Special tests for orthopedic examination pdf download

Examination Content Blueprint 7th Edition. Download PDF. Newsletter Sign Up. Sign Up. Appeals Process. Sign Up To Our Newsletter. Quick Links. Get In Touch. Phone: Fax: Virginia Ave, St. Paul, MN MOC Certified Dr. Directory Conditions Treated Chiropractic Orthopedist. All Rights Reserved. Pant Hospital , Guru Nanak Eye Centre, and Maulana Azad Institute of Dental Sciences co-exist on one campus which provides an extraordinary environment for medical education and training.

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Note the data in the question. Because of the potential for splashes of infective material occurring during the wound irrigation or suctioning of the tracheostomy, option 3 is correct. Health Promotion and Maintenance The Health Promotion and Maintenance category addresses the principles related to growth and development.

According to the NCSBN, this Client Needs category also addresses content required to assist the individual to prevent health problems; to recognize alterations in health; and to develop health practices that promote and support optimal wellness. See Box for an example of a question in this Client Needs category. Box Health Promotion and Maintenance The nurse is choosing age-appropriate toys for a toddler.

Which toy is the best choice for this age? Puzzle 2. Toy soldiers 3. Large stacking blocks 4. A card game with large pictures. Note the strategic word, best. Toddlers like to master activities independently, such as stacking blocks. Because toddlers do not have the developmental ability to determine what could be harmful, toys that are safe need to be provided.

A puzzle and toy soldiers provide objects that can be placed in the mouth and may be harmful for a toddler. A card game with large pictures may require cooperative play, which is more appropriate for a school-age child. Psychosocial Integrity The Psychosocial Integrity category addresses content required to promote and support the ability of the client to cope, adapt, and problem-solve during stressful events. The NCSBN also indicates that this Client Needs category addresses the emotional, mental, and social well-being of the client experiencing stressful events and care for the client with an acute or chronic mental illness.

Box Psychosocial Integrity A client with end-stage chronic obstructive pulmonary disease has selected guided imagery to help cope with psychological stress. Which client statement indicates an understanding of this stress-reduction measure? Answer: 4 This question addresses the Client Needs category Psychosocial Integrity and the content addresses coping mechanisms. Focus on the subject, a characteristic of guided imagery. Guided imagery involves the client creating an image in the mind, concentrating on the image, and gradually becoming less aware of the offending stimulus.

It can be done anytime and anywhere; some clients may use other relaxation techniques or play music with it. Basic Care and Comfort addresses content for providing comfort and assistance to the client in the performance of activities of daily living. Pharmacological and Parenteral Therapies addresses content for administering medications and parenteral therapies, such as intravenous therapies and parenteral nutrition, and.

Physiological Adaptation addresses content for managing and providing care to clients with acute, chronic, or life-threatening conditions. See Box for examples of questions in this Client Needs category. Which suggestion should the nurse provide to the client to alleviate this problem?

Use a wheelchair to move around. Stand erect and use a cane to ambulate. Keep the feet close together while ambulating and use a walker. Consciously think about walking over imaginary lines on the floor. Answer: 4 This question addresses the subcategory Basic Care and Comfort in the Client Needs category Physiological Integrity and addresses client mobility and promoting assistance in an activity of daily living to maintain safety.

Focus on the subject, akinesia. Having these clients imagine lines on the floor to walk over can keep them moving forward while remaining safe. Pharmacological and Parenteral Therapies The nurse monitors a client receiving digoxin for which early manifestation of digoxin toxicity?

Note the strategic word, early. Digoxin is a cardiac glycoside that is used to manage and treat heart failure and to control ventricular rates in clients with atrial fibrillation. The most common early manifestations of toxicity include gastrointestinal disturbances such as anorexia, nausea, and vomiting.

Neurological abnormalities can also occur early and include fatigue, headache, depression, weakness, drowsiness, confusion, and nightmares. Reduction of Risk Potential A magnetic resonance imaging MRI study is prescribed for a client with a suspected brain tumor. The nurse should implement which action to prepare the client for this test? Shave the groin for insertion of a femoral catheter.

Remove all metal-containing objects from the client. Keep the client NPO nothing by mouth for 6 hours before the test. Instruct the client in inhalation techniques for the administration of the radioisotope. Focus on the subject, preparing a client for an MRI. In an MRI study, radiofrequency pulses in a magnetic field are converted into pictures.

All metal objects, such as rings, bracelets, hairpins, and watches, should be removed. In addition, a history should be taken to ascertain whether the client has any internal metallic devices, such as orthopedic hardware, pacemakers, or shrapnel. A femoral catheter is not used for this diagnostic test.

An intravenous IV catheter may be inserted if a contrast agent is prescribed. Additionally, shaving is not a common practice because of the risk for microabrasions and infection. If needed, hair may be clipped away from a surgical or insertion site. Inhalation of the radioisotope may be prescribed with other types of scans but is not a part of the procedures for an MRI. Physiological Adaptation A client with renal insufficiency has a magnesium level of 3. On the basis of this laboratory result, the nurse interprets which sign as significant?

It addresses an alteration in body systems. Focus on the data in the question. The normal magnesium level is 1. A magnesium level of 3. Neurological manifestations begin to occur when magnesium levels are elevated and are noted as symptoms of neurological depression, such as drowsiness, sedation, lethargy, respiratory depression, muscle weakness, and areflexia. Bradycardia and hypotension also occur. These processes are incorporated throughout the major categories of Client Needs. See Box for an example of a question that incorporates the Integrated Process of Caring.

Box Integrated Processes A client is scheduled for angioplasty. This is a well-known and easy procedure for the cardiologist. Answer: 1 This question addresses the subcategory Caring in the category of Integrated Processes. Option 2 demeans the client and does not encourage further sharing by the client. A pilot study on NGN questions is being conducted by the NCSBN, and results demonstrate that there is an asymmetrical relationship between knowledge and clinical judgment; thus, recall of learned material is not translating to safety and efficacy in practice.

This is the impetus behind these new item types. Research on these new item types is still being conducted. The candidate will be informed if the. Regardless, you need to focus and use critical thinking and clinical judgment skills to answer these correctly. These NGN question types can include CLOZE items, enhanced multiple response, enhanced hot spots, extended drag and drop, dynamic exhibits, and constructed response.

Additionally, case studies may accompany some question types, and media may be integrated in these questions. Some questions may require you to use the mouse and cursor on the computer. For example, you may be presented with a picture that displays the arterial vessels of an adult client. With the NGN questions, you receive matrix-type items and may be asked to highlight answers. You may also be asked to enter short answer information and to provide a short rationale for your answer selections, such as with the CLOZE or constructed response item types.

In all types of questions, the answer is scored as either right or wrong. Credit is not given for a partially correct answer. In addition, all question types may include pictures, graphics, tables, charts, sound, or rich media scenarios using video or virtual simulation.

The NCSBN provides specific directions for you to follow with all question types to guide you in your process of testing. Be sure to read these directions as they appear on the computer screen. Examples of some of these types of questions are noted in this chapter. All question types are provided in this book and on the accompanying Evolve site.

Multiple-Choice Questions Many of the questions that you will be asked to answer will be in the multiple-choice format. These questions provide you with data about a client situation and four answers, or options. Fill-in-the-Blank Questions Fill-in-the-blank questions may ask you to perform a medication calculation, determine an intravenous flow rate, or calculate an intake or output record on a client.

You will need to type only a number your answer in the answer box. If the question requires rounding the answer, this needs to be performed at the end of the calculation.

The rules for rounding an answer are described in the tutorial provided by the NCSBN and are also provided in the specific question on the computer screen. In addition, you must type in a decimal point if necessary. See Box for an example. The nurse prepares how many. Fill in the blank. Record your answer using one decimal place. Answer: In this question, you need to focus on the subject, mL per dose, and use the formula for calculating a medication dose.

When the dose is determined, you will need to type your numeric answer in the answer box. Always follow the specific directions noted on the computer screen. Also, remember that there will be an on- screen calculator on the computer for your use.

Multiple-Response Questions For a multiple-response question, you will be asked to select or check all of the options, such as nursing interventions, that relate to the information in the question. In these question types, there may be 1 correct answer, there may be more than 1 correct answer, or all answers could be correct. No partial credit is given for correct selections. You need to do exactly as the question asks, which will be to select all of the options that apply.

Box Multiple-Response Question The emergency department nurse is caring for a child suspected of acute epiglottitis. Which interventions apply in the care of the child? Select all that apply. Maintain the child in a supine position. In a multiple-response question, you will be asked to select or check all of the options, such as interventions, that relate to the information in the question.

Focus on the subject, interventions for the child with suspected acute epiglottitis. To answer this question, recall that acute epiglottitis is a serious obstructive inflammatory process that requires immediate intervention and that airway patency is a priority.

Auscultating lung sounds allows the nurse to obtain information about airway patency without causing further airway compromise by examining the throat. Examination of the throat with a tongue depressor or attempting to obtain a throat culture is contraindicated because the examination can precipitate further obstruction. A lateral neck and chest x-ray is obtained to determine the degree of obstruction, if present.

To reduce respiratory distress, the child should sit upright. The child is placed on an oxygen saturation monitor to monitor oxygenation status. Tracheostomy and intubation may be necessary if respiratory distress is severe. Remember to follow the specific directions given on the computer screen. Ordered-Response Questions In this type of question, you will be asked to use the computer mouse to drag and drop your nursing actions in order of priority.

Information will be presented in a question and, based on the data, you need to determine what you will do first, second, third, and so forth. The unordered options will be located in boxes on the left side of the screen, and you need to move all options in order of priority to ordered- response boxes to the right side of the screen.

Specific directions for moving the options are provided with the question. See Figure for an example. These type of practice questions are located on the accompanying Evolve site.

Figure or Hot Spot Questions A question with a picture or graphic will ask you to answer the question based on the picture or graphic. The question could contain a chart, a table, or a figure or illustration.

You also may be asked to use the computer mouse to point and click on a specific area in the visual. A chart, table, figure, or illustration may appear in any type of question, including a multiple-choice question. Box Figure Question A client who experienced a myocardial infarction is being monitored via cardiac telemetry. The nurse notes the sudden onset of this cardiac rhythm on the monitor refer to figure and immediately takes which action? Initiates cardiopulmonary resuscitation CPR.

Continues to monitor the client and then contacts the cardiologist. Answer: 2 This question requires you to identify the cardiac rhythm, and then determine the priority nursing action. Note the strategic word, immediately. This cardiac rhythm identifies a coarse ventricular fibrillation VF. The goals of treatment are to terminate VF promptly and to convert it to an organized rhythm. If a defibrillator is not readily available, CPR is initiated until the defibrillator arrives. Options 1, 3, and 4 are incorrect actions and delay lifesaving treatment.

You will be provided with tabs or buttons that you need to click to obtain the information needed to answer the question. A prompt or message will appear that will indicate the need to click on a tab or button. The nurse determines that oral contraceptives are contraindicated because of which documented items? Refer to chart. Focus on the subject, the item s that are a contraindication to the use of oral contraceptives. Oral contraceptives are contraindicated in women with a history of any of the following: thrombophlebitis and thromboembolic disorders, cardiovascular or cerebrovascular diseases including stroke , any estrogen- dependent cancer or breast cancer, benign or malignant liver tumors, impaired liver function, hypertension, and diabetes mellitus with vascular involvement.

Item 2 is a thromboembolic disorder with associated thrombophlebitis. Items 3 and 4 are cardiovascular diseases. The medications the client is taking are not specific contraindications to oral contraceptives. Item 11 has components that are contraindicated; of note is that this client has polycythemia, which is a thromboembolic disorder and therefore is contraindicated for the use of oral contraceptives.

Graphic Item Option Questions In this type of question, the option selections will be pictures rather than text. You will need to use the computer mouse to click on the option that represents your answer choice.

Box Graphic Item Option Question The nurse should place the client in which position to administer an enema? Refer to the figures in 1 to 4. Answer: 2 This question requires you to select the picture that represents your answer choice.

Focus on the subject, the position for administering an enema. This position allows the enema solution to flow downward by gravity along the natural curve of the sigmoid colon and rectum, improving the retention of solution. Option 1 is a prone position. Option 3 is a dorsal recumbent position. Option 4 is a supine position. Audio Questions Audio questions will require listening to a sound to answer the question. These questions will prompt you to use the headset provided and to click on the sound icon.

You will be able to click on the volume button to adjust the volume to your comfort level, and you will be able to listen to the sound as many times as necessary. Content examples include, but are not limited to, various lung sounds, heart sounds, or bowel sounds.

Examples of this question type are located on the accompanying Evolve site Fig. Video Questions Video questions will require viewing of an animation or video clip to answer the question.

These questions will prompt you to click on the video icon. There may be sound associated with the animation and video, in which case you will be prompted to use the headset. Content examples include, but are not limited to, assessment techniques, nursing procedures, or communication skills. Additionally, case studies may accompany some question types. You are encouraged to access www. An enhanced multiple-response question is similar to a multiple-choice question in that it usually allows more than one option to be chosen.

The difference is that an enhanced multiple-response question presents a long list of options. The NCLEX examination committee has not yet provided specific information as to how these question types will be presented. An example of one way they may be presented can be located in Box Michael tells the nurse that Victoria has not been able to tolerate any physical activity and that when she tries to do something she tires very easily. On assessment, the nurse notes that Victoria exhibits shortness of breath on exertion;.

Victoria is hospitalized. Her current home medications include betaxolol hydrochloride for glaucoma and glimepiride for type 2 diabetes mellitus. She also takes over-the-counter hydroxyaluminum sodium carbonate to help prevent acid indigestion. Heart failure is diagnosed.

In addition to the medication that Victoria takes at home, the following medications are prescribed: captopril, furosemide, metoprolol, and digoxin.

What should the nurse discuss with the team? The need for respiratory treatments. That the antacid could affect the absorption of digoxin. That metoprolol may mask symptoms of hypoglycemia. That the antacid must be used with caution in clients with glaucoma. That potential systemic side effects of betaxolol hydrochloride include heart failure. That betaxolol hydrochloride may contribute to hypertension when taken with the newly prescribed medications.

Answer: 1, 2, 3, 4, 5, 7 Victoria is 76 years of age. In addition to her age, her poor respiratory status and inability to tolerate activity place her at risk for falls. These factors require implementing a plan of care that will meet her needs.

Antacids increase the digoxin level by increasing digoxin absorption or bioavailability. Antacids also decrease the absorption of captopril. However, antacids are not a concern in clients with glaucoma. Ophthalmic beta blockers can have additive therapeutic or adverse effects when given with systemically administered beta blockers or other cardiovascular medications. Toxic reactions to beta blockers are rare but primarily involve the cardiovascular system.

Symptoms include bradycardia, cardiac failure, hypotension, and bronchospasm. Treatment involves discontinuation of the medication and supportive care e. In addition, the nonselective beta blockers can interfere with the normal responses to hypoglycemia, such as tremor, tachycardia, and nervousness, in essence masking the signs and symptoms of hypoglycemia.

Hypotension is more likely than hypertension in clients taking beta-blocker medications. On review of the laboratory data, the nurse notes the following:. Complete the following sentences by choosing from the dropdown lists. Other side effects associated with ACE inhibitors include headache, dizziness, fatigue, insomnia, and weight loss.

Digoxin is a cardiac glycoside and would require clarification about administration if the pulse were below 60 beats per minute or if she were showing signs of toxicity. Glimepiride is used to manage blood glucose levels and would require clarification about administration if the blood glucose was low. Furosemide is a diuretic. Although the nurse would monitor for a drop in BP in the client receiving furosemide, the primary concern is hypokalemia.

Shortness of breath has subsided, and vital signs are stable. Her color is pale, but she is showing no signs of respiratory compromise. She still has bilateral crackles in the lower lobes with no expectoration of mucus. The nurse prepares to administer morning medications to Victoria. What assessment is unnecessary before administering the digoxin? Enter the assessment in the box below. Digoxin is a cardiac glycoside. It will decrease the heart rate and could affect the heart rhythm.

If the pulse is slower than 60 or greater than bpm, the digoxin is withheld and the primary health care provider or cardiologist is notified. It is not necessary to check the pedal pulses before administering the digoxin. The nurse would also check the morning digoxin level to. Gastrointestinal disturbances are early signs of digoxin toxicity, so the nurse would assess the client for any discomfort. Visual disturbances are also signs of digoxin toxicity, so the nurse would assess the client for these disturbances.

In this type of question, you will need to select a response from a drop-down menu. Dynamic Exhibit and Constructed Response A constructed response is a type of open-ended question that requires a short- answer response. The answer is constructed using information that can be found in a dynamic exhibit, such as a case study. Enhanced Hot Spots An enhanced hot spot question may presented in various ways. This question type could include an exhibit, a case study, assessment data or other information, or a figure in which you may need to use the mouse and cursor and point and click to locations as asked in the question.

An enhanced hot spot may also ask you to highlight specific information. Box NGN Item: Enhanced Hot Spot Which areas should the nurse place the stethoscope to check the right bronchovesicular breath sounds, the left bronchovesicular breath sounds, the right vesicular breath sounds, the left vesicular breath sounds, and the bronchial breath sounds? Five areas need to be selected to answer this question. Three types of breath sounds are considered normal in certain parts of the thorax. These include vesicular, bronchovesicular, and bronchial.

These breath sounds should be clear to auscultation. Bronchial breath sounds are located over the trachea. Bronchovesicular breath sounds are located over the main bronchi. Vesicular breath sounds are located over the lesser bronchi, bronchioles, and lobes.

Extended Drag and Drop There are various ways in which extended drag and drop question types will be presented. An extended drag and drop question will provide you with several pieces of specific information and will ask you to order that information into the correct order of action or placement. Drag each client to the most appropriate health care provider. A client who requires frequent transfusion. A client with respiratory failure A client receiving continuous tube feedings.

A client who requires a bed bath and on a mechanical ventilator. A client requiring abdominal wound A client who requires hourly pulse irrigations and dressing changes every 3 and blood pressure measurements.

The nurse must determine the most appropriate assignment based on the education and skills of the health care provider and the needs of the client.

In general, noninvasive interventions, such as skin care, range-of-motion exercises, ambulation, grooming, and hygiene measures, can be assigned to the AP. In general, a LPN or vocational nurse VN can perform not only the tasks that a AP can perform but also certain invasive tasks, such as dressing changes, wound irrigations, tube feedings, colostomy irrigations, suctioning, urinary catheterization, and medication administration oral, subcutaneous, intramuscular, and selected piggyback medications , according to the education and job description of the LPN or VN.

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