raloxifene in the evening Holding the raloxifene and notifying the physician Administering the raloxifene with food or milk Having the patient sit upright for 30-60 minutes following administration

Raloxifene is contraindicated in clients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene can be given without regard to food or time of day. Raloxifene is a selective estrogen receptor modulation medication. Sitting upright for 30-60 minutes is indicated with drugs classified as bisphosphonates.

A physician suspects a patient may have rheumatoid arthritis due to the patient's presenting symptoms. What diagnostic testing can be ordered to help a physician diagnose rheumatoid arthritis? Select all that apply: A. Rheumatoid factor B. Uric acid level C. Erythrocyte sedimentation D. Dexa-Scan E. X-ray imaging

The answers are A, C, and E. These are diagnostic tests to help diagnose RA. Option B is used in gout, and option D is used with osteoporosis.

A nurse practitioner provides health teaching to the family of a 75-year-old woman who has trouble walking independently. The nurse reviews age-related changes to the musculoskeletal system with the family. Which of the following statements would the nurse include in her teaching? Select all that apply. Tendons become more elastic. Intervertebral discs become thin. Muscles atrophy. Muscle fibrosis increases. Collagen increases

Age-related musculoskeletal changes could include: -Gradual, pregoressive loss of bone mass after age 30 - Vertebral Collapse -Increase in collagen and resultant fibrosis (<strength/flexibility) - Muscle atrophy - Tendons less elastic - Progressive deterioration/thinning of cartilage and intervertebral disks - Lax ligaments (weak)

What are some risk factors for osteoporosis?

Lifestyle risk factors for osteoporosis include lack of exposure to sunshine, a diet low in calcium and vitamin D, cigarette smoking, consumption of alcohol and/or caffeine, and lack of weight-bearing exercise. Lack of weight-bearing exercise, not aerobic exercise, is a lifestyle risk factor for osteoporosis. A diet low in calcium and vitamin D, not a low-protein, high-fat diet, is a lifestyle risk factor for osteoporosis. An estrogen deficiency or menopause is an individual risk factor for osteoporosis. Other individual risk factors include female gender, non-Hispanic white or Asian race, increased age, low weight and body mass index, family history of osteoporosis, low initial bone mass, and contributing coexisting medical conditions and medications.

A 63 year old patient has severe osteoarthritis in the right knee. The patient is scheduled for a knee osteotomy. You are providing pre-op teaching about this procedure to the patient. Which statement made by the patient is correct about this procedure?* A. "This procedure will realign the knee and help decrease the amount of weight experienced on my right knee." B. "A knee osteotomy is also called a total knee replacement." C. "A knee osteotomy is commonly performed for patients who have osteoarthritis in both knees." D. "This procedure will realign the unaffected knee and help alleviate the amount of weight experienced on the right knee."

The answer is A. A knee osteotomy is NOT known as a total knee replacement. A knee osteotomy can be used as an alternative for a total knee replacement but is not the same thing. In addition, a knee osteotomy is performed when there is OA on only one side of the knee.

Which of the following are the major hormonal regulators of calcium homeostasis? Select all that apply. Parathormone Calcitonin Thyroid Cortisol Growth hormone

The balance between bone resorption (removal or destruction) and formation is influenced by the following factors: physical activity; dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone PTH AND CALCITONIN REGULATE CALCIUM HOMEOSTASIS!!!

A patient is prescribed Alendronate (Fosamax) at 0800 for the treatment of osteoporosis. As the nurse you know you must administer this medication:* A. on an empty stomach with a full glass of water and keep the patient upright for 30 minutes. B. right after breakfast and to lay the patient flat (as tolerated) for 30 minutes. C. with food but to avoid giving this medication with dairy products. D. on an empty stomach with a full glass of juice or milk.

The answer is A. Alendronate (Fosamax) is a bisphosphonate which is known for causing GI upset, especially inflammation of the esophagus. These medications should be taken with a full glass of water in morning on empty stomach with NO other medication. The patient should sit up for 30 minutes (60 minutes with Boniva) after taking the medication, and not eat anything for 1 hour after taking (helps the body absorb more of the medicine.)

4. Thinking back to the scenario in question 3, what other signs and symptoms are associated with appendicitis. SELECT-ALL-THAT-APPLY: Increased red blood Cells Patient has the desire to be positioned in the prone position to relieve pain Umbilical pain that extends in the right lower quadrant Abdominal rebound tenderness Abdominal Flaccidity

The answers are: C and D. These are classic signs and symptoms found in patients with appendicitis. Option A is wrong because the patient may have increased WHITE blood cells (not red). Option B is wrong because the patient may have the desire to be in the fetal position (side-lying with the knees bent) to relieve the pain. The prone position would increase the pain. Option E is wrong because the patient would have abdominal RIGIDITY (not flaccidity).

You're developing a nursing care plan for a patient with gout present in the right foot. What specific nursing interventions will you include in this patient's plan of care? Select all that apply:* A. Encourage fluid intake of 2-3 liter per day. B. Provide patient with foods high in purine with each meal daily. C. Place patient's right foot in a foot board while patient is in bed. D. Administer PRN dose of Aspirin for a pain rating greater than 5 on 1-10 scale. E. Apply alternating cold and warm compresses to right foot as tolerated by the patient daily.

The answers are A, C, E. These options are correct nursing intervention for this patient. Option B is wrong because the patient should consume food LOW in purines (remember purines increase uric acid levels). Option D is wrong because patients should AVOID aspirin. Aspirin (even low doses) increase uric acid levels.

1. During a routine health check-up visit a patient states, "I've been experiencing severe pain and stiffness in my joints lately." As the nurse, you will ask the patient what questions to assess for other possible signs and symptoms of rheumatoid arthritis? Select-all-that-apply:* A. "Does the pain and stiffness tend to be the worst before bedtime?" B. "Are you experiencing fatigue and fever as well?" C. "Is your pain and stiffness symmetrical on the body?" D. "Is your pain and stiffness aggravated by extreme temperature changes?"

The answers are B and C. Patients with RA will experience pain and stiffness in the morning (for more than 30 minutes) not bedtime. It is common for patients to have a fever and be fatigued...remember RA affects the whole body not just the joints. It will also affect the same joints on the opposite side of the body. Therefore, if the right wrist is inflamed, painful, and stiff the left wrist will be as well. RA is NOT aggravated by extreme temperatures. This is found in osteoarthritis.

A patient with osteoarthritis is describing their signs and symptoms. Which signs and symptoms below are NOT associated with osteoarthritis? Select-all-that-apply:* A. Morning stiffness greater than 30 minutes B. Experiencing grating during joint movement C. Fever and Anemia D. Symmetrical joint involvement E. Pain and stiffness tends to be worst at the end of the day

The answers are: A, C, D. These options are signs and symptoms found with rheumatoid arthritis NOT osteoarthritis. In OA: morning stiffness is LESS than 30 minutes, it is NOT systemic as RA (so fever and anemia will not be present), and it is asymmetrical (both joints are not involved). Pain and stiffness will actually be worst at the end of the day compared to the beginning due to overuse of the joints.

The nurse is changing the dressing of a chronic wound. There is no sign of infection or heavy drainage. How long will the nurse leave the wound covered for? 6 to 12 hours 12 to 24 hours 24 to 36 hours 48 to 72 hours

The natural wound-healing process should not be disrupted. Unless the wound is infected or has a heavy discharge, it is common to leave chronic wounds covered for 48 to 72 hours and acute wounds for 24 hours.

A patient is taking Calcitonin for osteoporosis. The patient should be monitored for?* A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia

A patient is taking Calcitonin for osteoporosis. The patient should be monitored for? A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia The answer is C. Calcitonin is made from salmon calcitonin and acts like the hormone calcitonin which is produced naturally by the thyroid gland. It decreases osteoclast activity, which can decrease calcium levels. Therefore, the patient is at risk HYPOcalcemia.

A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about? Amitriptyline (Elavil) Duloxetine (Cymbalta) Gabapentin (Neurontin) Cyclobenzaprine (Flexeril)

Nonprescription analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) and short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. Tricyclic antidepressants (e.g., amitriptyline [Elavil) and the newer dual-action serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine [Cymbalta]) (Karp et al., 2010) or atypical seizure medications (e.g., gabapentin [Neurontin], which is prescribed for pain from radiculopathy) are used effectively in chronic low back pain.

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? penicillamine (Cuprimine) methotrexate (Rheumatrex) plicamycin (Mithracin) raloxifene (Evista)

Raloxifene (Evista) is used for the prevention and treatment of osteoporosis.

A patient is recovering after having an appendectomy. The patient is 48 hours post-op from surgery and is tolerating full liquids. The physician orders for the patient to try solid foods. What types of foods should the patient incorporate in their diet? A. Foods high in fiber Foods low in fiber Foods high in carbohydrates Foods low in protein

The answer is A. It is best for the patient to follow a diet high in fiber to prevent straining during bowel movements.

A patient is ordered by the physician to take Allopurinol (Zyloprim) for treatment of gout. You've provided education to the patient about this medication. Which statement by the patient requires you to re-educate them about this medication?* A. "This medication will help relieve the inflammation and pain during an acute attack." B. "It is important I have regular eye exams while taking this medication." C. "I will not take large doses of vitamin C supplements while taking this medication." D. "Allopurinol decreases the production of uric acid."

The answers are A, C, E. These options are correct nursing intervention for this patient. Option B is wrong because the patient should consume food LOW in purines (remember purines increase uric acid levels). Option D is wrong because patients should AVOID aspirin. Aspirin (even low doses) increase uric acid levels.

3. A 23 year old patient is admitted with suspected appendicitis. The patient states he is having pain around the umbilicus that extends into the lower part of his abdomen. In addition, he says that the pain is worst on the right lower quadrant. The patient points to his abdomen at a location which is about a one-third distance between the anterior superior iliac spine and umbilicus. This area is known as what?

This is known as McBurney's Point and is a classic sign and symptom in patients with appendicitis.

Emergency medical technicians transport a client to the emergency department. They tell the nurse, "He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he's comatose. We intubated him and he's maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag." Which intervention by the nurse has the highest priority? Assessing the left leg Assessing the pupils Placing the client in Trendelenburg's position Assessing level of consciousness (LOC)

In this scenario, airway and breathing have been established, so the nurse's priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the left leg. Neurologic assessment of the pupils and LOC are secondary concerns to airway, breathing, and circulation. The nurse doesn't have enough data to warrant putting the client in Trendelenburg's position.

A nurse is providing a class on osteoporosis at the local seniors' center. Which of the following statements related to osteoporosis is most accurate? Osteoporosis is categorized as a disease of the elderly. A nonmodifiable risk factor for osteoporosis is a person's level of activity. Secondary osteoporosis occurs in women after menopause. Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.

When corticosteroid therapy is discontinued, the progression of osteoporosis is halted, but restoration of lost bone mass does not occur. Osteoporosis is not a disease of the elderly because its onset occurs earlier in life, when bone mass peaks and then begins to decline. A person's level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.

You are providing a free clinic seminar to participants about gout. Which statement by a participant about the occurrence of gout is correct? A. "Gout attacks tend to awake the person out of their sleep in the middle of the night." B. "The pain felt with gout tends to be intense during the first 30 minutes." C. "It is best for a patient experiencing gout to tightly bandage the affected extremity." D. "Typically acute gout attacks are predictable and tend to occur once or twice a week."

The answer is A. This is the only correct statement about gout. Option B is wrong because the pain felt with gout tends to intensify within 4-24 hours (not 30 minutes). Option C is wrong because any type of pressure (even the pressure of bed linens) can majorly increase the pain felt with gout. Option D is wrong because gout attacks come on suddenly and may only occur once and tend to have several months or a year between attacks.

9. A patient is scheduled for appendectomy at noon. While performing your morning assessment, you note that the patient has a fever of 103.8 'F and rates abdominal pain 9 on 1-10. In addition, the abdomen is distended and the patient states, "I was feeling better last night but it seems the pain has become worst." The patient is having tachycardia and tachypnea. Based on the scenario, what do you suspect the patient is experiencing? Pulmonary embolism Colon Fistulae Peritonitis Hemorrhage

The answer is C. Based on the patient's presenting symptoms, the patient is most likely experiencing peritonitis because the appendix has ruptured. The key clues in this scenario are the classic signs and symptoms of peritonitis (tachycardia, tachypnea, high temperature, and abdominal pain/distension) along with the patient's statement that they were feeling better last night (hence probably the time the appendix ruptured) which periodically relieved the pain at the appendix but allowed for the contents of the appendix to leak into the peritoneal cavity....hence causing peritonitis.

An 18 year old patient is admitted with appendicitis. Which statement by the patient requires immediate nursing intervention? "The pain hurts so much it is making me nauseous." "I have no appetite.". "The pain seems to be gone now." "If I position myself on my right side, it makes the pain less intense."

The answer is C. It is important that the nurse monitors the patient's pain level. If the patient reports that the pain has suddenly decreased or is gone, this is a warning sign that the appendix may have perforated (ruptured). If the appendix has ruptured, the sudden decrease in pain will be followed by more pain due to peritonitis (which is life- threatening). Therefore, the nurse should notify the doctor immediately.