NURS 510 Nursing Research Methods

Correct Answer: C) Osteoarthritis

Explanation:

Osteoarthritis (OA) is a degenerative joint disease commonly affecting weight-bearing joints, such as the knees. It typically presents with joint pain, swelling, stiffness, and reduced range of motion, especially after prior joint trauma. OA is non-inflammatory, so there is usually no warmth, erythema, or fever. The symptoms described—localized joint issues without systemic signs and a history of joint trauma—are classic for OA.

Why other options are wrong:

A) Osteoporosis:

A bone density disorder, not a joint disease. It is typically asymptomatic until a fracture occurs and does not cause joint pain or swelling.

B) Systemic Lupus Erythematosus (SLE):

An autoimmune systemic disease that usually affects multiple joints symmetrically and may present with systemic symptoms like fever, rash, and fatigue—none of which are present here.

D) Rheumatoid arthritis (RA):

An inflammatory autoimmune disease that typically affects multiple joints symmetrically and presents with warmth, erythema, morning stiffness, and systemic symptoms like fatigue or low-grade fever. The absence of these features makes RA unlikely.

Correct Answer: E)

Explanation:

A greenstick fracture is a type of incomplete fracture in which the bone bends and cracks on one side but does not break completely through—similar to bending a green twig. It is most common in children due to their softer, more flexible bones. In the illustration, E clearly shows a bent bone with a partial break on one side, consistent with the appearance of a greenstick fracture.

Why the other options are incorrect:

A) Shows a comminuted fracture, where the bone is broken into multiple pieces.

B) Shows a transverse fracture, a straight horizontal break across the bone.

C) Shows an oblique fracture, which runs at an angle to the bone’s axis.

D) Shows a segmental fracture, with two separate breaks creating a floating segment.

F) Shows a spiral fracture, which wraps around the bone, usually caused by twisting force.

Correct Answer: B) Compound

Explanation:

A compound fracture (also called an open fracture) occurs when the broken bone pierces through the skin, exposing the fracture to the external environment. This type of fracture carries a high risk of infection, soft tissue damage, and complications such as delayed union or nonunion, all of which can significantly prolong the healing process. Treatment often requires surgical intervention, antibiotic therapy, and extended recovery time.

Why the other options are incorrect:

A) Undisplaced:

An undisplaced fracture means the bone remains aligned, making it generally easier and faster to heal with immobilization alone. There’s typically no surgical intervention required.

C) Greenstick:

Common in children, a greenstick fracture is incomplete—the bone bends and cracks on one side. Due to children’s strong healing capacity and the limited severity of the fracture, healing is usually quick and uncomplicated.

D) Oblique:

An oblique fracture runs diagonally across the bone. While it may need stabilization (e.g., casting or sometimes surgery), it typically heals faster than a compound fracture as long as it is properly aligned and infection-free.

Correct Answer: B) Oral corticosteroids

Explanation:

B) Oral corticosteroids: These are least likely to be included in the early management of osteoarthritis (OA). Osteoarthritis is a non-inflammatory joint disease, and while corticosteroids have strong anti-inflammatory effects, they are not routinely used orally in OA due to limited benefit, potential systemic side effects, and better alternatives. Corticosteroids may be used in intra-articular injections for moderate-to-severe flares, but not as a first-line oral therapy.

Why the other options are more likely to be used:

A) NSAIDs:

These are commonly used to manage pain and inflammation associated with osteoarthritis. NSAIDs like ibuprofen or naproxen are first-line pharmacologic treatments, especially when acetaminophen is not sufficient.

C) Acetaminophen:

Often recommended as an initial analgesic due to its safety profile, especially in older adults or those at risk for gastrointestinal side effects from NSAIDs.

D) OTC topical creams:

Topical agents like capsaicin or NSAID-based creams (e.g., diclofenac gel) are helpful in localized joint pain, particularly for the hands and knees, and are commonly included early in conservative management plans.

Correct Answer: C) 25-year-old female receiving chemotherapy for cancer

Explanation:

Intra-renal (intrinsic) acute kidney injury (AKI) results from direct damage to the kidney tissue itself, including the glomeruli, tubules, or interstitium. Certain chemotherapy drugs, such as cisplatin and methotrexate, are known to be nephrotoxic, particularly to the renal tubules. These agents can cause acute tubular necrosis, a common form of intra-renal injury. Patients receiving chemotherapy must be monitored closely for signs of renal dysfunction.

Why the Other Options Are Wrong:

A) 54-year-old male with bladder cancer:

Bladder cancer is more likely to cause post-renal AKI due to obstruction of urine flow, not intra-renal damage.

B) 65-year-old male with benign prostatic hyperplasia:

BPH can lead to urinary outflow obstruction, increasing the risk of post-renal AKI, especially if there’s significant retention and backflow pressure on the kidneys.

D) 36-year-old female with renal artery stenosis:

Renal artery stenosis reduces blood flow to the kidney, which may lead to pre-renal AKI, particularly if prolonged. However, unless ischemia progresses to the point of tissue death, it does not directly cause intra-renal injury.

Correct Answer: C) Vaccine

Explanation:

Vaccination is the most effective strategy for preventing Hepatitis A, B, and D:

Hepatitis A and B have reliable and widely available vaccines.

Hepatitis D only occurs in individuals with Hepatitis B, so the HBV vaccine also indirectly protects against HDV.

This makes vaccination the most effective targeted prevention method for types with available vaccines.

Why the other options are incorrect:

A) Screening of blood and organs prior to donation:

This prevents bloodborne types like Hepatitis B and C, but not fecal-oral types like Hepatitis A and E. It’s essential but not comprehensive.

B) Proper handling of needles:

Helps prevent needle-transmitted hepatitis, especially B and C, but has no effect on food or waterborne viruses like HAV or HEV.

D) Hand-washing:

Effective in preventing fecal-oral transmission of Hepatitis A and E, but does not prevent bloodborne types (HBV, HCV, HDV).

Correct Answer: B) Prostaglandins are causing the upward displacement of the thermostatic set point

Explanation:

Pyrexia (fever) develops when endogenous pyrogens—such as interleukin-1 (IL-1), IL-6, and tumor necrosis factor (TNF)—are released in response to infection or inflammation. These pyrogens stimulate the hypothalamus to produce prostaglandin E2 (PGE2). PGE2 then acts on the hypothalamus to elevate the body’s thermostatic set point, leading the body to initiate heat-generating behaviors like shivering and vasoconstriction, which raise core temperature to match the new set point.

Why the other options are incorrect:

A) The hypothalamus is synthesizing and releasing TRH to inhibit heat dissipating behaviors:

Thyrotropin-releasing hormone (TRH) stimulates TSH release for thyroid hormone regulation, not directly involved in fever development or heat conservation behaviors.

C) The anterior pituitary is releasing ACTH to stimulate heat generating behaviors:

ACTH is involved in the stress response and cortisol production, not directly in fever induction or thermoregulation.

D) Leukotrienes are stimulating epinephrine and thyroxine to increase basal metabolic rate:

Leukotrienes are inflammatory mediators, but they are not key players in pyrexia development, and this statement inaccurately links them to hormonal effects not central to the fever mechanism.

Correct Answer: D) "Taking steroids and NSAIDs can increase the risk for stomach ulcers so we need to discuss an alternate plan for pain management."

Explanation:

Prednisone (a corticosteroid) and ibuprofen (a nonsteroidal anti-inflammatory drug or NSAID) both increase the risk of gastrointestinal (GI) irritation, ulcers, and bleeding. Using these together significantly raises the risk of peptic ulcer disease due to their combined effects on gastric mucosa and prostaglandin inhibition. For patients who require both, gastroprotection (e.g., proton pump inhibitors) or alternative pain control strategies should be considered. The nurse should advocate for safer pain management options and collaborate with the provider to prevent complications.

Why the Other Options Are Wrong:

A) "Prednisone can exacerbate pain by increasing prostaglandin synthesis..."

This is inaccurate. Prednisone actually inhibits prostaglandin synthesis by blocking phospholipase A2, contributing to its anti-inflammatory and pain-relieving effects. It does not exacerbate pain through prostaglandin production.

B) "I will talk to the provider about having your prednisone switched to alternate day dosing..."

Alternate-day dosing may reduce long-term side effects but is not typically used for acute pain management. Also, pain control often requires daily anti-inflammatory coverage, especially in autoimmune diseases with chronic inflammation.

C) "Ibuprofen is not a very strong analgesic..."

Ibuprofen is actually an effective NSAID for pain and inflammation, especially at higher doses. The concern here is not its potency but the risk of GI complications when combined with corticosteroids.

Correct Answer: C) Psychopharmacological medications have similar dosing across all age groups.

Explanation:

C) Psychopharmacological medications have similar dosing across all age groups is not accurate and should not be included in client education. Age significantly affects drug metabolism and clearance, especially in older adults and children. Older adults often require lower doses due to reduced liver and kidney function, altered body composition, and increased sensitivity to drug effects. Children also require carefully adjusted dosages based on age and weight.

Why the other options are correct:

A) Renal disease may impact drug choice and dose in some clients:

Correct. Renal impairment affects drug elimination, requiring dose adjustments to prevent accumulation and toxicity.

B) These medications have the risk for cytochrome P450 interactions that impact the action of the medication:

Correct. Many psych meds are metabolized by liver enzymes, especially the CYP450 system, and may have drug-drug interactions that alter effectiveness or increase side effects.

D) Hepatic disease can impact dose:

Correct. The liver metabolizes most psychotropic drugs. If liver function is impaired, drug levels can accumulate, necessitating dose reductions or alternative medications.