Page 1
1
NCLEX® - RN & PN TEST PREP COURSE Conductedby:
GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN [email protected] #714-679-9320Fax#909-247-2721
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Overview of Anatomy and Physiology • Functions Of The Skeletal System
– Support
– Protection
– Movement – Mineral Storage
– Hematopoiesis
• Structure Of Bones – Four Classifications Based On Form And Shape
• Long, Short, Flat, And Irregular
2
Page 2
2
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
3
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Laboratory and Diagnostic Examinations
• Radiographic Studies – Myelogram
– Nuclear Scanning – Magnetic Resonance Imaging (MRI)
– Computed Axial Tomography (CT Or CAT Scan)
– Bone Scan
• Endoscopic Examination – Arthroscopy
4
Page 3
3
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
5
Endoscopic Spinal Microsurgery
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Laboratory And Diagnostic Examinations
• Aspiration – Synovial fluid aspiration
• Electrographic procedure
– Electromyogram (EMG)
• Laboratory Tests
– Calcium – Erythrocyte
Sedimentation Rate (ESR)
– Lupus Erythematosus (LE) Preparation
– Rheumatoid Factor (RF)
– Uric Acid (Blood)
6
Page 4
4
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
7
Rheumatoid Arthritis Osteoarthritis • Most Serious Form Of Arthritis • Chronic, Systemic Disease • Most Common In Women Of
Childbearing Age • Autoimmune Disorder, But May
Also Be Genetic • Characterized by periods of
remission and exacerbations • Limited range of motion (morning stiffness)
• Nonsystemic, noninflammatory disorder that progressively causes bones and joints to degenerate
• Cause is unknown • Caused by trauma, infections,
previous fractures, rheumatoid arthritis, stress on weight-bearing joints
Inflammatory Disorders of the Musculoskeletal System
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
8
Page 5
5
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
• Diagnostic Tests • Radiography Studies Show Loss Of
Articular Cartilage And Change In Bone Structure
• Laboratory Tests
– Erythrocyte Sedimentation Rate (ESR)
– Rheumatoid Factor (RF)
– Synovial Fluid Aspiration
9
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Medical Management / Nursing Interventions
• Medications: Salicylates, NSAIDS, COX-2 Inhibitors, Potent Anti-inflammatory Agent Slow-acting Anti-inflammatory Agents, Disease-Modifying Anti-rheumatoid Drugs
• Rest: 8-10 Hours Of Sleep A Night • Exercise: Range Of Motion 2-3 Times Per Day
• Heat: Hot Packs, Heat Lamp, And/Or Hot Paraffin • Rehabilitation
10
Page 6
6
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Herberden’s Vs. Bouchard’s
11
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
12 (From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2nd ed.]. St. Louis: Mosby.)
Page 7
7
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Ankylosing Spondylitis • Etiology/pathophysiology
• Chronic, progressive disorder of the sacroiliac and hip joints, the synovial joints of the spine, and the adjacent soft tissues
• Most common in young men • Strong hereditary tendency
– Clinical manifestations/assessment
• Pain and stiffness in back; decreased ROM • Elevated temperature; tachycardia; hyperpnea
13
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
14
Page 8
8
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
u Medical management/nursing interventions • Exercise balanced with rest • Heat applications
• Gait enhancers (canes, walkers, etc.)
• Medications
– Salicylates (aspirin), NSAIDs (Motrin), steroids (cortisone)
• Surgery
– Osteotomy – Joint replacement
15
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Gout (Gouty Arthritis)
� Etiology/pathophysiology
• Metabolic disease resulting from an accumulation of uric acid in the blood
• Caused by an ineffective metabolism of purines • Primary: hereditary factors • Secondary: use of certain drugs, complication of other
diseases • Affects men more frequently than women • Does not occur before puberty in males or before
menopause in females
16
Page 9
9
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Gout
17
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
– Clinical Manifestations/Assessment
• Excruciating Pain • Edema • Inflammation (Most Common In The Great Toe) • Tophi
– Diagnostic Tests • Serum And Uric Acid
Level, CBC, ESR • Radiography Studies • Synovial Fluid Aspiration
18
• Medications
– Colchicine, Phenylbutazone (Butazolidin), Indomethacin (Indocin), Corticosteroids, Allopurinol (Zyloprim), Sulfinpyrazone (Anturane)
• Encourage Fluid Intake
• Monitor Intake And Output
• Bedrest And Joint Immobilization
• Diet: Avoid Foods High In Purines
Page 10
10
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Osteoporosis
– Etiology/pathophysiology • Reduction of bone mass
• Most common in women ages 55-65 • Contributing factors: immobilization; steroids; high intake of
caffeine; diet low in calcium, high in protein; smoking; sedentary lifestyle
– Clinical manifestations/assessment • Backache
• Porous and brittle bones • Dowager’s hump
19
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Dowager’s Hump
20
Diagnostic Tests • CBC, Serum Calcium,
Phosphorus, Alkaline Phosphatase, Blood Urea Nitrogen, Creatinine Level, Urinalysis, Liver And Thyroid Function Tests
• Radiography Studies
– Medical Management/Nursing Interventions
• Calcium Supplements, Vitamin D
• Weight-bearing Exercises • Estrogen, Alendronate
(Fosamax) • Diet: Milk And Dairy
Products; Limit Caffeine
Page 11
11
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Osteomyelitis• Etiology/Pathophysiology
• Local Or Generalized Infection Of The Bone And Bone Marrow
• Staphylococci Are The Most Common Cause
• Introduced Through Trauma (Injury Or Surgery) Or Via The Bloodstream From Another Site In The Body To The Bone
• Bacteria Invade The Bone And Degeneration Of Bone Occurs
21
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
22
• Clinical Manifestations/Assessment – Persistent, Severe, And
Increasing Bone Pain – Wound Draining Purulent
Fluid
– Signs And Symptoms Of Infection: Temperature, Tachycardia, And Tachypnea
– Edema Of Affected Area • Diagnostic Tests
– Radiography Studies; Bone Scan
– CBC; ESR; Cultures Of Blood And Drainage
Page 12
12
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
– Medical management/nursing interventions • Antibiotic therapy
– Broad-spectrum antibiotic
• Surgery: removal of necrotic bone • Absolute rest of affected extremity • Wound care
– Irrigate with hydrogen peroxide or antibiotic solution; cover with sterile dressing
• Drainage and secretion precautions • Diet: high in calories, protein, and vitamins
23
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Fibromyalgia syndrome (FMS)
• Etiology/Pathophysiology
– Musculoskeletal Chronic Pain Syndrome
– Unknown Etiology
• Clinical Manifestations/Assessment
– Generalized Aching
– Irritable Bowel Syndrome – Tension Headache
– Paresthesia Of Upper Extremities
– Sensation Of Edematous Hands
24
• Diagnostic tests – No specific laboratory or
radiographic tests diagnose FMS
• Medical management/nursing interventions – Patient education and
reassurance
– Tricyclic antidepressants
– Exercise
– Relaxation techniques
Page 13
13
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
25
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Surgical Interventions For Total Knee Or Total Hip Replacement
• Knee arthroplasty (total knee replacement) – Replacement of the knee joint
– Restore motion of the joint, relieve pain, or correct deformity
• Hip arthroplasty (total hip replacement)
– Replacement of the hip joint
26
Page 14
14
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
• Arthroplasty
• Nursing interventions • Empty and record HemoVac
• Give oxygen 2-3 L/min
• Incentive spirometer; cough and deep-breathe
• Record I&O • Bedrest for 24-48 hours
• Change dressing as ordered
• Diet as ordered • Neurovascular checks and vital
signs every 4 hours
27
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
– Nursing Interventions (Continued) • Maintain Position Of Operative Area • Physical Therapy Will Initiate Ambulation And
Prescribe Routine • Encourage Fluid Intake
• Antiembolisim Stockings • Avoid Adduction And Hyperflexion Of Hip • Encourage Fluid Intake And High-fiber Foods
• Use Toilet Riser To Prevent Hyperflexion Of Hip
28
Page 15
15
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Fractures • Fracture of the hip
– Etiology/pathophysiology
• Most common type of fracture
• Women at higher risk due to osteoporosis • Types: intracapsular and extracapsular
– Clinical manifestations/assessment
• Severe pain at site • Inability to move the leg voluntarily
• Shortening or external rotation of the leg
29
30
Page 16
16
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
• Fracture Of The Hip (Continued) – Diagnostic Tests
• Radiographic Examination • Hemoglobin
– Medical Management/Nursing Interventions
• Buck’s Or Russell’s Traction Until Surgery
• Surgical Repair – Internal Fixation – Neufeld Nail And Screws,
Kuntscher Nail – Prosthetic Implants
31
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Complications of Fractures • Compartment syndrome
– Cause • Progressive development of
arterial vessel compression and reduced blood supply to an extremity
Clinical manifestations/assessment
• Sharp pain with movement, numbness or tingling in the affected extremity, cool and pale or cyanotic, slow capillary refill
Medical management/nursing interventions
• Fasciotomy (incision into the fascia)
32
Page 17
17
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Shock – Cause
• Blood loss, pain, fear
– Clinical manifestations/assessment
• Altered level of consciousness, restlessness
• Hypotension, tachycardia, and tachypnea
• Pale, cool, moist skin
– Medical management/nursing interventions
• Restore blood volume; shock trousers
• Oxygen
33
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
• Fat Embolism – Cause
• Embolization of fat tissue with platelets
– Clinical manifestations/assessment
• Irritability, restlessness,disorientation, stupor, coma, chest pain, and dyspnea
– Medical management/nursing interventions
• IV fluids • Steroids, digoxin
• Oxygen
34
Page 18
18
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
• Gas Gangrene – Cause
• Infection of skeletal muscle by Clostridium
– Clinical manifestations/assessment • Pain at site of injury
• Signs of infection; gas bubbles under the skin
• Necrotic skin at site; foul odor from wound
Medical management/nursing interventions
• Excision of gangrenous tissue • Antibiotics; strict aseptic
technique
35
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
36
Page 19
19
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
• Thromboembolus
– Cause • Blood vessel is occluded by
an embolus
– Clinical manifestations/assessment
• Area tingles and is cold, numb, and cyanotic
• Pulmonary embolus causes a sharp thoracic pain
– Medical management/nursing interventions
• Anticoagulants
37
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Skeletal Fixation Devices • External Fixation Devices
– Skeletal Pin External Fixation
• Immobilizes Fractures By The Use Of Pins Inserted Through The Bone And Attached To A Rigid External Metal Frame
• Casts/Cast Brace – Made Of Layers Of Plaster Of Paris, Fiberglass, Or Plastic
Roller Bandages – Stockinette Applied, Then A Sheet Of Wadding, And
Casting Material
38
Page 20
20
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
39
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Traction The process of putting an extremity, bone, or group of muscles under tension by means of weights and pulleys to:
• Align and stabilize a fracture site • Relieve pressure on nerves • Maintain correct positioning • Prevent deformities • Relieve muscle spasms
Skeletal or skin
40
Page 21
21
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
41
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Traumatic Injuries • Carpal Tunnel Syndrome
– Etiology/pathophysiology • Compression of the median nerve between
the carpal ligament and other structures
• Predisposing factors – Obese, middle-aged women – Employment in occupations involving
repetitious motions of the fingers and hands
42
Page 22
22
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
43
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Clinical Manifestations/Assessment – Paresthesia
– Hypoesthisia – Burning Pain Or Tingling In
The Hands – Inability To Grasp Or Hold
Small Objects – Edema Of The Hand, Wrist,
Or Fingers – Muscle Atrophy
– Depressed Appearance At The Base Of The Thumb On The Palmer Side
44
Diagnostic tests • Physical exam—
Tinel’s sign • Electromyogram • MRI
Medical management/nursing interventions
• Immobilizer • Elevate extremity • ROM exercises • Surgery
Page 23
23
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Herniation Of Intervertebral Disk • Etiology/pathophysiology
– Rupture of the fibrocartilage surrounding an intervertebral disk, releasing the nucleus pulposus that cushions the vertebrae above and below
– Lumbar and cervical herniations are most common
– May occur from lifting, twisting, trauma, or degenerative changes
45
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Clinical Manifestations/Assessment • Lumbar
– Low Back Pain That Radiates Over The Buttock And Numbness And Tingling In Affected Leg
• Cervical
– Neck Pain, Headache, And Neck Rigidity
Diagnostic Tests
• CAT Scan, Myelography, And Electromyelography
46
– Medical Management/Nursing Interventions • Bedrest
• Pain Medication
• Muscle Relaxants
• Physical Therapy
• Traction
• Surgery
– Laminectomy, Spinal Fusion, Diskectomy, Chemonucleolysis
Page 24
24
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Tumors Etiology/pathophysiology
• May be primary or secondary • Benign or malignant • Osteogenic sarcoma • Osteochondroma
Clinical manifestations/assessment • Spontaneous fractures • Anemia • Pain especially with weight-
bearing • Edema and discoloration of skin
at site
47
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Amputation • Amputation of a portion of or an entire extremity
– Malignant tumors,injuries, impaired circulation, congenital deformities, infections
• Postoperative nursing interventions – Raise foot of bed to elevate extremity – Encourage movement – Place in prone position at least two times a day – Elastic wraps to shape residual extremity – Assess for respiratory complications – Phantom-limb pain is normal
48
Page 25
25
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
49
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
50
Page 26
26
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Assessment Scoliosis
• Lateral curvature of the spine
Kyphosis • A rounding of the
thoracic spine
• Hump-backed appearance
Lordosis
• An increase in the curve at the lumbar region
51
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
52
Page 27
27
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
• Nursing Diagnoses
– Mobility, Impaired Physical
– Mobility, Impaired Bed
– Coping, Ineffective
– Anxiety
– Pain
– Knowledge, Deficient
53
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
MusculoskeletalSystemDisorders
The nurse received a patient with early symptom of rheumatoid arthritis. Which of the following would the nurse most likely assess?
1. Limited flexion of joint. 2. Deformation of the hands. 3. Early morning stiffness.
4. Rheumatoid nodules.
54
Page 28
28
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
The nurse is assigned to a patient where his right leg is placed in a continuous passive motion (CPM) device. Which of the following would the nurse perform when caring for a patient receiving CPM therapy?
1. Adjusting the setting as needed to prevent client discomfort. 2. Increasing the range-of-motion setting at least every 8
hours.
3. Maintaining proper position of the joint on the CPM machine.
4. Discontinuing the CPM therapy when range of motion increases to 90 degrees.
55
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
When is the best time for the patient to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis?
1. At bed time. 2. On arising. 3. Immediately after the meal.
4. On an empty stomach.
56
Page 29
29
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
A patient has undergone insertion of a femoral head prosthesis. Which of the following activities the patient would avoid?
1. Crossing the legs while sitting down.
2. Using a high raised commode seat. 3. Using an abductor splint while lying on the side.
4. Change position every two hours.
57
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Which of the following actions would be the priority for a patient after above-the knee amputation and develops a dime-sized bright red spot on the middle of the ace bandage?
1. Elevating the stump. 2. Reinforcing the dressing. 3. Calling the surgeon. 4. Drawing a mark around the site.
58
Page 30
30
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
The nurse is assigned to a patient who will be using the crutches for the first time. The nurse instructs the patient to support her weight primarily on which of the following body areas?
1. Axilla. 2. Elbows. 3. Upper arms. 4. Hands.
59
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721
Because a client has a Thomas splint, the nurse would need to assess the client regularly for which of the following?
1. Signs of skin pressure in the groin area. 2. Evidence of decreased breath sounds. 3. Skin breakdown behind the heel.
4. Urinary retention.
60
Page 31
31
NCLEX-RN & PN TEST PREP COURSE
Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN
[email protected] #714-679-9320Fax#909-247-2721