1 Inflammatory Bowel Disease

1
Meet the
Pati
ent
: Ms. Chan Lieu
is a 56
-
year
-
old Korean
-
American female with a history of osteoporosis. She
visits the clinic, reporting the onset of low back pain.
Priority Data Collection
:
The nurse notes the
patient
’s history of osteoporosis
愀湤⁨攀爠爀攀灯牴昀漀眠扡挀欠
灡楮⸠䅳⁍猀⸠䰀楥甠睡汫猠瑯⁴桥⁥砀愀洠牯潭Ⱐ琀桥畲獥⁰牥瀀愀牥猠瑯⁣潭灬攀琀攀 愀⁨楳琀潲礀 愀湤⁰栀礀獩捡氠慳猀攀獳洀攀湴Ⱐ
景挀畳楮最渠瑨攀畳捵汯獫敬攀瑡氠猀礀獴攀洮
1.
The nurse begins the assessment as the
patient
ambulates in the hallway. What
observations should the
nurse make while the
patient
is walking to the exam room? (Select all that apply.)
A)
Fine motor function.
B)
Posture.
C)
Gait.
D)
Bone density.
E)
Balance.
2.
Once the
patient
is settled in the exam room, which action by the
nurse has the highest priority?
A)
Obtain more in
-
depth information about the
patient
’s osteoporosis management.
䈩
刀攀癩攀眠瑨攀 
灡瑩攀湴
’s medical record for any history of bone or spinal fractures.
䌩
䝡瑨敲⁤愀琀愀⁡扯畴⁴桥 湡瑵牥Ⱐ汯捡瑩潮Ⱐ愀湤⁤甀牡瑩潮昀
瑨攠
灡瑩攀湴
’s back pain.
䐩
䌀潭灡爀攀⁢楬愀瑥牡氠洀甀獣汥⁳瑲攀渀最瑨⁡湤⁴潮攀⁩渠瑨攠
灡瑩攀湴
’s lower extremities.
䵳⸠䰀楥甠灬愀挀攀猠桥爠桡湤癥爠桥爠汵浢愀爠愀爀攀愀⁴漠猀桯眠瑨攀畲獥⁴桥潣愀瑩潮昀⁨攀爠灡楮 愀湤⁲愀瑥猠楴 愀琠愠㜠潮 
愀⁳捡汥映㄀
ⴀ
㄰⸠周攀甀牳攀⁣潮獵氀瑳 
瑨攠攀汥挀瑲潮椀挀 浥摩挀愀瑩潮⁡摭椀湩獴牡瑩潮⁲攀挀潲搠愀湤潴敳⁡⁰牥猀挀物灴楯渠
景爀⁡渠愀湴椀
ⴀ
楮晬愀浭愀瑯爀礀 浥摩挀愀瑩潮⸀
3.
Indomethacin (Indocin) 50 mg capsules by mouth every 6 hours as needed for back pain is prescribed.
Indomethacin 25 mg capsules are available.
How many capsules should the nurse administer? (Enter the
numerical value only. If rounding is required, round to the whole number.)
The nurse returns 30 minutes after administering the medication, and Mrs. Lieu states her back pain is now a
1 on a sca
le of 1
-
10. Mrs. Lieu states she is able to proceed with the rest of the musculoskeletal assessment.
4.
Ms. Lieu shares with the nurse that she often experiences knee pain. The nurse asks Ms. Lieu about other
common joint symptoms. On which symptoms shoul
d the nurse focus? (Select all that apply.)
A)
Stiffness.
B)
Swelling.
C)
Cramping.
D)
Numbness.
E)
Warmth.
2
5.
Because of Ms. Lieu’s
history of knee pain and current report of low back pain, which nursing action is
most useful in developing an initial plan of care for the
patient
?
A)
Obtain a family medical history.
B)
Complete a functional assessment.
C)
Observe for callus formation
.
D)
Ask about any recent weight gain.
6.
Which information in Ms. Lieu’s history reflects a high risk for low back pain?
A)
Frequently travels with her husband to Korea by air to visit relatives.
B)
Spends her evenings working in her large vegetable a
nd flower garden.
C)
Often rides a bicycle to her job as a history professor at a local college.
D)
Volunteers on the weekend as a tour guide at a historical city mansion.
After completing the history, the nurse begins the physical assessment of the
patient
’s musculoskeletal
system.
Spinal Assessment
:
The nurse begins the physical assessment and prepares to assess the curvatures of the
patient
’s spine.
7.
To check for scoliosis, the nurse provides which
patient
instruction?
A)
Stand with arms straight
at your sides and your feet together.
B)
Place hands on hips and lean to one side and then the other.
C)
Twist from one side to the other with your hands on your hips.
D)
Place feet apart and slowly raise both arms above your head.
The
patient
has no ob
vious scoliosis, and the nurse continues the spinal assessment.
8.
When observing the
patient
from the side, the nurse observes a slightly convex thoracic curve and a
slightly concave lumbar curve. What action should the nurse take in response to these fi
ndings?
A)
Ask the
patient
how long she has had a “Dowager’s hump.”
B)
Record these symptoms of osteoporosis in the
patient
’s chart.
C)
Document the normal spinal curvature on the assessment form.
D)
Note the
patient
’s poor posture as a possible cause of
her back pain.
9.
While assessing the spine, the nurse assesses Ms. Lieu’s low back pain further. Which action will help
determine the cause of her pain?
A)
Ask the
patient
to lie supine and raise one leg, keeping it straight.
B)
Watch the
patient
while s
he stands upright and slowly squats down.
C)
Instruct the
patient
to balance on one foot with her arms at her sides.
D)
Help the
patient
to a prone position, rotating both legs inward.
3
10.
Ms. Lieu follows the nurse’s instructions to swing her arms
forward and up in a wide arc, then back. This
action allows the nurse to observe what shoulder range of motion?
A)
Internal and external rotation.
B)
Abduction and adduction.
C)
Flexion and hyperextension.
D)
Forward and reverse motion.
11.
While asse
ssing shoulder range of motion, the nurse notes the absence of crepitation with movement.
What action should the nurse take in response to this finding?
A)
Document this normal finding in the assessment.
B)
Ask the
patient
about her intake of dietary calc
ium.
C)
Record the degree of the range of motion limitation.
D)
Review the
patient
’s record for a history of arthritis.
Upper Extremity Assessment
:
Ms. Lieu does not exhibit any sciatic pain. After completing the spinal
assessment, the nurse assists Ms.
Lieu back to a sitting position, with her legs dangling over the edge of the
exam table.
The nurse begins the assessment of Ms. Lieu’s upper extremities.
12.
The nurse next assesses the
patient
’s elbows. When comparing these joints bilaterally, for what
should the
nurse observe? (Select all that apply.)
A)
Skin color.
B)
Tympany.
C)
Contour.
D)
Resonance.
E)
Size.
13.
The nurse observes Ms. Lieu as she rests her lower arms on a table with her hands at a 90 degree angle to
the table and the thumbs up
. Ms. Lieu turns her hands upward with the back of the hand flat on the table and
then downward with the palm flat on the table. What action is the nurse observing?
A)
Flexion and extension of the wrist.
B)
Elbow supination and pronation.
C)
Lower arm a
dduction and abduction.
D)
Hand and finger hyperextension.
14.
The nurse prepares to palpate the joints in Ms. Lieu’s wrist and hands. First, the nurse supports the
patient
’s hands. What action should the nurse take next?
A)
Use both thumbs to apply gent
le pressure.
B)
Use the index fingers to lightly compress the pulses.
C)
Ask the
patient
to spread her fingers apart.
D)
Instruct the
patient
to make a fist with both hands.
5
Lower Extremity Assessment
19.
Ms. Lieu lies down on the exam table in a
supine position. The nurse assesses adduction and abduction of
the hip by instructing the
patient
to take what action?
A)
Bend the knee so the foot is flat on the table and allow the knee to drop inward then outward.
B)
Swing the entire leg laterally and
then medially, keeping the knee straight while moving.
C)
Lift each leg straight above the body to a 90
-
degree angle.
D)
Turn both legs so the toes are pointed inward and then outward.
Ms. Lieu demonstrates full range of motion of her hips.
20.
While M
s. Lieu moves her legs through the various forms of range of motion, the nurse grades her muscle
strength. To indicate 100% muscle strength, the nurse assesses for movement against which? (Select all that
apply.)
A)
gravity.
B)
rest.
C)
light touch.
D)
pain.
E)
resistance.
21.
To assess muscle strength in the foot, the nurse next asks the
patient
to dorsiflex her foot. The
patient
points her toes downward. What action should the nurse take next?
A)
Apply gentle pressure over the
patient
’s toes.
B)
Place one hand on the bottom of the
patient
’s foot.
C)
Ask the
patient
to flex her foot upward.
D)
Help the
patient
evert and then invert her foot.
22.
Ms. Lieu states she is uncomfortable lying on the exam table, so the nurse assists her to a sitting
position
before completing the assessment of her knees. The nurse begins by observing the anterior thighs and knees.
How should the nurse assess for the presence of muscle atrophy?
A)
Gently apply pressure around the patella.
B)
Observe the size of the m
uscle.
C)
Palpate the tissues for edema.
D)
Measure the muscle with a goniometer.
23.
Earlier, Ms. Lieu reported that she often experiences unilateral left knee pain. The nurse palpates her left
knee and notes the presence of a small amount of swelling.
Which sign should the nurse attempt to elicit?
A)
Bulge sign.
B)
Battle sign.
C)
Allis sign.
D)
Tinel’s sign.
6
A Change in Condition
:
Following the completion of the assessment, Ms. Lieu stands up next to the exam
table. She grabs hold of the table a
nd lurches forward, indicating that her knee suddenly “gave way.” The
nurse assists her back to a sitting position on the exam table.
24.
Upon further questioning by the nurse, Ms. Lieu reports that this buckling of her knee has occurred
several times pre
viously. What additional information is most important for the nurse to obtain?
A)
Whether she takes any pain medication for her knee pain.
B)
The date she last had her bone density measured.
C)
Any recent history of trauma or injury to the affected
knee.
D)
How frequently she performs weight
-
bearing exercises.
25.
The nurse performs McMurray’s test and hears an audible click while maneuvering Ms. Lieu’s left leg. In
response to this finding, what action should the nurse implement?
A)
Observe the
patient
’s gait as she walks across the room.
B)
Explain to the
patient
that her knee dislocation has resolved.
C)
Plan to instruct the
patient
about knee strengthening exercises.
D)
Report the assessment to the clinic healthcare provider.
Case Outcome
:
The
nurse notifies the healthcare provider of the positive McMurray’s test and summarizes
the other assessment findings. After medical evaluation, Ms. Lieu undergoes surgery to repair her torn
meniscus and is now participating in physical therapy for knee reh
abilitation and for her lower back strain.

Post Merge: 9 years ago

please does anyone have the case study on MS lieu Osteoporosis

Inflammatory Bowel Disease
1.   A
2.   B
3.   B
4.   B,E
5.   A
6.   D
7.   B
8.   C
9.   A
10.   B
11.   D
12.   D
13.   D
14.   A
15.   D
16.   D
17.   C
18.   17
19.   C
20.   C
21.   D
22.   B
23.   A
24.   A
25.   A
26.   C
27.   D
28.   C
29.   D
30.   B