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An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test?
- A. Bone densitometry
- B. Hip bone radiography
- C. Computed tomography (CT)
- D. Magnetic resonance imaging (MRI)
Correct Answer: A
Rationale: Bone densitometry is considered the most accurate test for osteoporosis and for predicting a fracture. As such, it is more likely to be used than CT, MRI, or x-rays.
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A nurse on the orthopedic unit is assessing a patient's peroneal nerve. The nurse will perform this assessment by doing which of the following actions?
- A. Pricking the skin between the great and second toe
- B. Stroking the skin on the sole of the patient's foot
- C. Pinching the skin between the thumb and index finger
- D. Stroking the distal fat pad of the small finger
Correct Answer: A
Rationale: The nurse will evaluate the sensation of the peroneal nerve by pricking the skin centered between the great and second toe. None of the other listed actions elicits the function of one of the peripheral nerves.
A nurse is caring for a patient with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this patient?
- A. Bilirubin
- B. Potassium
- C. Alkaline phosphatase
- D. Creatinine
Correct Answer: C
Rationale: Alkaline phosphatase is elevated during early fracture healing and in diseases with increased osteoblastic activity (e.g., metastatic bone tumors). Elevated bilirubin, potassium, and creatinine would not be expected in a patient with metastatic bone tumors.
A child is growing at a rate appropriate for his age. What cells are responsible for the secretion of bone matrix that eventually results in bone growth?
- A. Osteoblasts
- B. Osteocytes
- C. Osteoclasts
- D. Lamellae
Correct Answer: A
Rationale: Osteoblasts function in bone formation by secreting bone matrix. Osteocytes are mature bone cells and osteoclasts are multinuclear cells involved in dissolving and resorbing bone. Lamellae are circles of mineralized bone matrix.
A patient has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action?
- A. Arrange for a STAT assessment of the patient's serum calcium levels.
- B. Perform active range of motion exercises.
- C. Assess the patient's joint function symmetrically.
- D. Contact the primary care provider immediately.
Correct Answer: D
Rationale: This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.
Diagnostic tests show that a patient's bone density has decreased over the past several years. The patient asks the nurse what factors contribute to bone density decreasing. What would be the nurse's best response?
- A. For many people, lack of nutrition can cause a loss of bone density.
- B. Progressive loss of bone density is mostly related to your genes.
- C. Stress is known to have many unhealthy effects, including reduced bone density.
- D. Bone density decreases with age, but scientists are not exactly sure why this is the case.
Correct Answer: A
Rationale: Nutrition has a profound effect on bone density, especially later life. Genetics are also an important factor, but nutrition has a more pronounced effect. The pathophysiology of bone density is well understood and psychosocial stress has a minimal effect.