Unit 10
A 40-year-old male client has a congenital syndrome that affects the function of the Langerhans cells of his epidermis. The man's care provider would expect which of the following manifestations of his condition? A) Increased susceptibility to infection B) High permeability of his epidermis to environmental materials C) Lighter skin tone than other individuals of the same ethnicity D) Frequent separation between the dermal and epidermal layer of his skin
A
A 71-year-old male with a suspected diagnosis of osteoarthritis is being scheduled for a knee aspiration. The client is surprised to learn that his knee joint contains fluid and asks the physician ordering the procedure what the main role of the fluid is. Which of the following statements best underlies the explanation that the physician will provide? A) Synovial fluid allows for joint movement by minimizing friction. B) Fluid in the synovial cavities is essential for its role in immunity, and deficits indicate autoimmune etiologies. C) Synovial fluid allows for the diffusion of gases and nutrients to cartilage that lacks blood supply. D) The fluid inhibits clot formation in bone surfaces that are in constant contact
A
A 74-year-old female has been diagnosed with osteoporosis after her bone density scan indicated osteopenia. Which of the following factors would her care team be most likely to rule out as contributors to her health problem? A) The woman is an African American and was exposed to asbestos in her work. B) She has been a heavy drinker for her whole adult life and has diabetes mellitus. C) The client takes corticosteroids for treatment of her long-standing osteoarthritis. D) The woman has an estrogen deficiency and has never undergone hormone therapy.
A
A new patient arrives at the clinic. The physician is suspecting that the patient may have systemic lupus erythematosus (SLE) given the clinical manifestations related to joint pain, skin changes, and a history of pleural effusions. The nurse should anticipate which of the following diagnostic test will be a priority to facilitate with the diagnosis? A) Anti-DNA antibody test B) Routine hemoglobin C) C-reactive protein D) B-cell lymphocytes
A
A public health nurse has learned that a colleague has been screening for scoliosis during visits made to schools even though such screening is not mandated. How should the nurse best respond to the colleague? A) "The potentially harmful outcomes of screening have been shown to outweigh the benefits." B) "Screening for scoliosis has been proven to be inaccurate." C) "Screening is unnecessary now that we know scoliosis is a benign condition." D) "The low prevalence and incidence of scoliosis have made screening unnecessary."
A
An 80-year-old female with a diagnosis of osteoporosis receives daily supplements of calcitonin in the form of a nasal spray that she instills each morning. Which of the following phenomenon would her care providers expect to result from her supplementation? A) Decreased serum calcium levels B) Increased bone resorption C) Acceleration of osteoclast action D) An increase in bone formation
A
The skin is richly supplied with arteriovenous anastomoses in which blood flows directly between an artery and a vein, bypassing the capillary circulation. What is the primary significance of these structures? A) They regulate body temperature. B) They process sensory information. C) They control the formation of "goose bumps" D) They combat skin infections.
A
When trying to explain the advantages of using an emollient over other products to a patient suffering from dry skin, the nurse will emphasize emollients A) can replenish the oils on the skin surface because they contain fatty acids. B) will draw water out from the deeper skin layers. C) provide moisture-proof material to the skin by providing a thick creamy layer as a barrier. D) will contain some form of numbing agent like lidocaine to help with the itching
A
Child/parents are coming into the physician's office to get the results of some diagnostic testing relating to his knee pain and unusual stiffness and fatigue. The physician suspects the child may have slipped capital femoral epiphysis. The nurse should anticipate that the treatment will involve: Select all that apply. A) no weight bearing on the femur. B) bed rest. C) traction. D) injection of steroids into the joint. E) high dose of calcium supplements.
A B C
A female client who is suspected of having psoriasis. Which of the following aspects of the woman's history and her care provider's assessment would be potential contributors to her health problem? Select all that apply. A) The woman takes an angiotensin-converting enzyme inhibitor for the treatment of hypertension. B) She has been diagnosed with arthritis. C) The woman has a family history of diabetes. D) Skin trauma of any kind often precedes an outbreak. E) The woman has dark skin.
A B D
A physician is attempting a differential diagnosis of a 30-year-old female who is suspected of having systemic lupus erythematosus (SLE). Which of the following aspects of the physician's assessment and the client's history would be considered potentially indicative of SLE? Select all that apply. A) The client has a "butterfly rash" on her nose and cheeks. B) She complains of intermittent joint pain. C) The woman states that she has numerous environmental allergies. D) The client has been hospitalized twice in the past for pleural effusions. E) Blood work indicates low red cells, white cells, and platelets.
A B D E
An 11-year-old boy with skin lesions on his trunk characteristic of ringworm has been brought to the family's primary care provider by his mother. Which of the following aspects of the clinician's assessment relates most directly to the suspected diagnosis? A) Previous infection with other parasitic worms B) Potential contact with the fungus from pets or other children C) Allergic reactions to drugs and environmental substances D) The child's infant immunization history
B
An 81-year-old woman has noted a gradual decrease in the moisture of her skin over many years. Which phenomena associated with the aging process are known to contribute to her xerosis? Select all that apply. A) Separation of the basement membrane from adjacent dermal and epidermal layers B) Changing composition of sebaceous gland secretions C) Flattening of the dermal rete ridges D) Decreased moisture secretions from sweat glands E) Decrease in skin capillaries
B C D E
A few of the more experienced nurses are sitting around a lunch table discussing the changes they are seeing in their skin. Which of the following would be considered normal age-related changes? Select all that apply. A) Thickening of the dermis layer. B) Reduction in subcutaneous tissue. C) Increased hair growth on back and legs. D) Dry, scaly skin.
B D
A 16-year-old boy has been diagnosed with ankylosing spondylitis. Which of the following etiologies is responsible for his health problem? A) Infection B) Friction between bones C) Immune response D) Inappropriate bone remodeling
C
A 30-year-old woman has just given birth to a boy. How will the mother's bone marrow differ from that of her son? A) Her bone marrow performs additional functions for the maintenance of homeostasis that her son is not able to yet perform. B) The son will have a greater proportion of adipose tissue in his bone marrow. C) Proportionately, the infant will have more red marrow and less yellow marrow than his mother. D) The amount of yellow marrow in the son's bones will decrease as he develops.
C
A 44-year-old man has been diagnosed with chronic urticaria, the exact cause of which cannot be determined. What is the pharmacological treatment that is most likely to be of most use to the man? A) topical retinoids B) epinephrine C) antihistamines D) benzoyl peroxide
C
A 7-year-old boy has been diagnosed with juvenile idiopathic arthritis (JIA), and his parents are anxious to know how his health problem will affect his short-term and longer-term future. What can his health care provider most accurately tell the family? A) "Because JIA is an autoimmune disease, the long-term prognosis is quite poor and his mobility is likely to decline over time." B) "The earlier that we can schedule joint replacement surgeries, the better his prognosis will be." C) "With appropriate use of anti-inflammatory drugs along with lifestyle modifications, your son stands a good chance of leading a normal life." D) "We can relieve many of the symptoms or JIA and ensure his mobility, but there is a risk he'll develop a systemic immune response beyond his joints."
C
A child comes in to show his parents (who are nurses) a blister on his foot from "breaking in" a new pair of shoes. The child wants to "pop the blister" to get all the fluid out of it, so it would not hurt so much when he puts on shoes/socks. The parents know that breaking the skin of the blister will put him at risk for A) fluid volume deficit. B) further edema due to loss of proteins. C) secondary infection. D) activity intolerance
C
A frustrated 26-year-old female has sought a referral to a dermatologist in an effort to resolve her sweating and body odor that persists despite good hygiene. Which of the following facts would underlie the explanation that her physician provides about her problem? A) Sebaceous secretions vary in both quantity and constituency between individuals. B) Excess production by eccrine sweat glands, combined with bacteria, produces a characteristic odor in moist areas of the body. C) Apocrine sweat glands produce a substance that is more oily than sweat from other sources. D) Occlusion of sebaceous glands in the axillae and groin results in proliferation of microorganisms.
C
A patient asks the nurse why his hip fracture (head of the femur) bone has died (osteonecrosis). The nurse responds based on which of the following pathophysiological principles? A) All fractured bones interrupt blood supply and thereby results in death of the bone no matter where it is located. B) Most of the time when the head of the femur breaks, the entire neck region is disconnected to the rest of the bone so the blood vessels are severed. C) Since the head of the femur has only limited collateral circulation, interruption in the blood flow from the fracture causes necrosis and irreversible damage. D) When the femur head breaks, it dislocates and crushes the surrounding area causing the blood vessels to be occluded.
C
A public health nurse is conducting a health promotion teaching session at a seniors' drop-in center. Which of the following teaching points about hip fractures in older adults is most justified? A) "Current treatment options for hip fractures in older adults mean that surgery is no longer a common necessity." B) "Because of their generally higher body mass, men are particularly susceptible to breaking a hip in a fall." C) "Most hip fractures are actually a break at the very top of the thigh bone." D) "Because bone density is largely determined by your genes, there's little you can do to prevent hip fractures other than avoiding falls."
C
In which of the following locations would a clinician expect to find a ligament? A) At the attachment points between ribs and the sternum B) Between the radius bone of the arm and the biceps brachii muscle C) Around the capsule that forms the knee joint D) Between the individual plates of the skull
C
The physician is considering prescribing an anti-tumor necrosis factor (TNF) like infliximab for a rheumatoid arthritis patient. Which of the following statements is accurate about the advantages of using a TNF inhibitor? A) "Since TNF inhibitors have few side effects, these drugs will fit well into your regimen." B) "Your disease-modifying antirheumatic drug (DMARD) methotrexate has more cardiovascular side effects than TNF inhibitors." C) "TNF inhibitors help slow the disease progression and improve your ability to perform routine ADL functions." D) "Not only do TNF inhibitors control your disease better but they also will interrupt the inflammatory cascade at several levels."
C
Which of the following changes in an 86-year-old male's skin would necessitate further examination and possible medical treatment? A) A decrease in general sebaceous gland activity B) Appearance of new skin tags on his chest C) A new mole-like growth on his forearm D) Appearance of a keratosis on the man's trunk
C
Which of the following clients is most likely to have low bone density? A) A 70-year-old woman with increased numbers of osteoblasts. B) A 78-year-old female whose osteoclast function is inhibited. C) A 65-year-old male who is noted to have osteopenia. D) A 68-year-old male who takes vitamin D supplements.
C
Which of the following components of immune function is absent in the dermis? A) Macrophages B) T cells C) Lymph nodes D) Mast cells
C
Which of the following is an aspect of the bone growth and development that occurs during the first two decades of life? A) Most bone abnormalities can be traced to anomalies in the embryonic stage of development. B) The physiological effects of in utero positioning normally remain into late adolescence. C) Cartilage cells at the metaphyseal end of the bone plate are replaced by bone cells. D) Bone length increases through childhood, while bone diameter remains static.
C
Which of the following statements best conveys an aspect of the process of keratinization? A) Keratin cells synthesized in the dermis migrate to the surface over 20 to 30 days. B) Mitosis that begins with the cells of the stratum granulosum results in a continual supply of new keratinocytes. C) The stratum germinativum continuously produces new keratinocytes to replace losses. D) The basal cells of the epidermis migrate to the skin surface at a rate that matches superficial losses of skin cells.
C
Which of the following structures would likely be present in a hair follicle in a man's groin but not in a follicle on his face? A) Arrector pili muscle B) Sebaceous gland C) Apocrine gland D) Hair papilla
C
While explaining to the parents of a 5-year-old why the child's fractured femur has so much swelling and bruising, the nurse will include which of the following statements? A) "Your child fell out of the tree with so much force that the body is trying to send extra fluid to the area of the break." B) "All bone fractures have lots of bruising so it's nothing to worry about." C) "This bone is hollowed out, and the inside of the shaft produces marrow where red blood cells are formed." D) "There are a lot of cartilage attaching to the shaft of the femur, so when you break that bone, it ruptures the cartilage and causes more swelling."
C
While measuring the height of a 12-year-old girl during an office visit, the primary care physician noted a deviation of the girl's spine. This was subsequently quantified as being a right curve scoliosis of approximately 10-degree deviation. Which of the following treatment options is most clearly indicated? A) Use of a Milwaukee brace during waking hours B) Surgical correction of the girl's spine C) Observation and no active treatment D) Use of external rods to correct the deviation
C
A 68-year-old woman has had her mobility and quality of life severely affected by rheumatoid arthritis (RA). Place the following pathophysiological events involved in her health problem in the correct order that they most likely occurred. Use all the options. A) Inflammatory response B) Interaction between rheumatoid factor (RF) and IgG C) T-cell-mediated immune response D) Pannus invasion E) Destruction of articular cartilage
C B A D E
A patient is suspected to have osteomalacia based on his clinical manifestations and lab/diagnostic workup (low calcium levels, transverse lines on x-ray). The nurse would expect the patient to have which of the following clinical manifestations? Select all that apply. A) Nerve palsy in upper extremities. B) Calcification of aortic valve. C) Bone pain. D) Muscle weakness. E) Cold limb with absent pulses.
C D
A 30-year-old woman, who just found out that she is pregnant, seeks a treatment for her severe acne. What is the most appropriate treatment for her skin condition? A) Accutane B) Low-dose tetracycline C) Retin-A D) A benzoyl peroxide agent
D
An 8-year-old child has just been diagnosed with systemic lupus erythematosus (SLE). The parents wonder what the child's prognosis is going to be. Which of the following findings would be considered a good prognostic indicator of the extent/seriousness of the disease? A) Complaints of arthralgias and arthritis in joints with movement B) Ligaments and tendons hurt during passive ROM C) Has a rash on the nose and cheeks D) Swelling in the face and eyes and rust/blood-colored urine
D
Which of the following individuals who has recently presented to a hospital emergency department is displaying an injury that involves his or her fibrocartilage? A) A 7-year-old girl whose ear has been lacerated during a dog attack B) A 24-year-old male who has had his trachea crushed in a workplace accident C) A 15-year-old boy who has suffered a knee injury during a football game D) A 78-year-old man who has fallen and is suspected of having a "slipped disc" in his back
D
While reviewing the bones in anatomy class, the instructor discusses this type of bone that protects the underlying structures. A good example of a flat bone is: A) metatarsal bones. B) vertebrae. C) femur. D) skull.
D
A 13-year-old girl and her father come in to the local health clinic hoping to see an orthopedic doctor about the girl's stiff and warm knee. The father reports that she hurt it sliding into base during a softball game, and the daughter concurs, but with further discussion, it becomes clear that the slide made an existing pain worse. Her knee had been stiff, warm, and shiny and had been keeping her awake at night for a week or so before the game. Which of the following might be the cause of the girl's symptoms? A) Osteosarcoma B) Osteoma C) Chondroma D) Osteochondroma
A
A 16-month-old boy has a normal weight for his age but a height far below the normal range. His list of symptoms includes a protruding abdomen, lethargy, bow legs, muscle weakness, and irritability. His teeth have not yet developed, and he has difficulty standing. What is the child's most likely diagnosis? A) Rickets B) Rachitic rosary C) Paget disease D) Developmental dysplasia of the hip
A
A 31-year-old man who has worked for several years installing fiberglass insulation has developed itchy, irritating lesions on his wrists and forearms over the last several months. He has applied moisturizing creams repeatedly and has taken antihistamines but has experienced no significant improvement. He is understandably concerned about the potential effect this could have on his livelihood and has asked his care provider when treatment will resolve the problem. What is the care provider's most appropriate response? A) "A steroid cream will likely help but often the skin problem lasts long after contact with the product that irritates the skin." B) "You're clearly allergic to the fiberglass in your insulation, and over-the-counter allergy medications are likely to resolve the problem quite rapidly." C) "The problem is that your skin is producing and sloughing off cells prematurely; this will respond well to a topical steroid." D) "There are medications I can prescribe that will cure this sensitivity, but they tend to take many months to take full effect."
A
A 51-year-old male with a history of hypertension has received a kidney transplant. The client's physician is explaining some of the consequences of the procedure, including the fact that he will need to be on long-term steroid therapy. Which of the following teaching points should the physician emphasize? A) "One of the risks that these steroids bring is the possibility that part of a bone might die." B) "Steroids will help your body to not reject your new kidney, but they bring a risk of bone infection." C) "You're going to have to avoid contact sports because the steroids will make your bones very susceptible to breakage." D) "If you notice sudden limb pain after taking your steroid pills, it could be an increase in pressure in the compartment around your muscles."
A
A female tennis player has suffered an injury to her shoulder that has affected her bursae in the joint. Which of the following consequences would be most expected from this aspect of her injury? A) Increased friction on the tendons of the shoulder joint B) Direct contact between the humerus and scapula bones C) Loss of connection between the humerus bone and biceps muscle. D) Fusing of the head of the humerus with the glenoid capsule of the scapula.
A
Clinical investigation of a 40-year-old female client with diverse dermatological signs and symptoms has focused on the woman's basement membrane. Which of the following skin functions would a clinician most likely attribute to a region of the integument other than the basement membrane? A) Lack of sensory nerve impulse conduction B) Formation of blisters on various skin surfaces C) Lack of adhesion between the dermis and epidermis D) Large immunoglobulin deposits
A
Following a motorcycle accident that resulted in bilateral femoral fractures, a 42-year-old male has been receiving skeletal traction for the past 8 days. His care providers would recognize that which of the following risks is paramount? A) Risk of thromboemboli B) Risk of compartment syndrome C) Risk of permanent muscle atrophy D) Risk of decreased bone density and increased future fracture risk
A
The infant of a family that has recently immigrated to the United States from South Asia has been diagnosed with rickets. Bone density scanning would yield which of the following characterizations of the infant's bones? A) The child's bones are far softer than those of healthy children. B) The infant has bones that are brittle and susceptible to breakage. C) The child's bones lack bone matrix and prevent weight bearing. D) The child's bones are oversized due to insufficient osteoclasts.
A
The osteoporosis patient asks the nurse to explain what a bisphosphonate medication does. The nurse will respond, A) "This medication helps prevent bone resorption, which will help prevent fractures." B) "These drugs increase your phosphorus levels and thereby help with your calcium levels as well." C) "This medication stimulates your parathyroid gland to increase osteoclastic activity." D) "This medication plays an important role in bone remodeling."
A
The parents of a newborn who has been diagnosed with developmental dysplasia of the hip ask the nurse about the reason this harness has to be on their child. The nurse responds, A) "This harness allows your baby some mobility as it slowly brings the leg back into abduction." B) "The harness is meant to help the baby be moved without increasing his pain." C) "The harness will keep the leg immobile and force the femoral head back into the cup-shaped socket of the hip bone." D) "Infants with dysplasia of the hip need to keep the leg still, and this harness will provide the immobility needed for healing postsurgery."
A
Which of the following characteristics most accurately applies to compact (cortical) bone? A) It is found along lines of stress in the body. B) The bone is arranged in an interwoven, lattice-like pattern. C) It is relatively light but still strong. D) The surface of the bone is lined with osteogenic cells.
A
Which of the following clients of an oncologist is likely to have the poorest prognosis? A) A 69-year-old man who has been diagnosed with stage IV malignant melanoma B) A 70-year-old whose skin cancer has been identified as nodular ulcerative basal cell carcinoma C) A 51-year-old women whose biopsy has revealed intraepidermal squamous cell carcinoma D) A 59-year-old woman who has invasive squamous cell carcinoma
A
Which of the following individuals is most likely to develop a form of reactive arthritis? A) A 24-year-old male who completed treatment for a chlamydial infection 1 year ago B) A 46-year-old female who has a long-standing diagnosis of systemic lupus erythematosus C) A 3-year-old girl who was born with a 20-degree congenital scoliosis D) A 79-year-old male who had a total hip replacement 2 months prior
A
Which of the following newborn infants demonstrates the highest risk of presenting with developmental dysplasia of the hip (DDH)? A) A girl who was born with toeing-in and who was in a breech presentation B) A twin girl who required resuscitation after delivery C) A boy who was born by caesarian section to a 44-year-old first-time mother D) A boy with Down syndrome who was exposed to cocaine in utero
A
Which of the following pathophysiological phenomena would be most indicative of ankylosing spondylitis? A) Loss of motion in the spinal column and eventual kyphosis B) A progressive loss of range of motion in the knee and hip joints C) A facial "butterfly rash" and multiorgan involvement D) Decreased bone density in long bones
A
While working in an allergy clinic, the nurse notices that many patients come in with all types of skin reactions. The nurse working in this area knows that which cells play a role in the development of allergic skin condition? A) Langerhans cells B) Merkel cells C) Spherical melanosomes D) Keratin
A
The parents of an active 9-year-old are leaving the emergency department (ED) following cast placement for their son's lower extremity as a result of a fall in soccer. The nurse should emphasize that assessment of the cast is important and that they should bring their son back to the ED if they note which of the following signs and symptoms? Select all that apply. A) Cold, pale toes on the side with the cast. B) Patient complaining of tingling and numbness in the casted leg. C) Swelling in the lower leg has remained the same since they left the ED 12 hours ago. D) Pulses are palpable below the level of the cast. E) Bruising noted in the lower foot and toes
A B
A 22-year-old woman has sustained a lateral blow to her right knee during a game, and subsequent imaging has confirmed a severe meniscus injury. Which of the following consequences should the woman expect over the course of recovery? Select all that apply. A) Decreased lubrication in the knee joint B) Decreased stability of the knee C) Reduced shock absorption capacity D) Presence of infectious microorganisms in the synovial capsule E) Rapid restoration of the cartilage cells in the meniscus
A B C
A boy has arrived home after experiencing his first outdoor camping trip with his Boy Scout troupe. Upon arrival at home, he is very uncomfortable and scratching at a rash. It appears that he contacted poison ivy and that it has spread to many areas on his body. The nurse in the clinic will likely prescribe which of the following treatment measures for this child? Select all that apply. A) Prescription for corticosteroids. B) Cool showers especially right before bedtime. C) Over-the-counter antihistamines. D) Occlusive ointments with high petroleum content.
A B C
A 17-year-old male experienced third-degree full-thickness burns 2 days ago to his lower limbs after a fire at his workplace. Which of the following complications should his care team foresee and regularly assess for? Select all that apply. A) Systemic infection B) Fluid volume deficit C) Respiratory dysfunction D) Hypermetabolic response E) Constipation and bowel obstruction
A B C D E
A nurse practitioner student is trying to distinguish the various rashes they will be seeing in their pediatric rotation. Their nurse preceptor is assisting by describing the rash associated with rubeola. Which of the following characteristics would apply to rubeola? Select all that apply. A) Rash is macular and blotchy. B) Maculopapular rash covering the trunk and spreading to the appendages. C) The rash usually begins on the face and then spreads to the legs/arms. D) The rash forms vesicles with depressed centers that are filled with yellow-colored fluid. E) The painful rash follows a nerve root usually on only one side of the body.
A C
When educating the patient with ankylosing spondylitis, the nurse should emphasize which of the following treatment interventions? Select all that apply. A) Encourage sleeping supine on an extra firm mattress if possible. B) Prop self up in bed with extra pillows if having respiratory congestion. C) Try using the heating pad prior to exercise to help stretching and improve movement. D) Wear a knee immobilizer while biking to facilitate ability to exercise for longer periods. E) Modify diet to include more protein from red meats and green vegetables for vitamin K.
A C
While speaking to a senior citizen club about osteoarthritis (OA), which of the following facts are accurate to share? Select all that apply. A) By the time you are in your 70s, about 85% of adults will have some form of OA B) Men usually get OA in their hands, whereas women get OA primarily in their hips C) Obesity in women has been correlated to having OA in the knees D) Heredity does not play a significant role in the development of OA
A C
A patient has been admitted with a fractured pelvis that occurred in an auto accident just a few hours ago. The nurse notices a slight change in behavior. Which of the following clinical manifestations would lead the nurse to suspect that the patient has fat emboli that has migrated? Select all that apply. A) Complaints of substernal chest pain B) Complaints of pain in the lower abdomen and back C) Pulse rate 120 with temperature of 99.7°F D) Profuse diaphoresis with pallor noted E) Urine output of 30 mL/hour
A C D
Following bone density scanning and diagnostic imaging, a 4-year-old boy has been diagnosed with Legg-Calvé-Perthes disease. Which of the following findings, signs, and symptoms would lead clinicians to this conclusion? Select all that apply. A) The boy has significant difficulty in walking. B) The boy's feet toe-in when standing upright. C) The child has limited abduction of the affected hip. D) His femoral head region is noted to be necrotic. E) There are numerous microfractures where his patellar tendon and tibia articulate
A C D
A 13-year-old girl has presented to a clinic with her mother explaining that she had an oval-shaped red patch on her chest a week ago but that more of the lesions are now appearing on her back. On examination, the lesions on her back are in a "Christmas tree" pattern. What is the girl's most likely diagnosis? A) Lichen planus B) Pityriasis rosea C) Rosacea D) Melasma
B
A 17-year-old male has been diagnosed with osteosarcoma of the upper tibia following several months of leg pain. Which of the following statements by the client demonstrates that he has an accurate understanding of his diagnosis? A) "I guess it's good that at least my tumor's a benign type." B) "I'm really nervous about having to get surgery and chemo." C) "I'm gaining hope from the fact that it's really rare for someone to die from this." D) "It still feels surreal that I'm going to have to get my leg amputated."
B
A 22-year-old male who has been backpacking around Southeast Asia for several months has responded well to treatment for scabies that he acquired while on his trip. What follow-up measures should be taken? A) Continuing his antibiotics until the full course is completed B) Treatment of individuals that he has been in close contact with C) Applying corticosteroid creams for at least 8 weeks to prevent recurrence D) Avoiding potentially irritating products such as dyes and perfumes
B
A 41-year-old woman has been diagnosed as having a loose body of cartilage in her left knee. What data would most likely lead clinicians to this conclusion? A) A visible hematoma is present on the anterior portion of the knee. B) The woman experiences intermittent, painful locking of her joint. C) Computed tomography indicates a complete tear of her knee ligament. D) An x-ray shows that her femoral head and tibia are no longer articulated.
B
A 51-year-old woman who was born congenitally blind and deaf is able to distinguish individuals by light touch of the individual's face. Which of the following components of the woman's skin innervation likely contributes the most to this ability? A) Ruffini corpuscles B) Meissner corpuscles C) Pacinian corpuscles D) Nociceptors
B
A 70-year-old woman's family physician has recommended a vitamin D supplement. The woman states that she tries hard to take as few pills as possible and questions her physician on the rationale and necessity of the hormone. How can the physician most accurately reply to the client's concerns? A) "Vitamin D can prevent osteoporosis by increasing the density of your bones." B) "Vitamin D is important in order for your body to absorb the calcium that you consume in your diet." C) "When your liver is unable to produce enough on its own, it's important to take vitamin D supplements to promote bone strength." D) "Vitamin D slows down the rate that your body breaks down your bones."
B
A female toddler has been diagnosed with toeing-in (metatarsus adductus). What teaching should the pediatrician provide to the parents of the child about her diagnosis? A) "She will likely walk later than most children, but it will resolve itself with time." B) "We'll likely need to start putting the first of a series of casts on her legs quite soon." C) "The best time to perform the surgery that's needed will be at age 3 or 4." D) "While there's no effective treatment for her toeing-in, most children learn to accommodate the problem and walk independently."
B
A nurse is teaching a wellness group among a group of older adult women. One of the women has asked for advice about preventing osteoporosis, which affects many of her friends. What is the nurse's best response to the woman's query? A) "Osteoporosis has been shown to have a strong genetic basis, so there is little you can do to prevent it." B) "Weight-bearing exercise is helpful, as are calcium supplements." C) "If possible, scaling back your hormone replacement therapy will reduce your osteoporosis risk." D) "There are drugs called glucocorticoids that both prevent osteoporosis and treat it if you do develop it."
B
After falling off his bicycle, an 8-year-old boy has a large abrasion on his posterior thigh that has removed the epidermis in the region but left the dermis largely intact. Which of the following changes in integumentary system would be expected in the area of his wound? A) Profuse bleeding from removal of his epidermis B) Fewer Merkel and Langerhans cells in the region C) Exposure of the underlying subcutaneous tissue D) Removal of hair follicle roots from the area of the wound bed
B
Although the client's primary care provider has downplayed the symptoms, a geriatrician suspects that an 82-year-old female has polymyalgia rheumatica. Which characteristic symptomatology would most likely have led the specialist to suspect this health problem? A) Extended periods of walking cause pain that extends from her ankles, knees, and sciatic nerve. B) The woman complains of aching and morning stiffness in her neck, shoulder, and pelvis. C) Range of motion in the woman's wrists and ankles is greatest in the morning and decreases over the course of a day. D) The woman's metatarsal joints are inflamed and sensitive to touch.
B
Due to her progressing osteoarthritis (OA), an 80-year-old woman is no longer able to perform her activities of daily living without assistance. Which of the following phenomena most likely underlies the woman's situation? A) Inappropriate T-cell-mediated immune responses have resulted in articular cartilage degeneration. B) Loss of articular cartilage and synovitis has resulted from inflammation caused when joint cartilage attempted to repair itself. C) Excessive collagen deposits have accumulated in the woman's synovial joints. D) Bone overgrowth in synovial joints has resulted in fusing of adjacent bones that normally articulate.
B
Following exposure to poison oak while camping, a 20-year-old male is experiencing pruritus as a consequence of his immune response to irritants in the plant. What physiological process best accounts for his complaint? A) His body is communicating a low-level pain response as a protective measure. B) Free nerve endings are initiating an itch-specific signal to the somatosensory cortex. C) Local irritation of Langerhans cells is sending signals by way of myelinated type C nerve fibers. D) Ruffini corpuscles are transmitting the message of pruritus to the cerebral cortex.
B
The nurse knows that which of the following patients listed below is at high risk for developing a hip fracture? A) A 77-year-old male who runs marathons and maintains a BMI of 25. B) An 82-year-old female with macular degeneration and uses a walker to go to the bathroom. C) A 64-year-old male with uncontrolled diabetes and chronic kidney disease on dialysis. D) A 73-year-old nursing home patient with long-term continence issues but able to walk the hallways for exercise
B
Which of the following facts accounts for the variation in skin tone that exists between individuals? A) Someone with dark skin has more melanocytes in his or her skin layers. B) Darker-skinned individuals have melanosomes that produce melanin faster. C) Dark skin is associated with spherical melanosomes, which produce and "package" pigment differently. D) Greater numbers of keratinocytes result in darker skin tone
B
Which of the following individuals demonstrates a health problem with his or her axial skeleton? A) A 21-year-old male who fractured his humerus while snowboarding. B) A 40-year-old man who has a contusion to the left temporal bone of his skull following a motor vehicle accident. C) A 79-year-old female who has undergone hemiarthroplasty (hip replacement surgery). D) A 30-year-old pregnant woman who has a separated pubic symphysis.
B
Which of the following individuals is likely to have the highest risk of developing tuberculosis osteomyelitis? A) A 55-year-old female who is in renal failure secondary to poorly controlled type 1 diabetes B) A 79-year-old man who is immunocompromised following a bone marrow transplant C) A 30-year-old man who has undergone open reduction and internal fixation of his fractured tibia D) A 68-year-old woman who had a laminectomy 4 days prior for treatment of her chronic back pain
B
Which of the following is the best example of a diarthrodial joint? A) The interface between the body of the femur and the epiphyseal plates at the ends of the bone B) The interphalangeal joint between the proximal and middle phalanges of the fingers C) The suture between the frontal and parietal bones of the skull D) The syndesmoses between the two sides of the pelvis
B
Which of the following recent admissions to an emergency department is most likely to be diagnosed with a greenstick fracture? A) A 20-year-old football player who had an opposing player fall laterally on his leg B) An 8-year-old boy who fell out of a tree and on to his arm C) An 81-year-old woman with a history of osteoporosis who stumbled and fell on her hip D) A 32-year-old woman who fell awkwardly on her arm while skiing
B
While an infant is in the supine position with both knees flexed, the clinician applies gentle downward pressure to both knees, and the knee and thigh are abducted as an upward and medial pressure is applied to the proximal thigh. This examination technique, used to screen for a reducible dislocation, is called A) Galeazzi test. B) Ortolani maneuver. C) clubfoot test. D) Trendelenburg test.
B
While reviewing the following diagnostic findings on a group of patients with joint complaints, which finding would be a priority for further investigation and possible medical intervention? A) A male client has elevated levels of serum uric acid but lacks symptoms. B) Synovial fluid aspiration indicates the presence of monosodium urate crystals. C) A man reveals that he eats organ meat two to three times weekly. D) A 55-year-old male reveals that it takes a day or two for oral colchicines to relive his attacks of gout.
B
While reviewing the role of the parathyroid hormone in the balance of calcium and phosphate levels, the nursing faculty will emphasize that the kidney responds to parathyroid stimulation by A) increasing reabsorption of sodium in the distal tubules. B) reducing the reabsorption of phosphate. C) stimulating production of red blood cells. D) decreasing the reabsorption of calcium.
B
While studying the skin in a science class, a student asks why all people have a pinkish color to their lips/mucous membranes. The instructor would respond by citing which of the following responses? A) Melanocytes are the pigment-synthesizing cells. B) Pheomelanin is the yellow to red pigment particularly concentrated in the lips and nipples of humans. C) Tyrosinase is responsible for all-colored cell production. D) A person with tiny melanocytes will have more concentrated pigment resulting in darker color.
B
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: Select all that apply. A) osteomalacia. B) neoplasia of the bone. C) osteoporosis. D) genu varum. E) bone necrosis.
B C
A male patient in his 50s has just been diagnosed with hyperuricemia. He has had multiple flare-ups of his first metatarsophalangeal joint pain and swelling. The pain is so severe that he cannot sleep with any covers/sheets over his feet at night. The nurse should anticipate that the patient will likely be prescribed: Select all that apply. A) Tylenol (acetaminophen) for the pain. B) allopurinol (Zyloprim) to decrease uric acid levels. C) calcium carbonate used to increase the intake of calcium. D) Anturane (sulfinpyrazone) to increase excretion of urate. E) sevelamer (Renagel) to reduce the absorption of phosphate
B D
During pathophysiology class, a nursing student asks the faculty what purpose do the osteoprogenitor cells serve. From the following list, identify the purpose of these cells. Select all that apply. A) Formation of red blood cells B) Growth and remodeling of bone C) Anchorage point for blood vessels D) Repair of bone E) Supply nerves to the bone matrix
B D
The nurse is caring for a patient in the hospital for pneumonia but also has a severe case of psoriasis that is being treated with methotrexate. During the morning assessments, which of the following lab values would alert the nurse that the patient may be experiencing a side effect to this medication? Select all that apply. A) Serum potassium (K+) level 3.6 mmol/L B) Platelet count 37 × 103/μL C) Alanine aminotransferase (ALT) 28 units/L D) White blood cell count 1.2 × 103/μL
B D
Which of the following endocrine functions are responsible for increased resorption of bone that results in a reduction of the number and function of osteoclasts? Select all that apply. A) Calcitonin secretion B) Decrease in estrogen levels C) Stimulation of excess thyroid hormone D) Release of catecholamines E) Increase movement of calcium and phosphate from bone into the extracellular fluid
B D
Which of the following patients would the nurse expect to find woven bone scaffolding in place to facilitate healing? Select all that apply. A) A 14-year-old patient recovering from a head injury following a diving accident B) A 22-year-old patient recovering from an auto accident where he incurred a fracture of his femur C) An 85-year-old nursing home patient who is undergoing rehabilitation therapy for the arthritis in his knee D) A 55-year-old prostate cancer patient undergoing radiation therapy for bone metastasis
B D
A 44-year-old woman who has a long-standing diagnosis of SLE has been able to control her symptoms with lifestyle modifications for several years, but has presented to her care provider due to recent exacerbation. Which of the following pharmacological treatment options is her care provider most likely to rule out first? A) Nonsteroidal anti-inflammatory drugs B) Corticosteroids C) Antiplatelet aggregators D) Immunosuppressive drugs
C
An 18-year-old female of Southeast Asian ancestry is distraught over the recent appearance of white patches on her forearms and upper arms, which have been subsequently confirmed as vitiligo. Which of the following statements by the woman express an accurate understanding of her condition? A) "I suppose it's some comfort that my patches are small and will always stay out of sight in the future." B) "I'm thankful that there are medications to cure this, but I'm nervous about the side effects." C) "I suppose this shouldn't come as too much of surprise, since this tends to run in my family." D) "I'm surprised that I ended up contacting that fungus that caused this problem for me."
C
An elderly patient has arrived at the physician's office complaining of a rash. Upon further investigation, the patient states that the rash feels like a burning pain but also has some tingling. It is extreme sensitive to touch, and it's "like crazy." The nurse notes that the rash is made up of vesicles and located on the right thoracic region. The nurse suspects the patient has A) chickenpox. B) German measles. C) herpes zoster. D) human papillomavirus.
C
Bone is connective tissue, in which the intercellular matrix has been impregnated with inorganic calcium salts, that has great tensile and compressible strength but is light enough to be moved by coordinate muscle contractions. One third of the dry weight of bone is composed of which of the following? A) Bone cells, inorganic salts, and blood vessels B) Hydroxyapatite, calcium carbonate, and calcium fluoride C) Bone cells, blood vessels, and nerves D) Organic matter and inorganic salts
C
Following a fall 4 weeks prior that was caused by orthostatic hypotension, an 83-year-old male has fractured his femoral head. His care provider has stated that the healing process is occurring at a reasonable pace and that the man will regain full function after healing and rehabilitation. Which of the following cells is most responsible for restoring the integrity of the man's broken bone? A) Osteocyte B) Osteoclast C) Osteoblast D) Osteoma
C
Following prosthetic joint replacement of the knee, the patient continues to complain of pain and discomfort above what would be expected. There is poor incisional healing. The clinic nurse is concerned when she sees that the incision is still draining after 3 weeks post-op. The nurse suspects a prosthetic joint infection. The nurse should anticipate the physician will prescribe A) complete bed rest with immobilization of the knee. B) high doses of nonsteroidal anti-inflammatory drugs. C) antimicrobial treatment depending on the microbe. D) wound irrigations with hydrogen peroxide twice daily.
C
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? A) Genu varum, which can be treated by bracing B) Flatfoot, which will require orthopedic shoes C) Genu valgum necessitating a series of surgeries D) Femoral torsion, which will spontaneously resolve before puberty
C
When trying to explain to a patient diagnosed with a benign bone tumor, the nurse should emphasize the fact that benign tumors primarily A) grow rapidly and can spread to the surrounding tissue. B) cause growth of other tumors as they spread their cancer cells into the bloodstream. C) tend to grow very slowly without destroying the supporting tissue. D) occur as a result of tumors in other areas of the body metastasizing into the bone.
C
While studying bones in pathophysiology class, the nursing students learn that the Haversian canals are composed of A) calcium salts. B) collagen. C) lymphatics. D) glycosaminoglycans
C
home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which of the following statements best captures what is likely occurring? A) The client is possibly experiencing direct penetration osteomyelitis in which microorganisms have entered through his foot wound. A 56-year-old male is obese and has poorly controlled type 2 diabetes mellitus. The home care nurse who changes the dressing on his chronic foot ulcer three times weekly has noted that the client's bone is now visible in the wound bed. The client has a fever and has not complained of any notable increase in pain to his foot. Which of the following statements best captures what is likely occurring? A) The client is possibly experiencing direct penetration osteomyelitis in which microorganisms have entered through his foot wound. B) Infectious microorganisms in his blood supply have proliferated in the distal portions of his skeletal system. C) Vascular insufficiency has contributed to infection in both soft tissue and now his bone. D) His immunocompromised status associated with diabetes has allowed skin flora to penetrate his foot bone via the surface wound. portions of his skeletal system. C) Vascular insufficiency has contributed to infection in both soft tissue and now his bone. D) His immunocompromised status associated with diabetes has allowed skin flora to penetrate his foot bone via the surface wound
C
A patient is showing the nurse some changes in his skin that he found while taking a shower. Which of the following lesions would give the nurse concern that it might be a precancerous lesion? Select all that apply. A) Soft, flesh-colored papule located on the neck and "armpit." B) Wart-like, tan-brown lesion that is sharply outlined and a few centimeters in diameter. C) Several dry, brown, scaly lesions that are approximately 1 cm in diameter, and a few of the lesions are showing some ulceration. D) Tan to brown lesions commonly called "liver spots" are located on the forearm and hands. E) Red-colored mark close to the skin surface located on the face.
C D
A 35-year-old woman who has been in recovery from alcoholism for 2 years presents at her primary care physician's office with chronic hip pain. She reports that as part of her commitment to her recovery, she began exercising regularly about a year earlier. After a month or two, her hip began to hurt when she ran on the treadmill. She stretches, has had a physical trainer check her form to ensure that it is correct, and rests adequately between each workout. Six months ago, the pain began waking her at night, and now it is constant. She is not aware of any injury to her hip and has no other outward symptoms. Which of the following is most likely to be the cause of her pain? A) Hematogenous osteomyelitis B) Osteomyelitis with vascular insufficiency C) Tuberculosis of the bone D) Osteonecrosis
D
A 36-year-old female who has experienced diverse symptoms for several years has finally had her health problems attributed to scleroderma (systemic sclerosis) and has committed herself to learning as much about the disease as she can. Which of her following statements would her nurse want to correct or clarify? A) "I'm surprised that in this day and age, they still don't know what causes scleroderma." B) "I suppose this explains why I have such terrible circulation to my hands and feet." C) "I'm scared by the damage that this could cause to my heart and lungs." D) "The worst part of this so far has been learning that there aren't any treatments for scleroderma."
D
A 56-year-old female with a diagnosis of breast cancer has developed bone metastases, which her oncologist would like to treat with radiation therapy. What is her physician's most likely primary goal in the treatment plan of the metastases? A) Thorough elimination of neoplastic cells in the bone structure B) Preservation of normal weight bearing and range of motion C) Ensuring vascular supply to the bone is not affected D) Prevention of pathologic fractures
D
A 64-year-old man was diagnosed 19 months ago with bilateral osteoarthritis (OA) in his knees, and has come to his family physician for a checkup. The client and his physician are discussing the effects of his health problem and the measures that the man has taken to accommodate and treat his OA in his daily routines. Which of the following statements by the client would necessitate further teaching? A) "I'm really trying to lose weight, and I've been able to lose 15 lb this year so far." B) "I've been doing muscle-strengthening exercises twice a week at the community center near my house." C) "Even though I don't like it, I've been using my walker to take some of the weight off my knees." D) "I've been avoiding painkillers because I know they can mask damage that I might be inflicting on my knees."
D
A care aide who works in a long-term care facility recognizes the high incidence and prevalence of a stage I pressure ulcer in immobile older adults. Which of the following protocols in the facility would the care aide advocate changing? A) Residents with persistently low food intake are identified. B) Immobilized residents are turned every 2 hours during both day and night. C) Residents are frequently encouraged to increase their fluid intake. D) Wound dressings are applied promptly to all identified or potential pressure ulcers.
D
A man's primary care physician has characterized his skin lesion as being a temporary eruption but has cautioned him against repeated rubbing or scratching as to avoid lichenization. What is the most likely categorization of the man's skin lesion? A) A blister B) A corn C) A callus D) A rash
D
A nurse is providing care for a client who has had a cast applied to her fractured arm 6 hours prior. The client is now complaining of severe pain that she describes as "even worse than when I broke my arm." What would be the nurse's best course of action? A) Administration of analgesics and teaching the client about the normal course of pain after a fracture B) Teaching the client simple range of motion exercises to promote circulation and perfusion C) Taking the client's temperature due to the possibility of infection D) Assessment of motor and sensory function with the goal of identifying compartment syndrome
D
A nurse is teaching a client about the role that skin plays in forming a barrier to environmental agents and microorganisms. The nurse would recognize that which of the following types of cells/junctions are involved in the communication and regulation of the immune response and the secretions of cytokines? A) Gap junctions B) Desmosomes C) Adherens junctions D) Keratinocytes
D
A patient comes into the orthopedic clinic complaining of severe pain in his hip that was not caused by a fall. On inspection, the femur and tibia are bowed. There is also a reduced angle of the femoral neck, which gives the patient a "waddling gait" appearance. The doctor suspects Paget disease. The patient asks how he got that. The nurse will respond, A) "It's because you don't eat enough calcium-rich foods in your diet." B) "When you were a child you probably broke you hip, and since it wasn't displaced, you continued to walk on it." C) "It might be related to a thyroid condition. We will need to run some more blood work." D) "It's most likely a genetic predisposition. Do you know if anyone else in your family has this problem?"
D
A person with severe lymphedema is asking the nurse where specifically are the lymph vessels located in the skin layers. The nurse would respond, A) "Basement membrane." B) "Merkel cell layer." C) "Subcutaneous tissue layer." D) "Papillary dermis layer."
D
Following a progressive onset of fatigue, aching, and joint stiffness over the last 2 years, a 69-year-old male has recently been diagnosed with rheumatoid arthritis (RA). Which of the following teaching points should his primary care physician include during the office visit in which this diagnosis is communicated to the client? A) "The symptoms you've been experiencing are the result of damage inside your joints, but I'll start you medications that will reverse this damage." B) "It's important that you maximize your level of activity, since decreasing your mobility will worsen the disease." C) "The best treatment plan is to try all other available treatments before resorting to using medications." D) "Steroids and anti-inflammatory drugs that I'll prescribe will likely bring some relief to your symptoms."
D
Following genetic testing and a thorough history from the child's mother and father, a 5-month-old boy has been diagnosed with osteogenesis imperfecta. What teaching point should the care team provide to the mother and father? A) "His skeleton is prone to breakage, and we'll begin hormone therapy to treat this." B) "His hips are extremely susceptible to dislocation, so rough play is out of the question." C) "You'll need to commit to calcium supplementation for the duration of his development." D) "You'll need to be very careful to avoid causing fractures to his fragile bones."
D
Laparoscopic knee surgery in a 22-year-old basketball player has necessitated entry into the synovial cavity. The surgeon performing the procedure would be aware of which of the following relevant characteristics of synovial tissue? A) Synovial tissue has a slow rate of healing compared to muscle tissue. B) Damage to synovial tissue is known to be excruciatingly painful. C) The synovial membrane lacks direct blood supply, precluding bleeding into the joint. D) Few pain receptors are located in the synovial membrane.
D
The father of an 18-month-old girl noticed a small vesicle on her face several days ago. The lesion ruptured and left a straw-colored crust that remained on the girl's face. The eruption of new vesicles has prompted him to bring the child to the emergency department. Which of the following treatments for the child's skin problem is most likely? A) A topical antifungal ointment B) An oral corticosteroid C) An antiviral ointment D) A topical antibiotic
D
When trying to discern the extent of a burn, the nurse will note that second-degree full-thickness burns are characterized by A) extending into the subcutaneous tissue. B) noting that blood vessels have clotted and can be seen under the burned skin. C) redness or pinkness noted, but no blister formation is present on the epidermis. D) extensive pain along with waxy white areas with blister formation
D
When working with a patient with diffuse scleroderma who is exhibiting a "stone face" expression, the nurse should consider which of the following to be a priority nursing diagnosis for this patient? A) Ineffective tissue perfusion related to tightening of the facial skin B) Activity intolerance related to muscle tightening in lower extremities C) Oral mucous membrane, impaired due to restricted motion of the mouth D) Aspiration, risk related to swallowing impairments
D
Which of the following teaching points is most appropriate for a teenager who has sought care for the treatment of his severe acne? A) "Avoiding high-fat foods and chocolate won't cure your acne, but it will likely improve it a lot." B) "All the creams and ointments that you can buy have been shown to be no real help for acne." C) "It's important for you to vigorously wash your face several times a day." D) "You might need antibiotic pills in addition to a cream for your face."
D
While being tackled, a 20-year-old football player puts 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? A) "This strain will likely resolve itself with sufficient rest." B) "You've suffered a severe sprain, and you might need a cast." C) "Your wrist contusion will have to be observed for bleeding under the skin surface." D) "It looks like a mild to moderate sprain, and you'll need to keep it immobilized for a few weeks."
D
