TEST 5 – Chapter 22 – Flashcards
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The nurse is caring for a patient who has been experiencing axial skeletal pain for 3 months and who reports mental confusion and forgetfulness. The nurse finds that the patient also has insomnia and fatigue. Which condition does the nurse anticipate in the patient?
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*Fibromyalgia syndrome* manifests as a widespread pain in the muscles. The patient with fibromyalgia syndrome may also have fatigue and insomnia along with the pain. This condition may cause psychosocial distress in the patient, leading to cognitive problems such as mental confusion and forgetfulness.
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Which disease conditions are associated with hard, nontender Heberden and Bouchard nodules?
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*Osteoarthritis* is characterized by hard, nontender Heberden and Bouchard nodules. The bony outgrowths of distal interphalangeal joints are called Heberden nodes, and the bony outgrowths of proximal interphalangeal joints are called Bouchard nodes.
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What does the nurse expect to observe in a patient with fibromyalgia?
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Fibromyalgia is characterized by pain on both sides of the body, above and below the waist, and in the axial skeleton. The nurse may find *paraspinal spasms* in the patient with fibromyalgia.
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The nurse is caring for a patient who has rheumatoid arthritis. While performing a musculoskeletal assessment, the nurse hears a crunching or grating sound that accompanies movement of the joints. Which term will the nurse use to describe this finding?
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*Crepitation* is an audible and palpable crunching or grating sound associated with movement. In diseases such as rheumatoid arthritis, the articular surfaces in the joints become rough and the synovium becomes inflamed, causing crunching or crepitation.
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During the assessment of a patient, the nurse finds that the distal part of the great toe is directed away from the body's midline. Which complication is present in the patient?
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*Hallux valgus* is a deformity in which the great toe deviates away from the medial prominence of the head of the first metatarsal. Generally, the toes point straight forward and lie flat.
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What does the nurse tell a patient with carpal tunnel syndrome when performing the Phalen test?
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In carpal tunnel syndrome, atrophy occurs in the median nerve of the wrist and the hand that causes pain, burning, and numbness. During the Phalen test, which is used to assess if a patient has carpal tunnel syndrome, the nurse asks the patient to *hold the wrist in acute flexion for 60 seconds*.
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While assessing a geriatric patient, the nurse is performing the get up and go test. What is the nurse trying to assess in the patient?
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The get up and go test helps assess the increased *risk of fall* in older adults. The nurse records the time it takes for the patient to rise from the armchair, walk for 10 feet, turn, walk back, and sit down again. A healthy adult older than 60 years can manage this test in less than 10 seconds.
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While performing a head-to-toe assessment on a patient, the nurse instructs the patient to rest in a supine position. The nurse tells the patient, "Raise each leg and extend your knees." What is the nurse focusing on in this part of the assessment?
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the hips
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The nurse is assessing the integrity of the spinal accessory nerve (cranial nerve XI). What should the nurse ask the patient to do?
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Shrug the shoulders
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Which characteristic feature indicates a positive Allis sign?
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The Allis test helps in assessing for hip dislocation. The nurse performs this test by comparing the lengths of the legs; the *presence of one knee lower than the other* indicates a positive Allis sign.
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The nursing instructor is teaching a class on the types of joints. Which statement by the student nurse about synovial joints indicates effective learning?
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Synovial joints are freely movable joints. The bones in a synovial joint are separated from each other and are enclosed in the synovial cavity with synovial fluid inside.
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Which joint facilitates pronation and supination movements of the hand and the forearm?
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*Radioulnar joint* Pronation is turning the forearm so that the palm faces down. Supination is turning the forearm so that the palm faces up. The elbow joint consists of three bones: the humerus, radius, and ulna. The radius and ulna articulate with one another at two radioulnar joints: one at the elbow and the other at the wrist. Both the radius and ulna move together and permit the pronation and supination movements of the hand and the forearm.
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A soccer player complains of locking and pain that is localized in the knee. On further interview, the nurse learns that the player has a history of knee trauma. On further assessment, the nurse suspects a torn meniscus. Which test helps the nurse in coming to this conclusion?
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The *McMurray test* detects knee injuries. A positive McMurray sign is a confirmation of a torn meniscus. During this test, the heel is held with one hand and the knees are flexed. The other hand is placed on the knee with fingers on the medial side. Rotating the leg in and out helps loosen the joint. Along with rotating the legs externally, the valgus stress is applied on the knee. The McMurray test only proves to be positive for a torn meniscus, when a clicking sound is heard or felt after slowly extending the legs.
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While performing the McMurray test on a patient who has swelling at the knee joint, the nurse feels a click. Which complication does the nurse suspect in the patient?
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A *torn meniscus* is damage to the cartilage present at the knee joint. This may cause swelling and pain at the site. The nurse holds the heel of the patient and asks the patient to flex the knee and hip. A positive McMurray test or a click sound while performing the McMurray test indicates a torn meniscus.
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The nurse asks a patient to move his or her arm away from the midline of the body. What is this angular motion called?
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abduction
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The nurse is caring for an adolescent who reports severe pain below the knees while playing soccer. After reviewing the diagnostic reports, the nurse finds that the patient has swelling of the tibial tubercle. Which is the best nursing intervention in this situation?
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*Instruct the adolescent to take a break from soccer for a while.* Osgood-Schlatter disease refers to the inflammation of the patellar ligament present at the tibial tuberosity or below the knee. Painful swelling of the tibial tubercles indicates that the adolescent has Osgood-Schlatter disease. This occurs due to repeated stress on the muscles around the knee joint, leading to an inflammation of the patellar ligament at the tibial tuberosity. Osgood-Schlatter disease is common in males after puberty, and the symptoms may resolve with rest. The adolescent need not completely avoid playing soccer, because this condition resolves and it may not cause any permanent deformity in the adolescent.
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An obese patient reports continuous throbbing pain in the foot. On assessment, the nurse finds that the patient has swelling, redness, and tender pain around the metatarsal-phalangeal joint. On reviewing the laboratory reports, the nurse finds the patient also has increased uric acid levels in the blood and urate crystals in the joint fluids. What does the nurse infer from the findings?
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*The patient has acute gout.* Acute gout is an inflammatory arthritis characterized by redness, swelling, heat, and continuous throbbing pain in the joints. A patient's laboratory reports would show excess uric acid in the blood and urate crystals in the joints.
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The nurse suspects carpal tunnel syndrome in a patient. Which assessment technique would the nurse perform on the patient?
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The Phalen test reproduces numbness and burning in a person with carpal tunnel syndrome. It is a disorder of the wrist. To perform the Phalen test, *the patient is asked to hold the hands back to back while flexing the wrists 90 degrees*.
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Which condition involves the accumulation of sodium urate crystals in the joint space?
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*Tophi with chronic gout* Tophi are collections of sodium urate crystals that appear in and around the joint. Tophi may appear in the joints of the patient with chronic gout.
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Which test helps in screening a child's fine and gross motor skills?
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Denver II Test
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A patient complains of pain, redness, and a burning sensation in the joints. On assessment, the nurse finds that the joint feels soft and boggy on palpation. What can the nurse deduce from the findings?
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*Gouty arthritis* is joint effusion or synovial thickening, seen first as a bulge or fullness in grooves on either side of the olecranon process. Redness and heat can extend beyond the area of the synovial membrane. The joint appears soft, boggy, or fluctuant on palpation.
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Which structure connects the knee joint at both sides and prevents its dislocation?
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*Collateral ligaments* connect the knee joint at both sides and prevent dislocation by giving medial and lateral stability.
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While assessing a patient, the nurse begins palpation on the anterior thigh about 10 cm from the patella. The nurse then proceeds toward the knee, exploring the region of the suprapatellar pouch of the patient. For what is the nurse assessing with this technique?
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The nurse is assessing for atrophy in the quadriceps muscles.
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An elderly patient complains of stiffness in the knee joints and severe pain with motion. On further assessment, the nurse learns that the patient has inflamed joints with a hard bony protuberance on the joint. What can the nurse suspect from the findings?
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In *osteoarthritis*, joints show stiffness and swelling. Osteoarthritis manifests as hard, bony protuberances along with pain and limitation of motion. Osteoarthritis is a noninflammatory, localized, progressive disorder involving deterioration of articular cartilage and subchondral bone.
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An elderly patient reports pain and swelling at the base of the thumb. After assessing the patient, the nurse suspects carpel tunnel syndrome. Which finding enabled the nurse to reach this conclusion?
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A *positive Tinel sign* refers to the presence of tingling or burning in reaction to percussion over the median nerve at the wrist, which indicates carpel tunnel syndrome. A thenar eminence is the characteristic sign of carpel tunnel syndrome. Thenar muscles are present on the palm and the base of the thumb, and the patient may have pain due to swelling of the thenar muscles.
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Which nursing intervention helps the nurse assess the trigeminal nerve?
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Cranial nerve V, or the trigeminal nerve, innervates the muscles of the jaw and mediates motor functions such as biting and chewing. Therefore, the nurse *asks the patient to move the jaw forward and laterally* to check the integrity of the trigeminal nerve.
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A parent explains, "My daughter doesn't stand properly because of a difference in the height of her shoulders." The nurse suspects structural scoliosis. Which finding supports the nurse's suspicion?
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Structural scoliosis is fixed, and the child will have curvature while standing and also while bending. The difference in elevation of shoulders and the difference in height of the hips characterize scoliosis in the child. The forward bend test helps confirm this disorder. The child may have *humping of the ribs on one side while bending* due to the unequal elevation of the shoulders.
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Which condition does the nurse expect in a patient who is on prolonged bed rest?
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*Adhesive capsulitis* refers to the formation of fibrous tissues in the joint capsule, resulting in stiffness, progressive limitation of motion, and pain. It is associated with prolonged bed rest resulting in shoulder immobility for longer periods.
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During an assessment, the nurse finds that a child has genu varum (bowlegs). Which finding in the patient enabled the nurse to make such a conclusion?
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A distance of 3 cm between the knees when the medial malleoli are together A persistent space of more than 2.5 cm between the knees when the medial malleoli are together indicates genu varum, or bowlegs.
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While assessing a child with Down syndrome, the nurse finds webbing between the adjacent fingers of the palm. Which other findings would the nurse observe in the child?
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The *simian crease* is a palmar crease that extends across the palm and is a characteristic finding in Down syndrome. Syndactyly, or webbed fingers, may also occur in the child with Down syndrome.
