Chapter 18 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 18

Question 1

Type: MCMA

After assessing an older patient which musculoskeletal changes will the nurse attribute as being a normal part of the aging process?

Standard Text: Select all that apply.

1. Loss in height

2. Lower leg muscle atrophy

3. Calcification of the finger joints

4. Swan neck deformity of the hands

5. Decreased range of motion in the shoulders

Correct Answer: 1,2,5

Rationale 1: A change in the musculoskeletal status that is a normal part of the aging process is a loss in height.
Reference: Page 480

Rationale 2: A change in the musculoskeletal status that is a normal part of the aging process is lower leg muscle atrophy.
Reference: Page 480

Rationale 3: Calcification of the finger joints is associated with osteoarthritis which is not a normal change in the musculoskeletal status with aging.
Reference: Page 480

Rationale 4: Swan neck deformity of the hands is associated with rheumatoid arthritis which is not a normal change in the musculoskeletal status with aging.
Reference: Page 480

Rationale 5: A change in the musculoskeletal status that is a normal part of the aging process is a change in range of motion of the major joints such as the shoulders.
Reference: Page 480

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Explain normal changes in the musculoskeletal system associated with aging.

Question 2

Type: MCSA

An older patient is diagnosed with osteoarthritis. How should the nurse explain this health problem to the patient?

1. A metabolic bone disease

2. Occurs from synovial inflammation

3. Most common in thin, small-built female patients

4. Involves erosion of joint cartilage with new bone formation in joint spaces

Correct Answer: 4

Rationale 1: Osteoarthritis is not a metabolic bone disease. Metabolic bone diseases include osteoporosis, osteomalacia, and Pagets disease.
Reference: Page 484

Rationale 2: Rheumatoid arthritis is a joint disease that involves synovial inflammation.
Reference: Page 484

Rationale 3: Obesity is associated with osteoarthritis. A thinner body structure in females is associated with osteoporosis.
Reference: Page 484

Rationale 4: Osteoarthritis is characterized by progressive erosion of the cartilage within joints, which is then replaced by new bone in the joint spaces.
Reference: Page 484

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Implement the nursing management principles related to the nursing care of older patients with arthritis.

Question 3

Type: MCSA

An older patient is brought to the emergency department with a suspected fractured hip. For which diagnostic test will the nurse prepare the patient to confirm the diagnosis?

1. Bone scan

2. X-ray of the hip

3. Bone mineral density (BMD)

4. Magnetic resonance imaging (MRI) of the hip

Correct Answer: 2

Rationale 1: A bone scan detects skeletal trauma and disease by determining the degree to which the matrix of the bone takes up a bone-seeking radioactive isotope. A bone scan may help to diagnose a stress fracture in the older person who continues to experience pain after a skeletal x-ray has negative findings.
Reference: Page 490

Rationale 2: An x-ray of the hip is used to confirm the diagnosis of the fracture. The test is readily available in hospitals, can be done relatively quickly, and details the type of fracture.
Reference: Page 490

Rationale 3: The BMD measures the mineral density of the bone, which reflects bone strength and is used as an indicator of osteoporosis. An example of BMD, the dual energy x-ray absorptiometry (DEXA), is done at the site of the proximal femur to predict hip fracture risk.
Reference: Page 490

Rationale 4: The MRI, which requires special facilities, cannot show calcification or bone mineralization, and images of bone structure are not as useful as those of an x-ray.
Reference: Page 490

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify risk factors for the older person related to common musculoskeletal problems.

Question 4

Type: MCMA

An older patient is surprised to learn of a diagnosis of rheumatoid arthritis. What should the nurse explain to the patient about this health problem?

Standard Text: Select all that apply.

1. It leads to deformities of the hands.

2. It is caused by a vitamin D deficiency.

3. It is diagnosed by a positive pannus blood test.

4. It is characterized by low bone mass and compromised bone strength.

5. It causes systemic problems that can affect the heart, lungs, and kidneys.

Correct Answer: 1,5

Rationale 1: Rheumatoid arthritis is an inflammatory condition that leads to deformities of the hands.
Reference: Page 487

Rationale 2: Osteomalacia, demineralization of the bone, is caused by a deficiency of vitamin D.
Reference: Page 487

Rationale 3: Pannus, a proliferation of tissue in the synovial space, can be observed on x-rays after the disease has progressed.
Reference: Page 487

Rationale 4: Osteoporosis is characterized by a loss in bone mass leading to compromised bone strength.
Reference: Page 487

Rationale 5: In addition to joint symptoms, patients with severe and advanced RA have systemic and non-joint manifestations of the disease which include pleurisy with effusion, pericarditis and myocarditis, and renal involvement.
Reference: Page 487

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 5

Type: MCMA

An older patient is prescribed the medication alendronate (Fosamax). How should the nurse instruct the patient about this medication?

Standard Text: Select all that apply.

1. Take the medication with breakfast.

2. Take the medication with 8 ounces of milk.

3. Take the medication with 8 ounces of water only.

4. Take the medication with a calcium supplement at the same time.

5. Remain in an upright position for 30 minutes after taking the medication.

Correct Answer: 3,5

Rationale 1: This medication should be taken on an empty stomach and not with breakfast.
Reference: Page 495

Rationale 2: This medication should be taken on an empty stomach and not with milk.
Reference: Page 495

Rationale 3: This medication should be taken with 8 ounces of water only.
Reference: Page 495

Rationale 4: This medication does not need to be taken with a calcium supplement.
Reference: Page 495

Rationale 5: The patient should be instructed to remain in an upright position for 30 minutes after taking this medication.
Reference: Page 495

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 6

Type: MCSA

While walking in an assisted living facility an older patient falls. Which assessment finding indicates to the nurse that the patient has sustained a hip fracture?

1. Pain relieved by moving the affected extremity

2. Redness, tenderness, and severe swelling at the hip joint

3. Position with the injured leg shortened and externally rotated

4. Bending the injured leg at the knee and internally rotating the leg

Correct Answer: 3

Rationale 1: With a fractured hip any movement of the leg is likely to cause severe muscle spasms and pain.
Reference: Page 489

Rationale 2: Redness, tenderness, and swelling are the classic signs of inflammation not immediately present after hip fracture.
Reference: Page 489

Rationale 3: The patient with a fractured hip is often in extreme pain and assumes a position with the leg shortened on the affected side and externally rotated because of gravity and the pull of the muscles.
Reference: Page 489

Rationale 4: Any movement of the leg on the side of the affected hip is likely to cause severe muscle spasms and further pain. Extreme pain associated with a hip fracture prevents any voluntary movement of the leg.
Reference: Page 489

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Identify risk factors for the older person related to common musculoskeletal problems.

Question 7

Type: MCSA

An older patient with osteoarthritis is prescribed acetaminophen (Tylenol) for pain. What should the nurse teach the patient about this medication?

1. Excessive acetaminophen can cause gastrointestinal irritation.

2. Taking acetaminophen around-the-clock will slow the progression of osteoarthritis.

3. Acetaminophen cannot be used with nonsteroidal anti-inflammatory drugs (NSAIDs).

4. The maximum amount of acetaminophen should not exceed 4 grams in a 24-hour period.

Correct Answer: 4

Rationale 1: Gastrointestinal irritation is associated with NSAIDs, such as ibuprofen.
Reference: Page 496

Rationale 2: No treatment or medication is known to slow the progression of osteoarthritis.
Reference: Page 496

Rationale 3: Acetaminophen is considered one of the safest drugs. Persons can safely use both acetaminophen and NSAIDs at the same time as long as they use dosages within safe limits.
Reference: Page 496

Rationale 4: Acetaminophen can be given up to 4 g/day with minimal toxicity. Higher doses may cause liver damage.
Reference: Page 496

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 8

Type: MCMA

An older patient wants to prevent the onset of osteoporosis. How can the nurse instruct the patient at this time?

Standard Text: Select all that apply.

1. Stop smoking and reduce caffeine intake.

2. Ingest adequate amounts of calcium every day.

3. Have an annual bone mineral density (BMD) test.

4. Increase the intake of beverages containing phosphorous.

5. Perform isometric exercises for 30 minutes at least 3 times a week.

Correct Answer: 1,2,3

Rationale 1: Risk factors for the development of osteoporosis include smoking and caffeine intake.
Reference: Page 499

Rationale 2: Inadequate intake of calcium is a risk factor for the development of osteoporosis.
Reference: Page 499

Rationale 3: A BMD test is used to determine bone strength and risk for osteoporotic fracture. A BMD test is recommended for women under age 65 with risk factors, all women over 65, and after a fracture. BMD tests are sometimes repeated to monitor effects from medications used to treat osteoporosis.
Reference: Page 499

Rationale 4: The patient should be instructed to reduce the intake of phosphorous to prevent the onset of osteoporosis.
Reference: Page 499

Rationale 5: Regular weight-bearing exercise, such as walking, slows bone loss. Isometric exercises will not slow bone loss.
Reference: Page 499

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify risk factors for the older person related to common musculoskeletal problems.

Question 9

Type: MCSA

At the completion of an assessment the nurse determines that an older patient is at risk for the development of osteoporosis. What did the nurse assess in this patient?

1. Obese with hip pain with ambulation

2. Ingests three glasses of skim milk daily

3. Eats three to five servings of shrimp and liver per week

4. Takes corticosteroids for 10 years for chronic pulmonary disease

Correct Answer: 4

Rationale 1: Obesity is not a risk factor for osteoporosis but predisposes the patient to osteoarthritis.
Reference: Page 499

Rationale 2: Skim milk is a good source of calcium and vitamin D, which prevents or slows osteoporosis.
Reference: Page 499

Rationale 3: A diet rich in shellfish and organ meats is high in purine, which may predispose the patient to gout.
Reference: Page 499

Rationale 4: Long time use of corticosteroids is a risk factor for developing osteoporosis.
Reference: Page 499

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Identify risk factors for the older person related to common musculoskeletal problems.

Question 10

Type: MCMA

While making a visit to an older patient the nurse screens the home environment for potential hazards that could precipitate a fall. What should the nurse urge the patient to eliminate in the home?

Standard Text: Select all that apply.

1. Throw rugs

2. Night-lights

3. The use of a cane

4. Railings on the stairway

5. Telephone with a long cord

Correct Answer: 1,5

Rationale 1: Throw rugs in the home environment increase the risk of the older patient tripping over the rugs and falling.
Reference: Page 500

Rationale 2: Improving the lighting at night will reduce the risk of falls in the home.
Reference: Page 500

Rationale 3: Using an assistive device such as a cane will decrease the patients risk of falling in the home.
Reference: Page 500

Rationale 4: Adding railings on the stairway will reduce the patients risk of falling in the home.
Reference: Page 500

Rationale 5: Eliminating a telephone with a long cord will reduce the patients risk of tripping over the cord and falling in the home.
Reference: Page 500

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify risk factors for the older person related to common musculoskeletal problems.

Question 11

Type: MCSA

An older patient is concerned that many friends are having joint replacements and wants to know what can be done to prevent having to have one as well. Which modifiable risk factor should the nurse suggest the patient focus on at this time?

1. Physical inactivity

2. Cigarette smoking

3. Alcohol consumption

4. Body mass index (BMI)

Correct Answer: 4

Rationale 1: Of all of the modifiable risk factors for osteoarthritis the one that would have the greatest impact to prevent the need for joint replacement is obesity. Physical inactivity does not increase the patients risk of needing joint replacement surgery.
Reference: Page 501

Rationale 2: Of all of the modifiable risk factors for osteoarthritis the one that would have the greatest impact to prevent the need for joint replacement is obesity. Cigarette smoking does not increase the patients risk of needing joint replacement surgery.
Reference: Page 501

Rationale 3: Of all of the modifiable risk factors for osteoarthritis the one that would have the greatest impact to prevent the need for joint replacement is obesity. Alcohol consumption does not increase the patients risk of needing joint replacement surgery.
Reference: Page 501

Rationale 4: Of all of the modifiable risk factors for osteoarthritis the one that would have the greatest impact to prevent the need for joint replacement is obesity. Body mass index (BMI) is a measurement used to identify obesity.
Reference: Page 501

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 2. Identify risk factors for the older person related to common musculoskeletal problems.

Question 12

Type: MCSA

The nurse teaches an older patient with gout about the prescribed medication allopurinol (Zyloprim). What will the nurse explain as the purpose of this medication?

1. Neutralizes uric acid

2. Blocks the excretion of uric acid

3. Lowers the formation of uric acid

4. Increases the excretion of uric acid

Correct Answer: 3

Rationale 1: There are a variety of medications available to treat gout. Allopurinol (Zyloprim) does not neutralize uric acid.
Reference: Page 498

Rationale 2: There are a variety of medications available to treat gout. Allopurinol (Zyloprim) does not block the excretion of uric acid. This action would make the patients gout worse.
Reference: Page 498

Rationale 3: Allopurinol acts as a uric acid synthesis inhibitor so it acts to lower the formation of uric acid.
Reference: Page 498

Rationale 4: Other medications such as Probenecid and sulfinpyrazone are uricosuric agents that work by increasing the excretion of uric acid.
Reference: Page 498

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 13

Type: MCMA

The nurse is caring for an older patient diagnosed with Pagets disease. What will the nurse most likely assess in this patient?

Standard Text: Select all that apply.

1. Tinnitus

2. Gingivitis

3. Muscle aches

4. Deep bone pain

5. Bowing of the tibia

Correct Answer: 1,3,4,5

Rationale 1: The clinical manifestations of Pagets disease can include tinnitus caused by thickened bony growths on the interior of the skull that impinge cranial nerves and cause hearing problems.
Reference: Page 484

Rationale 2: Gingivitis is not a manifestation of Pagets disease. Malocclusion of the teeth can occur.
Reference: Page 484

Rationale 3: The older patient may complain of pain in muscle due to damage or pressure caused by the disease.
Reference: Page 484

Rationale 4: Bone pain is the most frequently reported symptom that may be described as deep and aching.
Reference: Page 484

Rationale 5: Mechanical deformities of the long bones may result in bowing of the femur or tibia.
Reference: Page 484

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 14

Type: MCSA

The nurse is planning an education program for senior community members on the benefits of exercise. What information will the nurse provide about regular exercise?

1. It increases the need for analgesic medications.

2. If performed in excess as a young adult it will lead to osteoporosis.

3. It prevents muscle atrophy and improves mobility which reduces the risk of falls.

4. It should be avoided in those with rheumatoid arthritis because it causes inflammation.

Correct Answer: 3

Rationale 1: Exercise done regularly and not in excess may decrease the need for analgesic medications.
Reference: Page 501

Rationale 2: Weight-bearing exercises help build bone strength and prevent osteoporosis.
Reference: Page 501

Rationale 3: Exercise will slow muscle atrophy that occurs with aging, and promote flexibility and strength, thus improving mobility. This will decrease the likelihood of falls.
Reference: Page 501

Rationale 4: It is important that patients with rheumatoid arthritis follow an exercise program to maintain range of motion in joints and perform strength training. Excessive exercise should be avoided during times of peak inflammation.
Reference: Page 501

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Discuss the nonpharmacological management of the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 15

Type: MCMA

The nurse identifies the diagnosis of impaired physical mobility as being appropriate for an older patient. What defining characteristics did the nurse most likely assess in this patient?

Standard Text: Select all that apply.

1. Impaired coordination

2. Difficulty with self-care

3. Limited range of motion

4. Decreased muscle strength

5. Inability to purposefully move

Correct Answer: 1,3,4,5

Rationale 1: A defining characteristic for the nursing diagnosis of impaired physical mobility is impaired coordination.
Reference: Page 489

Rationale 2: Difficulty with self-care could be caused by pain or fatigue and not necessarily be due to impaired physical mobility.
Reference: Page 489

Rationale 3: A defining characteristic for the nursing diagnosis of impaired physical mobility is limited range of motion.
Reference: Page 489

Rationale 4: A defining characteristic for the nursing diagnosis of impaired physical mobility is decreased muscle strength.
Reference: Page 489

Rationale 5: A defining characteristic for the nursing diagnosis of impaired physical mobility is the inability to purposefully move.
Reference: Page 489

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: 3. Formulate nursing diagnoses of older adults related to common musculoskeletal problems.

Question 16

Type: MCSA

The nurse is preparing to document an age-related change in posture observed in an older patient. Which term will the nurse most likely use to describe this observation?

1. Scoliosis

2. Lordosis

3. Kyphosis

4. Sway back

Correct Answer: 3

Rationale 1: Scoliosis is an s shaped spinal curvature that is not an age-related change in posture.
Reference: Page 479

Rationale 2: Lordosis is a spinal curvature that is not an age-related change in posture.
Reference: Page 479

Rationale 3: Kyphosis is a generalized curvature of the spine that affects posture and is associated with aging.
Reference: Page 479

Rationale 4: Sway back is a spinal curvature that is not an age-related change in posture.
Reference: Page 479

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 1. Explain normal changes in the musculoskeletal system associated with aging.

Question 17

Type: MCSA

A 60-year-old patient, beginning an exercise program of walking and swimming, asks if this activity is wise considering the patients age. How should the nurse respond to the patient?

1. Muscle fibers atrophy, preventing training.

2. Muscle tissue is still able to be trained effectively.

3. There will be some age-related changes, as you have lost half of your muscle mass.

4. There may be a reduction in ability to train as a result of a lack of muscle regeneration.

Correct Answer: 2

Rationale 1: There is a great deal of variation in muscle function in the older person. Muscle function remains trainable well into advanced age, and the regenerative function of muscle tissue remains normal in the older person.
Reference: Page 479

Rationale 2: Muscle function remains trainable well into advanced age.
Reference: Page 479

Rationale 3: Some muscles decrease in size, resulting in weakness. The shape of muscles becomes more prominent and feels more distinct.
Reference: Page 479

Rationale 4: Muscle tissue continues to regenerate.
Reference: Page 479

Global Rationale:

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Discuss the nonpharmacological management of the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 18

Type: MCMA

An older patient with multiple rib fractures is diagnosed with osteomalacia. What should the nurse teach the patient to help prevent further problems from this diagnosis?

Standard Text: Select all that apply.

1. Begin steps to stop smoking.

2. Increase the intake of chicken and fish.

3. Ingest dairy products fortified with vitamin D.

4. Engage in weight bearing exercises 3 times a week.

5. Expose the hands and the face for 15 minutes a day to direct sunlight.

Correct Answer: 3,5

Rationale 1: Smoking is not identified as being a direct cause of osteomalacia.
Reference: Page 483

Rationale 2: Increasing the intake of chicken and fish is not identified as a method to reduce the onset of osteomalacia.
Reference: Page 483

Rationale 3: Osteomalacia occurs with a primary deficiency in vitamin D. The patient should be encouraged to ingest dairy products fortified with vitamin D.
Reference: Page 483

Rationale 4: Weight bearing exercises will help prevent osteoporosis.
Reference: Page 483

Rationale 5: Exposing the hands and face for 15 minutes a day to direct sunlight will help synthesize vitamin D through the skin.
Reference: Page 483

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Discuss the nonpharmacological management of the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 19

Type: MCSA

An older patient with back pain is scheduled for computerized tomography (CT). What information should the nurse provide to the patient about this diagnostic test?

1. Only clear liquids will be permitted the evening prior to the test.

2. An IV will be inserted to administer the isotopes prior to the scan.

3. Clicking noises will occur during the test and ear plugs can be worn.

4. The machine will rotate and provide 180-degree imagery to aid in the diagnostic process.

Correct Answer: 4

Rationale 1: There are no dietary restrictions associated with a CT scan.
Reference: Page 490

Rationale 2: An IV is not needed for this diagnostic test. Isotopes are not inserted for this scan.
Reference: Page 490

Rationale 3: Clicking is heard during the MRI.
Reference: Page 490

Rationale 4: A CT scan is obtained with an X-ray machine that rotates 180 degrees around the patients body or head.
Reference: Page 490

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 20

Type: MCMA

The nurse is designing a teaching plan for a middle-aged patient experiencing arthritis of the hips and hands from constant computer work. What should the nurse include in this instruction?

Standard Text: Select all that apply.

1. Apply cold to reduce pain.

2. Apply heat to reduce swelling.

3. Stand up and walk frequently to prevent constant sitting.

4. Alternate weight-bearing with non-weight-bearing exercises.

5. Take frequent rest breaks from using the computer keyboard.

Correct Answer: 1,3,4,5

Rationale 1: Application of cold helps to reduce the pain associated with arthritis.
Reference: Page 502

Rationale 2: Applying heat to a painful joint will decrease pain and improve flexibility. Applying cold reduces swelling.
Reference: Page 502

Rationale 3: Sitting can be a repetitive movement. The patient should be encouraged to stand up and walk frequently to prevent constant sitting.
Reference: Page 502

Rationale 4: A strategy to prevent joint loading in the patient with arthritis is to alternate weight-bearing and non-weight-bearing exercises.
Reference: Page 502

Rationale 5: A strategy to provide rest for repetitive joint movement is to take frequent rest breaks from using the computer keyboard.
Reference: Page 502

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Implement the nursing management principles related to the nursing care of older patients with arthritis.

Question 21

Type: MCMA

An older patient with rheumatoid arthritis describes severe pain during times of inflammation. What should the nurse teach the patient to do to help minimize episodes of inflammation?

Standard Text: Select all that apply.

1. Lose weight.

2. Rest painful joints.

3. Splint the specific joints.

4. Use larger joints when possible.

5. Perform full ROM exercises daily.

Correct Answer: 1,2,3,4

Rationale 1: Steps to reduce joint stress during times of inflammation include losing weight.
Reference: Page 503

Rationale 2: Steps to reduce joint stress during times of inflammation include resting painful joints.
Reference: Page 503

Rationale 3: Steps to reduce joint stress during times of inflammation include splinting specific joints.
Reference: Page 503

Rationale 4: Steps to reduce joint stress during times of inflammation include using larger joints when possible.
Reference: Page 503

Rationale 5: Doing full ROM exercises daily is a strategy to prevent contractures, muscle weakness, and atrophy.
Reference: Page 503

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Implement the nursing management principles related to the nursing care of older patients with arthritis.

Question 22

Type: MCSA

The nurse is caring for an older patient recovering from a total hip replacement. Which intervention will prevent dislocation of the hip prosthesis?

1. Encourage early ambulation.

2. Provide pain medication as needed.

3. Apply intermittent compression devices.

4. Place a wedge between the legs to keep the hip in abduction.

Correct Answer: 4

Rationale 1: Early ambulation is an action to promote healing of a total knee replacement.
Reference: Page 506

Rationale 2: Providing pain medication as needed will help with activity and healing and not prevent dislocation of the hip prosthesis.
Reference: Page 506

Rationale 3: The application of intermittent compression devices helps prevent the development of deep vein thrombosis seen in patients recovering from a total knee replacement.
Reference: Page 506

Rationale 4: An intervention to prevent dislocation of the hip prosthesis is the placement of a wedge, splint, or two pillows between the legs to keep the hip in abduction.
Reference: Page 506

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Compare the pharmacological management and nursing responsibilities related to the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 23

Type: MCSA

The nurse instructs an older patient on ways to manage acute episodes of gout at home. Which patient statement indicates that teaching has been effective?

1. Ice packs to the painful areas will be helpful.

2. I will need to reduce my fluid intake to 2 L/day.

3. I should eat liver at least one or two times per week to promote healing.

4. Application of heat to my joints is recommended to manage the discomfort.

Correct Answer: 1

Rationale 1: The use of ice packs to manage gout-related pain is recommended.
Reference: Page 503

Rationale 2: The patient should increase fluid intake to 3 L/day to promote renal function and prevent stones.
Reference: Page 503

Rationale 3: The patient should avoid foods high in purine such as organ meats.
Reference: Page 503

Rationale 4: The patient should be instructed to avoid the application of heat if inflammation is present.
Reference: Page 503

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5. Discuss the nonpharmacological management of the older person with common musculoskeletal problems, including osteoporosis, osteomalacia, Pagets disease, osteoarthritis, rheumatoid arthritis, gout, pseudogout, and hip fractures.

Question 24

Type: MCSA

The nurse is concerned that a patient with arthritis is at an increased risk for falling. What did the nurse observe in this patient?

1. Sitting down in a chair

2. Able to turn while walking

3. Rocking to get up from a chair

4. Raising the foot completely off of the floor when walking

Correct Answer: 3

Rationale 1: The patient who is able to sit down into a chair without problems is not at risk for falling.
Reference: Page 504

Rationale 2: The patient who is able to turn while walking is not at risk for falling.
Reference: Page 504

Rationale 3: The patient who needs to rock to get up from sitting in a chair is at risk for falling.
Reference: Page 504

Rationale 4: The patient who is able to raise the foot completely off of the floor when walking is not at risk for falling.
Reference: Page 504

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2. Identify risk factors for the older person related to common musculoskeletal problems.

Question 25

Type: MCSA

An older patient with arthritis is prescribed to begin an exercise regimen. How should the nurse instruct the patient about exercising?

1. Perform resistive exercises daily with weights.

2. Perform active range of motion to all joints every day.

3. Overstretch all muscle groups for 20 minutes each day.

4. Use high intensity when performing isometric exercises.

Correct Answer: 2

Rationale 1: The nurse should instruct the patient to perform resistive exercises twice a week and gradually add weights.
Reference: Page 501

Rationale 2: The nurse should instruct the patient to perform active range of motion daily to all joints.
Reference: Page 501

Rationale 3: The nurse should instruct the patient to avoid overstretching muscles when stretching all muscle groups for 10 minutes each day.
Reference: Page 501

Rationale 4: The nurse should instruct the patient to keep the intensity low when performing isometric exercises.
Reference: Page 501

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Implement the nursing management principles related to the nursing care of older patients with arthritis.

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