Blueprint Exam 1 CH 41,42,43

Question 1

Know what the “Pathophysiology” of osteoarthritis is

Answer 1

Osteoarthritis is characterized by degeneration of articular cartilage with hypertrophy of the underlying and adjacent bone. New bone growth is stimulated by exposed bone surfaces, causing bone spurs to develop. Classified as a non-inflammatory condition.

Question 2

Know the class of what the drug “Leflunomide (Arava)”is in and what which type of arthritis it is used to treat

Answer 2

Arava is a DMARD. Used to treat RA.

Question 3

To control chronic pain for osteoarthritis, know how frequently should the analgesics should be administered?

Answer 3

Analgesics should be taken every 4-6 hr. to control osteoarthritis pain.

Question 4

Know what could be put on a toilet seat for a patient who had a total hip replacement?

Answer 4

A raised toilet seat.

Question 5

Know one of the “main” benefits of a CPM (Continuous Passive ROM machine)

Answer 5

A CPM machine is used to reduce scar tissue formation and improve ROM.

Question 6

Know what a connective tissue disease affects in the patient’s body

Answer 6

Bone, cartilage, ligaments and tendons.

Question 7

Know the patient who is most likely to develop a connective tissue disease, related to gender

Answer 7

Effect women more than men.

Question 8

Know the function of connective tissue in the body

Answer 8

Joint mobility

Question 9

When collecting a health history from the patient with a connective tissue disease, what would the nurse be certain to inquire about?

Answer 9

Inquire about major childhood and adult illnesses, operations, and current medications and allergies. Ask whether a history of TB, poliomyelitis, DM, gout, arthritis, rickets, infection of bones or joints, autoimmune diseases, and neuromuscular disabilities exists.

Question 10

Know what characteristic is diagnostic of rheumatoid arthritis

Answer 10

The most common symptom of RA is pain in the affected joints that is aggravated by movement. Morning stiffness lasting more than 1 hr. is almost always a feature of RA, unlike with osteoarthritis where stiffness lasts only a few minuets.

Question 11

If a patient is taking “Alendronate (Fosamax), what does the nurse tell the patient, that is required of the patient?

Answer 11

Take with 6-8 oz water on arising in am. Nothing else by mouth for 30 min and don’t lay down for 30 min afterwards.

Question 12

Know why glucocorticoids medications are used as the last choice in the treatment of rheumatoid arthritis

Answer 12

Because they mask the signs of infection.

Question 13

Know what physiological reason a patient with osteoporosis should maintain a regular exercise program

Answer 13

Promotes bone formation and improves strength, balance and reaction time, thereby reducing risk of falls and fractures.

Question 14

Know what type of teaching on the renal would need to be done by the Nurse for a diagnosis of gout?

Answer 14

Maintain a fluid intake of at least eight 8 oz glasses daily to reduce risk of uric acid stone formation in the urinary tract.

Question 15

Know what a low purine diet is and be able to give examples of food included in that diet

Answer 15

Avoid food high in purine. ( sweet potatoes)

Question 16

Immediately after surgery, for a patient who had a total knee replacement, the Nurse would carefully want to assess and document what?

Answer 16

Monitor circulation and sensation in the affected extremity. (cap refill)

Question 17

Know, for a postmenopausal woman, who is not taking hormone replacement therapy, how many mg of elemental calcium, should the patient take on a daily basis

Answer 17

1200-1500 mg/day of calcium.

Question 18

Know what diagnostic test result would be positive for muscle degeneration, in a patient with “Polymyositis”

Answer 18

Muscle biopsy.

Question 19

Know what would be included in the Nurses teaching for a patient with carpal tunnel syndrome instructions?

Answer 19

Splinting to prevent flexion and hyperextension, glucocorticoid injections and surgical release of transverse carpal ligament.

Question 20

Be familiar with discharge instructions that should be given to a patient who had a total hip replacement

Answer 20

Teach about self-care, wound care and signs of infection. Watch for dislocation.

Question 21

Know an exercise that would benefit a patient with bursitis of the shoulder

Answer 21

Once pain resolves, progressive ROM, such as “walking” the fingers of the affected arm up the wall, is helpful.

Question 22

Know how “Probenecid (Benemid)” works and what it does for gout

Answer 22

Increases urinary excretion of uric acid. Takes several weeks for full therapeutic effect.

Question 23

Two days after surgery, for a patient with a crushed pelvis, know what the s/s of fat embolism are

Answer 23

Respiratory distress is the first sign, followed by tachycardia, tachypnea, fever, confusion and decreased level of consciousness. (petechiae)

Question 24

Know what a Nurse would teach an older patient with a newly casted Colles fracture

Answer 24

Encourage patient to move fingers and thumb to promote circulation and reduce swelling and move shoulders to prevent stiffness and contracture. Cast care.

Question 25

With a patient who has osteomyelitis after multiple fractures, what type of surgery, would follow antibiotic therapy?

Answer 25

Surgical removal of dead bone tissue, hardware or both.

Question 26

Know the s/s of compartment syndrome

Answer 26

Primary symptom of compartment syndrome is pain, especially with touch or movement that can not be relieved with opioid analgesia. Other s/s are edema, pallor, weak or unequal pulses, cyanosis, tingling, numbness, paresthesia, and finally severe pain.

Question 27

**Be familiar with all of the stages of “Bone Healing”

Answer 27

Stage 1: Hematoma formation
Stage 2: Fibrocartilage
Stage 3: Callus
Stage 4: Ossiifacation
Stage 5: Consolidation and remodeling

Question 28

In a patient who was just admitted for a pelvic fracture, what would be the Nurses assessment of “most concern”

Answer 28

Assess urine output. Absence of urine may indicate a perforated bladder.

Question 29

If a patient falls and breaks a hip, know the “cardinal sign” of a broken hip

Answer 29

Pain, effected leg rotated out.

Question 30

Know what Nursing discharge teaching would be, related to cast care, for a patient with a fractured radius, in a plaster of paris cast

Answer 30

Keep cast dry, do not remove padding, do not stick anything down into cast.

Question 31

Know what a Nurse assisting with an application of a short arm plaster cast application, would do with the stockinet

Answer 31

Put well fitted stockinette on arm before casting.

Question 32

For a patient who sustains a fractured hip and femur in an MVA, who is in russells traction for several weeks, what main complication will the nursing care focus on

Answer 32

Impaired circulation, inadequate fracture alignment, skin breakdown and soft tissue injury - DVT

Question 33

For a 78 year old patient with a history of osteoporosis, who fell with a subcapital femoral fracture, who is scheduled for ORIF, what type of traction would the patient be placed in?

Answer 33

Buck’s traction.

Question 34

Know what a “Comminuted” fracture is

Answer 34

When bone is broken or crushed into small pieces.

Question 35

If a patient who has avascular necrosis of hips is to walk with crutches using a 4 point gait, how would you describe the walking instructions to the patient?

Answer 35

Four point gait: right crutch, left foot, left crutch, right foot.

Question 36

If a patient has a compound fracture, where does a nurse assess for pulses?

Answer 36

Check pulse in areas distal to the wound and compare with other limbs.

Question 37

Know what s/s of infection are underneath a cast

Answer 37

Swelling, discoloration of toes or fingers, pain during motion and burning or tingling under cast.

Question 38

Know what the highest priority nursing diagnosis would be after surgery for a patient with an open reduction and external fixation of the ankle

Answer 38

Risk of infection.

Question 39

When a patient has been placed in full “Spica (body) Cast” and patient c/o nausea and abdominal distention, what syndrome should the LVN report?

Answer 39

Cast syndrome.

Question 40

Know what the finding is that would produce the “most” concern when performing pin care for a patient with an external fixator

Answer 40

Prevent the migration of organisms along the pin from the skin to the bone.

Question 41

If a Nurse is performing a neurovascular assessment of a patient in skeletal traction, what abnormal sign does the Nurse want to assess?

Answer 41

Assess effected extremity for temperature, pain, sensation, motion.

Question 42

Know how weights should hang, that are applying traction

Answer 42

Freely

Question 43

Know what a “Greenstick” fracture is

Answer 43

An incomplete fracture most often seen in children, bone splinted on one side but only bent on the other side.

Question 44

Know what early ambulation with a pelvic fracture will prevent

Answer 44

Clots

Question 45

If a patient who is having his leg amputated and is also having a prosthesis fitting during surgery, at the same time, know what the pre-op teaching plan includes regarding dressings

Answer 45

Explain the type of device to be used, as well as the process of fitting the patient and instructing the patient in its use. In some situations, a limb prosthesis may be placed while the patient is still in the operating room. This requires placement of a rigid dressing to accommodate the temporary prosthesis.

Question 46

Know how long it is before a patient with a BKA, can bear weight

Answer 46

A patient can usually bear full weight on a permanent prosthesis approximately 3 months after amputation.

Question 47

If you have patient who is 80 years old and has had vascular problems and is scheduled for left BKA, how would know the patient understands the procedure?

Answer 47

Patient is able to repeat that fitting of the prosthesis is delayed until the residual limb has healed adequately.

Question 48

Know what the two diagnostic tests that are done pre-op for patient having a BKA

Answer 48

Arteriography: detects arterial occlusion.
Pulse volume recording (plethysomography): used to evaluate arterial blood flow to an extremity.
Doppler ultrasound: used to assess pulses, patency of blood vessels.

Question 49

If a patient has an elbow disarticulation, how will the limb be severed?

Answer 49

Through the joint.

Question 50

Know what the thermographic finding of “cool spots” in a certain area indicates

Answer 50

Cool areas generally indicate a decreased blood flow as compared with warm areas.

Question 51

Know what a patient with PVD and diabetes can do to prevent an amputation, regarding vasoconstriction

Answer 51

Diet, medication and exercise.

Question 52

Know what a “closed amputation” is usually performed for

Answer 52

Closed amputations are usually performed to create a weight-bearing residual limb or stump, which is especially important for lower extremity amputations.

Question 53

With a “Myoelectric ally” controlled prosthesis, know what controls the movement

Answer 53

Nerves

Question 54

What should the Nurse do to reduce the possibility of hip contractures in a patient with above the knee amputation? What position should the patient placed in?

Answer 54

Patient is instructed to lie prone (if tolerable), with the head turned away from the affected side for 30 minutes three or four times a day.

Question 55

Know what pre-operative exercises should be for a patient undergoing a lower-extremity amputation, what type of training?

Answer 55

Upper body training is important to strengthen the arms.

Question 56

Know what the greatest danger in the post operative period is, for a patient after amputation

Answer 56

Hemorrhage, edema, infection and pain.

Question 57

If a patient comes into the ER with amputated thumb from a lawn mower accident in a glass jar, what should the nurse do?

Answer 57

Current preservation techniques include wrapping the amputated parts in a clean cloth saturated with normal saline or Ringer’s lactate solution. These parts are then placed in a sealed plastic bag that is placed in ice water. Direct contact between the amputated part and the ice can lead to further tissue damage and cell death.

Question 58

If you are a home health Nurse and a patient who has a below the elbow prosthesis, has a limb that is red, edematous and warm to touch, what should the nurse do?

Answer 58

Monitor the patients temperature for elevations that may indicate infection.

Question 59

Know what post-operative care for a patient with replantation of the right thumb includes?

Answer 59

Elevation of the limb and microvascular precautions. Take care not to elevate the limb above the level of the heart, because this may impair arterial flow. Microvascular precautions include avoiding any substances or conditions that contribute to blood vessel spasm or constriction. Encourage the patient to abstain from nicotine and caffeine containing products for 7-10 days. Maintain room temperature at 80 degrees to prevent compensatory vasoconstriction. Loosen tight or restrictive gowns or pajamas. Administer drugs as ordered and monitor for adverse effects.

Question 60

Know what late s/s of hemorrhage are in the post operative period after an amputation

Answer 60

Hypotension and cyanosis.

Question 61

Know what the post operative complication is that should always be reported to a physician is

Answer 61

If pain is not relieved after administering analgesic agents.