1
NRn511/NRn511nFinalnpracticenquestions.
FinalnExam nPractice nQuestions
Questionn1.nMatthew,nage n52,nisnanchefnwhonjustnseveredn2 nofnhisnfingersnwithnanmeatncutter.nYounwouldnrecommen
dnthatnhe:
1. Wrapnthe nseverednfingersntightlyninnandryntowelnfor ntransportntonthe nemergencyndepartmentnwithnhim.
2. Leave nthe nseverednfingersnatnthe nscene nbecause nfingersncannotnbe nreattached.
3. Immediatelynfreeze nthe nseverednfingersnfor nreattachmentninnthe nnear nfuture.
4. Wrapnthe nfingersninnanclean,ndampncloth; nsealnthemninnanplastic nbag; nandnplace nthe nbagninnannice nwater nbat
h.nRationales
Optionn1:
Severednfingersnshouldnbenwrappedninnanclean,ndampncloth; nsealedninnanplastic nbag; nandnplacedninnannice nwater nbat
h.nOptionn2:
Severednfingersncannbe nreattachednafter n1 nton2 ndays—or nmore—
ifnproperlynstored.nOptionn3:
Severednfingersnshouldnbenwrappedninnanclean,ndampncloth; nsealedninnanplastic nbag; nandnplacedninnannice nwater nbat
h,nnotnfrozennor nkeptnatnbodyntemperature.
Optionn4:
Ifnanclientnhasnseverednhisnfingers,nthe nfingersnshouldnbenwrappedninnanclean,ndampncloth; nsealedninnanplastic nbag; npl
acedninnannice nwater nbath; nandntransportedntonthe nemergencynroomnalongnwithnthe nclient.
The nvalgusnstressntest,nvarusnstressntest,nLachmanntest,nandnthumbnsignnare nallnconsiderednstandardntestsntonche
cknthe nintegritynofnthenligamentsnofnthenknee. nWhichntest nwouldnthe nnursenpractitioner nchoose ntonassessnthe nant
erior ncruciate nligament n(ACL),nwhichnisnthe nmost ncommonlyninvolvednstructure ninnsevere nknee ninjury?
1. Valgusnstressntest.
2. Varusnstressntest.
3. Lachmanntest.
4. Thumbnsign.
n Rationalesn Op
tionn1:
The nvalgusnstressntestnassessesnstabilitynofnthe nmedialncollateralnligamentn(MCL).n
Optionn2:
The nvarusnstressntestnassessesnstabilitynofnthe nlateralncollateralnligamentn(LCL).nOp
tionn3:
The nLachmanntestnassessesnthe nACL.nOpti
onn4:
The nthumbnsignnassessesnthe nposterior ncruciate nligamentn(PCL).
Lillian,nage n70,nwasntoldnthat nshe nhasnosteoporosis. nWhennshe nasksnyounwhat nthisnis,nyounrespondnthat nosteopor
osis:
1. Developsnwhennlossnofnbone noccursnmore nrapidlynthannnewnbone ngrowth.
2. Isnandegenerative njointndisease ncharacterizednbynlossnofncartilage ninncertainnjoints.
3. Isnanchronic ninflammatoryndisorder nthatnaffectsnmultiple njoints.
Pnangnen 1n|n138
, 2
NRn511/NRn511nFinalnpracticenquestions.
4. Isnanbone ndisorder nthatnhasntondonwithninadequate nmineralizationnofnthe nbones
.nRationales
Optionn1:
Osteoporosisndevelopsnwhennbone nresorptionnoccursnmore nrapidlynthannbone ndeposition.nOpti
onn2:
Osteoarthritisnisnandegenerative njointndisease ncharacterizednbyndegenerationnandnlossnofnarticular ncartilage ninnsyno
vialnjoints.
Optionn3:
Rheumatoidnarthritisnisnanchronic,nsystemic ninflammatoryndisorder ncharacterizednbynpersistentnsynovitisnofnmultiple
n joints.
Optionn4:
Osteomalacianisnanmetabolic nbone ndisorder ncharacterizednbyninadequate nmineralizationnofnthe nbone nmatrix,noftenn
causednbynvitaminnDndeficiency.
Mike,nage n42,nangolfnpro,nhasnhadnchronicnbacknpainnfor nmanynyears. nHisnworkupnrevealsnthat nitnisnnotnthe nresult n
ofnandegenerative ndisknproblem. nHisnbackn“goesnout”nabout ntwice npernyear,nandnhe nisnoutnofnworknfor nabout nan
weekneachntime. nWhichnofnthe nfollowingnshouldnthe nnurse npractitioner nadvise nhim ntondo?
1. Consider nchangingncareersntonsomethingnlessnphysical.
2. Beginnanplannednexercise nprogramntonstrengthennbacknmuscles.
3. Make nannappointmentnwithnanneurosurgeon nfor nansurgicalnconsultation.
4. Startnonnandailynlow-
dose nnarcotic ntontake nawaynthe npain.nRationales
Optionn1:
Suggestingnancareer nchange nshouldnbe nconsiderednonlyninncasesnofndisabilitynor ninabilityntonsafelyncontinue none’s
currentnemployment.
Optionn2:
Innthisncase,nMike nmaynbenefitnfromnanregular nplannednexercise nprogramntonstrengthennhisnbacknmusclesnandnattemp
tntonreduce nthe nprobabilitynofnfuture nepisodesnofnbacknpain.
Optionn3:
Surgerynisnrecommended nonlynfor nclientsnwithnlownbacknpainncausednbyndegenerative ndiskndisorders,nandnthennonl
ynwhennsevere nneurologic ninvolvementnhasnoccurred.nSurgerynbenefitsnonlynapproximatelyn1%nofnpeople nwithnlownb
acknproblems.
Optionn4:
Narcotic npainnmedicationsnare nnotnconsiderednfirst-
line ntreatmentnfor nmechanicalnbacknpain.nCourse nTopic: nMusculoskeletalnProblemsnConcept(s):n
21820Cognitive nLevel: nAnalysisn[Analyzing]
Janine,nage n69,nhasnclassnIII nrheumatoidnarthritis. nAccordingntonthe nAmericannRheumatism nAssociation,nwhichnof
n the n followingn describesn her n abilityn ton function?
1. Adequate nfor nnormalnactivitiesndespite nanhandicapnofndiscomfortnor nlimitednmotionnofnone nor nmore njoints.
2. Largelynor nwhollynincapacitated,nbedridden,nor nconfinedntonanwheelchair,npermittingnlittle nor nnonself-care.
3. Completelynable ntoncarrynoutnallnusualndutiesnwithoutnhandicap.
4. Adequate ntonperformnonlynanfewnor nnone nofnthe ndutiesnofnusualnoccupationnor nself-
care.nRationales
Optionn1:
Pnangnen 2n|n138
, 3
NRn511/NRn511nFinalnpracticenquestions.
ClassnIInrefersntonthe nclientnwhose nfunctionnisnadequate nfor nnormalnactivitiesndespite nanhandicapnofndiscomfortnor nli
mitednmotionnofnone nor nmore njoints.
Optionn2:
ClassnIVnrefersntonthe nclientnwhonisnlargelynor nwhollynincapacitated,nbedridden,nor nconfinedntonanwheelchair,npermit
tingnlittle nor nnonself-care.
Optionn3:
ClassnInrefersntonthe nclientnwhoncanncarrynoutnallnusualndutiesnwithoutnhandicap.nO
ptionn4:
The nAmericannRheumatismnAssociationnhasnestablishednfunctionalnclassesnIntonIVntondescribe nanclient’snabilityntona
ccomplishnactivitiesnofndailynliving.nBecause nJanine nisnclassnIII,nher nfunctionnwouldnbe nadequate ntonperformnonlynanfe
wnor nnone nofnthe ndutiesnofnusualnoccupationnor nself-care.
For nannadult npatient nwithnanknee ninjury,nthe nnurse npractitioner nordersnannonsteroidalnanti-
inflammatoryndrugn(NSAID)ntonbe ntakennonnanroutine nbasisnfor nthe nnext n2 nweeks. nPatient nteachingnshouldninclu
de nwhichnofnthe nfollowing?
1.
“Younmayntake nthisnmedicationnonnannemptynstomachnasnlongnasnyouneatnwithinntwontonthree nhoursnofntakingnit.”
2.
“Ifnone npillndoesnnotnseemntonhelp,nyouncanndouble nthe ndose nfor nsubsequentndoses.”
3.
“Ifnyounnotice nnausea,nvomiting,nor nblacknor nbloodynstools,ntake nthe nnextndose nwithnanglassnofnmilknor nanfullnmeal.”
4.
“Ifnyounhave nadditionalnpain,nannoccasionalnacetaminophenn(Tylenol)nisnpermittedninnbetweennthe nusualndosesnofnthe
NSAID.”
Rationales
n Option n 1:
WhennteachingnclientsnaboutnNSAIDs,ntellnthemnnotntontake nthese ndrugsnonnannemptynstomachnbutntontake nthemnwit
hnfoodnor nmilk.
Optionn2:
Clientsnshouldnbe ntaughtntonnever ntake nmore nthannthe nprescribedndose nofnannNSAIDndue ntonthe nlikelihoodnofnincrea
singnthe nchancesnofngastrointestinaln(GI)nandnkidneyndamage.
Optionn3:
WhennteachingnclientsnaboutnNSAIDs,ntellnthemntonstopnthe nmedicationnandncallnimmediatelynifntheynnotice nanynna
usea,nvomiting,ncoffee-groundsnemesis,nblacknstools,nor nbloodninnthe nstool.
Optionn4:
Ifnthe nclientnisnhavingnadditionalnpain,nacetaminophenn(Tylenol)nmaynbe ntakenninnconjunctionnwithnannNSAIDnbecaus
e nitnisnnotnannNSAIDnandnwillnnotnpotentiate ngastric nbleeding.
Sean,nanfactorynline nworker,nhasnosteoarthritisn(OA)nofnthe nright nhand. nAccordingntonthe nAmericannCollege nofnRhe
umatologyn(ACR),nthe nguidelinesnfor npharmacologicntreatment ninclude:
1. Acetaminophen,ntramadol,nandnintra-articular ncorticosteroidninjections.
2. Oralnnonsteroidalnanti-inflammatoryndrugsn(NSAIDs),ntramadol,nandnarticular ncorticosteroid ninjections.
3. Acetaminophen,ntopicalncapsaicin,nandntopicalnnonsteroidalnanti-inflammatoryndrugsn(NSAIDs).
4. Topicalncapsaicin,ntopicalnnonsteroidalnanti-
inflammatoryndrugsn(NSAIDs),nandnoralnNSAIDs.nRationales
Pnangnen 3n|n138
, 4
NRn511/NRn511nFinalnpracticenquestions.
Optionn1:
Acetaminophen,noralnnonsteroidalnanti-inflammatoryndrugsn(NSAIDs),ntramadol,nandnintra-
articular ncorticosteroid ninjectionsnare nrecommended nfor ninitialnmanagementnofnhipnOA.
Optionn2:
Acetaminophen,noralnNSAIDs,ntramadol,nandnintra-
articular ncorticosteroid ninjectionsnare nrecommended nfor ninitialnmanagementnofnhipnOA.
Optionn3:
The nACRnconditionallynrecommendsnacetaminophen,noralnNSAIDs,ntopicalnNSAIDs,ntramadol,nandnintra-
articular ncorticosteroid ninjectionsnfor nOA nofnthe nknee.
Optionn4:
Topicalncapsaicin,ntopicalnNSAIDs,noralnNSAIDs,nandntramadolnare nrecommended nbynthe nACRnfor nthe ntreatmentnofnO
A nofnthe nhand.
Margaret,nage n55,npresentsntonyounfornevaluationnofnleft nhandnandnwrist npainnandnswellingnafter nanslipnandnfalln
onnthe nice nyesterday. nOnnexamination,nyounnote ntendernessnat nhern“anatomicalnsnuffbox.” nYounknownthisnpro
bablynindicatesna(n):
1. Ulnar nstyloidnfracture.
2. Scaphoidnfracture.
3. Hamate nfracture.
4. Radialnheadnfracture.
n Rationales
Optionn1:
Annulnar nstyloidnfracture nwouldnproduce ntendernessnatnthe ndistalnulna.nO
ptionn2:
There nisntendernessnover nthe n“anatomicalnsnuffbox”ninnanscaphoidn(akannavicular)nfracture,nthe nmostncommonninjury
n ofn the n carpaln bones.n Poor n blood n supply n putsn the n scaphoid n bone n atn riskn ofnavascular n necrosis; n therefore,n wristn pain
n andn tendernessn inn the n anatomicaln snuffbox,n even n withoutn history n ofn antecedentn trauma,n warrantn an wristn x-ray.
Optionn3:
A nfracture nofnthe nhooknofnthe nhamate nisnannuncommonninjurynseenninngolfersnandnplayersnofnracketnsportsnthatninvo
lvesnpainnandntendernessnonnthe nulnar nside nofnthe npalm.
Optionn4:
A nradialnheadnfracture nwouldnresultninnpainnatnthe nelbownjointnwhere nthe nradialnheadnliesnproximalntonthe ndistalnh
umerus.nBe nsure nnotntonconfuse nthe nradialnheadn(proximalnendnofnthe nradius)nwithnthe nradialnstyloidn(distalnendnofnt
he nradiusnatnthe nwrist).
Jim,nage n22,nanstocknboy,nhasnannacute nepisode nofnlownbacknpain. nThe nnurse npractitioner nordersnannonsteroidalnant
i-ninflammatoryndrugn(NSAID)nandnshouldneducate nhim ninnwhichnofnthe nfollowing?
1. Maintainingnmoderate nbednrestnfor n3 nton4 ndays.
2. Callingnthe noffice nfor nnarcotic nmedicationnifnthere nisnnonreliefnwithnthe nNSAIDnafter n24 nton48 nhours.
3. Beginningnlower nbacknstrengtheningnexercisesndependingnonnpainntolerance.
4. WearingnanBostonnbrace natnnight
.nRationales
Optionn1:
Pnangnen 4n|n138
NRn511/NRn511nFinalnpracticenquestions.
FinalnExam nPractice nQuestions
Questionn1.nMatthew,nage n52,nisnanchefnwhonjustnseveredn2 nofnhisnfingersnwithnanmeatncutter.nYounwouldnrecommen
dnthatnhe:
1. Wrapnthe nseverednfingersntightlyninnandryntowelnfor ntransportntonthe nemergencyndepartmentnwithnhim.
2. Leave nthe nseverednfingersnatnthe nscene nbecause nfingersncannotnbe nreattached.
3. Immediatelynfreeze nthe nseverednfingersnfor nreattachmentninnthe nnear nfuture.
4. Wrapnthe nfingersninnanclean,ndampncloth; nsealnthemninnanplastic nbag; nandnplace nthe nbagninnannice nwater nbat
h.nRationales
Optionn1:
Severednfingersnshouldnbenwrappedninnanclean,ndampncloth; nsealedninnanplastic nbag; nandnplacedninnannice nwater nbat
h.nOptionn2:
Severednfingersncannbe nreattachednafter n1 nton2 ndays—or nmore—
ifnproperlynstored.nOptionn3:
Severednfingersnshouldnbenwrappedninnanclean,ndampncloth; nsealedninnanplastic nbag; nandnplacedninnannice nwater nbat
h,nnotnfrozennor nkeptnatnbodyntemperature.
Optionn4:
Ifnanclientnhasnseverednhisnfingers,nthe nfingersnshouldnbenwrappedninnanclean,ndampncloth; nsealedninnanplastic nbag; npl
acedninnannice nwater nbath; nandntransportedntonthe nemergencynroomnalongnwithnthe nclient.
The nvalgusnstressntest,nvarusnstressntest,nLachmanntest,nandnthumbnsignnare nallnconsiderednstandardntestsntonche
cknthe nintegritynofnthenligamentsnofnthenknee. nWhichntest nwouldnthe nnursenpractitioner nchoose ntonassessnthe nant
erior ncruciate nligament n(ACL),nwhichnisnthe nmost ncommonlyninvolvednstructure ninnsevere nknee ninjury?
1. Valgusnstressntest.
2. Varusnstressntest.
3. Lachmanntest.
4. Thumbnsign.
n Rationalesn Op
tionn1:
The nvalgusnstressntestnassessesnstabilitynofnthe nmedialncollateralnligamentn(MCL).n
Optionn2:
The nvarusnstressntestnassessesnstabilitynofnthe nlateralncollateralnligamentn(LCL).nOp
tionn3:
The nLachmanntestnassessesnthe nACL.nOpti
onn4:
The nthumbnsignnassessesnthe nposterior ncruciate nligamentn(PCL).
Lillian,nage n70,nwasntoldnthat nshe nhasnosteoporosis. nWhennshe nasksnyounwhat nthisnis,nyounrespondnthat nosteopor
osis:
1. Developsnwhennlossnofnbone noccursnmore nrapidlynthannnewnbone ngrowth.
2. Isnandegenerative njointndisease ncharacterizednbynlossnofncartilage ninncertainnjoints.
3. Isnanchronic ninflammatoryndisorder nthatnaffectsnmultiple njoints.
Pnangnen 1n|n138
, 2
NRn511/NRn511nFinalnpracticenquestions.
4. Isnanbone ndisorder nthatnhasntondonwithninadequate nmineralizationnofnthe nbones
.nRationales
Optionn1:
Osteoporosisndevelopsnwhennbone nresorptionnoccursnmore nrapidlynthannbone ndeposition.nOpti
onn2:
Osteoarthritisnisnandegenerative njointndisease ncharacterizednbyndegenerationnandnlossnofnarticular ncartilage ninnsyno
vialnjoints.
Optionn3:
Rheumatoidnarthritisnisnanchronic,nsystemic ninflammatoryndisorder ncharacterizednbynpersistentnsynovitisnofnmultiple
n joints.
Optionn4:
Osteomalacianisnanmetabolic nbone ndisorder ncharacterizednbyninadequate nmineralizationnofnthe nbone nmatrix,noftenn
causednbynvitaminnDndeficiency.
Mike,nage n42,nangolfnpro,nhasnhadnchronicnbacknpainnfor nmanynyears. nHisnworkupnrevealsnthat nitnisnnotnthe nresult n
ofnandegenerative ndisknproblem. nHisnbackn“goesnout”nabout ntwice npernyear,nandnhe nisnoutnofnworknfor nabout nan
weekneachntime. nWhichnofnthe nfollowingnshouldnthe nnurse npractitioner nadvise nhim ntondo?
1. Consider nchangingncareersntonsomethingnlessnphysical.
2. Beginnanplannednexercise nprogramntonstrengthennbacknmuscles.
3. Make nannappointmentnwithnanneurosurgeon nfor nansurgicalnconsultation.
4. Startnonnandailynlow-
dose nnarcotic ntontake nawaynthe npain.nRationales
Optionn1:
Suggestingnancareer nchange nshouldnbe nconsiderednonlyninncasesnofndisabilitynor ninabilityntonsafelyncontinue none’s
currentnemployment.
Optionn2:
Innthisncase,nMike nmaynbenefitnfromnanregular nplannednexercise nprogramntonstrengthennhisnbacknmusclesnandnattemp
tntonreduce nthe nprobabilitynofnfuture nepisodesnofnbacknpain.
Optionn3:
Surgerynisnrecommended nonlynfor nclientsnwithnlownbacknpainncausednbyndegenerative ndiskndisorders,nandnthennonl
ynwhennsevere nneurologic ninvolvementnhasnoccurred.nSurgerynbenefitsnonlynapproximatelyn1%nofnpeople nwithnlownb
acknproblems.
Optionn4:
Narcotic npainnmedicationsnare nnotnconsiderednfirst-
line ntreatmentnfor nmechanicalnbacknpain.nCourse nTopic: nMusculoskeletalnProblemsnConcept(s):n
21820Cognitive nLevel: nAnalysisn[Analyzing]
Janine,nage n69,nhasnclassnIII nrheumatoidnarthritis. nAccordingntonthe nAmericannRheumatism nAssociation,nwhichnof
n the n followingn describesn her n abilityn ton function?
1. Adequate nfor nnormalnactivitiesndespite nanhandicapnofndiscomfortnor nlimitednmotionnofnone nor nmore njoints.
2. Largelynor nwhollynincapacitated,nbedridden,nor nconfinedntonanwheelchair,npermittingnlittle nor nnonself-care.
3. Completelynable ntoncarrynoutnallnusualndutiesnwithoutnhandicap.
4. Adequate ntonperformnonlynanfewnor nnone nofnthe ndutiesnofnusualnoccupationnor nself-
care.nRationales
Optionn1:
Pnangnen 2n|n138
, 3
NRn511/NRn511nFinalnpracticenquestions.
ClassnIInrefersntonthe nclientnwhose nfunctionnisnadequate nfor nnormalnactivitiesndespite nanhandicapnofndiscomfortnor nli
mitednmotionnofnone nor nmore njoints.
Optionn2:
ClassnIVnrefersntonthe nclientnwhonisnlargelynor nwhollynincapacitated,nbedridden,nor nconfinedntonanwheelchair,npermit
tingnlittle nor nnonself-care.
Optionn3:
ClassnInrefersntonthe nclientnwhoncanncarrynoutnallnusualndutiesnwithoutnhandicap.nO
ptionn4:
The nAmericannRheumatismnAssociationnhasnestablishednfunctionalnclassesnIntonIVntondescribe nanclient’snabilityntona
ccomplishnactivitiesnofndailynliving.nBecause nJanine nisnclassnIII,nher nfunctionnwouldnbe nadequate ntonperformnonlynanfe
wnor nnone nofnthe ndutiesnofnusualnoccupationnor nself-care.
For nannadult npatient nwithnanknee ninjury,nthe nnurse npractitioner nordersnannonsteroidalnanti-
inflammatoryndrugn(NSAID)ntonbe ntakennonnanroutine nbasisnfor nthe nnext n2 nweeks. nPatient nteachingnshouldninclu
de nwhichnofnthe nfollowing?
1.
“Younmayntake nthisnmedicationnonnannemptynstomachnasnlongnasnyouneatnwithinntwontonthree nhoursnofntakingnit.”
2.
“Ifnone npillndoesnnotnseemntonhelp,nyouncanndouble nthe ndose nfor nsubsequentndoses.”
3.
“Ifnyounnotice nnausea,nvomiting,nor nblacknor nbloodynstools,ntake nthe nnextndose nwithnanglassnofnmilknor nanfullnmeal.”
4.
“Ifnyounhave nadditionalnpain,nannoccasionalnacetaminophenn(Tylenol)nisnpermittedninnbetweennthe nusualndosesnofnthe
NSAID.”
Rationales
n Option n 1:
WhennteachingnclientsnaboutnNSAIDs,ntellnthemnnotntontake nthese ndrugsnonnannemptynstomachnbutntontake nthemnwit
hnfoodnor nmilk.
Optionn2:
Clientsnshouldnbe ntaughtntonnever ntake nmore nthannthe nprescribedndose nofnannNSAIDndue ntonthe nlikelihoodnofnincrea
singnthe nchancesnofngastrointestinaln(GI)nandnkidneyndamage.
Optionn3:
WhennteachingnclientsnaboutnNSAIDs,ntellnthemntonstopnthe nmedicationnandncallnimmediatelynifntheynnotice nanynna
usea,nvomiting,ncoffee-groundsnemesis,nblacknstools,nor nbloodninnthe nstool.
Optionn4:
Ifnthe nclientnisnhavingnadditionalnpain,nacetaminophenn(Tylenol)nmaynbe ntakenninnconjunctionnwithnannNSAIDnbecaus
e nitnisnnotnannNSAIDnandnwillnnotnpotentiate ngastric nbleeding.
Sean,nanfactorynline nworker,nhasnosteoarthritisn(OA)nofnthe nright nhand. nAccordingntonthe nAmericannCollege nofnRhe
umatologyn(ACR),nthe nguidelinesnfor npharmacologicntreatment ninclude:
1. Acetaminophen,ntramadol,nandnintra-articular ncorticosteroidninjections.
2. Oralnnonsteroidalnanti-inflammatoryndrugsn(NSAIDs),ntramadol,nandnarticular ncorticosteroid ninjections.
3. Acetaminophen,ntopicalncapsaicin,nandntopicalnnonsteroidalnanti-inflammatoryndrugsn(NSAIDs).
4. Topicalncapsaicin,ntopicalnnonsteroidalnanti-
inflammatoryndrugsn(NSAIDs),nandnoralnNSAIDs.nRationales
Pnangnen 3n|n138
, 4
NRn511/NRn511nFinalnpracticenquestions.
Optionn1:
Acetaminophen,noralnnonsteroidalnanti-inflammatoryndrugsn(NSAIDs),ntramadol,nandnintra-
articular ncorticosteroid ninjectionsnare nrecommended nfor ninitialnmanagementnofnhipnOA.
Optionn2:
Acetaminophen,noralnNSAIDs,ntramadol,nandnintra-
articular ncorticosteroid ninjectionsnare nrecommended nfor ninitialnmanagementnofnhipnOA.
Optionn3:
The nACRnconditionallynrecommendsnacetaminophen,noralnNSAIDs,ntopicalnNSAIDs,ntramadol,nandnintra-
articular ncorticosteroid ninjectionsnfor nOA nofnthe nknee.
Optionn4:
Topicalncapsaicin,ntopicalnNSAIDs,noralnNSAIDs,nandntramadolnare nrecommended nbynthe nACRnfor nthe ntreatmentnofnO
A nofnthe nhand.
Margaret,nage n55,npresentsntonyounfornevaluationnofnleft nhandnandnwrist npainnandnswellingnafter nanslipnandnfalln
onnthe nice nyesterday. nOnnexamination,nyounnote ntendernessnat nhern“anatomicalnsnuffbox.” nYounknownthisnpro
bablynindicatesna(n):
1. Ulnar nstyloidnfracture.
2. Scaphoidnfracture.
3. Hamate nfracture.
4. Radialnheadnfracture.
n Rationales
Optionn1:
Annulnar nstyloidnfracture nwouldnproduce ntendernessnatnthe ndistalnulna.nO
ptionn2:
There nisntendernessnover nthe n“anatomicalnsnuffbox”ninnanscaphoidn(akannavicular)nfracture,nthe nmostncommonninjury
n ofn the n carpaln bones.n Poor n blood n supply n putsn the n scaphoid n bone n atn riskn ofnavascular n necrosis; n therefore,n wristn pain
n andn tendernessn inn the n anatomicaln snuffbox,n even n withoutn history n ofn antecedentn trauma,n warrantn an wristn x-ray.
Optionn3:
A nfracture nofnthe nhooknofnthe nhamate nisnannuncommonninjurynseenninngolfersnandnplayersnofnracketnsportsnthatninvo
lvesnpainnandntendernessnonnthe nulnar nside nofnthe npalm.
Optionn4:
A nradialnheadnfracture nwouldnresultninnpainnatnthe nelbownjointnwhere nthe nradialnheadnliesnproximalntonthe ndistalnh
umerus.nBe nsure nnotntonconfuse nthe nradialnheadn(proximalnendnofnthe nradius)nwithnthe nradialnstyloidn(distalnendnofnt
he nradiusnatnthe nwrist).
Jim,nage n22,nanstocknboy,nhasnannacute nepisode nofnlownbacknpain. nThe nnurse npractitioner nordersnannonsteroidalnant
i-ninflammatoryndrugn(NSAID)nandnshouldneducate nhim ninnwhichnofnthe nfollowing?
1. Maintainingnmoderate nbednrestnfor n3 nton4 ndays.
2. Callingnthe noffice nfor nnarcotic nmedicationnifnthere nisnnonreliefnwithnthe nNSAIDnafter n24 nton48 nhours.
3. Beginningnlower nbacknstrengtheningnexercisesndependingnonnpainntolerance.
4. WearingnanBostonnbrace natnnight
.nRationales
Optionn1:
Pnangnen 4n|n138
