Nokea
A patient is undergoing diagnostic testing for suspected Paget's disease. What assessment finding is most consistent with this diagnosis?
- A. Altered serum magnesium levels
- B. Altered serum calcium levels
- C. Altered serum potassium levels
- D. Altered serum sodium levels
Correct Answer: B
Rationale: Serum calcium levels are altered in patients with osteomalacia, parathyroid dysfunction, Paget's disease, metastatic bone tumors, or prolonged immobilization. Paget's disease is not directly associated with altered magnesium, potassium, or sodium levels.
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A nurse on a patient has been experiencing significant pain in her knee and diagnostic imaging reveals an effusion in the synovial capsule. What intervention should the nurse anticipate?
- A. Arthrography
- B. Knee replacement
- C. Arthrocentesis
- D. Arthroscopy
Correct Answer: C
Rationale: Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for examination or to relieve pain due to effusion. Arthrography is used to visualize joint structures, not to remove fluid. Arthroscopy is a diagnostic visualization, and knee replacement is not indicated for effusion.
The nurse's comprehensive assessment of an older adult involves the assessment of the patient's gait. How should the nurse best perform this assessment?
- A. Instruct the patient to walk heel-to-toe for 15 to 20 steps.
- B. Instruct the patient to walk in a straight line while not looking at the floor.
- C. Instruct the patient to walk away from the nurse for a short distance and then toward the nurse.
- D. Instruct the patient to balance on one foot for as long as possible and then walk in a circle around the room.
Correct Answer: C
Rationale: Gait is assessed by having the patient walk away from the examiner for a short distance. The examiner observes the patient's gait for smoothness and rhythm. Looking at the floor is not disallowed and gait is not assessed by observing balance on one leg. Heel-to-toe walking ability is not gauged during an assessment of normal gait.
A nurse is explaining a patient's decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones?
- A. Thyroid hormone
- B. Growth hormone
- C. Estrogen
- D. Vitamin B12
- E. Luteinizing hormone
Correct Answer: A,B,C
Rationale: The balance between bone resorption and formation is influenced by the following factors: physical activity; dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone. Luteinizing hormone and vitamin B12 do not play a role in bone formation or resorption.
A patient's fracture is healing and callus is being deposited in the bone matrix. This process characterizes what phase of the bone healing process?
- A. The reparative phase
- B. The reactive phase
- C. The remodeling phase
- D. The revascularization phase
Correct Answer: A
Rationale: Callus formation takes place during the reparative phase of bone healing. The reactive phase occurs immediately after injury and the remodeling phase builds on the reparative phase. There is no discrete revascularization phase.
The nurse is performing an assessment of a patient's musculoskeletal system and is appraising the patient's bone integrity. What action should the nurse perform during this phase of assessment?
- A. Compare parts of the body symmetrically.
- B. Assess extremities when in motion rather than at rest.
- C. Percuss as many joints as accessible.
- D. Administer analgesia 30 to 60 minutes before assessment.
Correct Answer: A
Rationale: When assessing bone integrity, symmetric parts of the body, such as extremities, are compared. Analgesia should not be necessary and percussion is not a clinically useful assessment technique. Bone integrity is best assessed when the patient is not moving.