QuizBBB: July 2018

Answer: Cushing's cats are often diabetic and have severe insulin resistance. The same thing is seen in cats with acromegaly. However, acromegaly is seen mostly in male cats, while Cushing's is seen predominantly in females.

True or false: adrenal tumors occur much more frequently in female dogs than in males.

Answer: True. About 70% of adrenal tumors in dogs are seen in female dogs.

Name 4 dog breeds predisposed to Cushing's Disease.

- Poodles
- Boston Terrier
- Boxer
- Dachshund

An older client has bilateral osteoarthritis in his hips. What would be important for the nurse to teach this client regarding protection of his joints?

1. Use a cane or walker for ambulation.
2. Sit in straight back chairs that you can get out of easily.
3. Use a wheel chair when you are tired.
4. Exercise regularly and control weight.

Answer: 4

Regular exercise increases and strengthens joint mobility, in addition to muscles supporting the joints. It also increases cartilage formation for continued joint mobility. Weight reduction, if appropriate, is critical to decreasing stress on weight-bearing joints. Sitting in a straight back chair does facilitate movement but does not protect the joints. Using devices assists in ambulation and promotes independence but does not offer joint protection as well as exercise and weight loss.

Which dietary recommendations would the nurse encourage for a client who has just been diagnosed with gout?

1. Increase protein
2. Increase intake fluids to 3000 ml daily
3. Avoid foods containing chocolate
4. Avoid eating cranberries and prunes

Answer: 2

The client should increase the intake of fluids to promote excretion of uric acid. Some physicians prescribe a low-purine diet to decrease formation of uric acid crystals. Chocolate, cranberries, and prunes do not have any effect on the gout. (Ignatavicius, Workman, 7 ed., p. 350.)

A client with osteoarthritis in the left knee has had a total knee replacement. What is important to include in the postoperative nursing care plan?

1. Use constant passive motion (CPM) to promote joint flexibility.
2. Wrap the knee in a loose fitting absorbent bandage to promote flexibility.
3. Maintain bed rest for 2 days to maintain extension and immobilization of leg.
4. Insert a urinary retention catheter since client is on total bed rest for 2 days.

Answer: 1

Constant passive motion is utilized early to maintain joint flexibility. A compression dressing is used immediately after surgery. The client is ambulated as early as possible. A urinary retention catheter is not used with bed rest unless it is absolutely necessary and the client cannot void on his own. (Ignatavicius, Workman, 7 ed., pp. 329-330.)

The nurse understands that which characteristic of rheumatoid arthritis distinguishes it from both osteoarthritis and gouty arthritis?

1. Impact is on weight-bearing joints
2. Symmetric involvement of joints
3. Uric acid serum levels are elevated
4. Range-of-motion crepitus

Answer: 2

Rheumatoid arthritis is bilateral and symmetric. Osteoarthritis and gouty arthritis are unilateral. Crepitus is associated with osteoarthritis. Elevated serum uric acid levels occur in gouty arthritis, and an impact on weight-bearing joints is observed with osteoarthritis. (Lewis, et al, 8 ed., p. 1651.)

A client has a problem with severe painful osteoarthritis. A regimen of heat, massage, and exercise has been ordered. What is the desired response to this treatment?

1. Help maintain joint flexibility and relieve pain and stiffness.
2. Restore range of motion previously lost.
3. Prevent the inflammatory process.
4. Assist the client to effectively cope with pain.

Answer: 1

The nurse is screening an older woman for the early signs of osteoporosis. What assessment findings would be strongly suggestive of the presence of osteoporosis?

1. Increased pain in lower back when walking
2. A limp when walking because one leg is shorter
3. Waddling gait, frequently requiring assistive devices
4. Decrease of 3 inches in height

Answer: 4

The classic initial observations that indicate osteoporosis is the loss of height along with the spinal deformity of kyphosis or "dowager's hump." The back pain is generally continuous and does not just occur with walking. Both legs are the same length, and the gait is not particularly affected in the early stages.

Which of the following put a woman at increased risk for development of osteoporosis?

1. Hormone replacement therapy
2. Menopausal age
3. Prolonged steriod intake
4. Fractured hip
5. Hyperthyroid disease
6. Compromised pulmonary function

Answers: 2, 3, 5

Menopausal or post menopausal women, prolonged steroid intake, and hyperthyroid disease have been associated with the development of osteoporosis. Hormone replacement actually decreases the risk factor, but use of it must be considered with other associated risks. Presence of a fracture may indicate that osteoporosis is present but is not considered a risk factor. Compromised pulmonary function may occur as a result of the kyphosis but is not considered a risk factor.

The nurse is preparing health teaching for adult women regarding the prevention of osteoporosis. What would be important to include in the teaching plan?

1. Daily walking for 15 to minutes
2. Supplemental calcium intake
3. Reduction of caffeine intake
4. Increased intake of water
5. Avoidance of sunlight because of photosensitivity
6. Increase intake of fresh fruit and vegetables

Answers: 1, 2, 3, 6

Daily walking, supplemental calcium, and reduction of caffeine intake are the most common preventive measures in women at increased risk for osteoporosis. Some sunlight is encouraged to facilitate utilization of vitamin D and the absorption of the calcium intake. Increased water intake is healthy, but not specific for osteoporosis. Fruits and vegetables are important to a healthy diet and should be encouraged.

A child has an injured wrist and will not allow the nurse to exam the injured arm. Both parents and child are upset. What is a priority nursing intervention?

1. Tell the parents to hold the child down, so the arm can be examined.
2. In a soothing voice, ask the child to point to the "ouchie" or pain and move fingers.
3. Obtain an order for pain analgesic and then examine the arm.
4. Call radiology and have them come to the emergency room to obtain x-ray films.

Answer: 2

Before any measures (obtaining x-rays and administration of analgesics) are started, an initial assessment is the priority. It will be important to calm the child and gain the child's trust. Inspection and observation are important, so asking the child to point to the painful part and moving the fingers, along with noting any pallor or abnormal position would be part of the initial assessment. Parents are not to be asked to restrain their child. If restraint is necessary, then the parents need to leave the room and the nurse needs to obtain assistance from other personnel. (Hockenberry, Wilson, 9 ed., p. 1639.)

The nurse understands that which of the following is characteristic of fractures in children?

1. The younger the child, the faster a fracture heals.
2. Epiphyseal fractures seldom occur because of the elasticity of the growth plate.
3. A child's bone is more pliable and porous as compared with an adult's bone
4. A child's bone is thinner, weaker, and less osteogenic than that of an adult.

Answer: 1

The healing of fractures is more rapid in children, as compared with adults. The speed of healing is inversely related to the age of the child: the younger the child, the more rapid the healing process. The epiphyseal plate is a frequent site of injury during trauma, because it is the weakest point of long bones. Children's bones are more pliable and porous, which allows them to bend, buckle, and break, and have greater porosity, which increases the flexibility of the bone providing a good shock absorber for any forceful injury. The adult, not the child, has periosteum that is thinner, weaker, and less osteogenic.

A client has been fitted with crutches. The nurse is assessing the crutches to determine if they properly fit the client. What observation would cause the nurse the most concern?

1. When the client is standing, with the hands placed on the hand supports, the arms are straight.
2. There is space of about 1 to 2 in between the axillary fold and the top of the crutch.
3. The client can comfortably place crutches about 6 to 8 in lateral to the heel of his foot when walking.
4. The arms are flexed about 30 degrees and resting on the hand supports when the client is standing.

Answer: 1

When the client is standing at rest, the arms should be flexed about 30 degrees. This allows for weight bearing on the hand supports and not under the client's arm when the client begins to walk. There should be about 1 to 2 in between the axillary fold and the top of the crutch to prevent axillary nerve damage. The client should be able to comfortably place the crutches about 6 to 8 in lateral to the heel of the foot.

The nurse is caring for a client with a fractured hip who has been placed in Buck's traction. On assessing the client, the nurse determines the client's feet are touching the end of the bed. What would be the best nursing action?

1. Assist the client to move up in the bed.
2. Raise the head of the bed.
3. Turn the client to the unaffected side.
4. Take no action if the client is comfortable.

Answer: 1

Pulling the client up in the bed will restore traction, and raising the foot of the bed will decrease the amount of sliding. Turning the client may cause further damage. Taking no action allows the traction to remain ineffective in this situation.

The nurse is caring for a client with a fractured femur that has not been repaired. Fat emboli and pulmonary emboli are both potential complications of this condition. Which symptoms would be suggestive of fat emboli versus a pulmonary emboli?

1. Difficulty breathing
2. Blood-tinged sputum
3. Restless and confusion
4. Petechiae over the trunk and in axillary folds

Answer: 4
Difficulty with respirations, blood-tinged sputum or frothy sputum, chest pain, and restlessness, irritability, and confusion are all common to pulmonary and fat emboli. A pulmonary embolus does not precipitate the development of petechiae over the trunk, buccal membrane, conjunctival sacs, and in anterior axillary folds.

A client's x-ray film shows a fractured right femur. The nurse will assess the client for what potential complication?

1. Fat embolus
2. Septicemia
3. Hypovolemic shock
4. Cardiogenic shock

Answer: 1

The common complications associated with a femoral shaft fracture include fat embolism, nerve and vascular injury, and problems with bone union and soft tissue injury.

A client is being discharged after receiving a left total hip replacement. He has been instructed on how to use a cane by physical therapy. The nurse is evaluating the client's use of the cane. What observation would indicate the client understands how to use the cane?

1. The cane is held with the right hand and is advanced forward with the left leg.
2. The cane is advanced with the left foot, and held on the left side.
3. The cane is positioned in front of the client and he walks toward the cane.
4. The cane is to the left side; the client bears weight on it when advancing the left leg.

Answer: 1

The cane should be held in the hand opposite the affected leg and should be advanced with the affected leg. The cane would be placed in the right hand, and then the cane is advanced with the left leg. The cane should not be held in the hand on the same side as the injury.

An older woman is being discharged home after repair of a left hip fracture. Which statement by the client would indicate to the nurse that additional teaching is needed?

1. "I put an extension on the toilet seat to make it higher."
2. "I will ask for help in putting on my shoes and socks."
3. "I will use a walker for a while until I am more stable."
4. "I can sleep in any position that is comfortable."

Answer: 4

The client needs to maintain abduction on the affected left extremity. She should not sleep on her right side with her left leg crossing over the right (Sims position). An extension for the toilet seat to make it higher and using a walker are appropriate for the client. Asking for help with shoes and socks helps prevent extreme flexion of the affected hip.

Fat embolism is a major complication of a client with a fractured femur. What assessment finding would alert the nurse to the possibility of this complication occurring?

1. Ecchymosis on lower extremities
2. Blood-tinged sputum
3. Complaints of bone pain
4. Complaints of muscle spasms.

Answer: 2

Fat emboli, which are made up of lipase and fatty acids, can cause an inflammatory response in the lungs with blood-stained sputum, condition may progress to pulmonary edema with severe hypoxia. Petechiae on the chest may occur and are a classic sign of fat emboli; however, it is a late sign. Ecchymosis on the lower extremities is not an indication of fat emboli. The client is already experiencing bone pain from the fracture.

A client has a fractured femur and is scheduled for surgery and stabilization with internal fixation. The nurse is assessing the client for the development of a fat embolism. What early assessment findings would suggest the development of this complication?

1. Swelling and redness in the affected area.
2. Blood and fat in the stool
3. Hypotension
4. Confusion and restlessness

Answer: 4

Confusion and restlessness are early signs of hypoxia. A fat embolism travels through the venous system to the lungs, where it lodges and causes an interstitial pneumonitis; this will precipitate symptoms of acute respiratory distress. Swelling and redness of the affected area would a normal observation. Blood and fat in the stool is not an indication of a fat embolism. The client may experience hypotension, but hypotension is not as specific as changes in orientation and level of consciousness.

An older client is admitted for treatment of a fractured left hip. The fracture is repaired by internal fixation. What would be a priority nursing intervention regarding positioning this client in the immediate postoperative period?

1. Keeping the client in low Fowler's position to facilitate slight hip flexion
2. Elevating the foot of the bed to prevent venous pooling in the lower extremities
3. Placing a trochanter roll at the thigh on the left side to prevent internal rotation
4. Placing a pillow or foam frame between the legs to maintain abduction of the left leg

Answer: 4

Maintaining the leg in an abducted position is critical in the first few days after surgery for a client with a fractured hip. This maintains the intactness of the hip joint. The trochanter roll at the thigh will assist to prevent external rotation, not internal rotation. The foot of the bed may be slightly elevated, but maintaining abduction is more critical.

The nurse is concerned about compartmental syndrome in an 8-year-old client with a greenstick fracture. For what will the nurse teach the mother to observe?

1. Swelling and discoloration of the hand distal to the fracture site
2. Hematoma formation and pain in the upper arm and shoulders
3. Severe pain radiating proximal to the cast and fracture area
4. Decreased sensation and decreased ability to move the fingers of the affected hand

Answer: 4

Indications of compartmental syndrome include pain, decreased sensation and decreased mobility in the extremity distal to the fracture/cast, decreased or loss of pulse distal to injury, skin cool to touch and blanched in color in an area distal to the fracture/cast. Swelling and discoloration commonly occur as a result of the bruising of the injury. Usually no symptoms are proximal to the fracture site.

The nurse is caring for a client who has undergone repair of a fractured hip. What will be an important nursing action?

1. Keeping the client flat in bed until adequate healing has occurred
2. Maintaining the client in Buck's traction with leg adducted
3. Getting the client up in a chair, non-weight bearing the day after surgery
4. Keeping the client's leg slightly bent at the knee to prevent internal rotation

Answer: 3

Providing the client is stable, early mobilization is encouraged. This is frequently the day after surgery. When the hip is pinned (internal fixation), early mobility is possible. The client may be maintained in Buck's traction before the hip repair, not after the repair. Keeping the client flat is unnecessary; she should be turned while in bed. The affected leg should be maintained straight and in an abducted position to prevent adduction and internal rotation.

A client with a complete transverse fracture of the left femur has been treated with an external fixator device. The nurse is caring for the client the day after the procedure. What would be an important nursing intervention in caring for this client?

1. Notify the physician for clear fluid oozing from the pin sites.
2. Maintain continuous pull on the weights of the traction.
3. Cleanse each pin site every 4 hours with warm water and rinse thoroughly.
4. Assess pin sites for purulent drainage and inflammation.

Answer: 4

The placement of an external device requires pins to be placed in the bone to stabilize the fracture. Infection is a common complication. Serous drainage from the pin sites is expected for the first 48 hours. Most often no traction is involved with the treatment. Pin sites generally are cleansed once a day. Currently no standards are set for pin care, but hydrogen peroxide, normal saline, and antibiotic ointment commonly are used.

The nurse is assisting a client to learn how to use an aluminum pick up walker to help stabilize her gait after repair of a fractured hip. Which nursing observations of the client's activity would indicate the client understands how to use the walker?

1. Places the walker forward and walks into walker with affected leg first, flexing both arms about 30 degrees
2. Puts the walker in front, leaning into the walker, and takes several small steps, keeping the arms straight
3. Standing straight, moves the walker forward with each step
4. Places the walker in front and swings both legs together to move into walker

Answer: 1

After repair of a fractured hip, the client would have partial weight bearing as tolerated on the affected leg. Arms are flexed 30 degrees when standing in the walker. The walker is advanced and the client steps into the walker with the affected leg first, bearing weight on the walker as the client moves forward. Leaning into walker before taking a step could put the client off balance. Taking small steps forward as the walker is advanced does not provide stability to the injured hip. A swing-through gait is not appropriate for a client with partial weight bearing.

Twelve hours after a total hip replacement, a client complains of sudden chest pain and shortness of breath. What is the priority nursing action?

1. Reposition and elevate the head of bed.
2. Medicate with an analgesic.
3. Administer oxygen at 2 L/min via nasal cannula.
4. Notify the doctor regarding the pain status.

Answer: 3

Pain in the leg is expected but chest pain is not. The nurse should start oxygen and then notify the physician. There is possibility of a fat embolism, myocardial ischemia, or pulmonary emboli. The other measures of repositioning and medicating are not appropriate with the onset of sudden chest pain.

A client is placed in Buck's traction after admission for a fractured hip. The client asks the nurse to help reposition him toward the head of the bed. What would be an important nursing consideration when repositioning this client?

1. Place the weights on the corners of the bed to allow the nurse to move the client.
2. Add additional weight to the hanging weight to keep the client's position in balance.
3. Release the traction tension and weight while moving the client.
4. Use a draw sheet with one other person and carefully slide the client up the bed.

Answer: 4

Using a draw sheet to help with moving the client would maintain the counter traction. Traction weights should be free and not touching the floor. The nurse must not increase traction tension, release tension, or lift the traction during repositioning.

An older adult client is admitted to the hospital following a fall in which they sustained a fractured pelvis. What would be priority nursing care?

1. Determine the activity before the fall
2. Assess urine and stool for presence of blood.
3. Determine hemoglobin and hematocrit
4. Assist the client to turn every 2 hour

Answer: 2

Puncture of the bladder or bowel and vascular bleeding are a priority in the initial period after the fracture. The client also should be assessed for abdominal bruising and increasing abdominal distention and rigidity. Activity before the fall can be determined later; physiologic needs are a priority. The hemoglobin and hematocrit will be evaluated, but it would not be indicative of immediate bleeding. The client should remain in the supine position with the head slightly elevated and no turning until the stability of the fracture has been determined.

The nurse is teaching a client how to perform isometric exercises. What is an example of an isometric exercise?

1. Exercising both arms and legs extremities simultaneously
2. Running in place for 5 minutes, then taking a pulse check
3. Press back of the knee down and lift heel from the bed
4. Moving arms and legs through full range of motion

Answer: 3

Isometric exercises involve initiating a muscle contraction by pressing against a stationary object, or resistance (pushups, hip lifts). Exercising both arms and legs simultaneously or running in place are not examples of isometric exercises. Moving extremities through full range of motion is not an example of isometric exercise.

A client is admitted with a femoral neck hip fracture. The nurse would assess for what complication before repair of this type of fracture?

1. Fat emboli
2. Septicemia
3. Vascular damage
4. Compartment syndrome

Answer: 3

A femoral fracture because of close proximity to the femoral artery could create a risk of hemorrhage, hypovolemia, and shock, especially in the period before the repair. Sepsis is not a common problem in the initial period. Fat emboli are possible but less frequent with this type of fracture. Compartment syndrome occurs with constriction and interference of circulation distal to the fracture, which is not characteristic of a pelvic fracture.

The parents of a child with an above the knee plaster cast are preparing to take the child home. The nurse would know that the teaching was successful if the parents make which of the following statements?

1. "We can dry the casts faster with a heat lamp."
2. "We will keep a wire hanger nearby in case of an itch."
3. "We will need to frequently check the temperature and color of our child's toes."
4. "We can keep the cast clean with soap and water."

Answer: 3

The parents will need to assess the extremities distal to the cast for neurovascular circulation, which is the priority issue. External heat such as a heat lamp should not be used to dry the cast, because it would promote swelling inside of the cast. However, a hair dryer on low setting can be used until the cast is thoroughly dried. Putting water on a plaster cast can soften it and cause it to become misshapen and lose strength. Nothing should be inserted into the cast.

The nurse is caring for a client on the operative day following a herniated lumbar disk. What would be a priority nursing assessment?

1. Monitor the level and location of pain.
2. Determine peripheral pulse rate.
3. Evaluate the client for presence of venous stasis.
4. Check the dressing for presence of clear fluid.

Answer: 4

In a lumbar laminectomy, observing the dressing for presence of clear drainage, which may be spinal fluid, is critical. This must be reported to the surgeon immediately, and the client will be at an increased risk of infection. The pain level and location should be closely monitored, but the observation of the dressing for spinal fluid is more critical. The client will need to be evaluated for presence of and prevention of venous stasis, but spinal fluid leakage is more important the operative day. Presence and quality of peripheral pulses, not rate, should be assessed as part of the total assessment.

A client has a herniated nucleus pulposus at L5-S1, causing swelling toward the right spinal nerve root. Where would the nurse anticipate the client will feel pain or discomfort?

1. Radiating down the right hip to the thigh
2. Along the lower left side of the back and down to the left calf
3. Lower back bilaterally
4. From across the pelvis to the center of the lower back

Answer: 1

A herniated nucleus pulposus of L5-S1 will affect primarily the lower back, with radiation down one leg, and depending on which area the swelling impinges on, the spinal nerve root. In this case, it would be radiating down the right leg. The pain is most often not felt bilaterally or across the pelvis.

Postoperatively, after a lumbar laminectomy, the client continues to complain of the same low back pain that he had before surgery. The nurse knows that this finding may be caused by what problem?

1. Failure of the surgeon to remove the client's herniated disk
2. Swelling in the operative area that compresses adjacent structures
3. Twisting of the client's spine when he turns side to side
4. Limitation of movement resulting from spinal fusion

Answer: 2

After surgery, edema may cause compression of structures in the operative area, resulting in similar pain the client experienced before surgery. Twisting will cause pain, but it is usually a different pain than the pain the client experienced before surgery. Limitation of movement will decrease pain. (Ignatavicius, Workman, 7 ed., p. 963-964.)

The nurse is obtaining a health history on a toddler who was recently diagnosed with osteomyelitis of a leg. What would priority assessment questions include?

1. "When did you notice the had an elevated temperature?"
2. "Does your child have any type of food allergies?"
3. "Is there a family history of cardiac disorders?"
4. "Has your toddler had a recent infection, such as an earache?"
5. "Have there been any recent injuries to the affected leg?"
6. "Has the child recently taken and completed any antibiotics?"

Answers: 1, 4, 5, 6

Osteomyelitis is caused by bacteria and frequently is found after an internal infection, such as an ear infection. The onset of an elevated temperature may indicate the beginning of an infection. Leg injury may have broken the skin and allowed deep tissue penetration that could have progressed to osteomyelitis. Prescription (and compliance) with recent antibiotics is important, because decreased compliance could result in progression of an infection. The other questions would be asked as part of the health history but are not the most relevant given the diagnosis of osteomyelitis of a leg.

A school-age child has a diagnosis of juvenile rheumatoid arthritis. What instruction(s) to assist in decreasing the child's joint pain should the nurse provide to the parents?

1. Have the child use elevators of repeated trips up and down stairs.
2. Perform all range-of-motion exercises daily, even if joints are acutely inflamed.
3. Encourage the child to take naps in the afternoon.
4. As soon as the child is awake in the morning, administer an NSAID.
5. Have the child soak in a warm tub for 15 minutes just after arising in the morning.
6. Encourage swimming and pool activities.

Answers: 1, 5, 6

Rheumatoid arthritis may cause chronic, severe joint pain. Using the elevator would decrease joint stress from repetitive movements. Acutely inflamed joints may need temporary rest and immobilization with lightweight splints sometimes prescribed to prevent deformity from muscle spasms and contractures. Moist heat is beneficial, especially in the mornings when the joints are stiff. NSAIDs should be taken after meals and not on an empty stomach. Exercising in a pool allows freedom of movement without weight on the joint. Naps are not encouraged, because they promote stiffness during the day and may interfere with the child sleeping at night.

An adolescent is in the postoperative recovery area after surgery for scoliosis repair involving placement of a Harrington rod. What is a priority nursing action?

1. Evaluate for presence of bowel sounds.
2. Provide assistance when getting out of bed to use the bathroom.
3. Use log-rolling procedure when changing positions.
4. Monitor skin for development of pressure ulcers.

Answer: 3

Using log-rolling procedure is the most important nursing action immediately after surgery to prevent damage to the fusion and instrumentation. Typically, the client is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. Monitoring the skin for development of pressure ulcers is certainly a nursing action, but not an immediate priority, but more of an issue if the client is immobile for a long period of time. Bowel sounds are normally diminished or absent immediately after general surgery, so assessment for the presence of bowel sounds would not be a priority.

The school nurse is called to the school parking lot, where one of the children is hit by a slow moving motor vehicle in the school parking lot. The school nurse finds the child on the ground in the parking lot not moving extremities, looking dazed, but responding to questions. What is a priority nursing action?

1. Ask the child to move the lower extremities.
2. Have another person assist with moving the child to the school clinic.
3. Talk soothingly with the child while completing a focused assessment.
4. Have someone call the EMS system.

Answer: 4

It is important and the main priority for a traumatic injury, such as a pedestrian and motor vehicle accident, that the child not be moved until the EMS team arrives with proper equipment to stabilize the spinal cord to prevent further injury. The child needs immediate attention and further assessment to rule out spinal cord injury at a hospital. Talking soothingly to the child and continuing a focused assessment are nursing actions that would be performed after activation of EMS.

In reviewing the physical assessment on a newborn, the nurse notes that a "hip click" was noted by the health care provider on the initial assessment. What other characteristics would the nurse assess for that commonly is associated with this finding?

1. Shortened quadriceps
2. Lateral deviation of patella
3. Limited adduction
4. Shortening of leg on affected side

Answer: 4

The hip click is a classic finding in an infant with a congenital dislocation of the hip. Typical findings include Ortolani's (hip click) sign, limited abduction, shortening of the extremity on the affected side, and asymmetric gluteal folds.

The nurse is positioning an infant who has an uncorrected congenital hip dislocation. What would be the proper position in which to place this infant with regard to the congenital problem?

1. Prone with the hips slightly elevated
2. On the left side with pillow between legs.
3. Hips abducted and feet in a neutral position.
4. Hips abducted and feet extended.

Answer: 3

The nurse should position the infant with the hips abducted and feet in neutral position. This will maintain proper alignment of the hips and lower extremities. This can be achieved initially with the infant placed on his or her back and a pillow wedged between the legs. Adduction may displace the head of the femur and lead to hip dislocation. (Hockenberry, Wilson, 9 ed., p. 422.)

The nurse is assessing a preadolescent girl for scoliosis. How would the nurse perform this assessment?

1. Have the girl bend forward from the waist and observe for asymmetry in the back and hip area.
2. Examine the girl unclothed from the waist down; examine movement of the hips and legs.
3. Have the girl walk heel to toe and observe the gait and pelvis.
4. Place the girl on her back and flex the knees and observe for misalignment.

Answer: 1

The child should remove her shirt (leave on bra or swimsuit top) and bend at the waist. The nurse should examine for uneven hips and shoulders or a visible curvature of the spine. The waist line may be uneven, and one hip may be more prominent. Movement of the hips, walking, and flexing the knees do not provide information regarding scoliosis.

Besides a hip-spica cast, what other devices are used in the treatment of hip dysplasia in a child?

1. Pavlik harness
2. Daily adduction and abduction exercises
3. Harrington rod
4. A large, rounded pillow

Answer: 1

To help stabilize the hip, a Pavlik harness may be used from birth until around 6 months of age. Then, if continued immobilization is needed, a spica cast may be applied after closed reduction of the hip. The hip needs stabilization, not mobility, thus exercises are not appropriate. Adduction, especially, would contribute to redislocation of the hip. Harrington rods are surgically inserted to treat scoliosis. Although pillows may provide comfort, they do not provide sufficient support. (Hockenberry, Wilson, 9 ed., pp. 422-423.)

The nurse would consider the teaching plan successful when an adolescent states that she understands that the Milwaukee brace should be worn:

1. During school hours only
2. At night when sleeping
3. During gym class
4. 23 hours a day

Answer: 4

The Milwaukee brace should be worn about 23 hours a day. The adolescent can be out of the brace for about an hour when showering or exercising. (Hockenberry, Wilson, 9 ed., p. 1669.)

A client is scheduled for an open magnetic resonance imaging (MRI) to evaluate for left tibia osteomyelitis. Which information obtained by the nurse indicates that the nurse should consult with the health care provider before scheduling an MRI?

1. Client has a pacemaker
2. Client is claustrophobic
3. Client is allergic to shellfish
4. Client is pregnant.
5. Client wears a hearing aid and contact lenses
6. Client has an implanted insulin pump

Answer. 1, 4, 6

The physician should be contacted regarding clients with pacemakers (the magnetic field interferes with the function of the pacemaker and interferes with the test as well), clients with implanted insulin pumps, pregnant clients, obese clients, and any client who requires life support equipment (the equipment will malfunction in a magnetic field). Hearing aids can be removed; contact lenses should not be a problem. This is an open MRI, so claustrophobia should not be an issue. Contrast medium is not used, so shellfish allergy is not a contraindication to MRI. (Ignatavicius, Workman,7 ed., p. 1115-1116.)

While playing tennis, a client suffers an injury to the knee. Which diagnostic test would the nurse anticipate the health care provider ordering to identify soft tissue injury?

1. X-Ray
2. MRI
3. Arthroscopy and thermography of joint
4. Duplex venous doppler

Answer: 2

An MRI records the signals from the cells in a manner that provides information to evaluate soft tissue structures (tumors, blood vessels). An x-ray would be useful in diagnosing fractures. Arthroscopy is used for visualizing the joints, and thermography uses an infrared detector to measure inflammatory response in a joint. A duplex venous Doppler is an ultrasound of the veins most useful in determining deep vein thrombosis. (Ignatavicius, Workman,76 ed., p. 1115.)