exam 4

Question 1

What are some physiological changes that occur with aging regarding the musculoskeletal system?

Answer 1

Decreased bone density, which can lead to osteoporosis. Decreased muscle mass (sarcopenia), strength, and flexibility. Joint stiffness and decreased range of motion due to wear and tear of cartilage. Slower healing and repair of tissues. Decreased balance and coordination due to weakening of muscles and joints.
Can sometimes shrink in height from the shortening of the vertebrae

Question 2

Why should someone who is diagnosed with osteoporosis take extra precautions in preventing falls?

Answer 2

o Osteoporosis causes bones to become fragile and more prone to fractures even with minor trauma or falls. Preventing falls is crucial to reduce the risk of fractures, particularly in areas like the hip, spine, and wrist.
o Some clients, such as those who are postmenopausal, are at risk for osteoporosis (low bone mass). Adequate intake of calcium, 1,000 to 1,200 mg daily, can decrease the risk for bone loss and protect bones against fractures.

Question 3

When obtaining subjective data, how might a patient describe their bone pain if they have a fracture? (see text pg 583).

Answer 3

o Typically, bone pain is described as deep, sharp, and intense. It may worsen with movement and may be associated with swelling, bruising, or deformity at the fracture site.
o Sharp or stabbing, intense of severe, deep or penetrating, worsening with movement or pressure, localized pain, swelling, tenderness to the touch
o A popping sound at the time of injury can indicate a severe sprain or fracture and indicate the need for further investigation and action.

Question 4

rheumatoid arthritis

Answer 4

o RA: Autoimmune disorder, affects joints symmetrically, primarily involves inflammation, stiffness in the morning, and can cause systemic symptoms like fatigue and fever.
- is typically on smaller joints, and symmetrical. Typically worse in the mornings

Question 5

osteoarthritis

Answer 5

o OA: Degenerative joint disease, affects weight-bearing joints (hips, knees), usually occurs asymmetrically, involves wear and tear of cartilage, with pain that worsens with activity and improves with rest.
- typically on the weight bearing joints, worsens with activity and improves with rest

Question 6

How could you assess for carpal tunnel syndrome?

Answer 6

o Tinel’s sign: Tapping over the median nerve at the wrist may elicit tingling or pain. (lightly tapping over the nerve to see if it generates a tingling sensation)
o Phalen’s test: Flexing the wrists for 60 seconds to see if it causes tingling or numbness in the fingers.

Question 7

How could you assess for fluid in the knee?

Answer 7

o Bulge test: Apply pressure to both sides of the knee and see if fluid shifts, indicating effusion.

Question 8

signs and symptoms of gout

Answer 8

Intense pain, swelling, and redness, especially in the big toe, often occurring after drinking alcohol or eating purine-rich foods. Caused by the buildup of uric acid crystals in the joints.

Question 9

signs and symptoms of shoulder dislocations

Answer 9

Pain, inability to move the shoulder, deformity, and swelling. Caused by trauma or extreme rotation.
will likely show obvious deformities and severe pain

Question 10

signs and symptoms of peripheral neuropathy

Answer 10

Numbness, tingling, burning sensations in the extremities. Often caused by diabetes, alcohol abuse, or vitamin deficiencies.
May see atrophy of the small muscles and absent reflexes

Question 11

signs and symptoms of parkinsonism

Answer 11

Tremors, rigidity, bradykinesia (slow movement), postural instability. Caused by damage to the brain’s dopamine-producing neurons.

Question 12

Unequal ____ may accompany hip ____ after 2 to 3 months of age.

Answer 12

Unequal gluteal folds may accompany hip dysplasia after 2 to 3 months of age.

Question 13

Stereognosis

Answer 13

The ability to recognize objects placed in the hand by touch alone.

Question 14

Kinesthesia

Answer 14

The ability to perceive the position and movement of body parts.

Question 15

Graphesthesia

Answer 15

The ability to recognize numbers or letters drawn on the skin

Question 16

Extinction

Answer 16

Testing the ability to identify stimuli on both sides of the body simultaneously.

Question 17

What is the difference between the plantar reflex and Babinski reflex?

Answer 17

o Plantar reflex: Normal response is flexion of the toes when the sole of the foot is stroked.
o Babinski reflex: An abnormal response, seen as dorsiflexion (upward movement) of the big toe and fanning of the other toes, indicating neurological damage.

Question 18

myoclonus

Answer 18

sudden, brief jerks or twitches of muscles

Question 19

chorea

Answer 19

involuntary, jerky movements, often seen in conditions like Huntington’s disease

Question 20

tremors

Answer 20

rhythmic, oscillatory movements, often caused by Parkinson’s disease or other conditions

Question 21

What is a hernia, and what is the most common type and it’s characteristic findings?

Answer 21

A hernia is a protrusion of an organ or tissue through an opening in the muscle or tissue that holds it in place. The most common type is an inguinal hernia, characterized by a bulge in the lower abdomen or groin area, often more noticeable when coughing or lifting.
when assessing for the inguinal, palpate the inguinal canal

Question 22

What are some causes of withdrawal from sexual activity later in life?

Answer 22

Physical issues like erectile dysfunction, vaginal dryness, or decreased libido.
Emotional issues such as depression, anxiety, or the loss of a partner.
Medications or health conditions that impact sexual function.

Question 23

dysuria

Answer 23

painful urination

Question 24

urgency

Answer 24

a sudden, strong urge to urinate

Question 25

hesitancy

Answer 25

difficulty starting urination

Question 26

nocturia

Answer 26

frequent urination at night

Question 27

hematuria

Answer 27

blood in the urine

Question 28

stress incontinence

Answer 28

involuntary urine leakage when coughing, sneezing, or laughing

Question 29

What is the appropriate technique for assessing a hernia?

Answer 29

Palpate the area while the patient stands or coughs, looking for bulging or a lump in the groin or abdomen. Assessing a hernia on a male, have then shift their weight to the opposite side of where the hernia is located.

Question 30

What is a Hydrocele? What are s/s of a hydrocele? What assessment could confirm one?

Answer 30

A hydrocele is a fluid-filled sac around the testicle. Symptoms include a painless, smooth swelling in the scrotum. Assessment includes transillumination, where a light shone through the scrotum will illuminate the fluid (red or pink color).

Question 31

Difference between a urethral stricture and phimosis?

Answer 31

Urethral stricture: Narrowing of the urethra, leading to difficulty urinating Phimosis: A condition where the foreskin cannot be retracted over the head of the penis.

Question 32

What assessments can be done to evaluate the prostate?

Answer 32

Digital rectal exam (DRE): Palpation of the prostate via the rectum to check for enlargement, lumps, or hardness Prostate-specific antigen (PSA) test: A blood test to measure levels of PSA, which can be elevated in prostate cancer or benign conditions.

Question 33

What’re signs and symptoms of perimenopause?

Answer 33

Hot flashes, irregular periods, mood swings, sleep disturbances, vaginal dryness, and reduced fertility.

Question 34

What is a major safety consideration regarding oral contraceptives?

Answer 34

The risk of blood clots, particularly for women who smoke or have other risk factors such as obesity, hypertension, or a history of thromboembolic events

Question 35

Difference between trichomoniasis and candidiasis?

Answer 35

Trichomoniasis: Caused by a protozoan parasite, leads to vaginal discharge, itching, and odor. Is an STI Candidiasis: Caused by a yeast infection, leads to thick, white, cottage cheese-like discharge, and itching.

Question 36

What is the purpose of a pap test?

Answer 36

To screen for cervical cancer or precancerous changes in the cervix, typically detecting human papillomavirus (HPV) infections that can lead to cervical cancer.

Question 37

What vital organ is located in the LUQ? What is an important consideration regarding assessment of this organ?

Answer 37

o The spleen is located in the left upper quadrant (LUQ) of the abdomen. o Important consideration: When assessing the spleen, you must be cautious about palpating it in a patient with splenomegaly (enlarged spleen) as it can rupture easily. The patient should be positioned appropriately, and you should avoid deep palpation if there’s suspicion of splenomegaly.

Question 38

Is it normal to see a pulsation in the abdomen from the aorta? Where in the abdomen would you observe this?

Answer 38

Yes, aortic pulsations can sometimes be visible, particularly in thin individuals. You would observe this slightly above the umbilicus in the midline of the abdomen, where the aorta is located. - below the xiphoid, above the umbilicus, slightly left of the midline

Question 39

How does the order of an abdominal assessment differ from assessing other body systems? What is the rationale for this difference?

Answer 39

o The abdominal assessment differs in its order of assessment. The typical order for abdominal exams is inspection, auscultation, palpation, and percussion. o Rationale: Auscultation is done before palpation because palpation can alter bowel sounds, potentially causing false findings. Palpating first can also cause discomfort or trigger bowel movements, so auscultation is performed first to listen to bowel sounds accurately.

Question 40

What is pyrosis? In what patient population is this commonly seen?

Answer 40

o Pyrosis is the medical term for heartburn, a burning sensation in the chest or throat caused by stomach acid backing up into the esophagus. o It is commonly seen in patients with gastroesophageal reflux disease (GERD) and is more prevalent in older adults, pregnant women, and those who are overweight or have a history of smoking or alcohol use.

Question 41

What is pernicious anemia? Why might older adults be at more risk for developing this condition?

Answer 41

o Pernicious anemia is a condition where the body cannot absorb vitamin B12 due to a lack of intrinsic factor, a protein necessary for vitamin B12 absorption in the small intestine. o Older adults are at increased risk because gastric atrophy (decreased stomach acid production) is more common with age, reducing intrinsic factor secretion, leading to impaired B12 absorption.

Question 42

What is CVA tenderness? How do you assess a patient for this, and what is it a sign of?

Answer 42

o CVA (costovertebral angle) tenderness is tenderness or pain when tapping on the area of the back just below the rib cage, at the level of the kidneys on the back. o You assess it by gently tapping the area with your fist or using a flat hand. It can be a sign of kidney infection (pyelonephritis), kidney stones, or glomerulonephritis.

Question 43

What is abdominal ascites? What is the most common cause of this?

Answer 43

o Abdominal ascites is the accumulation of fluid in the peritoneal cavity, causing abdominal swelling. o The most common cause is liver cirrhosis, often related to chronic alcohol abuse or hepatitis.

Question 44

What is a key sign of a GI bleed? What medication might cause similar signs?

Answer 44

o A key sign of a GI bleed is the presence of melena (black, tarry stools) or hematemesis (vomiting blood). o Medications such as NSAIDs (e.g., ibuprofen, aspirin) can cause gastrointestinal bleeding, leading to similar signs due to their effect on the stomach lining.

Question 45

Symptoms of appendicitis include:

Answer 45

 Abdominal pain, starting near the belly button and moving to the right lower quadrant.  Fever, nausea, and vomiting.  Rebound tenderness (pain upon release of pressure).  Positive Rovsing’s sign (pain in the right lower abdomen when palpating the left side).

Question 46

if you can't hear bowel sounds on a patient, what should you do?

Answer 46

o If bowel sounds are not heard, you should listen for 5 minutes in each quadrant using the diaphragm of your stethoscope before determining that bowel sounds are absent. o Absent bowel sounds for this period may indicate an issue like ileus or bowel obstruction.

Question 47

The Murphy sign test assesses for what? How is this done?

Answer 47

The murphy sign assesses for cholecystitis (inflammation of the gallbladder) - the test is done by palpating the right upper quadrant below the rib cage as the patient takes a deep breath. If the patient experiences pain and abruptly stops inhaling due to the discomfort, the test is positive

Question 48

What class of medication is ibuprofen and aspirin? What is the relationship between these medications and peptic ulcer disease?

Answer 48

o Ibuprofen and aspirin are both NSAIDs (nonsteroidal anti-inflammatory drugs). o These medications can increase the risk of peptic ulcer disease because they inhibit prostaglandins, which are protective to the stomach lining. Without these prostaglandins, the stomach becomes more susceptible to damage from stomach acid.