Patho Final - Ch 49
If a child with genu valgum does not self-correct after he or she begins weight-bearing, what condition could result?
Subluxation
Which assessment finding is a negative cardiac response to exercise?
The client's diastolic blood pressure increases
Which assessment finding leads the nurse to suspect a child has Blount disease?
Rotational deformity of the proximal tibia
A major complication of prolonged bed rest is an increased risk of kidney stones. The nurse knows that this is most likely related to:
Saturation of urine with calcium salts
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 manipulation and casting
The nurse caring for a child with a deficiency of vitamin D knows that the deficiency places the child at risk for:
Rickets
Which statement will the nurse impart to the parent of a child with Legg-Calvé-Perthes disease?
"A genetic pattern for this disease has not been established"
A child with Osgood-Schlatter disease most often presents with which assessment finding?
Pain in front of the knee
Which intervention should the nurse recommend to best minimize the risk of nutritional rickets in an infant whose culture supports long-term breast-feeding without the introduction of foods? Select all that apply.
Vitamin D exposure, Regular exposure to sunlight
A 2-year-old has bowing of the legs (genu varum). When should the health care professional should be concerned?
When there is a large separation between the knees greater than 15 degrees
Which intervention should the nurse include in the initial care plan for a child who is "toeing out"?
Assess the child periodically
A postmenopausal woman is ordered to take calcium supplements daily. Which intervention is essential for this client?
Assessing Vitamin D levels prior to starting calcium
The first manifestation that a client has osteoporosis is when presenting with which condition?
A bone fracture
Disuse of a muscle and muscle atrophy contribute to the weakening and wasting of muscle tissue. What else do they contribute to?
Joint contractures
Which client needs screening for osteoporosis?
Anyone with an eating disorder
An adult with flat feet is complaining about pain. Which statements will best help this client? Select all that apply.
"Be fitted for good shoes with arch supports" - "Surgery may be needed if symptoms do not decrease" - "Losing weigh may ease the pain"
A nurse holds an exercise class for older adults and knows which statement by a class member requires clarification?
"Exercise can help to keep down the salt levels that cause high blood pressure"
It is suspected that a client has osteomalacia. What should the nurse teach the client about potential causes of this condition?
"Insufficient calcium absorption and phosphate deficiency are the causes"
What information would the nurse include when teaching potential parents about prevention of congenital deformities? Select all that apply.
"Limit exposure to alcohol" - "Do not take any medication without first talking to your health care provider"
A new mother asks, "Why are you examining my baby's hips?" What is the nurse's best response?
"Musculoskeletal screening is important to identify anything that needs intervention"
The nurse has just finished teaching a client newly diagnosed with rheumatoid arthritis about the disease. The nurse determines that teaching is effective when the client states:
"Rheumatoid arthritis includes joint involvement that is usually symmetric and polyarticular"
The nursing instructor is teaching about osteoporosis and tells students that reduced physical activity can contribute to the loss of bone mass. What does the nurse tell the students is the rationale for this?
"reduced physical activity increases the rate of bone loss, as mechanical forces are important stimuli for normal bone remodeling"
A physician is providing care for several clients on a hospital-based medical ward. Which client is most likely to experience chronic fatigue?
51-year-old woman admitted for exacerbation of her multiple sclerosis
Which child requires further assessment of potential abnormalities?
A child who is walking but has external rotations of the feet
Which disorder places a client at increased risk for secondary osteoporosis? Select all that apply.
Celiac disease, hyperparathyroidism, multiple myeloma, long-term corticosteroid use
A child has been diagnosed with myopathic neuromuscular scoliosis. What other concurrent diagnosis may the child have?
Cerebral palsy
An increase in the level of receptor activator of nuclear factor kappa-β ligand (RANKL) results in which physiologic activity?
Changes in the rate of bone remodeling
Which of the following statements is true about congenital clubfoot?
Clubfoot may be associated with congenital syndromes
The older adult client tells the nurse that she believes she is getting shorter. The nurse explains to the client that height loss is caused by which occurrence with aging?
Compression of the vertebral column
Which clients should the nurse assess to determine if they have premature osteoporosis?
Compression of the vertebral column
The nurse is working with an older adult client who wishes to implement an exercise program. Which exercise regimen provides the most complete plan?
Cycling and lifting weights with a yoga class
Which of the following is a priority goal for a client with pes planus (flat feet)?
Decreased pain
In contrast to osteoporosis, osteomalacia causes which outcome, without the loss of bone matrix?
Defective mineralization
When assessing a client diagnosed with Paget disease focused in the skull, the nurse should anticipate which findings? Select all that apply.
Headaches, intermittent tinnitus, vertigo, hearing loss
Which assessment finding indicates a positive respiratory response to exercise?
Increased alveolar perfusion
Which statement is true concerning acute fatigue?
It serves a protective function for the body
The pediatric nurse is providing teaching to a parent of a child with toeing-out (slew foot). Which statement should the nurse include in the teaching?
It will most likely self-correct as the child becomes proficient in walking
The nurse is assessing a female client's risk for osteoporosis. Which factor places this client at greatest risk?
Menopause
When explaining to a class of nursing students the effects of dysregulation of the RANKL/RANK/OPG pathway, the instructor emphasizes that this plays a prominent role in the pathogenesis of which bone diseases? Select all that apply.
Neoplasia of the bone, osteoporosis
While measuring the height of a 12-year-old girl, the primary care provider noted a deviation of the girl's spine. This was quantified as being a right curve scoliosis of approximately 10 degrees deviation. Which treatment option is most appropriate?
Observation and no active treatment
Which statement will the nurse include when teaching about fetal development?
Ossification of the fetal skeleton begins in the ninth week
A 42-year-old client is admitted to the hospital with severe back pain, intermittent tinnitus, constant headache, and vertigo. He states that the back pain has been a problem for a number of years, but the other symptoms are quite new. Upon further examination, it is noted that he has unexplained hearing loss, and his femur and tibia have begun to bow. What condition does this client most likely have?
Paget Disease
Which statement is true about treatment of developmental dysplasia of the hip?
Treatment needs to be individualized
Which of the following should the nurse teach a client about syndactyly?
"This is a simple webbing of the fingers or toes"
A nurse is evaluating the progress of a client with chronic fatigue syndrome. Which statement by the client indicates successful symptom management?
"My schedule includes yoga and a weekly club meeting"
A nursing instructor is teaching students about metabolic bone diseases. She realizes a need for further instruction when one student states:
"Osteopenia is a condition that is only common in the elderly"
A client with osteomalacia asks, "How can I be deficient in vitamin D?" Which of the following is the nurse's best response?
"Tell me about your daily food intake"
A couple has just learned their neonate is diagnosed with osteogenesis imperfecta, and they ask, "What caused our child to get this disease?" What should the health care provider teach the couple about their neonate's condition?
"This is something that your child may have inherited from one or both of you"
Which clients are exhibiting manifestations of chronic fatigue? Select all that apply.
A 42-year-old who has experiences muscle pain, insomnia, and continuous fatigue for 6 months - A 56-year-old who is receiving chemotherapy for cancer and feels fatigue even with additional naps - A 75-year-old who has shortness of breath from heart failure, sleeps 8 hours nightly, and awakens tired
The nurse is reviewing the health histories of four clients. Select the client most at risk for developing secondary osteoporosis.
A 60-year-old female taking prednisone for asthma
Nursing students are studying metabolic disorders of the skeletal system and correctly identify which factor to be the major cause of osteoporosis?
Aging process
Adult rickets can result from several disorders. It can also have a pharmacologic basis for its onset. Which medication can cause rickets in an adult?
Aluminum-sparing antacids
The nurse is teaching a prevention program on premature osteoporosis. The nurse determines the participants understand the information when they identify which cause of osteoporosis that is commonly seen in female athletes playing endurance sports?
Amenorrhea
Which best describes metatarsus adductus?
An adducted forefoot that gives the foot a kidney-shaped appearance
The nurse is providing an education session regarding mobility for a client who experienced a myocardial infarction 10 days ago. While reviewing for this educational session, the nurse should recognize that which teaching point would not be appropriate to discuss with this client?
An individual who has been on bed rest has a faster heart beat and as a result there can be an increase in blood pressure
A child presents to the emergency room with suspected trauma to the growth plate in the ankle during a soccer game. Which step is the best intervention?
Assess the child for pain and prepare for diagnostic studies
The nurse is screening a newborn for developmental dysplasia of the hip. Which assessment finding supports this diagnosis?
Asymmetrical gluteal and thigh folds
Which assessment technique/sign should the nurse utilize on a newborn to screen for developmental dysplasia of the hip?
Barlow
Scoliosis is an abnormal curvature of the spine. Why is it first noticed?
Because of the deformity it causes
The nurse knows which teaching statement listed below best captures an aspect of chronic fatigue syndrome (CFS)?
Biological markers for the diagnosis of CFS
The nurse is providing care for an adult client whose current medication regimen includes calcitonin and a bisphosphonate. The nurse should recognize the likely need for:
Bone density testing on a scheduled basis
Which condition is considered a supportive factor in the diagnosis of chronic fatigue syndrome (CFS)?
Depression
A 70-year-old female client tells the health care provider she is concerned because she is getting shorter and her posture is not as good as it used to be. The provider completes an assessment of her spine and notes a loss of height in the vertebral column and kyphosis. This assessment would be recognized as:
Dowager hump
Which factors can influence the growth of cells in the epiphyseal growth plate? Select all that apply.
Epiphyseal separation as a result of trauma to the site, Vitamin C deficiency, Vitamin D deficiency
The nurse is performing an admission assessment to a rehabilitation unit. Which assessment tools should she utilize to determine an alert client's normal activities, perceived level of activity tolerance, or level of fatigue?
Human activity profile
An older adult is being evaluated for chronic fatigue. Which assessment data by the nurse would support the diagnosis?
Inability to concentrate; awakens after a few hours of sleep and cannot return to sleep
The primary care provider has positioned an infant in the supine position with both knees flexed and applied gentle downward pressure to both knees. The knee and thigh have been abducted while an upward and medial pressure was applied to the proximal thigh. What examination technique has been performed on this infant?
Ortolani Maneuver
The health care provider finds these assessment findings: (1) pain in the front of the knee; (2) swelling/tenderness with a prominent tibial tubercle. Which diagnosis correlates to these findings?
Osgood-Schlatter disease
An adult female client describes the pain in her hand as having an audible grinding and cracking sound, especially in her thumb with the inability to open a jar. The health care provider suspects the client has which type of joint disease?
Osteoarthritis
A 75-year-old female has been admitted to the hospital with a hip fracture. She states, "All I did was fall into my chair, not even very hard." Upon diagnostic testing, the client's bones shows loss of trabeculae from cancellous bone and thinning of the cortex. Which diagnosis is most likely?
Osteoporosis
Which assessment findings assist in diagnosing Legg-Calvé-Perthes disease? Select all that apply.
Pain in the thigh, pain in the knee, difficulty walking, limpness
After a week in which a client worked four 12-hour shifts and went home to two children with the flu, the client is feeling fatigued. How should this client's fatigue be categorized?
Physiologic
The nursing instructor is teaching about osteoporosis and informs the class that certain groups of children are also at a higher risk for decreased bone mass. Which group of children are at risk for developing osteoporosis? Check all that apply.
Premature infants, children on corticosteroids, infants with a low birth weight, children with cystic fibrosis
Which groups are at increased risk for decreased bone mass? Select all that apply.
Premature infants, low-birth-weigh infants, children with cystic fibrosis
The nurse assessing a 12-year-old boy documented to have Osgood-Schlatter disease anticipates which assessment finding?
Prominence of the tibial tubercle
A 16-month-old boy has a normal weight for his age but a height far below the normal range. His list of symptoms includes a protruding abdomen, lethargy, bow legs, muscle weakness, and irritability. His teeth have not yet developed and he has difficulty standing. What is the child's most likely diagnosis?
Rickets
An infant is born with a clubfoot. The nurse should anticipate which treatment measures will be instituted?
Serial manipulations and casting
Which clients are at highest risk for osteomalacia? Select all that apply.
The client from northern China and the client over 70 years old
A postmenopausal client questions the nurse about the diagnosis of osteoporosis. Which statement describes the pathology of osteoporosis?
The process of bone renewal after menopause is slowed in relation to the occurrence of bone breakdown
The client with osteoporosis asks the nurse to explain what a bisphosphonate medication does. The nurse will respond:
This medication helps prevent bone resorption, which in turn will help prevent fractures