ANSWER AND RATIONALE MUSCOLOSKELETAL

1. A patient reports all of the following symptoms. Which of these symptoms would indicate to the nurse a serious complication of systemic lupus erythematosus? a. Fatigue c. Joint pain b. Hematuria d. Oral ulcers Which of the following disorders would a nurse e pect to identify when assessing a patient who us e periencing afternoon slumps! carbohydrate cra"ing and weight gain during the fall and winter months that disappear in spring and summer? a. #a$or depressi"e disorder c. %ysthymic disorder b. &easonal affecti"e disorder d. 'ipolar %isorder

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'. &ystemic lupus erythematosus + &34. is characteri0ed by alternating periods of remissions and e arcerbations. 8ormal symptoms of &34 include microscopic hematuria! that the patient would not see. 2herefore! if the patient reports hematuria! it should be considered a serious complication '. 7eople with seasonal affecti"e disorder report a cra"ing for! and increased consumption of! carbohydrates! weight gain! fatigue and irritability during the winter months. A re"ersal of these symptoms occurs in the spring and summer! with elation! increased social acti"ity! decreased appetite and weight loss occurring

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A 12)year)old girl has a long leg cast applied to her left leg. &he is being instructed in crutch)wal*ing with no weight bearing on her left leg. Which of the following obser"ations indicates that the girl needs further teaching? a. &he is using the three)point gait b. Her elbows are slightly fle ed c. &he places the crutches appro imately si to eight inches +1, to 2- cm. in front of her with each step d. &he is supporting her weight on the a illary bars and hand pieces of the crutches

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%. 2he a illa should not rest on the crutches. &uch pressure may cause discomfort and ner"e damage. 2he weight of the body should be borne by the hands. 2he girl needs further instruction in this area

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%ia0epam + 1alium. is prescribed for a patient with low bac* pain. 2he desired therapeutic action of "alium in this situation is to a. reduce an iety le"els b. eliminate pain sensation c. suppress the inflammatory process d. lessen muscle spasticity

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D. Diazepam ( Valium) is pres ri!e" #$r a pa%ie&% 'i%( l$' !a ) pai& %$ "e rease mus le spasms

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A patient who has a spinal cord transection is in spinal shoc*. On assessment! the nurse would e pect the patient to describe which of the following findings ion the lower e tremities? a. 3oss of sensation c. 4 cessi"e diaphoresis b. 5omplaints of tingling d. 5onstant tremors

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A. A pa%ie&% 'i%( a spi&al $r" %ra&se %i$& (as &$ m$+eme&% $r #eeli&, !el$' %(e le+el $# %(e i&-ur.

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A si )year)old child has a short arm cast placed on the right e tremity. While assessing the fingers during immediate period after casting! a nurse would report which of the following finding? a. #ild enema b. 7ain on mo"ement c. &light coolness of the cast when touched d. 5apillary refill greater than three seconds

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D. Capillar. re#ill ,rea%er %(a& %'$ se $&"s i&"i a%es +as ular $mpr$mise $r pressure #r$m %(e imm$!ilizi&, "e+i e

b. 9. Which of the following medications would a nurse ha"e a"ailable when administering an in$ection of heparin sodium to a patient? a. 8alo one hydrochloride +narcan. b. 7rotamine sulfate c. 7hytonadione + a:ua#47H;2O8. d. 7hentolamine mesylate + <egitine. 2o promote the s*in integrity of a patient who is in <ussell>s traction! which of the following measures should be included in the care plan? a. Ha"ing the patient lie on the right side for 2minutes e"ery two to three hours b. 7lacing pillows under the patient>s sacral and scapular areas c. #assaging the patient>s bac* and buttoc*s fre:uently d. Applying an antiseptic solution to the patient>s bony prominences after bathing 2he bowel retraining program for a patient who has had cerebro"ascular accident should include which of the following measures? a. 5hec*ing for impaction daily b. @ncreasing the inta*e of mil* products c. Atili0ing incontinent pads until control is achie"ed d. 4stablishing a consistent time for elimination

&elf)care deficit d. disturbance

&leep

pattern

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'. 7rotamine sulfate is the antidote for heparin to icity and o"erdose

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5. #assaging the patient>s bac* and buttoc*s fre:uently promotes s*in integrity and should be included in the care of a patient in traction

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%. 'owel retraining is established by pro"iding a consistent time for e"acuation each day

1-. A patient who has hyperthyroidism is ta*ing methima0ole +2apa0ole. and attends the clinic regularly. 2o e"aluate the effecti"eness of 2apa0ole therapy! the nurse should consider which of the following :uestions? a. Has the patient>s "ision impro"ed? b. Has the patient>s appetite impro"ed? c. Has the patient>s need for sleep decreased? d. Has the patient>s pulse rate decreased? 11. 7rior to surgery for correction of congenital hip dysplasia in four)month)old infant! which of the following home care instructions would a nurse include in the teaching plan for the infant>s family? a. B Apply double diapers when changing the infant.C b. B 7erform passi"e range)of)motion on the lower e tremities.C c. B &upport the legs in an adducted position with pillows during sleep.C d. B A"oid placing the infant in upright position.C 12. A 12)year)old child who has been diagnosed with scoliosis is to be treated with a #ilwau*ee brace. 2o which of the following nursing diagnoses would a nurse gi"e priority? a. &*in integrity c. @mpaired gas e change

1-. %. 2apa0ole is used to decrease iodine use and inhibit the synthesis of thyroid hormones. 2herefore! metabolic acti"ity will be decreased if the treatment is effecti"e

11. A. #ultiple diapers can be sued prior to surgery to effecti"ely separate the child>s legs and hold the legs in an abducted! e ternally rotated position

12. A. Alteration in s*in integrity is the priority nursing diagnosis. &*in e coriation can occur if the leather and plastic pads of the brace touch the child>s s*in. 2he brace can be worn o"er a tee shirt

c. a pillow d. bed 1(. Which of the following guidelines should a nurse include in the teaching plan for a patient who has Osteoarthritis? a. Achie"e ideal body weight b. @ncrease daily calcium inta*e to 1,-mg c. #aintain a high)fiber diet d. &leep at least 1- hours each day 1/. A si )year)old child who sustained a fracture has a long leg cast applied to the left leg. Which of the following statements! if made by a parent! would indicate the need for further teaching? a. B @ will call the clinic if my child complains of sudden pain on his foot.C b. B @ will chec* the s*in temperature of my child>s toes at least once a day.C c. B @ should not e pect my child to ha"e sensation in the toes while the cast is on.C d. B @ should not let my child put anything inside the cast to relie"e itching.C 1,. A nurse places a patient in four)point restraints following orders from a physician. Which of the following measures should the nurse in the patient>s care of plan? a. &ociali0e with other patients once a shift b. 5hec* circulation periodically c. 7ro"ide stimulating di"ersional acti"ities d. Assess rectal temperature fre:uently 16. A nurse conducts discharge teaching with a patient who is in cer"ical traction with a halo apparatus. Which of the following statements indicates that the patient needs further instructions? a. B @ will need to wear the halo for se"eral months.C b. B @ should remo"e the halo when @ shower.C c. B @ plan to ta*e a wal* e"ery day.C d. B @ will continue my pre"ious diet.C 19. A patient who has had a right hip replacement should be instructed to carry out which of the following techni:ues when turning in bed? a. 'ring both *nees to the chest before turning b. Deep an abductor wedge between the legs c. #aintain fle ion of the affected hip d. #o"e the affected leg with the unaffected foot 1=. Which of the following nursing measures is appropriate when caring for a patient who has undergone a right! abo"e)the)*nee amputation? a. Ambulating the patient in the hallway with crutches b. 7lacing the patient in a chair during wa*ing hours

Deeping the patient>s stump ele"ated on 4ncouraging the patient to lie prone in

1(. A. 8utritional counseling for weight reduction may be necessary to eliminate e cessi"e strain on the $oints of a patient with osteoarthritis.

1/. 5. 2his statement indicates a need for further teaching. 2he child should ha"e sensation while the cast is in place. Obser"ation such as pain! swelling! discoloration of the e posed portions! lac* of pulsation and warmth and the inability to mo"e the e posed part are reported immediately

1,. '. <estraints encircle the limbs! placing the patient at ris* for circulation being restricted to the distal areas of the e tremities. 5hec*ing the patients circulation e"ery 1,)(- minutes will allow the nurse to ad$ust the restraints before in$ury form decreased blood flow occurs. 2he nurse must document the time of the chec* and the degree of capillary refill

16. A. 2he long term goal is to ha"e the patient return to full function in appro imately three months

19. '. 'ecause dislocation of a total hip prosthesis is a possible complication of the surgery! the patient>s legs are to be *ept away from the middle of the body! or abducted. 2o ensure that abduction is maintained and the prosthesis does not dislocate! the patient is instructed to *eep an abduction pillow between the legs

1=. %. 2he patient should be assisted into the prone position e"ery three to four hours for 2- to (-) minute periods! 2his is necessary to pre"ent hip fle ion contractures

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He will identify his areas of interest He will engage in occupational therapy

1?. @f a patient were to de"elop thrombophlebitis at an intra"enous infusion site! which of the following early findings should the nurse e pect to obser"e? a. 7allor and swelling b. 4rythema and heat c. #ottling and coolness d. 3ea*age of fluid and numbness 2-. Which of the following measures should be included in the care plan of a patient whose left leg is in traction? a. 5hec*ing the feet for the presence of an*le clonus b. 8oting the color of the toenails after applying temporary pressure c. Assessing the femoral arteries for e:uality of pulses d. 7recussing the *nee for a patellar refle 21. Following a hip replacement! the patient should ha"e the affected hip placed in which of these positions? a. 4 tended! with a wedge between the legs b. Fle ed! with the *nee supported on sandbags c. 4le"ated! with pillows under the leg from the *nee to the an*le d. <otated e ternally! with a trochanter roll in place 22. A 1,)year old boy has undergone a spinal instrumentation at the le"el of 2/ to 2, for scoliosis. 'ecause there is an order to maintain strict bed rest! a nurse should use which of the following techni:ues when repositioning the boy? a. Assist the patient in pulling himself up with the o"erhead trape0e bar b. 2urn the patient>s head to one side! then ha"e him reach for the rail to turn c. 7lace the bed in 2rendelenburg position! then ha"e the boy roll to one side d. Ase an assistant and logroll the patient to the desired side 2(. A nurse would assess a patient who has undergone a lumbar laminectomy for which of the following post)surgical complications? a. %eep "ein thrombosis c. @ntemittent claudification b. Arinary fre:uency d. Flan* pain 2/. A physician tells a (-)year)old man who had an abo"e the *nee amputation that he will not be able to return to his construction wor*. Which of the following long)term goals would be an appropriate e pectation of the man? a. He will de"elop alternati"e "ocational s*ills b. He will ac*nowledge his loss

1?. '. 2hrombophlebitis is the formation of a clot with inflammation of a "ein. 5linical manifestation s are tenderness! redness and warmth. 4dema may oir may not occur

2-. '. 7atients in traction should be assessed for ner"e and circulatory disturbances. 2o chec* for capillary filling times! the patient>s nail beds are compressed to produce blanching and assessed for return of color

21. A. Following a hip replacement! the patient>s affected hip should be placed in e tension! with an abduction wedge between his legs

22. %. &coliosis is a comple spinal deformity that includes cur"ature of the spine. @t can be congenital but more commonly de"elops during the growth spurt of early adolescence. 2o maintain proper body alignment after surgery! the patient should a"oid twisting mo"ements that can cause indwelling instruments to twist the spine. 3og)rolling is preferred when mo"ing the child.

2(. A. Following a lumbar laminectomy! the patient should wear anti)embolism stoc*ings or another anti)embolism de"ice to pre"ent deep "ein thrombosis

2/. A. A long)term goal for a (-)year)old man who is unable to return to construction wor* would be to de"elop alternate "ocational s*ills

2,. A patient with hypothyroidism is to recei"e le"othyro ine sodium + &ynthroid.! 9, mcg by @1 push. 2he medication a"ailable is labeled 2-!cgE1-ml. Which of the following doses is the correct amount? a. ,.- ml b. (.9,ml c. /.9,ml d. 2., ml

2,. 2he formula for this calculation is as follows %esired amount "olume A"ailable amount 9, mcg 1- ml 9,2-(.9,ml F dose

F dose F dose F dose

26. A patient who has "ascular insufficiency of the lower e tremities e periences intermittent claudification. 2o which of the following nursing diagnoses would a nurse gi"e priority? a. @neffecti"e thermoregulation b. 8on)compliance with treatment plan c. Acti"ity intolerance d. Alteration in the body image

26. 5. Acti"ity intolerance should be addressed as a priority. 2he pain of intermittent claudification is alle"iated by cessation of acti"ity

Opportunities are often disguised as hard work, so most people fail to recognize them. -Ann Landers