Ch 41 - Test bank PDF

Preview

Summary

Chapter 41: Management of Patients With Musculoskeletal Disorders A nurse is caring for an adult patient diagnosed with a back strain. What health education shnurse provide to this patient? ould the A) Avoid lifting more than one-third of body weight without assistance. B) Focus on using back muscle...

Description

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

783

Chapter41:ManagementofPatientsWithMusculoskeletalDisorders  1.

Anurseiscaringforanadultpatientdiagnosedwithabackstrain.Whathealtheducationshouldthe nurseprovidetothispatient?

A)

Avoidliftingmorethanone-thirdofbodyweightwithoutassistance.

B)

Focusonusingbackmusclesefficientlywhenliftingheavyobjects.

C)

Liftobjectswhileholdingtheobjectasafedistancefromthebody.

D)

Tightentheabdominalmusclesandlockthekneeswhenliftingofanobject.

Ans:

A Feedback: Thenursewillinstructthepatientonthesafeandcorrectwaytoliftobjectsusingthestrongquadriceps musclesofthethighs,withminimaluseoftheweakbackmuscles.Topreventrecurrenceofacutelow backpain,thenursemayinstructthepatienttoavoidliftingmorethanone-thirdofhisweightwithout help.Thepatientshouldbeinformedtoplacethefeetahip-widthaparttoprovideawidebaseof support,thepersonshouldbendtheknees,tightentheabdominalmuscles,andlifttheobjectclosetothe bodywithasmoothmotion,avoidingtwistingandjerking.

2.

Anurseisdiscussingconservativemanagementoftendonitiswithapatient.Whichofthefollowingmay beaneffectiveapproachtomanagingtendonitis?

A)

Weightreduction

B)

Useoforalopioidanalgesics

C)

Intermittentapplicationoficeandheat

D)

Passiverangeofmotionexercises

Ans:

C Feedback: Conservativemanagementoftendonitisincludesrestoftheextremity,intermittenticeandheattothe joint,andNSAIDs.Weightreductionmaypreventfutureinjuriesbutwillnotrelieveexistingtendonitis. Range-of-motionexercisesmayexacerbatepain.Opioidswouldnotbeconsideredaconservative treatmentmeasure.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

3.

784

Apatientpresentsatacliniccomplainingofpaininhisheelsobadthatitinhibitshisabilitytowalk. Thepatientissubsequentlydiagnosedwithplantarfasciitis.Thispatientsplanofcareshouldinclude whatintervention?

A)

Wrappingtheaffectedareainlambswoolorgauzetorelievepressure

B)

GentlystretchingthefootandtheAchillestendon

C)

Wearingopen-toedshoesatalltimes

D)

Applyingtopicalanalgesicointmenttoplantarsurfaceeachmorning

Ans:

B Feedback: Plantarfasciitisleadstopainthatislocalizedtotheanteriormedialaspectoftheheelanddiminishes withgentlestretchingofthefootandAchillestendon.Dressingsofanykindarenotoftherapeutic benefitandanalgesicointmentsdonotaddressthepathologyoftheproblem.Open-toedshoesareofno particularbenefit.

4.

Anurseisprovidinganeducationalclasstoagroupofolderadultsatacommunityseniorcenter.Inan efforttopreventosteoporosis,thenurseshouldencourageparticipantstoensurethattheyconsumethe recommendedadequateintakeofwhatnutrients?Selectallthatapply.

A)

VitaminB12

B)

Potassium

C)

Calcitonin

D)

Calcium

E)

VitaminD

Ans:

D,E Feedback: AdietrichincalciumandvitaminDprotectsagainstskeletaldemineralization.Intakeofvitamin B12andpotassiumdoesnotdirectlyinfluencetheriskforosteoporosis.Calcitoninisnotconsideredtobe adietarynutrient.

5.

Anurseisprovidingaclassonosteoporosisatthelocalseniorscenter.Whichofthefollowing statementsrelatedtoosteoporosisismostaccurate?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Osteoporosisiscategorizedasadiseaseoftheelderly.

B)

Anonmodifiableriskfactorforosteoporosisisapersonslevelofactivity.

C)

Secondaryosteoporosisoccursinwomenaftermenopause.

D)

Slowdiscontinuationofcorticosteroidtherapycanhalttheprogressionoftheosteoporosis.

Ans:

D

785

Feedback: Whencorticosteroidtherapyisdiscontinued,theprogressionofosteoporosisishalted,butrestorationof lostbonemassdoesnotoccur.Osteoporosisisnotadiseaseoftheelderlybecauseitsonsetoccurs earlierinlife,whenbonemasspeaksandthenbeginstodecline.Apersonslevelofphysicalactivityisa modifiablefactorthatinfluencespeakbonemass.Lackofactivityincreasestheriskforthedevelopment ofosteoporosis.Primaryosteoporosisoccursinwomenaftermenopause. 6.

Anurseisteachingapatientwithosteomalaciaabouttheroleofdiet.Whatwouldbethebestchoicefor breakfastforapatientwithosteomalacia?

A)

Cerealwithmilk,ascrambledegg,andgrapefruit

B)

Poachedeggswithsausageandtoast

C)

Waffleswithfreshstrawberriesandpowderedsugar

D) Ans:

Abageltoppedwithbutterandjamwithasidedishofgrapes

A Feedback: ThebestmealoptionistheonethatcontainsthehighestdietarysourcesofcalciumandvitaminD.The bestselectionamongthoselistediscerealwithmilk,andeggs,asthesefoodscontaincalciumand vitaminDinahigherquantityovertheothermenuoptions.

7.

AnurseiscaringforapatientwithPagetsdiseaseandisreviewingthepatientsmostrecentlaboratory values.WhichofthefollowingvaluesismostcharacteristicofPagetsdisease?

A)

Anelevatedlevelofparathyroidhormoneandlowcalcitoninlevels

B)

Alowserumalkalinephosphataselevelandalowserumcalciumlevel

C)

Anelevatedserumalkalinephosphataselevelandanormalserumcalciumlevel

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Anelevatedcalcitoninlevelandlowlevelsofparathyroidhormone

Ans:

C

786

Feedback: PatientswithPagetsdiseasehavenormalbloodcalciumlevels.Elevatedserumalkalinephosphatase concentrationandurinaryhydroxyprolineexcretionreflecttheincreasedosteoblasticactivityassociated withthiscondition.AlterationsinPTHandcalcitoninlevelsareatypical. 8.

Whichofthefollowingpatientsshouldthenurserecognizeasbeingatthehighestriskforthe developmentofosteomyelitis?

A)

Amiddle-ageadultwhotakesibuprofendailyforrheumatoidarthritis

B)

Anelderlypatientwithaninfectedpressureulcerinthesacralarea

C)

A17-year-oldfootballplayerwhohadorthopedicsurgery6weeksprior

D)

Aninfantdiagnosedwithjaundice

Ans:

B Feedback: Patientswhoareathighriskofosteomyelitisincludethosewhoarepoorlynourished,elderly,and obese.Theelderlypatientwithaninfectedsacralpressureulcerisatthegreatestriskforthe developmentofosteomyelitis,asthispatienthastworiskfactors:ageandthepresenceofasoft-tissue infectionthathasthepotentialtoextendintothebone.Thepatientwithrheumatoidarthritishasonerisk factorandtheinfantwithjaundicehasnoidentifiableriskfactors.Thepatient6weekspostsurgeryis beyondtheusualwindowoftimeforthedevelopmentofapostoperativesurgicalwoundinfection.

9.

Anurseiscaringforapatientwithabonetumor.Thenurseisprovidingeducationtohelpthepatient reducetheriskforpathologicfractures.Whatshouldthenurseteachthepatient?

A)

Strivetoachievemaximumweight-bearingcapabilities.

B)

Graduallystrengthentheaffectedmusclesthroughweighttraining.

C)

Supporttheaffectedextremitywithexternalsupportssuchassplints.

D)

Limitrelianceonassistivedevicesinordertobuildstrength.

Ans:

C

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

787

Feedback: Duringnursingcare,theaffectedextremitiesmustbesupportedandhandledgently.Externalsupports (splints)maybeusedforadditionalprotection.Prescribedweight-bearingrestrictionsmustbefollowed. Assistivedevicesshouldbeusedtostrengthentheunaffectedextremities. 10. Apatientpresentsatacliniccomplainingofbackpainthatgoesallthewaydownthebackofthelegto thefoot.Thenurseshoulddocumentthepresenceofwhattypeofpain? A)

Bursitis

B)

Radiculopathy

C)

Sciatica

D)

Tendonitis

Ans:

C Feedback: Sciaticanervepaintravelsdownthebackofthethightothefootoftheaffectedleg.Bursitisis inflammationofafluid-filledsacinajoint.Radiculopathyisdiseaseofanerveroot.Tendonitisis inflammationofmuscletendons.

11. Apatienttellsthenursethathehaspainandnumbnesstohisthumb,firstfinger,andsecondfingerof therighthand.Thenursediscoversthatthepatientisemployedasanautomechanic,andthatthepainis increasedwhileworking.Thismayindicatethatthepatientcouldpossiblyhavewhathealthproblem? A)

Carpeltunnelsyndrome

B)

Tendonitis

C)

Impingementsyndrome

D)

Dupuytrenscontracture

Ans:

A Feedback: Carpeltunnelsyndromemaybemanifestedbynumbness,pain,paresthesia,andweaknessalongthe mediannerve.Tendonitisisinflammationofmuscletendons.Impingementsyndromeisageneralterm thatdescribesalllesionsthatinvolvetherotatorcuffoftheshoulder.Dupuytrenscontractureisaslowly progressivecontractureofthepalmarfascia.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

788

12. Anurseisassessingapatientwhoreportsathrobbing,burningsensationintherightfoot.Thepatient statesthatthepainisworstduringthedaybutnotesthatthepainisrelievedwithrest.Thenurseshould recognizethesignsandsymptomsofwhathealthproblem? A)

Mortonsneuroma

B)

Pescavus

C)

Halluxvalgus

D)

Onychocryptosis

Ans:

A Feedback: Mortonsneuromaisaswellingofthethird(lateral)branchofthemedianplantarnerve,whichcausesa throbbing,burningpain,usuallyrelievedwithrest.Pescavusreferstoafootwithanabnormallyhigh archandafixedequinusdeformityoftheforefoot.Halluxvalgus(bunion)isadeformityinwhichthe greattoedeviateslaterallyandthereisamarkedprominenceofthemedialaspectofthefirstmetatarsalphalangealjointandexostosis.Onychocryptosis(ingrowntoenail)occurswhenthefreeedgeofanail platepenetratesthesurroundingskin,laterallyoranteriorly.

13. Anurseisreviewingthepathophysiologythatmayunderlieapatientsdecreasedbonedensity.What hormoneshouldthenurseidentifyasinhibitingboneresorptionandpromotingboneformation? A)

Estrogen

B)

Parathyroidhormone(PTH)

C)

Calcitonin

D)

Progesterone

Ans:

C Feedback: Calcitonininhibitsboneresorptionandpromotesboneformation,estrogeninhibitsbonebreakdown,and parathyroidincreasesboneresorption.Estrogen,whichinhibitsbonebreakdown,decreaseswithaging. Parathyroidhormone(PTH)increaseswithaging,increasingboneturnoverandresorption.Progesterone isthemajornaturallyoccurringhumanprogestogenandplaysaroleinthefemalemenstrualcycle.

14. Apatientisundergoingdiagnostictestingforosteomalacia.Whichofthefollowinglaboratoryresultsis mostsuggestiveofthisdiagnosis? A)

Highchloride,calcium,andmagnesium

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Highparathyroidandcalcitoninlevels

C)

Lowserumcalciumandmagnesiumlevels

D)

Lowserumcalciumandlowphosphoruslevel

Ans:

D

789

Feedback: Laboratorystudieswillrevealalowserumcalciumandlowphosphoruslevel. 15. An80-year-oldmaninalong-termcarefacilityhasachroniclegulcerandstatesthattheareahas becomeincreasinglypainfulinrecentdays.Thenursenotesthatthesiteisnowswollenandwarmtothe touch.Thepatientshouldundergodiagnostictestingforwhathealthproblem? A)

Osteomyelitis

B)

Osteoporosis

C)

Osteomalacia

D)

Septicarthritis

Ans:

A Feedback: Whenosteomyelitisdevelopsfromthespreadofanadjacentinfection,nosignsofsepticemiaare present,buttheareabecomesswollen,warm,painful,andtendertotouch.Osteoporosisisthemost prevalentbonediseaseintheworld.Osteomalaciaisametabolicbonediseasecharacterizedby inadequatemineralizationofbone.Septicarthritisoccurswhenjointsbecomeinfectedthroughspreadof infectionfromotherpartsofthebody(hematogenousspread)ordirectlythroughtraumaorsurgical instrumentation.

16. Apatienthasreturnedtotheunitafterundergoinglimb-sparingsurgerytoremoveametastaticbone tumor.Thenurseprovidingpostoperativecareinthedaysfollowingsurgeryassessesforwhat complicationfromsurgery? A)

Deficientfluidvolume

B)

Delayedwoundhealing

C)

Hypocalcemia

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Pathologicfractures

Ans:

B

790

Feedback: Delayedwoundhealingisacomplicationofsurgeryduetotissuetraumafromthesurgery.Nutritional deficiencyisusuallyduetotheeffectsofchemotherapyandradiationtherapy,whichmaycauseweight loss.Pathologicfracturesarenotacomplicationofsurgery. 17. Anurseiscaringforapatientwhois12hourspostoperativefollowingfootsurgery.Thenurseassesses thepresenceofedemainthefoot.Whatnursingmeasurewillthenurseimplementtocontroltheedema? A)

Elevatethefootonseveralpillows.

B)

Applywarmcompressesintermittentlytothesurgicalarea.

C)

Administeraloopdiureticasordered.

D)

Increasecirculationthroughfrequentambulation.

Ans:

A Feedback: Tocontroltheedemainthefootofapatientwhoexperiencedfootsurgery,thenursewillelevatethe footonseveralpillowswhenthepatientissittingorlying.Diuretictherapyisnotanappropriate interventionforedemarelatedtoinflammation.Intermittenticepacksshouldbeappliedtothesurgical areaduringthefirst24to48hoursaftersurgerytocontroledemaandprovidesomepainrelief. Ambulationwillgraduallyberesumedbasedontheguidelinesprovidedbythesurgeon.

18. Apatientwithdiabetesisattendingaclassonthepreventionofassociateddiseases.Whatactionshould thepatientperformtoreducetheriskofosteomyelitis? A)

Increasecalciumandvitaminintake.

B)

Performmeticulousfootcare.

C)

Exercise3to4timesweeklyforatleast30minutes.

D)

Takecorticosteroidsasordered.

Ans:

B Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

791

Diabeticfootulcershaveahighpotentialforprogressingtoosteomyelitis.Meticulousfootcarecanhelp mitigatethisrisk.Corticosteroidscanexacerbatetheriskofosteomyelitis.Increasedintakeofcalcium andvitaminsaswellasregularexercisearebeneficialhealthpromotionexercises,buttheydonot directlyreducetheriskofosteomyelitis. 19. Anurseisplanningthecareofanolderadultpatientwithosteomalacia.Whatactionshouldthenurse recommendinordertopromotevitaminDsynthesis? A)

Ensuringadequateexposuretosunlight

B)

Eatingalow-purinediet

C)

Performingcardiovascularexercisewhileavoidingweight-bearingexercises

D)

Takingthyroidsupplementsasordered

Ans:

A Feedback: BecausesunlightisnecessaryforsynthesizingvitaminD,patientsshouldbeencouragedtospendsome timeinthesun.Alow-purinedietisnotarelevantactionandthyroidsupplementsdonotdirectlyaffect bonefunction.Actionmustbetakentopreventfractures,butweight-bearingexercisewithinsafe parametersisnotnecessarilycontraindicated.

20. Apatientpresentstoacliniccomplainingofalegulcerthatisnthealing;subsequentdiagnostictesting suggestsosteomyelitis.Thenurseisawarethatthemostcommonpathogentocauseosteomyelitisis what? A)

Staphylococcusaureus

B)

Proteus

C)

Pseudomonas

D)

Escherichiacoli

Ans:

A Feedback: S.aureuscausesover50%ofboneinfections.Proteus,Pseudomonas,andE.coliarealsocauses,butto alesserextent.

21.

AnurseisprovidingcareforapatientwhohasarecentdiagnosisofPagetsdisease.Whenplanningthis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

792

patientsnursingcare,interventionsshouldaddresswhatnursingdiagnoses?Selectallthatapply. A) B) C) D) E) Ans:

ImpairedPhysicalMobility AcutePain DisturbedAuditorySensoryPerception RiskforInjury RiskforUnstableBloodGlucose

A,B,C,D Feedback: PatientswithPagetsdiseaseareatriskofdecreasedmobility,pain,hearingloss,andinjuriesresulting fromdecreasedbonedensity.Pagetsdiseasedoesnotaffectbloodglucoselevels.

Anurseiscaringforapatientwhoisbeingassessedfollowingcomplaintsofsevereandpersistentlow 22. backpain.Thepatientisscheduledfordiagnostictestinginthemorning.Whichofthefollowingare appropriatediagnostictestsforassessinglowbackpain?thatapply. A)

Computedtomography(CT)

B)

Angiography

C)

Magneticresonanceimaging(MRI)

D)

Ultrasound

E)

X-ray

Ans:

A,C,D,E Feedback: Avarietyofdiagnostictestscanbeusedtoaddresslowerbackpain,includingCT,MRI,ultrasound,and X-rays.Angiographyisnotrelatedtotheetiologyofbackpain.

23. Anurseisreviewingthecareofapatientwhohasalonghistoryoflowerbackpainthathasnot respondedtoconservativetreatmentmeasures.Thenurseshouldanticipatetheadministrationofwhat drug? A)

Calcit...