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CPNRE Practice Questions and answers graded A+ already passed 2023, Exams of Nursing

North-West College - Van Nuys Nursing

CPNRE Practice Questions and answers graded A+ already passed 2023

Typology: Exams

2022/2023

Available from 09/28/2023

arnezieme9 🇺🇸

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Care of Patients

with Muscular

skeletal 2023

Problems

Diagnostic Evaluation

X-Ray Studies

•Determine bone density, texture, erosion and changes in bone

relationships

•Cortex-widening, narrowing, or signs of irregularity

•Joints-reveal fluid, irregularity, spur formation, narrowing &

changes in joint structure

•Multiple views

•Serial x-rays

Computed Tomography

•Performed with or without the use of oral or intravenous contrast

•Shows more detailed cross-sectional image of body

•Visualize and assess tumors

•Injury to the soft tissue, ligaments or tendons

•Severe trauma to the chest, pelvis, head or spinal cord

•Allergy to dye

•Pipe fitter need additional testing before mri

Magnetic Resonance Imaging

•Noninvasive imaging technique that uses magnetic fields and

radio waves to create high- resolution pictures of bones and soft

tissues

•Visualize and assess torn muscles, ligaments, and cartilage;

herniated discs

•Because an electromagnet is used, patients w any metal

implants (ie cochlear implants, clips, pacemakers) cannot have

Partial preview of the text

Download CPNRE Practice Questions and answers graded A+ already passed 2023 and more Exams Nursing in PDF only on Docsity!

Care of Patients

with Muscular

skeletal 2023

Problems

Diagnostic Evaluation X-Ray Studies

Determine bone density, texture, erosion and changes in bone relationships
Cortex-widening, narrowing, or signs of irregularity
Joints-reveal fluid, irregularity, spur formation, narrowing & changes in joint structure
Multiple views
Serial x-rays Computed Tomography
Performed with or without the use of oral or intravenous contrast
Shows more detailed cross-sectional image of body
Visualize and assess tumors
Injury to the soft tissue, ligaments or tendons
Severe trauma to the chest, pelvis, head or spinal cord
Allergy to dye
Pipe fitter need additional testing before mri Magnetic Resonance Imaging
Noninvasive imaging technique that uses magnetic fields and radio waves to create high- resolution pictures of bones and soft tissues
Visualize and assess torn muscles, ligaments, and cartilage; herniated discs
Because an electromagnet is used, patients w any metal implants (ie cochlear implants, clips, pacemakers) cannot have

this procedure.

Loud, knocking sound Arthrography
Identify the cause of any unexplained joint pain and progression of joint disease
A radiopaque contrast agent or air is injected into the joint cavity to visualize the joint structures, such as ligaments, cartilage, tendons and joint capsule
ROM to the joint to distribute the contrast agent while a series of x-rays are obtained
If a tear is present, the contrast agent leaks out of the joint
Discomfort or tingling
Compression elastic bandage
Ice and rest Bone Densitometry
Evaluates bone mineral density
Predicts fracture risk through accurate monitoring of bone density changes in patients with osteoporosis who are undergoing treatments
Measured through the heel
Best achieved through hip and spine

Evaluate muscle weakness, pain and disability
Abnormality of function and differentiate muscle and nerve problems
Identify the extent of damage if nerve function does not return within 4 months of an injury
Needle electrodes are inserted into selected muscles and responses to electrical stimuli are recorded on an oscilloscope
Anticoagulant therapy
Skin infections

Warm compresses post study Biopsy
Determine the structure and composition of bone marrow, bone, muscle or synovium to help diagnose specific diseases
Excising a sample of tissue that can be analyzed microscopically to determine cell morphology and tissue abnormalities
Post biopsy-Analgesics, edema, bleeding, pain, hematoma formation and infection
Ice, analgesic, antibiotics
Report signs of redness, bleeding, fever, chills or pain Laboratory Studies
Primary musculoskeletal problem
Paget’s disease of the bone
Developing complication
Infection
Baseline for instituting therapy
Anticoagulant therapy
Response to therapy
Cause of bone loss
Before surgery
Coagulation studies to detect bleeding tendencies because bone is vascular tissue Serum Calcium Levels
Altered in patients with:
Osteomalacia: altered calcium level this disease weaken the bone
Parathyroid dysfunction
Paget’s disease: disrupt old bone replacement with new bone tissue
Metastatic bone tumors
Prolonged immobilization Serum Phosphorus Levels
Inversely related to calcium levels
Diminished in osteomalacia associated with malabsorption syndrome
Acid phosphatase is elevated in:
Paget’s disease
Metastatic cancer
Early fracture healing
Diseases w increased osteoblastic activity

Parathyroid hormone (PTH)
Vitamin D Muscle damage
Elevated Creatine kinase
Elevated Aspartate aminotransferase Rate of bone turnover
Osteocalcin Bone destruction
Parathyroid dysfunction
Metastatic bone tumors
Multiple myeloma The Patient Undergoing Orthopedic Surgery Orthopedic Surgery
Conditions that may be corrected
Unstable fractures
Deformity
Joint disease
Necrotic or infected tissue
Tumors
Open reduction (ORIF)
Bone graft
Amputation
Total joint replacement Joint Replacement #
Severe joint pain and disability
Joint degeneration
Osteoarthritis
Rheumatoid arthritis
Trauma
Congenital deformity
Femoral neck fracture may cause disruption of the blood supply and subsequent avascular necrosis- avascular necrosis (death of tissue due to insufficient blood supply)
femur fracture can bleed up to 1500 mL of blood into your leg and you don’t know it, important to check BP (late sign drop I bp)

Nursing Interventions

Anemic or bleeding risk patient-Epogen or Procrit or iron supplements-ferrous sulfate

Maintenance of the femoral head component in the acetabular cup is essential
Risk for dislocation is more common when the hip is in full flexion, adducted (legs together) and internally rotated
Correct position is needed at ALL times

Correct positioning

Keep the patient in abduction- movement away from the center or median line of the body
Use the abduction splint, wedge pillow
The patient should not be turned to the operative side, which could cause dislocation, unless specified by the surgeon
Do not flex the affected hip
High-seat orthopedic chairs are used to minimize hip joint flexion Total Hip Arthroplasty
Promote ambulation
Monitoring wound drainage
Preventing venous thromboembolism
Preventing infection
Promoting home and transitional care Total Knee Arthroplasty
Patients whose joint pain cannot be managed by nonsurgical treatment and who have severe pain and functional disability r/t destruction of joint surfaces by osteoarthritis, rheumatoid arthritis or posttraumatic (osteonecrotic) arthritis
The femoral joint component can be metal or ceramic
The tibial component has a polyethylene surface 1.) Review continuous passive motion CPM machine what is what are they use for what post op surgery it is used for Nursing Interventions
Post op, knee is dressed with a compression bandage
Ice or cold packs
Neurovascular status
Low molecular weight Heparin
Flexion of the foot hourly, while awake
Wound suction drain (24-48 hours)
Continuous passive motion (CPM) device : exercise bike in the bed certain degree they start moving they go that immediately first day after post op.
Continuous passive motion (CPM) device- keeps prosthetic knee in motion and may prevent formation of scar tissue, which could decrease knee mobility and increase postoperative pain

**- Turn off machine while patient is having a meal in bed

When machine is not in use, do not store it on the floor Management of Patients with Musculoskeletal Disorders Low Back Pain**
Caused by lumbosacral strain, unstable lumbosacral ligaments and weak muscles, intervertebral disc problems and unequal leg length
Comorbidities: depression, smoking, alcohol abuse, obesity and stress
Older patients experience pain w osteoporotic vertebral fractures, osteoarthritis of the spine, and spinal stenosis Pathophysiology
The spinal column is constructed of rigid vertebrae and flexible intervertebral discs held together by complex joints, ligaments and paravertebral muscles
It allows flexibility while protecting the spinal column
Obesity, postural problems, structural problems and overstretching of the spinal supports may result in back pain
As we age the fibrocartilage discs become dense and irregularly shaped Clinical Manifestations
Acute: sharp pain caused by activity but relieved by rest Back pain accompanied by tenderness and voluntary restriction of spinal movement suggests one or more compression vertebral fractures
Chronic : movement restriction and spinal deformity may result in constipation, abdominal distention, reflux esophagitis, and respiratory compromise in severe cases
Radiculopathy-pain radiating down the leg from a diseased spinal nerve root
Sciatica-pain radiating from an inflamed sciatic nerve
Gait, spinal mobility, reflexes, leg length, leg motor strength
Muscle spasm
The classic “dowager’s hump” or kyphosis of dorsal spine is often present Assessment & Diagnostic Findings

History and physical
Gait and neurologic testing
Spinal fracture
Cancer
Infection Medical Management
Most back pain resolves within 4-6 weeks with analgesics, rest and avoidance of strain
NSAIDS
Muscle relaxants-cyclobenzaprine (Flexeril)

history of osteoporosis, especially mother, history of low-trauma fracture after age 50

Modifiable: low body weight, thin build, chronic low calcium and or vitamin D intake, estrogen or androgen deficiency, current smoking (active or passive), high alcohol intake (three or more drinks a day), lack of physical exercise or prolonged immobility

Etiology & Genetic Risk

Peak adult bone mass is achieved between the ages of 18 and 25 years
Primary osteoporosis occurs in women after menopause in men later in life
Failure to develop optimal peak bone mass and low vitamin D levels contribute to the development of osteopenia wo associated bone loss (Osteomalacia)
Increase Calcium and vitamin D intake
Regular weight-bearing exercise
Lifestyle modification
Reduce use of caffeine, tobacco, carbonated soft drinks and alcohol notes: People with less exposure to sunlight are at higher risk because of lack of vitamin d and calcium absorption
When protein deficiency serum calcium is protein bound so protein is needed to increase calcium Medications or disease that affect bone metabolism
Corticosteroids
Celiac disease
Hypogonadism
Anticonvulsants –phenytoin-Dilantin
Thyroid replacement-Levothyroxine-Synthroid
Antiestrogens-medroxy-progesterone-Depo-Provera
Proton pump inhibitors-Nexium Health Promotion & Maintenance
Characterized by reduced bone mass, deterioration of bone matrix and diminished bone architectural strength
Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased
Estrogen, which inhibits bone breakdown, also decreases with aging
Parathyroid hormone increases with age and increases bone turnover and resorption
Teach importance of exercise, which builds bone tissue
Teach high-risk people to avoid activities that cause jarring to prevent potential vertebral compression fractures Osteoporotic Changes Slide #72 Assessment

Bariatric surgery patients are at risk because as the duodenum is bypassed, it is the primary site for absorption of calcium
Vertebral column assessment- the ringers hump look for kyphosis of dorsal spine
Pain is worse with activity and relieved with rest
Pt state they are shorter, back pain after lifting, pain 2.) Alkaline phosphatase levels
What do the levels indicate Assessment and Diagnostic Findings
Undetectable on routine x-rays until has been significant demineralization, resulting in radiolucency of the bones
When the vertebrae collapse, causing compression fractures, the thoracic vertebrae become wedge shaped and the lumbar vertebrae biconcave
Lab studies- serum calcium, phosphate, alkaline phosphate, urine calcium excretion, hematocrit, erythrocyte sedimentation rate (ESR)
X-ray studies show decrease bone density Planning & Implementation
Diet rich in calcium and vitamin D
Diet of milk, cheese, broccoli, canned salmon
Calcium fortified orange juice
Weight training exercise
Avoid exercise alcohol and caffeine consumption
If patient is lactose intolerant, choose soy products to get calcium
Walking for 30 min, 3-5 times a week is the single most effective exercise for osteoporosis prevention Pharmacologic therapy
Caltrate, Citracal taken with meals or beverage, high in vitamin C to promote absorption Bisphosphonates-inhibits osteoclasts, causing decreased bone loss and increased bone mass; most common drugs used for osteoporosis but some are also approved for Paget’s disease and hypercalcemia related to cancer; before starting this therapy patients should have an oral assessment and

preventative dentistry

Fosamax : a bisphosphonate, remind patient to take drug 30 min before food, drink, and other drugs to prevent interactions; instruct patient to remain upright sitting or standing for 30 min after taking drug to help prevent esophagitis
Actonel
Boniva

CPNRE Practice Questions and answers graded A+ already passed 2023, Exams of Nursing

Related documents

Partial preview of the text

Download CPNRE Practice Questions and answers graded A+ already passed 2023 and more Exams Nursing in PDF only on Docsity!

Care of Patients

with Muscular

skeletal 2023

Problems