NCLEX® - RN & PN TEST PREP COURSE

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NCLEX® - RN & PN TEST PREP COURSE Conductedby:

GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN [email protected]#714-679-9320Fax#909-247-2721

NCLEX-RN & PN TEST PREP COURSE

Conductedby:GeorgeMataMontausRN,MSN/EdandWalterUrdasDonatoBSN,RN

[email protected]#714-679-9320Fax#909-247-2721

Overview of Anatomy and Physiology •  Functions Of The Skeletal System

–  Support

–  Protection

–  Movement –  Mineral Storage

–  Hematopoiesis

•  Structure Of Bones –  Four Classifications Based On Form And Shape

•  Long, Short, Flat, And Irregular

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Laboratory and Diagnostic Examinations

•  Radiographic Studies –  Myelogram

–  Nuclear Scanning –  Magnetic Resonance Imaging (MRI)

–  Computed Axial Tomography (CT Or CAT Scan)

–  Bone Scan

•  Endoscopic Examination –  Arthroscopy

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Endoscopic Spinal Microsurgery




Laboratory And Diagnostic Examinations

•  Aspiration –  Synovial fluid aspiration

•  Electrographic procedure

–  Electromyogram (EMG)

•  Laboratory Tests

–  Calcium –  Erythrocyte

Sedimentation Rate (ESR)

–  Lupus Erythematosus (LE) Preparation

–  Rheumatoid Factor (RF)

–  Uric Acid (Blood)

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Rheumatoid Arthritis Osteoarthritis •  Most Serious Form Of Arthritis •  Chronic, Systemic Disease •  Most Common In Women Of

Childbearing Age •  Autoimmune Disorder, But May

Also Be Genetic •  Characterized by periods of

remission and exacerbations •  Limited range of motion (morning stiffness)

•  Nonsystemic, noninflammatory disorder that progressively causes bones and joints to degenerate

•  Cause is unknown •  Caused by trauma, infections,

previous fractures, rheumatoid arthritis, stress on weight-bearing joints

Inflammatory Disorders of the Musculoskeletal System




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•  Diagnostic Tests • Radiography Studies Show Loss Of

Articular Cartilage And Change In Bone Structure

•  Laboratory Tests

– Erythrocyte Sedimentation Rate (ESR)

– Rheumatoid Factor (RF)

– Synovial Fluid Aspiration

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Medical Management / Nursing Interventions

•  Medications: Salicylates, NSAIDS, COX-2 Inhibitors, Potent Anti-inflammatory Agent Slow-acting Anti-inflammatory Agents, Disease-Modifying Anti-rheumatoid Drugs

•  Rest: 8-10 Hours Of Sleep A Night •  Exercise: Range Of Motion 2-3 Times Per Day

•  Heat: Hot Packs, Heat Lamp, And/Or Hot Paraffin •  Rehabilitation

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Herberden’s Vs. Bouchard’s

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12 (From Kamal, A., Brocklehurst, J.C. [1991]. Color atlas of geriatric medicine. [2nd ed.]. St. Louis: Mosby.)

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Ankylosing Spondylitis •  Etiology/pathophysiology

•  Chronic, progressive disorder of the sacroiliac and hip joints, the synovial joints of the spine, and the adjacent soft tissues

•  Most common in young men •  Strong hereditary tendency

–  Clinical manifestations/assessment

•  Pain and stiffness in back; decreased ROM •  Elevated temperature; tachycardia; hyperpnea

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u Medical management/nursing interventions • Exercise balanced with rest • Heat applications

• Gait enhancers (canes, walkers, etc.)

• Medications

– Salicylates (aspirin), NSAIDs (Motrin), steroids (cortisone)

• Surgery

– Osteotomy – Joint replacement

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Gout (Gouty Arthritis)

�  Etiology/pathophysiology

•  Metabolic disease resulting from an accumulation of uric acid in the blood

•  Caused by an ineffective metabolism of purines •  Primary: hereditary factors •  Secondary: use of certain drugs, complication of other

diseases •  Affects men more frequently than women •  Does not occur before puberty in males or before

menopause in females

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Gout

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–  Clinical Manifestations/Assessment

•  Excruciating Pain •  Edema •  Inflammation (Most Common In The Great Toe) •  Tophi

– Diagnostic Tests •  Serum And Uric Acid

Level, CBC, ESR •  Radiography Studies •  Synovial Fluid Aspiration

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•  Medications

–  Colchicine, Phenylbutazone (Butazolidin), Indomethacin (Indocin), Corticosteroids, Allopurinol (Zyloprim), Sulfinpyrazone (Anturane)

•  Encourage Fluid Intake

•  Monitor Intake And Output

•  Bedrest And Joint Immobilization

•  Diet: Avoid Foods High In Purines

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Osteoporosis

–  Etiology/pathophysiology •  Reduction of bone mass

•  Most common in women ages 55-65 •  Contributing factors: immobilization; steroids; high intake of

caffeine; diet low in calcium, high in protein; smoking; sedentary lifestyle

–  Clinical manifestations/assessment •  Backache

•  Porous and brittle bones •  Dowager’s hump

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Dowager’s Hump

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Diagnostic Tests •  CBC, Serum Calcium,

Phosphorus, Alkaline Phosphatase, Blood Urea Nitrogen, Creatinine Level, Urinalysis, Liver And Thyroid Function Tests

•  Radiography Studies

–  Medical Management/Nursing Interventions

•  Calcium Supplements, Vitamin D

•  Weight-bearing Exercises •  Estrogen, Alendronate

(Fosamax) •  Diet: Milk And Dairy

Products; Limit Caffeine

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Osteomyelitis•  Etiology/Pathophysiology

•  Local Or Generalized Infection Of The Bone And Bone Marrow

•  Staphylococci Are The Most Common Cause

•  Introduced Through Trauma (Injury Or Surgery) Or Via The Bloodstream From Another Site In The Body To The Bone

•  Bacteria Invade The Bone And Degeneration Of Bone Occurs

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•  Clinical Manifestations/Assessment –  Persistent, Severe, And

Increasing Bone Pain –  Wound Draining Purulent

Fluid

–  Signs And Symptoms Of Infection: Temperature, Tachycardia, And Tachypnea

–  Edema Of Affected Area •  Diagnostic Tests

–  Radiography Studies; Bone Scan

–  CBC; ESR; Cultures Of Blood And Drainage

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– Medical management/nursing interventions • Antibiotic therapy

– Broad-spectrum antibiotic

• Surgery: removal of necrotic bone • Absolute rest of affected extremity • Wound care

– Irrigate with hydrogen peroxide or antibiotic solution; cover with sterile dressing

• Drainage and secretion precautions • Diet: high in calories, protein, and vitamins

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Fibromyalgia syndrome (FMS)

•  Etiology/Pathophysiology

–  Musculoskeletal Chronic Pain Syndrome

–  Unknown Etiology

•  Clinical Manifestations/Assessment

–  Generalized Aching

–  Irritable Bowel Syndrome –  Tension Headache

–  Paresthesia Of Upper Extremities

–  Sensation Of Edematous Hands

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•  Diagnostic tests –  No specific laboratory or

radiographic tests diagnose FMS

•  Medical management/nursing interventions –  Patient education and

reassurance

–  Tricyclic antidepressants

–  Exercise

–  Relaxation techniques

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Surgical Interventions For Total Knee Or Total Hip Replacement

•  Knee arthroplasty (total knee replacement) – Replacement of the knee joint

– Restore motion of the joint, relieve pain, or correct deformity

•  Hip arthroplasty (total hip replacement)

– Replacement of the hip joint

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•  Arthroplasty

•  Nursing interventions •  Empty and record HemoVac

•  Give oxygen 2-3 L/min

•  Incentive spirometer; cough and deep-breathe

•  Record I&O •  Bedrest for 24-48 hours

•  Change dressing as ordered

•  Diet as ordered •  Neurovascular checks and vital

signs every 4 hours

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– Nursing Interventions (Continued) • Maintain Position Of Operative Area • Physical Therapy Will Initiate Ambulation And

Prescribe Routine • Encourage Fluid Intake

• Antiembolisim Stockings • Avoid Adduction And Hyperflexion Of Hip • Encourage Fluid Intake And High-fiber Foods

• Use Toilet Riser To Prevent Hyperflexion Of Hip

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Fractures •  Fracture of the hip

–  Etiology/pathophysiology

•  Most common type of fracture

•  Women at higher risk due to osteoporosis •  Types: intracapsular and extracapsular


•  Severe pain at site •  Inability to move the leg voluntarily

•  Shortening or external rotation of the leg

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•  Fracture Of The Hip (Continued) –  Diagnostic Tests

•  Radiographic Examination •  Hemoglobin

–  Medical Management/Nursing Interventions

•  Buck’s Or Russell’s Traction Until Surgery

•  Surgical Repair –  Internal Fixation –  Neufeld Nail And Screws,

Kuntscher Nail –  Prosthetic Implants

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Complications of Fractures •  Compartment syndrome

–  Cause •  Progressive development of

arterial vessel compression and reduced blood supply to an extremity

Clinical manifestations/assessment

•  Sharp pain with movement, numbness or tingling in the affected extremity, cool and pale or cyanotic, slow capillary refill

Medical management/nursing interventions

•  Fasciotomy (incision into the fascia)

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Shock –  Cause

• Blood loss, pain, fear


• Altered level of consciousness, restlessness

• Hypotension, tachycardia, and tachypnea

•  Pale, cool, moist skin

–  Medical management/nursing interventions

•  Restore blood volume; shock trousers

• Oxygen

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•  Fat Embolism –  Cause

•  Embolization of fat tissue with platelets


•  Irritability, restlessness,disorientation, stupor, coma, chest pain, and dyspnea


•  IV fluids •  Steroids, digoxin

•  Oxygen

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•  Gas Gangrene –  Cause

•  Infection of skeletal muscle by Clostridium

–  Clinical manifestations/assessment •  Pain at site of injury

•  Signs of infection; gas bubbles under the skin

•  Necrotic skin at site; foul odor from wound


•  Excision of gangrenous tissue •  Antibiotics; strict aseptic

technique

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•  Thromboembolus

–  Cause •  Blood vessel is occluded by

an embolus


•  Area tingles and is cold, numb, and cyanotic

•  Pulmonary embolus causes a sharp thoracic pain


•  Anticoagulants

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Skeletal Fixation Devices •  External Fixation Devices

–  Skeletal Pin External Fixation

•  Immobilizes Fractures By The Use Of Pins Inserted Through The Bone And Attached To A Rigid External Metal Frame

•  Casts/Cast Brace –  Made Of Layers Of Plaster Of Paris, Fiberglass, Or Plastic

Roller Bandages –  Stockinette Applied, Then A Sheet Of Wadding, And

Casting Material

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Traction The process of putting an extremity, bone, or group of muscles under tension by means of weights and pulleys to:

•  Align and stabilize a fracture site •  Relieve pressure on nerves •  Maintain correct positioning •  Prevent deformities •  Relieve muscle spasms

Skeletal or skin

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Traumatic Injuries •  Carpal Tunnel Syndrome

– Etiology/pathophysiology • Compression of the median nerve between

the carpal ligament and other structures

• Predisposing factors – Obese, middle-aged women – Employment in occupations involving

repetitious motions of the fingers and hands

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Clinical Manifestations/Assessment –  Paresthesia

–  Hypoesthisia –  Burning Pain Or Tingling In

The Hands –  Inability To Grasp Or Hold

Small Objects –  Edema Of The Hand, Wrist,

Or Fingers –  Muscle Atrophy

–  Depressed Appearance At The Base Of The Thumb On The Palmer Side

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Diagnostic tests •  Physical exam—

Tinel’s sign •  Electromyogram •  MRI


•  Immobilizer •  Elevate extremity •  ROM exercises •  Surgery

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Herniation Of Intervertebral Disk •  Etiology/pathophysiology

–  Rupture of the fibrocartilage surrounding an intervertebral disk, releasing the nucleus pulposus that cushions the vertebrae above and below

–  Lumbar and cervical herniations are most common

–  May occur from lifting, twisting, trauma, or degenerative changes

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Clinical Manifestations/Assessment •  Lumbar

– Low Back Pain That Radiates Over The Buttock And Numbness And Tingling In Affected Leg

•  Cervical

– Neck Pain, Headache, And Neck Rigidity

Diagnostic Tests

•  CAT Scan, Myelography, And Electromyelography

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–  Medical Management/Nursing Interventions •  Bedrest

•  Pain Medication

•  Muscle Relaxants

•  Physical Therapy

•  Traction

•  Surgery

– Laminectomy, Spinal Fusion, Diskectomy, Chemonucleolysis

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Tumors Etiology/pathophysiology

•  May be primary or secondary •  Benign or malignant •  Osteogenic sarcoma •  Osteochondroma

Clinical manifestations/assessment •  Spontaneous fractures •  Anemia •  Pain especially with weight-

bearing •  Edema and discoloration of skin

at site

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Amputation •  Amputation of a portion of or an entire extremity

–  Malignant tumors,injuries, impaired circulation, congenital deformities, infections

•  Postoperative nursing interventions –  Raise foot of bed to elevate extremity –  Encourage movement –  Place in prone position at least two times a day –  Elastic wraps to shape residual extremity –  Assess for respiratory complications –  Phantom-limb pain is normal

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Assessment Scoliosis

•  Lateral curvature of the spine

Kyphosis •  A rounding of the

thoracic spine

•  Hump-backed appearance

Lordosis

•  An increase in the curve at the lumbar region

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•  Nursing Diagnoses

– Mobility, Impaired Physical

– Mobility, Impaired Bed

– Coping, Ineffective

– Anxiety

– Pain

– Knowledge, Deficient

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MusculoskeletalSystemDisorders

The nurse received a patient with early symptom of rheumatoid arthritis. Which of the following would the nurse most likely assess?

1.   Limited flexion of joint. 2.   Deformation of the hands. 3.   Early morning stiffness.

4.   Rheumatoid nodules.

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The nurse is assigned to a patient where his right leg is placed in a continuous passive motion (CPM) device. Which of the following would the nurse perform when caring for a patient receiving CPM therapy?

1.   Adjusting the setting as needed to prevent client discomfort. 2.   Increasing the range-of-motion setting at least every 8

hours.

3.   Maintaining proper position of the joint on the CPM machine.

4.   Discontinuing the CPM therapy when range of motion increases to 90 degrees.

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When is the best time for the patient to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis?

1.   At bed time. 2.   On arising. 3.   Immediately after the meal.

4.   On an empty stomach.

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A patient has undergone insertion of a femoral head prosthesis. Which of the following activities the patient would avoid?

1.   Crossing the legs while sitting down.

2.   Using a high raised commode seat. 3.   Using an abductor splint while lying on the side.

4.   Change position every two hours.

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Which of the following actions would be the priority for a patient after above-the knee amputation and develops a dime-sized bright red spot on the middle of the ace bandage?

1.   Elevating the stump. 2.   Reinforcing the dressing. 3.   Calling the surgeon. 4.   Drawing a mark around the site.

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The nurse is assigned to a patient who will be using the crutches for the first time. The nurse instructs the patient to support her weight primarily on which of the following body areas?

1.   Axilla. 2.   Elbows. 3.   Upper arms. 4.   Hands.

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Because a client has a Thomas splint, the nurse would need to assess the client regularly for which of the following?

1.   Signs of skin pressure in the groin area. 2.   Evidence of decreased breath sounds. 3.   Skin breakdown behind the heel.

4.   Urinary retention.

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NCLEX® - RN & PN TEST PREP COURSE

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