A large tree fell across the thighs of a man who works as a logger, producing a crushing injury. The muddy ground cushioned the impact and x-rays revealed no broken bones. His thighs are bruised and swollen with pedal pulses present, but the left is stronger than the right. It is most important for the nurse to include in this client's plan of care assessment for signs of which pathophysiological condition?

Peripheral neuropathy.

Osteomyelitis.

Fat embolism.

Compartment syndrome.

Answer and Explanation

The Correct Answer is D

A) Peripheral neuropathy:

Peripheral neuropathy involves damage to the peripheral nerves and is not directly related to the described crushing injury. While nerve injury can occur as a result of trauma, the signs and symptoms described in the scenario, such as unequal strength between the left and right thighs, are more indicative of a potential vascular or musculoskeletal issue rather than peripheral neuropathy.

B) Osteomyelitis:

Osteomyelitis is a bone infection that can occur secondary to trauma or as a complication of open fractures. While it is possible for a crushing injury to lead to osteomyelitis if there is bone involvement or an open wound, the scenario mentions that x-rays revealed no broken bones. Additionally, the signs and symptoms described, such as bruising and swelling of the thighs, are not specific to osteomyelitis.

C) Fat embolism:

Fat embolism occurs when fat globules enter the bloodstream, often following traumatic injury to long bones or orthopedic procedures. While a crushing injury can theoretically lead to fat embolism, the absence of long bone fractures in the x-rays makes this less likely. Additionally, fat embolism typically presents with respiratory symptoms such as dyspnea and hypoxemia, which are not described in the scenario.

D) Compartment syndrome:

Correct. Compartment syndrome is a serious condition that can occur following a crushing injury, especially in the extremities. It is characterized by increased pressure within a muscle compartment, leading to compromised blood flow and potential tissue damage. Signs and symptoms of compartment syndrome include severe pain, swelling, bruising, decreased or absent pulses, and neurological deficits. The unequal strength between the left and right thighs could indicate neurological deficits due to compromised blood flow or nerve compression, making assessment for signs of compartment syndrome crucial in this client's plan of care. If compartment syndrome is suspected, prompt medical intervention, such as fasciotomy to relieve pressure, may be necessary to prevent complications.

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Correct Answer is B

Explanation

Otosclerosis is a condition characterized by abnormal bone growth in the middle ear, specifically involving the stapes bone. This abnormal bone growth interferes with the transmission of sound vibrations from the middle ear to the inner ear, resulting in conductive hearing loss. Here's a breakdown of each option:

A) Presbycusis:

Presbycusis refers to age-related hearing loss, typically involving sensorineural components such as the degeneration of hair cells in the inner ear or changes in the auditory nerve. While presbycusis is a common cause of hearing loss in older adults, it is not directly related to otosclerosis or previous ear surgeries.

B) Conductive:

Correct. Otosclerosis primarily affects the middle ear by causing abnormal bone growth around the stapes bone, which can immobilize it and interfere with sound transmission to the inner ear. As a result, individuals with otosclerosis often experience conductive hearing loss, where sound is not effectively conducted from the outer or middle ear to the inner ear.

C) Endolymphatic:

Endolymphatic hydrops, also known as Ménière's disease, involves abnormal fluid accumulation in the inner ear, leading to symptoms such as vertigo, tinnitus, and fluctuating sensorineural hearing loss. While inner ear disorders like endolymphatic hydrops can cause sensorineural hearing loss, otosclerosis primarily affects the conductive components of hearing.

D) Sensorineural:

Sensorineural hearing loss occurs due to dysfunction or damage to the inner ear (cochlea) or auditory nerve pathways leading to the brain. This type of hearing loss is typically permanent and can result from various factors, including age-related changes, noise exposure, and certain medical conditions. While sensorineural hearing loss can coexist with conductive hearing loss in some cases, otosclerosis primarily causes conductive hearing loss rather than sensorineural hearing loss.

A. Small, skin-colored, pedunculated papules in areas of skin folds and on other areas as skin tags. B. Hyperpigmented areas that vary in form and color and are slightly elevated from the skin. C. Hyperactive sebaceous areas forming comedones, papules, pustules on the face, neck, and upper back. D. Sharply demarcated silvery scaling plaques with underlying redness on the elbows and knees.

Correct Answer is C

Explanation

Acne vulgaris is a common skin condition characterized by various types of lesions, including comedones, papules, and pustules, primarily affecting areas with a high density of sebaceous glands, such as the face, neck, chest, and upper back. Here's why option C is the correct choice:

A) Small, skin-colored, pedunculated papules in areas of skin folds and on other areas as skin tags:

This description is more characteristic of acrochordons or skin tags, which are benign skin growths commonly found in areas of friction or skin folds. Skin tags are not typically associated with acne vulgaris.

B) Hyperpigmented areas that vary in form and color and are slightly elevated from the skin:

This description suggests post-inflammatory hyperpigmentation, which can occur after resolution of inflammatory lesions in acne vulgaris. However, it does not capture the primary pathological findings observed in active acne lesions.

C) Hyperactive sebaceous areas forming comedones, papules, pustules on the face, neck, and upper back:

Correct. Acne vulgaris is characterized by the formation of various lesions, including comedones (open and closed), papules, and pustules, resulting from the obstruction of hair follicles and overactivity of sebaceous glands. These lesions typically appear on areas with a high density of sebaceous glands, such as the face, neck, chest, and upper back.

D) Sharply demarcated silvery scaling plaques with underlying redness on the elbows and knees:

This description is more indicative of psoriasis, a chronic autoimmune skin condition characterized by sharply demarcated, raised, silvery scaling plaques commonly affecting extensor surfaces such as the elbows and knees. Psoriasis lesions are distinct from those seen in acne vulgaris.

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Naxlex Comprehensive Predictor Exams

The nurse is providing care for a client with a diagnosis of otosclerosis due to previous ear surgeries. Which type of pathological hearing loss supports the client's clinical history?

Correct Answer is B

Explanation

The nurse is caring for a young adult who reports uncontrolled acne vulgaris. Which pathological findings should the nurse observe on inspection of skin areas commonly affected in acne vulgaris?

Correct Answer is C

Explanation

The nurse is explaining the underlying cause of bruising with a client who is recently diagnosed with acute leukemia. Which pathophysiology is a result of the myeloblastic dysfunction of leukemia?

The nurse is caring for a client with stage 4 chronic kidney disease. Which interpretation should the nurse make about the client's glomerular filtration rate (GFR)?

A client with chronic osteoarthritis is troubled by knee pain. Which pathophysiological process is contributing to the pain?

A client received midazolam 2 mg and morphine sulfate 4 mg for a liver biopsy. After the procedure, the nurse positions the client on the right side and monitors the vital signs. Which is the physiological reason for the nurse's intervention?

A male client with type 1 diabetes mellitus (DM) develops a gangrenous toe and is admitted for possible amputation. Which pathophysiological consequence of DM has contributed to this client's complication?

The nurse is assessing a client with a gunshot wound to the abdomen who is admitted to the intensive care unit (ICU) following a 3-hour surgical procedure. Which elevated laboratory value indicates pancreatic damage?