orthoP NCLEX.doc

A client seeks care for low back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? 1. Pain radiating down the posterior thigh 2. Back pain when the knees are flexed 3. Atrophy of the lower leg muscles 4. Homans' sign Correct Answer: 1 Your Answer: 1 RATIONALES: A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate, low back pain. If nerve root compression remains untreated, weakness or paralysis of the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis. The nurse is teaching a client with osteomalacia how to take prescribed vitamin D supplements. The nurse stresses the importance of taking only the prescribed amount because high doses of vitamin D can be toxic. Early signs and symptoms of vitamin D toxicity include: 1. GI upset and metallic taste. 2. dry skin, hair loss, and inflamed mucous membranes. 3. flushing and orthostatic hypotension. 4. sensory neuropathy and difficulty maintaining balance. Correct Answer: 1 Your Answer: 1 RATIONALES: GI upset and metallic taste are early signs and symptoms of vitamin D toxicity. Such toxicity also may cause headache, weakness, renal insufficiency, renal calculi, hypertension, arrhythmias, muscle pain, and conjunctivitis. Dry skin, hair loss, and inflamed mucous membranes suggest vitamin A toxicity. Flushing and orthostatic hypotension (effects of vasodilation) may result from nicotinic acid and nicotinamide supplements, used to correct niacin deficiency. Sensory neuropathy and difficulty maintaining balance suggest pyridoxine toxicity. A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? 1. "Do all your chores in the morning, when pain and stiffness are least pronounced." 2. "Do all your chores after performing morning exercises to loosen up." 3. "Pace yourself and rest frequently, especially after activities." 4. "Do all your chores in the evening, when pain and stiffness are least pronounced." Correct Answer: 3 Your Answer: 3 RATIONALES: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. Option 1 is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Options 2 and 4 are incorrect because the client should pace herself and take frequent rests rather than doing all chores at once. 1 orthoP NCLEX.doc A 51-year-old client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What would the nurse suspect is the most likely cause of the client's urination problem? 1. Renal calculi 2. Urinary tract infection 3. Benign prostatic hyperplasia 4. Dehydration Correct Answer: 1 Your Answer: 1 RATIONALES: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A urinary tract infection (UTI) commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination. A common bone disease that usually affects middle-aged and elderly people. It's marked by inflammation of the bones, softening and thickening of the bones, excessive bone destruction, and unorganized bone repair; the result is bowing of the long bones. The cause is unknown. A client has acute, painful muscle spasms. The physician prescribes chlorzoxazone (Paraflex), 500 mg P.O. t.i.d. A centrally acting skeletal muscle relaxant, chlorzoxazone commonly is used to treat: 1. muscle spasm caused by cerebral palsy. 2. chronic musculoskeletal disorder. 3. lower extremity spasticity. 4. severe muscle spasm. Correct Answer: 4 Your Answer: 4 RATIONALES: Chlorzoxazone is used to treat acute, painful musculoskeletal conditions or severe muscle spasm. Centrally acting skeletal muscle relaxants like chlorzoxazone are ineffective in treating spasticity associated with chronic neurologic disease, such as cerebral palsy. They can treat acute musculoskeletal disorders, not chronic ones. Chlorzoxazone and the other relaxants are used to treat spasticity of any extremity. A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond? 1. "You should ask your physician about that." 2. "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." 3. "You may experience progressive deterioration in all voluntary muscles." 4. "This form of muscular dystrophy is a relatively benign disease that progresses slowly." Correct Answer: 3 Your Answer: 3 RATIONALES: Muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly 2 progressive, relatively benign form of muscular dystrophy; it usually arises before age 10. A group of degenerative genetic diseases characterized by weakness and the progressive atrophy of skeletal muscles with no evidence of nervous system involvement. The nurse is caring for a client who complains of lower back pain. Which instructions should the nurse give to the client to prevent back injury? 1. "Bend over the object you're lifting." 2. "Narrow the stance when lifting." 3. "Push or pull an object using your arms." 4. "Stand close to the object you're lifting." Correct Answer: 4 Your Answer: 4 RATIONALES: Standing close to an object when lifting moves the body's center of gravity closer to the object, allowing the legs, rather than the back, to bear the weight. No one should bend over an object when lifting; instead, the back should be straight, and bending should be at the hips and knees. When lifting, spreading the legs apart widens the base of support and lowers the center of gravity, providing better balance. Pushing or pulling an object using the weight of the body, rather than the arms or back, prevents back strain. Using a larger number of muscle groups distributes the workload. A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? 1. "It's common in females after menopause." 2. "It's a degenerative disease characterized by a decrease in bone density." 3. "It's a congenital disease caused by poor dietary intake of milk products." 4. "It can cause pain and injury." 5. "Passive range-of-motion exercises can promote bone growth." 6. "Weight-bearing exercise should be avoided." Correct Answer: 1,2,4 Your Answer: 1,2,4 RATIONALES: Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen. The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth. The nurse is caring for a client with burns on his legs. Which nursing intervention will help to prevent contractures? 1. Applying knee splints 2. Elevating the foot of the bed 3. Hyperextending the client's legs