Patho Exam ? Ch 49

c) Dyspnea during activity Pg. 1237 Activity Intolerance and Fatigue During activity, dyspnea is not expected. If it occurs, the client should sit and rest. The other cardiovascular responses to exercise are expected: increased respiratory rate, heart rate and blood pressure.

13. Which cardiovascular response will the nurse assess in order to determine that a client has activity intolerance? a) Increased heart rate during activity b) Increased respiratory rate during activity c) Dyspnea during activity d) Increased blood pressure during activity

b) Rickets Pg. 1235 Clinical Manifestations All of these are symptoms for rickets that are noticed between 6 months and 3 years of age. The rachitic rosary refers to prominent rib cartilage, which is also a symptom of rickets. Paget disease is a progressive skeletal disorder characterized by increasing structural changes of the long bones, spine, pelvis, and cranium; it usually begins during mid-adulthood. DDH is developmental dysplasia of the hip.

3. A 16-month-old boy has a normal weight for his age but a height far below the normal range. His list of symptoms includes a protruding abdomen, lethargy, bow legs, muscle weakness, and irritability. His teeth have not yet developed and he has difficulty standing. What is the child's most likely diagnosis? a) Developmental dysplasia of the hip b) Rickets c) Paget disease d) Rachitic rosary

c) Anyone with an eating disorder Pg. 1231 Pathogenesis Having an eating disorder places clients at increased risk due to malabsorption of medications.

6. Which clients should the nurse assess to determine if they have premature osteoporosis? a) Anyone over the age of 70 b) Anyone under the age of 20 c) Anyone with an eating disorder d) Clients who run daily

a) The process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown Pg. 1230-1231 Osteoporosis With aging, the process of bone formation (renewal) is slowed in relation to bone resorption (breakdown). Estrogen levels decrease with menopause and contribute to bone loss. Multiple infections are not a factor in bone loss. Osteoporosis cannot be resolved with increasing calcium.

1. A postmenopausal client questions the nurse about the diagnosis of osteoporosis. Which statement describes the pathology of osteoporosis? a) The process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown b) Osteoporosis can be resolved with increasing calcium intake to strengthen the bones c) Estrogen levels increase with menopause and contribute to bone loss d) Bone loss occurs after multiple infections occur throughout a lifetime

a) Inability to concentrate; awakens after a few hours of sleep and cannot return to sleep Pg. 1237-1238 Chronic Fatigue Chronic fatigue has a psychological component that includes impaired cognition, which the person describes as an inability to concentrate and perform mundane tasks. There are reports of mood and sleep disturbances, balance problems, visual disturbances, and various degrees of anxiety and depression. Dementia is persistent functional impairment in several areas of intellect: language, memory, visuospatial ability, and cognition. Hallucinations are usually not associated with chronic fatigue.

10. An older adult is being evaluated for chronic fatigue. Which assessment data by the nurse would support the diagnosis? a) Inability to concentrate; awakens after a few hours of sleep and cannot return to sleep b) Reports experiencing complex visual hallucinations c) Uses a limited vocabulary, and often searches for words d) Unable to find the correct answer for simple questions like "What did you eat for lunch?"

d) An adducted forefoot that gives the foot a kidney-shaped appearance Pg. 1218 Toeing-In Metatarsus adductus, or in-toeing, is a common congenital deformity characterized by forefoot adduction with a normal hindfoot, giving the foot a kidney-shaped appearance. It can be caused by torsion in the foot, lower leg, or entire leg. A condition of toeing-out is caused by external femoral torsion. The other answers relate to congenital hip problems.

11. Which best describes metatarsus adductus? a) A condition involving a congenital dislocation at the hip b) An abnormal rotation of the hip c) A condition of toeing-out caused by external femoral torsion d) An adducted forefoot that gives the foot a kidney-shaped appearance

b) Serial manipulations and casting of the affected extremity Pg. 1227 Congenital Clubfoot When treatment of clubfoot is initiated during the first few weeks of life, a nonoperative procedure may be effective. Serial manipulations and casting are used gently to correct each component of the deformity. Surgery may be required for the most severe deformities. Bilateral hip spica cast is used to treat developmental dysplasia of the hip. Chemotherapy is used to treat cancers and is not needed for clubfoot.

12. Which teaching will the nurse provide for parents of a child who has clubfoot, or talipes? a) Bilateral hip spica cast b) Serial manipulations and casting of the affected extremity c) Chemotherapy d) Immediate corrective surgery

a) Increasing dietary consumption of vitamin D Pg. 1234 Osteomalacia Clients with osteomalacia need to have increased vitamin D, and exposure to natural sunlight will help increase the absorption. Losing weight and a bone marrow transplant will not be helpful.

14. In a client diagnosed with osteomalacia, what would be recommended to aid with improvement of the condition? a) Increasing dietary consumption of vitamin D b) Undergoing a bone marrow transplant c) Losing 5 to 10 pounds of weight d) Decreasing exposure to the natural UV radiation of the sun

b) The child should sit in the tailor position Pg. 1222 Femoral Torsion Children with internal femoral torsion (femoral anteversion) should be encouraged to sit in the tailor or crossed leg position. Internal femoral torsion is commonly seen during the first 6 years of life, especially in 3 to 4 year old girls. Children are most comfortable sitting in the "W" position with their hips between their knees.

15. The nurse is providing teaching to the parents of a 3-year-old girl with internal femoral torsion. Which statement should the nurse include? a) The condition will self correct b) The child should sit in the tailor position c) The condition is more common in boys than girls d) The most comfortable position for the child is the "M" position

c) The client should understand that activities with higher metabolic equivalents have higher workloads Pg. 1239 Table 49-2: Chronic Illnesses and Causes of Chronic Fatigue Metabolic equivalents or METs are a measure of the basal metabolic rate commonly used to express workload at various stages of activity. The energy expended in a resting position is equivalent to 1 MET. As activity increases, MET increases. Clients should strive to increase the use of activities with increased METs.

16. How will the nurse teach the client to utilize metabolic equivalents when starting an exercise routine? a) Metabolic equivalents tell the client to stop activity b) The client should strive to keep metabolic equivalents in activity to a minimum c) The client should understand that activities with higher metabolic equivalents have higher workloads d) As metabolic equivalents increase, activity decreases

d) Abnormalities present at birth Pg. 1219-1220 Toeing-In Congenital deformities are abnormalities that are present at birth. They range in severity from mild limb deformities, which are relatively common, to major limb malformations, which are relatively rare.

17. What is the definition of a congenital deformity? a) Deformities occurring from the birthing process b) Deformities occurring at inception c) Abnormalities occurring after birth d) Abnormalities present at birth

a) 51-year-old woman admitted for exacerbation of her multiple sclerosis Pg. 1238 Chronic Fatigue Neurologic conditions such as multiple sclerosis are particularly associated with chronic fatigue. Infections, wounds, and fistulae will undoubtedly cause fatigue but are less likely to contribute to the long-term presentation associated with chronic fatigue.

18. A physician is providing care for several clients on a hospital-based medical ward. Which client is most likely to experience chronic fatigue? a) 51-year-old woman admitted for exacerbation of her multiple sclerosis b) 45-year-old female paraplegic with a necrotic ischial wound c) 33-year-old man with cellulitis to his lower leg d) 68-year-old woman admitted for a rectovaginal fistula

a) Consumption of certain drugs by the mother b) Consumption of alcohol by the father c) Radiation d) Heredity e) Consumption of alcohol by the mother Pg. 1222 Hereditary and Congenital Deformities Heredity, radiation, and alcohol and drug consumption by the mother all could be contributors to congenital deformity. Consumption of alcohol by the father is not usually cited as a cause of a congenital musculoskeletal deformity.

19. What is a cause(s) of congenital musculoskeletal deformities? Select all that apply. a) Consumption of certain drugs by the mother b) Consumption of alcohol by the father c) Radiation d) Heredity e) Consumption of alcohol by the mother

a) Elimination of possible physical causes Pg. 1240 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis of CFS is often made by a process of elimination, and treatment requires a holistic approach. The other options are examples of very narrowly focused interventions.

2. The diagnosis of chronic fatigue syndrome (CFS) is made using both a holistic approach as well as: a) Elimination of possible physical causes b) Mental health screenings for depression and anxiety c) Focused physical and occupational therapies d) Aggressive diagnostic testing

c) Treatment needs to be individualized Pg. 1225 Developmental Dysplasia of the Hip Treatment for developmental dysplasia of the hip needs to be individualized. Subluxation often resolves on its own. Treatment should be completed within 6 months after birth. Not all infants will need surgery.

20. Which statement is true about treatment of developmental dysplasia of the hip? a) All infants will need surgery for this condition b) Treatment needs to be completed within 2 weeks c) Treatment needs to be individualized d) Subluxation never resolves on its own

c) "A genetic pattern for this disease has not been established" Pg. 1227 Legg-Calvé-Perthes Disease The nurse can teach parents that a genetic pattern for this disease has not been established. It occurs in 1 in 1200 live births and affects more males than females. The most common age at diagnosis is 7 years.

21. Which statement will the nurse impart to the parent of a child with Legg-Calvé-Perthes disease? a) "This disease is very common" b) "This disease mainly affects females" c) "A genetic pattern for this disease has not been established" d) "The most common age at diagnosis is 15 years"

a) Scoliosis b) Triangular appearance to face c) Blue or gray sclera Pg. 1224 Osteogenesis Imperfecta The clinical manifestations of osteogenesis imperfecta include a spectrum of disorders marked by extreme skeletal fragility. Four major subtypes of the disorder have been identified. The disorder is characterized by thin and poorly developed bones, which are susceptible to multiple fractures. Children with osteogenesis imperfecta have short limbs and a soft, thin cranium with bifrontal prominences that give a triangular appearance to the face. Other problems associated with defective connective tissue synthesis include thin skin, blue or gray sclera, abnormal tooth development, hypotonic muscles, loose-jointedness, scoliosis, and a tendency toward hernia formation. There are neither thick bones in the lower extremities nor thick skin in osteogenesis imperfecta.

22. What are the manifestations of osteogenesis imperfecta? Select all that apply. a) Scoliosis b) Triangular appearance to face c) Blue or gray sclera d) Thick bones in lower extremities e) Thick skin

d) Unilateral rotational deformity of the proximal tibia Pg. 1222 Figure 49.8: Genu Varum and Genu Valgum Blount disease, also known as tibia vara, is supported by unilateral rotational deformity of the proximal tibia. Inward angulation of the knees suggests genu valgum (knock knees). Rotational hip deformities suggest femoral torsion, which is not related to Blount disease, and this condition does not delay the child's ability to ambulate.

23. Which assessment finding leads the nurse to suspect a child has Blount disease (tibia vara)? a) Inability to walk by age 4 b) Bilateral rotational deformity of the hip joints c) Bilateral inward angulation of the knees d) Unilateral rotational deformity of the proximal tibia

a) Uneven shoulders or iliac crest Pg. 1229 Idiopathic Scoliosis The cardinal signs of scoliosis are uneven shoulders or iliac crest, prominent scapula on the convex side of the curve, asymmetry of the thoracic cage, and rib hump. Curves that are detected before menarche are more likely to progress than those detected after. This is not the only cause of pain in teens.

4. The nurse suspects idiopathic scoliosis in a client based on which assessment finding? a) Uneven shoulders or iliac crest b) Loss of bone density confirmed with x-ray c) Late onset of first menarche d) Reports of back pain in the teen years

b) Compression of the vertebral column Pg. 1232 Clinical Manifestations Aging is accompanied by a progressive decline in height, especially among older women. This decline in height is attributed mainly to compression of the vertebral column and kyphosis. While the other options do occur with aging, they do not cause a decrease in height.

5. The older adult client tells the nurse that she believes she is getting shorter. The nurse explains to the client that height loss is caused by which occurrence with aging? a) Osteoarthritis b) Compression of the vertebral column c) Decreased lean body mass d) Reduction in muscle strength

d) "My schedule includes yoga and a weekly club meeting" Pg. 1240 Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Chronic fatigue syndrome is a disorder of persistent unrelieved fatigue lasting longer than 6 months. It is managed through pacing activities, emotional support, an exercise program to regain strength, and structured activity to allow resumption of activities of daily living.

7. A nurse is evaluating the progress of a client with chronic fatigue syndrome. Which statement by the client indicates successful symptom management? a) "I work until I run out of energy, and then I rest" b) "I often find it is too much work to fix a meal" c) "My family wants me to volunteer at the animal shelter" d) "My schedule includes yoga and a weekly club meeting"

c) Serial manipulations and casting Pg. 1226-1227 Congenital Clubfoot Treatment of clubfoot is begun as soon as the diagnosis is made. When treatment is initiated during the first few weeks of life, a nonoperative procedure may be effective. Serial manipulations and casting are used gently to correct each component of the deformity. Surgery, muscle-relaxing medications, and skeletal traction are not primary treatment for clubfoot.

8. An infant is born with a clubfoot. The nurse should anticipate which treatment measures will be instituted? a) Surgery prior to leaving the hospital b) Administration of muscle-relaxing medications c) Serial manipulations and casting d) Skeletal traction with pins inserted into affected bones

d) Patellar subluxation Pg. 1222 Femoral Torsion Patellar subluxation can result in patellofemoral malalignment with patellar subluxation or dislocation and pain.

9. When a malalignment does not correct itself, or is not corrected by the time the child reaches the age of 10 to 12, a torsional deformity or malalignment becomes problematic. What is a problem that can occur with femoral anteversion? a) Metatarsus adductus b) Toeing-out c) Knees rub together d) Patellar subluxation