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WorksheetsChapter 44 practice quiz Part 2
Total questions: 50
Worksheet time: 37mins
Define Rheumatoid Arthritis
chronic, inflammatory autoimmune disease of the joint
chronic, systemic, inflammatory autoimmune disease of the joints.
degenerative joint disease
degenerative bone disease
RA is the least serious of all arthritic diseases
True
False
In a patient you suspected of having RA, which of the following subjective symptoms would you expect?
morning stiffness
fevers
joint pain
fatigue
bilateral joint pain
For the same RA patient, which objective data would you expect to see?
swelling of the joints
fatigue
muscle aches
fever
irritation
What is the catalyst for RA "Flares"
Idiopathic
antigens against the ligaments of the joints
stress
low hemoglobin hematocrit
excess of proteins in the body
Which diagnostic tests would be used for a patient suspected of having RA?
ESR
Synovial Fluid Aspiration
RF factor
Anti-RO
ANA
What is the main treatment class for RA?
antivirals
Corticosteroids
DMARDS
Salicylates
COX-2 Inhibitors
Besides DMARD's which alternative medication classes are likely to be furnished to patients with RA?
Salicylates
NSAIDS
COX -2 Inhibitors
Antimalarial
Antineoplastic Drugs
In RA intermittent immobilization the joint is crucial so as to slow inflammation
True
False
Beside physical activity what other nursing intervention/treatments are used for RA patients?
cryotherapy
balancing rest and activities
heat therapy
Fall precautions
use of orthopedic devices
What is the prognosis for Rheumatoid Arthritis?
manageable with antivirals combined with vitamin D
chronic with periods of remission which grow further apart as the disease develops
Chronic with stages 1(minimal) - 5(terminal)
Chronic, yet limited to a singal organ
What are MRI's typically used to find?
abnormalities of the bone
abnormalities of the joint
internal bleeding
internal inflammation
Do patients undergoing an MRI need any special precautions.
CBC for phosphorus levels
removal of all metal items
Isolation following to protect others from radiologic specimens
special eye pads to reduce the risk of becoming blind
What is phantom pain?
Pain where inflammation cannot be detected by ESR/WBC's
pain in an amputated limb
pain associated with psychosis
pain behind the inner cantus of the eye. Not real, yet is produces by false brain signals
What causes phantom pain
nerves at amputated site still send messages to the brain
Overabundance of RBC's at the site causes pressure
What is the treatment options for a client with unmanaged Phantom Pain?
Amputate the lib at a higher spot
inserting procaine into the stump
repeatedly hitting the limb against something
prescribing a sympathetic nerve block
Encourage the patient psychologically
During the healing stage of a fracture, what is the purpose of Callus's?
creates inflammation around the site to protect it
to form a bony deposit between and around the ends of the broken bone
mature osteoblasts that lay the ground work as well as create the new bone
tear down old bone
strengthens and adds calcium to the fracture
For the following symptoms/ afflictions, which would necessitate the uses of an Myelogram to assist in diagnosis?
herniated disks
tumors
callus'
infection
malignant melanomas of the skin
Of the following, are precautions/procedure used within a myelogram?
removal of oil based dye through spinal needle
removal of water based dye through spinal needle
placing patient in Semi-Fowlers for 12 hrs after Myelogram(water based)
if oil based dye, patient lays flat for 12 hrs
use of contrast
What is the appropriate response to a patient who worries over paralysis from needle injection?
You do not need to worry, the surgeon knows what he is doing
this is unlikely to happen as the needle will be inserted below the spinal level
This is unlikely to happen, but we can give you medication for your anxiety during the procedure if you prefer
You seem really anxious over the prospect of being paralyzed. Tell me more about this.
You are told that the patient you have not yet met has compartment syndrome. What can you expect?
a mental condition in which the patient ascribes certain personalities to various aspects of his or her life
degenerative chronic gangrene condition managed through antifungals and amputation
Patient has paralysis of a limb
loss of function in a single ear or eye
Which of the following subjective/ objective data would you expect to see in a patient with compartment syndrome?
unrelenting pain, not soothed by analgesia
inability to flex fingers or toes of affected area
absence of pulse in the affected area
coolness in the affected area
erythema of the effected area
what is the medical treatment for compartment syndrome?
DMARD's
NSAID's
fasciotomy
tracheotomy
As the nurse to a patient with compartment syndrome, what interventions would you apply?
cryotherapy
amputate the limb yourself
elevation of the leg no higher than the heart
place the patient in reverse Trendelenburg's position
remove anything constrictive to the limb
What is an irreversible consequence of Compartment syndrome if not properly managed?
cauterization of the limb
amputation of the limb
Volkmann's contracture
reduced use of the hand
What would be a likely scenario leading to a bone fracture?
kid falls from a skateboard
child trips in a bouncy house
a person who steps on a Lego barefoot
smoking frequently
Which diagnostic tests would be used to examine the fracture?
X-ray
Myelogram
Synovial fluid Aspiration
Dexa Scan
With the top row resembling 1-4, and the bottom row resembling 5-8;one and 5 beginning from the left side. which of the following are considered open fractures?
1
2
3
4
8
With the top row resembling 1-4, and the bottom row resembling 5-8;one and 5 beginning from the left side. which of the following are considered Simple fractures?
1
2
3
4
8
For patients with fractures, what is crucial
the affected area is given a tetanus shot
the patient be put on complete bed rest
the wound be soaked in saline solution
the patient requires the use of a bariatric chamber
How will you acquire the patients baseline if they are immobilized due to fracture?
A CBC with as many vitals are possible
7 P's
MILK acronym
SOAP acronym
What is ORIF, and how is it used in the context of a fracture?
Orthopedic Reduction and Infrared Fixation (used to image the affected area)
Open Reduction with Internal Fixation ( surgery to place fractured pieces back in original place)
Open Reduction Induced Fracture ( rebreaking an old wound that healed wrong)
For open fractures in addition to the precautions used for a closed fracture, what additional measures are used?
Debridement
transalpine cast
barbituric
wound culture
check for last tetanus shot administration?
In stage 1 post bone fracture healing, what occurs
bleeding
swelling
clots form
inflammation
In stage 2 post bone fracture healing, what occurs
osteoclast begin breaking down wound
swelling
osteoblasts form
inflammation
In stage 3 post bone fracture healing, what occurs
osteoblasts create new bone
osteoclasts destroy dead bone
WBC's create inflammation around the joint
collagen incorporates callus's
In stage 4 post bone fracture healing, what occurs
remodeling occurs when excess callus' reabsorbed
endothelial cell begin process of rebuilding skin
WBC's create inflammation around the joint
spongy bone laid down
What are the most common complications caused by fractures?
compartment syndrome
thromboembolus
fat embolism
leukopenia
Gas Gangrene
What causes Gas Gangrene?
shower fungi(gym)
Clostridium perfringens
unwashed genitals
C. Difficile
What clinical manifestations would you expect to see in a client with Gas Gangrene?
Gas bubbles under the skin
growth of moldy substances in dark moist areas of the body
Necrotic tissue
patient has difficulty walking
What would the medical management be for Gas Gangrene?
creating a new surgical site for oxygenation/ promote drainage
NSAIDS
Skeletal muscle relaxants
antibiotics
As a nurse treating a patient with Gas Gangrene, what interventions would you employ?
Initiate sterile technique
Scraping to lesson growths
Placing heated cloth over affected extremity
utilize cytogenesis
How would you describe the pathology of a thromboembolus?
blood vessel blocked by an embolism
an embolism that travel until it becomes stuck then dislodged again
What would be the clinical symptoms associated with a thromboembolus?
elevated triglyceride levels
Patient has dyspnea, hypertension, hypotension
cold, numb, and cyanosis of the affected area
patient has a sharp thoracic pain
What would the medical management be for a patient with a thromboembolus initially?
Anticoagulants
thrombectomy
ORIF
oxygen therapy
Nursing intervention for thromboembolus?
patient is on activity restrictions
Anti embolic stockings
Monitor I & O
Monitor PT, INR, PTT
What is the purpose of traction devices?
align and stabilize a fracture site
relieves pressure on the nerves in the cases of a herniated disk
helps maintain proper positioning
prevents deformities
relieves muscle spasms
Skeletal Traction used for the bones of the femur, tibia, humerus and cervical spine. How does it work?
pierces the heel of the foot, patient is given regional anesthesia
The pins form a tight mesh around the bone promoting immobilization
The pins are applied directly to the bone with patient under local or general anesthesia
applied to the skin and for short periods
Skin Traction
is used for a short amount of time and uses lighter weights
is used for long periods of time and requires patient to be under general sedation
only used in the third phase of fracture healing
only used in the 2nd round of fracture healing
What is the difference between buck's and Russell's traction
Bucks is for hip use, Russell's is for knee
Bucks is a sling on the knee, Russell's is used on the hip
The weight of the pins and pulleys is heavier is Buck's than Russell's
Russell's traction is used for fractures that are nearly completely healed
