NUR257 EXAM 1 EXAM 2024-2025, Exams of Nursing

Download NUR257 EXAM 1 EXAM 2024-2025 and more Exams Nursing in PDF only on Docsity! 1 | P a g e NUR257 EXAM 1 EXAM 2024-2025 WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED ANSWERS|FREQUENTLY TESTED QUESTIONS AND SOLUTIONS |ALREADY GRADED A+|NEWEST |GUARANTEED PASS|LATEST UPDATE A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? Weight gain, hypervigilance, hypothermia, and edema of the legs Facial erythema, pericarditis, pleuritis, fever, and weight loss Hypothermia, weight gain, lethargy, and edema of the arms Photosensitivity, polyarthralgia, and painful mucous membrane ulcers Facial erythema, pericarditis, pleuritis, fever, and weight loss A client has been living with rheumatoid arthritis (RA) for several years. Which diagnostic test will the nurse prepare the client for to determine the progression of the disease? Ultrasound MRI X-ray CT scan X-ray A client with systemic lupus erythematosus (SLE) is prescribed hydroxychloroquine. Which teaching will the nurse include for this client? Exercise Smoking cessation High-protein diet Vitamin D supplements Smoking cessation Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues? 2 | P a g e Rheumatoid arthritis Polymyalgia rheumatic Systemic lupus erythematosus Scleroderma Scleroderma The nurse is assessing a client with decreased dexterity of the hands related to rheumatoid arthritis. The nurse knows that which process causes joint deformities? Remission Inflammation Exacerbation Autoimmunity Inflammation A client diagnosed with degenerative joint disease of the fingers reports now having bumps on the fingers that do not hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are? Bouchard nodes Heberden nodes Rheumatoid nodules Tophi Heberden nodes A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis? Magnetic resonance imaging (MRI) Bone scan Muscle biopsy Computed tomography (CT) Muscle biopsy The nurse is teaching a client about the characteristics of osteoarthritis. The nurse determines the client teaching was successful when the client states that which of the following may occur with osteoarthritis? Clients will have an ulnar deviation. Clients will develop boutonniere deformity. Clients may have swan neck deformity. Clients may develop Heberden nodes. Clients may develop Heberden nodes. 5 | P a g e Auscultate the client's lung sounds. Review the client's medical record. Inspect the client's mouth. Observe the client's gait. Review the client's medical record. The nurse is caring for a client with hypertension and scleroderma. Which medication will the nurse expect to be prescribed for this client? Beta blocker Diuretic Angiotensin-converting enzyme inhibitors Vasodilator Angiotensin-converting enzyme inhibitors A client comes to the clinic and reports pain in the right great toe which is worse at night. Assessment reveals tophi. What does the nurse suspect? gouty arthritis rheumatoid arthritis reactive arthritis osteoarthritis gouty arthritis The client with an inflamed knee scheduled to have an arthrocentesis asks the nurse what the synovial fluid will look like. What is the best response by the nurse? The amount of fluid will be scant in volume. The fluid will be clear and pale. The fluid will be milky, cloudy, and dark yellow. The fluid will be straw colored. The fluid will be milky, cloudy, and dark yellow. A client is experiencing symptoms of giant cell arteritis (GCA). Which action will be taken to definitively diagnose this condition? Monitor the response to corticosteroids. Evaluate the erythrocyte sedimentation rate. Measure the C-reactive protein level. Obtain the results of a temporal artery biopsy. Obtain the results of a temporal artery biopsy. A client seeks medical attention for the development of red scaly lesions over the surface of both knees. Which question will the nurse ask to determine if the client is experiencing polymyositis? "Have you had a change in the strength of your legs?" 6 | P a g e "Have you taken any new medications?" "Have you changed the type of soap that you use?" "Have you noticed your skin is more dry lately?" "Have you had a change in the strength of your legs?" A client has been treated for migraine headaches for several months and comes to the clinic reporting no improvement. The nurse is talking with the client and hears an audible click when the client is moving the jaw. What does the nurse suspect may be happening? Pericardial friction rub Rhonchi Lung sounds are diminished in the apical area. Crackles in the bases Lung sounds are diminished in the apical area. A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease? Maintain a well-balanced diet and increase fluid intake to raise energy levels and promote tissue healing. If you have problems with a medication, you may stop it until your next physician visit. Avoid sunlight and ultraviolet radiation. Pace activities. If you have problems with a medication, you may stop it until your next physician visit. The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis? weakness joint swelling stiffness pain pain Azathioprine (Imuran) has been prescribed for the client with severe rheumatoid arthritis. The dose prescribed is 2 mg/kg/day orally in two divided doses. The medication available is a 50-mg scored tablet. The client weighs 110 pounds. How many milligrams will the nurse prepare per dose for the client? 50 A client with an acute exacerbation of arthritis is temporarily confined to bed. What position will the nurse recommend to prevent flexion deformities? side-lying with pillows supporting the shoulders and legs supine with pillows under the knees 7 | P a g e prone semi-Fowler's position prone The nurse is reviewing medications prescribed for a client with rheumatoid arthritis. Which medications will the nurse expect to be prescribed for this client? Select all that apply. Heparin sodium Aspirin Ibuprofen Morphine sulfate Methotrexate Aspirin Ibuprofen Methotrexate A client with kyphosis caused by ankylosing spondylitis (AS) asks if there are any procedures available to help with the spinal deformity and pain. Which procedure will the nurse prepare teaching for this client? Traction Bracing Cervical collar Osteotomy of the spine Osteotomy of the spine The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? disease-modifying antirheumatic drug therapy detection of systemic complications strategies for remaining active prevention of joint deformity strategies for remaining active A client is experiencing symptoms of rheumatoid arthritis. Which laboratory tests will the nurse expect to be prescribed for this client? Select all that apply. Antinuclear antibody Creatinine Hematocrit Erythrocyte count Rheumatoid factor Erythrocyte count Rheumatoid factor Antinuclear antibody The nurse is completing the physical assessment of a client with systemic lupus erythematosus (SLE). Which finding will the nurse recognize is most likely to indicate that the client is experiencing a change 10 | P a g e A client is diagnosed with psoriatic arthritis. In which areas will the nurse expect the client to experience pain? Select all that apply. Intercostals Achilles tendon Scapula Tibial tuberosities Plantar fascia Plantar fascia Achilles tendon Tibial tuberosities The side effect of bone marrow depression may occur with which medication used to treat gout? Colchicine Probenecid Prednisone Allopurinol Allopurinol The nurse is educating a client on signs and symptoms of fibromyalgia. Which assessment technique would cause pain that indicates fibromyalgia? Pinch the Achilles tendon. Inflate the blood pressure cuff an extra 20 mm Hg. Strike the patella with a reflex hammer. Apply pressure to the thumb. Pinch the Achilles tendon. Which of the following is an example of a gliding joint? Carpal bones in the wrist Hip Knee Joint at base of thumb Carpal bones in the wrist The nurse is assessing a new client with a musculoskeletal problem. What is the best question by the nurse to elicit more information related to the injury? What is the duration and location of discomfort or pain?" "What is your age?" "Do you have any chronic disorder or recent injury?" "What kind of work do you do?" "Do you have any chronic disorder or recent injury?" There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting: involuntary function. 11 | P a g e All options are correct. movement of skeletal bones. organ function. movement of skeletal bones. The nurse is educating a group of students about peroneal nerve damage. The nurse knows that which assessment will show this type of nerve damage? Skin prick along the client's skin with the index finger Pricking of the skin along the medial side of the foot Dorsiflexion of the foot and extension of the toes Stretching of the client's thumb above the wrist Dorsiflexion of the foot and extension of the toes A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint? In the fingers Between the vertebrae At the hip Skull at the temporal and occipital bones Skull at the temporal and occipital bones The nurse is preparing to perform a musculoskeletal assessment for a client with chronic muscle pain. Which assessment technique would be an appropriate tool to evaluate this type of pain? Listen for cracking with movement. Palpate for the balloon sign. Measure the girth of the thigh. Flex the bicep against resistance. Flex the bicep against resistance. Which term refers to mature compact bone structures that form concentric rings of bone matrix? Trabecula Endosteum Cancellous bone Lamellae Lamellae Which nursing instruction is most important to stress when teaching on calcium intake? Eat green, leafy vegetables. Maintain diary sources of calcium intake. Drink calcium- and vitamin D-fortified orange juice. Provide age-related calcium intake recommendations. Provide age-related calcium intake recommendations. 12 | P a g e A nurse understands the influence of hormones on bone maintenance. Therefore, the nurse knows that a patient on long-term cortisol may experience: Accelerated bone modeling. Increased bone resorption. Increased deposits of calcium in the bone. Inhibition of osteoclasts. Increased bone resorption. The nurse is planning care for a client with a musculoskeletal injury. Which nursing diagnosis would be the highest priority? Ineffective Health Maintenance Risk for Impaired Tissue Perfusion Delayed Surgical Recovery Acute Pain Acute Pain The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding? Dowager's hump Lordosis Scoliosis Kyphosis Lordosis Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? aspirin NPH insulin furosemide digoxin aspirin A client has recently undergone an invasive joint examination to enable the identification of bone composition. Which signs and symptoms should the nurse monitor in this client? hypersensitivity reaction nausea and vomiting swelling and bleeding tingling sensation or numbness swelling and bleeding A nursing student asks the nurse why older adults are at risk for falls. The best response by the nurse is: "Cartilage deteriorates with age." "Ligaments become lax with age." 15 | P a g e Prick the top of the middle finger. Prick the top or distal surface of the index finger. Prick the skin midway between the thumb and second finger. Prick the distal fat pad on the small finger. Prick the distal fat pad on the small finger. A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse? "Once you stop exercising, the contraction of the muscle does not regain its strength." "While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy." "The muscle mass has decreased from the lack of calcium in the cells." "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." The nurse is assessing a client's gait. What assessments indicate the client has a normal gait? Select all that apply. knee flexion steppage shuffling smoothness spastic hemiparesis smoothness knee flexion The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.) Tenting skin turgor Limited range of motion Cool temperature of the extremity Pale, cyanotic, or mottled color More than 3-second capillary refill Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill The nurse is assessing a young client during an annual sports physical at school. The assessment reveals that the client has lateral curving of the spine. The nurse reports to the health care professional that the 16 | P a g e assessment revealed scoliosis. epiphysis. diaphysis. lordosis. scoliosis. A client is having repeated tears of the joint capsule in the shoulder, and the health care provider orders an arthrogram. What intervention should the nurse provide after the procedure is completed? Select all that apply. Administer a mild analgesic. Actively exercise the area immediately after the procedure. Inform the client that a clicking or crackling noise in the joint may persist for a couple of days. Apply heat to the area for 48 hours. Apply a compression bandage to the area. Apply a compression bandage to the area. Administer a mild analgesic. Inform the client that a clicking or crackling noise in the joint may persist for a couple of days. Choose the correct statement about the endosteum, a significant component of the skeletal system: Covers the marrow cavity of long bones Contains blood vessels and lymphatics Facilitates bone growth Supports the attachment of tendons to bones Covers the marrow cavity of long bones A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material? Osteoclasts are involved in the destruction and remodeling of bone. Long bones typically contain more red bone marrow than yellow. Osteocytes are transformed into osteoblasts or mature bone cells. The yellow marrow is responsible for manufacturing red blood cells. Osteoclasts are involved in the destruction and remodeling of bone. Which nursing action is most important in caring for the client following an arthrogram? Assist the client with passive range of motion. Apply ice to the joint. Administer morphine sulfate. Keep the joint below the level of the heart. Apply ice to the joint. A client has an elbow injury that involves the cartilage in that joint. The nurse understands that which type of cartilage has been affected? Costal cartilage 17 | P a g e Semilunar cartilage Fibrous cartilage Hyaline cartilage Hyaline cartilage A client visits the health care provider for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature. Which region of the spine should the nurse assess for complications? Thoracic Sacral Lumbar Cervical Thoracic The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse? The patient has neurofibromatosis. The patient has lupus erythematosus. The patient has rheumatoid arthritis. The patient has osteoarthritis. The patient has rheumatoid arthritis. The nurse is taking care of a client with lower motor neuron destruction. How would the nurse document on the electronic health record the muscle tone in the client's lower legs? Atonic Spastic Limp Flaccid Atonic A client's blood test results reveal an elevated alkaline phosphatase. What might this indicate? osteomalacia systemic lupus erythematosus Paget's disease a bone tumor a bone tumor A patient is scheduled for a bone marrow biopsy. The nurse explains to the family that the bone marrow is located mainly in four areas. She tells the family that the site to be used would be the: Sternum. Humerus. 20 | P a g e cartilage. bursae. fascia. external soft tissue. Which term refers to muscle tension being unchanged with muscle shortening and joint motion? Contracture Fasciculation Isotonic contraction Isometric contraction Isotonic contraction A client is scheduled for a bone scan. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Which nursing considerations are correct in preparing a client for a bone scan? Select all that apply. Ensure that the client does not have any allergies to the isotope. Ensure the client is NPO for 12 hours before the test. Inform the client that the radiopaque isotope will be administered intravenously. Encourage the client to drink fluids to help distribute and eliminate the isotope. Inform the client that the radiopaque isotope will be administered intravenously. Ensure that the client does not have any allergies to the isotope. Encourage the client to drink fluids to help distribute and eliminate the isotope. A client reports being consistently tired, with no energy. The client's CBC indicates low hemoglobin. Where is hemoglobin manufactured? femur eyes ulna ribs ribs The nurse is assessing a client for dietary factors that may influence her risk for osteoporosis. The nurse should question the client about her intake of what nutrients? Select all that apply. Simple carbohydrates Vitamin D Calcium Soluble fiber Protein Calcium Vitamin D What instructions should the nurse include in the discharge teaching for the client following an arthroscopy? "The pain should be well-controlled with Tylenol." 21 | P a g e "Keep the leg in the dependent position as much as possible." "Numbness and tingling in the foot are expected the first 24 hours." "It is normal to feel hot spots over the puncture site." "The pain should be well-controlled with Tylenol." A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding? Rigidity Atonic Flaccidity Tetanic Flaccidity A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. What procedure will the nurse prepare the client for? Bone densitometry Arthrogram Arthrocentesis Arthroscopy Arthrogram The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as? Scoliosis Kyphosis Osteoporosis Lordosis Kyphosis Which of the following is the priority nursing diagnosis for the client preparing for a bone marrow biopsy? Deficient knowledge: procedure Acute pain Risk for ineffective peripheral tissue perfusion Risk for infection Deficient knowledge: procedure The nurse is assessing a client's peroneal nerve. What technique will the nurse use? Prick the medial surface of the sole. Ask the client to invert and evert the foot. 22 | P a g e Ask the client to plantar flex the toes. Prick the skin mid-way between the great and second toe. Prick the skin mid-way between the great and second toe. A pediatric client is recovering from an anaphylactic reaction to an allergen. In the first assessment, the client presents with a periorbital accumulation of blood, a common occurrence in children. What type of allergic reaction presents "allergic shiners"? type II type I type IV type III type I The nurse reviews laboratory results requested to track HIV. What laboratory test measures HIV RNA levels and is the best predictor of HIV disease progression? Enzyme immunoassay (EIA) CD4/CD8 Western blot Viral load Viral load Cryptococcus meningitis is suspected in a client with HIV. Which manifestations would be consistent with cryptococcus meningitis? Select all that apply. Hyperreflexia Psychomotor slowing Vacant stare Stiff neck Seizures Stiff neck Seizures A client with AIDS develops pneumocystis pneumonia. The nurse would most likely expect to include administration of which agent in the client's plan of care? Azithromycin Aerosolized pentamidine TMP-SMZ Clindamycin TMP-SMZ A client is diagnosed with pneumocystis pneumonia (PCP). What medication does the nurse anticipate educating the client about for treatment? 25 | P a g e blindness Which of the following is a lack of one or more of the five immunoglobulins? Agammaglobulinemia Panhypoglobulinemia Telangiectasia Hypogammaglobulinemia Hypogammaglobulinemia A patient with common variable immunodeficiency (CVID) is extremely fatigued and not feeling well. What lab test does the nurse anticipate the patient will have to detect a common development related to the disease? B12 level Glucose level Blood urea nitrogen (BUN) and creatinine Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) B12 level The nurse is preparing to infuse gamma-globulin intravenously (IV). When administering this drug, the nurse knows the speed of the infusion should not exceed what rate? 3 mL/min 10 mL/min 6 mL/min 1.5 mL/min 3 mL/min A client is suspected of having an immune system disorder. The health care provider wants to perform a diagnostic test to confirm the diagnosis. What test should the nurse prepare the client for? Complete chemistry panel T-and C-cell assays Plasmapheresis Enzyme-linked immunosorbent assay Enzyme-linked immunosorbent assay The nurse is caring for a client with an autoimmune disease. What is a characteristic of autoimmune disorders? Affects only older adults and infants less than 3 months Profound fatigue with no identifiable cause Progressive tissue damage without any verifiable etiology Absence of a triggering event Progressive tissue damage without any verifiable etiology The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T 26 | P a g e lymphocyte count? Between 200 to 350/mm3 Less than 200/mm3 Greater than 500/mm3 Between 350 to 499/mm3 Greater than 500/mm3 The nurse is caring for a client who has been admitted for the treatment of AIDS. In the morning, the client tells the nurse that he experienced night sweats and recently "coughed up some blood." What is the nurse's most appropriate action? Place the client on respiratory isolation and inform the physician. Perform oral suctioning to reduce the client's risk for aspiration. Review the client's most recent viral load and CD4+ count. Assess the client for additional signs and symptoms of Kaposi sarcoma. Place the client on respiratory isolation and inform the physician. A client is diagnosed with a primary immune deficiency disease (PIDD). For which additional conditions will the nurse assess this client? Select all that apply. Inflammatory bowel disease Multiple sclerosis Rheumatoid arthritis Thyroid disease Myasthenia gravis Thyroid disease Rheumatoid arthritis Inflammatory bowel disease When describing the effects of treatment for phagocytic cell disorders, which of the following would the nurse include as being the most successful? Use of granulocyte transfusions Gene therapy Antibiotic therapy Hematopoietic stem cell transplantation Hematopoietic stem cell transplantation The nurse is gathering data from laboratory studies for a client who has HIV. The client's CD4+ cell count is 200/mm³, and the client has been diagnosed with pneumocystis pneumonia. What does this indicate to the nurse? The client's CD4+ cell count has decreased due to the pneumocystis pneumonia. The client has advanced HIV infection. The client has converted from HIV infection to AIDS. The client has another infection present that is causing a decrease in the CD4+ cell count. The client has converted from HIV infection to AIDS 27 | P a g e A client's antibody test for HIV showed no antibodies. For which reason would the client need to have a nucleic acid test completed before being told that testing for HIV is negative? The client engages in high risk behavior Two tests need to be done for every client The antibody test for HIV is not sensitive The client may be in stage 0 of the disease The client may be in stage 0 of the disease Which condition is an early manifestation of HIV encephalopathy? Headache Vacant stare Hallucinations Hyperreflexia Headache Which microorganism is known to cause retinitis in people with HIV/AIDS? Cryptococcus neoformans Cytomegalovirus Pneumocystis carinii Mycobacterium avium Cytomegalovirus A client with AIDS is having a recurrence of 10 to 12 loose stools a day. What medication may help this client with controlling the chronic diarrhea? Rifaximin Octreotide Atropine diphenoxylate Bismuth subsalicylate Octreotide When do most perinatal HIV infections occur? In utero Through casual contact Through breastfeeding After exposure during delivery After exposure during delivery A patient had unprotected sex with an HIV-infected person and arrives in the clinic requesting HIV testing. Results determine a negative HIV antibody test and an increased viral load. What stage does the nurse determine the patient is in? Latent infection Tertiary infection Secondary infection Primary infection 30 | P a g e Hypoparathyroidism Congenital heart defect Hypercalcemia A client with end-stage acquired immunodeficiency syndrome (AIDS) has profound manifestations of Cryptosporidium infection caused by the protozoa. What client need should in the nurse focus on when planning this client's care? antiretroviral therapy fluid replacement high-calorie nutrition pain management fluid replacement Which diagnostic test measures HIV RNA in the plasma? Enzyme-linked immunoassay Viral load Western blotting assay Enzyme immunoassay Viral load A client is administered foscarnet to treat a case of CMV retinitis. Which adverse effect should the nurse closely monitor in the client? Hypotension Electrolyte imbalances Peripheral neuropathy Anemia Electrolyte imbalances A nursing student assists a registered nurse to admit a client with a primary immunodeficiency. The nurse explains to the student that primary immunodeficiencies predispose people to three conditions. Which of the following three are those conditions? Malnutrition Autoimmunity Cancer Phagocytic dysfunction Severe infections Severe infections Autoimmunity Cancer 31 | P a g e When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority? Grieving related to the poor prognosis of the condition Anxiety related to an inherited disorder Risk for infection related to altered immune cell function Impaired skin integrity related to persistent deep skin abscesses Risk for infection related to altered immune cell function The nursing instructor is discussing hypersensitivity responses with a clinical group. What allergic reaction(s) would the nursing instructor talk about? Select all that apply. Unmediated Cytotoxic Immune complex Atopic Typical Cytotoxic Atopic Immune complex A nurse has created a plan of care for an immunodeficient client, specifying that care providers take the client's pulse and respiratory rate for a full minute. What is the rationale for this aspect of care? Hemodynamic instability is one of the main complications of immunodeficiency. Respirations affect heart rate in immunodeficient clients. These clients' blunted inflammatory responses can cause subtle changes in status. Immunodeficient clients are prone to ventricular tachycardia and atrial fibrillation. These clients' blunted inflammatory responses can cause subtle changes in status. Which of the following are common sites of visceral involvement of Kaposi's sarcoma? Select all that apply. Heart Lungs Brain Lymph nodes Gastrointestinal tract Lymph nodes Gastrointestinal tract Lungs When administering a gamma-globulin infusion, what nursing guideline applies? Weigh the client after treatment. Administer pretreatment prophylactic antihistamine as ordered 8 hours prior to infusion. 32 | P a g e Observe clients with high gamma-globulin rates for severe reactions over clients with low gamma- globulin rates. Do not exceed an infusion rate of 3 mL/min. Do not exceed an infusion rate of 3 mL/min. Which of the following would a nurse be least likely to identify as a cause of secondary immunodeficiency? Burns Diabetes Chronic stress Genetics Genetics Which of the following tests determines initiation of antiretroviral treatment? CD4/CD8 ratio Western blot Viral load Enzyme immunoassay (EIA) CD4/CD8 ratio A client who is HIV positive is successfully treated for a stage 3 opportunistic illness. In which way will the client's care change when the CD4+T-lymphocyte count is 1500 cells/L? Care is at stage 0 because the illness is undetectable Care is limited to stage 2 of the disease Care can return to be for stage 1 of the disease Care remains at stage 3 of the disease Care remains at stage 3 of the disease A nurse is working in a health clinic at a retirement community. What is the nurse's primary rationale for recommending HIV testing for older adults? Age-related immune system changes increase the risks of infections for older adults. Older adults may have received HIV-infected blood transfusions before 1985. Older gay men, feeling less inhibited by social mores, tend to have multiple sex partners. Older adults, who are sexually active don't use condoms. Age-related immune system changes increase the risks of infections for older adults. A nurse is visiting the home of a client with AIDS who is experiencing HIV encephalopathy. When developing the plan of care for the client and his caregiver, the nurse identifies the nursing diagnosis of disturbed thought processes related to confusion and disorientation secondary to HIV encephalopathy. Which expected outcome would be most appropriate for the nurse to document on the client's plan of care? The client remains free of any injury when out of bed. The client can state that he is at his home. 35 | P a g e A client is diagnosed with common variable immunodeficiency (CVID). What would the nurse identify as potential infections for this client? Select all that apply. Hemophilus influenzae Streptococcus pneumoniae Staphylococcus aureus Pneumocystis jiroveci pneumonia Hemophilus influenzae Streptococcus pneumoniae Staphylococcus aureus A client is infected with human immunodeficiency virus (HIV) after sharing needles with another intravenous (IV) drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection? 3 to 6 weeks 3 to 12 weeks 6 to 18 weeks 1 to 2 weeks 3 to 12 weeks When administering intravenous immunoglobulin (IVIG), what is the most important action for the nurse to take? Administer the infusion at a rate of 5 to 10 mL per minute. Assess the client for nausea, vomiting, and hematuria indicative of a severe reaction. Review the chart to obtain information about the client's height and weight. Premedicate the client with acetaminophen and diphenhydramine 30 minutes before starting. Premedicate the client with acetaminophen and diphenhydramine 30 minutes before starting. A client seeks medical attention to learn why an infection has been resistant to antibiotic therapy. Which laboratory test will the nurse anticipate being used first to determine if the client has a primary immune deficiency disease (PIDD)? Immunoglobulin levels HIV-1 differentiation assay Complete blood count and differential HIV-1/HIV-2 immunoassay Complete blood count and differential A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? SCID CVID DAF AIDS 36 | P a g e AIDS When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? He is immune to HIV. He has not been infected with HIV. Antibodies to HIV are present in his blood. Antibodies to HIV are not present in his blood. Antibodies to HIV are not present in his blood. Which nursing action is essential before an EIA test is performed? Performing Western blotting Performing a polymerase chain reaction test Obtaining a general consent for medical care from the client Obtaining a written consent from the client Obtaining a general consent for medical care from the client Students are reviewing information from the Centers for Disease Control and Prevention (CDC) for a class presentation about preventing the transmission of HIV. Which of the following would the students be least likely to include in their presentation? A dental dam is used for oral contact with the vagina or rectum. Nonlatex lambskin condoms are highly effective in preventing HIV infection. Male condoms must be used consistently and correctly to be effective. Circumcision is an effective means to reduce the risk of males acquiring HIV. Nonlatex lambskin condoms are highly effective in preventing HIV infection. The nurse is preparing a teaching plan for a client with an immunodeficiency. What aspect would the nurse emphasize as most important? Adherence to prophylactic medication administration Identifying the signs and symptoms of infection Incorporation of treatment regimens into daily patterns Frequent and thorough handwashing Frequent and thorough handwashing A client with a primary immunodeficiency is undergoing genetic testing. This testing would be of least benefit in identifying which condition? Common variable immunodeficiency (CVID) DiGeorge syndrome Severe combined immunodeficiency disease (SCID) Wiskott-Aldrich syndrome Common variable immunodeficiency (CVID) A client with cytomegalovirus (CMV) infection reports difficulty seeing. The physician determines that the client is developing CMV retinitis. What medication does the nurse anticipate the client will receive 37 | P a g e for this? foscarnet fluconazole zidovudine azithromycin foscarnet A client is admitted with a tentative diagnosis of acquired immunodeficiency syndrome (AIDS). The client undergoes biopsies of facial lesions and the preliminary report indicates Kaposi's sarcoma. Which action by the nurse is most appropriate? Tell the client that Kaposi's sarcoma is common in people with AIDS. Inform the client of the biopsy results and support the client emotionally. Pretend not to notice the lesions on the client's face. Explore the client's feelings about facial disfigurement. Explore the client's feelings about facial disfigurement. Phagocytic dysfunction is characterized by the following. Choose all that apply. Chronic eczematoid dermatitis Immunity to infection with herpes simplex Increased incidence of bacterial infections Rapid heartbeat Manifestation of underlying disease processes Increased incidence of bacterial infections Chronic eczematoid dermatitis A patient presents to a clinic on May 1 and tells the nurse practitioner that he had a 1-month sexual relationship with a friend who did not disclose that he was HIV positive. The relationship ended last week. The nurse tells the patient that after infection with HIV, the immune system responds by making antibodies against the virus; therefore the patient should expect this to happen by: May 20 July 1 June 5 May 8 June 5 The nurse assesses a client who is diagnosed with human immunodeficiency virus (HIV) for adverse reactions associated with the prescribed medication, abacavir. Drag words from the choices below to fill in each blank in the following sentence. The nurse provides emergency intervention when the client exhibits the following symptoms: ________, ________, and ________. nausea 40 | P a g e Boney erosions on x-ray Atherosclerotic plaques on an arteriogram Reduced muscle mass on CT scan Boney erosions on x-ray A client with rheumatoid arthritis reports disrupted sleep because of pain and stiffness. Which recommendations will the nurse make to help the client achieve restful sleep? Select all that apply. Use relaxation exercises. Create a quiet sleep environment. Avoid caffeine before bedtime. Establish a set time to sleep every night. Take pain medications four hours before sleep. Use relaxation exercises. Establish a set time to sleep every night. Avoid caffeine before bedtime. Create a quiet sleep environment. A client is experiencing an acute attack of gout. Which medications will the nurse anticipate being prescribed for this client? Select all that apply. Ibuprofen Allopurinol Colchicine Prednisone Febuxostat Colchicine Prednisone Ibuprofen A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects? methotrexate aspirin celecoxib hydroxychloroquine aspirin A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining? celecoxib ibuprofen 41 | P a g e sulfasalazine methotrexate celecoxib A client with systemic lupus erythematosus is prescribed belimumab. For which reason will the nurse question giving the client this medication? Received a live vaccination a week ago Bilateral knee joint swelling is present Report of constipation Discoid rash present over the face Received a live vaccination a week ago The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess? (Select all that apply.) Butterfly-shaped rash on the face Productive cough Dyspnea owing to fibrotic cardiac tissue Decreased ventilation owing to lung scarring Dysphagia owing to hardening of the esophagus Decreased ventilation owing to lung scarring Dysphagia owing to hardening of the esophagus Dyspnea owing to fibrotic cardiac tissue A client with rheumatoid arthritis wants to participate in water aerobics classes for arthritis at the community center. Which statement will the nurse respond to this client? "Be sure to wear nonslip footwear for safety." "Don't go if your joints are inflamed." "Have someone check your blood pressure before exercising." "That's not the best activity for misaligned joints." "Be sure to wear nonslip footwear for safety." A client cringes in pain when the nurse places the stethoscope over the upper back to assess breath sounds. On which condition will the nurse focus when assessing this client? Ankylosing spondylitis Liver disease Gallbladder disease Fibromyalgia Fibromyalgia Which finding is consistent with the diagnosis of rheumatoid arthritis? Cloudy synovial fluid 42 | P a g e Decreased ESR Increased C4 complement component Increased red blood cell count Cloudy synovial fluid A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication? Since the medication is able to be obtained over the counter, it has few side effects. Take the medication on an empty stomach in order to increase effectiveness. Take the medication with food to avoid stomach upset. Inform the health care provider if there is ringing in the ears. Take the medication with food to avoid stomach upset. immunity The body's specific protective response to foreign agent or organisms - Resistance to disease, specifically infectious disease Immunopathology the study of diseases that results from dysfunction of the immune system Components of the immune system Bone marrow: T cells and B cells Lymphoid tissue: spleen and lymph nodes True/False Immunity refers to the body's nonspecific protective response to an invading foreign agent or organism False - Immunity refers to the body's specific protective response to an invading foreign agent or organism B lymphocytes mature in the _________________. bone marrow T lymphocytes mature in the_____________. Thymus, where they also differentiate into cells with various functions Functions of the immune system To remove foreign antigens such as viruses and bacteria to maintain homeostasis - Phagocytosis - Inflammatory response Phagocytosis Monocytes are responsible for engulfing and destroying foreign bodies and toxins 45 | P a g e first line of defense: phagocytic immune response -involves the WBC which have the ability to ingest foreign particle, and destroy the invading agent second protective response defense: the humeral immune response (antibody response) Third mechanism of defense: cellular immune response involves T lymphocytes which can turn into special cytotoxic (killer) T cells that attack the pathogens. Humoral Immune Response - Antigen recognition - Antibodies (IgA, IgD, IgE, IgG, IgM) defend against foreign invaders - Antigen-antibody binding Cellular Immune Response T Lymphocytes - Attack invaders directly, secrete cytokines Helper T cells Activate macrophages, B cells and T cells. Cytotoxic T cells destroy pathogens and release chemicals called cytokines Memory T cells Remember antigen and quickly stimulate immune response on reexposure Supressor T cells decrease B-cell response after infection is gone and antibodies aren't needed True/false Autoimmune disorders are more common in women than men True Variables that effect immune system function - Age and gender - Nutrition - History of infection or immunization - Allergies - Presence of conditions or disorders: autoimmune disorders, cancer or neoplasm, chronic illness, surgery or trauma - Medications and transfusions - Lifestyle - Psychoneuroimmunologic factors Assessment of the Immune System 46 | P a g e Health history, including nutrition, infections, immunizations, allergies, autoimmune disorders, cancer, and chronic illness Physical exam, including lymph node assessment in addition to other body systems Tests to evaluate immune function WBC count and differential Bone marrow biopsy Humoral and cellular immunity tests Phagocytic cell function test Complement component tests Hypersensitivity tests Specific antigen-antibody tests HIV infection tests Nurse's Role in Evaluation of the Immune System Offer support Reduce anxiety Provide patient education and counseling Complement System proteins in the blood that help antibodies and T cells kill their target - Ignites to start the immune response Three functions: - Defend the body against bacterial infection - Bridge natural and acquired immunity - Dispose of immune complexes Primary Immune Deficiency Disorders (PIDD): Pathology - Genetic - Majority diagnosed in infancy - Male to female ratio of 5-1 - Prevents body from developing normal immune responses - May affect phagocytic function, B cells, or T cells, or the compliment system. PIDD clinical manifestations - Multiple infections despite treatment - Infection with unusual/opportunistic organisms - Failure to thrive, poor growth - Positive family history True/False: Primary immune deficiency disorders result from external factors such as infection. 47 | P a g e False - Primary immune deficiency disorders are genetic PIDD Nursing management - Nursing care is meticulous - Reduce risk of infection! - hand hygiene - Infection prevention precautions - Continual monitoring for early signs of infection - teaching: patients and caregivers to administer medications at home - Ongoing education and support Role of spleen it filters blood by removing old red blood cells, removing iron from hemoglobin for reuse, produces lympohcytes and antibodies to fight infection, acts as a filter for foriegn bodies, serves as a reservoir for blood that can be added to the cardiovascular system. Nursing management of immune deficiency - Appropriate hand hygiene - infection prevention precautions - continual monitoring for early signs of infection - teach patients and caregivers to administer medications and therapy at home - provide ongoing education and support Human Immune Deficiency Virus (HIV): Modes of transmission HIV-1 Transmitted in body fluids that contain infected cells - Blood and blood products - Seminal fluid - Vaginal secretions - Mother-to-child - NOT through casual contact PLWHA Persons living with HIV/AIDS HIV prevention - education on how to eliminate or reduce risks associated with HIV infections and AIDS - prevention education (behavioral interventions, HIV testing, linkage to treatment and care) 50 | P a g e type of skin cancer often seen in patients with AIDS; consists of brownish-purple papules that begin in skin and spread to internal organs Neurologic manifestations of HIV -Effects on cognition, motor function attention, visual memory, visuospatial function -Peripheral neuropathy -HIV encephalopathy -Fungal infection, Cryptococcus neoformans -Progressive multifocal leukoencephalopathy -Depression and apathy HAND HIV Associated Neurocognitive Disorder (Dementia) Integumentary manifestations of HIV Herpes zoster Seborrheic dermatitis Gynecologic manifestations of HIV -Genital ulcers -Persistent, recurrent vaginal candidiasis -Pelvic inflammatory disease -Menstrual abnormalities Treatment of HIV/AIDS No cure but antiviral drugs can slow down affects Antiretroviral Therapy (ART) - Suppress HIV replication - Reduce morbidities and prolong duration and quality of life - restore and preserve immunologic function - Suppress plasma HIV viral load - Prevent transmission Assessment of the Patient with HIV/AIDS 51 | P a g e - Identification of potential risk factors - Physical status - Psychological status - Immune system functioning - Nutritional status - Respiratory status - Neurologic status - Fluid and electrolyte balance - Knowledge level Problems/Complications of the patient with HIV/AIDS - Development of HAND (dementia) - Body image changes - Adverse effects of medications Planning and goals for patients with HIV/AIDS - Improved nutritional status - Increased socialization and expression of grief - Increased knowledge regarding disease prevention and self-care - Absence of complications. Which of the following is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection. a. cryptococcal meningitis b. neuropathy c. progressive multifocal leukoencephalopathy d. HIV encephalopathy d. HIV encephalopathy - Formerly referred to as AIDS dementia complex, HIV encephalopathy is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection. Allergy - Hypersensitive reaction to an allergen initiated by immunologic mechanisms that is usually mediate by IgE antibodies - An inappropriate, often harmful response of the immune system to normally harmless substances. atopy/atopic Refers to IgE-mediated diseases, such as allergic rhinitis, that have a genetic component. Immunoglobulins and allergic Response -Antibodies (IgE, IgD, IgG, IgM, and IgA) formed by lymphocytes and plasma cells 52 | P a g e -IgE antibodies are involved in allergic disorders -IgE molecules bind to an allergen and trigger mast cells or basophils -These cells then release chemical mediators such as histamine, serotonin, kinins, SRS-A, and neutrophil factor -These chemical substances cause the reactions seen in allergic response * IgE sets of the compliment cascade Hypersensitivity An abnormal heightened reaction to a stimulus of any kind. Type I hypersensitivity: Anaphylactic Reaction A reaction characterized by vasodilation, increased capillary permeability, smooth muscle contraction and eosinophilia. - Systemic reactions may involve laryngeal stridor, angioedema, hypotension, and bronchial, GI, or uterine spasm. - Local reactions are characterized by hives. Examples include extrinsic asthma, allergic rhinitis, and reactions to insect stings. Type II: Cytotoxic hypersensitivity Reaction A hypersensitive reaction which involves binding either IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. - The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade - Examples include: Myasthenia graves, Pernicious anemia, Hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia Type III: immune complex hypersensitivity - Marked by acute inflammation resulting from formation and deposition of immune complexes - The joints and kidneys are particularly susceptible to this kind of reaction - Associated with Systemic lupus, serum sickness, nephritis, rheumatoid arthritis. - S/S include urticaria, joint pain, fever, rash, adenopathy Type IV hypersensitivity reaction A delayed, or cellular reaction occurs 1-3 days after exposure to an antigen. - The reaction, which results in tissue damage, involves activity by lymphokines, macrophages, and lysozymes. - Erythema and itching are common. - examples include: Contact dermatitis, graft-versus-host disease, sarcoidosis, Hashimoto's thyroiditis. Assessment of patients with allergic disorders •History and manifestations; comprehensive allergy history 55 | P a g e - Past health History - Contributing factors - Previous treatments and their effectiveness - Patient's support systems. (disease can be debilitating) Assessment of Rheumatic disease: Physical Assessment Physical Examination Functional Assessment - History and observation - Gait, posture, general musculoskeletal sie and structure - Gross deformities and abnormalities in movement - Symetry, size, and contour of other connective tissues, such as the skin and adipose tissue. Which of the following statements should help guide nursing care for the patient with fibromyalgia? a. Patients with fibromyalgia rarely respond to treatment b. Patients with fibromyalgia may feel as if their symptoms have not been taken seriously c. all patients with fibromyalgia have the same type of symtoms d. patients with fibromyalgia will eventually lose their ability to walk. b. Patients with fibromyalgia may feel as if their symptoms have not been taken seriously Planning and goals for the patient with a rheumatic disorder - Relief of Pain and Discomfort - Relief of fatigue - maintain optimal functional mobility - performs self-care activities independently - effective coping behaviors - absence of complications * Maintain overall functionality as much as possible. Interventions to maintain functional ability - Range of motion - Isometric exercise - Dynamic exercise - Aerobic exercise - Pool exercise Functions of the musculoskeletal system -Protection of vital organs -Framework to support body structures, mobility -Movement; produce heat and maintain body temperature 56 | P a g e -Facilitate return of blood to the heart -Reservoir for immature blood cells -Reservoir for vital minerals Osteoblasts Function in bone formation Osteocytes mature bone cells that function in bone maintenance - located in the lacunae Osteoclasts multinuclear cells function in destroying, resorbing, and remodeling bone Osteogenesis Process of bone formation Ossification the process of formation of the bone matrix and deposition of minerals regulating factors of bone formation and maintenance - Stress and weight bearing - Vitamin D - Parathyroid hormone and calcitonin - Blood supply - Calcium True/False: Bone is in a constant state of turnover True Bone Healing process Stage 1: Hematoma formation (1-2 days after fracture) Stage 2: Fibrocartilaginous callus formation Stage 3: Bony callus formation (Ossification begins during the 3rd of 4th week) Stage 4: Remodeling (Osteoclasts remove necrotic bone) remodeling of bone The process of resorption and formation of bone Synarthrosis immovable joint; (eg, sutures of the cranium) amphiarthrosis joint 57 | P a g e slightly movable (ex: joint between the pelvic bones) Diarthrosis (synovial) joint freely movable joint Types of Diarthrodial Joints -Hinge -Pivot -Condylar -Ellipsoid -Saddle -Ball-and-socket Joint Structures - Joint Capsule - Ligaments - Tendons - Bursa Sac Ligament Connects bone to bone Tendon Connects muscle to bone Flaccid (adj.) limp, not firm; lacking vigor or effectiveness "wet noodle" Sarcomere The contractile unit of skeletal muscle that contains actin and myosin 60 | P a g e Absence of feeling Diagnostic tests for musculoskeletal disorders - Radiographs - Computed tomography (CT) - MRI - Arthrography - Bone Densitometry - Bone Scan - Arthroscopy - Arthrocentesis - Electromyography - Biopsy - Laboratory Studies Clinical Indications for Diagnostic Tests (Musculoskeletal) - Study Changes in the structure of the bone - Assess for tumors, soft tissue injury, fractures - Visualie torn muscles, ligaments, cartilage, herniated disks - Identify cause of unexplained joint pain and joint disease progression - Evaluation of bone mineral density MRI nursing interventions - May hear knocking sound - May take 30-90 minutes to complete the test - Assess for contraindications - Assess for allergies for contrast testing - Because it is a giant magnet, patients with most metal implants (i.e. cochlear implants) or clips are not candidates for MRI. - Patients who experience claustrophobia may be unable to tolerate the confinement of a closed MRI without sedation. Arthography (arthrogram) Used to identify the cause of any unexplained joint pain and progression of joint disease. - A radiopaque contrast agent or air is injected into the joint cavity to visualize structures. The joint is put through its range of motion to distribute the contrast agent while a series of x-rays are obtained. If a tear is present, the contrast agent leaks out of the joint and is evident on the X-ray image. 61 | P a g e Arthrography Nursing Considerations - client may feel discomfort and tingling - Nurse may provide comfort measures (ice, mild analgesia) - Explain to patient that it is normal to experience clicking or cracking in joints for 24-48 hours after until the contrast agent or air is absorbed. Bone scan nursing interventions -assess for allergies to radioisotopes -encourage fluids to distribute isotope Arthroscopy direct visualization of the interior of a joint using a special fiberoptic endoscope called an arthroscope Arthroscopy nursing interventions -Post procedure wrap joint with compression dressing to control swelling - Joint is kept extended and elevated to reduce swelling. -Monitor neurovascular status -Instruct family to monitor signs and symptoms of complications (fever, excessive bleeding, swelling, numbness, cool skin) Arthrocentesis is: Joint aspiration to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Arthrocentesis nursing interventions 62 | P a g e - Remove hair from procedure site (with electric razor) - Administer analgesics - Apply ice 24 to 48 hours post procedure Electromyography (EMG) recording the strength of muscle contraction as a result of electrical stimulation Electromyography (EMG) nursing interventions - Assess for use of anticoagulants (needle electrodes may cause bleeding in the muscle) - Assess for active skin infection (needles may spread infection into the muscle) - Avoid using any lotions or creams on the day of the test - Warm compresses may relieve residual discomfort after the study Biopsy nursing interventions -monitor site for bleeding and edema -administer analgesics and antibiotics Which of the following statements about magnetic resonance imaging is false? a. credit cards with magnetic strips may be erased b. non removable cochlear implant devices can become inoperable c. transdermal patches that have a thin layer of aluminized back must be covered with gauze d. jewelry and hair clips must be removed before MRI is performed c. transdermal patches that have a thin layer of aluminized back must be covered with gauze Abduction Movement away from the midline of the body Adduction Movement toward the midline of the body Arthroplasty 65 | P a g e compression of the median nerve as it passes between the ligament and the bones and tendons of the wrist - Occurs frequently in women between 30 and 60 - commonly caused by repetitive band and wrist movements Tinel Sign: Assessment for Carpal Tunnel Syndrome Percuss lightly over the median nerve, located on the inner aspect of the wrist. If the patient reports tingling, numbness, and pain, the test is considered positive. ganglion A collection of neurologic gelatinous material near the tendon sheaths and joints - Appears as a round, firm, cystic swelling, usually on the dorsal of the wrist. What is bursitis? a. inflammation of a fluid-filled sac in the joint b. new bone growth around a sequestrum c. disease of a nerve root d. inflammation of muscle tendons a. inflammation of a fluid-filled sac in the joint Duputyren's Disease results in a slowly progressive contracture of the palmar fascia that causes flexion of the fourth, fifth, and somethings middle finger, rendering these fingers more or les useless. Nursing management of the patient undergoing surgery of the hand or wrist * Start in Pre-op; Reinforce in post-op - Surgery is usually an ambulatory procedure - Patient education is a major nursing need - Neuromuscular assessment is vital; every hour for the first 24 hours, assess motor function only as prescribed; instruct patient in signs and symptoms to assess and report - Pain control measures: medication, elevation, intermittent ice or cold 66 | P a g e - Prevention of infection: keep dressing clean and dry, wound care, S/S of infection - Assistance with ADLs and measures to promote independence. Common foot problems - Callus - Corn - Hammer toe - Ingrown toenail: Onychocryptosis - Clawfoot: Pes cavus - Hallux valgus - Morton neuroma - Flatfoot: Pes planus - Plantar fasciitis Callus a thickening of part of the skin on the hands or feet caused by repeated rubbing Corn An area of hyperkeratosis produced by internal pressure or external pressure. Hammer Toe flexion deformity of the interphalangeal joint that may involve several toes. - Tight socks or shoes may push an overlying toe back into the high of the other toes. oncyhocryptosis Nail becomes buries in the skin due to an abnormal growth, commonly called an ingrown nail. 67 | P a g e - A secondary infection or granulation tissue may develop. Pes Cavus "Claw foot" Abnormally high arch of the foot and a fixed equines deformity of the forefoot. hallux valgus deformity in which the great toe deviates laterally - an abnormal enlargement of the joint at the base of the great toe occurs - Acute bursitis symptoms include a reddened area, edema, and tenderness. Morton Neuroma Benign mass of plantar digital nerves of the foot. Pes planus (flat foot) Decreased height of medial longitudinal arch. Etiologies: Genetics, muscle weakness, ligament laxity, paralysis, overpronation, trauma, disease (RA) Normal in infant/toddler feet Decreased ability to form rigid lever for push-off Rx: Education emphasizing limitation of high-impact sports, use of proper footwear, orthotics. 70 | P a g e -Most prominent modifiable risk factor for OA is obesity -Diet and exercise can help minimize symptoms of OA in patients with obesity Clinical manifestations of osteoarthritis - Pain, stiffness, and functional impairment - Joint pain aggravated by movement or exercise and relieved by rest - Morning stiffness is present; usually brief, lasting less than 30 minutes - Onset is routinely insidious, progressing over multiple years - Affected joint may be enlarged with a decreased ROM - Most often in weight-bearing joints (hips, knees, cervical and lumbar spine) Management of Osteoarthritis - Decrease pain and stiffness - Exercise, especially in the form of cardiovascular aerobic exercise and lower extremity strength training - Weight loss - Occupational and physical therapy - Pharmacologic management directed toward symptom management and pain control Used in conjunction with nonpharmacologic strategies Osteoporosis Most prevalent bone disease in the world - Normal Homeostatic bone turnover is altered, and the rate of bone resorption is greater than the rate of bone formation, resulting in los of total bone mass. - Bone becomes porous, brittle, and fragile and breaks easily under stress. osteoporosis prevention - Balanced diet high in calcium and vitamin D throughout life - Use of calcium supplements to ensure adequate calcium intake: take in divided doses with vitamin C - Regular weight-bearing exercises: 20 to 30 minutes a day Increases balance Reduces incidence of falls and fractures Weight training stimulates bone mineral density (BMD) How long does a patient taking bisphosphonates need to stay upright after administration? a. 10 minutes 71 | P a g e b. 20 minutes c. 30 minutes d. 120 minutes c. 30 minutes Bisphosphonate administration Admin in the morning with a full glass of water on an empty stomach. Must stay upright for 30-60 minutes Osteomalacia - A metabolic bone disease characterized by inadequate bone mineralization - Softening and weakening of the long bones causes pain, tenderness, and deformities caused by the bowing of bones and pathologic fractures - Deficiency of activated vitamin D causes lack of bone mineralization and low extracellular calcium and phosphate - Causes include gastrointestinal disorders, severe renal insufficiency, hyperparathyroidism, and dietary deficiency management of osteomalacia - Reduce pain and discomfort - Correct underlying cause - Kidney disease: supplement calcitriol - Malabsorption: Increased doses of vitamin D and Calcium - Exposure to sunlight may be recommended Paget disease of bone (osteitis deformans) - Disorder of localized bone turnover - Bone structure becomes disorganized, weak, and highly vascular - Manifestations include skeletal deformities, mild to moderate aching pain, and tenderness and warmth over bones - Might appear to be bone cancer. Paget disease pharmacologic management - Antineoplastic therapy - NSAIDs - Calcitonin 72 | P a g e - Bisphosphonates (etidronate) - Plicamycin: A cytotoxic antibiotic Osteomyelitis Infection of the bone - Is a secondary infection (extension of soft tissue infection) Typically occurs in area with lower resistance or trauma Osteomyelitis interventions Pain relief Prevention Septic arthritis - Watch for systemic sepsis - High risk > 80 years old - Most common single knee or hip joins - Warm, painful, swollen joint with decreased ROM. Systemic chills, fever, and leukocytosis are sometimes present. - Prompt recognition and treatment are key Treatment of septic arthritis - Aspiration of joint to remove fluid, exudate and debris - Immobilization of joint - Pain relief - Antibiotics Bone Tumors - benign More common, slow growing, and present few symptoms - bone cysts: expanding lesions within the bone - Osteoid osteoma: painful tumor in children and young adults, presents like cancer - Osteoclastomas: benign for long periods but may invade local tissue and cause destruction. Bone Tumors-Malignant (Primary) - Primary tumors •Osteosarcoma-most common and most often fatal •Chondrosarcoma, Ewing sarcoma, fibrosarcoma - Soft tissue sarcomas •Liposarcoma, fibrosarcoma of soft tissue, rhabdomyosarcoma - Prognosis depends on the type and whether the tumor has metastasized