Musculoskeletal/GI/Multisystem Flashcards
When teaching a client how to manage gout, which food should the nurse tell the client to avoid?
- Shrimp
- Legumes
- Broccoli
- Bananas
1
High purine foods should be avoided with gout to prevent exacerbation. The nurse should recommend that the client avoid shrimp.
Ibuprofen is an nonsteroidal anti-inflammatory drugs (NSAIDS) which is commonly used for muscle strains and aches. Which should the nurse recognize as a serious side effect of ibuprofen?
- Nephrotoxicity.
- Xerostomia.
- Hallucination.
- Convulsions.
1
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. NSAIDs have nephrotoxic effects and should be avoided in patients with kidney disease.
The nurse is assessing a client with a deep puncture wound, accompanied with swelling and erythema noted at the base of frontal (L) knee; the area is hot to touch; and the client complains of constant, throbbing pain which increases with movement. Client’s current temperature is 101.6°F (38.7°C) and their leukocytes are double the normal value and the erythrocyte sedimentation rate (ESR) reflects a normal value. The presenting clinical signs and symptoms are indicative of which condition?
- Osteomyelitis.
- Ewing’s sarcoma.
- Rheumatoid arthritis.
- Compartment syndrome.
1
Osteomyelitis is an infection in the bony tissue. Osteomyelitis can be caused by bacteria, viruses or fungi. Invasion of one of these stimulate an inflammatory response which leads to vascular leakage and edema. Ischemia and necrosis of the bone occurs as a result. Acute osteomyelitis presents with fevers above 101°F (38.3°C); swelling around the affected area; erythema; tenderness and bone pain which is constant, localized, pulsating which increases with movement. Puncture wounds provide a mechanism of direct entry for the invasion of pathogenic organisms.
A client with a left tibial fracture has a short leg cast. While assessing the client, the nurse notes that the left foot is edematous, with taught, pale, cool skin. The pedal pulse is present but weaker than the pulse in the right foot. Capillary fill in the left foot is slower than in the right foot. The client is requesting pain medication within one hour of the last dose and reports that the right foot is feeling numb. Which intervention would improve the client’s condition?
- Administration of a muscle relaxant intramuscularly.
- Elevation of the left leg above the level of the heart.
- Fasciotomy procedure performed by a surgeon.
- Application of cool compresses over the cast.
3
The client is exhibiting clinical signs and symptoms of acute compartment syndrome. The only way to relieve the pain caused by this condition is a fasciotomy. This phenomenon occurs when there is increased pressure in one or more compartment areas of the body surrounded by fascia. The lower leg and forearm are the most common sites this occurs. Increasing pain which is not relieved by pain medication, tautness of skin, edema, decrease pulses and capillary refill, accompanied by paleness accompanied by the history of the tibial fracture are indicative of acute compartment syndrome.
A client has been diagnosed with an ankle sprain. The nurse should anticipate that the client will need which medication?
- Naproxen sodium.
- Hydrocortisone.
- Ciprofloxacin.
- Chloroquine.
1
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium, are recommended for treatment of sprains.
Name 5 items to avoid while on Warfarin
If possible, avoid:
* Allopurinol
* NSAIDs
* Acetaminophen
* Vitamin E
* Histamine blockers
* Cholesterol-reducing drugs
* Antibiotics
* Oral contraceptives
* Antidepressants
* Thyroid drugs
* Antifungal agents
* Other anticoagulants
* Corticosteroids
* Herbs, such as St. John
’
s wort, garlic, ginseng, Ginkgo biloba
The nurse is presenting a class at the community center about the prevention of colorectal cancer. Which statements should the nurse include in their teaching?
- Decrease the consumption of fat, refined carbohydrates and low in animal fat.
- After the age of 50, a colonoscopy should be done every 10 years.
- Increase the consumption vegetables such as broccoli, cabbage and sprouts.
- Exercise a minimum of three to four times a week.
- Fecal occult blood testing should be done yearly, starting at the age of 30.
1, 2, 3, 4
The nurse should include in the class on colorectal cancer: decrease the amount of fat, refined carbohydrates and animal fat in their diets. Clients should be told to consumed more baked and broiled foods, high fiber and plants that come from a stem or stalk such as broccoli, cabbage, cauliflower and sprouts. These types of plants have been shown to help protect the intestinal mucosa from colon cancer. The class should also include the importance of not being sedentary, avoidance of smoking and excessive alcohol. After the age of 50, the participants should be told that they should have a colonoscopy every 10 years; or a double-contrast barium enema or sigmoidoscopy with fecal occult blood testing every five years.
A client from a nursing home is admitted with diagnoses of diabetes mellitus, chronic pancreatitis and alcoholism. The healthcare provider has prescribed the client pancrelipase (Creon, Pancrease). How should the nurse document the effectiveness of this prescribed medication?
- The absence or presence of delirium tremors.
- The character and quality of abdominal pain.
- Glucometer readings before and after each meal.
- The number, frequency and consistency of stools per day.
4
Pancrelipase is a pancreatic enzyme to aid in the digestion of carbohydrates, protein and fat due to pancreatic insufficiency from the chronic pancreatitis. To evaluate the effectiveness, the nurse should record the number, frequency and consistency of the client’s daily stools. If the medication is being effective the stools should become less frequent and have less steatorrhea.
A nurse is preparing a client diagnosed with advanced stomach cancer for tumor removal with surgical stomach resection followed by adjuvant chemotherapy. The nurse should understand the ultimate goal of this plan of care is what?
- Curative.
- Palliative.
- Diagnostic.
- Exploratory.
2
Client’s plan of care for advanced stomach cancer is dependent upon the advancement of the cancer. Stomach cancer is asymptomatic in the early stages and usually not diagnosed until advanced and has metastasized. Surgical removal of a tumor followed by chemotherapy or radiation is generally palliative to improve the client’s quality of life who may be experiencing an obstruction, hemorrhage or pain. Survival rate for clients with advanced stomach cancer is five years.
The nurse is assessing a client that is experiencing indigestion and vague abdominal pain that radiates to the right shoulder, increase passing of gas, burping and nausea whenever they eat greasy fried food. The client has clay-colored stool, urine that appears dark colored and foamy. Based on the clients presenting signs and symptoms which condition is this client most likely to be diagnosed?
- Pancreatitis.
- Cholecystitis.
- Appendicitis.
- Gastroenteritis.
2
Cholecystitis is inflammation of the gallbladder which occurs when gallstones (cholelithiasis) obstruct the gallbladder’s cystic duct. The obstructed duct causes the entrapment of the bile which in turn causes inflammation of the gallbladder. The entrapped bile then causes the client’s stool to be clay-colored due to lack of bile and their urine becomes dark and foamy as the kidneys attempt to excrete the excess circulating bilirubin out through the urine. The gastric symptoms of flatulence, dyspepsia, eructation and abdominal pain that radiates to the (R) shoulder occur whenever fatty or large volume of food is ingested.
A client is admitted with coffee ground emesis. This symptom is indicative of which diagnosis?
- Lower GI bleed.
- Upper GI bleed.
- Appendicitis.
- Diverticulitis.
2
Stomach enzymes breaks down any blood from an upper GI bleed, which leads the vomitus to appear as dark coffee ground emesis. Coffee ground emesis is a clinical sign of an upper GI bleed.
Which assessment finding indicates a client is progressing into stage II of shock?
- “Bowel sounds are diminished.”
- “Skin is hot and flushed.”
- “Slow, labored breathing begins.”
- “Heart rate decreases.”
1
In stage II of shock, the body initiates a series of compensatory mechanisms. The endocrine system’s compensatory mechanism releases a series of hormones to increase blood pressure and glucose levels in the body. During this stage, the client’s bowel sounds may diminish.
While assessing a client’s health history, the nurse notes that the client has been prescribed an anti-diarrheal. The nurse should notify the healthcare provider of which health outcome found during the assessment ?
- Abdominal cramping.
- Flatulence and bloating.
- Absence of bowel sounds.
- Passage of hard, solid stools.
3
The absence of bowel sounds could be indicative of paralytic ileus, a rare condition associated with anti-diarrheal use. Treatment of a paralytic ileus typically includes placement of a nasogastric tube, close medical management, and possible surgical intervention.
Which finding indicates that a client with hypertension may be experiencing a potential complication of the disease?
- Bradycardia.
- Elevated blood urea nitrogen.
- Polyuria.
- Dry skin.
2
Hypertension can cause vascular damage to the kidneys. An elevated blood urea nitrogen (BUN) level indicates kidney dysfunction, a complication associated with hypertension.
The last bowel movement recorded on a client’s electrical medical record (EMR) was three days ago. Which actions should the nurse take next?
- Ask the client when was the last bowel movement.
- Measure the abdominal girth and note in the EMR.
- Do an assessment of the abdomen for constipation.
- Obtain a prescription for an enema or suppository.
- Inquire about the client’s normal frequency of bowel movements.
1, 3, 5
The first steps are to conduct an assessment, including interviewing the client about last bowel movement and typical patterns. An assessment of the client’s abdomen would include auscultation and palpation.
