Study guide 45 and 46 Flashcards
1
Q
______ and _____ = Synaptic clef
A
This is the space between the muscle fiber and the motor neuron/ Acetylcholine is released into this area
2
Q
_____ and _____ = axon terminal
A
This contains the transmitter acetylcholine in vesicles/ This is located at the end of the motor neuron
3
Q
_____ and _____ = Sarcolemma
A
This is the cell membrane of the muscle fiber/ Electrical impulse is sent over this
4
Q
Provides a smooth surface on the joint surfaces
A
Articular cartilage
5
Q
Encloses the joint similar to a sleeve
A
Joint capsule
6
Q
Lines the joint capsules and secretes synovial fluid
A
Synovial membrane
7
Q
Prevents friction within the joint cavity
A
Synovial fluid
8
Q
Permits tendons to slide easily across a joint
A
Bursae
9
Q
Disc of fibrous cartilage between bones
A
Symphysis
10
Q
Movement in all planes
A
Ball and socket
11
Q
Movement in one plane
A
Hinge
12
Q
Relating to a joint
A
Articular
13
Q
Rotation
A
Pivot
13
Q
Side- to - side movement
A
Gliding
14
Q
Movement in several planes
A
Saddle
15
Q
Small sacs of synovial fluid between joints and tendons
A
Bursa
16
Q
Grating sound as joint or bone moves
A
Crepitation
17
Q
Swollen synovial tissue within the joint
A
Synovitis
18
Q
Bones appear as white areas
A
X-rays
19
Q
Contrast media used to view joint structures (tendons, ligaments, cartilage)
A
Arthrogram
20
Q
Radio waves and magnetic field view of soft tissue
A
Magnetic resonance imaging
21
Q
Insertion of needle into joint space to aspirate fluid, obtain a specimen, or install medication
A
Arthrocentesis
21
Q
Endoscopy of joints with local or general anesthesia
A
Arthroscopy
21
Q
Enzyme made by osteoblasts to mineralize bone
A
Serum alkaline phosphatase
22
After injection, a radioisotopic is taken up by bone and 2 hours later a camera scans the body front and back
Bone scan
23
Mineralizes bones and teeth
Serum phosphorus
23
Stored in bone to make bone rigid
Serum calcium
24
Special x-ray evaluating bone density
Dual energy x-ray absorptiometry
25
End product of purine metabolism
Uric acid
26
Mr. John Allen, age 45, was an automobile accident and comes to the emergency department with a fractured femur of the right leg, reporting pain in the right leg. After the health care provider (HCP) sees him, the nurse collects data.
What priority data does the nurse collect from Mr. Allen's history
Allergies, medical conditions, medications, surgeries,
injury, cause and mechanism of injury (e.g., twisting,
crushing, stretching; how the patient is injured will indi-
cate other injuries to look for)
27
Mr. John Allen, age 45, was an automobile accident and comes to the emergency department with a fractured femur of the right leg, reporting pain in the right leg. After the health care provider (HCP) sees him, the nurse collects data.
What areas does the nurse focus on first during Mr. Allen's physical examination?
Inspection: area of injury, asymmetry, mobility and range
of motion, swelling, deformity and limb length, ecchymosis. Palpation: skin temperature, crepitation, tenderness,
sensation
28
Mr. John Allen's case study:
Based on the collected data, the nurse will consult the HCP regarding the patient's pain medication order based on a reaction the patient had to it in the past.
Develop a CUS communication to consult the HCP regarding the pain medication order.
-C: This is Janet, LVN in the emergency department. I am
concerned about Mr. Allen’s analgesic order. He has
had a reaction to the medication in the past.
-U: I am uncomfortable with him receiving this analgesic.
-S: I believe it could be unsafe for him to receive it.
29
Mr. John Allen's case study:
Based on the collected data, the nurse will consult the HCP regarding the patient's pain medication order based on a reaction the patient had to it in the past.
How often does the nurse have the patient rate his pain? After pain medication administration, when does the nurse recheck the patient's pain level?
The frequency of pain-level evaluation is based on the
patient’s pain severity, duration of action of analgesics administered, and agency policy. Pain level is reeval-
uated based on the administered analgesic’s onset of
action: For intravenous analgesics, reevaluation is
in 15–30 minutes; oral analgesics are reevaluated in
45–60 minutes
30
Mr. John Allen's case study:
Based on the collected data, the nurse will consult the HCP regarding the patient's pain medication order based on a reaction the patient had to it in the past.
What action does the nurse take after identifying a diminished right pedal pulse during data collection
The nurse notifies the HCP immediately
31
Mr. John Allen's case study:
Based on the collected data, the nurse will consult the HCP regarding the patient's pain medication order based on a reaction the patient had to it in the past.
What teaching does the nurse reinforce for Mr. Allen?
Explanation of pain management and procedures and
tests to be performed, the importance of reporting
symptoms
32
Mr. John Allen's case study:
Based on the collected data, the nurse will consult the HCP regarding the patient's pain medication order based on a reaction the patient had to it in the past.
Two days later, the nurse notes that Mr. Allen is having difficulty with transferring and ambulation. Who does the nurse collaborate with?
The HCP and physical therapy
33
The nurse is caring for a patient who is undergoing an arthroscopy of the knee with ligament repair. Which of the following would be included in nursing preoperative care for the patient 3 hours prior to surgery (select all that apply)
A)Provide clear liquids up to 2 hours before surgery
B)Provide plain toast
C)Explain the surgical procedure
D)Explain the anesthetic agents
E)Teach the patient to perform Straight- leg raises
F)Reinforcing how to perform coughing and deep- breathing exercises
A)Provide clear liquids up to 2 hours before surgery
F)Reinforcing how to perform coughing and deep- breathing exercises
34
The nurse is caring for a patient who has undergone a right knee arthroscopy. Two hours after the procedure, the patient's right pedal is diminished compared with the previous data collection. What action should the nurse take?
A) Notify the surgeon
B)Obtain temperature
C) Perform neurovascular assessment in 30 minutes
D)Change the dressing
A) Notify the surgeon
35
The nurse is caring for a patient with a fractured left leg. Which of the following findings during a neurovascular check of the lower extremities would the nurse recognize as a priority to report to the health care- provider? (select all that apply)
A) Strong bilateral post-tibial pulses
B)Right foot capillary refill less than 2 seconds
C) Bilateral dorsal flexion
D)Pallor of the left leg
E) Left foot capillary refill of 4 seconds
D)Pallor of the left leg
E) Left foot capillary refill of 4 seconds
36
The nurse is assigned to care for a patient who has been diagnosed with a musculoskeletal disease that causes decreased bone density. Which data collection questions are most appropriate by the nurse? (Select all that apply)
A) "Have you had any broken bones?"
B) "Has your doctor informed you not to exercise so you will not break a bone?"
C) "What forms of physical activity are you able to participate in?"
D) "Does your spouse have any bone problems?"
E) "Do you exercise regularly?"
F) "What is typically included in your daily diet?"
A) "Have you had any broken bones?"
C) "What forms of physical activity are you able to participate in?"
E) "Do you exercise regularly?"
F) "What is typically included in your daily diet?"
37
A patient is scheduled for a computerized tomography scan with contrast of the chest. Which of the following questions is appropriate for the nurse to ask during data collection to help ensure the scan is safely completed?
A) "Do you have metal of implants in your body?"
B) "Have you had a reaction to contrast int he past?"
C) "Are you allergic to bananas?"
D) "Are you allergic to shrimp?"
B) "Have you had a reaction to contrast int he past?"
38
The nurse would evaluate the patient as requiring further teaching if the patient stated which of these serum blood tests is elevated in gout? (Select all that)
A) Alkaline phosphatase
B)Calcium
C)Creatine kinase
D)Myoglobin
E)Phosphorus
F)Uric acid
A) Alkaline phosphatase
B)Calcium
C)Creatine kinase
D)Myoglobin
E)Phosphorus
39
The nurse is inspecting the knee of a patient who reports pain and stiffness. As the patient moved the knees, the nurse hears a grating sound. The nurse correctly documents the grating sound as which one of the following?
A)Crepitation
B) Effusion
C)Friction rub
D)Subcutaneous emphysema
A)Crepitation
40
What actions should the nurse take after observing a joint that has grating sound with movements? (Select all that apply)
A) Abduct the extremity
B) Adduct the extremity
C) Flex the joint
D) immediately stop joint movements
E) protect the joint
F) Maintain joint immobilization
D) immediately stop joint movements
E) protect the joint
F) Maintain joint immobilization
41
The nurse is gathering functional data on a patient with arthritis. The nurse would collect data in which of these areas? (select all that apply)
A) Ability to feed self
B) Appearance of joints
C) Bathing practices
D) pain level
E) Dressing ability
F) Response to treatment
A) Ability to feed self
C) Bathing practices
E) Dressing ability
42
Following a patient's bone biopsy of the iliac crest, the nurse inspects the biopsy site. Which of these findings is the priority for the nurse to report as a complication that occur immediately following a bone biopsy.
A) Crepitation
B) Hematoma formation
C)Infection
D) Joint dislocation
B) Hematoma formation
43
What is a complication of an open fracture?
Osteomyelitis
44
How can the nurse help prevent debilitating bone infection?
Hand hygiene and use of sterile technique for dressing
changes
45
What treatment was used for Alex's phantom pain?
Analgesics
46
arhtro (joint) + itis (inflammation)
Arthritis
47
Arthro (joint) + plasty (creation of)
Arthroplasty
48
Snovia(synovial fluid or tissue) + itis (inflammation)
Synovitis
49
Arhtro (joint) + Centesis (Puncture of a cavity)
Arthrocentesis
50
Hyper (excessive) + uric (uric acid) + emia (in blood)
Hyperuricemia
51
Vascul (blood vessel) + itis (inflammation)
Vasculitis
52
a (without)+ vascular (blood) + necrosis (death)
Avascular necrosis
53
re (again)+ plant (to plant)+ tion (process)
Replantation
54
Hemi (half)+ pelv (pelvis) + Ectomy (removal of)
Hemipelvectomy
55
Fascia (fibrous tissue)+ otomoy (opening into)
Fasciotomy
56
osteo (bone )+ sarco (flesh) + oma( tumor)
Osteosarcoma
57
Osteo (bone) + myel (bone marrow) + itis (inflammation)
Osteomyelitis
58
More than two fragments that appear to float
Comminuted
59
At right angle to bone
Transverse
60
Splintered and bent, occurring mainly in children
Greenstick
61
More than two fragments driven into each other
Impacted
62
Extends into articular surface
interarticular
63
Runs along axis of bone
Longitudinal
64
Oblique fracture line
Oblique
65
Spontaneous fracture from bone disease
Pathological
66
Fracture twists around shaft of bone
Spiral
67
From repeated stress (e.g. jogging)
Stress
68
True or false:
replace worn shoes with ones of s different height and type
False. New shoes should be the same height and the
same type
69
True or false:
Clean the prothesis socket with alcohol and water and dry it completely
False. Clean with mild soap and water.
70
Use garters to keep socks or stockings in place
True
71
True or false: Replace worn inserts and liners when they become too soiled to clean
True
72
True or false:
Oil the mechanical parts as instructed by the physician
False. Grease the parts as instructed by the prosthetist
73
Avoid excessive physical or emotional ______
Stress
74
______ alcohol
Avoid
75
Drink plenty of _____, especially water
fluids
76
Avoid all forms of ______ and medications containing ______.
aspirin/ aspirin
77
______ diuretics
Avoid
78
Avoid high _____ foods, such as organ meats, shell fish, and oily fish, such as _______
Purines/ Sardines
79
A nurse is caring for a patient being transferred into bed who has just had a plaster long-leg cast applied. The patient reports pain of 6 on scale of 0 to 10. Place the nursing interventions in order of priority.
1)Obtain vitals signs
2)Palm cast as positioning upon pillow
3)Check circulation, sensory, and mobility status
4) Administer ordered analgesic
5) Expose cast to air so it can dry
1) Administer ordered analgesic
2) obtain vital signs
3)Check circulation, sensory, and mobility status
4) Expose cast to air so it can dry
5)Palm cast as positioning upon pillow
80
Nursing diagnosis: Impaired physical mobility related to hip precautions and surgical plan: Interventions
Reinforce hip precautions, and transfer
and ambulation techniques.
* Monitor the patient for and take
measures to prevent complications
of immobility.
* Turn patient every 2 hours to the
side ordered and check skin.
* Protect skin: Keep pressure off of
heels, elbows and sacrum; use barrier
cream for incontinence; provide
adequate diet and hydration.
* Teach patient to deep breathe and
cough every 2 hours while awake and/
or use incentive spirometer every hour
while awake.
* Apply thigh-high compression stockings
and/or compression devices as ordered.
* Give anticoagulants as ordered.
* Provide analgesics as prescribed espe-
cially before movement or ambulation.
* Encourage the patient to practice leg
exercises.
* Mobilize patient as soon as possible as
prescribed.
81
Nursing diagnosis: Impaired physical mobility related to hip precautions and surgical plan: Rationale
* Activity is restricted due
to hip precautions and
weight- bearing limitations.
* Immobility complications
can occur in multiple body
systems if preventive
measures are not used
82
Nursing diagnosis: Impaired physical mobility related to hip precautions and surgical plan: Evaluation
* Does the patient transfer and
ambulate as instructed by
physical therapy?
* Is the patient free from complications of immobility?
83
Mr. Shelly, an 82-year-old resident of a long-term care facility, fell and fractured his left hip. He undergoes a surgical repair of the hip the next day.
What complications is Mr. Shelby at risk of developing?
Acute compartment syndrome, fat embolism, osteomyelitis, pulmonary embolism, pneumonia
84
Mr. Shelly, an 82-year-old resident of a long-term care facility, fell and fractured his left hip. He undergoes a surgical repair of the hip the next day.
What data does the nurse monitor to detect complications?
Neurovascular checks on the operative left leg, incision
status, respiratory status, vital signs with temperature.
85
Mr. Shelly, an 82-year-old resident of a long-term care facility, fell and fractured his left hip. He undergoes a surgical repair of the hip the next day.
Which of the following complications are (a) limb threatening? (b) life threating?
(a) Acute compartment syndrome, osteomyelitis; (b) fat embolism, pulmonary embolism
86
Mr. Shelly, an 82-year-old resident of a long-term care facility, fell and fractured his left hip. He undergoes a surgical repair of the hip the next day.
What interventions does the nurse implement to prevent postoperative complications?
Coughing and deep breathing hourly while awake, early ambulation as ordered, ensuring adequate hydration, hand hygiene, sterile technique for dressing changes
87
Forty- two hours later, Mr. Shelby develops tachypnea and reports dyspnea. He displays confusion. The nurse notes petechiae on his upper chest and neck. His vitals are temperature 99.5F (37.5C), blood pressure 132/84 mm Hg, apical pulse 102, respirations 28.
Develop a CUS communication for MR. Shelby
C: I am concerned that Mr. Selby is experiencing a complication of his fracture.
U: I am uncomfortable with his condition, as he is exhibiting symptoms of fat emboli.
S: I am concerned for his safety, as I believe he is experiencing a life-threatening event and must be seen and
treated immediately
88
The nurse is called her neighbor's yard after he had an accident while using a saw to cut wood and severed the end of his finger. Which of the following actions does the nurse take with the severed body part so it may be considered for replantation? (select all that apply)
A) Cover it with a warm, dry towel
B) Place it directly on dry ice
C) Wrap it in a cool, moist cloth
D) Wrap it in a dry, sterile dressing
E) Seal it in a plastic bag
F) Place it in ice
C) Wrap it in a cool, moist cloth
E) Seal it in a plastic bag
89
The nurse is caring for Mr. Able, age 46, who has gout. Which of these morning laboratory values does the nurse monitor for this patient?
A) Blood urea nitrogen
B) Cholesterol
C) Creatinine
D) Uric Acid
D) Uric Acid
90
A patient sustains a closed fracture of the right tibia and is placed in a long- leg plaster cast, which is still damp. Which of the following methods does the nurse use to move the cast when repositioning it to prevent complications?
A) Ask the patients to self- position leg
B) Uses palms to move the cast
C) Uses fingers to grasp cast
D) Monitor dampness of cast and avoids moving it until it is dry
B) Uses palms to move the cast
91
A patient is being treated with gold therapy for rheumatoid arthritis. Which of the following interventions is essential when gold therapy is started? (select all that apply)
A) Remove all metal objects the patient is wearing
B) Check allergies to iodine
C) Give test dose of gold
D) Plan biweekly dosing schedule
E) Monitor the patient after the injection
F) Instruct the patient to obtain daily weights
C) Give test dose of gold
E) Monitor the patient after the injection
92
The nurse is caring for a patient who has a fractured ankle in a cast resting on a pillow. The patient has morphine 2 to 4 mg intravenously ordered every 3 hours prn. The patient received morphine 4 mg 2 hours and e45 minutes ago. The patient is rating the pain at 10 out of 10and moans that the leg hurts. Vital signs are within normal limits the patient has good capillary refill. Which of the following actions is most appropriate for the nurse to take next?
A) Apply ice to cast
B) Notify the health care provider immediately
C)Remove the pillow under the cast
D) Prepare morphine 4 mg for administration
D) Prepare morphine 4 mg for administration
92
The nurse turns a 2 day postoperative patient with a right total hip replacement using pillows between the leg. The nurse later returns and finds the patient lying supine with legs crossed. Which of the following should the nurse immediately observe to determine whether a complication has developed?
A) The right knee for crepitation
B) The left leg for internal rotation
C) The left leg for loss of function
D) The right leg for shortening
D) The right leg for shortening
93
The nurse reinforces discharge teaching for Mr. sims, age 55, who had an acute episode of gout. The nurse would evaluate Mr. Sims as understanding the teaching if he says which of the following can be included in his diet? (Select all that apply)
A) Cod
B) Chicken
C) Eggs
D) Liver
E) Sardines
F)Cherries
A) Cod
B) Chicken
C) Eggs
F)Cherries
94
The nurses reinforce discharge teaching Mr. Sims, age 55. who had an acute episode of gout. The nurse would evaluate Mr. Sims as understanding the teaching if he says which of the following medications to prevent a gout attack? (Select all that applies)
A) Aspirin
B) Acetaminophen
C) Motrin
D) Codeine
E) Excedrin
F) Percodan
A) Aspirin
E) Excedrin
F) Percodan
95
The nurse is caring for a patient with an external fixation device. Which of the following actions should the nurse implement? (select all that apply)
A) avoid touching pins
B) Clean pins with hydrogen peroxide four times daily
C) Follow agency protocol for pin care
D) Loosen screws holding the pins during cleaning
E) Monitor pin sites at least daily
F) Use strict aseptic technique for pin care
C) Follow agency protocol for pin care
E) Monitor pin sites at least daily
F) Use strict aseptic technique for pin care
96
The nurse is contributing to the plan of care for a 77-year-old resident. Which patient data does the nurse recognizes as a risk factor for the resident who has a history of a pathological fracture? (select all that apply)
A) History of falling
B) Paget disease
C) Chair yoga
D) Cancer
E) osteoporosis
F) Daily carbonated beverages
B) Paget disease
D) Cancer
E) osteoporosis
97
The nurse is changing the dressing on a patient's open fracture. Which of the following actions are essential for the nurse to perform to help prevent osteomyelitis? (Select all that apply)
A) Wear a protective gown
B) Perform hand hygiene before dressing
C) wear goggles
D) Use aseptic technique
E) wear sterile gloves to apply new dressing
B) Perform hand hygiene before dressing
D) Use aseptic technique
E) wear sterile gloves to apply new dressing
98
The nurse reinforces teaching the resident, who has risk factors for osteoporosis, prevention methods. The nurse evaluates the resident as understanding the technique if the patient states she will implement lifestyle changes that will include which of these? (select all that apply)
A) daily walking
B) Increased milk intake
C) Limited dark green leafy vegetables
D) Weight training
E) Maintaining normal weight
F) Calcium supplement
A) daily walking
B) Increased milk intake
D) Weight training
F) Calcium supplement
99
The nurse is to administer alendronate (Fosamax). to a resident Which of the following actions should the nurse implement to safely administer the medication? (Select all that apply)
A) Verify allergies
B) administer at bedtime
C) Give on an empty stomach
D) Give with 6 to 8 ounces of water only
E) After administration, with 1 hour before giving other medications
F) Instruct patient to remain upright for 30 minutes
A) Verify allergies
C) Give on an empty stomach
D) Give with 6 to 8 ounces of water only
F) Instruct patient to remain upright for 30 minutes
100
The nurse is teaching the patient about contracture prevention after an above- the- knee amputation. The nerve evaluates the patient as requiring further teaching if the patient states which of these interventions should be used? (select all that apply)
A) Lie prone for 30 minutes
B) Sit in chair for 2 hours
C) Elevate stump on pillow daily
D) Ensure stump lies flat on bed
E) Elevate head of bed during the day
F) elevate foot of bed daily
B) Sit in chair for 2 hours
C) Elevate stump on pillow daily
E) Elevate head of bed during the day
F) elevate foot of bed daily
101
A patient with osteoarthritis who had a right total knee replacement tells the nurse that the other knee is becoming painful. Which of the following is the most appropriate instruction to help the patient preserve function of the left knee?
A) Reduce dietary purines
B) Maintain ideal body weight
C) Maintain normal uric acid level
D) Begin a jogging program
B) Maintain ideal body weight
102
A patient who has a 36- hour- old surgically repaired left fractured femur had morphine 3 mg intravenously 1 hour ago and is now reporting unrelieved pain of 10 out of 10. Which nursing action is most appropriate?
A) Notify the health-care provider
B) Apply buck traction
C) Massage the left leg
D) administer prescribed analgesic
A) Notify the health-care provider
103
A resident return to the long-term care center after a right total hip replacement. The nurse should reinforce teaching for maintaining which of the following postoperative leg position?
A) Legs in adduction
B) Internal leg rotation
C) Legs in abduction
D) More than 90-degree hip flexion
C) Legs in abduction
