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WorksheetsCh44 practice quiz Part 1
Total questions: 56
Worksheet time: 42mins
Your patient is complaining of pain in his big toe of his left foot. the pain occurs at night and causes swelling . He's frustrated because it happens often, but he can never tell when. Which of the following is the doctor likely to do based on the big book?
advise patient to avoid sardines, herring and anchovies
prescribe vitamin D3
prescribe probenecid
prescribe Aspirin
check serum uric acid levels
When performing a history for suspected gout, which of the following clue you in to the possibility?
the patient eats a lot vegetables
parent who had a history of gout
the patient has said the pain is bilateral and simultaneous
patient has a history of alcohol consumption
patient uses diuretics
You are reviewing a patients(female) charts. Which of the following are causes for concern?
ESR (22 mm/hr)
Uric acid levels ( 4.5 mg/dl)
WBC's ( 10,500/mm)
platelets ( 250,000 /mm)
aPTT (15 seconds)
Your patient with gout complains that night pain is unrelieved. He is currently on probenecid, colchicine, dexamethasone, and methotrexate. Which of the following is correct in regards to orthodox gout treatment?
aspirin will be added to assist with pain management.
all medications need to be discontinued and a new regimen started
due to adverse side effect( bone pain), dexamethasone will be discontinued
colchicine will be removed
define gout
chronic, progressive rheumatic disorder that affects many areas, but primarily the spine
chronic loss of bone density
acute, inflammatory accumulation of uric acid in the blood.
chronic, systemic inflammatory disease that affects many organs but the ligaments and cartilage
A key characteristic of gout is
Heberden's Node
benign tumors
tophi
Bouchard's node
gangrene and amputation of the affected limb
for your Gout patient, which of the following is a wrong intervention/patient teaching to perform?
Advise no alcohol or food high in purines
bed rest and immobilization of the affected joint
increase fluid intake
monitor I&O
decrease fluid intake
What do you tell your patient who asks the typical outcome of gout?
ask the doctor, I just pass meds
I'm sorry, Gout is degenerative, the general prognosis is 2 years as multiple organs are affected.
Gout is not curable and your symptoms will last longer with each inflammation period.
If you eliminate foods high in purines from your diet and take the prescribed medication as dictated, you can have full recovery in as little as 3 months
Gout is chronic, vitamin D supplements, coupled with methotrexate can limit symptoms
Your patient is complaining in the chest and lumbar vertebral areas. She says she feels stiff and you can hear her bones giving off a "creaky" sound. Which of the following do you suspect?
RA
OA
SLE
Osteomyelitis
calcium deficiency induced fractures
When taking your patients health history, he says he has no family history of any disease, he does not smoke/drink, exercises and eats healthily, nor had any blunt traumas recently. However his symptoms appear to be OA. why would you diagnose this?
He presents with petechiae and dyspnea
because he mentions bilateral and simultaneous inflammation
OA can be idiopathic
because all seniors have OA
Which of the following would be at the lowest risk for acquiring OA?
45 year old male with a sedentary lifestyle
a warehouse worker
a football player
a woman age 75
a ballerina
Where are OA symptoms typically seen?
hands of women
the necks of women
feet of men
knees and elbow joints
hips of men
Osteoarthritis is
comorbid with other rheumatic diseases
the least diagnosed form of arthritis
the most common form of arthritis
the most serious form of arthritis
Your patient with OA does not want to leave bed. She is scared of physical activity pain. Which exercises if any would you recommend for her?
biking
archery
no weight/ slow squats and chest strengthening exercises
swimming
light stair climbing
Which of the following are a key trait of osteoarthritis?
tophi
malignancy
benign tumors
cholecystitis
nodes on the hands
The physician is trying to diagnose Osteoarthritis, which of the following diagnostic tests is he likely to order?
Dexa scan
MRI
XRAY
synovial fluid biopsy
bone scans
Which of the following should the nurse teach her client in regards to their medication?
To take the prescribed does of mycophenolate as prescribed, can cause blindness
to monitor their Blood pressure while taking Aspirin
That phantom pain is often associated with aspirin use
digoxin can cause paresthesia, notify physician so as to lower dose or change medication
If your OA patient is complaining of unrelieved pain, which of the following are you likely to see in the MAR for pain?
IV prednisone
IV cortisone
IV acyclovir
IV Dilaudid tablets
Carisoprodol tablets
Joint replacement for OA patients is most likely to be for the ....... and .........?
(a)
Should the physician wish to provide alternative therapy to your OA patient, what is she likely to prescribe/ recommend?
Glucosamine
physical therapy
imagery
dopamine reuptake inhibitors
massages
As the nurse, what is the primary intervention for OA patients?
movement
keeping affected limb immobilized till inflammation passes
teaching patient proper medication administration
requesting restraints (raised side rails) to limit fall risk.
placing the bed in lowest position and rails around the room to support the patient
Total hip replacement is indicated when arthritis involves the
the head of the femur
acetabulum
cocci
iliac crest
your patient has neither involvement of the femur, nor acetabulum. What other indications could result in needing a hip arthroplasty?
fractures
lacerations
tumors
fat emboli
injuries
in a client requiring a hip arthroplasty, which of the following interventions would you preform?
assess clients cooperativeness to preserve circulation
prevent impairment of the skin
prevent hypostatic pneumonia
deep breathing every 2 hours(incentive spirometer)
asses for hypotension, tachycardia, tachypnea, hypovolemia
Which of the following diagnostic procedures is the physician likely to request before the hip arthroplasty?
Dexa Scan
MRI
X-ray
Bone scan
none of the above
During the hip arthroplasty, which of the following is likely used
hemovac (closed wound suction)
cardiovac (closed wound suction)
renalvac (closed wound suction)
cephalovac (closed wound suction)
What are the postoperative interventions you will provide for a hip arthroplasty patient?
neurovascular checks every 24 hrs, then every 2 hrs for 24 hours, then every 4 hours, along with vitals
provide analgesia via a PCA pump
Provide embolism stalking before and after the procedure
maintain leg position with abduction splint/ pillow
use assistive device to reach objects on the floor
What are the 7 P's of neurovascular check?
pulselessness, paresthesia, paralysis, polar temperature, pallor, puffiness, pain
pulselessness, paresthesia, poor circulation, paralysis, pallor, polar field inversion, puffiness, pain
paresthesia, paralysis, pulselessness, polar temperature, pallor, pain
this is not the correct acronym. the correct one is peanut
Post operative hip arthroplasty should report which of the following to their provider immediately according to the book?
malaise and excessive fatigue unrelieved for 3 days
dehiscence
evisceration of the surgical site
erythema of the foot if the repaired joint
numbness and tingling in extremities
sprains affects the ............?
ligaments and muscles
ligaments
muscles
strains affects the ............?
ligaments and muscles
ligaments
muscles
Directly following hip arthroplasty, Jackson-Pratt drainage tubes should be
removed and delegate monitoring and suctioning to nursing staff
replaced with hemovac
maintained
removed
have their suctioning function slowed to allow synovial fluid to accumulate
Describe a fat embolus
accumulation of fatty tissues
embolization of tissue fat, platelets, fatty acids within lung capillaries
embolization of platelets and RBC's
vasoconstriction which causes fats to clot
What makes fat emboli deadly?
uric acid concentration leading to Renal failure
its not deadly, but will cause dizziness/blackouts
the capacity to puncture the lungs or heart
hypoxia and tissue damage of the brain
In a patient suspected of having a fat embolism, what subjective information would you assess?
orientation
sweating
irritability
crackles
Chest pain
In patients suspected of having a fat embolism, which of the following objective data can you expect to find?
fainting spells
Hypoxemia
crackles
ecchymoses
petechiae
In a patient with a fat embolus, petechiae would be locarted where?
conjunctiva of the eye
neck
chest
armpits
abdomen
In a patient with a fat embolus, which diagnostic tests are typically used?
X-ray
Blood gasses(hypoxemia)
CBC( hemoglobin/hematocrit)
CBC (platelet count)
Renal panel (BUN)
Medical management of a fat emboli would include?
Oxygen therapy
corticosteroids
Digoxin(increases circulatory output)
antiemetics
incentive spirometer
For your patient with a fat embolus which of the following interventions would be performed?
assessment of arterial blood gasses
Monitor I &O
have patients remove their anti-embolic stockings at night
massage the area over the embolus to break it up
assess daily weight
Which of the following would you use to describe osteoporosis to a client diagnosed with it?
age related bone thinning
deposits of malignant tumors degrade bone structure over time
loss of bone density
accumulation of uric acid in the blood
degenerative bone disease resulting from inflammation
who is at the highest risk for osteoporosis?
A woman who is 56 years old
A man who is 65 years old
A man whos mother had osteoporosis
A woman who is 56 years old with family Hx of osteoarthritis
why do women between the ages of 55 and 65 have a high risk for osteoporosis
decrease in prostaglandin function
testosterone imbalance
estrogen deficiency
release of luteinizing hormone in menopause
Less vitamin D synthesis than men of a same age
Which ethnic groups/stature are most indicated for osteoporosis
Small Caucasian and Oriental women
Large African and steppe women
Small women of South American or Middle Eastern descent
Large women of German or Scandinavian heritage
What are the risk factors ascribed to osteoporosis?
smoking
drinking
genetic/environmental factors
lack of exercise
low social-economic standing
You have a patient with Osteoporosis. Which of the following initial symptoms would not surprise you?
creaky bones
bone pain
vertebral fracture
hip fracture
pain in the bones of the extremeties
Define lordosis
rounding of the lumbar spine
lateral curvature of the spine
increase of the spine inwards
rounding of the thoracic spine
Define scoliosis
rounding of the lumbar spine
lateral curvature of the spine
increase of the spine inwards
rounding of the thoracic spine
Define kyphosis
rounding of the lumbar spine
lateral curvature of the spine
increase of the spine inwards
rounding of the thoracic spine
In your patient with osteoporosis, which diagnostic procedures would be used to verify the diagnosis?
Blood test for Calcium/Phosphorus
XRAY
Dexa scan
Nuclear scan
Bone mineral density scan
For patients the doctor would prescribe a vitamin D supplement. What would be contraindicated with this treatment?
amphetamines
smoking
Alcohol
muscle-skeletal relaxants
corticosteroids
After the attending physician prescribes Alendronate for advanced Osteoporosis which patient teaching would you need to reinforce?
Administer Alendronate with 6-8 oz. of water
sitting upright 30 minutes after ingestion of Fosamax
Patient must drink Fosamax with milk
monitor patient for nausea, dizziness, leg cramps, hypercalcemia
sit upright 30 minutes after taking Alendronate
For patients who have not had their pain controlled via analgesia, what are the next viable options?
hip arthroplasty
vertebroplasty
Kyphoplasty
angioplasty
nephrectomy
Your patient was admitted to the hospital for pain associated with scoliosis. After being admitted he wants to leave 4 hours later after pain is controlled. What is the appropriate response?
Your physician advises against it, but if you must please sign these AMA papers
When you were admitted you signed agreeing to follow our 24 hour holding policy
order sedatives
Have patient sign AMA papers, and provide teaching on home pain management
Of the following interventions/ Patient teaching, Which of the following would you not preform for your Osteoporosis patient?
provide safety measures against falls
place bed in the lowest position
advise substituting smoking for nicotine patch
place a sit chair in patients shower
advise patient to take recommended Vitamin D supplement
How would you respond to a client who asked the general outcome of osteoporosis?
your condition is chronic, fracture episodes will be more frequent every year
your condition is chronic, Vitamin D supplements can slow bone loss
Your condition can be reversed with vitamin D supplements and immunoboosters
With 1 year of medical treatment you can reverse your disease
