Dunphy final clinical exam Nurs 671
Questions with Complete Solutions
Janet is a 30yo who has recently been diagnosed with a herniated disc at the level of L5-S1. She
is currently in the ER 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 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 3mo period is an indication for surgical intervention.
,d. All of the above. c. Intolerable pain for more than a 3mo period is an indication for
surgical intervention.
John is a 16yo boy who presents to the ER 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? McMurray circumduction test
The clinician suspects that a client has a patellar instability. In order to test for this, the client is
seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is
displaced laterally, and the knee flexed to 30 degrees. If instability is present, this maneuver
displaces the patella to an abnormal position on the lateral femoral condyle, and the client will
perceive pain. Testing for patellar instability in this way is known as: Apprehension sign
The clinician is caring for Diane, a 22yo woman who presents with an injured ankle. Diane asks
the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always
necessary for an injured ankle and that the decision to obtain radiographs is dependent on the
examination and Diane's description of her injury. Which of the following clues in Diane's exam
or history would alert the clinician to the need for obtaining radiographs?
,a. Inability to bear weight immediately after the injury
b. Development of marked ankle swelling and discoloration after the injury
c. Crepitation with palpation or movement of the ankle
d. All of the above d. All of the above
Mr. Jackson is a 65yo man recently diagnosed with osteoarthritis. The clinician has explained to
Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing
functional independence and mobility, minimizing disability, and preserving quality of life. Mr.
Jackson explains to the clinician that his first choice would be to use complementary therapies to
control his condition and asks what therapies are most effective in treating osteoarthritis. What
would be the appropriate response from the clinician?
a. "Complementary therapies should be considered only if surgical interventions are not
successful."
b. "I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to
discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your
condition."
c. "I would be happy to discuss all the treatment options with you. Complementary therapies, su
c. "I would be happy to discuss all the treatment options with you. Complementary
therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment
of osteoarthritis and have shown promise when used with standard medical therapy."
, 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 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 c. Bone mass density measurement by densitometry
What is the recommended daily calcium intake for adults over the age of 50 with low bone
mass? 1500mg/day
Questions with Complete Solutions
Janet is a 30yo who has recently been diagnosed with a herniated disc at the level of L5-S1. She
is currently in the ER 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 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 3mo period is an indication for surgical intervention.
,d. All of the above. c. Intolerable pain for more than a 3mo period is an indication for
surgical intervention.
John is a 16yo boy who presents to the ER 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? McMurray circumduction test
The clinician suspects that a client has a patellar instability. In order to test for this, the client is
seated with the quadriceps relaxed, and the knee is placed in extension. Next the patella is
displaced laterally, and the knee flexed to 30 degrees. If instability is present, this maneuver
displaces the patella to an abnormal position on the lateral femoral condyle, and the client will
perceive pain. Testing for patellar instability in this way is known as: Apprehension sign
The clinician is caring for Diane, a 22yo woman who presents with an injured ankle. Diane asks
the clinician if she will need an x-ray. The clinician explains to Diane that an x-ray is not always
necessary for an injured ankle and that the decision to obtain radiographs is dependent on the
examination and Diane's description of her injury. Which of the following clues in Diane's exam
or history would alert the clinician to the need for obtaining radiographs?
,a. Inability to bear weight immediately after the injury
b. Development of marked ankle swelling and discoloration after the injury
c. Crepitation with palpation or movement of the ankle
d. All of the above d. All of the above
Mr. Jackson is a 65yo man recently diagnosed with osteoarthritis. The clinician has explained to
Mr. Jackson that the goals for managing osteoarthritis include controlling pain, maximizing
functional independence and mobility, minimizing disability, and preserving quality of life. Mr.
Jackson explains to the clinician that his first choice would be to use complementary therapies to
control his condition and asks what therapies are most effective in treating osteoarthritis. What
would be the appropriate response from the clinician?
a. "Complementary therapies should be considered only if surgical interventions are not
successful."
b. "I am unfamiliar with the available complementary therapies for osteoarthritis and prefer to
discuss more mainstream treatments, such as NSAIDs and physical therapy, to manage your
condition."
c. "I would be happy to discuss all the treatment options with you. Complementary therapies, su
c. "I would be happy to discuss all the treatment options with you. Complementary
therapies, such as acupuncture, acupressure, and tai-chi, are being studied for use in the treatment
of osteoarthritis and have shown promise when used with standard medical therapy."
, 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 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 c. Bone mass density measurement by densitometry
What is the recommended daily calcium intake for adults over the age of 50 with low bone
mass? 1500mg/day
