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A patient with a fractured tibia accompanied by extensive soft tissue damage initially has a splint applied and held in place with an elastic bandage. What early sign should alert the nurse that the patient is developing compartment syndrome?
- A. Paralysis of the toes
- B. Absence of peripheral pulses
- C. Distal pain unrelieved by opioid analgesics
- D. Skin over the injury site is blanched when the bandage is removed
Correct Answer: C
Rationale: Unrelieved pain despite opioids is a hallmark of compartment syndrome.
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What test provides fast, precise measurement of the bone mass of the spine, forearm, and total body to evaluate osteoporosis?
- A. Bone scan
- B. Diskogram
- C. Quantitative ultrasound (QUS)
- D. Dual energy x-ray absorptiometry (DXA)
Correct Answer: D
Rationale: DXA is the gold standard for bone density measurement.
The presence of hemianesthesia, hemianopia & sensory hemiataxia suggests damage to the following:
- A. internal capsule
- B. thalamus opticus
- C. spinal cord
- D. black substance
Correct Answer: B
Rationale: Thalamus opticus is the correct answer because it is a key relay station for sensory information, including pain, temperature, and visual signals. Damage to the thalamus can result in hemianesthesia (sensory loss on one side), hemianopia (visual field loss on one side), and sensory hemiataxia (loss of coordination on one side) due to disrupted sensory processing.
What is the consequence for the ability of motor neurons to find their correct targets, if a section of the spinal cord is rotated, so that the antero-posterior axis is reversed?
- A. Anterior motor neurons enter the limb in a bundle in the posterior instead of the anterior, but then take novel pathways to find the correct anterior muscles to innervate.
- B. Anterior motor neurons enter the limb in a bundle in the posterior instead of the anterior, and follow pathways intended for posterior neurons to make contacts with posterior muscles.
- C. Anterior motor neurons change their course to enter the limb in the anterior, but take their usual pathways to find the correct anterior muscles.
- D. The motor neurons grow over to the other side of the spinal cord and resume their normal pathways into muscles on their normal side of the body.
Correct Answer: B
Rationale: When the antero-posterior axis of the spinal cord is reversed, motor neurons follow their intrinsic programming and enter the limb in the reversed position. They then innervate muscles based on their new position, leading to incorrect connections. This demonstrates the importance of spatial cues in guiding motor neurons to their correct targets.
The nurse is preparing a client with multiple sclerosis (MS) for discharge from the hospital to home. The nurse should tell the client:
- A. You will need to accept the necessity for a quiet and inactive lifestyle.
- B. Keep active, use stress reduction strategies, and avoid fatigue.
- C. Follow good health habits to change the course of the disease.
- D. Practice using the mechanical aids that you will need when future disabilities arise.
Correct Answer: B
Rationale: Encouraging activity, stress reduction, and fatigue management is essential for maintaining quality of life in MS. A completely inactive lifestyle is not recommended.
Which of the following is an incorrect pairing?
- A. norepinephrine dilates the pupil
- B. epinephrine increases blood pressure
- C. acetylcholine decreases digestion
- D. norepinephrine increases heart rate
Correct Answer: C
Rationale: The correct answer is C because acetylcholine actually increases digestion by stimulating the release of digestive enzymes and promoting peristalsis. A is incorrect because norepinephrine dilates the pupil, B is incorrect because epinephrine does increase blood pressure, and D is incorrect because norepinephrine does increase heart rate. Remember, acetylcholine is primarily responsible for parasympathetic responses, which include rest and digest functions.