Porth (2020) 5th nur 317 Flashcards
Chapter 49
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:
Decreased exposure to the natural UV radiation of the sun
Increasing dietary consumption of vitamin D
Gaining weight of 5 to 10 pounds
A bone marrow transplant
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.
The diagnosis of chronic fatigue syndrome (CFS) is made using both a holistic approach as well as:
aggressive diagnostic testing.
mental health screenings for depression and anxiety.
focused physical and occupational therapies.
elimination of possible physical causes.
The diagnosis of chronic fatigue syndrome (CFS) is made using both a holistic approach as well as:
aggressive diagnostic testing.
mental health screenings for depression and anxiety.
focused physical and occupational therapies.
elimination of possible physical causes.
A nurse is evaluating the progress of a client with chronic fatigue syndrome. Which statement by the client indicates successful symptom management?
“My family wants me to volunteer at the animal shelter.”
“My schedule includes yoga and a weekly club meeting.”
“I work until I run out of energy, and then I rest.”
“I often find it is too much work to fix a meal.”
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.
Which chronic disorders have been associated with chronic fatigue? Select all that apply.
Arthritis
Anemia
Asthma
Multiple sclerosis
Cardiac disease
Arthritis, Anemia, Multiple sclerosis, Cardiac disease
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.
Regarding embryonic development, in what week do the paddle-shaped limb buds of the lower extremities begin to appear?
26th week
10th week
4th week
1st week
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.
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?
“Your child has no arch as a result of congenitally tight heel cords.”
“This condition can be related to other issues such as cerebral palsy.”
“Your child developed this condition based on intrauterine positioning as a fetus.”
“Your child’s condition is a result of loose ligaments in the feet.”
“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.
Which statement is true concerning acute fatigue?
It lasts longer than 1 month.
It is not relieved by cessation of activity.
It has an insidious onset.
It serves a protective function for the body.
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.
The nurse is reviewing the health histories of four clients. Select the client most at risk for developing secondary osteoporosis.
A 42-year-old male with a healing leg fracture
An 80-year-old male who resides in an assisted living facility
A 60-year-old female taking prednisone for asthma
A 22-year-old female taking oral contraceptives
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.
A client diagnosed with Paget disease asks the health care provider how the disease developed. The best response would be:
“It can result from a deficiency in calcium.”
“It is a result of a sedentary lifestyle.”
“It is thought to have a probable association with a viral infection: paramyxovirus.”
“It results from a chromosomal disorder.”
“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.
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?
Rheumatoid arthritis
Developmental dysplasia of the hip
Recessive trait disorder
Osteogenesis imperfecta
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.
When assessing a client diagnosed with Paget disease focused in the skull, the nurse should anticipate which findings? Select all that apply.
Intermitent tinnitus
Visual disturbances
Vertigo
Headaches
Hearing loss
Intermitent tinnitus, Vertigo, Headaches, 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.
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.
Supplemental use of soy formula
Focused passive long bone exercise
Vitamin D supplements
Regular exposure to sunlight
Vitamin D supplements, 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.
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:
Lawn bowling for 1 hour per week
Brisk walking three times per week on a flat surface
High-impact aerobic exercise for 1 hour three times per week
Running 1 mile per day with good athletic shoes
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.
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.
Excessive caffeine intake
High-protein diet
Large bone structure
Alcoholism
Smoking
Excessive caffeine intake,
High-protein diet,
Alcoholism,
Smoking
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.
The nurse is caring for several clients who have chronic fatigue. Which intervention is the appropriate match for the cause of the clients’ fatigue?
Clients with loss of muscle mass who are given analgesics
Clients with depression who are given a sedative
Clients with insomnia who are served hot chocolate at bedtime
Clients with end-stage renal disease receiving erythropoietin
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.
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:
surgical relaxation of foot ligaments and tendons.
serial manipulations and casting.
full-time wearing of Denis Brown splint.
percutaneous tendoachilles lengthening.
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.
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:
Genu valgum
Internal femoral torsion
Genu varum
Bowleg
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.
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?
Fatigue Severity Scale
Human Activity Profile
Mini-Mental Examination
Ergometry
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.
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?
Anemia
Virchow triad
Increase in blood volume
Orthostatic intolerance
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.
The nurse suspects idiopathic scoliosis in a client based on which assessment finding?
Late onset of first menarche
Loss of bone density confirmed with x-ray
Reports of back pain in the teen years
Uneven shoulders or iliac crest
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.
