Week 1: Lewis Ch. 5, 62, 64

When teaching a 69-yr-old patient about self-care, what will promote health (select all that apply)? a. Proper diet b. Immunizations c. Teaching chair yoga d. Demonstrating balancing techniques e. Participation in health promotion activities

a, b, c, d, e. Any of these actions will promote health.

What emergency considerations must be included with facial fractures (select all that apply)? a. Airway patency b. Oral examination c. Cervical spine injury d. Cranial nerve assessment e. Immobilization of the jaw

a, c. Airway patency and cervical spinal cord injury are the emergency considerations with facial fractures. Oral examination and cranial nerve assessment will be done after the patient is stabilized. Immobilization of the jaw is done surgically for a mandibular fracture.

Which kind of hip fracture is usually repaired with a hip prosthesis? a. Intracapsular b. Extracapsular c. Subtrochanteric d. Intertrochanteric

a. A hip prosthesis is usually used for intracapsular fractures. The other options are all extracapsular fractures.

A patient with a fractured femur experiences the complication of malunion. The nurse recognizes that what happens with this complication? a. The fracture heals in an unsatisfactory position. b. The fracture fails to heal properly despite treatment. c. Fracture healing progresses more slowly than expected. d. Loss of bone substances occurs as a result of immobilization

a. A malunion occurs when the bone heals in the expected time but in an unsatisfactory position, possibly resulting in deformity or dysfunction. Nonunion occurs when the fracture fails to heal properly despite treatment. Delayed union is healing of the fracture at a slower rate than expected. In posttraumatic osteoporosis, the loss of bone substances occurs as a result of immobilization.

What should the nurse include in the teaching plan for the patient with SLE? a. Ways to avoid exposure to sunlight b. Increasing dietary protein and carbohydrate intake c. The necessity of genetic counseling before planning a family d. The use of nonpharmacologic pain interventions instead of analgesics

a. Acute exacerbations of SLE may be precipitated by overexposure to ultraviolet light, physical and emotional stress, fatigue, and infection or surgery. Dietary recommendations include small, frequent meals and adequate iron intake. Although SLE has an identified genetic association with HLA-DR2 and HLA-DR3, genetic counseling is not a usual recommendation. The major concern in planning a pregnancy is that there are increased risks for the mother and fetus during pregnancy, and exacerbations are common following delivery. Although nonpharmacologic methods of pain control are encouraged, the use of NSAIDs is often necessary to help control inflammation and pain.

An immediate postoperative prosthetic fitting during surgery is used for a patient with a traumatic below-the-knee amputation. During the immediate postoperative period, what is a priority nursing intervention? a. Monitor the patient's vital signs. b. Assess the incision for hemorrhage. c. Elevate the residual limb on pillows. d. Have the patient flex and extend the knee every hour.

a. Because the device covers the residual limb, the surgical site cannot be directly seen and postoperative hemorrhage is not apparent on dressings, requiring vigilant assessment of vital signs for signs of bleeding. Elevation of the residual limb with an immediate prosthetic fitting is not necessary because the device itself prevents edema formation. Exercises to the leg are not performed in the immediate postoperative period to avoid disruption of ligatures and the suture line.

A patient with a fractured right hip has an anterior ORIF of the fracture. What should the nurse plan to do postoperatively? a. Get the patient up to the chair on the first postoperative day. b. Ambulate the patient with partial weight bearing by discharge. c. Keep the leg abductor pillow on the patient even when bathing. d. Position the patient only on the back and the nonoperative side

a. Because the fracture site is internally fixed with pins or plates, the fracture site is stable and the patient is moved from the bed to the chair on the first postoperative day. Ambulation begins on the first or second postoperative day without weight bearing on the affected leg. Weight bearing on the affected extremity is usually restricted for 6 to 12 weeks until adequate healing is evident on x-ray. Abductor pillows are used for patients who have total hip replacements. The patient may be positioned on the operative side following internal fixation as prescribed by the HCP.

A patient taking ibuprofen for treatment of OA has good pain relief but is experiencing increased dyspepsia and nausea with the drug's use. The nurse consults the patient's HCP about doing what? a. Adding misoprostol to the patient's drug regimen b. Substituting naproxen (Naprosyn) for the ibuprofen c. Returning to the use of acetaminophen but at a dose of 5 g/day instead of 4 g/day d. Administering the ibuprofen with antacids to decrease the gastrointestinal (GI) irritation

a. Common side effects of nonsteroidal antiinflammatory drugs (NSAIDs) include gastrointestinal (GI) irritation and bleeding, dizziness, rash, headache, and tinnitus. Misoprostol is used to prevent NSAID-induced gastric ulcers and gastritis and would increase the patient's tolerance of any of the NSAIDs. The use of naproxen could cause the same gastric effects as ibuprofen. It is generally recommended that the daily dose of acetaminophen should not exceed 3 g/day to prevent liver damage. Antacids interfere with the absorption of NSAIDs.

During an acute exacerbation, a patient with SLE is treated with corticosteroids. The nurse would expect the corticosteroids to begin to be tapered when which serum laboratory results are evident? a. Decreased anti-DNA b. Increased complement c. Increased red blood cells (RBCs) d. Decreased erythrocyte sedimentation rate (ESR)

a. Efficacy of treatment with corticosteroids or immunosuppressive drugs is best monitored by serial anti-DNA titers and serum complement levels, both of which will decrease as the drugs have an effect. The patient with SLE often has a chronic anemia that is not affected by drug therapy. A reduction in erythrocyte sedimentation rate (ESR) is not as specific.

What is the rationale for a nurse to position a patient with an above-the-knee amputation with a delayed prosthetic fitting prone several times a day? a. To prevent flexion contractures b. To assess the posterior skin flap c. To reduce edema in the residual limb d. To relieve pressure on the incision site

a. Flexion contractures, especially of the hip, may be debilitating and delay rehabilitation of the patient with a leg amputation. To prevent hip flexion, the patient should avoid sitting in a chair with the hips flexed or having pillows under the surgical extremity for prolonged periods, and the patient should lie on the abdomen for 30 minutes three to four times a day to extend the hip.

What characterizes the pathophysiology of systemic lupus erythematosus (SLE)? a. Destruction of nucleic acids and other self-proteins by autoantibodies b. Overproduction of collagen that disrupts the functioning of internal organs c. Formation of abnormal IgG that attaches to cellular antigens, activating complement d. Increased activity of T suppressor cells with B-cell hypoactivity, resulting in an immunodeficiency

a. In systemic lupus erythematosus (SLE), autoantibodies are produced against nucleic acids, erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. This is a hypersensitive response, not immunodeficiency. Overproduction of collagen is characteristic of systemic sclerosis and abnormal IgG reactions with autoantibodies are characteristic of RA.

When is a fat embolism most likely to occur? a. 24 to 48 hours following a fractured tibia b. 36 to 72 hours following a skull fracture c. 4 to 5 days following a fractured femur d. 5 to 6 days following a pelvic fracture

a. Initial manifestations of fat embolism usually occur 24 to 48 hours after injury and are associated with fractures of long bones and multiple fractures related to pelvic injuries, including fractures of the femur, tibia, ribs, and pelvis. Venous thromboemboli (VTE) tend to form later after injury of the extremities and pelvis.

Which description is most characteristic of osteoarthritis (OA) when compared to rheumatoid arthritis (RA)? a. Not systemic or symmetric b. Rheumatoid factor (RF) positive c. Most commonly occurs in women d. Morning joint stiffness lasts 1 to several hours

a. OA is not systemic or symmetric. In OA, morning joint stiffness resolves in about 30 minutes. Rheumatoid arthritis (RA) is rheumatoid factor (RF) positive, occurs more in women than men, and is characterized by being systemic and affecting small joints symmetrically. In RA, morning joint stiffness lasts 60 minutes to all day.

What is a disadvantage of open reduction and internal fixation (ORIF) of a fracture compared to closed reduction? a. Infection b. Skin irritation c. Nerve impairment d. Complications of immobility

a. Open reduction uses a surgical incision to correct bone alignment with infection as the main disadvantage, as well as anesthesia complications or the effect of preexisting medical conditions. Skin irritation and nerve impairment is most likely with skin traction. Prolonged immobility is possible with skeletal traction.

The patient had a fracture. At 3 weeks to 6 months there is clinical union, and this is the first stage of healing that is sufficient to prevent movement of the fracture site when the bones are gently stressed. How is this stage of fracture healing documented? a. Ossification b. Remodeling c. Consolidation d. Callus formation

a. Ossification is the stage of fracture healing when there is clinical union and enough strength to prevent movement at the fracture site. Remodeling is the return to preinjury structural strength and shape. Consolidation is when the distance between bone fragments eventually closes and radiologic union first occurs. The callus formation stage appears by the end of the second week of injury when minerals and new bone matrix are deposited in the osteoid that is produced in the granulation tissue stage.

Which nursing actions would demonstrate the nurse's understanding of the concept of providing safe care without using restraints (select all that apply)? a. Placing patients with fall risk in low beds b. Asking simple yes-or-no questions to clarify patient needs c. Making hourly rounds on patients to assess for pain and toileting needs d. Placing a disruptive patient near the nurses' station in a chair with a seat belt e. Applying a jacket vest loosely so that the patient can turn but cannot climb out of bed

a. Placing patients with fall risk in low beds b. Asking simple yes-or-no questions to clarify patient needs c. Making hourly rounds on patients to assess for pain and toileting needs These actions are alternatives to restraints that may help to reduce falls and keep the patient safe. A jacket vest and a seat belt are forms of restraint and require an order and frequent reassessment and order renewal.

The x-ray shows that the patient's fracture is at the remodeling stage. What characteristics of the fracture healing process are happening at this stage (select all that apply)? a. Radiologic union b. Absorption of excess bone cells c. Return to preinjury strength and shape d. Semisolid blood clot at the ends of fragments e. Deposition and absorption of bone in response to stress f. Unorganized network of bone woven around fracture parts

a. Radiologic union b. Absorption of excess bone cells c. Return to preinjury strength and shape e. Deposition and absorption of bone in response to stress When the remodeling stage of healing occurs, radiologic union is present. Excess bone tissue is resorbed in the final stage of healing and union is complete. The bone gradually returns to its preinjury structure strength and shape. The osteoblasts and osteoclasts function normally in response to physical loading stress. The fracture hematoma stage is when the hematoma at the ends of the fragments becomes a semisolid blood clot. There is an unorganized network of bone composed of cartilage, osteoblasts, calcium, and phosphorus woven around fracture parts in the callus formation stage.

During assessment of the patient with scleroderma, what should the nurse expect to find? a. Thickening of the skin of the fingers and hands b. Cool, cyanotic fingers with thinning skin over the joints c. Swan neck deformity or ulnar drift deformity of the hands d. Low back pain, stiffness, and limitation of spine movement

a. Scleroderma is a disorder of connective tissue that causes skin thickening and tightening, resulting in symmetric, painless swelling or thickening of the skin of the fingers and hands, expressionless facial features, puckering of the mouth, and a small oral orifice. It does not cause the swan neck or ulnar drift deformities seen in RA or SLE. Low back pain and spinal stiffness are associated with ankylosing spondylitis.

A patient who had a below-the-knee amputation is to be fitted with a temporary prosthesis. It is most important for the nurse to teach the patient to do what? a. Inspect the residual limb daily for irritation. b. Apply an elastic shrinker before applying the prosthesis. c. Perform range-of-motion (ROM) exercises to the affected leg four times a day. d. Apply alcohol to the residual limb every morning and evening to toughen the skin.

a. Skin breakdown on the residual limb can prevent the use of a prosthesis, so the limb should be inspected every day for signs of irritation or pressure areas. A residual limb shrinker is an elastic stocking that is used to mold the limb in preparation for prosthesis use, but a cotton residual limb sock is worn with the prosthesis. Range-of- motion (ROM) exercises are not necessary when the patient is using a prosthesis. No substances except water and mild soap should be used on the residual limb.

If needed, which surgical treatment will the nurse first prepare the patient for in the presence of compartment syndrome? a. Fasciotomy b. Amputation c. Internal fixation d. Release of tendons

a. Soft tissue edema in the area of the injury may cause an increase of pressure within the closed spaces of the tissue compartments formed by the nonelastic fascia, creating compartment syndrome. If symptoms occur, it may be necessary to incise the fascia surgically, a procedure known as a fasciotomy. Amputation is usually necessary only if the limb becomes septic because of untreated compartment syndrome.

A patient with OA asks the nurse whether he could try glucosamine and chondroitin for control of his symptoms. The best response by the nurse includes what information? a. Some patients find these supplements helpful for relieving arthritis pain and improving mobility. b. Although these substances may not help, there is no evidence that they can cause any untoward effects. c. These supplements are a fad that has not been shown to reduce pain or increase joint mobility in patients with OA. d. Only dosages of these supplements available by prescription are high enough to provide any benefit in treatment of OA.

a. Some obtain relief for moderate to severe osteoarthritic pain but not for all patients using over-the-counter glucosamine and chondroitin sulfate. These substances should be discontinued if there are no effects after consistent use over 90 to 120 days. They may decrease the effectiveness of antidiabetic drugs and increase the risk of bleeding.

Teach the patient with fibromyalgia the importance of limiting intake of which foods (select all that apply)? a. Sugar b. Alcohol c. Caffeine d. Red meat e. Root vegetables

a. Sugar b. Alcohol c. Caffeine

What is a mental status assessment of the older adult especially important in determining? a. Potential for independent living b. Eligibility for federal health programs c. Service and placement needs of the individual d. Whether the person should be classified as frail

a. The results of mental status evaluation often determine whether the patient is able to manage independent living, a major issue in older adulthood. Other elements of comprehensive assessment could determine eligibility for special problems, determination of frailty, and total service and placement needs.

What should be included in the management during the first 48 hours after an acute soft tissue injury of the ankle (select all that apply)? a. Use of elastic wrap b. Initial immobilization and rest c. Elevation of ankle above the heart d. Alternating the use of heat and cold e. Administration of antiinflammatory drugs

a. Use of elastic wrap b. Initial immobilization and rest c. Elevation of ankle above the heart e. Administration of antiinflammatory drugs Consider the principle of RICE. Rest: movement should be restricted. Ice: cold should be used to promote vasoconstriction and to reduce edema. Compression: helps to decrease swelling. Elevate: the extremity above the level of the heart. Mild nonsteroidal antiinflammatory drugs (NSAIDs) may be needed to manage pain. Warm, moist compresses may be used after 48 hours for 20 to 30 minutes at a time to reduce swelling and provide comfort.

Which statement(s) about older people are only myths and illustrate the concept of ageism (select all that apply)? a. You can't teach an old dog new tricks. b. Old people are not sexually active. c. Most old people live independently. d. Most older adults can no longer synthesize new information. e. Most older people lose interest in life and wish they would die.

a. You can't teach an old dog new tricks. b. Old people are not sexually active. d. Most older adults can no longer synthesize new information. e. Most older people lose interest in life and wish they would die. Ageism is a negative attitude based on age.

An appropriate care choice for an older adult who lives with an employed daughter but needs help with activities of daily living is a. adult day care. b. long-term care. c. a retirement center. d. an assisted living facility.

a. adult day care.

A patient with a pelvic fracture should be monitored for a. changes in urine output. b. petechiae on the abdomen. c. a palpable lump in the buttock. d. sudden increase in blood pressure.

a. changes in urine output.

A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by a. formation of callus. b. complete bony union. c. hematoma at the fracture site. d. presence of granulation tissue.

a. formation of callus.

The nurse instructs the patient with an above-the-knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contracture. b. clot formation at the incision. c. skin irritation and breakdown. d. increased risk of wound dehiscence.

a. hip flexion contracture.

An ethnic older adult may feel a loss of self-worth when the nurse (select all that apply) a. prohibits visits from a faith healer. b. informs the patient about ethnic support services. c. allows a patient to rely on ethnic health beliefs and practices. d. emphasizes that a therapeutic diet does not allow ethnic foods. e. uses a medical interpreter to provide explanations and teaching.

a. prohibits visits from a faith healer. d. emphasizes that a therapeutic diet does not allow ethnic foods.

The nurse should teach the patient with ankylosing spondylitis the importance of a. regularly exercising and maintaining proper posture. b. avoiding extremes in environmental temperatures. c. maintaining patient's usual physical activity during flares. d. applying hot and cool compresses for relief of local symptoms.

a. regularly exercising and maintaining proper posture.

Number in sequence from 1 to 6 the pathophysiologic processes that occur in osteoarthritis (OA). a. Erosion of articular surfaces b. Incongruity in joint surfaces c. Reduction in motion d. Joint cartilage becomes yellow and granular e. Osteophytes form at joint edges f. Cartilage becomes softer and less elastic

a.3; b.5; c.6; d.1; e.4; f.2 d. Joint cartilage becomes yellow and granular f. Cartilage becomes softer and less elastic a. Erosion of articular surfaces e. Osteophytes form at joint edges b. Incongruity in joint surfaces c. Reduction in motion

Which descriptions are related to reactive arthritis (select all that apply)? a. Methotrexate is a treatment of choice b. Symptoms include urethritis and conjunctivitis c. Diagnosed by finding of hypersensitive tender points d. Increased risk in persons with decreased host resistance e. Infection of a joint often caused by hematogenous route f. Self-limiting arthritis following genitourinary or GI tract infections

b, f. Reactive arthritis is self-limiting and follows genitourinary or GI tract infection, with symptoms including urethritis and conjunctivitis. Methotrexate is the treatment of choice for psoriatic arthritis. Hypersensitive tender points diagnose fibromyalgia. There is increased risk of septic arthritis in persons with decreased host resistance. Joint infection may be caused by the hematogenous route.

A patient is discharged from the outpatient clinic following application of a synthetic fiberglass long arm cast for a fractured ulna. Before discharge, the nurse instructs the patient to do what? a. Never get the cast wet. b. Move the shoulder and fingers frequently. c. Place tape petals around the edges of the cast when it is dry. d. Use a sling to support the arm at waist level for the first 48 hours.

b. A patient with any type of cast should exercise the joints above and below the cast frequently and moving the fingers frequently will improve circulation and help to prevent edema. Unlike plaster casts, thermoplastic resin or fiberglass casts are relatively waterproof and, if they become wet, can be dried with a hair dryer on low setting. Tape petals are used on plaster casts to protect the edges from breaking and crumbling but are not necessary for synthetic casts. After the cast is applied, the extremity should be elevated at about the level of the heart to promote venous return and ice may be used to prevent edema.

The patient asks, "What does the doctor mean when he says that I have an avulsion fracture in my leg? I thought I had a sprain!" What is the best response by the nurse? a. "It is a fracture with more than two fragments." b. "It means that a ligament pulled a bone fragment loose." c. "The line of the fracture is twisted along the shaft of the bone." d. "The line of the fracture is at right angles to the longitudinal axis of the bone."

b. An avulsion fracture occurs when a ligament pulls a bone fragment loose, with pain similar to a sprain. A fracture with two or more fragments is a comminuted fracture. It is a spiral fracture when it is twisted around a bone shaft. It is a transverse fracture when the line of fracture is at right angles to the longitudinal axis.

The patient has had RA for some time but has not had success with previous medications. Although there is an increased risk for tuberculosis, which tumor necrosis factor (TNF) inhibitor is used with methotrexate to best treat symptoms? a. Parenteral gold b. Certolizumab (Cimzia) c. Tocilizumab (Actemra) d. Hydroxychloroquine (Plaquenil)

b. Certolizumab is a monoclonal antibody that is a TNF inhibitor and stays in the system longer and may show a more rapid reduction in RA symptoms. Parenteral gold alters immune responses that may suppress synovitis of active RA, but it takes 3 to 6 months to be effective. Tocilizumab blocks the action of the proinflammatory cytokine interleukin-6 (IL-6). Hydroxychloroquine is slow-acting antimalaria drug used initially for mild RA and requires periodic eye examinations to assess for retinal damage.

During treatment of the patient with an acute attack of gout, the nurse would expect to administer which drug first? a. Aspirin b. Colchicine c. Probenecid d. Allopurinol (Zyloprim)

b. Colchicine has an antiinflammatory action specific for gout and is the treatment of choice during an acute attack, often producing dramatic pain relief when given within 12 to 24 hours. Probenecid is a uricosuric drug that is used to control hyperuricemia by increasing the excretion of uric acid through the kidney. Aspirin inactivates the effect of uricosuric drugs and should not be used when patients are taking probenecid and other uricosuric drugs. Allopurinol, a xanthine oxidase inhibitor, is used to control hyperuricemia by blocking production of uric acid.

Following a total knee arthroplasty, a patient has a continuous passive motion (CPM) machine for the affected joint. The nurse explains to the patient that this device is used for what purpose? a. To relieve edema and pain at the incision site b. To promote early joint mobility and increase knee flexion c. To prevent venous stasis and the formation of a deep venous thrombosis d. To improve arterial circulation to the affected extremity to promote healing

b. Continuous passive motion (CPM) machines are frequently used following knee surgery to promote earlier joint mobility. Because joint dislocation is not a problem with knee replacements, early ambulation to prevent DVT and improve circulation, exercise with straight leg raises, and gentle ROM may also be encouraged postoperatively.

A patient is brought to the emergency department (ED) with an injured lower left leg following a fall while rock climbing. The nurse identifies the presence of a fracture based on what cardinal sign of fracture? a. Muscle spasms b. Obvious deformity c. Edema and swelling d. Pain and tenderness

b. Deformity is the cardinal sign of fracture but may not be apparent in all fractures. Other supporting signs include edema and swelling, localized pain and tenderness, muscle spasm, ecchymosis, loss of function, crepitation, and an inability to bear weight.

During the acute phase of dermatomyositis, what is an appropriate patient outcome? a. Relates improvement in pain b. Does not experience aspiration c. Performs active ROM four times daily d. Maintains absolute rest of affected joints

b. Dermatomyositis produces symmetric weakness of striated muscle, and weak neck and pharyngeal muscles may produce dysphagia. Weakened pharyngeal muscles lead to a poor cough, difficulty swallowing, and increased aspiration risk. Muscle tenderness or pain is uncommon, as is joint involvement. During an acute attack the patient is so weak that bed rest is needed and passive ROM is usually required.

A patient with gout is treated with drug therapy to prevent future attacks. The nurse teaches the patient that what is most important for the patient to do? a. Avoid all foods high in purine, such as organ meats. b. Have periodic determination of serum uric acid levels. c. Increase the dosage of medication with the onset of an acute attack. d. Perform active range of motion (ROM) of all joints that have been affected by gout.

b. During therapy with probenecid or allopurinol, the patient must have periodic determination of serum uric acid levels to evaluate the effectiveness of the therapy and to ensure that levels are kept low enough to prevent future attacks of gout. With the use of medications, strict dietary restrictions on alcohol and high-purine foods are usually not necessary. When the patient is taking probenecid, urine output should be maintained at 2 to 3 L per day to prevent urate from precipitating in the urinary tract and causing kidney stones. Patients should not alter their doses of medications without medical direction, and the drugs used for control of gout are not useful in the treatment of an acute attack. Joint immobilization is used for an acute attack of gout.

Which drug that prevents binding of the tumor necrosis factor and inhibits the inflammatory response is used in the management of RA? a. Anakinra (Kineret) b. Entanercept (Enbrel) c. Leflunomide (Arava) d. Azathioprine (Imuran)

b. Etanercept binds to tumor necrosis factor (TNF) and blocks its interaction with the TNF cell surface receptors, which decreases the inflammatory response. Anakinra is an interleukin-1 receptor antagonist, thus decreasing the inflammatory response. Leflunomide is an antiinflammatory that blocks immune cell overproduction. Azathioprine is an uncommonly used immunosuppressant that inhibits DNA, RNA, and protein synthesis.

When administering medications to the patient with chronic gout, the nurse would recognize which drug is used as a treatment for this disease? a. Colchicine b. Febuxostat c. Sulfasalazine d. Cyclosporine

b. Febuxostat

When positioning the patient after a total hip arthroplasty with a posterior approach, it is important that the nurse maintain the affected extremity in what position? a. Adduction and flexion b. Abduction and extension c. Abduction and internal rotation d. Adduction and external rotation

b. Following a total hip arthroplasty with a posterior approach, during hospitalization an abduction pillow is placed between the legs to maintain abduction and the leg is extended. Extremes of internal rotation, adduction, and 90-degree flexion of the hip must be avoided for 4 to 6 weeks postoperatively to prevent dislocation of the prosthesis.

The 58-yr-old male patient will be transferred from the acute care clinical unit of the hospital to another care area. The patient requires complicated dressing changes for several months. To which practice setting(s) could the patient be transitioned (select all that apply)? a. Acute rehabilitation b. Long-term acute care c. Intermediate care facility d. Transitional subacute care e. Programs for All-Inclusive Care for the Elderly (PACE)

b. Long-term acute care e. Programs for All-Inclusive Care for the Elderly (PACE) Long-term acute care provides acute care for an average length of greater than 25 days. Programs for All-Inclusive Care for the Elderly (PACE) provide skilled nursing home level care for adults age 55 and older if they have Medicare. Being dual-eligible will provide the care at no cost. Acute rehabilitation is a postacute level of care with therapies for returning the patient to the patient's best level of functioning. Intermediate care facilities provide convalescent care. Transitional subacute care facilities are used for 5 to 21 days.

After teaching a patient with RA about the prescribed therapeutic regimen, the nurse determines that further instruction is needed when the patient says what? a. "It is important for me to perform my prescribed exercises every day." b. "I should perform most of my daily chores in the morning when my energy level is highest." c. "An ice pack to a joint for 10 minutes may help to relieve pain and inflammation when I have an acute flare." d. "I can use assistive devices such as padded utensils, electric can openers, and elevated toilet seats to protect my joints."

b. Most patients with RA experience morning stiffness, and morning activities should be scheduled later in the day after the stiffness subsides. A warm shower in the morning and time to become more mobile before activity are advised. Ice for 10 minutes or splinting are helpful during increased disease activity. Management of RA includes daily exercises for the affected joints and protection of joints with devices and movements that prevent joint stress.

A patient with severe ulnar deviation of the hands undergoes an arthroplasty with reconstruction and replacement of finger joints. Postoperatively, what is it most important for the nurse to do? a. Position the fingers lower than the elbow at all times. b. Perform neurovascular assessments of the fingers every 2 to 4 hours. c. Encourage the patient to gently flex, extend, abduct, and adduct the fingers every 4 hours. d. Remind the patient that function of the hands is more important than their cosmetic appearance.

b. Neurovascular checks following surgery are essential to detect compromised neurologic and vascular function caused by trauma or edema. Postoperatively, the hands are elevated with a bulky dressing in place and when the dressing is removed, a guided splinting program is started. After discharge, exercises are performed three to four times each day. Before surgery, the patient is taught that the goal of the surgery is to restore function related to grasp, pinch, stability, and strength and the hands, not cosmetic appearance.

A patient recovering from an acute exacerbation of RA tells the nurse that she is too tired to bathe. What should the nurse do for this patient? a. Give the patient a bed bath to conserve her energy. b. Allow the patient a rest period before showering with the nurse's help. c. Tell the patient that she can skip bathing if she will walk in the hall later. d. Inform the patient that it is important for her to maintain self-care activities.

b. Pacing activities and alternating rest with activity are important in maintaining self-care and independence of the patient with RA, in addition to preventing deconditioning and a negative attitude. The nurse should not carry out activities for patients that they can do for themselves but instead should support and assist patients as necessary. A warm shower or sitting in a tub with warm water and towels over the shoulders may help to relieve some stiffness.

A patient with newly diagnosed SLE asks the nurse how the disease will affect her life. What is the best response the nurse can give the patient? a. "You can plan to have a near-normal life since SLE rarely causes death." b. "It is difficult to tell because the disease is so variable in its severity and progression." c. "Life span is shortened somewhat in people with SLE, but the disease can be controlled with long-term use of corticosteroids." d. "Most people with SLE have alternating periods of remissions and exacerbations with rapid progression to permanent organ damage."

b. Patients with SLE often find that one of the most difficult facets of the disease is its extreme variability in severity and progression. There is no characteristic pattern of progressive organ involvement, nor is it predictable as to which systems may become affected. SLE is now associated with a normal life span, but patients must be helped to adjust to the unknown course of the disease.

During assessment of the patient diagnosed with fibromyalgia, along with widespread pain, what should the nurse expect the patient to report? a. Generalized muscle twitching and spasms b. Nonrestorative sleep with resulting fatigue c. Profound and progressive muscle weakness that limits ADLs d. Widespread musculoskeletal pain that is accompanied by inflammation and fever

b. People with fibromyalgia typically experience nonrestorative sleep, morning stiffness, irritable bowel syndrome, and anxiety in addition to the widespread, nonarticular musculoskeletal pain and fatigue. Fibromyalgia is nondegenerative, nonprogressive, and noninflammatory. Neither muscle weakness nor muscle spasms are associated with the disease, although there may be tics in the muscle at the tender points

A patient complains of pain in the foot of a leg that was recently amputated. What should the nurse recognize about this pain? a. It is caused by swelling at the incision. b. It should be treated with ordered analgesics. c. It will become worse with the use of a prosthesis. d. It can be managed with diversion because it is psychologic.

b. Phantom limb sensation or pain may occur following amputation, especially if pain was present in the affected limb preoperatively. The pain is a real sensation to the patient and will first be treated with analgesics and other pain interventions (i.e., tricyclic antidepressants, antiseizure drugs, transcutaneous electrical nerve stimulation [TENS], mirror therapy, acupuncture). As recovery and ambulation progress, phantom limb sensation usually subsides.

To preserve function and the ability to perform activities of daily living (ADLs), what should the nurse teach the patient with OA? a. Avoid exercise that involves the affected joints. b. Plan and organize task performance to be less stressful to joints. c. Maintain normal activities during an acute episode to prevent loss of function. d. Use mild analgesics to control symptoms when performing tasks that cause pain.

b. Principles of joint protection and energy conservation are critical in being able to maintain functional mobility in the patient with OA, and patients should be helped to find ways to perform activities and tasks with less stress. Range-of-motion (ROM), isotonic, and isometric exercises of the affected joints should be balanced with joint rest and protection but during an acute flare of joint inflammation, the joints should be rested. If a joint is painful, it should be used only to the point of pain and masking the pain with analgesics may lead to greater joint injury.

A 78-yr-old female patient is admitted with nausea, vomiting, anorexia, diarrhea, and dehydration. She has a history of diabetes mellitus and 2 years ago had a stroke with residual right-sided weakness. Identify which characteristics of chronic illness the nurse will probably find in this patient (select all that apply). a. Self-limiting b. Residual disability c. Permanent impairments d. Infrequent complications e. Need for long-term management f. Nonreversible pathologic changes

b. Residual disability c. Permanent impairments e. Need for long-term management f. Nonreversible pathologic changes The diabetes mellitus and residual right-sided weakness from the cerebrovascular accident (CVA) contribute to the residual disability and permanent impairments. The diabetes requires long-term management, and both problems contribute to nonreversible pathologic change

Application of RICE (rest, ice, compression, and elevation) is indicated for initial management of which type of injury? a. Muscle spasms b. Sprains and strains c. Repetitive strain injury d. Dislocations and subluxations

b. Rest, ice, compression, and elevation (RICE) are indicated to prevent edema resulting from sprain and some strain injuries. Muscle spasms are usually treated with heat applications and massage. Repetitive strain injuries require cessation of the precipitating activity and physical therapy. Dislocations or subluxations require immediate reduction and immobilization to prevent vascular impairment and bone cell death.

Which other extraarticular manifestation of RA is most likely to be seen in the patient with rheumatoid nodules? a. Lyme disease b. Felty syndrome c. Sjögren's syndrome d. Spondyloarthropathies

b. Rheumatoid nodules develop in about half of patients with RA. Felty syndrome is most common in patients with long-standing RA. It is characterized by splenomegaly and leukopenia. Sjögren's syndrome occurs as a disease by itself or with other arthritic disorders. Lyme disease is a spirochetal infection transmitted by an infected deer tick bite. Spondyloarthropathies are interrelated multisystem inflammatory disorders that affect the spine, peripheral joints, and periarticular structures but they do not have serum antibodies.

A patient is admitted with an open fracture of the tibia following a bicycle accident. During assessment of the patient, about what specifically should the nurse question the patient? a. Any previous injuries to the leg b. The status of tetanus immunization c. The use of antibiotics in the last month d. Whether the injury was exposed to dirt or gravel

b. Tetanus prevention is always indicated if the patient has not been immunized or does not have current boosters. Infection is the greatest risk with an open fracture, and all open fractures are considered contaminated. Prophylactic antibiotics are often used in management of open fractures, but recent antibiotic therapy is not relevant, nor is previous injury to the site. Dirt or gravel contamination will be evident on physical assessment.

In a patient with a stable vertebral fracture, what should the nurse teach the patient to do? a. Remain on bed rest until the pain is gone. b. Logroll to keep the spine straight when turning. c. How to use bone cement to correct the problem. d. Take as much analgesic as needed to relieve the pain.

b. The spine should be kept straight by turning the shoulders and hips together (logrolling). This keeps the spine in good alignment until union has been accomplished. Bed rest may be required for a short time but not until the pain is gone. Bone cement is used by the surgeon to stabilize vertebral compression fractures. Analgesics should be taken only as ordered. If they do not relieve the pain, the HCP should be notified.

Examples of primary prevention strategies include a. colonoscopy at age 50. b. avoidance of tobacco products. c. teaching the importance of exercise to a patient with hypertension. d. intake of a diet low in saturated fat in a patient with high cholesterol.

b. avoidance of tobacco products.

In assessing the joints of a patient with osteoarthritis, the nurse understands that Bouchard's nodes a. are often red, swollen, and tender. b. indicate osteophyte formation at the PIP joints. c. are the result of pannus formation at the DIP joints. d. occur from deterioration of cartilage by proteolytic enzymes.

b. indicate osteophyte formation at the PIP joints.

A patient with rheumatoid arthritis is experiencing articular involvement. The nurse recognizes these characteristic changes include (select all that apply) a. bamboo-shaped fingers. b. metatarsal head dislocation in feet. c. noninflammatory pain in large joints. d. asymmetric involvement of small joints. e. morning stiffness lasting 60 minutes or more.

b. metatarsal head dislocation in feet. e. morning stiffness lasting 60 minutes or more.

A patient with osteoarthritis is scheduled for a total hip arthroplasty. The nurse explains the purpose of this procedure is to (select all that apply) a. fuse the joint. b. replace the joint. c. prevent further damage. d. improve or maintain ROM. e. decrease the amount of destruction in the joint.

b. replace the joint. d. improve or maintain ROM.

The woman with osteoporosis slipped on the ice and now her wrist hurts. If there is a fracture, what type of fracture is expected? a. Dislocation b. Open fracture c. Colles'fracture d. Incomplete fracture

c. A Colles' fracture most often occurs in patients over 50 years of age with osteoporosis and frequently when the patient attempts to break a fall with an outstretched arm and hand. Dislocation is the complete separation of articular surfaces of the joint caused by a ligament injury. Open fracture is when there is communication with the external environment. A fracture is incomplete if only part of the bone shaft is fractured and the bone is still in one piece.

The patient with osteoporosis had a spontaneous hip fracture. How should the nurse document this before the x-ray results return? a. Open fracture b. Oblique fracture c. Pathologic fracture d. Greenstick fracture

c. A pathologic fracture is a spontaneous fracture at the site of bone disease, such as osteoporosis. An open fracture is when there is communication with the external environment. The oblique fracture has a slanted fracture line. A greenstick fracture is splintered on the convex side, and the other side is in intact with a concave bend.

What is an ominous sign of advanced SLE disease? a. Proteinuria from early glomerulonephritis b. Anemia from antibodies against blood cells c. Dysrhythmias from fibrosis of the atrioventricular node d. Cognitive dysfunction from immune complex deposit in the brain

c. All body systems are affected by SLE. When the atrioventricular and sinus nodes are fibrosed and dysrhythmias occur, this is ominous. Although lupus nephritis can occur and lead to chronic kidney disease, treatment is available. Anemia, mild leukopenia, and thrombocytopenia are often present. Disordered thought processes, disorientation, memory deficits, and depression may occur.

A patient with an extracapsular hip fracture is admitted to the orthopedic unit and placed in Buck's traction. The nurse explains to the patient that the purpose of the traction is to do what? a. Pull bone fragments back into alignment b. Immobilize the leg until healing is complete c. Reduce pain and muscle spasms before surgery d. Prevent damage to the blood vessels at the fracture site

c. Although surgical repair is the preferred method of managing intracapsular and extracapsular hip fractures, initially patients frequently may be treated with skin traction, such as Buck's traction, to immobilize the limb temporarily and to relieve the painful muscle spasms before surgery is performed. Prolonged traction would be required to reduce the fracture or immobilize it for healing, creating a very high risk for complications of immobility.

When the nursing student asks the RN what an arthroplasty is, what is the best description the RN can give the student? a. Surgical fusion of a joint to relieve pain b. Correction of bone deformity by removal of a wedge or slice of bone c. Reconstruction or replacement of a joint to relieve pain and correct deformity d. Used in rheumatoid arthritis to remove the tissue involved in joint destruction

c. An arthroplasty is reconstruction or replacement of a joint to relieve pain and correct deformity, especially with osteoarthritis, RA, avascular necrosis, congenital deformities, or dislocations. Arthrodesis is the surgical fusion of a joint to relieve pain. An osteotomy removes a wedge of bone to correct a bone deformity. Synovectomy is used in RA to remove the tissue involved in joint destruction.

A 70-yr-old patient is being evaluated for symptoms of RA. The nurse recognizes what as the major problem in the management of RA in the older adult? a. RA is usually more severe in older adults. b. Older patients are not as likely to comply with treatment regimens. c. Drug interactions and toxicity are more likely to occur with multidrug therapy. d. Laboratory and other diagnostic tests are not effective in identifying RA in older adults

c. Because older adults are more likely to take many drugs, the use of multidrug therapy in RA is particularly problematic because of the increased likelihood of adverse drug interactions and toxicity. Rheumatic disorders affect younger and older adults. Older adults are not less compliant with drug regimens but may need help with complex regimens. Interpretation of laboratory values in older adults is more difficult in diagnosing RA because of age-related serologic changes, but the disease can be diagnosed.

The athlete comes to the clinic with bursitis. What does the nurse know happens to the tissue to cause pain when bursitis occurs? a. Tearing of a ligament b. Stretching of muscle and fascia sheath c. Inflammation of synovial membrane sac at friction sites d. Incomplete separation of articular surfaces of joint caused by ligament injury

c. Bursitis is inflammation of the synovial membrane sac at friction sites. Tearing of a ligament is a sprain. Stretching of muscle and fascia sheath is a strain. Incomplete separation of articular surfaces of joints caused by ligament injury is subluxation.

What is the leading cause of death in the United States? a. Cancer b. Diabetes mellitus c. Coronary artery disease d. Cerebrovascular accident e. Chronic obstructive pulmonary disease

c. Coronary artery disease is the leading cause of death in the United States

In teaching a patient with Sjögren's syndrome about drug therapy for this disorder, the nurse includes instruction on use of which drug? a. Pregabalin (Lyrica) b. Etanercept (Enbrel) c. Cyclosporine (Restasis) d. Cyclobenzaprine (Flexeril)

c. Cyclosporine (Restasis)

Which joint surgery is used to arthroscopically remove degenerative tissue in joints? a. Osteotomy b. Arthrodesis c. Debridement d. Synovectomy

c. Debridement removes degenerative tissue from joints. Osteotomy corrects bone deformity by removal of a wedge or slice of bone. Arthrodesis surgically fuses a joint to relieve pain. Synovectomy removes tissue involved in joint destruction from rheumatoid arthritis (RA).

What is the most important nursing measure in the rehabilitation of an older adult to prevent loss of function from inactivity and immobility? a. Using assistive devices such as walkers and canes b. Teaching good nutrition to prevent loss of muscle mass c. Performance of active and passive range-of-motion (ROM) exercises d. Performance of risk appraisals and assessments related to immobility

c. Exercise for all older adults is important to prevent deconditioning and subsequent functional decline from many different causes. Walkers and canes may improve mobility but can also decrease mobility if they are too difficult for the patient to use. Nutrition is important for muscles, but muscle strength is primarily dependent on use. Risk appraisals are usually performed for specific health problems.

During the physical assessment of the patient with early to moderate RA, what should the nurse expect to find? a. Hepatomegaly b. Heberden's nodes c. Spindle-shaped fingers d. Crepitus on joint movement

c. In early disease, the fingers of the patient with moderate RA may become spindle shaped from synovial hypertrophy and thickening of the joint capsule, have no joint deformities but may have limited joint mobility, have adjacent muscle atrophy, and may be inflamed. Splenomegaly may be found with Felty syndrome in patients with severe nodule-forming RA. Heberden's nodes and crepitus on movement are associated with osteoarthritis.

To assess for neurologic status in a patient with a fractured humerus, what should the nurse ask the patient to do? a. Evert, invert, dorsiflex, and plantar flex the foot. b. Assess the location, quality, and intensity of pain below the site of the injury. c. Abduct the fingers, oppose the thumb and small fingers, and flex and extend the wrist. d. Assess the color, temperature, capillary refill, peripheral pulses, and edema in the extremity.

c. Neurologic assessment includes evaluation of sensation, motor function, and pain in the upper extremity. Ask the patient to abduct the fingers (ulnar nerve), oppose the thumb and small fingers (median nerve), and flex and extend the wrist (or fingers if in a cast) (radial nerve). The nurse will assess pain and sensory perception in the fingers. Evaluation of the feet would occur in lower extremity injuries. Assessment of color, temperature, capillary refill, peripheral pulses, and edema evaluates vascular status.

A patient with a fractured tibia accompanied by extensive soft tissue damage initially has a splint applied and held in place with an elastic bandage. What early sign should alert the nurse that the patient is developing compartment syndrome? a. Paralysis of the toes b. Absence of peripheral pulses c. Distal pain unrelieved by opioid analgesics d. Skin over the injury site is blanched when the bandage is removed

c. Pain that is distal to the injury and is unrelieved by opioid analgesics is the earliest sign of compartment syndrome; paresthesia is also an early sign. Paralysis and absence of peripheral pulses will eventually occur if it is not treated but these are late signs that often appear after permanent damage has occurred. The overlying skin may appear normal because the surface vessels are not occluded.

The nurse suspects a fat embolism rather than a pulmonary embolism from a venous thrombosis when the patient with a fracture develops what? a. Tachycardia and dyspnea b. A sudden onset of chest pain c. Petechiae around the neck and upper chest d. Electrocardiographic (ECG) changes and decreased PaO2

c. Patients with fractures are at risk for both fat embolism and pulmonary embolism from VTE, but there is a difference in the time of occurrence, with fat embolism occurring shortly after the injury and thrombotic embolism occurring several days after immobilization. They both may cause pulmonary symptoms of chest pain, tachypnea, dyspnea, apprehension, tachycardia, and cyanosis. However, fat embolism may cause petechiae located around the neck, anterior chest wall, axilla, buccal membrane of the mouth, and conjunctiva of the eye, which differentiates it from thrombotic embolism.

What is one criterion identified by the American College of Rheumatology for a diagnosis of fibromyalgia? a. Fiber atrophy found on muscle biopsy b. Elimination of all other causes of musculoskeletal pain c. The elicitation of pain on palpation of at least 11 of 18 identified tender points d. The presence of the manifestations of systemic exertion intolerance disease (SEID)

c. The American College of Rheumatology identifies two criteria for the diagnosis of fibromyalgia: (1) pain is experienced in 11 of the 18 tender points on palpation and (2) the patient has a history of widespread pain for at least 3 months. The other findings may also be present but are not diagnostic for fibromyalgia.

The nurse teaches the patient with RA that which exercise is one of the most effective methods of aerobic exercise? a. Ballet dancing b. Casual walking c. Aquatic exercises d. Low-impact aerobic exercises

c. The best aerobic exercise is aquatic exercises in warm water to allow easier joint movement because of the buoyancy of the water. Water produces more resistance and can strengthen the muscles. Tai Chi is also a good form of gentle, stretching exercise that would be appropriate. Dancing and walking impact the joints of the feet and even low-impact aerobics could be damaging. Exercises for patients with RA should be gentle.

Twenty-four hours after a below-the-knee amputation, a patient uses the call system to tell the nurse that his dressing (a compression bandage) has fallen off. What is the first action that the nurse should take? a. Apply ice to the site. b. Cover the incision with dry gauze. c. Reapply the compression dressing. d. Elevate the extremity on a couple of pillows.

c. The compression dressing or bandage supports the soft tissues, reduces edema, hastens healing, minimizes pain, and promotes residual limb shrinkage. If the dressing is left off, edema will form quickly and may delay rehabilitation. Elevation and ice will not be as effective at preventing the edema that will form. Dressing the incision with dry gauze will not provide the benefits of a compression dressing.

Which type of fracture can occur when there is radial nerve and brachial artery damage and the fracture is reduced with a hanging arm cast? a. Fractured tibia b. Colles' fracture c. Fractured humerus d. Femoral shaft fracture

c. The fractured humerus may cause radial nerve and brachial artery damage, and it may be reduced nonsurgically with a hanging arm cast. A fractured tibia and femur are in the leg. The Colles' fracture is in the wrist and manifests with pronounced swelling and obvious deformity of the wrist; it is treated with closed manipulation and immobilization.

When preparing a patient for discharge following intermaxillary fixation of a mandibular fracture, the nurse determines that teaching has been successful when the patient says what? a. "I can keep my mouth moist by sucking on hard candy." b. "I should cut the wires with scissors if I begin to vomit." c. "I may use a bulk-forming laxative if my liquid diet causes constipation." d. "I should use a moist swab to clean my mouth every time I eat something."

c. The low-bulk, high-carbohydrate liquid diet and intake of air through a straw required during mandibular fixation often lead to constipation and flatus, which may be relieved with bulk-forming laxatives, prune juice, and ambulation. Hard candy should not be held in the mouth. Wires or rubber bands should be cut only in the case of cardiac or respiratory arrest, and patients should be taught to clear their mouth of vomitus or secretions. The mouth should be thoroughly cleaned with water, saline, or alkaline mouthwashes or using a Water Pik as necessary to remove food debris.

An 83-yr-old woman is being discharged from the hospital following stabilization of her international normalized ratio (INR) levels (used to assess effectiveness of warfarin therapy). She has chronic atrial fibrillation and has been on warfarin (Coumadin) for several years. Discharge instructions include returning to the clinic weekly for INR testing. Which statement by the patient indicates that she may be unable to have the testing done? a. "When I have the energy, I have taken the bus to get this test done." b. "I will need to ask my son to bring me into town every week for the test." c. "Should I just keep taking the same pill every day until I can get a ride to town?" d. "It is very important to have this test every week. I have several church friends who can bring me."

c. This statement indicates that this patient does not understand the importance of having the test every week and that the test results will determine ongoing dosing. The other three statements indicate that the patient is thinking about ways to get into town weekly.

The nurse suspects a neurovascular problem based on assessment of a. exaggerated strength with movement. b. increased redness and heat below the injury. c. decreased sensation distal to the fracture site. d. purulent drainage at the site of an open fracture.

c. decreased sensation distal to the fracture site.

Ageism is characterized by a. denial of negative stereotypes regarding aging. b. positive attitudes toward the elderly based on age. c. negative attitudes toward the elderly based on age. d. negative attitudes toward the elderly based on physical disability.

c. negative attitudes toward the elderly based on age.

A characteristic of a chronic illness is that it (select all that apply) a. has reversible pathologic changes. b. has a consistent, predictable clinical course. c. results in permanent deviation from normal. d. is associated with many stable and unstable phases. e. always starts with an acute illness and then progresses slowly.

c. results in permanent deviation from normal. d. is associated with many stable and unstable phases.

Nursing interventions directed at health promotion in the older adult are primarily focused on a. disease management. b. controlling symptoms of illness. c. teaching positive health behaviors. d. teaching regarding nutrition to enhance longevity.

c. teaching positive health behaviors.

An important nursing action to help a chronically ill older adult is to a. avoid discussing future lifestyle changes. b. ensure the patient that the condition is stable. c. treat the patient as a competent manager of the disease. d. encourage the patient to "fight" the disease as long as possible.

c. treat the patient as a competent manager of the disease.

The nurse identifies the presence of age-associated memory impairment in the older adult who states a. "I just can't seem to remember the name of my granddaughter." b. "I make out lists to help me remember what I need to do, but I can't seem to use them." c. "I forgot that I went to the grocery store this morning and didn't realize it until I went again this afternoon." d. "I forget movie stars' names more often now, but I can remember them later after the conversation is over."

d. Age-associated memory impairment is characterized by a memory lapse or benign forgetfulness that is not the same as a decline in cognitive functioning. Forgetting a name, date, or recent event is not serious, but the other examples indicate abnormal functioning.

A 72-yr-old man tells the nurse that he cannot perform most of the physical activities he could do 5 years ago because of overall joint aches and pains. What can the nurse do to assist the patient to prevent further deconditioning and decrease the risk for developing musculoskeletal problems? a. Limit weight-bearing exercise to prevent stress on fragile bones and possible hip fractures. b. Advise the patient to avoid the use of canes and walkers because they increase dependence on ambulation aids. c. Advise the patient to increase his activity by more frequently climbing stairs in buildings and other environments with steps. d. Discuss the use of stretching and warm up, as well as strengthening exercises to decrease aches and pain so that exercise can be maintained.

d. Almost all older adults have some degree of decreased muscle strength, joint stiffness, and pain with motion. Warming up before and stretching after exercise as well as strengthening exercises help to decrease aches and pains so that exercise can be maintained. Musculoskeletal problems in the older adult can be prevented with appropriate strategies, especially exercise. Walkers and canes should be used as necessary to decrease stress on joints so that activity can be maintained. Stair walking can create enough stress on fragile bones to cause a hip fracture and use of ramps may help to prevent falls. NSAIDs may also be prescribed.

What characteristics are common in spondyloarthropathies associated with human leukocyte antigen (HLA)-B27? a. Symmetric polyarticular arthritis b. Absence of extraarticular disease c. Presence of rheumatoid factor and autoantibodies d. High level of involvement of sacroiliac and peripheral joints

d. An unusually high frequency of human leukocyte antigen (HLA)-B27 is found in patients with ankylosing spondylitis, psoriatic arthritis, and reactive arthritis, and these diseases have a predilection for involvement of the peripheral joints, especially lower extremities, sacroiliitis, uveitis, intestinal inflammation, and skin lesions as well as an absence of rheumatoid factor and autoantibodies.

The patient works on a computer 8 hours each day. What kind of repetitive strain injury would be expected in this patient? a. Meniscus injury b. Rotator cuff injury c. Radial-ulnar fracture d. Carpal tunnel syndrome

d. Carpal tunnel syndrome would be expected related to the continuous wrist movements. Injuries of the meniscus, which is fibrocartilage in the knee, is common with athletes. Radial-ulnar fractures are seen with great force such as a fall or a car accident. Rotator cuff injuries occur with sudden adduction forces applied to the cuff while the arm is held in abduction. They are commonly seen with repetitive overhead motions.

A 60-yr-old woman has pain on motion in her fingers and asks the nurse whether this is just a result of aging. What information is the best response by the nurse? a. Joint pain with functional limitation is a normal change that affects all people to some extent. b. Joint pain that develops with age is usually related to previous trauma or infection of the joints. c. This is a symptom of a systemic arthritis that eventually affects all joints as the disease progresses. d. Changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age.

d. Cartilage destruction in the joints affects the majority of those affected by the age of 40 and when the destruction becomes symptomatic, osteoarthritis (OA) is said to be present. Degenerative changes cause symptoms after age 50 or 60 but more than half over age 65 have x-ray evidence of OA. Joint pain and functional disability should not be considered a normal finding in aging persons. OA is not a systemic disease but may be caused by a known event or condition that directly damages cartilage or causes joint instability (e.g., menopause, obesity).

After teaching a patient with RA to use heat and cold therapy to relieve symptoms, the nurse determines that teaching has been effective when what is said by the patient? a. "Heat treatments should not be used if muscle spasms are present." b. "Cold applications can be applied for 25 to 30 minutes to relieve joint stiffness." c. "I should use heat applications for 25 minutes to relieve the symptoms of an acute flare." d. "When my joints are painful, I can use a bag of frozen corn for 10 to 15 minutes to relieve the pain."

d. Cold therapy is indicated to relieve pain during an acute inflammation, can be applied with frozen packages of vegetables, and should last only 10 to 15 minutes at a time. Heat in the form of heating pads, moist warm packs, paraffin baths, or warm baths or showers is indicated to relieve stiffness and muscle spasm. Heat should not be applied for more than 20 minutes at a time.

A young patient with a fractured femur has a hip spica cast applied. While the cast is drying, what is most important for the nurse to do? a. Elevate the legs above the level of the heart for 24 hours. b. Turn the patient to both sides and prone to supine every 2 hours. c. Cover the cast with a light blanket to avoid chilling from evaporation. d. Assess the patient frequently for abdominal pain, nausea, and vomiting.

d. Complaints of abdominal pain or pressure, nausea, and vomiting are signs of cast syndrome that occur when hip spica casts or body jacket braces are applied too tightly, causing compression of the superior mesenteric artery against the duodenum. The cast may have to be split or removed, and the HCP should be notified. Elevation is not indicated for a spica cast, and the patient with a spica cast should not be placed in the prone position during the initial drying stage because the cast is so large and heavy it may break. A cast should never be covered with a blanket because heat builds up in the cast and may increase edema.

An 88-yr-old woman is brought to the health clinic for the first time by her 64-yr-old daughter. During the initial comprehensive nursing assessment of the patient, what should the nurse do? a. Ask the daughter whether the patient has any urgent needs or problems. b. Interview the patient and daughter together so that pertinent information can be confirmed. c. Refer the patient for an interprofessional comprehensive geriatric assessment because at her age she will have multiple needs. d. Obtain a comprehensive health history using physical, psychologic, functional, developmental, socioeconomic, and cultural assessments.

d. During an initial contact with an older adult, the nurse should perform a comprehensive nursing assessment that includes a health history using physical, psychologic, functional, developmental, socioeconomic, and cultural assessments. If available, a comprehensive interprofessional geriatric assessment may then be done to maintain and enhance the functional abilities of the older adult. The older adult and caregiver should be interviewed separately, and the older adult should identify his or her own needs, if possible.

What should the nurse include in discharge instructions for the patient following a hip prosthesis with a posterior approach? a. Restrict walking for 2 to 3 months. b. Take a bath rather than a shower to prevent falling. c. Keep the leg internally rotated while sitting and standing. d. Have a family member put on the patient's shoes and socks.

d. Having someone else put the patient's socks and shoes on for patients with hip prostheses with a posterior approach will protect the patient from extreme flexion, adduction, or internal rotation for at least 6 weeks to prevent dislocation of the prosthesis. Gradual weight bearing on the limb is allowed and ambulation should be encouraged. The leg should be not be internally rotated but kept in a neutral position.

An important nursing intervention for the patient with ankylosing spondylitis is to teach the patient to do what? a. Wear roomy shoes with good orthotic support. b. Sleep on the side with the knees and hips flexed. c. Keep the spine slightly flexed while sitting, standing, or walking. d. Perform back, neck, and chest stretches and deep-breathing exercises.

d. Kyphosis and involvement of costovertebral joints in ankylosing spondylitis lead to a bent-over posture and a decrease in chest expansion, manifestations that are managed with chest expansion and deep-breathing exercises. Postural training emphasizes avoiding forward flexion during any activities and the patient should sleep on the back without the use of pillows.

When working with older patients who identify with a specific ethnic group, the nurse recognizes that health care problems may occur in these patients because they a. live with extended families who isolate the patient. b. live in rural areas where services are not readily available. c. eat ethnic foods that do not provide all essential nutrients. d. have less income to spend for medications and health care services.

d. Older adults with an ethnic identity often have disproportionately low incomes and may not be able to afford Medicare deductibles or medications to treat health problems. Although they often live in older urban neighborhoods with extended families, they are not isolated. Ethnic diets have adequate nutrition, but health could be impaired if money is not available for food.

When caring for the patient with CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) associated with scleroderma, what should the nurse teach the patient to do? a. Maintain a fluid intake of at least 3000 mL/day. b. Avoid exposure to the sun or other ultraviolet light. c. Monitor and keep a log of daily blood pressure (BP). d. Protect the hands and feet from cold exposure and injury.

d. One of the most common and early manifestations of CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia) is Raynaud's phenomenon, which causes paroxysmal vasospasms of the digits with diminished blood flow to the fingers and toes on exposure to cold or stress, followed by cyanosis and then erythema on rewarming. The hands and feet must be protected from cold exposure and possible burns or cuts that may heal slowly, and smoking is contraindicated. Fluid intake and sensitivity to ultraviolet light are not factors in scleroderma. Cardiovascular involvement may occur, but it does not require daily monitoring.

What best describes the manifestations of OA? a. Smaller joints are typically affected first. b. There is joint stiffness after periods of inactivity. c. Joint stiffness is accompanied by fatigue, anorexia, and weight loss. d. Pain and immobility may be aggravated by falling barometric pressure.

d. Pain and immobility of OA may be aggravated by falling barometric pressure. OA affects weight-bearing joints of knees and hips. Stiffness occurs on arising but usually subsides after 30 minutes. Pain during the day is relieved with rest. Fatigue, anorexia, and weight loss are nonspecific manifestations of the onset of RA.

A 65-yr-old patient has undergone a right total hip arthroplasty with a cemented prosthesis for treatment of severe osteoarthritis of the hip. What is included in the activity the nurse anticipates for the patient on the patient's first postoperative day? a. Transfer from the bed to the chair twice a day only b. Only turning from the back to both sides every 2 hours c. Crutch walking with non-weight bearing on the operative leg d. Ambulation with a walker and limited weight bearing on the right leg

d. Physical therapy is initiated on the first postoperative day with ambulation using a walker and limited weight bearing for a patient with a cemented prosthesis and non-weight-bearing on the operative side for an uncemented prosthesis. In addition, the patient sits in the chair at least twice a day and is turned to the back and unaffected side with the operative leg supported. Crutches would be difficult to use the first postoperative day.

A patient has fallen in the bathroom of the hospital room and reports pain in the upper right arm and elbow. Before splinting the injury, the nurse knows that the priority management of a possible fracture should include which action? a. Elevation of the arm b. Application of ice to the site c. Notification of the health care provider d. Neurovascular checks below the site of the injury

d. Sensation, motor function, and pain distal to the injury should be checked before and after splinting to assess for nerve damage and documented to avoid doubts about whether a problem discovered later was missed during the original examination or was caused by the treatment. Peripheral vascular assessment is also needed. Then the HCP is notified. Elevation of the limb and application of ice should be instituted after the extremity is splinted.

Laboratory findings that the nurse would expect to be present in the patient with RA include a. polycythemia. b. increased immunoglobulin G (IgG). c. decreased white blood cell (WBC) count. d. antibodies to citrullinated peptide (anti-CCP).

d. The antibody to citrullinated peptide (anti-CCP) is more specific than RF for RA and may allow for earlier and more accurate diagnosis. Other tests include C-reactive protein (CRP) that is elevated from inflammatory reactions of RA, a finding that is useful in monitoring the response to therapy. Anemia, rather than polycythemia, is common, and immunoglobulin G (IgG) levels are normal. The white blood cell (WBC) count may be increased in response to inflammation and is also elevated in synovial fluid.

An older adult woman is admitted to the ED after falling at home. The nurse cautions her not to put weight on the leg after finding what in the patient assessment? a. Inability to move the toes and ankle b. Edema of the thigh extending to the knee c. Internal rotation of the leg with groin pain d. Shortening and external rotation of the leg

d. The classic signs of a hip fracture are shortening of the leg and external rotation accompanied by severe pain at the fracture site and additional injury could be caused by weight bearing on the extremity. The patient may not be able to move the hip or the knee, but movement in the ankle and toes is not affected.

A patient is seen at the outpatient clinic for a sudden onset of inflammation and severe pain in the great toe. A definitive diagnosis of gouty arthritis is made on the basis of what? a. A family history of gout b. Elevated urine uric acid levels c. Elevated serum uric acid levels d. Presence of monosodium urate crystals in synovial fluid

d. The definitive diagnosis of gout is established by finding needle-like monosodium urate crystals in the synovial fluid of an inflamed joint or tophus. Although there is a familial predisposition to hyperuricemia, both environmental and genetic factors contribute to gout. Hyperuricemia and elevated urine uric acid are not diagnostic for gout because they may be related to a variety of drugs or may exist as a totally asymptomatic abnormality in the general population.

One important nursing intervention for the patient with fibromyalgia is to teach the patient to do what? a. Rest the muscles as much as possible to avoid triggering pain. b. Plan nighttime sleep and naps to obtain 12 to 14 hours of sleep a day. c. Try the use of food supplements such as glucosamine and chondroitin for relief of pain. d. Use techniques such as biofeedback, meditation, or cognitive behavioral therapy to manage stress.

d. The pain and related symptoms of fibromyalgia cause significant stress, and anxiety is a common finding. Stress management is an important part of the treatment and may include any of the commonly used relaxation strategies as well as psychologic counseling.

What is most likely to cause the pain experienced in the later stages of OA? a. Crepitation b. Bouchard's nodes c. Heberden's nodes d. Bone surfaces rubbing together

d. The pain in later OA is caused by bone surfaces rubbing together after the articular cartilage has deteriorated. Crepitation occurs earlier in the disease with loose particles of cartilage in the joint cavity. Bouchard's nodes and Heberden's nodes are tender but occur as joint space decreases and as early as 40 years of age.

Following change-of-shift handoff, which patient should the nurse assess first? a. A 58-yr-old male experiencing phantom pain and requesting an analgesic b. A 72-yr-old male being transferred to a skilled nursing unit following repair of a hip fracture c. A 25-yr-old female in left leg skeletal traction asking for the weights to be lifted for a few minutes d. A 68-yr-old male with a new lower leg cast complaining that the cast is too tight and he cannot feel his toes

d. The patient with a tight cast may be at risk for neurovascular compromise (impaired circulation and peripheral nerve damage) and should be assessed first. The other patients should be seen as soon as possible. Providing analgesia for the patient with phantom pain would be the next priority. The patient in skeletal traction needs explanation of the purpose and functioning of the traction. She may need analgesia or muscle relaxants to help tolerate the traction. Checking on the patient being transferred would include reassurance and paperwork completion.

According to the Corbin and Strauss chronic illness trajectory, which statement describes a patient with an unstable condition? a. Life-threatening situation b. Increasing disability and symptoms c. Gradual return to acceptable way of life d. Loss of control over symptoms and disease course

d. The trajectory defines a life-threatening situation as a crisis. Increasing disability is described as downward. A gradual return to an acceptable way of life is a comeback.

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization. b. the patient cannot tolerate the surgery for a closed reduction. c. a temporary cast would be too unstable to provide normal mobility. d. adequate alignment cannot be obtained by other nonsurgical methods.

d. adequate alignment cannot be obtained by other nonsurgical methods.

Older adults who become ill are more likely than younger adults to a. complain about the symptoms of their problems. b. refuse to carry out lifestyle changes to promote recovery. c. seek medical attention because of limitations on their lifestyle. d. alter their daily living activities to accommodate new symptoms.

d. alter their daily living activities to accommodate new symptoms.

A patient is scheduled for total ankle replacement. The nurse should tell the patient that after surgery he should avoid a. lifting heavy objects. b. sleeping on the back. c. abduction exercises of the affected ankle. d. bearing weight on the affected leg for 6 weeks.

d. bearing weight on the affected leg for 6 weeks.

A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse notifies the surgeon of possible early compartment syndrome when the patient experiences a. increasing edema of the limb. b. muscle spasms of the lower arm. c. bounding pulse at the fracture site. d. pain when passively extending the fingers.

d. pain when passively extending the fingers.

In teaching a patient with SLE about the disorder, the nurse knows the pathophysiology of SLE includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG. b. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer. c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles. d. the production of a variety of autoantibodies directed against components of the cell nucleus.

d. the production of a variety of autoantibodies directed against components of the cell nucleus.

The nurse suspects an ankle sprain when a patient at the urgent care center describes a. being hit by another soccer player during a game. b. having ankle pain after sprinting around the track. c. dropping a 10-lb weight on his lower leg at the health club. d. twisting his ankle while running bases during a baseball game.

d. twisting his ankle while running bases during a baseball game.