Musculoskeletal
A nurse is assessing a patient who sustained a tibial fracture. Which of the following findings would indicate the development of compartment syndrome?
A. Capillary refill time of less than 2 seconds
B. Pain that is relieved with opioid analgesics
C. Absence of pedal pulse in the affected leg
D. Warm, erythematous skin around the fracture site
C. Absence of pedal pulse in the affected leg
Rationale:
Compartment syndrome is a serious complication of fractures caused by increased pressure within a confined space, leading to decreased perfusion. The hallmark signs include the "5 P's" (Pain, Pallor, Pulselessness, Paresthesia, and Paralysis). Absence of a pedal pulse is a late sign, indicating severe neurovascular compromise
A patient under general anesthesia begins exhibiting tachycardia, muscle rigidity, and a rapidly increasing temperature. Which medication should the nurse anticipate administering immediately?
A. Midazolam
B. Dantrolene
C. Naloxone
D. Flumazenil
B. Dantrolene
Rationale:
The patient is exhibiting signs of malignant hyperthermia, a life-threatening reaction to general anesthesia. Dantrolene is a muscle relaxant that helps reverse this condition by reducing calcium release from muscle cells. Prompt administration is critical to prevent severe complications
What is the difference between an intravenous pyelogram (IVP) and retrograde pyelogram?
The key differences are:
- IVP is less invasive as the dye is injected intravenously.
- Retrograde pyelogram involves catheterization of the urethra.
- IVP provides an overview of the entire urinary system.
- Retrograde pyelogram allows better visualization of the ureters and kidneys.
*** They are two different procedures used to visualize the urinary system, particularly the kidneys, ureters, and bladder.
A patient with suspected kidney stones is scheduled for an intravenous pyelogram (IVP). Which of the following is a contraindication for this test?
A. Pregnancy
B. Dehydration
C. Renal failure
D. Diabetes mellitus
Answer: C. Renal failure
Rationale: An IVP involves injecting contrast dye intravenously, which is filtered by the kidneys. In patients with renal failure, the dye may not be excreted properly, increasing the risk of complications. Pregnancy, dehydration, and diabetes are not absolute contraindications for an IVP.
What medications are used for BPH?
What should we be aware of when giving these medications?
5ARI + alpha 1 adrenergic antagonist
Flomax (tamsulosin) and dutasteride
- be aware of orthostatic hypotension (check for dizziness, headache, weakness)
- 5ARI reduce prostate size and can take up to 6 months to start working (should not be opened around women of childbearing age)
The nurse is providing discharge teaching to a patient following a total hip arthroplasty. Which statement made by the patient indicates a need for further teaching?
A. "I should avoid bending my hip more than 90 degrees."
B. "I will use an abduction pillow when sleeping."
C. "I can sit in a low recliner to relax."
D. "I should avoid crossing my legs at the knees."
C. "I can sit in a low recliner to relax."
Rationale:
Patients who have undergone hip arthroplasty should avoid low chairs or recliners, as this position increases hip flexion beyond 90 degrees, increasing the risk of dislocation. Instead, they should sit in chairs with firm seats and armrests
A nurse is monitoring a patient undergoing conscious sedation with midazolam. Which assessment finding requires immediate intervention?
A. Drowsiness and slurred speech
B. Respiratory rate of 8 breaths per minute
C. Blood pressure of 118/76 mmHg
D. Oxygen saturation of 96% on room air
B. Respiratory rate of 8 breaths per minute
Rationale:
Midazolam, a benzodiazepine used for conscious sedation, can cause respiratory depression. A respiratory rate below 10 breaths per minute requires immediate intervention. The nurse should prepare to administer flumazenil, the benzodiazepine reversal agent, if necessary
A nurse is caring for a patient scheduled for a lumbar puncture. Which action should the nurse take prior to the procedure?
A. Keep the patient NPO for at least 6 hours before the test
B. Ensure the patient voids before the procedure
C. Place the patient in a supine position before the procedure
D. Encourage fluid intake immediately before the test
B. Ensure the patient voids before the procedure
Rationale:
Before a lumbar puncture, the patient should empty the bladder to prevent discomfort and reduce the risk of accidental injury. The patient is typically positioned in a side-lying fetal position or sitting up and leaning forward. Fluids are encouraged after the procedure to reduce the risk of post-lumbar puncture headache
A patient is scheduled for a retrograde pyelogram. Which of the following nursing interventions is most appropriate?
A. Encourage increased fluid intake before the test
B. Administer a bowel preparation the day before
C. Instruct the patient to void before the procedure
D. Restrict fluids for 12 hours before the test
Answer: C. Instruct the patient to void before the procedure
Rationale: A retrograde pyelogram involves inserting a catheter into the bladder and instilling contrast dye. Instructing the patient to void before the procedure helps ensure an empty bladder, which facilitates better visualization during the test.
What are two important things to note for compartment syndrome when doing treatments?
Do NOT use a cold compress
Do NOT elevate the extremity above the heart.
A nurse is caring for a patient with osteoarthritis (OA). Which of the following interventions should the nurse include in the patient's plan of care?
A. Encourage bedrest and limit physical activity
B. Apply cold therapy to the affected joints before activity
C. Recommend weight-bearing exercises such as jogging
D. Encourage the use of moist heat packs for joint stiffness
D. Encourage the use of moist heat packs for joint stiffness
Rationale:
Moist heat is beneficial in reducing stiffness and improving mobility in patients with OA. Unlike rheumatoid arthritis, where rest is often necessary during flare-ups, OA benefits from gentle movement and heat application to improve joint flexibility
A nurse is preparing to assist with a procedure using lidocaine with epinephrine for local anesthesia. Which statement by the nurse indicates correct understanding?
A. "This medication is contraindicated in patients with a history of heart disease."
B. "Epinephrine prolongs the anesthetic effect and reduces bleeding at the site."
C. "This medication is safer than lidocaine alone due to its vasodilatory effects."
D. "The patient should be monitored for respiratory depression after administration."
B. "Epinephrine prolongs the anesthetic effect and reduces bleeding at the site."
Rationale:
Epinephrine is added to local anesthetics to cause vasoconstriction, which prolongs the numbing effect and minimizes bleeding. However, it should be used cautiously in patients with cardiac disease due to the risk of hypertension and tachycardia
A nurse is reviewing pre-procedure instructions for a patient scheduled for a magnetic resonance imaging (MRI) scan. Which statement by the patient indicates a need for further teaching?
A. "I should remove all metal objects before the procedure."
B. "I need to inform the technician if I have a pacemaker."
C. "I can keep my hearing aids in during the procedure."
D. "I may need sedation if I have claustrophobia."
C. "I can keep my hearing aids in during the procedure."
Rationale:
MRI machines use strong magnetic fields, which can interfere with metal-containing devices like hearing aids, pacemakers, and implants. The patient should remove all metallic objects before entering the MRI room. Patients with claustrophobia may require sedation
A 65-year-old male patient presents with urinary frequency and difficulty urinating. His prostate-specific antigen (PSA) level is 6.5 ng/mL. Which diagnostic test would be most appropriate to further evaluate his condition?
A. Cystoscopy
B. Culture and sensitivity
C. Renal ultrasound
D. Computed tomography (CT) scan
Answer: A. Cystoscopy
Rationale: Cystoscopy is a procedure that allows direct visualization of the bladder and urethra using a small camera inserted through the urethra. It is the most appropriate diagnostic test for evaluating urinary symptoms and an elevated PSA level, which may indicate prostate enlargement or prostate cancer. A culture and sensitivity test is used to identify and guide treatment for urinary tract infections. Renal ultrasound and CT scan are more appropriate for evaluating kidney-related issues.
A nurse is reviewing the laboratory results of a patient with suspected rheumatoid arthritis. The provider has ordered an erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) test. The nurse understands that an elevation in both ESR and CRP indicates which of the following?
A. Acute or chronic inflammation
B. Impaired liver function
C. Dehydration and electrolyte imbalance
D. Low risk for infection or autoimmune disease
A. Acute or chronic inflammation
Rationale:
Both ESR and CRP are nonspecific inflammatory markers used to detect the presence of inflammation, infection, or autoimmune diseases like rheumatoid arthritis and lupus.
ESR Normal Range
- Male: 0-20mm/hr
- Female: 0-30mm/hr
C-Reactive Protein Norm Range
- less than 10mg/L
A nurse is caring for a patient with a femur fracture. Which finding is most concerning and requires immediate intervention?
A. Localized pain and swelling
B. Shortness of breath and petechiae on the chest
C. Capillary refill less than 3 seconds
D. Muscle spasms near the fracture site
B. Shortness of breath and petechiae on the chest
Rationale:
Fat embolism syndrome (FES) is a life-threatening complication of long bone fractures, particularly in the femur. Classic signs include respiratory distress, petechiae, and neurological changes. Immediate intervention is necessary to prevent hypoxia and organ failure
A patient has just been transferred to the post-anesthesia care unit (PACU) after receiving propofol for general anesthesia. Which nursing intervention is the priority?
A. Monitor for nausea and vomiting
B. Assess airway patency and respiratory status
C. Evaluate pain level and provide analgesia
D. Encourage early ambulation to prevent DVT
B. Assess airway patency and respiratory status
Rationale:
Propofol, a commonly used general anesthetic, can cause profound respiratory depression. The priority is to ensure that the patient’s airway is open and that breathing is adequate. Once stabilized, the nurse can assess pain, nausea, and mobility
The nurse is providing post-procedure teaching to a patient who has undergone an arthroscopy of the knee. Which statement by the patient indicates correct understanding of the teaching?
A. "I should keep my leg elevated and apply ice to reduce swelling."
B. "I should bear full weight on my knee immediately after the procedure."
C. "If I experience mild pain or swelling, I should ignore it as it’s expected."
D. "I should avoid performing any range-of-motion exercises to prevent injury."
A. "I should keep my leg elevated and apply ice to reduce swelling."
Rationale:
After an arthroscopy, the patient should elevate the affected limb, apply ice, and limit weight-bearing activities for the first 24-48 hours to minimize swelling and pain. Gradual range-of-motion exercises may be encouraged per provider instructions
A 55-year-old female patient is being evaluated for a urinary tract infection (UTI). Which diagnostic test would be most appropriate to identify the causative organism and guide antibiotic treatment?
A. Cystoscopy
B. Culture and sensitivity
C. Prostate-specific antigen (PSA) test
D. Intravenous pyelogram (IVP)
Answer: B. Culture and sensitivity
Rationale: A culture and sensitivity test is the most appropriate diagnostic test for identifying the causative organism in a UTI and determining the appropriate antibiotic treatment based on the organism's sensitivity. Cystoscopy is used for visualizing the bladder and urethra, while a PSA test is used to screen for prostate cancer in men. An IVP is an imaging test used to evaluate the urinary tract.
A nurse is assessing a patient’s surgical incision and notes that the wound edges are well-approximated with minimal drainage. The nurse documents that the wound is healing by which type of intention?
A. Primary intention
B. Secondary intention
C. Tertiary intention
D. Quaternary intention
A. Primary intention
Rationale:
Primary intention healing occurs when wound edges are neatly approximated, such as in a surgical incision or clean laceration closed with sutures or staples. This type of healing has minimal tissue loss and scarring.
A patient with a cast on the lower leg reports increasing pain despite taking prescribed pain medications. The nurse notes that the toes are pale and cool to the touch. What is the nurse’s priority action?
A. Elevate the extremity above heart level
B. Apply ice packs to the affected area
C. Loosen the cast or notify the provider
D. Encourage the patient to wiggle their toes
C. Loosen the cast or notify the provider
Rationale:
Increasing pain, pallor, and coolness indicate compromised circulation, which could lead to compartment syndrome. The priority is to relieve pressure by loosening the cast if possible and notifying the provider immediately to prevent permanent tissue damage
A patient undergoing a colonoscopy with fentanyl and midazolam becomes unresponsive with a respiratory rate of 6 breaths per minute. Which medications should the nurse anticipate administering?
A. Flumazenil and naloxone
B. Dantrolene and neostigmine
C. Epinephrine and atropine
D. Lidocaine and protamine sulfate
A. Flumazenil and naloxone
Rationale:
A patient scheduled for an electromyography (EMG) asks how to prepare for the test. Which response by the nurse is correct?
A. "You should avoid caffeine and muscle relaxants for at least 3 hours before the test."
B. "You will need to fast for at least 8 hours before the test."
C. "You will be sedated to minimize discomfort during the procedure."
D. "Avoid drinking extra fluids before the test, as hydration can interfere with the results."
A. "You should avoid caffeine and muscle relaxants for at least 3 hours before the test."
Rationale:
An EMG measures muscle activity and nerve conduction. Caffeine and muscle relaxants can interfere with the results, so they should be avoided for at least 3 hours before the procedure. Sedation is not required, and fasting is not necessary
A 68-year-old male patient presents for his annual physical exam. His prostate-specific antigen (PSA) level is 5.2 ng/mL. Which of the following would be the most appropriate next step?
A. Immediately schedule a prostate biopsy
B. Repeat the PSA test in 6 months
C. Order a digital rectal exam (DRE)
D. Recommend a prostatectomy
Answer: B. Repeat the PSA test in 6 months
Rationale: A PSA level between 4-10 ng/mL is considered a gray zone, where the results are not clearly normal or abnormal. In this case, repeating the PSA test in 6 months is the most appropriate next step to monitor for any changes or trends. Immediately scheduling a biopsy or recommending a prostatectomy would be premature based on a single elevated PSA level. A DRE can be performed, but repeating the PSA test is the most appropriate initial step.
A nurse is completing preoperative teaching for a patient scheduled for abdominal surgery. Which statement by the patient indicates a need for further teaching?
A. "I will use an incentive spirometer after surgery to prevent lung complications."
B. "I should stop drinking clear fluids 2 hours before my surgery."
C. "I will not eat anything after midnight the night before my surgery."
D. "I will take my blood pressure medication with a sip of water the morning of surgery."
B. "I should stop drinking clear fluids 2 hours before my surgery."
Rationale:
Current guidelines recommend that patients stop clear fluids at least 2 hours before surgery, but this patient may need further clarification about other dietary restrictions. The general rule is: