Title: Quiz: Care of the Child with Disorders/Diseases of the Neurological, Sensory, and Musculoskeletal Systems
Course: PRN 0096 Practical Nursing III > Section: Nursing Care of Pediatric Client

Q: Which diagnostic exam is used to find pathological abnormalities of the brain?
- CT scan
- Nuclear medicine scan
- MRI
- Radiograph
A: MRI
If right: Magnetic resonance imaging (MRI) is used to detect pathological conditions of the cerebrum and spinal cord.
If wrong: Magnetic resonance imaging (MRI) is used to detect pathological conditions of the cerebrum and spinal cord.

Q: The patient has been diagnosed as having gouty arthritis. He asks the nurse to explain the cause of the inflammation of his great toe. The most appropriate nursing response is
- “You have calcium oxalate deposits that are seen in gouty arthritis.”
- “The inflammation is from small accumulations of uric acid crystals which are called tophi.”
- “The small nodules are not related to the arthritis condition.”
- “You have fat deposits that are common with gouty arthritis.”
A: “The inflammation is from small accumulations of uric acid crystals which are called tophi.”
If right: Gout is a metabolic disease resulting from an accumulation of uric acid in the blood. It is an acute inflammatory condition associated with ineffective metabolism of purines.
If wrong: Gout is a metabolic disease resulting from an accumulation of uric acid in the blood. It is an acute inflammatory condition associated with ineffective metabolism of purines.

Q: Which nursing intervention would be appropriate for a patient with rheumatoid arthritis?
- Sleeping at least 8 hours at night and a nap during the day
- Sleeping at 4-hour intervals at night
- No exercise regimen and apply ice to joints as needed
- Jogging at least 20 minutes three days a week
A: Sleeping at least 8 hours at night and a nap during the day
If right: Rest is important because fatigue is a major problem. Sleeping 8 to 10 hours a night and taking a 2-hour nap during the day are recommended.
If wrong: Rest is important because fatigue is a major problem. Sleeping 8 to 10 hours a night and taking a 2-hour nap during the day are recommended.

Q: When caring for a patient who is 34 years old and has rheumatoid arthritis, the nurse should remember that
- exercise should be avoided to decrease pain.
- the patient should be discouraged from performing activities of daily living.
- rest and exercise are both important parts of therapy.
- pain is best controlled by use of narcotic analgesics.
A: rest and exercise are both important parts of therapy.
If right: Rest is important because fatigue is a major problem. Exercise helps prevent the joints from “freezing” and the muscles from weakening.
If wrong: Rest is important because fatigue is a major problem. Exercise helps prevent the joints from “freezing” and the muscles from weakening.

Q: A 71-year-old patient is manifesting signs and symptoms of gout. When assessing him for signs and symptoms of gout, the nurse should pay particular attention to
- dietary intake of foods high in cholesterol.
- mobility in the hip and knee joints.
- edema or discoloration of the great toe.
- a history of trauma or occupational injury.
A: edema or discoloration of the great toe.
If right: Tophi (calculi containing sodium urate deposits that develop in periarticular fibrous tissue, typically in patients with gout) result in inflammation of the joint; it is unclear why this occurs. Typically the big toes are involved, but other joints can also be affected. Particular attention should be paid to foods high in purines.
If wrong: Tophi (calculi containing sodium urate deposits that develop in periarticular fibrous tissue, typically in patients with gout) result in inflammation of the joint; it is unclear why this occurs. Typically the big toes are involved, but other joints can also be affected. Particular attention should be paid to foods high in purines.

Q: A patient, age 44, has chronic osteomyelitis. He should be taught to
- take antibiotics prophylactically.
- avoid trauma to the affected bone.
- decrease activity levels.
- increase dietary intake of calcium and vitamin D.
A: avoid trauma to the affected bone.
If right: The patient must avoid trauma to the affected bone because pathological fracture is common.
If wrong: The patient must avoid trauma to the affected bone because pathological fracture is common.

Q: The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old female patient. This condition is known as
- scoliosis.
- lordosis.
- kyphosis.
- spondylitis.
A: lordosis.
If right: Common deformities include an increase in the curve at the lumbar space region that throws the shoulder back, making the “lordly or kingly” appearance that is known as lordosis. Scoliosis involves the S curvature of the spine. Kyphosis is the rounding of thoracic spine.
If wrong: Common deformities include an increase in the curve at the lumbar space region that throws the shoulder back, making the “lordly or kingly” appearance that is known as lordosis. Scoliosis involves the S curvature of the spine. Kyphosis is the rounding of thoracic spine.

Q: Rheumatoid arthritis is distinguished from osteoarthritis in that:
- Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.
- Rheumatoid arthritis is an autoimmune, degenerative disease; osteoarthritis is a systemic inflammatory disease.
- People with osteoarthritis are considered to be genetically predisposed; there is no known genetic component to rheumatoid arthritis.
- Osteoarthritis is often caused by a virus; viruses play no part in the pathogenesis of rheumatoid arthritis.
A: Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.
If right: RA is thought to be an autoimmune disorder. Degenerative joint disease is also known as osteoarthritis.
If wrong: RA is thought to be an autoimmune disorder. Degenerative joint disease is also known as osteoarthritis.

Q: Which ethnic group is at a highest risk of developing osteoporosis?
- African American women
- Caucasian and Asian women
- African American men
- Latino women
A: Caucasian and Asian women
If right: Caucasian and Asian women have a higher incidence of osteoporosis than African American women or Hispanic women.
If wrong: Caucasian and Asian women have a higher incidence of osteoporosis than African American women or Hispanic women.

Q: The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk for osteoporosis because her mother has osteoporosis. In teaching her about her osteoporosis, which information does the nurse include?
- Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
- Estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis.
- With a family history of osteoporosis, there is no way to prevent or slow bone reabsorption.
- Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.
A: Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
If right: To prevent osteoporosis, women are advised to have an adequate daily intake of calcium and vitamin D; exercise regularly; avoid smoking; decrease coffee intake; decrease excess protein in the diet; and engage in regular moderate activity such as walking, bike riding, or swimming at least 3 days a week. A contributing factor may be use of steroids.
If wrong: To prevent osteoporosis, women are advised to have an adequate daily intake of calcium and vitamin D; exercise regularly; avoid smoking; decrease coffee intake; decrease excess protein in the diet; and engage in regular moderate activity such as walking, bike riding, or swimming at least 3 days a week. A contributing factor may be use of steroids.

Q: Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines?
- Brain, liver, kidney
- Lettuce, corn, potatoes
- Beef, pork, chicken
- Fruits and fruit juices
A: Brain, liver, kidney
If right: Foods high in purines, such as brain, kidney, liver and heart, should be avoided, as well as alcohol.
If wrong: Foods high in purines, such as brain, kidney, liver and heart, should be avoided, as well as alcohol.

Q: Calcium is a mineral found in many foods that can slow bone loss during the aging process. The following are high in calcium:
- Oranges, yogurt
- Oranges, bananas
- Broccoli, yogurt
- Skim milk, eggs
A: Broccoli, yogurt
If right: Fresh oranges, bananas, and eggs are not good calcium choices. Broccoli and green vegetables, as well as yogurt, are considered calcium-rich foods.
If wrong: Fresh oranges, bananas, and eggs are not good calcium choices. Broccoli and green vegetables, as well as yogurt, are considered calcium-rich foods.

Q: A 76-year-old female patient is being seen for osteoarthritis of the knee in the clinic. In discussing strengthening exercises, which exercises would you recommend?
- Jogging
- Climbing stairs 2 to 3 times daily
- Bicycling for short distances
- Walking up and down small elevations
A: Bicycling for short distances
If right: Bicycling or swimming is recommended for osteoarthritis of the hip or knee. Jogging would put undue stress on knee joints. Climbing stairs should be avoided. Walking should be done on level ground, not up or down elevations.
If wrong: Bicycling or swimming is recommended for osteoarthritis of the hip or knee. Jogging would put undue stress on knee joints. Climbing stairs should be avoided. Walking should be done on level ground, not up or down elevations.

Q: Prolonged bed rest puts the older adult at risk for
- ankylosing spondylitis.
- pathological fractures.
- osteomyelitis.
- gout.
A: pathological fractures.
If right: Immobilization results in bone resorption, and the bone tissue becomes less dense. Prolonged bed rest puts the patient at risk for pathological fracture. This is a serious concern for an older adult in terms of regaining mobility.
If wrong: Immobilization results in bone resorption, and the bone tissue becomes less dense. Prolonged bed rest puts the patient at risk for pathological fracture. This is a serious concern for an older adult in terms of regaining mobility.

Q: A 65-year old patient has been diagnosed with rheumatoid arthritis (RA).  A diagnostic test used to confirm RA is:
- Complete blood count
- Erythrocyte sedimentation rate
- Prothrombin time
- Urinary uric acid level
A: Erythrocyte sedimentation rate

Q: A clinical sign of gouty arthritis is:
- Herberden’s nodes
- Pathological fractures
- Tophi deposits
- Homan’s dign
A: Tophi deposits

Q: What risk factors identified by the nurse would put a client at risk for developing osteoporosis?
- Menopause, stress, sedentary lifestyle, smoking, excessive alcohol intake, and diet deficient in calcium and vitamin D.
- Family history, age, history of falls, smoking, alcohol, and diet deficient in protein.
- Diet deficient in protein and carbohydrates, smoking, excessive alcohol intake, stress, and sedentary lifestyle.
- Inadequate sunlight exposure, obesity, depression, poor dietary intale of calcium, and excessive alcohol intake.
A: Menopause, stress, sedentary lifestyle, smoking, excessive alcohol intake, and diet deficient in calcium and vitamin D.

Q: The nurse prepares a client for a bone scan.  What priority assessment should the nurse perform for this client?
- History of claustrophobia
- Presence of intravenous (IV) access
- Current vital signs
- Presence of metallic implants such as a pacemaker or aneurysm clips
A: Presence of intravenous (IV) access

Q: The nurse observes that an18 year old female client has asymmetry of the shoulders and hips, and the hem of her dress is uneven.  The nurse suspects that the client may be presenting with which of the following disorders?
- Congenital hip dislocation
- Scoliosis
- Fractured tibia
- Degenerative disk disease
A: Scoliosis

Q: A group of childhood disorders characterized by progressive muscle weakness, muscle wasting  of symmetrical groups of muscles, and increasing disability and deformity describes which disorder?
- Scoliosis
- Lordosis
- Kyphosis
- Muscular dystrophy
A: Muscular dystrophy