Nokea
The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus of L4-5. Which scientific rationale explains the incidence of a ruptured disk in the elderly?
- A. The client did not use good body mechanics when lifting an object.
- B. There is an increased blood supply to the back as the body ages.
- C. Older clients develop atherosclerotic joint disease as a result of fat deposits.
- D. Clients develop intervertebral disk degeneration as they age.
Correct Answer: D
Rationale: Intervertebral disk degeneration with aging reduces disk hydration and elasticity, increasing rupture risk. Poor body mechanics is a risk but not the primary cause, blood supply decreases, and atherosclerosis affects joints differently.
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Which statement made by the client to the nurse provides the best evidence that the client understands the therapeutic plan?
- A. I should keep my hand as still as possible.
- B. I should stop playing golf for the time being.
- C. I can substitute playing miniature golf.
- D. I can wear a tight leather glove when golfing.
Correct Answer: B
Rationale: Tenosynovitis involves inflammation of the tendon sheath, often exacerbated by repetitive wrist motion. The physician recommends avoiding such motions temporarily. Stopping golf, which involves repetitive wrist actions, directly aligns with this plan, unlike miniature golf, which still requires wrist movement, or wearing a glove, which does not address motion.
Which explanation most accurately explains to the client the primary purpose of the splints?
- A. Splints are used to correct joint deformities.
- B. Splints are used to slow joint deterioration.
- C. Splints are used to improve hand strength.
- D. Splints are used to increase range of motion.
Correct Answer: B
Rationale: Splints immobilize joints to reduce inflammation and slow deterioration.
Which risk factor found in the client's medical record does the nurse identify as most significant for sustaining a hip fracture?
- A. The client is postmenopausal.
- B. The client is somewhat obese.
- C. The client has type 2 diabetes.
- D. The client is lactose intolerant.
Correct Answer: A
Rationale: Postmenopausal status is the most significant risk factor for hip fractures due to estrogen loss, which accelerates bone density reduction, increasing fracture risk. Obesity, diabetes, and lactose intolerance are less directly related.
When reviewing the chart of a 25-year-old male, the nurse reads that the client was diagnosed with an osteosarcoma of the distal femur. Which statement indicates the nurse's correct interpretation of the client's diagnosis?
- A. The tumor originated elsewhere in the client's body and metastasized to the bone.
- B. Osteosarcoma is the most common and most often fatal primary malignant bone tumor.
- C. The only treatment for osteosarcoma is a leg amputation well above the tumor growth.
- D. The tumor is nonmalignant;it can be excised and the bone replaced with a bone graft.
Correct Answer: B
Rationale: B. Osteosarcoma is a malignant primary tumor of the bone, appearing most frequently in males between 10 and 25 years (when bones grow rapidly). Prognosis depends on whether the tumor has metastasized to the lungs, but it is often fatal.
The nurse is discharging the client home with a plaster of Paris cast to the lower leg. Which self-care recommendation should the nurse include?
- A. Sprinkle powder in the cast to decrease moisture from sweating.
- B. Direct cool air from a hair dryer into the cast to relieve itching.
- C. Cover the cast with a plastic wrap before you bathe in a tub.
- D. Use hot, soapy water to wash the cast if it becomes very soiled.
Correct Answer: B
Rationale: B. Cool air from a hair dryer helps to control itching on the skin within a cast. Hot air is not recommended because it could burn the skin.