Davis_Edge_Questions_Week_5__6__7

Musculoskeletal Problems Question 1. Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows it is caused by urate crystals that “get stuck in the joint and cause pain.” She is on hydrochlorothiazide (HCTZ) for management of her hypertension. The NP should suspect a diagnosis of: Gout Question 2. Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome? Davis Edge Questions Week 5, 6, & 7 Musculoskeletal pain. - Musculoskeletal pain is not characteristic of chronic fatigue syndrome; rather, it is characteristic of fibromyalgia. The musculoskeletal pain, usually an achy muscle pain that may be localized or involve the entire body, is usually gradual in onset, although the onset may occasionally be sudden, such as after a viral illness. Question 3. Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-related change? Dorsal kyphosis. - Dorsal kyphosis, an exaggerated convexity of the thoracic curvature, typically accompanies the aging process. Question 4. The valgus stress test, varus stress test, Lachman test, and thumb sign are all considered standard tests to check the integrity of the ligaments of the knee. Which test would the nurse practitioner choose to assess the anterior cruciate ligament (ACL), which is the most commonly involved structure in severe knee injury? Lachman test. - The Lachman test assesses the ACL. Question 5. For an adult patient with a knee injury, the nurse practitioner orders a nonsteroidal anti-inflammatory drug (NSAID) to be taken on a routine basis for the next 2 weeks. Patient teaching should include which of the following? “If you have additional pain, an occasional acetaminophen (Tylenol) is permitted in between the usual doses of the NSAID.” - If the client is having additional pain, acetaminophen (Tylenol) may be taken in conjunction with an NSAID because it is not an NSAID and will not potentiate gastric bleeding. Question 6. You are assessing Jamal, age 16, after a football injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: Cruciate ligament. - Positive anterior and posterior drawer signs indicate injury to the anterior cruciate ligament and posterior cruciate ligament, respectively. The drawer and Lachman tests are utilized to assess for cruciate ligament injury. Question 7. Steve, age 32, fell off a roof while shingling it. He is complaining of pain in his left hip and leg area. Other than an x-ray, what would make you suspect a fractured pelvis? Hematuria. - If a client has a fractured pelvis, a test for hematuria will usually prove positive. A fracture of the pelvis usually results in hypovolemia due to a generally significant associated blood loss. Surrounding blood vessels rupture, which results in a large retroperitoneal hematoma and shock. Pelvic fractures also commonly injure the urinary bladder or urethra. A client with a fracture in several locations of the pelvis may need a pneumatic antishock garment to control the blood loss and stabilize the pelvis. Only x-ray studies will confirm the diagnosis. Question 8. During assessment of a client’s foot, the nurse practitioner notes that the foot is in alignment with the long axis of the lower leg and that weight-bearing falls on the middle of the foot from the heel, along the midfoot, to between the second and third toes. These findings best describe: A normal foot. - If you note during your assessment of your client’s foot that the foot is in alignment with the long axis of the lower leg and that weight-bearing falls on the middle of the foot from the heel, along the midfoot, to between the second and third toes, you would diagnose a normal foot. Question 9. Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which of the following diagnoses do you explore further? Herniated nucleus pulposus. - A plain x-ray will not show a herniated nucleus pulposus or a muscle strain. It will show spondylolisthesis, scoliosis, osteoarthritis, and spinal stenosis. Note that x-rays of the spine are not indicated in low back pain unless the cause of the pain is thought to be bony in origin or traumatic in nature or there is a need to rule out systemic disease. Question 10. The nurse practitioner suspects adolescent idiopathic scoliosis in Victoria, age 15, who is in her “growth spurt.” An Adams forward bend test is performed, and it is noted that the patient has a right-sided rib hump. What is this indicative of? Right thoracic curvature. - When you have a client bend forward to assess the spine (ie, the Adams forward bend test) and you note a right- sided rib hump, this is indicative of a right thoracic curve. Adolescent idiopathic scoliosis is defined as a lateral spinal curvature of greater than 10 degrees with no determined pathologic cause. Management consists of the 3 Os: observation, orthosis, and operation. Question 11. Jim, age 22, a stock boy, has an acute episode of low back pain. The nurse practitioner orders a nonsteroidal anti-inflammatory drug (NSAID) and should educate him in which of the following? Beginning lower back strengthening exercises depending on pain tolerance. - Years ago, muscle relaxants and bed rest were the treatments of choice for low back pain. Studies have now shown that resuming normal activity within the limits imposed by the pain has an effect as good as, if not better than, 2 days of bed rest. The key here is letting pain be your guide. Exercise should begin as soon as possible after the acute injury and be directed at building endurance and stamina, with consideration given to one’s pain tolerance. Question 12. Joyce, age 87, broke her wrist after falling off a curb. She just had a plaster cast applied to her wrist. In instructing Joyce and her family on allowing the cast to dry properly, tell them to: Change the position of Joyce’s arm every hour. - Instructions to the client and family on how to allow a cast to dry properly should include advising them to change the position of the casted extremity every hour. In this case, Joyce’s arm should be repositioned frequently to prevent indentations in the cast itself (caused by continuous placement on a pillow) and to ensure drying of all surfaces of the cast. Question 13. When teaching Alice, age 77, to use a cane because of osteoarthritis of her left knee, an important point to stress is: Advancing the cane with the ipsilateral (affected) leg. - When teaching clients about using a cane, tell them to advance the cane with the ipsilateral (affected) leg. Question 14. Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain? Spinal fracture. - The red flags for spinal fracture include major trauma or direct blow to the back in an adult, a minor fall or heavy lifting in a potentially osteoporotic or elderly person, prolonged steroid use, and age greater than 70. Question 15. Anne Marie states she has a maternal history of rheumatoid disease, but she has never been affected. Today she presents with complaints of dryness of the eyes and mouth. What is the most likely diagnosis? Sjögren syndrome - Sjögren syndrome, which affects the salivary and lacrimal glands, causes clients to have dry eyes and mouths. It is an inflammatory disease of the exocrine glands and may be an isolated entity or may be associated with other rheumatic diseases, such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). Question 16. Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. The nurse practitioner’s next step is to: Try neutral position wrist splinting and order an oral nonsteroidal anti-inflammatory drug (NSAID). - For the client who has just been given a diagnosis of carpal tunnel syndrome, your next step is to try neutral position wrist splinting and order an oral NSAID. For symptoms of less than 10 months’ duration, conservative treatment should be tried first. Question 17. A 55-year-old patient is able to complete range of motion (ROM) against gravity with some resistance. The nurse practitioner would assign which of the following numerical grades to this manual muscle testing description? 4 - Complete ROM against gravity with some resistance is given a numerical grade of 4 and described as good muscle strength. Question 18. Paul has a malignant fibrosarcoma of the femur. He recently had surgery and is now on radiation therapy. You want to order a test to determine the extent of the tumor invasion of the surrounding tissues and the response of the bone tumor to the radiation. Which of the following tests should you order? A magnetic resonance imaging (MRI) scan. - For Paul, who has a malignant fibrosarcoma of the femur, an MRI scan will determine the extent of the tumor invasion of the surrounding tissues and the response of the bone tumor to the radiation. It will also determine response to chemotherapy and detect recurrent disease. Question 19. The nurse practitioner (NP) suspects a herniated disk in a 72-year-old patient. The NP elevates the patient’s affected leg when she is in the supine position, and it elicits back and sciatic nerve pain, which indicates a positive test. This is known as which test or sign Straight leg raise test. - All of the tests listed are tests done to assess for a herniated disk. In the straight leg raise test, you elevate the affected leg when the client is in the supine position; back pain and sciatic nerve pain (ie, radiating leg pain) indicate a herniated disk. Question 20. Alan, age 46, presents with a tender, red, swollen knee. You rule out septic arthritis and diagnose gout by confirming: Hyperuricemia. - To diagnose gout, there should be hyperuricemia and a negative joint culture. Question 21. Matthew, age 52, is a chef who just severed 2 of his fingers with a meat cutter. You would recommend that he: Wrap the fingers in a clean, damp cloth; seal them in a plastic bag; and place the bag in an ice water bath. - If a client has severed his fingers, the fingers should be wrapped in a clean, damp cloth; sealed in a plastic bag; placed in an ice water bath; and transported to the emergency room along with the client. Question 22. Janine, age 69, has class III rheumatoid arthritis. According to the American Rheumatism Association, which of the following describes her ability to function? Adequate to perform only a few or none of the duties of usual occupation or self-care. - The American Rheumatism Association has established functional classes I to IV to describe a client’s ability to accomplish activities of daily living. Because Janine is class III, her function would be adequate to perform only a few or none of the duties of usual occupation or self-care. Question 23. A 55-year-old patient presents with complaints of paresthesias in the lower lateral arm, thumb, and middle finger. The nerve roots most commonly related to these symptoms are C6 and C7. The most likely diagnosis would be: Cervical radiculopathy. - Cervical nerve root compression of C6 and C7 causes cervical radiculopathy. Question 24. Sean, a factory line worker, has osteoarthritis (OA) of the right hand. According to the American College of Rheumatology (ACR), the guidelines for pharmacologic treatment include: Topical capsaicin, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and oral NSAIDs. - Topical capsaicin, topical NSAIDs, oral NSAIDs, and tramadol are recommended by the ACR for the treatment of OA of the hand. Question 25. Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, you note tenderness at her “anatomical snuffbox.” You know this probably indicates a(n): Scaphoid fracture. - There is tenderness over the “anatomical snuffbox” in a scaphoid (aka navicular) fracture, the most common injury of the carpal bones. Poor blood supply puts the scaphoid bone at risk of avascular necrosis; therefore, wrist pain and tenderness in the anatomical snuffbox, even without history of antecedent trauma, warrant a wrist x-ray. Question 26. June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back muscles and spine, without sciatica, and it is aggravated by sitting, standing, and certain movements. It is alleviated with rest. Palpation localizes the pain, and muscle spasms are felt. There was an insidious onset with progressive improvement. What is the most likely diagnosis? Musculoskeletal strain. - Pain over the lower back muscles and spine, without sciatica, is caused by musculoskeletal strain. Often there is no precipitating event, and there is an insidious onset. It is aggravated by sitting, standing, and certain movements. Palpation localizes the pain, and muscle spasms may be felt. It is alleviated by rest, and there is progressive improvement. Question 27. Greg, age 26, runs marathons and frequently complains of painful contractions of his calf muscles after running. You attribute this to: Hyponatremia. - Painful contractions of muscles after exertion, such as heat cramps, may be related to hyponatremia or other electrolyte imbalances. Usually the gastrocnemius and hamstring muscles are involved. Treatment of heat cramps includes passive muscle stretching, cessation of activities, transfer to a cooler environment, and drinking cool liquids. Sports drinks that contain electrolytes, such as Gatorade, may be beneficial. Question 28. Mr. McKinsey, age 69, was recently given a diagnosis of degenerative joint disease. Which assessment should the nurse practitioner use to check for effusion of the patient’s knee? Bulge test. - The bulge test assesses for an effusion of the knee. If effusion is present, a bulge will appear at the sides of or below the patella when the practitioner compresses the area above the patella. Question 29. The nurse practitioner is considering a diagnosis