NURS 623 Exam 4 2023-24 with correct answers

NURS 623 Exam 4 2023-24 1. One of the initial steps in assessing patients with musculoskeletal complaints is to determine whether the complaint is articular or nonarticular in origin. Which of the following is an example of an articular structure? a. Bone b. Synovium c. Tendons d. Fascia - correct answer b. Synovium 2. You have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion (ROM) with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is: a. Articular b. Inflammatory c. Nonarticular d. A and B - correct answer a. Articular 3. Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain? a. Decreased C-reactive protein b. Hyperalbuminemia c. Morning stiffness d. Weight gain - correct answer c. Morning stiffness 4. Which of the following statements concerning the musculoskeletal examination is true? a. The uninvolved side should be examined initially and then compared to the involved side. b. The part of the body that is causing the patient pain should be examined first. c. When possible, the patient should not be asked to perform active range-of-motion (ROM) exercises to avoid causing pain. d. Radiographs should always be obtained prior to examination so as not to cause further injury to the patient. - correct answer a. The uninvolved side should be examined initially and then compared to the involved side. 5. You are performing muscle strength testing on a patient presenting with musculoskeletal pain and find that the patient has complete ROM with gravity eliminated. Which numeric grade of muscle strength would you give this patient? a. 1 b. 2 c. 3 d. 4 e. 5 - correct answer b. 2 6. Mrs. Gray is a 55-year-old woman who presents with tightness, pain, and limited movement in her right shoulder. She denies any history of trauma. Her examination reveals a 75% reduction in both active and passive ROM of the right shoulder. Mrs. Gray also is experiencing tenderness with motion and pain at the deltoid insertion. Her medical history is significant for type 1 diabetes mellitus and hypertension. Her social history reveals that she is a secretary and that she is right-handed. Based on her examination and medical history, you suspect adhesive capsulitis, or "frozen shoulder." Which clue in Mrs. Gray's history supports this diagnosis? a. History of hypertension b. Her affected shoulder is also her dominant arm. c. Her history of diabetes mellitus d. Her work as a secretary predisposes her to repetitive motions. - correct answer c. Her history of diabetes mellitus Mrs. Anderson is a 35-year-old woman who has been recently diagnosed with carpal tunnel syndrome. She has two young children and asks the clinician what the chances are that they also will develop carpal tunnel syndrome. Which of the following responses would be correct regarding the risk of developing carpal tunnel syndrome? a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. b. Only people with occupations that require repeated flexion extension of the wrist, use of hand tools that require forceful gripping, or use of hand tools that vibrate are at risk for developing carpal tunnel. c. An underlying musculoskeletal disorder must be present for a person to develop carpal tunnel. d. Carpal tunnel syndrome only occurs in the presence of a hormonal imbalance. - correct answer a. Carpal tunnel syndrome commonly occurs in families. Genetic factors are thought to account for about one-half the risk of developing carpal tunnel. Which of the following statements is true regarding the treatment of carpal tunnel syndrome? a. The goal of treatment is to prevent flexion and extension movements of the wrist. b. Splints are used in carpal tunnel syndrome, because they allow for free movement of the fingers and thumb while maintaining the wrist in a neutral position. c. Corticosteroid injections are discouraged in the treatment of carpal tunnel syndrome because of the risks for median nerve damage, scarring, and infection. d. All of the above - correct answer d. All of the above Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc? a. Morning stiffness and limited mobility of the lumbar spine b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain c. Fever, chills, and elevated erythrocyte sedimentation rate d. Pathologic fractures, severe night pain, weight loss, and fatigue - correct answer b. Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain 11. The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs? a. "You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage." b. "You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication." c. "You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain." d. "It is important to take NSAIDs on an empty stomach in order to increase absorption." - correct answer a. "You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage." Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression? a. Gastrocnemius weakness b. A reduced or absent ankle reflex c. Numbness in the lateral foot d. Paresthesia of the perineum and buttocks - correct answer d. Paresthesia of the perineum and buttocks Which of the following statements is true concerning the management of the client with a herniated disc? a. Muscle relaxants and narcotics can be used to control moderate pain but should be discontinued after 3 weeks of use. b. An epidural injection is helpful in reducing leg pain that has persisted for at least 3 weeks after the herniation occurred. c. Intolerable pain for more than a 3-month period is an indication for surgical intervention. d. All of the above - correct answer c. Intolerable pain for more than a 3-month period is an indication for surgical intervention. John is a 16-year-old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear? a. Valgus stress test b. McMurray circumduction test c. Lachman test d. Varus stress test - correct answer b. McMurray circumduction test Normal estrogen function is important for preventing osteoporosis in both men and women. Estrogen works to prevent osteoporosis in which of the following ways? a. By decreasing the erosive activity of osteoclasts b. By promoting osteoclastogenesis c. By inhibiting osteoclast apoptosis d. All of the above - correct answer a. By decreasing the erosive activity of osteoclasts Which of the following tests is considered the gold standard for definitively diagnosing osteoporosis? a. Bone alkaline phosphatase levels b. Urinary N-telopeptide assay c. Bone mass density measurement by densitometry d. Magnetic resonance imaging - correct answer c. Bone mass density measurement by densitometry Mrs. Allen is a 60-year-old woman who has been diagnosed with osteoporosis. She is very concerned about the risk of breast cancer associated with hormone replacement therapy and is wondering what other treatments are available to her. The clinician explains that bisphosphonates are another class of drugs used in the prevention and treatment of osteoporosis. What teaching should the clinician give Mrs. Allen in regard to taking bisphosphonates? a. Taking bisphosphonates can result in hypercalcemia, so calcium intake should be decreased while taking this class of drugs. b. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying. c. This class of drugs can be taken at any time of the day without regard to meals. d. None of the above - correct answer b. There is potential for upper GI irritation, so these medications are contraindicated in people with abnormalities of the esophagus or delayed esophageal emptying. One of the most frequent presenting signs/symptoms of osteoporosis is: a. Goiter b. Abnormal serum calcium c. Elevated urine biochemical markers d. Bony fracture - correct answer d. Bony fracture Mrs. Thomas was seen in the office complaining of pain and point tenderness in the area of her elbow. The pain has increased following a day of gardening one week ago. A physical finding that differentiates the diagnosis and is most consistent with lateral epicondylitis (tennis elbow) is: a. Ecchymosis, edema, and erythema over the lateral epicondyle b. Pain at the elbow with resisted movements at the wrist and forearm c. Inability to supinate and pronate the arm d. Inability to flex or extend the elbow against resistance - correct answer b. Pain at the elbow with resisted movements at the wrist and forearm T/F-Osteoarthritis is primarily a noninflammatory condition. - correct answer True Evaluation of the knee? ACL - correct answer Lachmans test Anterior Drawer test Evaluation of the knee? MCL & LCL - correct answer Valgus/Varus stress Evaluation of the knee? Meniscal tears - correct answer McMurray & Apley Evaluation of the knee? PCL - correct answer Posterior drawer Evaluation of the knee? For patellar disloc. - correct answer Apprehension Which of these characteristics is true with someone with dementia? a. Tremors at rest b. Abrupt onset c. it is progressive to irreversible d. blank stare - correct answer c How do you test meningeal movement? - correct answer Kernig & Brudinzki Which statement about confusion is true? a. Confusion is a disease process. b. Confusion is always temporary. c. Age is a reliable predictor of confusion. d. Polypharmacy is a major contributor to confusion in older adults. - correct answer D. Polypharmacy Sondra's peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear? a. Meclizine b. Diphenhydramine c. Diamox d. Promethazine - correct answer C- Diamox The hallmark of an absence seizure is: a. No activity at all b. A blank stare c. Urine is usually voided involuntarily d. The attack usually lasts several minutes - correct answer B The hallmark of an simple partial seizure is: a. No activity at all b. A blank stare c. Consciousness intact d. The attack usually lasts several minutes - correct answer C The hallmark of an complex partial seizure is: a. No activity at all b. A blank stare c. Consciousness intact d. Lip smacking, invol. motor activity, hallucinations - correct answer D The hallmark of an generalized seizure is: a. No activity at all b. A blank stare c. Loss of consciousness, post-ictal phase d. Lip smacking, invol. motor activity, hallucinations - correct answer C How often should drug levels be monitored when a seizure medication has controlled the seizures, and the drug level is adequate? a. Every 3 months b. Every 6 months c. Annually d. Whenever there is a problem - correct answer B Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)? a. A teenage male b. A 65-year-old male c. A 25-year-old female d. A 60-year-old female - correct answer C-25 y/o Which of the following is a specific test to MS? a. Magnetic resonance imaging (MRI) b. Computed tomography (CT) scan c. A lumbar puncture d. There is no specific test. - correct answer D- no test Which drug for Alzheimer's disease should be administered beginning at the time of diagnosis? a. Cholinesterase inhibitors b. Anxiolytics c. Antidepressants d. Atypical antipsychotics - correct answer A Which cranial nerve is affected in a patient with a cerebrovascular accident who has difficulty chewing? a. CN V b. CN VII c. CN IX d. CN X - correct answer A Which patient is more likely to have a cluster headache? a. A female in her reproductive years b. A 40-year-old African American male c. A 55-year-old female who drinks 10 cups of coffee daily d. A 45-year-old male awakened at night - correct answer D Inattention and a sleep-wake cycle disturbance are the hallmark symptoms of? a. Dementia b. Alzheimer's disease c. Parkinson's disease d. Delirium - correct answer D Which type of meningitis is more benign, self-limiting, and caused primarily by a virus? a. Purulent meningitis b. Chronic meningitis c. Aseptic meningitis d. Herpes meningitis - correct answer c What is usually the first sign or symptom that a patient would present with that would make you suspect herpes zoster? a. A stabbing pain on one small area of the body b. A vesicular skin lesion on one side of the body c. A pain that is worse upon awakening d. A lesion on the exterior ear canal - correct answer B Gabby, aged 22, has Bell's palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her? a. "Most patients have complete recovery in 3 to 6 months." b. "Unfortunately, you'll probably have a small amount of residual damage." c. "Don't worry, I'll take care of everything." d. "You may have a few more episodes over the course of your lifetime but no permanent damage." - correct answer A Sam, aged 65, is started on L-dopa for his Parkinson's disease (PD). He asks why this is necessary. You tell him: a. "L-dopa is neuroprotective." b. "The primary goal of therapy is to replace depleted stores of dopamine." c. "This is the only drug that can provide symptomatic benefit." d. "This is the initial monotherapy drug." - correct answer B Which of the following is the most commonly experienced symptom of migraine? a. Light sensitivity b. Pulsatile pain c. Sound sensitivity d. Experiencing an aura - correct answer B Which of the following characteristics differentiates peripheral vertigo from central vertigo? a. The duration of central vertigo is shorter than that of peripheral vertigo. b. There is an auditory-associated symptom with peripheral vertigo and a visual-associated symptom with central vertigo. c. Central vertigo is positional, and peripheral vertigo is not. d. The onset of central vertigo is more sudden than that of peripheral vertigo. - correct answer B What antiplatelet agent is most widely used for secondary prevention of stroke? a. Aspirin b. Ticlopidine c. Clopidogrel d. Aspirin and clopidogrel - correct answer D Which herbal preparation may cause delirium and should be avoided in an elderly patient? a. Sam-e b. Saint John's Wort c. Melatonin d. Saw Palmetto - correct answer B Which statement is true regarding driving and patients with a seizure disorder? a. Once diagnosed with a seizure disorder, patients must never drive again. b. After being seizure free for 6 months, patients may drive. c. Each state has different laws governing driving for individuals with a seizure disorder. d. These persons may drive but never alone. - correct answer C The 'freezing phenomenon' is a cardinal feature of? a. Parkinson's disease b. Alzheimer's disease c. A CVA d. Bell's palsy - correct answer A Clinical features of insidious onset, slow progression, and a lack of other findings to explain the symptoms are fairly diagnostic of which condition? a. Guillain-Barré syndrome b. Parkinson's disease c. Alzheimer's disease d. Huntington's disease - correct answer B What is the main overall goal of therapy for the client with parkinson's disease? a. to halt the progression of the disease b. to keep the client functioning independently as long as possible c. to control the symptoms of the disease d. to ease the depression assoc. w/ the disease - correct answer b Which seizure type involves alteration of consciousness? a. myoclonic seizures b. absence seizures c. clonic seizures - correct answer b You are performing some neurological assessment tests on Daniel. When you ask Daniel to lie supine and flex his head to his chest, what are you assessing? a. Brudzinski's sign b. Kernig's sign c. Decorticate posturing d. Decerebrate posturing - correct answer a Which of the following drugs used for Parkinsonism mmimics dopamine? a. anticholinergics b. levodopa (L-dopa) c. bromocriptine d. tolcapone - correct answer c The older adult with delirium would present with which of the following behaviors? a. fatigue, apathy, and occ. agitation b. agitation, apathy, and wandering behavior c. agitation and restlessness d. slowness and absence of purpose - correct answer c What is the leading cause of bacterial meningitis in adults? a. Heamophilus influenza b. meningococcal c. streptococcus pneumoniae d. gram negative pneumonia - correct answer c You suspect Sarah, age 72, has a herniated disk. You elevate her affected leg when she is in the supine position, and so elicita back pain and sciatic pain, which indicates a positive test. This is known as which test or sign? a. femoral stretch teat b. cross straight-leg-raising test c. doorbell sign d. straight leg raising test - correct answer d. straight leg Don, age 62, calls to complain of a severe HA. Which of his following statements most concerns you? a. "it hurts when I turn my head a specific way" b. "It's the worst HA I've ever had" c. "Nothing I do seems to help this constant pain" D. "I'm so worried. Can you do a CT scan?" - correct answer b Carol, age 62, has swollen, boney proximal interphalangeal joints. You describe these as: a. heberdens nodes b. bouchards nodes c. oslers nodes d. murphys nodes - correct answer b Sandra, a computer programmer, has just been given a new disgnosis of carpal tunnel syndrome. Your next step is to: a. refer her to a hand sugreon b. take a more complete hx c. try neutral position wrist splinting and order an oral NSAID d. order a nerve conduction study such as electromyography - correct answer c Which of the following cardiac meds are used to treat migaine headaches? a. beta blockers b. nitrates c. angiotensin-converting enzyme inhibitors d. alpha-adrenergic blockers - correct answer a Sandy, age 49, presents w/ loss of anal sphincter tone, impaires micturition, incontinence, and progressive loss of strength in the legs. You suspect cauda equina syndrome. What is your next action? a. order PT b. order a lumbar/sacral x-ray c. order extensive lab work d. refer to a neurosugreon - correct answer d Which CN is evaluated when a wisp of cotton is lightly brushed against the corner of the eye? - correct answer CN 5 Which CN innervate the extraoccular muscle of the eyes? (3 of them) - correct answer CN 3, 4, & 6 Bell's palsy involves which CNs? - correct answer CN 7 The Rinne and the Weber tests are used to assess which CNs? - correct answer CN 8 Which of the following individuals is at higher risk for osteoporosis? a. 70 y/o woman of African ancestry who walks daily for exercise b. 42 y/o obese woman taking prednisone 10 mg daily for severe asthma for 2 yrs c. 55 y/o whit woman who is an aerobics instructor - correct answer b