EAQ- Musculoskeletal Quiz

Which condition is characterized by infection of a client's bone or bone marrow? A. Osteomalacia B. Osteomyelitis C. Herniated Disc D. Spinal stenosis

B. Osteomyelitis Osteomyelitis is infection of bone or bone marrow. Osteomalacia is a condition characterized by softening of bones due to calcium or vitamin D deficiency. Herniated disc is caused by structural damage of the intervertebral discs in which the nucleus pulposus seeps through a torn or stretched annulus. Spinal stenosis is narrowing of the spinal canal.

Which factor may cause neck pain in a client? A. Headache B. Poor posture C. Low body weight D. Sedentary lifestyle

B. Poor posture Poor posture may affect the nerves innervating the neck, thereby causing pain in the neck. Headache may be associated with neck pain, but it does not precipitate neck pain. Low body weight and sedentary lifestyle may cause osteoporosis.

A home care nurse is visiting a client who had a below-the-knee amputation. Which client statement indicates to the nurse that further teaching is needed? A. 'At night, I sleep with a pillow under my knees.' B. 'When I sit in a chair, I put my legs out straight on an ottoman.' C. 'I apply a firm, even bandage around the end of my affected leg every day.' D. 'I press the end of my affected leg against a soft surface several times during the day.'

A. 'At night, I sleep with a pillow under my knees.' A pillow may promote a flexion contracture of the hip and knee and may interfere with use of a prothesis and ambulation. The response 'When I sit in a chair, I put my legs out straight on an ottoman' expresses an action that prevents pooling of blood and edema in the extremities. The response 'I apply a firm, even bandage around the end of my affected leg every day' explains an activity that prevents edema and promotes residual limb shrinkage. Pressing the end of the affected leg against a soft surface several times during the day prepares the residual limb for weight-bearing and for use of a prosthesis.

The registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for additional instruction? A. 'I should walk on soft scatter rugs at home' B. 'I should drink 3000 mL of water every day' C. 'I should eat fruits and vegetables six times a day' D. 'I should exercise the joints above and below the cast daily'

A. 'I should walk on soft scatter rugs at home' A client with injuries due to a fall must avoid having throw or scattered rugs at home to reduce the incidence of falls. The registered nurse (RN) would encourage the client to drink 3000 mL of water per day to promote optimal bladder and bowel function. The client would eat six small meals with foods rich in fiber, such as fruits and vegetables, to prevent constipation. the RN has to encourage the client to perform exercise above and below the cast daily for a speedy recovery.

A client who had an above-the-knee amputation (AKA) has a pressure dressing on the end of the residual limb. The client asks, 'Why do I have to have this tight dressing on my leg?' Which response would the nurse provide? A. 'It decreases the swelling of the area.' B. 'It decreases the formation of scar tissue.' C. 'It prevents the formation of blood clots.' D. 'It reduces phantom limb pain.'

A. 'It decreases the swelling of the area.' The pressure dressing prevents fluid from shifting into the interstitial compartment; this promotes shrinkage of the residual limb to facilitate use of a prosthesis. Bandaging will not affect the formation of a scar, prevent blood clots, or reduce phantom limb pain.

A 70-year-old client is diagnosed with cartilaginous degeneration. Which action would the nurse take? A. Advise the client to take warm showers B. Teach the client isometric exercises C. Provide the client with supportive armchairs D. Demonstrate weight-bearing exercises to the client

A. Advise the client to take warm showers Clients with cartilaginous degeneration are advised to take warm showers because they increase blood flow to the region. Isometric exercises are indicated for clients with muscular atrophy. Sitting in a supportive armchair proves support to bony structures and prevents further deformities in a client with kyphosis. Weight-bearing exercises are indicated in clients with decreased bone density.

Which roles could the nurse assign to unlicensed assistive personnel (UAP) in caring for a client with a cast? Select all that apply. One, some, or all responses may be correct. A. Applying ice to the cast B. Positioning the casted extremity above heart level C. Marking the circumference of any drainage on the cast D. Looking for clinical manifestations of compartment syndrome E. Teaching range-of-motion exercises to the client and caregiver

A. Applying ice to the cast B. Position the casted extremity above heart level The role of unlicensed assistive personnel (UAP) in caring for the client with a cast or in traction involves applying ice to the cast and positioning the casted extremity above heart level. The licensed practical/vocational nurse (LPN/LVN) marks the circumference of any drainage on the cast. The registered nurse (RN) assess the client for clinical manifestations of compartment syndrome and teaches the client and caregiver range-of-motion exercises.

Which synovial joint movement is described as turning the sole away from the midline of the body? A. Pronation B. Eversion C. Adduction D. Supination

B. Eversion Eversion is a synovial joint movement that describes turning the sole outward away from the midline of the body. Pronation is a synovial joint movement that describes turning the palm downward. Adduction is a synovial joint movement that describes movement toward midline of the body. Supination is a synovial joint movement that describes turning the palm upward.

Which finding during a home health visit would prompt the nurse to provide a client with home safety instructions? Select all that apply. One, some, or all responses may be correct. A. Area rugs on the floor B. Clogged, dirty fireplace C. Multiple electrical cords D. Multiple prescribed medications E. Wheeled walker with uneven legs

A. Area rugs on the floor B. Clogged, dirty fireplace C. Multiple electrical cords D. Multiple prescribed medications E. Wheeled walker with uneven legs There are multiple potential hazards in the home clients should be educated about to avoid injury. Area rugs and multiple electrical cords on the floor pose a fall risk. A clogged, dirty fireplace could lead to carbon monoxide poisoning. Polypharmacy can cause mental status changes, confusion, and orthostatic blood pressure changes; these can increase the client's fall risk. If the nurse observes a wheeled walker with uneven legs, the physical therapist would be notified as they can follow-up to evaluate the mobility aid's safety.

When would the nurse being rehabilitation planning for the client who is scheduled for a below-the-knee amputation? A. Before the surgery takes place B. During the convalescent phase C. On discharge from the hospital D. When it is time for a prosthesis

A. Before the surgery takes place Rehabilitation should begin immediately. This includes preoperative discussion of the nature of the operation and rehabilitation techniques. During the convalescent phase, on discharge from the hospital, and when it is time for a prosthesis are too late; valuable rehabilitation time has been wasted.

Which hormones are responsible for altered serum calcium concentrations? Select all that apply. One, some, or all responses may be correct. A. Calcitonin B. Thyroxine C. Glucocorticoids D. Growth hormone E. Parathyroid hormone

A. Calcitonin E. Parathyroid hormone Produced by the thyroid gland, calcitonin decreases the serum calcium concentration if it increases above the normal level. Parathyroid hormones increase and stimulate bones to promote osteoclastic activity and release calcium into the blood in response to low serum calcium levels. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate protein metabolism to maintain the organic matrix of bone. Growth hormone helps increase bone length and determine the amount of bone matrix formed before puberty.

A client who has severe back pain is found to have a vertebral compression fracture. Which cause of fracture would the nurse consider when planning interventions? A. Collapse of the vertebral bodies B. Demineralization of the spinal cord C. Wear and tear of the spinous processes D. Bulging of the spinal cord from the vertebra

A. Collapse of the vertebral bodies Osteoporotic vertebrae collapse under the weight of the upper body or by improper or rapid turning, reaching, or lifting. Bones, not the spinal cord, demineralize in osteoporosis. Wearing and tearing of the spinous processes occur in osteoarthritis. The spinal cord does not rule; the nucleus pulposus bulges toward the spinal cord.

Which foot disorder is caused by continual pressure over bony prominences? A. Corn B. Wart C. Hammertoe D. Hallus rigidus

A. Corn A corn is a foot disorder caused by continual pressure over bony prominences. A plantar wart is a foot disorder caused by a virus. Hammertoe is a foot disorder caused by flexion and deformity in the joints. Hallux rigidus is caused by osteoarthritis.

Which factor contributes to skeletal calcium loss by a client who has paraplegia? A. Decreased weight bearing B. Inadequate fluid intake C. Decreased calcium intake D. Inadequate kidney function

A. Decreased weight bearing The bones respond to stress of weight-bearing exercise (walking, running, etc.) by laying down new bone substance along the lines of stress. Inactivity leads to reduced bone deposition and actual bone decalcification. Fluid intake has no effect on bone decalcification. Calcium intake does not alter bone demineralization in clients with paraplegia. Kidney function may be altered while bone decalcification occurs and stones are formed in the kidneys, but this is not the case of demineralization.

Which factors contribute to a client's slow rate of healing? Select all that apply. One, some, or all responses may be correct. A. Diabetes B. Cataract C. Smoking D. Dermatitis E. Alcohol abuse

A. Diabetes C. Smoking E. Alcohol abuse Diabetes causes narrowing of blood vessels, thereby causing diminished blood supply to the affected organ or tissue; clients with diabetes have a slow healing rate. Intake of tobacco through smoking may reduce the blood supply to the affected area, thereby slowing down the healing process. Alcohol abuse reduces the amount of nutrients and vitamins required for muscle growth, thereby affecting the healing process. Cataract is a disease of the eye and does not affect the musculoskeletal system. Similarly, dermatitis is a skin condition that does not affect the musculoskeletal system.

After an amputation of a limb, a client reports extreme discomfort in the area where the limb once was. On which goal would the nurse plan to focus interventions? A. Identifying actions to decrease pain in the lost limb B. Reversing feelings of hopelessness about the future C. Promoting mobility in the residual limb D. Facilitating the grieving process for the lost limb

A. Identifying actions to decrease pain the the lost limb Phantom limb sensation is a real experience with no known cause or cure. The pain must bee acknowledged and interventions to relieve the discomfort explored. There are no data indicating that the client is hopeless. Although promoting mobility in the residual limb may be effective for some people, it may not be effective for others; all possible interventions should be explored. There are no data indicating that the client is grieving.

Which hormones are involved in building and maintaining healthy bone tissue? Select all that apply. One, some, or all responses may be correct. A. Insulin B. Thyroxine C. Glucocorticoids D. Growth hormone E. Parathyroid hormone

A. Insulin C. Glucocorticoids D. Growth hormone Insulin works together with growth hormone to increase bone length, which helps build and maintain healthy bone tissue. Glucocorticoids regulate protein metabolism to reduce or intensify the organic matrix of bone. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion stimulates bones to promote osteoclastic activity and release calcium into the blood when serum calcium levels are lowered.

A student athlete reports muscle pain after a practice session. Which product of muscle metabolism would the nurse explain as being a cause of pain? A. Lactic acid B. Acetoacetic acid C. Hydrochloric acid D. Beta-hydroxybutyric acid

A. Lactic acid The ache in muscles that have been vigorously worked without adequate oxygen supply is caused in part by the buildup of lactic acid. During rest, the lactic acid is oxidized completely to carbon dioxide and water, providing adenosine triphosphate for further muscular contraction. Beta-hydroxybutyric acid and acetoacetic acid are not products of muscle contraction; they are ketone bodies resulting from incomplete oxidation of fatty acids. Hydrochloric acid is not a product of muscle contraction; it is present in the stomach to facilitate the digestive process.

Which activity will prepare the client who has a new above-the-knee amputation for crutch walking? A. Lifting weights B. Turning in bed C. Caring for the residual limb D. Performing phantom limb exercises

A. Lifting weights Preparation for crutch walking includes exercises to strengthen arm and shoulder muscles. Position changes help prevent hip flexion contractures but do not prepare the client for crutch walking. Caring for the residual limb promotes healing and helps prepare the limb for the prosthesis, but it does not prepare the client for crutch walking. The phantom limb sensation includes a feeling that the absent limb is present; there are no specific exercises for this phenomenon.

Which age-related finding would the nurse discover when assessing he health of a 69-year-old client? A. Big, wide opened eyes B. Presence of facial hair C. A bruise on the elbow D. Walking with neck bent forward

D. Walking with neck bent forward Aging is associated with changes in gait. Walking with neck bent forward suggests a gait change, supporting the nurse's conclusion. Wide opening of eyes is not an age-related change. The release of sex hormones in both men and women causes growth of facial hair, which is normal. A bruise could be a result of an injury and not limited to aging.

Which bursae are between the client's elbow and the skin? A. Olecranon B. Prepatellar C. Subacromial D. Trochanteric

A. Olecranon Bursae are small sacs of connective tissue lined with synovial membrane and synovial fluid that decrease the friction between moving parts. Olecranon bursae are found between the olecranon process of the elbow and the skin. Prepatellar bursae are found between the patella and the skin. Subacromial bursae are found between the head of the humerus and the acromion process of the scapula. Tochanteric bursae are found between the greater trochanter of the proximal femur and the skin.

Which is the first-line treatment for Paget's disease? A. Oral alendronate B. Oral calcium C. Intravenous pamidronate D. intravenous zoledronic acid

A. Oral alendronate Oral alendronate, a bisphosphonate, is the first-line treatment for Paget's disease. Clients with Paget's disease also are given 1500mg of calcium daily as a supplement to reduce the risk of hypocalcemia. When oral medications are ineffective, pamidronate and zoledronic acid are administered intravenously.

Which medication to treat osteoporosis would be contraindicated for a client who has a history of renal calculi? A. Os-cal B. Raloxifene C. Ibandronate D. Zoledronic acid

A. Os-cal Os-cal (a calcium supplement) should not be prescribed to a client with osteoporosis with a history of urinary stones. Raloxifene may increase liver function test values and worsen hepatic disease. Ibrandonate should not be prescribed to clients with gastric problems because of the risk of esophagitis and gastric ulcers. Zoledronic acid should not be prescribed to clients with poor oral hygiene because the medication may cause maxillary osteonecrosis.

When teaching a client about their disease process, which term would the nurse use to describe bone loss greater than normal but less than that caused by osteoporosis? A. Osteopenia B. Osteomyelitis C. Osteomalacia D. Osteoarthritis

A. Osteopenia The definition of osteopenia is bone loss that is more than normal but not yet at the level for a diagnosis of osteoporosis. Osteomyelitis is infection of bone or bone marrow. Osteomalacia is softening of bones due to calcium or vitamin D deficiency. Osteoarthritis is cartilage deteriorating in the joints.

Which area in the figure is the site of a subtrochanteric fracture? A. Point A B. Point B C. Point C D. Point D

A. Point A A subtrochanteric fracture is one that occurs below the lesser trochanter. Point A in the figure is the site of a subtrochanteric fracture. Point B is the site of an intertrochanteric fracture. Point C is the site of a sub capital fracture. Point D is the site of a capital fracture.

Which goal would the nurse identify as the reason for snugly bandaging the client's residual limb after an amputation? A. Promoting tissue shrinkage B. Preventing injury to the area C. Preventing suture line infection D. Promoting drainage of secretions

A. Promoting tissue shrinkage Wrapping of the residual limb applies pressure that prevents swelling and shapes it for the fitting of a prosthesis in the future. A sock is used to protect the residual limb from irritation and injury. Infection is not prevented in this manner; surgical asepsis should be maintained. Secretion drainage is not promoted by wrapping the limb; portable drainage systems are used for this purpose.

Which position would help the client who has an above-the-knee amputation prevent a contracture? A. Prone position B. Sitting position C. Supine position with a pillow under the residual limb D. Side-lying position with a pillow between the thighs

A. Prone position The prone position maintains the hips in extension, which helps prevent flexion contractures of the hips. The sitting position flexes the hips and knees, which promotes hip and knee flexion contractures. The supine position with a pillow under the residual limb will flex the hip, promoting a hip flexion contracture. In the side-lying position the left hip will be flexed, which will promote the development of a hip flexion contracture.

Which nursing action is beneficial for the client who has pain due to muscle spasm? A. Providing heat compresses at the site B. Providing a massage to the affected area C. Encouraging the client to perform isometric exercises D. Encouraging the client to do active range-of-motion (ROM) exercises

A. Providing heat compresses at the site The nurse provides thermotherapy (heat) to a client with muscle spasm. Heat compresses at the site of pain comfort the client by relaxing the muscle. A massage may stimulate muscle tissue contraction, which increases spasm and pain. The client with muscle spasm may not be able to perform isometric muscle-strengthening exercises. the client may be encouraged to perform active range-of0motion (ROM) exercises when the pain subsides.

Which estrogen antagonist would the health care provider prescribe a client for the prevention and treatment of osteoporosis in postmenopausal women? A. Raloxifene B. Denosumab C. Alendronate D. Zoledronic acid

A. Raloxifene Raloxifene prevents and treats osteoporosis in postmenopausal women by increasing bone mineral density, reducing bone desorption, and reducing incidences of osteoporotic vertebral fractures. Denosumab is a monoclonal antibody used to treat osteoporosis when other medications are not effective. Alendronate and zoledronic acid are commonly used for the prevention and treatment of osteoporosis.

Which musculoskeletal condition is illustrated in the figure? A. Scoliosis B. Kyphosis C. Torticollis D. Pes planus

A. Scoliosis Scoliosis is a lateral S-shaped curvature of the thoracic and lumbar spine. A client with scoliosis has unequal shoulder and scapular height when observed from the back. Kyphosis is an excessive outward curvature of the spine. Torticollis is the twisting of the neck in an unusual position to one side. Pes plans is an abnormal flatness of the sole and arch of the foot.

Which joint is an example of a condyloid joint? A. Wrist joint B. Elbow joint C. Shoulder joint D. Sacroiliac joint

A. Wrist joint The wrist joint is an example of a condyloid joint. It is a joint between the radial and carpals. The elbow joint is an example of a hinge joint. The shoulder joint is an example of a ball and socket joint. The sacroiliac joint is an example of a gliding joint.

Which information indicates a nursing student's accurate understanding about skeletal muscles? A. Skeletal muscle accounts for about half of a human being's body weight B. Skeletal muscle contraction propels blood through the circulatory system C. Skeletal muscle contraction is modulated by neuronal and hormonal influences D. Skeletal muscle occurs in the walls of hollow structures such as airways and arteries

A. Skeletal muscle accounts for about half of a human being's body weight Skeletal muscle is a type of striated voluntary muscle that accounts for about half of a human being's body weight. Cardiac muscle contraction propels blood through the circulatory system. Skeletal muscle contraction requires neuronal stimulation only. Smooth muscle, not skeletal, is found in the walls of hollow structures such as airways and arteries.

Which device would the nurse use to prevent footdrop for a client on bed rest after a cerebrovascular accident? A. Splints B. Blocks C. Cradles D. Sandbags

A. Splints Various types of splints or boots are available to keep the foot in a position of functional alignment. Blocks elevate the frame of the bed and have no effect on the position of the feet. Although a cradle will keep the pressure of the linen off the client's feet, which otherwise may promote footdrop, the cradle does not maintain functional alignment of the ankle. Sandbags help prevent rotation of an extremity or the head; they are not used to prevent footdrop.

Which action by a 70-year-old female client would best limit further progression of osteoporosis? A. Taking supplemental calcium and vitamin D B. Increasing the consumption of eggs and cheese C. Taking supplemental magnesium and vitamin E D. Increasing the consumption of milk products

A. Taking supplemental calcium and vitamin D Research demonstrates that women past menopause need at least 1500 mg of calcium a day, which is almost impossible to obtain through dietary sources because the average daily consumption of calcium is 300 to 500 mg. Vitamin D promotes the deposition of calcium into the bone. Consumption of eggs and cheese does not contain adequate calcium to meet requirements to prevent osteoporosis; these foods do not contain vitamin D unless fortified. If large amounts of magnesium are present, calcium absorption is impeded because magnesium and calcium absorption are competitive; vitamin E is unrelated to osteoporosis. Milk and milk products may not be consumed in quantities adequate to meet requirements to prevent osteoporosis.

Which treatment is beneficial for a client with muscle spasm? A. Thermotherapy B. Muscle massage C. Frequent position changes D. Muscle-strengthening exercise regimen

A. Thermotherapy Thermotherapy, the use of heat therapy, eases pain and muscle contraction; therefore, it is useful in treating muscle spasms. Muscle massage stimulates muscle tissue contraction and may worsen a muscle spasm. Frequent position changes are beneficial for a client with contracture. A muscle-strenghtning exercise regimen is beneficial for a client with muscle atrophy.

For which purpose is a goniometer used? A. To assess range of motion B. To reduce phantom limb sensation C. To prevent hip flexion contractures D. To immobilize a joint during fracture

A. To assess range of motion A goniometer is a device that measures the angle of a joint and is used to assess range of motion. Mirror therapy is used to reduce phantom limb sensation. Buck's traction boot is a type of skin traction used to prevent hip flexion contractures. Splints are used to immobilize a joint after a fracture.

The client can complete range of motion with gravity eliminated. Which grade would the nurse assign to the client's muscle strength? A. 1 B. 2 C. 3 D. 4

B. 2 When rating muscle strength, grade 2 indicates complete range of motion with gravity eliminated. Grade 1 indicates no joint motion and slight evidence of muscle contractility. Grade 3 is indicated by complete range of motion against gravity only. If there is complete range of motion against gravity with some resistance, then the grade would be 4.

A 90-year-old resident fell and fractured the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. Which general fact about the older adult would the nurse consider when caring for this client? A. Aging causes a lower pain threshold B. Aging reduces the physiological coping defenses C. Most confused states result from dementia D. Older adults psychologically tolerate changes well

B. Aging reduces the physiological coping defenses Aging causes a lowering of the physiological coping reserve of various systems of the body. the pain threshold increases with aging. There are many etiologies for confusion (e.g., medication intolerance, altered metabolic state, unfamiliar surroundings). As individuals age they become more entrenched in ideas, environment, and objects that are familiar, and thus do not tolerate change well.

The nurse is planning care for an immobilized client who had a stroke with right-sided hemiparesis. Which activity would the nurse include in the plan of care? A. Assess the client's lung sounds daily B. Assist the client to perform range-of-motion (ROM) exercises ever 1 to 2 hours C. Allow the client to sit upright in the chair for as long as tolerated D. Have the unlicensed nursing personnel reposition the client every 4 hours

B. Assist the client to perform range-of-motion (ROM) exercises every 1 to 2 hours Range-of-motion exercises should be performed often to prevent muscle atrophy and contractures. Assessing the client's lung sounds every 8 hours is the minimum the nurse would assess lung sounds and it is important, but it is not a priority in planning care for immobilization. The client should not be allowed to sit in a chair for prolonged periods of time because of skin breakdown and venous return. The nursing assistant should be instructed to turn the client at least every 2 hours.

Which structures protect a client's internal organs, support blood cell production, and store minerals? A. Joints B. Bones C. Muscles D. Cartilages

B. Bones Bones are the framework of the body; they support and protect internal organs. They also help in stem cell production from bone marrow, and they store minerals. Joints (articulations) help articulate the bones. Muscles are the bundles of fibrous tissue that contract to produce movement and maintain body posture. Cartilage is a hyaline, elastic, and fibrous tissue that often functions as a shock absorber.

When performing a physical assessment on a client, which term would the nurse use to describe a flat, poorly defined mass on the sole over a bony prominence and caused by pressure? A. Plantar wart B. Callus C. Ingrown nail D. Hypertrophic unfurl labium

B. Callus In foot problems, a callus description is a flat, poorly defined mass on the sole over a bony prominence that is caused by pressure. Plantar wart is a painful papillomatous growth caused by a virus. A sliver of toenail penetrating the skin and causing inflammation results in ingrown nail. A hypertrophic unfurl labium is a chronic hypertrophy of the nail lip caused by improper nail trimming.

Which observation would correspond to a muscle-strength rating of 3? A. No evidence of muscle contractility B. Can complete range of motion (ROM) against gravity C. No joint motion and slight evidence of muscle contractility D. Can complete ROM against gravity with some resistance

B. Can complete range of motion (ROM) against gravity A muscle-strength rating of 3 indicates that the client has a fair ROM and can complete ROM against gravity. No evidence of muscle contractility indicates that there is zero muscle strength. No joint motion and slight evidence of muscle contractility indicates trace muscle strength, which is a rating of 1. An ability to complete ROM against gravity with some resistance indicates good muscle strength, a rating of 4.

Which medications are useful to relieve pain associated with muscle spasms? Select all that apply. One, some, or all responses may be correct. A. Cefazolin B. Carisoprodol C. Fondaparinux D. Methocarbamol E. Cyclobenzaprine

B. Carisoprodol D. Methocarbamol E. Cyclobenzaprine Central and peripheral muscle relaxants such as carisoprodol, methocarbamol, and cyclobenzaprine are used to reduce muscle spasm pain. Cefazolin is a bone-penetrating antibiotic used prophylactically before surgery. Fondparinux is a low-molecular-weight heparin used to prevent venous thromboembolism (VTE) in clients schedule for orthopedic surgery.

When developing the plan of care for a client with rheumatoid arthritis, which client consideration would the nurse include? A. Surgery B. Comfort C. Education D. Motivation

B. Comfort Because pain is an all-encompassing and often demoralizing experience, the nurse would want to keep the client as pain-free as possible. Surgery corrects deformities and facilitates movement, which is not an immediate need. Concentration and motivation are difficult when a client is in severe pain.

Which nursing interventions would the nurse implement when providing postoperative care for a client who had a below-the-knee amputation? A. Maintain strict bed rest for 2 days postprocedure to reduce dependent edema B. Elevate residual leg slightly while keeping the knee joint straight for first 24 hours C. Hemorrhage rarely occurs during the early postoperative period D. The surgeon will change the dressing within 48 hours after the procedure

B. Elevate residual leg slightly while keeping the knee joint straight for first 24 hours Elevation of the residual limb helps prevent edema; however, slight elevation during the first 24 hours as continued elevation may lead to hip contractures. the knee joint is kept extended, not flexed during this time. The client usually is out of bed on the second postoperative day. Hemorrhage and infection are the two most common complications. The dressing usually is a pressure dressing, and the surgeon does not change the pressure dressing this soon postoperatively. Sometimes the pressure dressing has a cast in place to shape the residual leg for a prosthesis.

Which factor that contributes to the incidence of hip fractures is a higher risk for older adults? A. Carelessness B. Fragility of bone C. Sedentary existence D. Rheumatoid disease

B. Fragility of bone Bones become more fragile because of loss of bone density associated with the aging process; this often is associated with lower circulating levels of estrogens or testosterone. Carelessness is a characteristic applicable to certain individuals rather than to people within a developmental level. Although prolonged lack of weight-bearing activity is associated with bone demineralization, hip fractures also occur in active older adults. Rheumatoid diseases can affect the skeletal system but do not increase the incidence of hip fractures.

Which type of cast or splint will the nurse expect to see on a child with a fractured femur? A. Cylinder B. Hip spica C. Prefabricated knee D. Robert Jones

B. Hip spica A hip spica cast is now mainly used for femur fractures in children. A cylinder cast is used for knee fractures because it extends from the groin to the malleoli of the ankle. a prefabricated knee splint is a commonly used cast for lower extremity injuries. A Robert Jones dressing is composed of bulky padding materials, splints, and elastic wrap or stoninetyte used for lower extremity injuries.

Which phrase describes a greenstick fracture? A. More than two fragments B. Incomplete with one side bent C. Spontaneous, at the site of bone disease D. Across the longitudinal axis of the bone shaft

B. Incomplete with one side bent An incomplete fracture with one side splintered and the other side bent indicates a greenstick fracture. A fracture with more than two fragments that appear to be floating is known as a comminuted fracture. A pathological fracture is a spontaneous fracture found at the site of bone disease. A transverse fracture extends across the longitudinal axis of the bone shaft.

Which information would the nurse include in a teaching session about osteochondroma? A. It is a common malignant tumor B. It occurs most often in those 10 to 25 years old C. It has a high rate of local occurrence after surgery D. It frequently arises in cancellous ends of arm and leg bones

B. It occurs most often in those 10 to 25 years old Osteochondroma is common in the age group of 1- to 25 years. It is a primary benign tumor. Osteoclastoma has a high rate of local occurrence after surgery and chemotherapy. Osteoclastoma frequently arises in cancellous ends of arm and leg bones; osteochondroma occurs in the metaphysical portion of long bones.

Which joint would be palpated by the nurse to identify genu valgum? A. Hip B. Knee C. Temporomandibular D. Metacarpophalangeal

B. Knee Also known as knock-knees, genu valgum is a condition in which the knees are poorly aligned. The knee joint should be assessed for any abnormalities or the presence of effusion. The hip joint is assessed to determine mobility and to find any hip pain experienced in the groin or pain that radiates to the knees. The temporomandibular joint is palpated to determine any weakness or pain in the face. The metacarpophalangeal joint is palpated to assess hand function based on the range of motion.

When a client injures the amphiarthrodial joint, which joint did the client injure? A. Knee joint B. Pelvic joint C. Elbow joint D. Cranial joint

B. Pelvic joint Amphiarthrodial joints are those that permit slight movements. The pelvic joint is an example of amphiarthrodial joint. Knee and elbow joints are the examples of diarthrodial joints, which are freely movable. A cranial joint is an example of a synarthrodial joint, which is immovable.

Which action would the nurse take in caring for a client after surgical placement of an external fixator on the client's leg? A. Cleanse the pin sites with alcohol several times a day B. Perform a neurovascular assessment of the lower extremities C. Ambulate the client with partial weight bearing on the affected leg D. Maintain placement of an abduction pillow between the client's legs

B. Perform a neurovascular assessment of the lower extremities A neurovascular assessment identifies early signs and symptoms of compartment syndrome. Compartment syndrome is increased pressure within a closed fascial space caused by a fracture or soft-tissue damage that compresses circulatory vessels, nerves, and tissues, compromising viability of the limb. The nurse would monitor for the six Ps: unrelenting pain, pallor, paresthesia, pressure, pulselessness, and paralysis. In addition, the circumference of the extremity will increase, and the leg will feel hard and firm on palpation. Both legs are assessed for symmetry. There is no established standard of care associated with pincer; some primary health care providers believe that pin care is contraindicated because it disrupts the skin's natural barrier to infection. Initially the client should use a wheelchair or walk without bearing weight on the affected extremity. As healing occurs, the primary health care provider will prescribe progressive weight bearing exercises. Maintaining abduction of the leg is not necessary with an external fixation of the tibia.

The nurse advises a client recovering from a musculoskeletal injury to increase intake of which nutrient? A. Fat B. Protein C. Sodium D. Vitamin A

B. Protein People suffering from a musculoskeletal injury should be advised to increase their intake of protein to promotes tissue healing and recovery. Also important are adequate intake of fluids, fiber, and minerals such as calcium, phosphorus, and magnesium. Fat, sodium, and vitamin A are not specifically beneficial for musculoskeletal injuries.

Three days after a cast is applied to a client's fractured tibia, the client reports burning pain over the ankle that is not relieved by a change of position. The cast over the ankle feels warm to the touch. Which action would the nurse take first? A. Request a prescription for an antibiotic B. Report the data to the primary health care provider C. Administer the prescribed medication for pain D. Reassure the client that this is expected after a cat is applied

B. Report the data to the primary health care provider The client's concern indicates tissue hypoxia or breakdown and should be reported to the primary health care provider. Other data, such as elevated temperature or increased white blood cells, are not present to support the presence of an infection. Although administering the prescribed medication for pain will be done to provide relief of pain, the priority is to notify the primary health care provider. This is not a typical response to a cast and may indicate a complication.

Which bones are examples of a client's flat bones? Select all that apply. One, some, or all responses may be correct. A. Sacrum B. Scapula C. Sternum D. Humerus E. Mandible

B. Scapula C. Sternum Flat bones such as the scapula and sternum are compact bones separated by a layer of cancellous bone that contains bone marrow. Bones such as the sacrum and mandible are irregular bones; the appear in a variety of shapes and sizes. The humerus is a long bone with a central shaft and two widened ends.

Which individual's activities increase the risk of developing carpal tunnel syndrome? A. Housekeeper B. Software engineer C. Health care worker D. Professional athlete

B. Software engineer Carpal tunnel syndrome is a painful condition of the hands and fingers that is caused by repetitive movements that lead to compression of the medial nerve near the wrist. Computer-related jobs involve repetitive movement of the fingers and hand, thereby predisposing the individual to carpal tunnel syndrome. Musculoskeletal injuries can occur in clients whose jobs require manual labor, such as housekeepers and mechanics. Health care workers may be at risk for developing back injury caused by prolonged standing and excessive lifting. Professional athletes experience acute musculoskeletal injuries, such as joint dislocations and fractures.

Which diagnostic study is used to determine bone density? A. Diskogram B. Standard x-ray C. Computed tomography (CT) scan D. Magnetic resonance imaging (MRI)

B. Standard x-ray A standard x-ray is used to determine bone density. A diskogram is used to visualize abnormalities of the intervertebral disc. A CT scan is used to identify soft tissues, bony abnormalities, and various types of musculoskeletal trauma. MRI is used to diagnose avascular necrosis, disc disease, tumors, osteomyelitis, ligament tears, and cartilage tears.

Which clinical findings indicate compromised circulation for a client with a long leg cast? Select all that apply. One, some, or all responses may be correct. A. Foul odor B. Swelling of the toes C. Drainage on the cast D. Increased temperature E. Prolonged capillary refill

B. Swelling of the toes E. Prolonged capillary refill Constriction of circulation decreases venous return and increases pressure within the vessels. Fluid then moves into the interstitial spaces, causing edema. Impaired circulation is evidenced by prolonged capillary refill after the toes are compressed. A foul odor, drainage on the case, or an increased temperature may indicate the presence of an infection.

Which hormone increases the rate of protein synthesis? A. Estrogen B. Thyroxine C. Parathormone D. Vitamin D

B. Thyroxine Thyroxine increases the rate of protein synthesis in all the body tissues. Estrogen stimulates bone-building, which is known as osteoblastic activity. Parathormone promotes osteoclastic activity in a state of hypocalcemia. Vitamin D and its metabolites are produced in the body and transported in the blood to promote the absorption of calcium and phosphorus from the small intestine.

While providing care for a client with a second-degree left ankle sprain, the nurse raises the injured part above heart level. Which statement provides the reason behind this nursing intervention? A. To promote bone density B. To prevent further edema C. To reduce pain perception D. To increase muscle strength

B. To prevent further edema A client with a second-degree sprain may have a deeply torn ankle ligament with swelling and tenderness. Elevation of the injured lower limb above heart level helps mobilization of the excess fluid from the area and prevents further edema. Strengthening exercises help build bone density and muscle strength and significantly reduce the rim of sprains and strains. Cryotherapy and adequate rest help reduce pain by reducing the transmission and perception of pain impulses.

A client returns from surgery, after a right below-the-knee amputation, with the residual limb straight, but elevated on a pillow to prevent edema. In which position would the nurse place the client after the first postoperative day? A. Any position, as long as the residual limb remains immobilized B. Turn client to the prone position for 15 to 20 minutes at least three times a day C. For short periods, position the client in the right side-lying position D. Maintain elevation of the residual limb for a total of 3 days

B. Turn client to the prone position for 15 to 20 minutes at least three times a day Positioning the client in the prone position for short periods helps prevent hip flexion contractures. Do not immobilize the client's residual limb, but do not keep the joint bent for prolonged periods. Begin exercise to prevent contractures as soon as possible. Positioning the client in the right side-lying portion can cause trauma to the incision site and should be avoided. Do not elevate the client's residual limb for more than 48 hours because hip flexion contractures can result.

The nurse is preparing to initiate antibiotic therapy for a client who developed an incisional infection. Which task would the nurse ensure has been completed before starting the first dose of intravenous antibiotics? A. Red blood cell count B. Wound culture C. Knee x-ray D. Urinalysis

B. Wound culture A wound culture always should be completed before the first dose of antibiotic. A wound culture is obtained to determine the organism that is growing. A broad spectrum antibiotic often is given first; after the organism has been identified an organism-specific antibiotic can be given. There is no indication that a red blood cell count is needed; however, a white blood cell count would be beneficial. A urinalysis is not needed, because data gathered during the assessment indicate an incisional infection. At the early stage of infection, there is no need to obtain a knee x-ray.

A client who had an above-the-knee amputation has an elastic bandage around the residual limb. Which action would the nurse take when rewrapping the bandage? A. Apply it tightly so it does not slip off B. Reapply it only if it slips off C. Apply it smoothly without creases D. Reapply it with the limb in dependent position

C. Apply it smoothly without creases The elastic bandage must be applied smoothly without wrinkles, folds, or creases, because these can cause excessive pressure or irritation. Applying it tightly may impede circulation; the bandage should be snug, not tight. The bandage should be reapplied whenever necessary; this may be necessary if it slips off, if it is too tight or too loose, or if it becomes wrinkled or creased. The dependent position allows the blood vessels to become engorged; the bandage should be applied with the residual limb level with the heart.

Which instruction would the nurse give a client returning to work as a carpenter after surgery for carpal tunnel syndrome of the right hand? A. 'Avoid carrying tools with the arms.' B. 'Learn to hammer with the left hand.' C. 'Do stretching exercises during breaks.' D. 'Avoid power tools such as drills or screwdrivers.'

C. 'Do stretching exercises during breaks.' Stretching exercises will assist in keeping the muscles and tendons supple and pliable, thus reducing the traumatic consequences of repetitive activity. The problem is not caused by carrying articles in the arms but by repetitve-type trauma. Learning to hammer with the left hand is not a satisfactory alternative for a skilled carpenter. The use of power tools will not be a problem.

A middle-aged adult reports fatigue and decreased strength in the limbs. Which suggestion would the nurse provide to the client? A. 'Include more carbohydrates in your diet.' B. 'Drink 2 cups of milk daily.' C. 'Perform push-ups in the morning.' D. 'Use warm compresses on your muscles.'

C. 'Perform push-ups in the morning.' Decreased muscle strength occurs with aging. This can be resolved by performing isometric exercises. Therefore suggesting the client perform push-ups in the morning would be most beneficial. Increasing carbohydrates will not improve strength or prevent fatigue. Milk is rich in calcium, which is good for the overall health and especially the bones, but it will not increase strength. Warm compresses are used to reduce pain and inflammation caused by injury.

A client admitted to the hospital with an acute episode of rheumatoid arthritis (RA) asks why physical therapy has not been prescribed. Which response would the nurse make? A. 'Your primary healthcare provider must have forgotten to prescribe it.' B. 'Your condition is not severe enough to have physical therapy approved.' C. 'Your joints are still inflamed, and physical therapy can be harmful.' D. 'Physical therapy is not helpful for persons who suffer from RA.'

C. 'Your joints are still inflamed, and physical therapy can be harmful.' Rest is required during active inflammation of the joints to prevent injury; once active inflammation has receded, an activity and exercise regimen can begin. Physical therapy is not prescribed during a period of exacerbation because it can traumatize already inflamed joints. The extent of the arthritis is not the determinant; whether the process is in exacerbation or remission is the deciding factor. Physical therapy is helpful, but it is not perfumed during an acute exacerbation of the arthritis.

Which finding would the nurse document as a muscle strength score of 4? A. No detection of muscular contraction B. A barely detectable flicker or trace of contraction C. Active movement against gravity and some resistance D. Active movement against gravity only, not against resistance

C. Active movement against gravity and some resistance According to the muscle-strength scale, a score of 4 indicates active movement of the muscle against gravity and some resistance. A score of 0 indicates no muscular contraction. A score of 1 indicates a barely detectable flicker or trace of contraction. A score of 3 indicates active movement against gravity only, not against resistance.

Which instruction would the nurse provide to an older client using ice and heat to treat pain from back strain? A. Switch positions every 4 hours B. Use a heating pad for the first 24 hours C. Apply for 30-minute time intervals D. Place the ice pack directly to injury site E. Take ibuprofen every 4 hours PRN

C. Apply for 30-minute time intervals To prevent skin damage, ice and heat should only be applied for 20- to 30-minute intervals. Clients should be instructed to shift positions every hour to prevent skin breakdown. Ice should be used the first 24 to 48 hours followed by heat. Ice should never be directly applied to the skin as it can cause injury to the tissue. The client can take ibuprofen if approved by the health care provider.

A client returns from the post anesthesia care unit after a rotator cuff repair. Which action would the nurse take? A. Monitor for a pulse deficit B. Obtain hourly blood pressure readings C. Assess for capillary refill in the nail beds D. Put the should through range-of-motion exercises

C. Assess for capillary refill in the nail beds Capillary refill and quality of the pulse in the affected arm reflect the status of circulation distal to the operative site. A pulse deficit is the difference between the apical and radial rates. Monitoring for a pulse deficit is related to monitoring the function of the heart, not peripheral circulation. Obtaining hourly blood pressure readings is unnecessary. Placing the should through range-of-motion exercises is contraindicated immediately after surgery. In this situation, range-of-motion exercises require a primary health care provider's prescription.

Which joint helps in the gliding movement of the wrist? A. Pivot joint B. Hinge joint C. Biaxial joint D. Ball and socket joint

C. Biaxial joint The biaxial joint helps in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Hinge joints allow for flexion and extension. Ball and socket joints permit movement in the shoulders and hips.

Which ethnic group has a greater incidence of osteoporosis due to musculoskeletal differences? A. Irish Americans B. African Americans C. Chinese Americans D. Egyptian Americans

C. Chinese Americans Chinese Americans have an increased incidence of osteoporosis because they have shorter and smaller bones with lower bone density. Irish Americans have taller and broader bones than other Euro-Americans. African Americans have a decreased incidence of osteoporosis. Egyptian Americans are shorter in stature than Euro-Americans and African Americans.

Which medication is used in the treatment of a client with intervertebral disc disease? A. Etidronate B. Zoledronic acid C. Cyclobenzaprine D. Salmon calcitonin

C. Cyclobenzaprine Intervertebral disc disease often causes myalgia. Muscle relaxants, such as cyclobenzaprine, are used in its treatment. Etidronate, zoledronic acid, and salmon calcitonin are effective in the treatment of osteoporosis.

Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities? A. Thermography B. Plethysmography C. Duplex venous Doppler D. Somatosensory evoked potential

C. Duplex venous Doppler Duplex venous Doppler records an ultrasound of the veins, including blood flow abnormalities of the lower extremities, aiding detection of deep vein thrombosis. Thermography, which measures the heat radiating from the skin surface, is used to determine client response to anti-inflammatory medication therapy and inflamed joints. Plethysmography is used to record variations in volume and pressure of blood passing through tissues; the test is nonspecific. Somatosensory evoked potential is used to identify subtle dysfunction of lower motor neurons and primary muscle disease.

After a painful exacerbation of rheumatoid arthritis, a client is scheduled to begin a walking and exercise program. Which statements describes an expected outcome for this client? A. When pain free, begin exercising in a formal activity program B. Avoid exercising when there is a moderate amount of discomfort C. Exercise and be active unless the discomfort becomes too great D. Walk and exercise even when the pain is severe

C. Exercise and be active unless the discomfort becomes too great Some pain is to be expected, but the activity should not be continued when the pain becomes severe, because it can further traumatize the inflamed synovial membranes. It is unrealistic to expect the client to be pain free, so exercise would never begin. Some discomfort is expected; inactivity promotes the development of muscle atrophy and joint contracture. Activity should be curtailed when pain is severe.

Non-weight bearing with crutches has been prescribed for a client with a leg injury. Which activity would the nurse teach the client to prepare for crutch walking? A. Sit up in a chair to help strengthen back muscles B. Keep the unaffected leg in extension and abduction C. Exercise the triceps, finger flexors, and elbow extensors D. Use a trapeze frequently to strengthen the biceps muscles

C. Exercise the triceps, finger flexors, and elbow extensors The triceps, finger flexors, and elbow extensors are used in crutch walking and need strengthening. Although back muscles keep the person erect, the most important muscles for walking with crutches are the triceps, elbow extensors, finger flexors, and the muscles in the unaffected leg. Keeping the unaffected leg in extension and abduction will do nothing to promote cutch walking. A pushing, not a pulling, motion is used with crutches; the triceps, not the biceps, are used.

Which hormone aids in regulating intestinal calcium and phosphorous absorption? A. Insulin B. Thyroxine C. Glucocorticoids D. Parathyroid Hormone

C. Glucocorticoids Adrenal Glucocorticoids aid in regulating intestinal calcium and phosphorous absorption by increasing or decreasing protein metabolism. Insulin acts together with growth hormone to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion increases in response to decreased serum calcium concentration and stimulates the bones to promote osteoclastic activity.

The nurse finds the client on the floor, crying for help, with signs of a hip fracture. Which action would the nurse take first? A. Administer pain medication B. Place the affected extremity in traction C. Immobilize the affected extremity D. Notify the primary health care provider on call

C. Immobilize the affected extremity The nurse would immobilize the affected extremity first. Further damage and internal bleeding could occur if the extremity is not immobilized. Clients do experience pain with a hip fracture and will require pain medication; however, the emergency management for a fractured hip is to immobilize the extremity. The nurse will need to notify the client's primary health care provider, but the priority is to immobilize the extremity.

A client who is receiving radiation therapy for bone cancer lives alone and works full time. Which client action would the nurse encourage? A. Begin to perform regularly scheduled aerobic activity daily B. Take a leave of absence from work when receiving therapy C. Include rest periods during the day while receiving radiation D. Continue the activities usually performed before becoming ill

C. Include rest periods during the day while receiving radiation Radiation is fatiguing; therefore, rest periods will combat fatigue. rest ultimately will promote performance of activities of daily living and independence. increasing activity at this time is not advised because fatigue is a side effect of radiation. Maintaining independence is important, and a leave of absence may not be emotionally or financially feasible. Although normalizing activities is desirable, this may be unrealistic when the side effects of radiation therapy are considered.

Which position would the nurse use for placement of the affected extremity of a client who is recovering from an open reduction and internal fixation (ORIF) of a fractured hip? A. External rotation B. Slight hip flexion C. Moderate abduction D. Anatomic body alignment

C. Moderate abduction Abduction reduces stress on anatomic structures and maintains the head of the femur in the acetabulum. External rotation places stress on the acetabulum and the head of the femur. Hip flexion may dislodge the head of the femur from the acetabulum. Functional alignment places stress on the bone, soft tissue, and nail plate; it can cause damage and dislocation of the head of the femur.

Which element would the nurse focus on when teaching crutch-walking to a client who has a casted leg fracture? A. Establishing a schedule for pain medication B. Maintaining a fixed schedule of daily activities C. Modifying the home environment to prevent accidents D. Understanding that a more sedentary lifestyle is necessary

C. Modifying the home environment to prevent accidents Modifications in the home may be needed to permit safe use of crutches. Pain medications should not be required on a regular basis. The client may vary the schedule of activities based on abilities and responses to activities. The client does not have to be sedentary; crutches are used for ambulation.

The health care provider prescribed raloxifene for a client with osteoporosis. Which manifestation would the nurse monitor in this client? A. Check serum creatinine B. Monitor urinary calcium C. Monitor liver function tests D. Observe for anxiety and drowsiness

C. Monitor liver function tests Raloxifene increases the risk for hepatic disease. The nurse would monitor the client's liver function test when prescribed this medication. Check serum creatinine for clients prescribed zoledronic aced. Monitor urinary calcium in clients prescribed calcium supplements. Observe for anxiety and drowsiness in clients prescribed risendronate.

Which muscle-strength rating would the nurse record for a client who can complete range of motion with some resistance? A. 1 B. 2 C. 3 D. 4

D. 4 According to the common scale for grading muscle strength, a client who can complete range of motion with some resistance is given the rating 4. Rating 1 is given to a client with no joint motion and slight evidence of muscle contractility. Rating 2 is given to a client who can complete range of motion with gravity eliminated. Rating 3 is given to a client who can complete range of motion against gravity.

Which synovial joint movement is involved in turning a client's palm downward? A. Eversion B. Inversion C. Pronation D. Supination

C. Pronation Pronation is the movement involved in turning the palm downward. Eversion involves turning the sole outward away from the midline of the body. Inversion involves turning the sole inward towards the midline of the body. Supination involves turning the palm upward.

Which musculoskeletal abnormality would the nurse suspect in a client who exhibits short steps and drags a foot? A. Torticollis B. Pes planus C. Spastic gait D. Steppage gait

C. Spastic gait Spastic gait is a musculoskeletal abnormality, caused by cerebral palsy, that results in short steps and dragging of the foot. Torticollis is a twisting of the client's neck to one side. Pes planus, also called flatfoot, is an abnormal flatness of the sole and arch of the foot. Stoppage gait is an increase in hip and knee flexion to clear the foot from the floor; footdrop will be evident in the affected client.

A client sustains a back injury after falling 20 feet (6 m). In which position would the nurse place the client? A. Lateral position with a pillow between the knees B. Any position that reduces pain and is comfortable C. Supine position while not allowing the spine to flex D. Sitting position with a pillow placed in the small of the back

C. Supine position while not allowing the spine to flex When caring for a client with a suspected back injury, the client should be positioned to keep the vertebral column in alignment (back straight) to prevent further spinal cord damage by vertebral (bone) movements. The lateral position with a pillow between the knees is contraindicated, because it may cause the spine to torque. To prevent additional damage to the spinal cord, the vertebral column should be kept horizontal with the spine in alignment. The comfortable position chosen by the client may be contraindicated, because it may not maintain the spine in alignment. The sitting position is contraindicated because it causes the spine to flex, which can precipitate additional injury.

Which surgery is used as a prophylactic measure and as a palliative treatment for clients with rheumatoid arthritis (RA)? A. Osteotomy B. Arthrodesis C. Synovectomy D. Debridement

C. Synovectomy Synovectomy is a type of joint surgery that involves the removal of thickened synovial membrane. It is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA) because it prevents the serious destruction of joint surfaces. Osteotomy involves removing a wedge of bone to correct deformity and relieve pain. Arthrodesis is the surgical fusion of a joint. Debridement involves the surgical removal of degenerative debris from a joint.

Which statement explains the benefit of continuous regional analgesia versus conventional methods? A. It is easy to adjust the dose B. Neuropathic pain can be relieved C. Systemic side effects are minimal D. Parenteral medication is not needed

C. Systemic side effects are minimal Regional analgesia uses a local anesthetic to control pain; the local effect prevents systemic reactions. The dose adjustment involves the same level of complexity as conventional methods. The hip replacement involves somatic, not neuropathic, pain. Parenteral medication is used in conjunction with regional analgesia.

Which is an example of a short bone? A. Tibia B. Femur C. Tarsals D. Humerus

C. Tarsals Tarsals are short bones, unlike the tibia, femur, and humerus, which are long bones. Short bones do not have epiphysis and diaphysis.

Which principle should the nurse consider when assisting a client with crutches to learn the four-point gait? A. Elbows should be kept in rigid extension B. Most of the client's weight should be supported by axillae C. The client must be able to bear weight on both legs D. The affected extremity should be kept off the ground

C. The client must be able to bear weight on both legs In the four-point gait, the client brings the left crutch forward first, followed by the right foot; then the right crutch is brought forward, followed by the left foot. Thus both legs must be able to bear some weight. Although the arms are extended to allow the hands to bear weight, the elbows are not maintained in this position. Pressure on the axillae may damage nerves in the area. Both extremities must be able to bear weight and touch the ground.

Which diagnostic study would the health care provider use to investigate the cause of an inflamed joint and determine a client's response to anti-inflammatory medication therapy? A. Duplex venous Doppler B. Plethysmography C. Thermography D. Somatosensory evoked potential

C. Thermography Thermography uses an infrared detector that measures the degree of heat radiating from the skin's surface. Health care providers use this method to investigate the cause of an inflamed joint and in determining the client's response to anti-inflammatory medication therapy. Use of plethysmography is to record variations in volume and pressure of blood passing through tissues. Duplex venous Doppler records blood flow abnormalities to the lower extremities, which helps detect deep vein thrombosis. Somatosensory evoked potential use identifies subtle dysfunction of lower motor neuron and primary muscle disease.

Which instruction would the nurse give a client while performing McMurray's test? A. To raise the leg to 60 degrees B. To abduct the arm to 90 degrees C. To flex, rotate, and extend the knee D. To flex the knee to 30 degrees and pull the tibia forward

C. To flex, rotate, and extend the knee McMurray's test is done by flexion, internal rotation, and then extension of the knee. A straight-leg-raising test is performed by raising the leg to 60 degrees. The drop arm test is done by abducting the arm to 90 degrees. Lachman's 1st is performed by flexing the knee 30 degrees and pulling the tibia forward.

Which action would the nurse take to increase counetrtraction for a client in Buck traction? A. Add more weight to the traction B. Elevate the head of the client's bed C. Use a slight trendelenburg position D. Apply a chest restraint around the client

C. Use a slight trendelenburg position Elevating the foot of the bed uses gravity and the client's weight for countertraction. Elevating the head of the bed will not increase countertraction. Adding more weight to the traction will increase traction rather than countertraction. Tying a chest restraint around the client will have no effect on countertraction.

Which factors may have led to the development of flexion contractures in a client with osteoarthritis (OA)? A. Wearing shoes without insoles B. Elevating the legs 8 to 12 inches C. Using large pillows under the knees or head D. Placing a small pillow under the head in the supine position

C. Using large pillows under the knees or head The use of large pillows under the knees or head may result in flexion contractures that keep the client from straightening the knees fully. A client with OA will have severe pain in the affected joint during or after movement. In this case, the nurses would teach the client to position the joints in the functional position. Wearing shoes without insoles may result in pressure on painful metatarsal joints. The legs may be leveled 8 to 12 inches (20-30 cm) re reduce back discomfort associated with OA. The client may use a small pillow under their head when in the supine position to reduce discomfort, but otherwise, avoid the use of other pillows.

A client reports mild tenderness and swelling near the ankle while running. Which nursing instruction would help the client prevent future injury? A. 'Do vigorous endurance exercises.' B. 'Complete your activity with a balancing exercise.' C. 'Perform strengthening exercises in between your activity.' D. 'Do warm-up muscle exercises before performing an activity.'

D. 'Do warm-up muscle exercises before performing an activity.' A client with mild tenderness and swelling at the ankle area has a first-degree (mild) sprain. Warming up muscles then doing stretching exercises before performing any vigorous activity may reduce the risk of sprains and strains. The sprain may be reduced when endurance exercises start at a low level of effort and progress gradually to moderate level. Balancing exercises, which may overlap with some strengthening exercises, help prevent falling but are not as important in a strain as in proper warm-up. Strengthening exercises must be done before undertaking an activity to build muscle strength and bone density.

Which statement by a female client with a non-weight-bearing long leg cast indicates the need for additional discharge teaching? A. 'The cast can be wrapped in plastic when I take a shower.' B. 'I called my office to let them know I will be back at work next week.' C. 'The physical therapist is going to teach me how to walk with crutches.' D. 'I am going to give myself a pedicure with red nail polish when I get home.'

D. 'I am going to give myself a pedicure with red nail polish when I get home.' Red nail polish (or any opaque color) will interfere with the ability to assess the toes for capillary refill; effective capillary refill, after releasing compression of the toenail, confirms that the cast is not compromising circulation to the distal part of the extremity. Wrapping the cast in plastic is an effective way of protecting the long leg cast during a shower. usual daily activities can be resumed after the application of a cast. Teaching the client how to use the crutches is the role of they physical therapist.

Which statement by the client indicates that the nurse's teaching was effective regarding intravenous gentamicin therapy? A. 'I should drink lots of water if I am retaining urine.' B. 'I should use eyeglasses if I develop vision problems.' C. 'I should stop the medication when the symptoms have subsided.' D. 'I should report any hearing loss to the primary health care provider.'

D. 'I should report any hearing loss to the primary health care provider.' Acute osteomyelitis is treated with antibiotics such as gentamicin. Gentamicin use can cause ear toxicity; therefore, the client should report any hearing loss to the primary health care provider. Gentamicin also causes urine retention, but increasing water intake can aggravate this condition; therefore, the client should report this issue to the primary health care provider instead of increasing water consumption. Gentamicin may cause visual disturbances and should be reported to the primary health care provider; use of inappropriate eyeglasses, or use of glasses without first consulting the primary health care provider, increases the risk of falls or accidents to the patient. The client should not stop taking the medication without consulting the primary health care provider, even if the symptoms have subsided.

After signing a legal consent for hip replacement surgery and within hours before the surgery, the client states, 'I decided not to go through with the surgery.' Which response would the nurse use initially? A. 'Then you shouldn't have signed the consent.' B. 'I can understand why you changed your mind.' C. 'Tell me why you decided to refuse the operation.' D. 'Let's talk about your concerns regarding the procedure.'

D. 'Let's talk about your concerns regarding the procedure.' The response, 'Let's talk about your concerns regarding the procedure,' attempts to explore why the client is refusing the procedure and promotes communication. The response, 'Then you shouldn't have signed the consent,' is accusatory; the client has the right to withdraw consent at any time. The response, 'I can understand why you changed your mind,' draws conclusion without adequate data; also, the statement may increase the client's anxiety level. The response, 'Tell me why you decided to refuse the operation,' may be too direct and authoritative; also the statement may put the client on the defensive.

Which term describes synovial joint movement away from the midline of the body? A. Inversion B. Extension C. Pronation D. Abduction

D. Abduction Abduction is a synovial joint movement that involves movement of a part away from the midline of the body. Inversion is turning of the sole inward toward the midline of the body. Pronation is a synovial joint movement that involves the turning of the palm downward. Extension is a synovial joint movement that involves a straightening of joint that increases the angle between two bones.

Which client response is consistent with a s core of 3 on the muscle-strength scale? A. Absence of muscular contraction B. Active movement against full resistance C. Barely detectable contraction with palpation D. Active movement against gravity but not against resistance

D. Active movement against gravity but not against resistance The muscle-strength test is useful to grade the strength of a client muscles during contraction. The presence of active movement against gravity and not against resistance receives a score of 3 as per the muscle-strength scale. The complete absence of muscular contraction is scored as 0. The active movement against full resistance without evident fatigue indicates normal muscle strength and is scored as 5. Barely detectable contraction indicates weak muscle tone and is scored as 1.

Which client action would the nurse score as 3 on the muscle-strength scale? A. Active movement against gravity and some resistance B. Active movement of body part with elimination of gravity C. Active movement against full resistance without evident fatigue D. Active movement against gravity only and not against resistance

D. Active movement against gravity only and not against resistance According to the muscle-strength scale, a score of 3 indicates active movement against gravity only and not against resistance. A score of 4 indicates active movement against gravity and some resistance. A score of 2 indicates active movement of a body part with elimination of gravity. A score of 5 indicates active movement against full resistance without evident fatigue.

Which type of joint permits movement in any direction? A. Pivot B. Hinge C. Biaxial D. Ball-and-socket

D. Ball-and-socket Ball-and-socket joints permit movement in any direction. Pivot joints permit rotation. Hinge joints allow motion in one place. Biaxial joints permit gliding movement.

Which condition can be identified in a client using Phalen's test? A. Atrophy B. Bone tumor C. Rotator cuff injury D. Carpal tunnel syndrome

D. Carpal tunnel syndrome Whalen's test is used to detect carpal tunnel syndrome. A muscle biopsy is done for the diagnosis of atrophy. A computed tomography scan is done to diagnose a bone tumor. The drop arm test is performed to detect rotator cuff injuries.

A child's blood test after receiving a general anesthetic indicates increased intracellular calcium levels. Which medication would the nurse anticipate administering to this client? A. Aspirin B. Naproxen C. Ibuprofen D. Dantrolene

D. Dantrolene The administration of general anesthetic sometimes causes malignant hyperthermia in clients. The characteristics of malignant hyperthermia are increased levels of intracellular calcium in the body. Dantrolene sodium reduces the muscle tone and metabolism to decrease the calcium levels in the body. Dantrolene antagonizes the effects of malignant hyperthermia in this client. Do not administer aspiring to children because it increases the risk of Reye syndrome. Medications such as naproxen and ibuprofen may not reduce calcium levels in the body and thus are unable to reverse the effects of malignant hyperthermia in the client.

Which motions would the nurse perform on a client's ankle to demonstrate full range-of-motion? A. Flexion, extension, and rotation B. Abduction, flexion, adduction, and extension C. Pronation, supination, rotation, and extension D. Dorsiflexion, plantar flexion, eversion, and inversion

D. Dorsiflexion, plantar flexion, eversion, and inversion Dorsiflexion, plantar flexion, eversion, and inversion movements include all possible ranges of motion for the ankle joint. Although the ankle can be moved in a circular motion, flexion and extension more specifically are called dorsiflexion and plantar flexion in relation to the ankle. Also, eversion and inversion should be done when manipulating the ankle. The ankle cannot be abducted or adducted but can be inverted or everted. Pronation, supination, rotation, and extension refer to the upper extremities.

Which type of joint is present in between the client's tarsal bones? A. Pivot B. Hinge C. Saddle D. Gliding

D. Gliding The gliding joint is present in between the tarsal bones. The pivot joint is present in the proximal radioulnar joint. The hinge joint is present in the elbows and knees. The saddle joint is present in between the carpometacarpal joints of the thumb.

Which intervention would the nurse add to the care plan for a client who is to undergo electromyography? A. Encourage the client to sleep quietly during the procedure B. Prepare the client to stay in a sitting position during the procedure C. Inform the client that the procedure is both painless and noninvasive D. Instruct the client to avoid drinking coffee or tea 24 hours before the procedure

D. Instruct the client to avoid drinking coffee or tea 24 hours before the procedure An electromyogram is a diagnostic procedure used to evaluate electrical potential associated with skeletal muscle contraction. The nurse should instruct the client to avoid drinking coffee or tea in the 24 hours before the procedure to prevent stimulatory reactions. During the procedure, the client should be kept awake and instructed to cooperate with voluntary movement. The client is placed in a supine position on the table during the procedure for effective results. An electromyogram is a painful procedure because it involves insertion of needles.

Which tissue connects the client's tibia to the femur at the knee joint? A. Fascia B. Bursae C. Tendons D. Ligaments

D. Ligaments A ligament is a dense, fibrous connective tissue that connects bone to bone, such as the tibia to the femur at the knee joint. Ligaments provide stability while permitting controlled movement at the joint. Fascia is a connective tissue that can withstand limited stretching; it proved strength to muscle tissues. Bursae are smalls sacs of connective tissue lined with synovial membrane and synovial fluid that are located at bony prominences and joints to relieve pressure. A tendon is a dense, fibrous connective tissue that attaches muscle to bone.

Which nursing intervention prevents footdrop in a client with osteomyelitis? A. Elevating the foot with the use of pillows B. Consistently flexing the affected extremity C. Encouraging the client to change positions D. Neutral positioning of the foot with the use of a splint

D. Neutral positioning of the foot with the use of a splint A client with osteomyelitis is at an increased risk for footdrop, which results in an abnormal gait. Neutral positioning of the foot with the use of a splint can reduce the risk of footdrop in the client with osteomyelitis. Elevating the client's foot on pillows can reduce the risk of edema. Asking the client with osteomyelitis to flex the affected extremity can result in flexion contracture. Encouraging the client with osteomyelitis to change positions helps prevent complications associated with immobility and promotes comfort; carefully handle the involved limb and avoid excessive manipulation, which may lead to a pathological fracture.

Which client's joint fluid examination report indicates a normal finding? A. Presence of uric acid crystals in the fluid B. Floating fat globules in the fluid C. Thick, purulent fluid D. Transparent, straw-colored fluid

D. Transparent, straw-colored fluid Joint fluid is normally transparent and colorless or straw-colored. Client D's joint fluid is normal. The presence of uric acid crystals in client Ads fluid suggests gout. Floating fat globules in client B's joint fluid indicate a bone injury. The thick, purulent joint fluid found in client C indicates infection.

Which reason for a decrease in height is common in older women? A. Older adults have lower levels of growth hormone B. Older adults are not active enough, so they lose bone mass C. Older adults have poor posture, so they are shorter D. Older adults may have osteoporosis-related height changes

D. Older adults may have osteoporosis-related height changes Because of the decreasing amounts of estrogen in older women, there is a loss of calcium as well, which can lead to osteoporotic bone loss and a loss in height. Older adults have decreased levels of growth hormone but that does not cause a loss of height. Sweeping statements about older adults not being active enough or having poor posture are not accurate.

Which type of synovial joint movement is involved in moving the client's first and fifth metacarpals anteriorly from the flattened palm? A. Flexion B. Extension C. Abduction D. Opposition

D. Opposition Opposition is a synovial movement that involves moving the first and fifth metacarpals anteriorly from the flattened palm (cupping position). Flexion involves bending the joint as a result of muscle contractions that result in decreasing the angle between two bones. Extension involves the straightening of the joint that increases the angle between two bones. Abduction involves the movement of a part away from the midline of the body.

Which serum hormone level elevates in response to a client's total serum calcium concentration of 7.9 mg/dL (0.43 mmol/L)? A. Estrogen B. Thyroxine C. Growth hormone D. Parathyroid hormone (PTH)

D. Parathyroid hormone (PTH) The normal range of serum calcium lies between 9 and 10.5 mg/dL (0.5 and 0.55 mmol/L). When total serum calcium concentration levels lower, secretion of PTH increases and stimulates bones to promote osteoclastic activity, which increases serum calcium levels. Estrogens stimulate osteoblastic (bone-building) activity and inhibit PTH. Thyroxine increases the rate of protein synthesis in all types of tissues, including bone tissues. Growth hormones secreted by the anterior lobe of the pituitary gland are responsible for increasing bone length until puberty.

After surgery for a fractured hip, a client states, 'I don't remember when I have ever been so uncomfortable.' Which initial action would the nurse take? A. Notify the primary healthcare provider. B. Use distraction techniques. C. Medicate the client as prescribed. D. Perform a complete pain assessment

D. Perform a complete pain assessment A complete assessment must be performed to determine the location, characteristics, intensity, and duration of the pain. The pain may be incisional, result from a pulmonary embolus, or be caused by neurovascular trauma to the affected leg, and the intervention for each is different. Notifying the primary health care provider, using distraction techniques, and medicating the client as prescribed may be done after a complete assessment reveals that this is the appropriate interventions. Assessment is the priority.

Which key factor assists the nurse in assessing how a client will cope with the body image change after an above-the-knee amputation? A. Extent of the change B. Suddenness of the change C. Obviousness of the change D. Personal perception of the change

D. Personal perception of the change The reality of a situation is not the important issue at this time, but the client's feelings or perceptions about the change are the most important determinant of the client's ability to cope. The extent of change is not relevant; what is relevant is whether the client perceives the change as enormous or less important. Although suddenness of the change may influence a person's coping ability, this is not the primary factor influencing a client's coping mechanisms with body image changes. Although obviousness of the change may influence a person' coping ability, this is not the primary factor inflicting coping mechanisms with body image changes.

A nurse is caring for a client with a below-the-knee amputation. Which action would the nurse encourage the client to take to prepare the residual limb for a prosthesis? A. Abduct the residual limb when ambulating B. Dangle the residual limb off the bed frequently C. Soak the residual limb in warm water twice a day D. Press the end of the residual limb against a pillow periodically

D. Press the end of the residual limb against a pillow periodically The client usually is instructed to press the end of the residual limb against a pillow to toughen the limb for weight bearing; this process is begun by pushing the residual limb against increasingly harder surfaces. Abduction of the residual limb does not maintain functional alignment and should be avoided; it does not prepare the end of the residual limb for a prosthesis. Dangling the residual limb does not help prepare it for a prosthesis and may impede venous return, which prolongs healing. Soaking the residual limb in warm water twice a day may macerate the residual limb and hinder the use of a prosthesis.

After an above-the-knee amputation for bone cancer, an adolescent boy is returned to his room. He is monitored closely because of the potential for hemorrhage from the residual limb. Which would the nurse plan to keep at the bedside? A. Hemostat B. Vitamin K C. Protamine sulfate D. Pressure dressing

D. Pressure dressing A pressure dressing will control hemorrhage until surgical intervention can be instituted. A hemostat is not practical because bleeding may be internal. Vitamin K is the antidote for warfarin. There is no indication that the client is taking warfarin. Protamine sulfate is the antidote for an excessive amount of heparin; the client is not receiving heparin.

Which action would the nurse take postoperatively to position a client who had an open reduction and insertion of a prosthesis for a fracture of the femoral neck? A. Maintain the affected and unaffected leg in abduction B. Keep both legs in functional body alignment C. Intermittently place the client in the prone position D. Prevent adduction and external rotation of the affected extremity

D. Prevent adduction and external rotation of the affected extremity Adduction may cause dislocation of the new prosthesis, and external rotation increases tension on the suture line. Only the operated leg needs to be kept abducted. Keeping both legs in functional body alignment positions the affected leg too close to the midline and increases the danger of hip dislocation. The prone position is not advised because it puts excessive stress on the operative site.

Which clinical manifestation would the nurse expect to find from damage to major blood vessels caused by a fractured tibia? A. Increased blood pressure B. Extensive thigh edema C. Increased skin temperature of the foot D. Prolonged capillary refill of the toes

D. Prolonged capillary refill of the toes Damage to the blood vessels may decreases circulatory perfusion of the toes. Damage to the major blood vessels will more likely cause a decrease in blood pressure. The fracture is between the knee and the ankle, not in the thigh. Decreased circulatory perfusion of the foot causes the skin temperature to decrease.

Which type of diet would the nurse expect the primary health care provider to prescribe for a client diagnosed with rheumatoid arthritis? A. Salt-free, low-fiber diet B. High-calorie, low-cholesterol diet C. High-protein diet with minimal calcium D. Regular diet with vitamins and minerals

D. Regular diet with vitamins and minerals There are no dietary restrictions for clients with rheumatoid arthritis, but iron and vitamins should be encouraged to treat any underlying nutritional deficiencies. A salt-free, low-fiber diet is not indicated. A high-calorie diet will increase the client's weight; this is contraindicated because it will increase the strain o weight-bearing joints. A balanced diet should fulfill nutritional needs; there is no need to increase protein or restrict calcium.

Which joint is an example of a gliding joint? A. Wrist B. Elbow C. Shoulder D. Sacroiliac

D. Sacroiliac The sacroiliac joint connects the sacrum with the pelvis. it is a type of gliding joint, because one surface of the bone moves over another surface. The wrist joint is an example of a condyloid joint. the elbow joint is an example of a hinge joint. The shoulder joint is an example of a ball-and-socket joint.

Which type of joint is present in the client's shoulders? A. Pivotal B. Saddle C. Condyloid D. Spheroidal

D. Spheroidal The spheroidal joint is a ball and socket joint that provides flexion, extension, adduction, abduction, and circumduction in the shoulders and hips. The pivotal joint provides rotation in the atlas and axis, and at the proximal radioulnar joint. The saddle joint, which is at the carpometacarpal joint of the thumb, provides flexion, extension, abduction, adduction, and circumduction of the thumb-finger. The condyloid joint is a wrist joint between the radial and carpals; it provides flexion, extension, abduction, adduction and circumduction.

Several minutes after the start of a red blood cell infusion, the client reports itching. The nurse observes hives on the client's chest. Which action would the nurse take? A. Administer an antihistamine B. Flush the red blood cells with 5% dextrose C. Slow the rate of infusion D. Stop the transfusion

D. Stop the transfusion The client is experiencing an allergic reaction to the transfusion. The nurse would stop the transfusion immediately. The health care provider then should be notified. An antihistamine may be indicated but must be prescribed. Flushing red blood cells with dextrose will cause hemolysis and will not be effective in stopping the reaction. Slowing down the rate but continuing the infusion will make the situation worse.

At which joint would the nurse be able to palpate spongy swelling caused by excess synovial fluid? A. Biaxial joint B. Pivotal joint C. Synovial joint D. Temporomandibular joint

D. Temporomandibular joint The temporomandibular joint is palpated by asking the client to open his or her mouth; the nurse checks for any pain or weakness in the face. Common abnormal findings include tenderness, crepitus (a grating sound), and a spongy swelling caused by excess synovial fluid. Biaxial joints help in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Synovial joints provide movement at the point of contact of articulating bones such as the hip, shoulders, and knees.

A nurse is evaluating the actions of a caregiver for a client with a lower extremity cast. Which action of the caregiver indicates the nurse needs to provide additional instruction? A. Using a towel to dry the cast B. Moving joints above and below the cast regularly C. Elevating the injured part above heart level for 48 hours D. Wrapping the client's cast with a plastic cover for 36 hours

D. Wrapping the client's cast with a plastic cover for 36 hours Covering the cast in plastic for a prolonged period of time may lead to discomfort and need to be corrected by the nurse. All the other actions are correct. A towel may be used to blot dry the cast and prevent itching and infection. Moving joints above and below the cast daily prevents muscular atrophy. Elevation of the injured part above heart level for the first 48 hours helps to prevent edema due to fluid shift.

Which hormone promotes bone resorption in a client and potentially leads to decreased bone densities? A. Estrogen B. Calcitonin C. Growth hormone D. Parathyroid hormone (PTH)

When serum calcium levels lower, secretion of PTH increases and stimulates bones to promote osteoclastic activity, which promotes bone resorption. Estrogens stimulate osteoblastic (bone-building) activity and inhibit PTH. Calcitonin inhibits bone resorption and increases the renal exertion of calcium and phosphorus as needed to maintain balance in the body. Growth hormones secreted by the anterior lobe of the pituitary gland are responsible for increasing bone length.