NURS 317 Unit 6 Path Chapter 49 Flashcards

1
Q

When performing a musculoskeletal assessment on a young boy, the nurse notices that the boy has decreased space between the knees so that the medial malleoli cannot be brought together. The nurse documents this as:

A) Bowleg

B) Internal femoral torsion

C) Genu varum

D) Genu valgum

A

D) Genu valgum

Rationale:Genu valgum or knock-knees is the deformity described. It can be differentiated between genu varum, or bowlegs, in that the medial malleoli of the ankles can touch. Femoral torsion is a rotation (turning) of the thigh bone at the hip.

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2
Q

When assessing a client diagnosed with Paget disease focused in the skull, the nurse should anticipate which findings? Select all that apply.

A) Vertigo

B) Headaches

C) Intermittent tinnitus

D) Visual disturbances

E) Hearing loss

A

A) Vertigo
B) Headaches
C) Intermittent tinnitus
E) Hearing loss

Rationale:Involvement of the skull can cause headaches, intermittent tinnitus, vertigo, and eventual hearing loss. Visual impairment is not associated with Paget disease of the skull.

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3
Q

While getting up out of bed for the first time after surgery, a client reports feeling dizzy and faint. Which condition is the client most likely experiencing?

A) Increase in blood volume

B) Anemia

C) Virchow triad

D) Orthostatic intolerance

A

D) Orthostatic intolerance

Rationale:Orthostatic intolerance may occur in clients that have been on prolonged bed rest and results in symptoms of tachycardia, nausea, diaphoresis, and sometimes syncope or fainting. When there is a change in position a decrease (not an increase) in central blood volume occurs as blood is displaced to the lower extremities. Virchow triad refers to the three factors that predispose a client to venous thrombosis. There is no reason to believe this client is anemic, which generally presents with shortness of breath.

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4
Q

The diagnosis of chronic fatigue syndrome (CFS) is made using both a holistic approach as well as:

A) focused physical and occupational therapies.

B) mental health screenings for depression and anxiety.

C) aggressive diagnostic testing.

D) elimination of possible physical causes.

A

D) elimination of possible physical causes.

Rationale:Diagnosis of CFS is often made by a process of elimination, and treatment requires a holistic approach. The other options are examples of very narrowly focused interventions.

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5
Q

The nurse is providing teaching for parents of a 2-week-old infant just diagnosed with clubfoot. The nurse includes that the first treatment option is:

A) surgical relaxation of foot ligaments and tendons.

B) full-time wearing of Denis Brown splint.

C) percutaneous tendoachilles lengthening.

D) serial manipulations and casting.

A

D) serial manipulations and casting.

Rationale:Serial manipulations and casting will be the first treatment. Each of the other options is more involved and would be attempted after manipulation and casting.

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6
Q

Regarding embryonic development, in what week do the paddle-shaped limb buds of the lower extremities begin to appear?

A) 10th week

B) 26th week

C) 4th week

D) 1st week

A

C) 4th week

Rationale:The limb buds begin to develop late in the 4th week, with hands and fingers being developed by 41 to 43 days.

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7
Q

A client diagnosed with Paget disease asks the health care provider how the disease developed. The best response would be:

A) “It is a result of a sedentary lifestyle.”

B) “It can result from a deficiency in calcium.”

C) “It results from a chromosomal disorder.”

D) “It is thought to have a probable association with a viral infection: paramyxovirus.”

A

D) “It is thought to have a probable association with a viral infection: paramyxovirus.”

Rationale:Paget disease may be linked to both genetic and environmental influences: a positive family history; mutations in genes encoding proteins in the RANK signaling pathway; and/or a probable association with a virus, possibly a paramyxovirus, suggesting that a viral infection may serve as a trigger for development of Paget disease in genetically predisposed individuals. A more sedentary lifestyle will reduce the mechanical loading of the skeleton and may decrease the incidence and severity of Paget disease

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8
Q

The nurse is caring for a child who presented to the emergency department with multiple fractures in various stages of healing all over the body. The nurse collaborates with the physician on care for a client with which potential condition?

A) Rheumatoid arthritis

B) Developmental dysplasia of the hip

C) Osteogenesis imperfecta

D) Recessive trait disorder

A

C) Osteogenesis imperfecta

Rationale:Osteogenesis imperfecta needs to be considered after ruling out abuse related to the various stages of healing fractures. The condition can be inherited as a recessive trait, but infants are usually stillborn related to injury. The other options are not associated with the symptoms described.

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9
Q

A client with confirmed low bone density asks the nurse if there is anything she can to decrease the risk of trauma. The best response would be:

A) Lawn bowling for 1 hour per week

B) Running 1 mile per day with good athletic shoes

C) Brisk walking three times per week on a flat surface

D) High-impact aerobic exercise for 1 hour three times per week

A

C) Brisk walking three times per week on a flat surface

Rationale:Weight-bearing exercises such as walking, jogging, rowing, and weight lifting are important in the maintenance of bone mass. The other options place the person at risk for injury if the bones are weakened.

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10
Q

Which statement is true concerning acute fatigue?

A) It is not relieved by cessation of activity.

B) It lasts longer than 1 month.

C) It serves a protective function for the body.

D) It has an insidious onset.

A

C) It serves a protective function for the body.

Rationale:Acute fatigue serves a protective function to people who are out of condition. All of the other options are symptoms of chronic fatigue.

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11
Q

The nurse is performing an admission assessment to a rehabilitation unit. Which assessment tools should she utilize to determine an alert client’s normal activities, perceived level of activity tolerance, or level of fatigue?

A) Human Activity Profile

B) Fatigue Severity Scale

C) Mini-Mental Examination

D) Ergometry

A

A) Human Activity Profile

Rationale:The Human Activity Profile (HAP) is a paper and pencil test in which participants describe their normal activities, their perceived level of activity tolerance, or their level of fatigue. The Fatigue Severity Scale only assesses the fatigue and not the normal activities or tolerance. The ergometry and the Mini-Mental Examination are not directly related to assessing fatigue.

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12
Q

The nurse concludes that the participants of a community education class on prevention of osteoporosis are understanding the information when they identify which cause as a potential risk factor? Select all that apply.

A) Excessive caffeine intake

B) Large bone structure

C) High-protein diet

D) Smoking

E) Alcoholism

A

A) Excessive caffeine intake
C) High-protein diet
D) Smoking
E) Alcoholism

Rationale:Smoking, excessive alcohol and caffeine intake, and a high-protein diet are all risk factors for the development of osteoporosis. A small bone structure is a risk factor.

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13
Q

Which chronic disorders have been associated with chronic fatigue? Select all that apply.

A) Multiple sclerosis

B) Cardiac disease

C) Asthma

D) Arthritis

E)Anemia

A

A) Multiple sclerosis
B) Cardiac disease
D) Arthritis
E)Anemia

Rationale:Chronic fatigue occurs across a broad spectrum of disease states. It is a common complaint of persons with cancer, cardiac disease, end-stage renal disease, chronic lung disease, hepatitis C, arthritis, human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), and neurologic disorders such as multiple sclerosis. There are several types of cancer-related factors, the most prominent being anemia.

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14
Q

The nurse suspects idiopathic scoliosis in a client based on which assessment finding?

A) Late onset of first menarche

B) Reports of back pain in the teen years

C) Uneven shoulders or iliac crest

D) Loss of bone density confirmed with x-ray

A

C) Uneven shoulders or iliac crest

Rationale:The cardinal signs of scoliosis are uneven shoulders or iliac crest, prominent scapula on the convex side of the curve, asymmetry of the thoracic cage, and rib hump. Curves that are detected before menarche are more likely to progress than those detected after. This is not the only cause of pain in teens.

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15
Q

The nurse is caring for several clients who have chronic fatigue. Which intervention is the appropriate match for the cause of the clients’ fatigue?

A) Clients with insomnia who are served hot chocolate at bedtime

B) Clients with end-stage renal disease receiving erythropoietin

C) Clients with depression who are given a sedative

D) Clients with loss of muscle mass who are given analgesic

A

B) Clients with end-stage renal disease receiving erythropoietin

Rationale:Chronic fatigue may arise from different causes. If a client has anemia caused by renal failure, the hormone erythropoietin will help stimulate production of more red blood cells. Insomnia can be treated with a quiet environment, caffeine-free hot beverages, and short-term use of hypnotic agents. Antidepressants will be more effective for fatigue caused by depression. Loss of muscle mass creates a loss of endurance, but it is not usually painful.

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16
Q

The nurse is teaching a client diagnosed with osteomalacia about treatments to improve the condition. The best information for the nurse to provide would be:

A) A bone marrow transplant

B) Gaining weight of 5 to 10 pounds

C) Decreased exposure to the natural UV radiation of the sun

D) Increasing dietary consumption of vitamin D

A

D) Increasing dietary consumption of vitamin D

Rationale:Clients with osteomalacia need to have increased vitamin D and exposure to natural sunlight to help with absorption. If osteomalacia is caused by malabsorption, the treatment is directed toward correcting the primary disease. Weight gain would increase stress on the weakened bone. A transplant is not necessary as the problem is not involving the bone marrow.

17
Q

The nurse is reviewing the health histories of four clients. Select the client most at risk for developing secondary osteoporosis.

A) A 42-year-old male with a healing leg fracture

B) A 22-year-old female taking oral contraceptives

C) An 80-year-old male who resides in an assisted living facility

D) A 60-year-old female taking prednisone for asthma

A

D) A 60-year-old female taking prednisone for asthma

Rationale:Corticosteroid (e.g., prednisone) use is the most common cause of drug-related osteoporosis, and long-term corticosteroid use in the treatment of disorders such as rheumatoid arthritis and chronic obstructive lung disease is associated with a high rate of fractures. The prolonged use of aluminum-containing antacids (which increase calcium excretion) and anticonvulsants (which impair vitamin D production) may also contribute to bone loss. Persons with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) who are being treated with antiretroviral therapy are also at risk. The other options would not cause osteoporosis.

18
Q

A child is suspected of having flexible “flat feet” based on a physical assessment. When explaining this condition to the parents, what would be the best explanation of the etiology?

A) “Your child developed this condition based on intrauterine positioning as a fetus.”

B) “Your child’s condition is a result of loose ligaments in the feet.”

C) “This condition can be related to other issues such as cerebral palsy.”

D) “Your child has no arch as a result of congenitally tight heel cords.”

A

B) “Your child’s condition is a result of loose ligaments in the feet.”

Rationale:Flexible or supple “flat feet” (pes planus) is a result of loose ligaments in the foot. Rigid flat feet are seen in conjunction with congenitally tight heels or cerebral palsy. Intrauterine positioning has no bearing on this condition.

19
Q

A nurse is evaluating the progress of a client with chronic fatigue syndrome. Which statement by the client indicates successful symptom management?

A) “I often find it is too much work to fix a meal.”

B) “My schedule includes yoga and a weekly club meeting.”

C) “My family wants me to volunteer at the animal shelter.”

D) “I work until I run out of energy, and then I rest.”

A

B) “My schedule includes yoga and a weekly club meeting.”

Rationale:Chronic fatigue syndrome is a disorder of persistent unrelieved fatigue lasting longer than 6 months. It is managed through pacing activities, emotional support, an exercise program to regain strength, and structured activity to allow resumption of activities of daily living.

20
Q

Which intervention should the nurse recommend to best minimize the risk of nutritional rickets in an infant whose culture supports long-term breast-feeding without the introduction of foods? Select all that apply.

A) Vitamin D supplements

B) Supplemental use of soy formula

C) Focused passive long bone exercise

D) Regular exposure to sunlight

A

A) Vitamin D supplements
D) Regular exposure to sunlight

Rationale:Prolonged breast-feeding without vitamin D supplementation is thought to be a risk for the development of rickets. Although the vitamin D content of human milk is low, the combination of breast milk and sunlight exposure usually provides sufficient vitamin D. Soy formula is deficient in Vitamin D. Exercise is not a preventive measure for this disorder.