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WorksheetsTest Ngoại 161-230
Total questions: 70
Worksheet time: 35mins
What is the absolute indications for renal exploration following blunt trauma?
An expanding or pulsatile retroperitoneal hematoma or Grade V vascular renal injuries
Flank pain
Abdominal distention
Grade III trauma
What is the difference between compact bone and spongy bone?
They have different bone marrow.
They are made of different materials.
They have different sizes of bone cells.
They have different arrangement of bone cells.
What makes bones so strong?
Silica
Cartilage
Blood and marrow
Calcium and phosphorous
Which of the following statement is INCORRECT?
Bone is where most blood cells are made.
Bone serves as a storehouse for various minerals.
Bone is a dry and non-living supporting structure.
Bone protects and supports the body and its organs.
What is the last stage in the repair of a fracture?
Bony callus
Hematoma
Inflammation
Fibrocartilage callus
The cells that tear down and remodel bone are the …
Osteoblasts
Osteocytes
Osteoclasts
Macrophages
Which of the following describes bone remodeling?
Plastic surgery after an accident
Bone growth through adolescence
Joint replacement
Deposition and absorption of bone minerals
Bone-forming cells are called …
Osteoblast
Osteoclasts
Osteons
Osteocytes
The bone marrow that produces blood cells is found in …
Compact bone
Strong bones
Spongy bone
Developing bone
Which of the following is NOT a function of the skeletal system?
Support
Protection
Synthesis of growth hormones
Manufacture of red blood cells
Which of the following should be examined with the patient in the seated position?
Lower extremities.
Lumbar spine.
Upper extremities.
Leg strength.
Which of the following techniques is utilized in a general musculoskeletal examination?
Hot vs. cold contrast.
Sharp vs. dull contrast.
Range of motion.
Percussion.
Which nerve root supplies an Achilles reflex and sensation of the lateral foot?
S1
L5
L4
L3
Which of the following describes passive flexion of the hip?
Gently move the leg so that the ankle crosses over the opposite knee.
Gently roll the leg inward and outward.
Gently move the leg away from the midline.
Gently bring the knee to the chest while patient is supine.
Which of the following when compressed or deficient, exhibiting a hyperactive anal reflex and dysfunctional bladder?
T12, L1.
L1, L2, L3.
L2, L3, L4.
L5.
What is a key factor in assessing the elderly?
Simple language can be understood most easily.
Elderly injuries are due to falls.
Injuries are the result of normal physiologic changes and cannot be prevented.
Ability to perform activities of daily living is necessary for self-care.
Which of the following is significant related to neurovascular status?
Comparison between extremities is not necessary when assessing the operative limb.
Always elevate the extremity above the level of the heart.
Treatment of neurovascular compromise may include cast or splint removal, resolution of edema, or emergency fasciotomy.
It’s necessary to assess capillary refill, pulses, and sensation but not color, movement, temperature.
What of the following is accurate about the immobility effects to the integumentary system?
Redness at a site for 60 minutes or more after pressure has been removed indicates that a pressure area is developing.
Scar tissue and skin grafts are the same risk for breakdown as normal areas of the skin.
Children present the highest risk for pressure ulcers.
The sacrum and heels are most susceptible to the effects of shear.
Which of the following is a sound respiratory factor related to patient position changes?
Supine position permits gravity to pull mucus to dependent areas of the lung.
Deep inspiration and rapid exhalation required for coughing are attainable in any position.
Counter-resistance of chair or bed increases chest expansion.
Total lung capacity decreases with advancing age.
Which of the following is the most common sign of cardiac deconditioning from immobility?
Tachycardia.
Diaphoresis.
Nausea.
Postural hypotension.
Which of the following is true about musculoskeletal effects of immobility?
Decreased muscle mass is related to increased stress on muscle.
Immobility decreases muscle load, activity, and protein synthesis and also increases protein breakdown, resulting in muscle disuse atrophy.
Immobilized muscle loses about 1% of its original strength per day and varies with degree of immobility.
Muscle atrophies more quickly in a stretched position than if held in a shortened position.
Which of the following factors is associated with disuse osteoporosis seen in immobilized patients?
Osteoporosis is common proximal to fracture sites.
Only muscle contraction promotes blood flow into and out of bone.
Bone formation is enhanced, and, within a short period of time, the situation is reversed with early mobilization.
Osteoporosis is not common in paralyzed people.
Which of the following is considered an immobility influence on the urinary system?
The renal pelvis may not empty completely into the ureters.
Excessive stretch of bladder muscle may enhance the sensation to void.
Kidney excretes less amounts of minerals and salts.
Excretion of calcium is decreased 2 days after mobility begins, leading to stone formation.
Which of the following is conducive to preventing pressure ulcer formation?
Reposition every hour while in a chair.
Head of bed should be elevated to reduce pressure on the upper extremity pressure points.
Use of dynamic support if patient cannot assume various positions.
Use the Braden Scale only after the formation of a pressure ulcer.
Which of the following is a common therapeutic modality for problem prevention in a body system?
Discourage use of a hyperinflation device.
Perform physical therapy on only the affected extremity.
Encourage a high calorie diet.
Duplicate normal prehospital routine as much as possible.
Which of the following should occur after a pressure ulcer is detected?
Make all attempts to keep the area pressure reduced.
Provide diet low in carbohydrates and fats.
Remove pressure through repositioning, bridging, support devices, and specialized beds.
Monitoring should occur no more often than every 8 hours to reduce the risk of infection.
Which of the following increases the risk of orthostatic hypotension?
Urinary retention.
Diaphoresis.
Coumadin.
Cefazolin.
Which of the following is accurate related to addiction and tolerance?
Tolerance is a psychological dependence on the use of substances or activities for their psychic effects that is characterized by compulsive use.
Tolerance is needed for increased dosage of a drug for acute pain management.
Addiction easily occurs in people taking drugs for acute pain management.
Addiction occurs when a reduced effect is observed with a constant dose.
Which of the following characterizes chronic pain?
Arising from injured peripheral or central neural structures.
Follows acute injury or disease.
Resulting from the ongoing activation of primary afferent neurons by various stimuli.
Associated with malignancy (ongoing painful process such as cancer or rheumatoid arthritis) or no malignancy (tissue injury is non-progressive or healed, such as phantom limb or fibromyalgia).
Which of the following are considered physiological effects that are associated with unrelieved pain?
Increased gastric and bowel motility.
Decreased heart rate, decreased cardiac output, hypotension.
Decreased cortisol, decreased epinephrine, decreased glucagon.
Muscle spasm, impaired muscle function, fatigue, immobility.
Which of the following is a misconception related to pain management?
People usually do not become addicted to narcotics while in the hospital.
Active children can be in pain.
It is best to wait as long as possible to get or take pain medication.
The elderly do not have less pain sensitivity.
Which of the following is a principle of pain management?
The health care provider is the expert.
A generic pain management plan fits each disorder, disease, or procedure.
Combine analgesics for greater effect and fewer side effects than larger doses of a single medication.
Meperidine has the least side effects of IV narcotics.
Which of the following is a consideration for managing pain in a patient with an active addiction?
A person with an addictive disease may be relatively pain intolerant.
It is not necessary to consult an addiction or pain specialist to manage pain of a patient with an addictive disease.
Opioid use should be avoided in the patient with an addictive disease.
Mixed opioid agonists/antagonists are approved for use in a patient with an addictive disease.
Which of the following is a barrier related to the health care team regarding effective pain management in the elderly?
Seniors don’t want to use unfamiliar technology such as PCA pumps.
Failure to express pain means absence of pain.
Fear of being bothersome or distracting.
Everything is being done that can be done.
Which of the following is considered an effective nonpharmacologic intervention for chronic pain?
Formulate a partnership which demonstrates that the health care team is in charge of methods to reduce pain.
Heat is used instead of cold since warmth is a reassuring quality.
Relaxation techniques help to reduce anxiety and tension, which aggravate pain.
Pain is a serious thing, so humor should be avoided.
Which of the following is accurate related to routes of administration for analgesics?
Intramuscular route is route of choice because of even dose absorption.
Epidural infusion should be by continuous infusion only.
Transdermal route is effective for acute as well as chronic pain.
Subcutaneous route can be used if no IV access, but absorption is slower.
Which of the following is important to remember about NSAID use?
NSAIDs are contraindicted in patients with chronic renal failure or aspirin allergy.
Cox 2 inhibitors affect platelet aggregation the same way as other NSAIDs.
Like other NSAIDs, Ketorolac is only given orally.
Side effects include only nausea, anorexia, and gastritis.
Which of the following is accurate regarding equianalgesic dosage?
Two medications are considered equianalgesic if they are used by the same route.
Use of equianalgesic dosages increases the probability that dose route or drug changes will be accomplished without loss of pain control.
A drug is more effective if it is more potent than another drug.
Most opioids do not contain the same level of effectiveness.
Which of the following is a safety precaution related to epidural analgesia?
One RN is required to set up and program an epidural pump.
Nurses need to be certified during their orientation period to set up and program epidural pumps and to set dosages and parameters.
Pumps can be used interchangeably between IV and epidural infusions.
No other analgesics, hypnotics, or sedatives in addition to the epidural dosage are to be administered unless written by the MD responsible for the infusion.
Which of the following is necessary related to administration of IV conscious sedation?
Monitor blood pressure, respiratory rate, and O2 saturation every 10-15 minutes.
The assigned nurse should care for no more than one other patient besides the one receiving IV conscious sedation.
Assess level of consciousness and mental status, skin color and condition, pain status every 5 minutes.
Patient may drive self home after having met all post-procedural criteria.
Which of the following is accurate related to pain management in special populations?
Start analgesics at 1/3 the usual adult dosage for children.
Pain perception decreases with age.
Opioids are not too strong to use in the elderly.
There is no accurate way of assessing pain in the cognitively impaired patient.
Complications after orthopaedic surgical procedures are related to a patient’s:
Age, race, and medication use.
Age, ethnicity, and wound infection.
Age, co-morbidity, and mechanism of injury.
Open or closed injury, language barrier, and obesity.
Transient, fluctuation in cognition, consciousness, and misperceptions in medically ill patients are primary signs and symptoms of:
Delirium.
Fat embolism.
Deep vein thrombosis.
Pulmonary embolism.
On the third post-operative day after a total knee replacement the nurse notices that 64-year-old Mr. Albert has not eaten much of his lunch. He has no appetite and even though he is passing flatus, he feels bloated. He has not had a bowel movement since surgery. Bowel sounds are present. Which of the following complications is most likely.
Depression.
Constipation.
Paralytic ileus.
Bowel obstruction.
The primary etiologic factors for pressure sores are:
Age and dehydration.
Incontinence and depression.
Decreased sensation and nutritional status.
Pressure over bony prominences and shearing forces.
After eating lunch on the first postoperative day after a rodding of his fractured femur, 43-year old Bob Suppa complains of chest pain and shortness of breath. He is apprehensive and restless. Vital signs are: temperature of 100 degrees Fahrenheit, respiratory rate 22 breaths/minute, heart rate 96 beats/minute and regular. Which of the following is most likely the explanation for his symptoms?
Hemorrhage.
Pulmonary embolism.
Myocardial infarction.
Deep vein thrombosis.
External pneumatic compression and graduated compression stockings are used in the prevention of which of the following complications?
Fat embolism.
Deep vein thrombosis.
Pressure ulcer on the heel.
Pressure ulcer on the heel.
The following factors: low preoperative platelet count, acetabular and pelvic fracture, pre-operative use of aspirin to manage arthritic pain, and a 3 hour surgical procedure, all increase the risk of which of the following postoperative complications?
Deep vein thrombosis.
Fat embolism.
Hemorrhage.
Infection.
Nursing interventions to decrease the occurrence of post-operative wound infection include:
Provide adequate analgesia, maintain hydration, assess and provide for nutritional needs, and use aseptic technique with dressing changes.
Keep the room cool to avoid overheating, assess and provide for nutritional needs, and use aseptic technique with dressing changes.
Keep blood pressure on the high side to maintain perfusion, tolerate slight hyperglycemia to avoid the likelihood of an insulin reaction in a diabetic, and minimize fluid intake.
Encourage oral fluids over solids to enhance circulatory volume, keep patient warm to avoid vasoconstriction, minimize use of analgesics so that increased pain associated with infection will be easily recognizable.
Which of the following patients is at greatest risk of developing FES?
Patient with a forearm fracture.
Patient with a tibia fracture, with immediate closed reduction and cast.
Patient with a femur fracture with delayed open reduction internal fixation.
Patient with a hemiarthroplasty.
Women with a history of motion sickness and no history of tobacco use who receive opioid analgesics in the immediate postoperative period are at increased risk for:
Infection at the surgical site.
Hospital acquired pneumonia.
Postoperative urinary retention.
Postoperative nausea and vomiting.
Consistently keeping the head of the bed at 30-45 degrees is an important intervention to prevent which of the following complications in patients on mechanical ventilators?
Delirium.
Pulmonary embolism.
Ventilator acquired pneumonia.
Postoperative nausea and vomiting.
Mr. Smith, a 61 year old, had bilateral total knee replacements. On postoperative day #1 he was confused and short of breath. His oxygen saturations fluctuated between 68% and 91%. In addition, Mr. Smith developed a petechial rash on his neck. Which of the following most likely explain his symptoms?
Fat embolism.
Pulmonary embolism.
Myocardial infarction.
Hospital acquired pneumonia.
Johnny, a 7-year-old child, fell off his bicycle and sustained a right radial/ulna fracture. His fractures were closed reduced and a cast was applied from his wrist to above his elbow. After one day Johnny complained repeatedly of “lots of pain” despite the pain medication his parents gave him. His crying became more intense, and he developed numbness and tingling in his hand. Johnny’s parents brought him back to the hospital and he was diagnosed with:
A nonunion.
Being a “cry baby.”
A severe contusion.
Compartment syndrome
Which of the following actions should a nurse do first if concerned about signs and symptoms of compartment syndrome in a patient with a tibia fracture?
Send blood tests.
Inform the physician.
Administer pain medication.
Test the urine for myoglobin.
Your patient, a 61-year-old obese woman with a 40-pack year history of smoking, has been diagnosed with a delayed union of the right tibia. Which of the following measures is likely to make the biggest difference in successful healing of her fracture?
Monitoring her oxygen saturation regularly.
Weekly weights to facilitate efforts at weight loss.
Successful participation in a smoking cessation program.
Maintaining partial weight bearing for a minimum of 3 months.
Which of the following is not a presenting symptom for a person with a fractured hip?
Leg length discrepancy.
Affected leg externally rotated.
Pain and discoloration in the area.
Affected leg is adducted.
A patient is diagnosed with an intertrochanteric fracture. This is located:
Within the joint capsule.
Between the trochanters.
Below the lesser trochanter.
In the femoral neck.
Which of the following is not an appropriate nursing intervention?
Monitor his pain level and administer medications as need.
Instruct the patient on the proper gait for walker/crutches.
Teaching the patient about weight-bearing activity restrictions.
Make discharge plans with the patient’s family to prevent stress for the patient.
The physician's operative note indicates a primary total hip arthroplasty was performed. This means:
The head and neck of the femur and acetabulum were replaced.
Only one component of a total joint replacement was replaced.
The patient had a hip replacement previously.
The joint was totally excised due the arthritis pathology.
Which finding from the patient history and physical examination would most likely be the indication leading to arthroplasty surgery?
Anterior thigh pain radiating toward the knee, increasing overtime.
Decreased range of motion in the joint and increased pain.
Shortening of the affected extremity.
The patient needs to take ASA after his daily walks.
In teaching the patient about hip precautions, which of the following is not appropriate?
Don't sit in a low chair.
Don't sit with legs crossed.
Don't flex the hip more than 90 degrees.
Don't keep the extremity in neutral alignment or slightly abducted.
When transferring a post arthroplasty patient back to bed the patient complains of acute groin and hip pain and says they felt something "pop." What should the nurse anticipate?
Subluxation.
Dislocation.
Infection.
Fracture.
Which of the following is a true statement regarding a femoral osteotomy?
Late-stage arthritis present with joint congruency.
Procedure realigns the acetabulum with the femur.
Used for a mid-age adult as an alternative to an immediate total hip arthroplasty.
It is a permanent, long-term treatment option for most patients.
A 30-year-old female presents to the emergency room after a motor vehicle crash with the following symptoms: severe pain to the right lower extremity and inability to move it; bruising, swelling, and deformity mid-thigh with an open wound; and leg length discrepancy. Which of the following is a likely diagnosis?
Closed femur fracture.
Extracapsular hip fracture.
Dislocated hip.
Open femur fracture.
Which statement is true regarding pelvic fractures?
Pelvic fractures are always unstable.
Additional abdominal trauma is unlikely with severe fractures.
There are no major blood vessels of concern in the pelvic area.
Pelvic fractures can result in high-volume blood loss.
The patient requires revision of the total hip replacement he had implanted 12 years ago. Prior to insertion of the revision components it is most important to:
Assess ROM.
Rule out infection.
Keep the patient immobilized.
Advise the patient not to flex the hip > 90 degrees.
The patient had decreased ROM after his first total hip arthroplasty because of heterotrophic ossification in the hip flexor muscles. Following the revision total hip arthroplasty the patient should:
Begin physical therapy with aggressive ROM.
Disregard THR restrictions completely.
Undergo postoperative radiation.
Take aspirin prophylactically for two weeks.
The patient tells the surgeon that he would like the minimally invasive procedure for his total hip replacement. The surgeon explains that he is not a candidate because:
His BMI is 25.
He has a fixed flexion contracture of 15 degrees.
The etiology of his hip disease is osteonecrosis.
He is physically active.
Which of the following is CONTRAINDICATED for the operative leg following hip replacement surgery?
Adduction.
Abduction.
Hip flexion 90.
External rotation.
