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64 Cards in this Set

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A patient with bursitis of the shoulder asks the nurse what the bursa does. The nurse’s response is based on the knowledge that bursae

A. connect bone to bone.
B. separate muscle from muscle.
C. lubricate joints with synovial fluid.
D. relieve friction between moving parts.
D. relieve friction between moving parts.
The decreased agility found during assessment of the older adult is caused by the age-related change of

A. decrease in bone mass.
B. erosion of articular cartilage.
C. loss of elasticity in ligaments and cartilage.
D. decrease in number and diameter of muscle cells.
C. loss of elasticity in ligaments and cartilage.
While obtaining subjective assessment data related to the musculoskeletal system, it is particularly important for the nurse to ask about family history in the patient with

A. osteomyelitis.
B. osteomalacia.
C. low back pain.
D. rheumatoid arthritis.
D. rheumatoid arthritis.
The nurse explains to a patient with a distal tibial fracture returning for a 3-week checkup that healing is indicated by

A. callus formation.
B. complete union of bone.
C. presence of granulation tissue.
D. formation of a hematoma at the fracture site.
A. callus formation.
A patient with a comminuted fracture of the femur is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when

A. a cast would be too large to provide normal mobility.
B. the patient is able to tolerate long-term immobilization
C. adequate alignment cannot be obtained by other methods.
D. the patient cannot tolerate the discomfort of a closed reduction.
C. adequate alignment cannot be obtained by other methods.
An indication of a neurovascular problem noted during assessment of the patient with a fracture is

A. exaggeration of extremity movement.
B. petechiae on the head and upper thorax.
C. decreased sensation distal to the fracture site.
D. purulent drainage at the site of an open fracture.
C. decreased sensation distal to the fracture site.
A patient with a stable, closed fracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects compartment syndrome and notifies the physician when the patient experiences

A. pain at the fracture site.
B. increasing edema of the limb.
C. muscle spasms of the lower arm.
D. pain when the nurse passively extends the fingers.
D. pain when the nurse passively extends the fingers.
During the postoperative period, the patient with an above-the-knee amputation should be instructed that the residual limb should not be routinely elevated because

A. this position reduces the development of phantom pain.
B. the flexed position can promote hip flexion contracture.
C. this position promotes clot formation at the incision site and thigh.
D. unnecessary movement of the extremity can cause wound dehiscence.
B. the flexed position can promote hip flexion contracture.
A patient with rheumatoid arthritis is scheduled for an arthroplasty. The nurse explains that the purpose of this procedure is to

A. fuse a joint and reduce pain.
B. prevent further joint damage.
C. assess the extent of joint damage.
D. replace the joint and improve function.
D. replace the joint and improve function.
The nurse teaches a patient recovering from a total hip replacement that it is important to avoid

A. sleeping on the abdomen.
B. sitting with the legs crossed.
C. abduction exercises of the affected leg.
D. bearing weight on the affected leg for 6 weeks.
B. sitting with the legs crossed.
A patient with osteomyelitis is treated with surgical debridement followed by continuous irrigation of the affected bone with antibiotics. In responding to the patient who asks why oral or IV antibiotics cannot be used alone, the nurse explains that

A. the irrigation is necessary to wash out dead tissue and pus from the infected area.
B. the ischemia and bone death associated with osteomyelitis are frequently impenetrable to most blood-borne antibiotics.
C. there are no effective oral or IV antibiotics to treat <i>S. aureus,</i> the most common cause of osteomyelitis.
D. an irrigation can penetrate involucrum created by the infection and prevent bacterial spreading to other tissue.
B. the ischemia and bone death associated with osteomyelitis are frequently impenetrable to most blood-borne antibiotics.
In identifying people at risk for back injuries, the nurse recognizes that the person at greatest risk for low back pain is a(n)

A. long-distance truck driver.
B. 62-year-old widow who walks daily.
C. aerobics instructor who weighs 100 lb.
D. 25-year-old nurse who works in a newborn nursery.
A. long-distance truck driver.
The primary nursing responsibility in caring for a patient with acute low back pain associated with severe pain and muscle spasms is

A. teaching exercises such as straight-leg raises to decrease pain.
B. positioning the patient on the abdomen with the legs extended.
C. providing pain medication to promote exercise and ambulation.
D. assisting the patient to maintain activity restrictions with a gradual increase in activity.
D. assisting the patient to maintain activity restrictions with a gradual increase in activity.
.
The nurse advises the patient with early osteoporosis to

A. lose weight.
B. stop smoking.
C. eat a high-protein diet.
D. start swimming for exercise.
B. stop smoking.
In assessing the joints of a patient with rheumatoid arthritis, the nurse understands that the joints are damaged by

A. the development of Heberden’s nodes in the joint capsule.
B. the deterioration of cartilage by the enzyme hyaluronidase.
C. invasion of pannus into the joint capsule and subchondral bone.
D. bony ankylosis following inflammation of the joints in HLA-B27–positive individuals.
C. invasion of pannus into the joint capsule and subchondral bone.
Assessment data noted by the nurse in the patient with osteoarthritis commonly include

A. elevated ESR.
B. evening but no morning stiffness.
C. progressive joint pain with activity.
D. symmetric swelling of metacarpophalangeal joints.
C. progressive joint pain with activity.
An important nursing intervention in caring for the patient with ankylosing spondylitis is to teach the patient

A. thoracic stretching and ROM exercises to prevent deformity.
B. to sleep on the side with the legs flexed and supported with pillows.
C. to prevent enteric and venereal infections that precipitate recurring attacks.
D. that continuous therapeutic blood levels of NSAIDs can limit the progression of the disease.
A. thoracic stretching and ROM exercises to prevent deformity.
When teaching the patient with gout, the nurse should instruct the patient to

A. avoid foods high in fat and calories.
B. drink plenty of fluids on a daily basis.
C. apply ice packs to decrease joint pain.
D. have CBC and WBC levels monitored regularly.
B. drink plenty of fluids on a daily basis.
The nurse planning teaching for the patient with rheumatoid arthritis who is receiving multiple drug therapy includes information related to the need to

A. use aspirin only on an as-needed basis for pain relief.
B. use birth control during and 3 months following gold therapy.
C. have frequent laboratory monitoring while taking methotrexate.
D. stop taking any corticosteroids as soon as symptoms are relieved.
C. have frequent laboratory monitoring while taking methotrexate.
79 yr old man asks why he is "shrinking". The nurse explains:

a. decreased muscle mass results in stooped posture
b. loss of cartilage in the knees and hip joints cause loss of height
c. vertebrae become more compressed with thinning of intervertebral discs
c. vertebrae become more compressed with thinning of intervertebral discs
When obraining info about the pt's use of meds, the nurse recognizes that both bone and muscle function may be impaired when taking:

a. corticosteroids
b. potassium depleting diuretics
d. NSAIDS
a. corticosteroids
When assessing the traction of a patient with a fracture femur, nurse recognizes need for correction if:

a. weights are touching the floor
b. patient exercises the unaffected limb
c. ropes are in the center of pulley
a. weights are touching the floor
Patient with a fractured femur has a hip spica cast applied. While cast is drying the nurse should:

a. elevate the legs
b.cover cast with light blanket
c. assess patient frequently for abdominal pain, N&V
c. assess patient frequently for abdominal pain, N&V
Patient fell nd complains of pain in the right upper arm and elbow. Before splinting the nurse knows that emergency management of possible fracture should include:

a. elevation
b. appliecation of ice
c. neurovascular checks below the site of injury
c. neurovascular checks below the site of injury
Patient has splint applied and held in place with elastic bandage. An early sign that would alert the nurse that the patient is developing comprtment syndrome is:

a. paralysis of the toes
b. absence of peripheral pulses
c. progressive pain unrelieved by usual analgesics
c. progressive pain unrelieved by usual analgesics
Identify the 6 P's of compartment syndrome:
Parestheia
Pain
Pressure
Pallor
Paralysis
Pulselessnes
Patient with a fractured right hip has an open reduction and internal fixation of the fracture. Postop, the nurse plans to:

a. get the patient up to the chair the first postop day
b. position patient only on the back and unoperative side
c. keep leg abductor splint on pateient except when bathing
d. ambulate with partial weight bearing by discharge
a. get the patient up to the chair the first postop day
Discharge instruction for patient following hip porsthesis include:

a. take bath rather than shower to prevent falls
b. restrict walking for 2-3 months
c. have a family member put on patient's shoes and socks
c. have a family member put on patient's shoes and socks
Above the knee amputation scheduled for diabetic with gangrene in the toes. Patient asks why can't just remove the toes. Nurse responds:

a. "Prosthesis easier to fit with this type of amputation"
b. "The amputation must be high enough to have good circulation for healing"
c. "Infection in your lower leg that you cannot see must be removed"
b. "The amputation must be high enough to have good circulation for healing"
Patient with below-elbow amputation is withdrawn, will not look at arm, and asks to be left alone. Nursing diagnosis is:

a. impaired adjustment
b. disturbed body image
c. ineffective coping
b. disturbed body image
Patient complains of pain in foot of a leg that was recently amputated. Nurse recognizes that the pain:

a. is caused by swelling at incision
b. should be treated with ordered analgesics
c. manage with diversion since it is psychologic
b. should be treated with ordered analgesics
During immediate postop period of below knee amputation (BKA), most important for nurse to:

a. assess site for hemorrhage
b. monitor patient's vital signs
c. elevate residual limb
b. monitor patient's vital signs
Following knee arthroplasty, patient has continuous passive motion machine for affected joint. The nurse explains to patient that this device is used to:

a. relive edema and pain at incision site
b. promote early joint mobility and increase knee flexion
c. improve arterial circulatioin to the affected extremity to promote healing
b. promote early joint mobility and increase knee flexion
Which of the following laboratory values would the nurse expect to see for a client experiencing prolonged immobility?

A. Calcium 11.5 mg/dl
B. Sodium 142 mmol/L
C. Potassium 4.2 mmol/L
D. Hemoglobin 14.6 g/dl
A. Calcium 11.5 mg/dl

Immobility causes the release of calcium into the circulation, whereas normally the kidneys excrete the excess calcium. However, if the kidneys are unable to respond appropriately, hypercalcemia results. Pathological fractures may occur if calcium reabsorption continues as the client remains on bed rest or continues to be immobile.
A client has been on bed rest for several days. The client stands, and the nurse notes that the client's systolic pressure drops 20 mm Hg. Which of the following should the nurse document in the medical record?

A. Rebound hypotension
B. Positional hypotension
C. Orthostatic hypotension
D. Central venous hypotension
C. Orthostatic hypotension
The nurse puts elastic stockings on a client after major abdominal surgery. The nurse teaches the client that the stockings are used after a surgical procedure to:

A. Prevent varicose veins.
B. Prevent muscular atrophy.
C. Ensure joint mobility and prevent contractures.
D. Facilitate the return of venous blood to the heart.
D. Facilitate the return of venous blood to the heart.
The nurse is caring for a client who has osteoporosis. The nurse is teaching her about ways to prevent fractures. Which of the following statements by the client reflects a need for further education?

A. "I usually go swimming with my family at the YMCA three times a week."
B. "I need to ask my doctor if I should have a bone mineral density check this year."
C. "If I don't drink milk at dinner, I will eat broccoli or cabbage to get the calcium that I need in my diet."
D. "The more frequently I walk, the more likely I will be to fall and break my leg. I think I will get a wheelchair so I don't have to walk anymore."
D. "The more frequently I walk, the more likely I will be to fall and break my leg. I think I will get a wheelchair so I don't have to walk anymore."
A client had a left-sided cerebrovascular accident 3 days ago and is being given 5000 units of heparin subcutaneously every 12 hours to prevent thrombophlebitis. The client is receiving enteral feedings through a small-bore nasogastric tube because of dysphagia. Which of the following symptoms requires the nurse to call the health care provider immediately?

A. Hematuria
B. Unilateral neglect
C. Limited range of motion in the right hip
D. Coughing up of a moderate amount of clear, thin sputum
A. Hematuria
Which of the following is the highest priority nursing diagnosis for an immobilized client?

A. Risk for disuse syndrome
B. Risk for deficient fluid volume
C. Ineffective airway clearance
D. Ineffective peripheral tissue perfusion
C. Ineffective airway clearance
A patient with chronic osteomyelitis has been hospitalized for surgical removal of the infection. The nurse explains to the patient that surgical treatment is necessary because:

a. removal of the infection prevents the need for bone and skin grafting
b. formation of avascular scar tissue has led to a protected area of bacterial growth
c. anticiotics are not effective against microorganisms that cause chronic osteomyelitis
b. formation of avascular scar tissue has led to a protected area of bacterial growth
Nursing intervention that is carried out to prevent the development of complications in the patient with osteomyelitis is:

a. providing ROM q4h
b. gently handling the involved extremity during mvmt
c. using careful and appropriate disposal of soiled dressings
b. gently handling the involved extremity during mvmt
To determine causative agent if patient has developed an acute osteomyelitis at the fracture site, the nurse would expect testing to include:

a. x-ray
b. CT
c. bone biopsy
d. WBC and ESR
c. bone biopsy
Following 2 weeks of IV antibiotic therapy, a patient with acute osteomyelitis of the tibia is prepared for discharge from the hospital. The nurse determines that additional instruction is needed when the patient says:

a. "I will need to continue antibiotic therapy for 4-8 wks"
b. "I should notify the physician if the pain in my leg becomes worse."
c. I shouldn't bear weight on my affected leg until healing is complete"
d. "I can use a heating pad to my lower leg for comfort and to promote healing"
d. "I can use a heating pad to my lower leg for comfort and to promote healing"
During a follow-up visit to a patient wit hacute osteomyelitis treated wit hIV antibiotics, the home care nurse is told by the patient's wife that she can hardly get the patient to eat because his mouth is os sore. In checking the mouth, expect to find:

a. dry, cracked tongue
b. white, curdlike membranous lesions of the mucosa
c. ulcers of the mouth lips surrounded by reddened base
b. white, curdlike membranous lesions of the mucosa

Candidias
Nurse teaches patient with low back pain to:

a. perform daily exercise as a lifelong routine
b. sit in chair with the hips higher than knees
c. avoid occupations with back use
a. perform daily exercise as a lifelong routine
Patient with herniated disk and acute back pain is treated conservatively with rest and drug therapy. An important nursing intervention at this time is:

a. encourage foot and leg exercises
b. assess patients body mechanics to identify teaching needs
c. maintain the patient in a supine position with head slightly elevated and the knees flexed
c. maintain the patient in a supine position with head slightly elevated and the knees flexed
A laminectomy and spinal fusion is performed on a patient with a herniated lumbar intervertebral disk. During the postop period, the nurse notifies the MD when patient experiences:

a. paralytic ileus
b. urinary incontinence
c. greater pain at graft site than at lumbar incision site
b. urinary incontinence

Nerve damage
Before repositioningpatient ot the side after lumbar laminectomy the nurse:

a. has patient flex knees and hips
b. places a pillow between the patient's legs
c. has patient grasp side rail on opposite side of bed
b. places a pillow between the patient's legs

Log roll
60 yr old woman has pain on motion in her fingers and asks the nurse whether this is just a result of aging. The best response is:

a. joint pain with functional limitation is a normal change that affects all people
b.joint pain that develops with age is usually related to previous trauma or infection
c. changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age
c. changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age
To preserve function and the ability to perform ADLs the nurse teaches the patient with osteoarthritis to:

a. avoid exercise that involves affected joints.
b. plan and organize less stressful ways to perform tasks
c. maintain normal activities during an acute episode to prevent loss of function
b. plan and organize less stressful ways to perform tasks
Patient with osteoarthritis uses NSAIDs to decrease pain and inflammation. Common side effects of these are:

a. prolonged bleeding time, blood dyscrasias, and hepatic damage
b. fluid retntion, hypertension, and bruising
c. skin rashes, gastric irritation, and headache
c. skin rashes, gastric irritation, and headache
Patient with osteoarthritis wants to try glucosamine and chondroitin for control of symptoms. The best response is:

a. glucosamine should not be used by patients with diabetes because it can decrease blood glucose levels.
b. these supplements are a FAD
c. only dosages of these available by prescription are high enough to provide any benefit
a. glucosamine should not be used by patients with diabetes because it can decrease blood glucose levels.
Patient taking ibuprofen for treatment of OA has good pain relief but is experiencing dyspepsia and nausea. An appropriate alternative with less GI side effects would be:

a. rofecoxib (Vioxx)
b. naproxen (Naprosyn)
c. diclofenac (Voltaren)
a. rofecoxib (Vioxx)

COX-2 inhibitor
The basic pathophysiologic process of rheumatoid arthritis is:

a. destruction of joint cartilage by an autoimmune process
b. initiated by viral infection that destroys synovial membranes of joints
c. an immune response that activates complement and produces inflammation of joints and other organ systems
c. an immune response that activates complement and produces inflammation of joints and other organ systems
During physical assessment of patient with Rheumatoid Arth. the nurse would expect to find:

a. hepatomegaly
b. crepitus on joint movement
c. spindle-shaped fingers
d. Heberden's nodes
c. spindle-shaped fingers
Lab findings that the nurse would expect to be present in the pateint with rheumatoid arthritis include:

a. polycythemia
b. increased IGg
c. increased ESR
d. decreased WBC
c. increased ESR
70 yr old patient is being evaluated for symptoms of rheumatoid arthritis. Nurse recognizes that a major prob in the management of RA in the older adult is:

a. rheumatoid Arth. is usually more severe in older adults
b. drug interactions and toxicity are more likely to occur with multidrug therapy
c. lab and other diagnostic tests are not effective in identifying RA
b. drug interactions and toxicity are more likely to occur with multidrug therapy
After teaching a patient with RA about prescribed theraputic regimin, further teaching is needed when patient says:

a. "It is important for me to perform my prescribed exercises every day"
b. "I should perform most of my daily chores in the morning when i have the most energy"
c. "An ice pack for 10 min a day may relieve inflammation on joints"
d. "I can use assistive devices such as padded utensils, electric can openers, elevated toilet seats to protect my joints"
b. "I should perform most of my daily chores in the morning when i have the most energy"

Most stiff in the AM
Patient recovering from an acute exacerbation of RA tells the nurse she is too tired to bathe. The nurse should:

a. give patient a bath to conserve her energy
b. allow the patient a rest period before showering with the nurse's help
c. inform the patient that it is important for her to maintain self-care
b. allow the patient a rest period before showering with the nurse's help
Characteristics of spondyloarthritides associated with the HLA-B27 antigen include:

a. absence of extraarticular disease
b. symmetric polyarticular arthritis
c. presence of rheumatoid factor and autoantibodies
d. high involvement of sacroiliac joints and the spine
d. high involvement of sacroiliac joints and the spine

(absence of rheumatoid factor and autoantibodies)
An important nursing intervention for the patient with ankylosing spondylitis is to teach the patient to:

a. wear roomy shoes with good orthotic support
b. sleep on the side with the knees and hips flexed
c. keep the spine slightly flexed while sitting, standing, or walking
d. perform chest-cage stretching and deep chest breathing exercises
d. perform chest-cage stretching and deep chest breathing exercises

Kyphosis leads to stoop over, and poor chest expansion. Patient should sleep on their back.
Patient is seen at ouotpatien clinic for a sudden onset of inflammation and severe pain in the great toe. A diagnosis of gout is made on the basis of:

a. a family history of gout
b. elevated serum uric acid levels
c. the presence of sodium urate crystals in synovial fluid
c. the presence of sodium urate crystals in synovial fluid
During treatment of patient with an acute attack of gout, the nurse would expect to administer:

a. aspirin
b. colchicine
c. allourinol (Zyloprim)
d. probenecid (Benemid)
b. colchicine
Patient with gout is treated with drug therapy to prevent future attacks. The nurse teaches the patient that it is most important to:

a. avoid all foods high in purine, such as organ meats
b. perform active ROM of all joints that have been affected by gout
c. increase the dosage of meds wit the onset of an acute attack
d. have periodic determination of serum uric acid levels
d. have periodic determination of serum uric acid levels