As you review an elderly patient’s chart, you see osteoporosis listed as a diagnosis. Which of the following spinal deformities should the nurse expect to see during the nurse’s assessment?
Kyphosis.
Scoliosis.
Lordosis.
Ankylosis.
The Correct Answer is D
Choice A reason: Kyphosis, an exaggerated thoracic curvature, is expected in osteoporosis due to vertebral compression fractures from weakened bones, common in elderly patients. Recognizing this guides interventions like bracing or bisphosphonates, critical for preventing further fractures, improving posture, and reducing pain, enhancing quality of life in osteoporosis patients.
Choice B reason: Scoliosis, lateral spinal curvature, is typically congenital or idiopathic, not caused by osteoporosis, which leads to kyphosis. Assuming scoliosis risks misdiagnosis, diverting focus from fracture-related kyphosis, delaying treatments like calcium supplementation, critical for managing osteoporosis and preventing spinal deformities in elderly patients.
Choice C reason: Lordosis, exaggerated lumbar curvature, is not typical in osteoporosis, which primarily causes thoracic kyphosis from vertebral fractures. Misidentifying lordosis risks overlooking kyphosis, delaying interventions like physical therapy, essential for managing spinal deformities and preventing further bone loss in elderly patients with osteoporosis.
Choice D reason: Ankylosis, spinal joint fusion, is associated with ankylosing spondylitis, not osteoporosis, which causes kyphosis. Assuming ankylosis misguides assessment, risking neglect of osteoporosis-related fractures, delaying bisphosphonates or bracing, critical for preventing deformity progression and maintaining mobility in elderly patients with weakened bones.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: The left lower quadrant contains the sigmoid colon and parts of the small intestine, not the liver. Liver assessment involves palpation and percussion in the right upper quadrant, where it resides, making this choice incorrect for locating the liver anatomically.
Choice B reason: The liver is located in the right upper quadrant, beneath the diaphragm, extending slightly into the left upper quadrant. It is assessed via percussion and palpation in the RUQ to evaluate size or tenderness, making this the correct choice for liver localization.
Choice C reason: The left upper quadrant houses the stomach, spleen, and parts of the pancreas, not the liver’s primary location. While the liver’s left lobe extends slightly into the LUQ, its main mass is in the RUQ, making this choice incorrect.
Choice D reason: The right lower quadrant contains the appendix and cecum, not the liver. Liver assessment targets the right upper quadrant, where its bulk resides, making this choice incorrect for identifying the liver’s anatomical position during physical examination.
Correct Answer is D
Explanation
Choice A reason: A blood pressure of 90/80 mmHg is below normal, indicating hypotension, especially with a low systolic value. Normal adult blood pressure, per guidelines, is around 120/80 mmHg. Low readings may suggest dehydration or cardiovascular issues, requiring evaluation, making this choice incorrect.
Choice B reason: A reading of 95/60 mmHg is hypotensive, with both systolic and diastolic values below normal ranges. Normal blood pressure is approximately 120/80 mmHg, per American Heart Association guidelines. Such low readings may indicate shock or autonomic dysfunction, rendering this choice incorrect.
Choice C reason: A blood pressure of 180/60 mmHg is abnormal, with elevated systolic pressure indicating hypertension and a low diastolic value suggesting possible aortic regurgitation. Normal blood pressure is 120/80 mmHg. This reading requires urgent assessment, making it an incorrect choice for normal adult values.
Choice D reason: A blood pressure of 120/80 mmHg is considered normal for adults, per current guidelines like those from the American Heart Association. It reflects balanced systolic and diastolic pressures, indicating healthy cardiovascular function without signs of hypertension or hypotension, making it the correct choice.
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