NU272 Week 2 PrepU: Mobility

A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson's disease. The nurse would expect to administer this drug by which route? Oral Subcutaneous Intramuscular Intravenous

Oral Trihexyphenidyl is available only in an oral form.

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching? "Elevating my leg will reduce swelling after the procedure." "My physician may prescribe pain pills after the procedure." "I should use my heating pad this evening to reduce some of the pain in my knee." "I may notice some bruising or swelling in my knee."

"I should use my heating pad this evening to reduce some of the pain in my knee." The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.

While being tackled, a 20 year-old football player put out his hand to break his fall to the ground. Because the intense pain in his wrist did not subside by the end of the game, he was brought to an emergency department, where diagnostic imaging indicated an incomplete tear of the ligament surrounding his wrist joint. At the time of admission, his wrist was swollen with a severely restricted range of motion. What will his care team most likely tell the player about his diagnosis and treatment? "This strain will likely resolve itself with sufficient rest." "You've suffered a severe sprain and you might need a cast." "Your wrist contusion will have to be observed for bleeding under the skin surface." "It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks."

"It looks like a mild to moderate sprain and you'll need to keep it immobilized for a few weeks." Damage to the ligament structures is associated with sprains, and an incomplete tear would be indicative of a mild to moderate sprain. A strain is associated most commonly with overuse. A severe sprain would involve total disruption of the ligament.

A nurse is caring for a child with spina bifida. The child's mother asks the nurse what she did to cause the birth defect. Which statement would be the nurse's best response? "Older age at conception is one of the major causes of the defect." "It's a common complication of amniocentesis." "It has been linked to maternal alcohol consumption during pregnancy." "The cause is unknown and there are many environmental factors that may contribute to it."

"The cause is unknown and there are many environmental factors that may contribute to it." There is no one known cause of spina bifida, but scientists believe that it's linked to hereditary and environmental factors. Neural tube defects, including spina bifida, have been strongly linked to low dietary intake of folic acid. Maternal age doesn't have an impact on spina bifida. An amniocentesis is performed to help diagnose spina bifida in utero but doesn't cause the disorder. Maternal alcohol intake during pregnancy has been linked to intellectual disability, craniofacial defects, and cardiac abnormalities, but not spina bifida.

A nurse is caring for a client with a fractured elbow. Which instruction is important to give the client to prevent cartilage degeneration while the elbow is immobilized? "It is important to begin with vigorous exercise of the affected area as soon as the cast is removed." "To prevent cartilage atrophy, slowly and gradually resume exercising." "Once the elbow has been casted, you will not be able to exercise that joint for 3-6 months." "If you take a nonsteroidal anti-inflammatory medication prior to exercise, you will be able regain mobility faster."

"To prevent cartilage atrophy, slowly and gradually resume exercising." Cartilage atrophy is rapidly reversible with activity after a period of immobilization; impact exercise during the period of remobilization can prevent reversal of the atrophy. Slow and gradual remobilization may be important in preventing cartilage injury.

Which client is most likely to benefit from treatment with an antiparkinsonism agent? A client who has a medication-induced movement disorder A client who is being treated with an atypical antidepressant A client who has been admitted to the hospital with a diagnosis of lithium toxicity A client who is scheduled to begin electroconvulsive therapy (ECT) for the treatment of major depression

A client who has a medication-induced movement disorder Antiparkinsonism agents have been used to treat medication-induced movement disorders, such as neuroleptic-induced parkinsonism. The presence of lithium toxicity or the use of antidepressants or ECT is not likely to necessitate the use of antiparkinsonism agents.

A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action? Administer the medication as prescribed and monitor for therapeutic and adverse effects Contact the provider to question the frequency Contact the provider to question the dose Contact the provider to question the route

Administer the medication as prescribed and monitor for therapeutic and adverse effects This prescription is within recommended parameters. The nurse should administer the medication and monitor the client.

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy? Apply a cold pack at the insertion site. Apply warm compresses to the insertion site. Provide a gentle massage. Assist with performing ROM exercises.

Apply a cold pack at the insertion site. After covering the arthroscope insertion site with a bulky dressing and elevating the client's entire leg, the nurse needs to apply a cold pack at the site to minimize any chances of swelling.

Which statement reflects an aspect of the bone growth and development that occurs during the first two decades of life? Most bone abnormalities can be traced to anomalies in the embryonic stage of development. The physiologic effects of in utero positioning normally remain into late adolescence. Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells. Bone length increases through childhood while bone diameter remains static.

Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells. During development, the mature and enlarged cartilage cells at the metaphyseal end of the plate become metabolically inactive and are replaced by bone cells. This process allows bone growth to proceed without changing the shape of the bone or causing disruption of the articular cartilage. Abnormalities linked to the embryonic stage of development are uncommon. The physiologic effects of in utero positioning resolve by 3 to 4 years. Both length and diameter of bones increase during development.

A client recovering from surgery needs to be ambulated in the room twice a day. For which reason should the nurse question the use of a gait belt when ambulating this client? Client has mild cognitive impairment. Client is being treated for a wound infection. Client needs minimal assistance to ambulate. Client is recovering from abdominal surgery.

Client is recovering from abdominal surgery. A gait belt is used to transfer and assist a client with ambulation. A gait belt should not be used on a client with an abdominal incision that would be present after abdominal surgery. A gait belt would not necessarily be required for a client with mild cognitive impairment. A gait belt would not be required for a wound infection. A client needing minimal assistance would be a reason to use a gait belt.

Which nursing goal is a priority when caring for a client newly diagnosed with vertigo? Client will maintain therapeutic medication schedule. Client will remain safe while ambulating in the home. Client will have a caretaker with him or her in the home. Client will close eyes as needed to reduce symptoms.

Client will remain safe while ambulating in the home. Safety is always a concern when a client is experiencing vertigo. The goal of the nurse's instruction and care is for the client to remain safe. Maintaining a therapeutic medication schedule and caretaker and establishing strategies to reduce symptoms are important but not of highest priority.

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? A ganglion is the most common benign soft-tissue mass in the foot. A ganglion is a precursor to a primary bone tumor. Surgical excision is the treatment of choice for a ganglion. Dorsiflexion exacerbates signs and symptoms of a ganglion.

Dorsiflexion exacerbates signs and symptoms of a ganglion. Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the hand, not foot. It isn't a known precursor to a primary bone tumor. To treat a ganglion, the physician aspirates the ganglion, then injects a corticosteroid into the joint; the physician may also order nonsteroidal anti-inflammatory agents. Surgical excision is necessary only if signs and symptoms persist and the client's range of motion is impaired.

Which statements describe open reduction of a fracture? Select all that apply: It is performed in the operating room. The bone is surgically exposed and realigned. The client usually receives general or spinal anesthetic. The bone is restored to its normal position by external manipulation.

It is performed in the operating room. The bone is surgically exposed and realigned. The client usually receives general or spinal anesthetic. Statements describing open reduction are the following: It is performed in the operating room, the bone is surgically exposed and realigned, and the client usually receives general or spinal anesthetic. The bone is restored to its normal position by external manipulation with closed reduction.

Which types of play are most appropriate for the 3-month-old who is in an orthopedic cast? Baskets and soft balls Puzzles and cars Mobiles and rattles Colorful books and crayons

Mobiles and rattles Infants who are in an orthopedic cast must have stimulation by contact and play. They have limited ability to move. The best type of play for this age is a mobile that they can look at or a hand toy such as a rattle. The infant is unable to play with baskets and soft balls or books and crayons. The infants can hear musical instruments.

Which of the following is considered a central nervous system (CNS) disorder? Multiple sclerosis Guillain-Barré Myasthenia gravis Bell's palsy

Multiple sclerosis Multiple sclerosis is an immune-mediated, progressive demyelinating disease of the CNS. Guillain-Barré, myasthenia gravis, and Bell's palsy are peripheral nervous system disorders.

Which peripheral nerve injury will likely result in cellular death with little chance of regeneration? Nerve fibers destroyed close to the neuronal cell body Crushing injury where the nerve is traumatized but not severed Cutting injury where slow-regeneration axonal branches are located Incomplete amputation where tubular implants are used to fill in the gaps of nerves

Nerve fibers destroyed close to the neuronal cell body The successful regeneration of a nerve fiber in the PNS depends on many factors. If a nerve fiber is destroyed relatively close to the neuronal cell body, the chances are that the nerve cell will die; if it does, it will not be replaced. If a crushing type of injury has occurred, partial or often full recovery of function occurs. Cutting-type trauma to a nerve is an entirely different matter. A number of scar-inhibiting agents have been used in an effort to reduce this hazard, but have met with only moderate success. Various types of tubular implants have been used to fill longer gaps in the endoneurial tube but again only with moderate success.

Magnetic resonance imaging of a client's knee has revealed the presence of bursitis. The nurse should anticipate performing which intervention for bursitis? Applying Buck's traction with 10-pound weights Placing an ice pack on the knee to decrease swelling Administering an antihistamine like diphenhydramine to minimize inflammation Obtaining a surgical permit to repair the bursae

Placing an ice pack on the knee to decrease swelling Bursae contain synovial fluid, and they exist to prevent friction on a tendon. They are necessary in areas where pressure is exerted because of close approximation of joint structures. Bursae may become injured or inflamed, causing discomfort, swelling, and limitation in movement of the involved area. Buck's traction, diphenhydramine, and surgery are not the standard treatment for bursitis.

The health care provider is explaining the course of treatment to the parents of a 2-day-old infant born with congenital clubfoot. Which treatment options will likely be discussed? Serial manipulations and casting of the affected extremity Immediate corrective surgery Bilateral hip spica cast Steroids and pain medication

Serial manipulations and casting of the affected extremity 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 may be required for severe deformities or when nonoperative treatment methods are unsuccessful. It is performed most commonly between 6 and 12 months of age. Steroids and pain medication are not treatments of choice.

Which laboratory study indicates the rate of bone turnover? Urine calcium Serum calcium Serum phosphorous Serum osteocalcin

Serum osteocalcin Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.

A family brings their father to his primary care physician for a checkup. Since their last visit, they note their dad has developed a tremor in his hands and feet. He also rolls his fingers like he has a marble in his hand. The primary physician suspects the onset of Parkinson disease when he notes which abnormality in the client's gait? Slow to start walking and has difficulty when asked to "stop" suddenly Difficulty putting weight on soles of feet and tends to walk on tiptoes Hyperactive leg motions like he just can't stand still Takes large, exaggerated strides and swings arms/hands wildly

Slow to start walking and has difficulty when asked to "stop" suddenly The cardinal symptoms of Parkinson disease (PD) are tremor, rigidity (hypertonicity), and bradykinesia or slowness of movement. Bradykinesia is characterized by slowness in initiating and performing movements and difficulty in sudden, unexpected stopping of voluntary movements. Persons with the disease have difficulty initiating walking and difficulty turning. While walking, they may freeze in place and feel as if their feet are glued to the floor, especially when moving through a doorway or preparing to turn. When they walk, they lean forward to maintain their center of gravity and take small, shuffling steps without swinging their arms.

The nurse is caring for an 80-year-old client who was admitted to the hospital in a confused and dehydrated state. After the client got out of bed and fell, restraints were applied. She began to fight and was rapidly becoming exhausted. She has black-and-blue marks on her wrists from the restraints. What would be the most appropriate nursing intervention for this client? Sedate her with sleeping pills and leave the restraints on. Take the restraints off, stay with her, and talk gently to her. Leave the restraints on and talk with her, explaining that she must calm down. Talk with the client's family about taking her home because she is out of control.

Take the restraints off, stay with her, and talk gently to her. Physical restraints increase the possibility of the occurrence of falls, skin breakdown and contractures, incontinence, depression, delirium, anxiety, aspiration respiratory difficulties, and even death. The best action in this situation is for the nurse to remove the restraint, stay with the client and gently talk to her. Sedating her with sleeping pills is a chemical form of restraint. Leaving the restraints on the client to talk to her is going to cause further agitation and bruising of her wrists. The client's condition—not confusion and agitation—dictates when the client is discharged.

The nurse is caring for a client with myasthenia gravis. Which symptoms displayed by the client would indicate to the nurse that the client may be experiencing myasthenia crisis? The client has a sudden onset of severe weakness. The client begins to have projectile vomiting. The client begins to have tremors. The client has a fever, tachycardia, and low blood pressure.

The client has a sudden onset of severe weakness. People with myasthenia gravis may experience a sudden exacerbation of symptoms and weakness known as myasthenia crisis. Myasthenic crisis occurs when muscle weakness becomes severe enough to compromise ventilation, to the extent that ventilatory support and airway protection are needed. Myasthenic crisis usually occurs during a period of stress, such as infection, emotional upset, pregnancy, alcohol ingestion, cold exposure, or surgery.

The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for: infection. falls. excessive sedation. uncontrolled bleeding.

falls. Adverse effects of dopaminergic drugs such as carbidopa-levodopa include orthostatic hypotension. The dizziness and potential for fainting associated with this effect can increase the risk of falls.

A nurse is assessing a 15-year-old adolescent who's being admitted for treatment of anorexia nervosa. Which clinical manifestation is the nurse most likely to find? tachycardia warm, flushed extremities muscle weakness coarse hair growth

muscle weakness Anorexia nervosa frequently causes muscle weakness resulting from starvation or electrolyte imbalance. The reduced metabolism that occurs with severe weight loss produces bradycardia, not tachycardia and cold extremities, not warmed, flushed extremities. Soft, down-like hair (called lanugo) may cover the extremities, shoulders, and face of an anorectic client.

Which would be an inappropriate initial pain relief measure for the client with a cast? Application of cold packs Application of a new cast Administration of analgesics Elevation of the involved part

Application of a new cast Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary.

Which term is used to describe the inability to execute motor functioning, despite intact motor abilities?' Apraxia Aphasia Agnosia Executive functioning

Apraxia Apraxia is the impaired ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function. Agnosia is the inability to recognize the name of objects. Executive functioning is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? Growth hormone Vitamin D Sex hormones Calcitonin

Calcitonin Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.

Which term refers to the shaft of the long bone? Epiphysis Lordosis Scoliosis Diaphysis

Diaphysis The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

A client arrives in the clinic after having a tongue piercing performed and is unable to control the movement of the tongue. The nurse is aware that which nerve may have been damaged from the piercing? Vagus Trigeminal Abducens Hypoglossal

Hypoglossal The general somatic efferent LMNs of the lower segments of the medulla supply the extrinsic and intrinsic muscles of the tongue by means of the hypoglossal nerve (CN XII). Damage to the hypoglossal nerve results in weakness or paralysis of tongue muscles. When the tongue is protruded, it deviates toward the damaged and therefore weaker side because of the greater protrusion strength on the normal side.

A child is being treated for hematogenous osteomyelitis. Which statement is an accurate description of this type of osteomyelitis? The presence of dead bone tissue Introduction of microorganisms from the bloodstream Bacterial proliferation in the absence of the classic signs of infection Destruction of the vascular network in the endosteum

Introduction of microorganisms from the bloodstream Hematogenous osteomyelitis originates with infectious organisms that reach the bone through the bloodstream. Dead bone tissue is indicative of osteonecrosis, not osteomyelitis. Hematogenous osteomyelitis is normally accompanied by the classic signs and symptoms of infection; the destruction of the vascular network in the endosteum is not a hallmark of the hematogenous variant of osteomyelitis.

Which pathophysiologic phenomenon would be most indicative of ankylosing spondylitis? Loss of motion in the spinal column and eventual kyphosis. A progressive loss of range of motion in knee and hip joints. A facial "butterfly rash" and multi-organ involvement. Decreased bone density in long bones.

Loss of motion in the spinal column and eventual kyphosis. The characteristic trait of ankylosing spondylitis is progressive loss of spinal ROM and eventual kyphosis. Synovial joint involvement is not associated with the disease. A butterfly rash and multisystem involvement are associated with SLE. Decreased bone density does not normally accompany ankylosing spondylitis.

What areas of the body may be examined when bone densitometry is done? Select all that apply: hip spine wrist knee

hip spine wrist The hip, spine, wrist, finger, or heel bone may be examined during bone densitometry testing. The knee is not used for bone densitometry testing.

The nurse is teaching a pregnant client about injury prevention. Which instruction should the nurse include? "Wear your seat belt across your abdomen." "Take three 20-minute breaks during the workday." "Start going to the gym every day to improve your balance." "Change your shoes from high heels to flats."

"Change your shoes from high heels to flats." Balance changes during pregnancy. Wearing high heels places the woman off balance and can lead to falls. They can also lead to leg fatigue and increased swelling. Low heel or flat-heeled shoes are more appropriate for correct balance. When traveling in a car, the shoulder belt should cross between the breasts and over the upper abdomen, above the uterus. The lap belt should cross over the pelvis below the uterus. The steering wheel should be positioned as best as possible away from the uterus. Going to the gym every day is good exercise for the pregnant client, but the purpose is not for balance. Exercise promotes a sense of well-being, improves circulation, helps reduce constipation, and promotes muscle strength, tone, and endurance. For the working pregnant client, it is recommended to take two 10-15 rest periods in an 8-hour workday.

A nurse has been invited to speak to a support group for Parkinson's disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies? "Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases." "Drugs do not cure these disorders; they instead enhance quality of life." "Persons of all cultures are treated similarly and respond in similar ways to treatment." "Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction."

"Drugs do not cure these disorders; they instead enhance quality of life." It is most important that clients and their families know that Parkinson's disease as with other movement disorders are chronic, that there is no cure, and that drug therapy only serves to help decrease the severity of the symptoms. Symptoms are not normally eliminated completely. Culture must be considered because of catecholamine-O-methyltransferase (COMT), which affects the absorption of levodopa in the body. Some of the drugs used to treat movement disorders can pose a risk of causing renal or hepatic dysfunction, but not all.

A nurse is educating a patient newly diagnosed with Parkinson's disease. Which description would the nurse offer to describe the disease? "It is an acute disorder." "It is characterized by abnormalities in behavior." "It is characterized by abnormalities in movement and posture." "It is characterized by joint pliancy."

"It is characterized by abnormalities in movement and posture." Parkinson's disease is a chronic, progressive, degenerative disorder of the central nervous system characterized by abnormalities in movement and posture (e.g., tremor, bradykinesia, joint and muscular rigidity, postural instability).

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? An open reduction A fasciotomy A total hip replacement A total knee replacement

A fasciotomy A treatment option for compartment syndrome is fasciotomy.

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? Meniscography Bone densitometry Arthrography EMG

Arthrography Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. Meniscography is a distractor for this question. Bone densitometry is used to estimate bone mineral density. An EMG provides information about the electrical potential of the muscles and nerves leading to them.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Compound Greenstick Oblique Spiral

Compound A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

A nurse is assessing a client who will be discharged home after rehabilitation for a stroke. The nurse is questioning the client about his instrumental activities of daily living (IADLs). Which of the following would the nurse address? Bathing Grooming Dressing Cooking

Cooking Instrumental activities of daily living (IADLs) include cooking, cleaning, shopping, doing laundry, managing personal finances, developing social and recreational skills, and handling emergencies. Bathing, grooming, and dressing are activities of daily living (ADLs).

The nurse is caring for a child with a fractured femur in traction. Which action will the nurse complete while caring for this client? Ensure traction weights are hanging freely, not touching the bed or floor. Remove traction weights once per shift for 30 minutes and then replace them. Plan to add additional weights as the fracture heals, usually once per day. Have the unlicensed assistive personnel remove the weights daily and encourage the child to move around in bed.

Ensure traction weights are hanging freely, not touching the bed or floor. Traction is used as a pulling force on an extremity or body part. For it to be effective, the weights need to hang freely at all times and the ropes need to remain in the pulley grooves. The weights are not replaced or removed during traction. The child can move all extremities except the affected one(s). The child remains in traction until healing occurs, a cast is applied, or surgical repair is performed.

The nurse is caring for a client who sustained a femur fracture 3 days before. The nurse notes that the client, who was previously oriented, now doesn't know where he is. The nurse suspects which condition? Fat embolism syndrome (FES) Reflex sympathetic dystrophy Compartment syndrome Osteomyelitis

Fat embolism syndrome (FES) The FES refers to multiple life-threatening manifestations from the presence of fat droplets in the small blood vessels of the lung, kidney, brain, and other organs after a long bone (femur) or pelvic fracture. Initial symptoms of FES begin to develop within a few hours to 3 to 4 days after injury. The first symptoms include subtle changes in behavior and signs of disorientation. Reflex sympathetic dystrophy represents soft tissue complications of musculoskeletal injuries. Compartment syndrome is a condition of increased pressure within a limited space. Osteomyelitis represents an acute or chronic infection of the bone.

When a 4-year-old boy stands erect with his medial malleoli touching, the distance between his knees is 2 inches. What is the child's most likely diagnosis and treatment? Genu varum, which can be treated by bracing. Flatfoot, which will require orthopedic shoes. Genu valgum, necessitating a series of surgeries. Femoral torsion, which will spontaneously resolve before puberty.

Genu varum, which can be treated by bracing. Genu varum, or bowlegs, can be treated by bracing. The child's stance is not indicative of flatfoot, genu valgum, or femoral torsion.

Which precautions should the nurse take when a client is at risk of injury secondary to vertigo and probable imbalance? Grasp the siderails when rising to a standing position. Keep his or her eyes closed. Refrain from looking at one place. Immobilize the head to reduce the risk of falling

Grasp the siderails when rising to a standing position. The nurse should have the client use firm supports, such as siderails, whenever arising. There is no need to limit the client's gaze or head movements. Keeping the eyes closed can exacerbate disorientation.

A nurse is monitoring a client post cardiac surgery. What action would help to prevent cardiovascular complications for this client? Position the client in bed with pillows placed under his knees to hasten venous return. Keep the client from ambulating until the day after surgery. Implement leg exercises and turn the client in bed every 2 hours. Keep the client cool and uncovered to prevent elevated temperature.

Implement leg exercises and turn the client in bed every 2 hours. Ambulation and leg exercises increase circulation, which prevents cardiovascular complications. The nurse should provide covers, forced warm air, or other warming devices/techniques as necessary to prevent shivering and hypothermia caused by the surgical procedure, the procedure's length, anesthetic agents, a cool environment, the client's age, or the use of cool irrigating/infusion fluids. Pillows placed under the knees can cause venous pooling, leading to thrombophlebitis.

Which change exemplifies physiologic hypertrophy? Muscle mass increase with exercise Heart size increase in hypertension Lung size increase in emphysema Cell size increase with hypoxia

Muscle mass increase with exercise Hypertrophy that occurs as the result of normal physiologic conditions is seen as muscle mass increases with exercise. Heart size increase in hypertension is an example of pathologic increase, as is lung size increase in emphysema and cell increase with hypoxia.

Antibiotics such as gentamicin can produce a disturbance in the body that is similar to botulism by preventing the release of acetylcholine from nerve endings. In persons with preexisting neuromuscular transmission disturbances, these drugs can be dangerous. What disease falls into this category? Multiple sclerosis Duchenne muscular dystrophy Becker muscular dystrophy Myasthenia gravis

Myasthenia gravis The function of the striatum also involves local cholinergic interneurons, and their destruction is thought to be related to the choreiform movements of Huntington disease, another basal ganglia-related syndrome. The other answers do not involve the cholinergic interneurons of the striatum.

Guillain-Barré syndrome is characterized by which form of neuron damage? Mononeuropathy Polyneuropathy Peripheral neuropathy Transneuropathy

Polyneuropathy Polyneuropathies involve demyelination or axonal degeneration of multiple peripheral nerves that leads to symmetric sensory, motor, or mixed sensorimotor deficits. Guillain-Barre syndrome is an acute immune-mediated polyneuropathy.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? Keep the affected leg in a position of adduction. Use measures other than turning to prevent pressure ulcers. Prevent internal rotation of the affected leg. Keep the hip flexed by placing pillows under the client's knee.

Prevent internal rotation of the affected leg. The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

Which of the following is the final stage of fracture repair? Remodeling Cartilage calcification Cartilage removal Angiogenesis

Remodeling The final stage of fracture repair consists of remodeling the new bone into its former structural arrangement. During cartilage calcification, enzymes within the matrix vesicles prepare the cartilage for calcium release and deposit. Cartilage removal occurs when the calcified cartilage is invaded by blood vessels and becomes reabsorbed by chondroblasts and osteoclasts. Angiogenesis occurs when new capillaries infiltrate the hematoma, and fibroblasts from the periosteum, endosteum, and bone marrow produce a bridge between the fractured bones.

When teaching a group of nursing students about rheumatic disorders, a nurse emphasizes which important differences when caring for the older adult? Need for pain relief Stiffness in the morning Risk for falls Muscle weakness

Risk for falls The pain, stiffness, and muscle weakness affect daily life, often threatening independence and quality of life. Symptoms of the rheumatic diseases can also have an indirect effect on and even threaten the duration of life for older adults. The weakness and gait disturbance that often accompany rheumatic diseases can contribute to the likelihood of falls and fractures.

Which is not a guideline for avoiding hip dislocation after replacement surgery: The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Keep the knees apart at all times. Put a pillow between the legs when sleeping. Never cross the legs when seated.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

A client who is being seen in the outpatient clinic reports a single episode of unilateral arm and leg weakness and blurred vision that lasted approximately 45 minutes. The client is most likely experiencing: Transient ischemic attack (TIA) Cardiogenic embolic stroke Thrombotic stroke Lacunar infarct

Transient ischemic attack (TIA) Transient ischemic attacks are brief episodes of neurologic function resulting in focal cerebral ischemia not associated with infarction that usually resolve in 24 hours. The causes of transient ischemic attack are the same as they are for stroke. Embolic stroke usually has a sudden onset with immediate maximum deficit. Lacunar infarcts produce classic recognizable "lacunar syndromes" such as pure motor hemiplegia, pure sensory hemiplegia, and dysarthria with clumsy hand syndrome.

An administrative assistant at a large factory visits the medical unit and tells the nurse she is having pain in the right wrist, numbness in the index finger, and decreased mobility of the right hand. The nurse suspects the client has: a fracture of the hand. carpal tunnel syndrome. a herniated cervical disc. an infection in the bone.

carpal tunnel syndrome. Adults with jobs that require repetitive movement (typists, assembly line workers, supermarket checkers, computer operators) may develop carpal tunnel syndrome, a compression of the median nerve that causes pain and decreases hand mobility. A fracture would most likely be accompanied by symptoms including pain, swelling, and an inability to use the extremity. A herniated cervical disk would likely be accompanied by symptoms involving numbness and discomfort of the neck and arms. There are no manifestations consistent with an infection in the bone.

Which is a manifestation(s) of peripheral neuropathy? Select all that apply: muscle weakness increased muscle mass muscle wasting sensory changes increased body temperature

muscle weakness muscle wasting sensory changes Polyneuropathy affects several nerves and can cause muscle weakness and/or paralysis, resulting in muscle wasting. Numbness and tingling are common sensory changes associated with this type of neuropathy.

The nurse is providing teaching for parents of a 2-week-old infant just diagnosed with clubfoot. The nurse includes that the first treatment option is: serial manipulations and casting. percutaneous tendoachilles lengthening. full-time wearing of Denis Brown splint. surgical relaxation of foot ligaments and tendons.

serial manipulations and casting. Serial manipulations and casting will be the first treatment. Each of the other options is more involved and would be attempted after manipulation and casting.

After being thrown off the back of a bull, a bull rider can move his arms but has loss of motor function in the lumbar and sacral segments of the spinal cord. This is referred to as: Tetraplegia Quadriplegia Paraplegia Anterior cord syndrome

Paraplegia Tetraplegia and quadriplegia are loss of motor or sensory function after damage to neural structures in the cervical segments of the spinal cord. Paraplegia refers to loss of motor or sensory function in thoracic, lumbar, or sacral segments. The arms function as normal. Anterior cord syndrome includes loss of motor function provided by the corticospinal tracts and loss of pain and temperature sensation from damage to the lateral spinothalamic tracts.

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? Impacted fracture Transverse fracture Compound fracture Pathologic fracture

Pathologic fracture A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.

The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects? impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression constipation, nausea, and vomiting sleep disturbances, nocturnal enuresis, and impaired mobility nausea, vomiting, migraine headaches, and developmental regression

impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression Unrelieved acute pain can lead to impaired mobility; anorexia, causing poor nutritional intake; delayed wound healing; anxiety and irritability; somatic symptoms; sleep disturbances; avoidance; developmental regression; and increased parental distress. Constipation, nausea, vomiting, nocturnal enuresis, and migraine headaches are not effects of acute pain.

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

"Apply ice packs for the first 24 to 48 hours, then apply heat packs." The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

A client admitted with dehydration reports feeling dizzy with ambulation. What teaching would the nurse provide to the client? "Dizziness when you change position can occur when fluid volume in the body is decreased." "Dizziness can occur due to changes in the hospital environment." "Dizziness can occur when baroreceptors overreact to the changes in BP." "Dizziness is caused by very low blood pressure when you lie down."

"Dizziness when you change position can occur when fluid volume in the body is decreased." Dehydration is a cause for orthostatic hypotension, which causes a temporary drop in BP when the client rises from a reclining position. Dizziness is not associated with environmental changes. Dizziness or changes in orthostatic BP occurs when baroreceptors do not respond quickly enough to restore adequate circulation to the brain. Dizziness may be caused by low blood pressure. However, the client is dizzy with ambulation not when lying down.

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy? Increased diameter of the calf Capillary refill < 3 seconds Toes move freely without pain Bounding dorsalis pedis pulses

Increased diameter of the calf Increasing diameter of the calf can be indicative of bleeding into the muscle. The other findings are within normal limits.

A female tennis player has suffered an injury to her shoulder that has affected her bursae in the joint. Which consequence would be most expected from this aspect of her injury? Increased friction on the tendons of the shoulder joint. Direct contact between the humerus and scapula bones. Loss of connection between the humerus bone and biceps muscle. Fusing of the head of the humerus with the glenoid capsule of the scapula.

Increased friction on the tendons of the shoulder joint. The primary role of bursae is the reduction of friction on tendons. Damage to the bursae would not result in bone-to-bone contact, fusing of the joint, or separation between normally connected muscle and bone.

The nurse is performing range-of-motion exercises on a client's arm. The nurse starts by lifting the arm forward to above the head of the client. Which action would the nurse perform next? Move the opposite arm forward to above the head of the client. Return the arm to the starting position at the side of the body. Rotate the lower arm and hand so the palm is up. Move the arm across the body as far as possible.

Return the arm to the starting position at the side of the body. The nurse would return the joint to a neutral position (i.e., its normal position of alignment) when finishing each exercise.

A patient with Parkinson's disease is experiencing an on-off syndrome. What does the nurse recognize that the patient's clinical symptoms will be? The patient will have unilateral resting tremors and then will have a period of no tremors present. The patient will have a slow, shuffling gait and then will be able to move at a faster pace. The patient will have a period when medication with levodopa will be unnecessary. The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication.

The patient will have periods of near immobility, followed by a sudden return of effectiveness of the medication. The patient may experience an on-off syndrome in which sudden periods of near immobility ("off effect") are followed by a sudden return of effectiveness of the medication ("on effect"). Changing the drug dosing regimen or switching to other drugs may be helpful in minimizing the on-off syndrome.