Exam 3 Musculoskeletal Test Bank

In taking the health history of a client with severe painful osteoarthritis, the nurse would expect the client to report which of the following? 1. A gradual onset of the disease, with involvement of weight-bearing joints 2. A sudden onset of the disease, with involvement of all joints 3. Complaints of joint stiffness after periods of activity 4. Pain that improves with use of the joint

1. A gradual onset of the disease, with involvement of weight-bearing joints Osteoarthritis has a gradual onset and affects weight-bearing joints with pain that is more pronounced after exercise. The onset of osteoarthritis is gradual, not sudden. The client will usually complain of increased stiffness in the morning and also following periods of inactivity, with improvement following activity. Joint pain generally worsens with joint use and in the early stages of osteoarthritis, joint pain is relieved by rest. (Lewis 8 ed, p. 1642).

A 20-year-old client has developed osteomyelitis two weeks after a fishhook was removed from his foot. The client asks "Why do I need to take this antibiotic for 6 weeks?" Which rationale best explains the need for long term antibiotic therapy? 1. Bone has poor circulation 2. Tissue trauma requires antibiotics 3. Feet are normally more difficult to treat 4. Fishhook injuries are highly contaminated

1. Bone has poor circulation

In monitoring a client's response to disease modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply. 1. Control of symptoms during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show no progression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after the injection is given 6. A low-grade temperature on rising in the morning that remains throughout the day

1. Control of symptoms during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show no progression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow the progression of joint degeneration. In addition, an improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction should the nurse provide? 1. Drink 3000 mL of fluid a day. 2. Take the medication on an empty stomach. 3. The effect of the medication will occur immediately. 4. Any swelling of the lips is a normal expected response.

1. Drink 3000 mL of fluid a day. Rationale: Clients taking allopurinol are encouraged to drink 3000 mLof fluid a day, unless otherwise contraindicated. Afull therapeutic effect may take 1 week or longer. Allopurinol is to be given with, or immediately after, meals or milk. Aclient who develops a rash, irritation of the eyes, or swelling of the lips or mouth should contact the health care provider because this may indicate hypersensitivity.

Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the health care provider about the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hypothyroidism 4. Diabetes mellitus

1. Glaucoma Rationale: Because cyclobenzaprine has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, glaucoma, and increased intraocular pressure. Cyclobenzaprine should be used only for a short time (2 to 3 weeks). The conditions in options 2, 3, and 4 are not a concern with this medication.

A 55-year-old male client with severe painful osteoarthritis is recommended a regimen of heat, massage, and exercise. Why is the patient recommended such regimen? Because this regimen will: 1. Help relax muscles and relieve pain and stiffness 2. Restore range of motion previously lost 3. Prevent the inflammatory process 4. Help the client cope with pain effectively

1. Help relax muscles and relieve pain and stiffness Osteoarthritis has a gradual onset and affects weight-bearing joints with pain that is more pronounced after exercise. The onset of osteoarthritis is gradual, not sudden. The client will usually complain of increased stiffness in the morning and also following periods of inactivity, with improvement following activity. Joint pain generally worsens with joint use and in the early stages of osteoarthritis, joint pain is relieved by rest. (Lewis 8 ed, p. 1642).

A male client has been in a body cast for the past 2 days to treat numerous broken vertebrae from a fall. The client is reporting dyspnea, vomiting, epigastric pain, and abdominal distention. Which action demonstrates the best clinical judgement by a nurse? 1. Immediately notifies the client's physician of these findings 2. Initiates oxygen at 2 liters per nasal cannula to relieve the dyspnea 3. Place ice packs around the cast to reduce the abdominal distention 4. Administers ondansetron (Zofran®), the prescribed antiemetic on the client's MAR

1. Immediately notifies the client's physician of these findings

Which of the following statements by the client who has recently had a total hip replacement indicates that the client does not understand the mobility limitations? 1. "I should not bend down to put on shoes or socks." 2. "It is okay to cross my legs if I am sitting in a chair." 3. "I should put a pillow between my legs when lying on my side. 4. "I should not sit in low chairs or on toilet seats that are low."

2. "It is okay to cross my legs if I am sitting in a chair." Clients with total hip replacement should not bring their operative leg across midline, which may result in a prosthesis dislocation. Clients should maintain abduction (pillow between legs) and use elevated toilet seats. Crossing the legs is adduction, which is contraindicated for this client.

A nurse reports to a physician that a 75-year-old client continues to experience phantom limb pain following an above-the-knee amputation (AKA) despite nursing interventions of distraction and administering the prescribed morphine sulfate. Which interventions to minimize the altered sensory perceptions should the nurse anticipate that the physician might prescribe? Select all that apply. 1. Local anesthetic to the residual limb 2. Transcutaneous electrical nerve stimulation (TENS) 3. An antiseizure medication such as oxcarbazepine (Trileptal®) 4. Reducing the client's activity level until the sensations resolve 5. A different analgesic, such as meperidine hydrochloride (Demerol®) 6. A beta-blocker medication such as atenolol (Tenormin)

1. Local anesthetic to the residual limb 2. Transcutaneous electrical nerve stimulation (TENS) 3. An antiseizure medication such as oxcarbazepine (Trileptal®) 6. A beta-blocker medication such as atenolol (Tenormin) A local anesthetic or TENS provide pain relief for some. Beta -blockers may relieve dull, burning discomfort, and ant seizure medications control stabbing and cramping pain. Additional medications include tricyclic antidepressants to improve mood and coping ability

The nurse is teaching a class on primary prevention of osteoporosis. What is the most important information for the nurse to provide? 1. Maintain optimal calcium intake 2. Place necessary items within reach of the client 3. Install safety rails in the bathroom to prevent falls 4. Use a professional alert system in the home in case a fall occurs when the client is alone.

1. Maintain optimal calcium intake

A client with severe arthritis has been receiving maintenance therapy of prednisone 10mg/ day for the past 6 weeks. The nurse should instruct the client to immediately report which symptom? 1. Respiratory infection 2. Joint pain 3. Constipation 4. Joint swelling

1. Respiratory infection

Which treatments should a nurse plan for a client being seen in the clinic for a second-degree ankle sprain? 1. Rest, elevate the extremity, apply ice, and apply a compression bandage. 2. Perform range of motion to determine the extent of injury, apply heat, check circulation and sensation, and examine the ankle. 3. Reduce pain with moist heat, then apply ice to reduce swelling; check circulation, motion, and sensation; and elevate the ankle. 4. Refer the client immediately to an orthopedic surgeon, administer analgesics, control swelling with ice, and encourage rest and elevation.

1. Rest, elevate the extremity, apply ice, and apply a compression bandage.

A client with osteoarthritis is taking high doses of nonsteroidal anti-inflammatory medications. What should the nurse teach the client about taking these medications? 1. Take prescribed medication with food to lessen the likelihood of an upset stomach 2. Do not stop taking the medication suddenly; the dose needs to be decreased gradually 3. Use mouthwash to rinse the mouth after taking this medication 4. Do not drive or use heavy machinery if dizziness occurs

1. Take prescribed medication with food to lessen the likelihood of an upset stomach

The nurse is caring for a client who has had hip surgery, with insertion of hardware. The nurse would be most concerned with which assessment finding? 1. Temperature of 101.6° F orally 2. Complaints of discomfort during repositioning 3. Old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep-breathing exercises

1. Temperature of 101.6° F orally

When developing a teaching plan for a client who is prescribed acetaminophen (Tylenol) for muscle pain, which information should the nurse expect to include? Select all that apply. 1. The drug can be used if the person is allergic to aspirin. 2. Acetaminophen does not affect platelet aggregation. 3. This drug causes little or no gastric distress. 4. Acetaminophen exerts a strong anti-inflammatory effect. 5. The client should have the international normalized ratio (INR) checked regularly

1. The drug can be used if the person is allergic to aspirin. 2. Acetaminophen does not affect platelet aggregation. 3. This drug causes little or no gastric distress. Acetaminophen is an alternative for a client who is allergic to aspirin. It does not affect platelet aggregation and the client does not need to have coagulation studies (such as INR). Acetaminophen causes little or no gastric distress. Acetaminophen exerts no antiinflammatory effects.

A client is confined to bed with a fracture of the left femur. He begins receiving subcutaneous low-molecular-weight heparin (LMWH) injections. What is the purpose of this medication? 1. To prevent thrombophlebitis and pulmonary emboli associated with immobility 2. To promote vascular perfusion by preventing formation of micro emboli in the left leg 3. To prevent venous stasis, which promotes vascular complications associated with immobility 4. To decrease the incidence of fat emboli associated with long bone fractures

1. To prevent thrombophlebitis and pulmonary emboli associated with immobility Because of the high risk of venous thromboembolism (VTE) after a femur or hip fracture, prophylactic anticoagulant drugs such as warfarin and low-molecular-weight heparin such as enoxaparin may be ordered to prevent thromboembolic complications in the immobilized client. It is not effective in preventing fat emboli or venous stasis or promoting vascular perfusion. (Lewis et al., 10 ed., p. 1468)

Which is an appropriate outcome for a client with rheumatoid arthritis who is receiving anti-inflammatory drugs and physical therapy? The client will: 1. manage joint pain and fatigue to perform activities of daily living 2. maintain full range of motion in joints 3. prevent the development of further pain and joint deformity 4. take anti-inflammatory medications as needed for pain

1. manage joint pain and fatigue to perform activities of daily living

A 28-year-old client and his spouse were involved in a motorcycle accident in which his spouse was killed. The client, being treated in the progressive care unit for multiple rib fractures and a broken leg, asks the nurse in which room his wife is located. Which response is most appropriate? 1. "Your wife is not in the hospital." 2. "I'm sorry, but your wife did not survive the accident." 3. "I need to get your family so that you can talk to them about your wife." 4. "The doctor will be talking to you about your wife and where she is located."

2. "I'm sorry, but your wife did not survive the accident."

A 70-year-old male client is admitted to the medical-surgical unit with a fractured femur and with skeletal traction to the right leg. The client reports severe right leg pain during rounding. Which action should the nurse perform first? 1. Perform pin site care 2. Notify the health care provider 3. Check the client's alignment in bed 4. Remove the weights from the traction

3. Check the client's alignment in bed

The nurse provides crutch walking instructions to a client following arthroscopic knee surgery. Which statement, by the client, would indicate a need for further teaching? 1. "When I sit down, I can hold both crutches in my right hand." 2. "When I go up the stairs, I should advance the affected leg first" 3. "I should not put my body weight on my underarms when I use my crutches" 4. "I will move both crutches forward together, and move my affected leg forward with the crutches"

2. "When I go up the stairs, I should advance the affected leg first" The client should assume the tripod position and transfer weight to crutches. When going up stairs, the unaffected leg should go up first while the crutches and the operative leg stay on the lower step. The affected leg should advance after the crutches and the unaffected leg.

A client returns from the first session of scheduled physical therapy following total knee replacement surgery. The nurse assesses that the client's knee is swollen, slightly erythematous, and painful. The client rates the pain as 7 out of 10 and has not had any scheduled pain medication today. What should the nurse do? Select all that apply. 1. Gently massage the area to increase circulation to reduce pain 2. Administer pain medication as prescribed 3. Elevate the leg and apply a cold pack 4. Notify the health care provider 5. Call physical therapy to cancel the next treatment

2. Administer pain medication as prescribed 3. Elevate the leg and apply a cold pack

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the health care provider (HCP) if fatigue occurs.

2. Avoid the use of alcohol. Rationale: Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other central nervous system depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is a side effect. Restriction of fluids is not necessary, but the client should be warned that urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the HCP about fatigue.

A client, with a femoral fracture, is in skeletal traction. During the initial shift assessment, the nurse finds that the weight used in traction is heavier than specified by the nursing care plan. What action should the nurse take first? 1. Ask the health care provider, during rounds, if the order was changed 2. Check the health care provider's orders to see if the orders included a weight change 3. Assume that the health care provider ordered the weight change 4. Remove the weight and replace it with the weight specified in the care plan.

2. Check the health care provider's orders to see if the orders included a weight change

The nurse is caring for a client after a motor vehicle accident. The client has a fractured tibia, and bone is noted protruding through the skin. Which action is of priority? 1. Provide manual traction above and below the leg. 2. Cover the bone area with a sterile dressing 3. Apply an ace bandage around the entire lower limb 4. Apply an immobilizer to the area

2. Cover the bone area with a sterile dressing

A client newly diagnosed with deep vein thrombosis of the left lower extremity is on bed rest. What should the nurse instruct the nursing assistant providing routine morning care for the client to do? 1. Check that the legs are in a low, dependent position 2. Ensure that the lower extremity is elevated 3. Massage the leg and foot with lotion 4. Place one or two pillows under the client's left knee

2. Ensure that the lower extremity is elevated

A client newly diagnosed with deep vein thrombosis of the left lower extremity is on bed rest. What should the nurse instruct the nursing assistant providing routine morning care for the client to do? 1. Check that the legs are in a low, dependent position 2. Ensure that the lower extremity is elevated 3. Massage the leg and foot with lotion 4. Place one or two pillows under the client's left knee

2. Ensure that the lower extremity is elevated DVT causes edema; therefore, the UAP should elevate the extremity to promote venous return. Dependent positioning is appropriate for a client with arterial insufficiency. Placing a pillow under the knee would position the foot in a low position, and pressure behind the knee may obstruct venous flow. Massaging the extremity could dislodge the thrombus

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder? 1. Myxedema 2. Kidney disease 3. Hypothyroidism 4. Diabetes mellitus

2. Kidney disease Rationale: Colchicine is used with caution in older clients, debilitated clients, and clients with cardiac, kidney, or gastrointestinal disease. The disorders in options 1, 3, and 4 are not concerns with administration of this medication.

Which of the following tasks is appropriate for the registered nurse to delegate to experienced unlicensed assistive personnel? 1. Obtain a 24-hour diet recall from a client recently admitted with anorexia nervosa 2. Obtain a clean-catch urine specimen from a client suspected of having a urinary tract infection 3. Observe the amount and characteristics of the returns from a continuous bladder irrigation for a client after a transurethral resection 4. Observe a client newly diagnosed with diabetes mellitus practice injection techniques using an orange.

2. Obtain a clean-catch urine specimen from a client suspected of having a urinary tract infection

The nurse is assessing a client who had a fractured femur repaired with an external fixator device. Which assessment finding(s) would cause the nurse concern regarding the development of compartmental syndrome? Select all that apply. 1. Decrease in pulse rate in affected leg 2. Paresthesia distal to area of injury 3. Toes on affected leg cool to touch and edematous 4. Complaints that pins are hurting 5. Complaints of leg pain unrelieved by analgesics or repositioning 6. Client angry and calling loudly to the nurse every 10 minutes

2. Paresthesia distal to area of injury 3. Toes on affected leg cool to touch and edematous 5. Complaints of leg pain unrelieved by analgesics or repositioning Paresthesia, edema, and leg pain unrelieved by analgesics are classic indicators of the development of compartmental syndrome. With a femur fracture the will be edema, a decrease in rate is not an indication of pressure, a decrease in pulse strength is. Anger can be due to immobility, and the pins do not usually cause pain, but this may be a sign of infection.

A client with a lower leg amputation, is experiencing edema, so a nursing assistant (NA) elevates the client's residual left limb on pillows. What is the most appropriate action by the nurse when observing that the client's leg has been elevated? 1. Thank the NA for being so observant and intervening appropriately. 2. Remove the pillows, raise the foot of the bed, and inform the NA that the limb should not be elevated on pillows because it could cause a flexion contracture. 3. Inform the NA that this was the correct action at this time in the client's recovery, but once the client's incision heals the leg should not be elevated. 4. Report the incident to the surgeon and tell the NA to complete a variance report because the client's leg should not have been elevated.

2. Remove the pillows, raise the foot of the bed, and inform the NA that the limb should not be elevated on pillows because it could cause a flexion contracture.

A female client with rheumatoid arthritis has been on aspirin 650mg and Deltasone (Prednisone) 10mg bid for the last 2 years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has 1. Headaches 2. Tarry stools 3. Blurred vision 4. Decreased appetite

2. Tarry stools Aspirin impedes clotting by blocking prostaglandin synthesis, which can lead to bleeding. A side effect of Deltasone is gastric irritation, also leading to bleeding. Tarry stools indicate bleeding in the upper GI system

A client had a cast applied to the left femur to stabilize a fracture. To promote early rehabilitation, what should the nurse do? 1. Call physical therapy to provide passive exercise of the affected limb 2. Teach the client how to do isometric exercises of the quadriceps 3. Show the family how to do active range of motion exercises of the unaffected limb 4. Obtain weights so the client can exercise the upper extremities.

2. Teach the client how to do isometric exercises of the quadriceps The nurse should teach the client how to do isometric exercise, contraction of the quadriceps muscle without movement of joint, to maintain muscle strength. Physical therapy may assist the client later, and will then teach the client how to do active exercises and crutch walking if prescribed. The client will be able to move the unaffected limb; the family will not need to assist. If the client will be using crutches, building upper extremity strength will be helpful, but the immediate need is to maintain and develop strength in the quadriceps.

A licensed practical nurse is reporting observations and cares to a registered nurse (RN). Based on the report, which client should the RN assess immediately? 1. The client, 2 hours following a total knee replacement, who has 100 mL bloody drainage in the suction container of an autotransfusion drainage system 2. The client with a crush injury to the arm who was given another analgesic and a skeletal muscle relaxant for throbbing, unrelenting pain 3. The client in a new body cast who was turned every 2 hours and supported with waterproof pillows 4. The client with an external fixator on the left leg,having serous drainage from the pin sites

2. The client with a crush injury to the arm who was given another analgesic and a skeletal muscle relaxant for throbbing, unrelenting pain Throbbing, unrelenting pain could be the first sign of compartment syndrome.The neurovascular status of the extremity should be assessed. Unrelieved pressure can lead to compromised circulation and avascular necrosis. Postoperative drainage from a total knee replacement ranges from 200 to 400 mL during the first 24 hours. This amount is neither alarming nor sufficient enough to autotransfuse. The client in a body cast should be turned q2h to promote drying of the cast. To avoid cracking or denting of the cast,the client is supported with waterproof pillows that touch each other without open spaces. Some serous drainage, which is due to tissue trauma and edema,is expected from pin sites of an external fixator.

A client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept, which is most important for the nurse to assess? 1. The injection site for itching and edema 2. The white blood cell counts and platelet counts 3. Whether the client is experiencing fatigue and joint pain 4. Whether the client is experiencing a metallic taste in the mouth, and a loss of appetite

2. The white blood cell counts and platelet counts Rationale: Infection and pancytopenia are adverse effects of etanercept. Laboratory studies are performed prior to and during medication treatment. The appearance of abnormal white blood cell counts and abnormal platelet counts can alert the nurse to a potentially life-threatening infection. Injection site itching is a common occurrence following administration. A metallic taste and loss of appetite are not common signs of adverse effects of this medication.

A nurse is taking care of a patient with status post total hip replacement. To prevent dislocation of the hip prosthesis following total hip replacement surgery, a nurse should plan to: 1. Place pillows or a wedge pillow between the client's legs to keep them adducted. 2. Use a fracture bedpan and instruct the client to flex the unaffected hip and use the trapeze to lift the pelvis while the nurse places the pan. 3. Prevent hip flexion by not elevating the head of the bed more than 90 degrees. 4. Elevate both of the client's legs when sitting in the wheelchair to decrease swelling.

2. Use a fracture bedpan and instruct the client to flex the unaffected hip and use the trapeze to lift the pelvis while the nurse places the pan.

The nurse is making assignments for the next shift. Which client can be assigned to a licensed practical nurse? 1. A client who just had coronary artery bypass graft (CABG) 2. A client who needs initial admission assessment 3. A client who is receiving glargine subcutaneously 4. A client who has C3 to C5 spine injury

3. A client who is receiving glargine subcutaneously

A client with a below-the -knee amputation is experiencing phantom limb pain. Which action by the nurse would be most effective in relieving the pain? 1. Acknowledging the presence of the pain 2. Elevating the stump on a pillow 3. Applying a transcutaneous nerve stimulator unit (TENS) 4. Rewrapping the stump

3. Applying a transcutaneous nerve stimulator unit (TENS)

The nurse at an orthopedic joint clinic is preparing pre-operative teaching for client scheduled for total hip replacement surgery. Which would be included in the teaching plan? 1. Avoid sitting in a recliner. 2. Make sure that commode seats are at low levels 3. Avoid crossing the legs when sitting. 4. Physical therapy will assist with adduction leg exercises

3. Avoid crossing the legs when sitting.

The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect should the nurse monitor? 1. Tachycardia 2. Rapid pulse 3. Bradycardia 4. Hypertension

3. Bradycardia Rationale: Intravenous administration of methocarbamol can cause hypotension and bradycardia. The nurse needs to monitor for these adverse effects. Options 1, 2, and 4 are not effects with administration of this medication.

31 A 24-year-old client, diagnosed with acute osteomyelitis in the left leg, has acute pain in the leg that intensifies on movement. The client has a temperature of 101°F (38.3°C) and a reddened, warm area in the midcalf region over the shaft of the tibia. Based on this information, what should the nurse do? 1. Prepare the client for possible left lower leg amputation 2. Instruct the client to keep the leg immobile 3. Develop a plan for pain management 4. Obtain a prescription for fluid replacement.

3. Develop a plan for pain management

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing the pain? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The recent occurrence of the fracture

3. Impaired tissue perfusion -Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. -Pain that is not relieved by these measures should be reported to the health care provider because pain unrelieved by medications and other measures may indicate neurovascular compromise. -Because this is a new closed fracture and cast, infection would not have had time to set in.*Intense pain after casting is normally not associated with anxiety or the recent occurrence of the injury. -Treatment following the fracture should assist in relieving the pain associated with the injury.

The nurse is analyzing the laboratory studies on a client receiving dantrolene. Which laboratory test would identify an adverse effect associated with the administration of this medication? 1. Platelet count 2. Creatinine level 3. Liver function tests 4. Blood urea nitrogen level

3. Liver function tests Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and throughout the treatment interval. Dantrolene is administered at the lowest effective dosage for the shortest time necessary. Test-Taking Strategy: Eliminate options 2 and 4 because these tests assess kidney function and are comparable or alike. From the remaining options, you must recall that this medication affects liver function.

When planning a health promotion class with a group of women, the nurse should include which information about reducing the risk of developing osteoarthritis? 1. Following a high-protein diet 2. Exercise for 20 minutes at least twice a week 3. Maintain a normal weight 4. Take a multivitamin supplement daily

3. Maintain a normal weight

A client with type 2 diabetes mellitus has been placed in skeletal traction following a motor vehicle collision. The provider is concerned developing osteomyelitis. The provider orders IV antibiotics, blood culture, recreation therapy, and pin site care. What is the priority nursing intervention for this client? 1. Ask the recreation therapist to see the client for diversional activities for better pain control 2. Administer the antibiotic 3. Obtain a blood specimen for culture 4. Perform pin site care

3. Obtain a blood specimen for culture

A client has a leg immobilized in traction. Which of the following activities demonstrated by the client indicate that the client understands actions to take to prevent muscle atrophy? 1. The client adducts the affected leg every 2 hours. 2. The client rolls the affected leg away from the body's midline twice per day. 3. The client performs isometric exercises to the affected extremity three times per day. 4. The client asks the nurse to add a 5-lb weight to the traction for 30 minutes/ day.

3. The client performs isometric exercises to the affected extremity three times per day. Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger. Adduction of the leg puts work onto the hip joint as well as altering the pull of traction. Rolling the leg, or external rotation, alters the pull of traction. Additional weight should not be added to traction unless ordered by the physician; it will not prevent muscle atrophy.

A nurse is caring for a client diagnosed with a fracture. The health care provider has ordered a high-protein diet for the client. The nurse explains to the client that a high-protein diet is ordered because protein: 1. promotes gluconeogenesis 2. has anti-inflammatory properties 3. promotes cell growth and bone union 4. decreases pain medication requirements

3. promotes cell growth and bone union

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my healthcare provider let me try that?" Which response by the nurse would be most appropriate? 1. "It's the healthcare provider's prerogative to decide how to treat you. The healthcare provider has chosen what is the best for your situation." 2. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3. "That drug is used for cases that are more advanced than yours. You are not eligible for this treatment now." 4. "Every person is different. What works for one client may not always be effective for another."

4. "Every person is different. What works for one client may not always be effective for another."

A 42-year-old client recently had a total hysterectomy and bilateral oophorectomy. Which of response, by the client, would indicate an understanding about osteoporosis? 1. "Osteoporosis only affects women over 65 year of age" 2. "My risk for osteoporosis is low because I still have my thyroid gland." 3. "I'm still producing hormones, so I don't have to worry about osteoporosis" 4. "I need to take precautions to prevent osteoporosis because I have had surgically induced menopause"

4. "I need to take precautions to prevent osteoporosis because I have had surgically induced menopause"

An elderly client with Alzheimer's dementia is being admitted from a post anesthesia unit following a hip hemiarthroplasty to treat a hip fracture. Which intervention should a nurse initially plan for the client's pain control? 1. Apply a fentanyl (Duragesic®) transdermal patch. 2. Initiate morphine sulfate per patient-controlled analgesia (PCA) with a basal rate. 3. Administer intravenous morphine sulfate based on the client's report of pain. 4. Administer scheduled doses of morphine sulfate intravenously around the clock.

4. Administer scheduled doses of morphine sulfate intravenously around the clock. In addition to scheduling pain medication around the clock, supplemental NSAIDs can be administered to reduce inflammation and enhance the effects of the analgesic. A transdermal analgesic patch is used to treat chronic, not acute, pain. Usually a PCA affords the client better control over the pain and avoids the peaks and valleys associated with intermittent analgesics. However, the client with dementia would be unable to adequately use PCA. The client with dementia typically cannot report the level of pain accurately

A 40 y/o male with a compound fracture of the left femur is being admitted to an orthopedic unit. Which of the following action is best for the registered nurse to take? 1. Ask unlicensed assistive personnel to obtain the client's vital signs while the nurse obtains a history from his wife. 2. Ask a licensed practical nurse to assess the peripheral pulses of the client's leg while the nurse completes the admission forms. 3. Ask a licensed practical nurse to obtain phone orders from the physician while the nurse completes the admission forms. 4. Ask the unlicensed assistive personnel to obtain equipment for the client's care while the nurse talks with the client and his wife.

4. Ask the unlicensed assistive personnel to obtain equipment for the client's care while the nurse talks with the client and his wife.

A diabetic client is admitted with a tentative diagnosis of osteomyelitis secondary to a wound on the ankle. The client's ankle is painful, red, swollen, and warm, and the wound is persistently draining. The client's temperature is 102.2°F (39°C). Based on the client's status, which written physician's order should a nurse plan to defer until later? 1. Obtain wound culture. 2. Administer ceftriaxone (Rocephin®) 1 g IV (intravenously) q12 hours. 3. Apply splint to immobilize ankle. 4. Begin teaching on self-administration of home IV antibiotics.

4. Begin teaching on self-administration of home IV antibiotics.

A client with diabetes and a right below-the-knee amputation tells the nurse that he feels pain in the amputated leg, even though the leg is gone. The nurse's response is based on what information? 1. Phantom pain is experienced by most amputees; it will resolve without pain medication. 2. The client thinks he feels pain, but it is actually a response to his denial about the amputation. 3. The nurse cannot adequately assess the pain; therefore, medication cannot be given. 4. Phantom pain occurs when the nerve endings have not adjusted to the loss of the extremity, and the client should be offered pain medication.

4. Phantom pain occurs when the nerve endings have not adjusted to the loss of the extremity, and the client should be offered pain medication. Phantom limb pain is real pain for the client and is common in amputees. Phantom pain can best be controlled by pain medication. It is important to respect a client's interpretation of the experience of pain and offer him or her pain medication.

A client with diabetes and a right below-the-knee amputation tells the nurse that he feels pain in the amputated leg, even though the leg is gone. The nurse's response is based on what information? 1. Phantom pain is experienced by most amputees. It will resolve without pain medication. 2. The client thinks he feels pain, but it is actually a response to his denial about the amputation. 3. The nurse cannot adequately assess the pain; therefore, medication cannot be given. 4. Phantom pain occurs when the nerve endings have not adjusted to the loss of the extremity. The client should be offered pain medication.

4. Phantom pain occurs when the nerve endings have not adjusted to the loss of the extremity. The client should be offered pain medication.

The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take? 1. Apply ice to the site. 2. Call the health care provider. 3. Apply a dry sterile dressing and elevate it on one pillow. 4. Rewrap the residual limb with an elastic compression bandage.

4. Rewrap the residual limb with an elastic compression bandage. If the client with an amputation has a cast or elastic compression bandage that slips off, the nurse must wrap the residual limb immediately with another elastic compression bandage. Otherwise, excessive edema will form rapidly, which could cause a significant delay in rehabilitation. If the client had a cast that slipped off, the nurse would have to call the HCP so that a new one could be applied. Elevation on 1 pillow is not going to impede the development of edema greatly once compression is released. Ice would be of limited value in controlling edema from this cause. If the HCP were called, the prescription likely would be to reapply the compression dressing anyway.

A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which should the nurse specifically observe in the postoperative period? 1. Hemorrhage 2. Edema of the residual limb 3. Slight redness of the incision 4. Separation of the wound edges

4. Separation of the wound edges Clients with diabetes mellitus are more prone to wound infection and delayed wound healing because of the disease. Postoperative hemorrhage and edema of the residual limb are complications in the immediate postoperative period that apply to any client with an amputation. Slight redness of the incision is considered normal, as long as the incision is dry and intact.

The nurse is one of several persons who witnessed a vehicle hit a pedestrian at fairly low speed on a small street. The victim is dazed and tries to get up. The leg appears fractured. Which intervention should the nurse take? 1. Try to reduce the fracture manually. 2. Assist the victim to get up and walk to the sidewalk. 3. Leave the victim for a few moments to call an ambulance. 4. Stay with the victim and encourage the person to remain still.

4. Stay with the victim and encourage the person to remain still. With a suspected fracture, the victim is not moved unless it is dangerous to remain in that spot. The nurse should remain with the victim and have someone else call for emergency help. A fracture is not reduced at the scene. Before the victim is moved, the site of fracture is immobilized to prevent further injury

Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions on administration of the medication. Which instruction should the nurse provide? 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4. Take the medication with a full glass of water after rising in the morning. Rationale: Precautions need to be taken with the administration of alendronate to prevent gastrointestinal adverse effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

Which order written by a physician should be a priority for a nurse caring for a client who sustained an unstable pelvic fracture in a motor vehicle accident? 1. Urinalysis 2. Blood alcohol level 3. Computed tomography (CT) scan of the pelvis 4. Two units of cross-matched whole blood

4. Two units of cross-matched whole blood

A client is being treated with Buck's traction (skin traction). What are the most important nursing interventions for this client? 1. Remove the traction boot every 6 hours to provide skin care. 2. Check and clean the pin sites at least three times daily. 3. Check the area around the hip where the traction is applied. 4. Verify that weights are in the amounts ordered and are hanging freely.

4. Verify that weights are in the amounts ordered and are hanging freely. Always check the weight amounts and make sure they are not lodged against the bed or another area. There are no pin sites because Buck's traction is skin traction, not skeletal traction.

A nurse assesses a client 4 hours after a left total knee replacement. The client has a knee immobilizer in place with medial and lateral ice packs that have warmed. The surgical extremity's neurovascular status is intact and vital signs stable. A Stryker® wound drain, an autotransfusion drainage system, has 350 mL drainage collected. The client reports pain at a level 3, which is tolerable, and denies nausea. The client has not voided since before surgery. Which interventions should the nurse plan to implement at this time? 1. Notify the client's physician. 2. Remove the immobilizer and place a pillow behind the client's knee to create a 90-degree knee flexion. 3. Stand the client at the bedside to facilitate bladder emptying. 4. Place the affected extremity in a continuous passive motion device (CPM) to begin early motion. 5. Replace the ice packs in the knee immobilizer.

5. Replace the ice packs in the knee immobilizer.

An elderly client, with Rheumatoid arthritis, is being treated with prednisone. Which complications can occur with long-term corticosteroid therapy? a. Decreased immune system. b. Breast cancer and uterine cancer. c. Deep vein thrombosis and pulmonary embolism d. Osteoporosis and diabetes mellitus e. Weight gain and lactose intolerance.

d. Osteoporosis and diabetes mellitus

The nurse is making assignments for the next shift. Which client can be assigned to a licensed practical nurse (LPN)? a. A 89 y/o male client who is receiving glargine insulin subcutaneously. b. A 56 y/o male client who has C3 to C5 spine injury. c. A 49 y/o female client who just had a coronary artery bypass graft (CABG). d. A 20 y/o male client who needs initial admission assessment.

a. A 89 y/o male client who is receiving glargine insulin subcutaneously.

In taking the health history of a client with severe painful osteoarthritis, the nurse would expect the client to report which of the following a. A gradual onset of the disease, with involvement of weight-bearing joint b. Become tired easily c. Pain that improves with use of the joint d. A sudden onset of the disease, with involvement of all joints. e. Complaints of joint stiffness and swelling after periods of activity.

a. A gradual onset of the disease, with involvement of weight-bearing joint

A 40 year old male with a compound fracture of the left femur is being admitted to an orthopedic unit. Which of the following actions is BEST for the registered nurse to take? a. Ask the unlicensed assistive personnel to obtain equipment for the client's care while the nurse talks with the client and his wife. b. Ask a licensed practical nurse to assess the peripheral pulses of the client's left leg while the nurse completes the admission forms. c. Ask an unlicensed assistive personnel to obtain phone orders from the physician while the nurse completes the admission forms. d. Ask an unlicensed assistive personnel to obtain the client's vital signs while the nurse obtains a history from his wife.

a. Ask the unlicensed assistive personnel to obtain equipment for the client's care while the nurse talks with the client and his wife.

A client, with a femoral fracture, is in skeletal traction. During the initial shift assessment, the nurse finds that the weight used in traction is heavier than specified by the nursing care plan. What action should the nurse take first? a. Check the health care provider's orders to see if the orders included a weight change b. Remove the weight and replace it with the weight specified in the care plan. c. Report to the charge nurse and write an incident report. d. Ask the health care provider, during rounds, if the order was changed e. Assume that the health care provider ordered the weight change

a. Check the health care provider's orders to see if the orders included a weight change

A client returns from the first session of scheduled physical therapy following total knee replacement surgery. The nurse assesses that the client's knee is swollen, slightly erythematous, and painful. The client rates the pain as 7 out of 10 and has not had any scheduled pain medication today. What should the nurse do? Select all that apply. a. Elevate the leg and apply a cold pack. b. Administer pain medication as prescribed. c. Call physical therapy to cancel the next treatment. d. Gently massage the area to increase circulation to reduce pain. e. Notify the health care provider.

a. Elevate the leg and apply a cold pack. b. Administer pain medication as prescribed.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing the pain? a. Impaired tissue perfusion. b. The anxiety of the client c. Infection under the cast d. Immobility of affected arm. e. The recent occurrence of the fracture.

a. Impaired tissue perfusion.

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing which would most likely result from this improper crutch measurement? a. Injury to the brachial plexus nerves b. A fall and further injury c. Skin breakdown in the area of the axilla d. Triceps muscle tears e. Impaired range of motion while the client ambulates

a. Injury to the brachial plexus nerves

A nurse reports to a physician that a client continues to experience phantom limb pain following an above the knee amputation (AKA) despite nursing interventions of distraction and administering the prescribed morphine sulfate. Which interventions to minimize the altered sensory perceptions should the nurse anticipate that the physician might prescribed? Select all that apply a. Local anesthetic to the residual limb b. Transcutaneous electrical nerve stimulation (TENS) c. Reducing the client's activity level until the sensation resolve d. heat/cold pack e. A different analgesic, such as meperidine hydrochloride (Demerol)

a. Local anesthetic to the residual limb b. Transcutaneous electrical nerve stimulation (TENS) d. heat/cold pack

When planning a health promotion class with a group of women, the nurse should include which information about reducing the risk of developing osteoarthritis? a. Maintain a normal weight b. Exercises for 60 minutes daily, 7 days a week c. Following a high-protein diet d. Take a multivitamin supplement daily e. Exercise for 20 minutes twice a week

a. Maintain a normal weight

The nurse is caring for a client who is 30 year old with a fracture of the right femur and left tibia. Both legs have casts. The nurse assesses the following: respirations are 30 per minute and rapid and shallow; presence of faint expiratory wheezing; and coughing produces thin pink sputum. The client is yelling at the nurse and wants to be released from the hospital; this is behavior unlike that previously reported. The last pain medication was administered 3 hours ago. What should the nurse do first? a. Notify the healthcare provider b. Administer pain medications as prescribed. c. Cut slits in the top of the casts d. Administer antianxiety medications as prescribed. e. Obtain a chest X ray

a. Notify the healthcare provider

The laboratory notifies the nurse that a client who had a total knee replacement 3 days ago and is receiving heparin for deep vein thrombosis (DVT) has an activated partial thromboplastin time (aPTT) of 150 seconds. After verifying the values, the nurse calls the healthcare provider. What prescription for the client should the nurse recommend that healthcare provider consider? a. Protamine sulfate b. Warfarin c. Continue Heparin d. Vitamin K e. Platelets

a. Protamine sulfate

A nurse assesses a client 3 hrs after a left total knee replacement. The client has a knee immobilizer in place with medial and lateral ice packs that have warmed. The surgical extremity's neurovascular status is intact and vital signs stable. A wound drain, an autotransfusion drainage system, has 200 ml drainage collected. The client reports pain at a level 3, which is tolerable, and denies nausea. The client has not voided since before surgery. Which interventions should the nurse plan to implement at this time? a. Replace the ice packs in the knee immobilizer. b. Notify the client's physician c. Place the affected extremity in a continuous passive motion device (CPM) to begin early motion. d. Stand the client at the bedside to facilitate bladder emptying. e. Remove the immobilizer and place a pillow behind the client's knee to create a 90 degree knee flexion.

a. Replace the ice packs in the knee immobilizer.

The client who is scheduled for the right leg amputation in the afternoon asks the nurse, "Why won't the healthcare provider tell me exactly how much of my leg he is going to take off? Don't you think I should know that?" On which information should the nurse base the response? a. The adequacy of the blood supply to the tissues b. The need to remove as much of the leg as possible c. The ease with which a prosthesis can be fitted d. The client's ability to walk with a prosthesis

a. The adequacy of the blood supply to the tissues

A client with absence of pedal pulse, swelling and pain on right foot is scheduled for an arterial doppler study of the affected extremity. When preparing the client for this test, what should the nurse do? a. keep the client tobacco free for 30 minutes before the test. b. Have the client sign and informed consent form for the procedure c. Administer a pretest sedative as appropriate. d. Ask the client to take Aspirin 81mg 1 hour before the test. e. Wrap the client's left foot with a blanket.

a. keep the client tobacco free for 30 minutes before the test.

An elderly client with Alzheimer's dementia is being admitted from a post anesthesia unit following a hip hemiarthroplasty to treat a hip fracture. Which intervention should a nurse initially plan for the client's pain control? a. Administer scheduled doses of morphine sulfate intravenously around the clock. b. Administer intravenous morphine sulfate based on the client's report of pain. c. Initiate morphine sulfate per patient-controlled analgesia (PCA) with a basal rate. d. Apply a fentanyl (Duragesic) transdermal patch.

a.Administer scheduled doses of morphine sulfate intravenously around the clock.

A client nurse suspects that a client may have developed osteomyelitis 3 months following a left shoulder surgery. Which findings on assessment promoted the nurse's conclusion? Select all that apply a. Report by the client of a pulsating pain in the area that intensifies with movement b. Painful, swollen area on the left shoulder c. Sudden onset of chills d. Bradycardia e. Temperature of 103F (39-40C)

a.Report by the client of a pulsating pain in the area that intensifies with movement b. Painful, swollen area on the left shoulder c.Sudden onset of chills e.Temperature of 103F (39-40C)

The nurse is instructing a client who will have a total hip replacement tomorrow. Which information is the most important to include in the teaching plan at this time? a. Demonstrate coughing and deep-breathing techniques b. Assess the client's fears about the procedure c. Teach how to use assistive devices d. Show the client what an actual hip prosthesis looks like e. Teach how to prevent hip flexion

b. Assess the client's fears about the procedure

The nurse is instructing a female client recently diagnosed with osteoporosis about health promotion activities. The client has a 20 year history of smoking and has a sedentary lifestyle. Which information should the nurse include in the teaching? Select all that apply a. Add swimming to an exercise program b. Being walking for 20 to 30 minutes five times a week c. Join a smoking cessation program d. Perform range of motion exercises for the joints of the hand and wrist three times a day e. Increase calcium and vitamin D intake using dietary supplements as prescribed

b. Being walking for 20 to 30 minutes five times a week c. Join a smoking cessation program e. Increase calcium and vitamin D intake using dietary supplements as prescribed

One month after discharge, a client who had a left total hip replacement calls a clinic reporting acute constant pain in the left groin and hip area and feeling like the left leg is shorter than the right. A nurse advises the client to the clinic immediately suspecting: a. Aseptic loosening of the prosthesis b. Dislocation of the prosthesis c. Fracture of right hip d. Deep Vein Thrombosis (DVT) e. Wound infection

b. Dislocation of the prosthesis

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptoms of compartment syndrome? a. Pain that increases when the arm is dependent b. Numbness and tingling in the fingers c. Pain that is out of proportion to the severity of the fracture d. Cold, bluish-colored fingers

b. Numbness and tingling in the fingers

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which activity observed by the nurse indicates the need for additional teaching? a. Pushing with palms when rising from a chair b. Working at an even pace as work-rest-work schedule. c. Carrying a laundry basket with clinched fingers and fists d. Holding packages close to the body e. Sliding objects

c. Carrying a laundry basket with clinched fingers and fists Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

The client in the rehabilitation hospital refuses to participate in physical therapy following surgery for repair of a fractured right femur sustained in a motor vehicle accident. The client also fractured the left forearm. Which should be the priority nursing intervention when encouraging the client to participate in therapy? a. Medicate the client for pain after the therapy. b. Explain that insurance will not pay if the client does not participate in therapy daily c. Determine why the client refuses to participate in therapy sessions d. Have the healthcare provider make the client go to therapy e. Medicate the client for pain 30 minutes prior to the therapy

c. Determine why the client refuses to participate in therapy sessions

Male client has been in a body cast for the past 2 days to treat numerous broken vertebrae from a fall. The client is reporting dyspnea, vomiting, epigastric pain, and abdominal distention. Which action demonstrates the best clinical judgement by a nurse? a. Initiates oxygen at 2 liters per nasal cannula to relieve the dyspnea b. Place ice packs around the cast to reduce the abdominal distention c. Immediately notifies the client's physician of these findings d. Administer Morphine 2 mg IVP as prescribed e. Administers ondansetron (Zofran), the prescribed antiemetic

c. Immediately notifies the client's physician of these findings

A 25-year-old female client has just had a plaster cast applied to her right forearm following the reduction of a closed radius fracture due to an inline skating accident. What is the priority nursing assessment for this client? a. Whether the cast needs peeling b. Whether the cast is completely dry c. Sensation and movement of fingers d. Whether the client is having any pain e. Whether the range of motion of the right shoulder is intact.

c. Sensation and movement of fingers

The client with traction for a fractured femur is having difficulty managing self-care activities. Which outcome indicates a successful completion of a goal of promoting independence for this client? a. The client allows the spouse to assume total responsibility for care b. The client allows the nurse to complete care in an efficient manner without interfering c. The client assists as much as possible in care, demonstrating increased participation over time d. The client accepts that self-care is not possible while in traction

c. The client assists as much as possible in care, demonstrating increased participation over time

A licensed practical nurse is reporting observations and cares for a registered nurse (RN). Based on the report, which client should the RN assess immediately? a. The client in a new body cast who was turned every 2 hours and supported with waterproof pillows. b. The client, 2 hours following a total knee replacement, who has 100 ml bloody drainage in the suction container of an autotransfusion drainage system. c. The client with a crush injury to the arm who was given another analgesic and a skeletal muscle relaxant for throbbing, unrelenting pain. d. The client with an external fixator on the left leg, having serous drainage from the multiple pin sites.

c. The client with a crush injury to the arm who was given another analgesic and a skeletal muscle relaxant for throbbing, unrelenting pain.

A client with a fractured leg has been instructed to ambulate without weight bearing on the affected leg. The nurse evaluates that the client is ambulating correctly if the client uses which crutch-walking gait? a. swing to gait b. two point gait c. three point gait d. four point gait

c. three point gait

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my healthcare provider let me try that?" Which response by the nurse would be most appropriate? a. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." b. "It's the healthcare provider's prerogative to decide how to treat you. The healthcare provider has chosen what is the best for your situation." c. "That drug is used for cases that are more advanced than yours. You are not eligible for this treatment now." d. "Every person is different. What works for one client may not always be effective for another."

d. "Every person is different. What works for one client may not always be effective for another."

A client with osteoarthritis tells the nurse, "I know it's important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which response by the nurse would be most appropriate? a. "Tell the healthcare provider about your symptoms. Maybe your analgesic medication can be increased." b. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." c. "You are probably exercising too much. Decrease. d. "Take a warm tub bath or shower before exercising. This may help with your discomfort.

d. "Take a warm tub bath or shower before exercising. This may help with your discomfort.

A 23-year-old patient with a recent history of encephalitis is admitted to the medial unit with new onset generalized tonic-clonic seizures. Which nursing activities included in this patient's care will be best to delegate to an LPN whom you are supervising? a. Document the onset time, nature of seizure activity and postictal behaviors for all seizures. b. Teach patient about the need for good oral hygiene c. Develop a discharge plan, including physician visits and a referral to the Epilepsy Foundation d. Administer phenytoin (Dilantin) 200 mg PO daily

d. Administer phenytoin (Dilantin) 200 mg PO daily

A client admitted with a gastric ulcer has been vomiting bright red blood. The client states that she took Ibuprofen 600 mg 2 tabs every 4 hours for 10 days for her knee pain. The hemoglobin level is 5.11 g/dL, and blood pressure is 100/50 mm Hg. The client and her family state that their religious beliefs do not support the use of blood products and refuse blood transfusions as a treatment for bleeding. The nurse should collaborate with the healthcare provider and family to plan to take which action next? a. Give enough blood to keep the client form dying b. Notify the hospital attorney c. Discontinue all measures d. Attempt to stabilize the client through the use of fluid replacement e. Request the client to leave the hospital and to sign the Against Medical Advice (AMA).

d. Attempt to stabilize the client through the use of fluid replacement

A 24-year-old client, diagnosed with acute osteomyelitis in the left leg, has acute pain in the leg that intensifies movement. The client has a temperature of 101 F (38.3 C) and a reddened, warm area in the mid-calf region over the shaft of the tibia. Based on this information, which nursing intervention should be the priority? a. Continue assessing vital signs. b. Obtain a prescription for fluid replacement. c. Instruct the client to keep the leg immobile d. Develop a plan for pain management. e. Prepare the client for possible left lower leg amputation

d. Develop a plan for pain management.

A client with an extracapsular hip fracture returns to the nursing unit after internal fixation and pin insertion with a drainage tube to the incision site. Her husband asks, "Why does she have this tube inserted in her hip?" Which response would be the best? a. This will prevent blood clots after the operation. b. We have a way to administer antibiotics into the wound c. This way we will not have to irrigate the wound d. Fluid will drain and not accumulate at the site e. The tube helps us to detect a wound infection

d. Fluid will drain and not accumulate at the site

The nurse teaches a client about heat and cold treatment to manage arthritis pain. Which statement indicates that the client still has a knowledge deficit? a. With heat, I should apply it for no longer than 20 minutes at time. b. I can use heat and cold two times a day only c. I can use heat and cold as often as I want. d. Heat producing liniments can be used with other heat devices e. Ten to fifteen minutes per application is the maximum time of cold applications.

d. Heat producing liniments can be used with other heat devices Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold.

A client with schizophrenia and diabetes and a right below-the-knee amputation tells the nurse that he feels pain in the amputated leg, even though the leg is gone. The nurse's response is based on what information? a. The nurse cannot adequately assess the pain because it is not real pain; therefore, medication cannot be given. b. The client thinks he feels pain, but it is actually a response to his denial about the amputation. c. The nurse should administer the client's medications for schizophrenia as scheduled. d. Phantom pain occurs when the nerve endings have not adjusted to the loss of the extremity. The client should be offered pain medication e. Phantom pain is experienced by most amputees. It will resolve without pain medication

d. Phantom pain occurs when the nerve endings have not adjusted to the loss of the extremity. The client should be offered pain medication

The nurse and a licensed practical nurse (LPN) are caring for a group of clients. Which nursing responsibility should not be assigned to the LPN? a. Administer a skeletal muscle relaxant to a client with an exacerbation of multiple sclerosis. b. Monitor morning blood work of the client diagnosed with secondary progressive multiple sclerosis. c. Discuss bowel regimen medications with the healthcare provider for the client with multiple sclerosis. d. Teach self-catheterization to the client diagnosed with multiple sclerosis.

d. Teach self-catheterization to the client diagnosed with multiple sclerosis.

A client with medical history of osteoporosis and rheumatoid arthritis had a posterolateral total hip replacement 2 days ago. What information should the nurse not include in the client's plan of care? a. Do not allow the client to bend down to tie or slip on shoes b. Place ice on the incision after physical therapy c. Allow the client to be in the supine position or in the lateral position on the unoperated side d. When using a walker, encourage the client to keep the toes pointing inward e. Position a pillow between the legs to maintain abduction.

d. When using a walker, encourage the client to keep the toes pointing inward

A client had a cast applied to the left femur to stabilize a fracture. To promote early rehabilitation, what should the nurse do? a. Obtain weights so the client can exercise the upper extremities. b. Call physical therapy to provide passive exercise of the affected limb c. Show the family how to do active range of motion exercises of the unaffected limb d. Teach the client how to do isometric exercises of the quadriceps

d.Teach the client how to do isometric exercises of the quadriceps

The nurse is planning care for a group of clients who have had total hip replacement. Of the clients listed below, who is at highest risk for infection and should be assessed first? a. A 75-year-old who has asthma. b. A 95-year-old client who is 6 feet tall and weighs 180 lb. c. 55 year old who has a past medical history of DM. d. A 90-year-old who lives alone e. A 34-year-old who is diagnosed with periodontitis

e. A 34-year-old who is diagnosed with periodontitis

A client has a left tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the fracture despite the morphine injection administered 30 minutes ago. Which should be the nurse's next assessment? a. Pain with a pain rating scale b. Potential for drug toxicity. c. Respiratory rate d. Temperature. e. Distal pulses

e. Distal pulses

What is the priority nursing intervention in the care of a client in balanced suspension traction for a complete transverse fracture of the left femur? a. Assessment of sacral area for possible pressure ulcer. b. Increasing fluid intake to prevent the development of renal stone caused by urinary stasis. c. Maintaining abduction device between the legs to prevent external rotation of the affected leg d. Assessment of the hip site and movement of extremity distal to injury e. Frequent checks regarding level of pain and sensation distal to the affected extremity

e. Frequent checks regarding level of pain and sensation distal to the affected extremity

A nurse is caring for a client who has been admitted to the hospital with a musculoskeletal injury. When the nurse applies an ice pack on the injury site the client asks the nurse, "why has cold therapy been ordered"? Which statement is the best answer for the question? a. It numbs the nerves and dilates the vessels b. It promotes circulation and reduces muscle spasms c. It promotes analgesia and circulation. d. It helps pain relief. e. It causes local vasoconstriction and prevents edema.

e. It causes local vasoconstriction and prevents edema.

Immediately following an automobile accident, a 21-year old client has severe pain in the right chest from hitting the steering wheel and a compound fracture of the right tibia and fibular and multiple lacerations and contusions. What is the priority nursing goal for this client? a. Maintain adequate circulating volume. b. Decrease chest pain c. Maintain adequate sensation of right foot d. Reduce the client' anxiety e. Maintain adequate oxygenation

e. Maintain adequate oxygenation Blunt chest trauma can lead to respiratory failure. Maintenance of adequate oxygenation is the priority for the client. Decreasing the client's anxiety is related to maintaining effective respirations and oxygenation. Although pain is distressing to the client and can increase anxiety and decrease respiratory effectiveness, pain control is secondary to maintaining oxygenation, as is maintaining adequate circulatory volume.

A client with a lower leg amputation is experiencing edema, so a nursing assistant (NA) elevates the client's residual left limb on pillows. What is the most appreciated action by the nurse when observing that the client's leg has been elevated? a. Report to the charge nursing and request switch assignment of the NA since the NA does not know how to take care of the client. b. Report the incident to the surgeon and tell the NA to complete an incident report because the client's leg should not have been elevated. c. Thank the NA for being so observant and intervening appropriately d. Inform the NA that this was the correct action at this time in the client's recovery, but once the client's incision heals the leg should not be elevated. e. Remove the pillow, raise the foot of the bed, and inform the NA that the limb should not be elevated on pillows because it could cause a flexion contracture

e. Remove the pillow, raise the foot of the bed, and inform the NA that the limb should not be elevated on pillows because it could cause a flexion contracture

A client who has a medical history of DM and HTN with osteoarthritis is taking high doses of nonsteroidal anti-inflammatory medications. What should the nurse teach the client about taking these medications? a. Do not stop taking the medication suddenly because it will decrease blood pressure. b. Take blood sugar before taking those medications. c. Use mouthwash to rinse the mouth after taking these medications to prevent stomatitis. d. Do not drive or use heavy machinery if dizziness occurs e. Take prescribed medication with food to lessen the likelihood of an upset stomach

e. Take prescribed medication with food to lessen the likelihood of an upset stomach

A debilitated 69-year-old client has been admitted to the medical surgical unit from a nursing home with a diagnosis of osteoarthritis and rheumatoid arthritis. During the health history, the nurse learns that the client has been on prolonged bed rest. What is the most appropriate nursing intervention for this client? a. Administer Tylenol every 6 hours for better pain control b. Have the client lie as still as possible and give adequate pain medicine c. Provide only passive range of motion (ROM) and decrease stimulation d. Encourage and educate coughing and deep breathing and limit fluid intake e. Turn the client every two hours and encourage coughing and deep breathing

e. Turn the client every two hours and encourage coughing and deep breathing