HH: Week 4&5: MSK Disorders - Quiz

A 2 year-old client with a fractured right femur is in a hip spica cast for 6 weeks. What recommendations should the nurse make to the child's parents? Select all that apply. A. To introduce new fruit juices to support hydration. B. To ensure a well-balanced diet of vegetables and fiber. C. To provide frequent small meals. D. To place a large bib or towel over the cast while feeding the child. E. To assess daily bowel movements and risk for constipation.

B., C., D., & E. - A well-balanced diet of vegetables and fiber, as well as increased fluid intake to prevent constipation is recommended for children with hip spica casts. The parents should assess regular bowel movements and monitor for constipation. It is helpful to provide frequent small meals to prevent abdominal cramping and to ensure the cast is covered while the child is eating. New foods and especially new fruit juices should not be added to the diet because they can cause loose stools.

A formerly independent client with a long-leg cast is experiencing impaired mobility related to cast application. What can the nurse suggest to the client? Select all that apply. A. The nurse can assist the client with ROM exercises q3-4h. B. The nurse can teach the client to do isometric exercises. C. The nurse should elevate the client's cast on a pillow. D. The nurse should teach the client to weight bear on the affected limb. E. The nurse should administer around-the-clock analgesia.

A. & B. - The nurse can help promote mobility by assisting with ROM exercises every 3-4h and teaching the client to do isometric exercises (a contraction of a group of muscles). Elevating the client's limb is a strategy for pain management, the client should not weight bear on the affected limb, and around-the-clock analgesia is indicated for pain management after the cast application not immobility.

The nurse is caring for a client with fractured ribs after a motorcycle accident. Which of the following observed nursing actions would warrant immediate intervention? Select all that apply. A. The nurse administers the client morphine 5 mg IV over 20 min. B. The nurse applies ice to the site of injury. C. The nurse secures pressure tape around the client's chest. D. The nurse administers ibuprofen 400 mg PO q4h. E. The nurse positions the client in high Fowler's.

A. & C. - Clients with fractured ribs can experience hypoventilation and respiratory depression from narcotic analgesics. Binding or restricting the movement of the chest with a pressure dressing can also cause hyperventilation and respiratory distress. It is appropriate to ice the site of injury, administer non-steroidal anti-inflammatory drugs, and place the client in high Fowler's to promote ease of respiration.

The nurse explains to a client with a distal tibial fracture returning for 3-week checkup that healing is indicated by which of the following? A. Callus formation. B. Complete bony union. C. Hematoma at the fracture site. D. Presence of granulation tissue.

A. - Bones go through a remarkable reparative process of self-healing (i.e. union) that occurs in stages. The third stage is callus formation. As minerals (i.e. calcium, phosphorus, and magnesium) and new bone matrix are deposited in the osteoid, an unorganized network of bone is formed that is woven about the fracture parts. Callus is composed primarily of cartilage, osteoblasts, calcium, and phosphorus. It usually appears by the end of the second week after injury. Evidence of callus formation can be verified on X-rays.

An immobilized client has disuse osteoporosis. What would the nurse expect to find on assessment of the client? A. High serum calcium levels. B. Footdrop. C. A decreased risk for pathological fractures. D. Increased risk for pressure ulcers.

A. - Calcium leaving the bone results in high serum calcium levels in the blood. Footdrop occurs when the foot is permanently fixed in plantar flexion. The client is at increased risk for pathological fractures due to this condition. Pressure ulcers are a risk with immobility, but are not associated with disuse osteoporosis.

Which of the following medications require that the nurse complete a thorough musculoskeletal assessment as an important component of client care? A. Corticosteroids. B. Antiplatelet aggregators. C. á-adrenergic blockers. D. Calcium-channel blockers.

A. - Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. á-blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly implicated in damage to the musculoskeletal system.

A client is being treated for contractures with Dunlop's traction. What should the nurse ensure when caring for a client with this type of traction? A. Applies 7-10 lbs of weight to an upper limb B. Uses skin traction on the lower leg, with a padded sling under the knee with two lines of pulling force. C. Uses skin traction and is applied to one or both legs using straps or a commercially prepared foam boot. D. Uses a head halter with a cutout for the ears and face.

A. - Dunlop's traction applies 7-10 pounds of weight to an upper limb for the treatment of contractures or fractures of the humerus or elbows.

During the postoperative period, what should the client with an above-the-knee amputation (AKA) be told about the problem of routinely elevating the residual limb? A. The flexed position can promote hip flexion contracture. B. This position reduces the development of phantom pain. C. This position promotes clot formation at the incision site and thigh. D. Unnecessary movement of the extremity can cause wound dehiscence.

A. - Flexion contractures may delay the rehabilitation process after amputation. The most common and debilitating contracture is hip flexion. To prevent flexion contractures, the patient should avoid sitting in a chair for more than 1 hour with hips flexed or with pillows under the surgical extremity. Unless specifically contraindicated, assist the patient to lie on the abdomen for 30 minutes three or four times each day and position the hip in extension while prone.

The nurse is assessing a client with a lower leg fracture for complications. Which of the following symptoms would most likely indicate possible compartment syndrome? A. Persistent and severe pain unrelieved by analgesics. B. Temperature of 100.4 F (38 C). C. Cold and clammy skin. D. A WBC count of 11,000/mm3.

A. - Pain that increases in intensity and remains unrelieved by analgesic medications can indicate compartment syndrome. A temperature of 100.4 F (38 C) and a high WBC count indicates a possible infection. Cold and clammy skin indicates possible hemorrhage or hypovolemic shock.

The client asks the nurse about acupuncture for symptom management of osteoarthritis in the knee. Which of the following responses by the nurse is most appropriate? A. "Acupuncture has been shown to be beneficial for osteoarthritis." B. "Acupuncture is contraindicated for clients with osteoarthritis." C. "I suggest trying the physician's prescribed medication before using acupuncture." D. "Acupuncture may help with acute inflammation."

A. - Patients who have not found success in traditional medical interventions use complementary and alternative therapy for symptom relief. Acupuncture is a commonly used symptom management intervention for OA.

Which of the following symptoms should the nurse be monitoring for, in a client with a pelvic fracture? A. Changes in urinary output. B. Petechiae on the abdomen. C. A palpable lump in the buttock. D. Sudden increase in blood pressure.

A. - Pelvic fractures may cause serious intra-abdominal injury, such as hemorrhage, and laceration of the urethra, bladder, or colon. Patients may survive the initial pelvic injury, only to die of sepsis, FES, or VTE. Because a pelvic fracture can damage other organs, the nurse should assess bowel and urinary elimination and distal neurovascular status.

The nurse is caring for an older-adult client who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively the nurse expects which of the following interventions will be included in the care of the affected leg? A. Progressive leg exercises to obtain 90-degree flexion. B. Early ambulation with full weight bearing on the left leg. C. Bed rest for three days with the left leg immobilized in extension. D. Immobilization of the left knee in 30-degree flexion for two weeks to prevent dislocation.

A. - The client is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the client requires good pain management and often the use of a continuous passive motion (CPM) machine.

A client with a cast, for a left tibial fracture, receives morphine for pain. Approximately 30 minutes later, the client reports increasing pain like "pins and needles" at his left foot despite the morphine injection. What should be the nurse's next action? A. Check the client's distal pulses. B. Ask the client to rate their pain using a numeric scale. C. Take the client's blood pressure. D. Ask the client if they have a morphine allergy.

A. - The nurse should assess the client's ability to move their toes and for the presence of distal pulses, including conducting a neurovascular assessment of the area below the chest. Increasing pain that is unrelieved by analgesics is an early manifestation of compartment syndrome, which can lead to permanent damage to the nerves and muscles. Compartment syndrome occurs when tissue pressure within a confined body space becomes elevated and restricts blood flow.

A client with a fracture to the right humerus is in Dunlop's traction prior to surgery. What should the nurse observe for a client in Dunlop's traction? Select all that apply. A. Ensure the pulling forces on the arm are engaged in two different directions. B. Check that the client's shoulder is abducted 90 degrees. C. Ensure the pin sites are cleaned daily using sterile technique. D. Ensure there are no more than 6 lbs on the single pulley system. E. Ensure the client's chin strap is in alignment with their thorax.

A., B., & D. - The client lies flat with their shoulder abducted 90 degrees. A single pulley system is used to put their affected arm in the air (up to 6 lbs of weight is used on this pulley), another weight is placed (no more than 1 lb) on the upper arm. This creates pulling forces in two different directions that creates a pull in a third direction to stabilize the fracture.

A client with a short leg cast is experiencing increased pain after cast application. Which of the following actions are appropriate for this client? Select all that apply. A. Apply ice bags along the sides of the cast. B. Increase the frequency of neurovascular checks. C. Assess the tightness of the cast by checking with two fingers around the cast edges. D. Elevate the casted extremity on a pillow. E. Administer analgesic therapy.

A., B., C., & D. - Increased pain after cast application is often due to swelling. Pain should be addressed by applying ice bags along the sides of the cast, increasing the frequency of neurovascular checks, and assessing the tightness of the cast with two fingers around the edges. The nurse should not administer analgesia without notifying the HCP first because analgesics do not relieve edema and could mask symptoms of swelling.

A client with a body cast is diagnosed with body cast syndrome and is awaiting emergency surgery. What should the nurse expect in the client's plan of care? Select all that apply. A. The client will require a nasogastric tube and attached to suction. B. A peripheral IV line with isotonic fluid will be ordered by the HCP. C. The client will benefit from being placed in a prone position. D. The client will require sedation with fentanyl until the surgery is completed. E. The client may have part of or the entire cast removed.

A., B., C., & E. - The client will require partial or full removal of the body cast. They will be NPO for surgery and should have an NG tube inserted and placed on suction, an IV line and fluid should be initiated to ensure hydration and promote renal function, the client will benefit from being placed in a left-sided or prone position.

The nurse is assessing a client in Buck's extension. When caring for clients in traction, which of the following contributes to skin breakdown? Select all that apply. A. Clients requiring increased weight used with traction. B. Clients with pressure ulcers. C. Clients over 60 years of age. D. Clients with increased tissue perfusion. E. Clients with decreased nutritional intake.

A., B., C., & E. - The more weight applied, the higher risk of skin breakdown in traction. Tractions should not be used for clients with pressure ulcers or abrasions. Older persons, clients with tissue perfusion problems, and clients with poor nutritional intake are at an increased risk of skin breakdown while in traction.

A nurse working in the ED is caring for a client who fractured their left ankle while playing hockey. Which of the following are complications of a fracture that the nurse should assess for? Select all that apply. A. Fat embolism. B. Avascular necrosis. C. Infection. D. Respiratory depression. E. Compartment syndrome.

A., B., C., & E. - When a client suffers a fracture, they are predisposed to other complications that the nurse must be aware of and assess. These include fat embolism, avascular necrosis, infection, osteomyelitis, compartment syndrome, and pulmonary embolism. Respiratory depression is not a complication seen with a fracture.

A nurse has been assigned to a 15 year-old client who has just received surgery for a spinal fusion due to idiopathic scoliosis. Which of the following nursing interventions demonstrates the proper postoperative care for this client? Select all that apply. A. Log-roll client when changing positions. B. Monitor for hypertension. C. Frequent pain medication administration. D. Perform frequent skin assessments. E. Assess the neurovascular status of the client's extremities.

A., C., D., & E. - Following surgery, clients are monitored in an acute care setting and log-rolled to prevent damage to the fusion and instrumentation. Pain is generally most severe in the first few days, requiring around-the-clock administration of analgesics. Skin care is important and pressure relieving mattresses or beds may be required to prevent pressure injuries. Prompt recognition of any neurovascular impairment is imperative because delayed paralysis may develop and requires surgical intervention.

A client sprains their ankle while playing basketball. Which of the following reflects the RICE treatment for sprains? Select all that apply. A. Ice B. Restrict C. Rest D. Compression E. Elevation F. Immobilize

A., C., D., & E. - RICE stands for Rest, Ice, Compression, and Elevation. The main purpose of the RICE regimen is to reduce pain and tissue inflammation.

The nurse is providing discharge teaching to the parent of a 5-year-old child that was placed in a cast following a fracture to his forearm. Which of the following statements by the nurse are appropriate discharge instructions? Select all that apply. A. Do not allow the child to insert small items inside the cast. B. Pool exercise is encouraged as it allows freedom of movement and provides support. C. Contact the HCP if the child's fingers become darker in colour. D. Elevate the injured arm on a pillow while resting. E. Relieve itching with medication recommended by the provider.

A., C., D., & E. - The child should not be allowed to insert anything inside the cast. Signs of discolouration warrant HCP notification as it may indicate a neurovascular compromise. It is recommended to consistently keep the injured arm elevated to increase venous return and prevent compartment syndrome. Itching can be relieved with an ice pack and the administration of medication as recommended by the provider. It is not recommended to place the cast in water such as a swimming pool.

A client with rheumatoid arthritis is scheduled for an arthroplasty. How should the nurse explain the purpose of this procedure? Select all that apply. A. To fuse the joint. B. To replace the joint. C. To prevent further damage. D. To improve or maintain ROM. E. To decrease the amount of destruction in the joint.

B. & D. - Arthroplasty is the reconstruction or replacement of a joint. This surgical procedure is performed to relieve pain, improve or maintain range of motion, and correct deformity.

The nurse is assessing a client in the outpatient clinic who has a longstanding history of rheumatoid arthritis and indicates increasing stiffness in the right knee that has culminated in complete fixation of the joint. Which of the following problems would the nurse document based upon the client symptoms? A. Atrophy. B. Ankylosis. C. Crepitation. D. Contracture.

B. - Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis. Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation (crepitus) is a grating or crackling sound that accompanies movement.

The nurse is caring for a client in Buck's traction. Which of the following interventions is the most important for a client in this type of traction? A. Encourage isometric exercises. B. Perform a skin assessment. C. Provide non-pharmacological distraction and activities. D. Cleanse the site with hydrogen peroxide.

B. - Buck's traction is a type of skin traction where weights are used to maintain alignment of the leg via a boot. Patients in skin traction are at an increased risk for skin breakdown; therefore, the nurse should perform frequent skin assessments and repositioning of these clients.

A client with a long bone fracture is immobilized with skeletal traction. Which of the following is a cardiovascular complication related to immobility? A. The client has noted atelectasis and coarse crackles in their lungs. B. The client has a reddened and painful area to their lower leg. C. The client has increased swelling due to low albumin levels. D. The client has fibrosis of connective tissue.

B. - Clients can develop thrombus formation in the veins during prolonged immobility. These symptoms are reflective of deep vein thrombosis.

The nurse is assessing a client after a fall from a ladder. Which of the following is an example of an abnormal finding during a musculoskeletal assessment? A. Muscle strength score of 5. B. Palpable crepitus over the client's left shoulder. C. Pink and warm skin. D. Capillary refill < 2 seconds.

B. - Crepitus, muscle atrophy, and tenderness are signs of musculoskeletal injury. Normal MSK assessment findings include the full range of motion of all joints without pain nor laxity, no joint swelling, no deformity or reputation, normal spinal curvatures, no tenderness on palpation of the spine, no muscle atrophy or asymmetry and a muscle strength score of 5.

A nurse observes a student nurse interacting with a client who is demonstrating signs of anxiety after being diagnosed with osteoarthritis. The student nurse states, "I think it would be helpful if we talk more about how you feel about this diagnosis." Which of the following communication techniques is the student nurse using? A. Reflecting B. Focusing C. Sharing perceptions D. Informing

B. - Focusing is a therapeutic communication technique wherein the nurse makes statements or asks questions that encourage the client to elaborate on a topic that is important to them. This allows the nurse to show interest in the client and keep the conversation goal-directed; it also allows the client to talk about concerns related to the problem.

The nurse is caring for a client with Russell's traction. When maintaining correct body alignment for this type of traction, what should the nurse remember to do? A. The nurse should ensure the client's foam boots' velcro straps are secured tightly. B. The nurse should ensure the client's hip and knee are immobilized in a flexed position. C. The nurse should ensure a single pulley system is used to provide weight to an upper extremity while weight is applied to the upper arm above the elbow. D. The nurse will instruct the client to lie in a supine position in order to maintain cervical alignment.

B. - Russell's traction uses skin traction on the lower leg and a padded sling under the knee. There are two lines of pulling force: one is along the longitudinal plane of the lower leg, and one is perpendicular to the leg. The hip and knee are immobilized in a flexed position.

The nurse is caring for a client who sustained a complete spinal cord injury to T4 after falling during a rock climbing accident. The client says, "I'll never walk, let alone climb, again. I wish I had died." What is the most appropriate response by the nurse? A. "Tell me more about your feelings regarding your injury." B. "Do you have a plan to end your life?" C. "I'm so sorry about your injury. I can't imagine what you're going through." D. "Let's focus on your recovery. We can start by doing some deep breathing and coughing exercises."

B. - Suicide assessment should be the first intervention for any clients expressing wishes to die. Asking the client if they have a plan to end their life is important in determining the level of risk for suicide. Although the client should be allowed to express feelings about the injury, dwelling on it and sympathy should be avoided. Focusing on recovery and planning small steps is appropriate, but suicide assessment is the priority.

A client presents with fatigue and joint pain that has become more and more severe over the past year. The client believes that they have osteoarthritis and requests corticosteroid injections "like my friend Ruth gets." Which of the following findings leads the nurse to suspect that the client has rheumatoid arthritis rather than OA? A. The client has been having difficulty completing her ADLs because of the pain and stiffness. B. The client complains of stiffness in both knees and wrists. C. Pain and stiffness is worse in the morning. D. The client suspects that she has not been getting enough calcium.

B. - The client presents with joint pain in both knees and wrists, this symmetrical pattern is typical of RA. Difficulty completing ADLs due to pain and stiffness, and increased pain and stiffness in the morning are symptoms characteristic of both OA and RA. Inadequate consumption of calcium is not related to OA or RA; this would be relevant for osteoporosis.

A young client with rheumatoid arthritis has been having difficulty ambulating because of the pain in his feet. While both feet are painful, the left foot is particularly troublesome because of a significant dislocation and deformity of the first metatarsal. The OT provides him with a straight cane to assist him with ambulation. Which of the following statements about the use of canes is incorrect? A. The handle of the cane should be level with the client's greater trochanter. B. The client should be instructed to hold the cane on the affected side. C. The client's elbow should be flexed at a 15-30 degree angle. D. The client should hold the cane 6" from the side of the foot.

B. - The client should be instructed to hold the cane on the unaffected or "stronger" side. The "bad" foot and the can should move forward at the same time, followed by the "good" foot.

The nurse is caring for several post-operative fracture clients. Which of the following clients should the nurse see first? A. A client with a calcaneus fracture with absent pedal pulse. B. A client with a fractured tibia and fibula who has a petechial rash and is complaining of shortness of breath. C. A client a femoral fracture who has 8/10 pain. D. A client with a hip fracture who has a temperature of 100 F (37.8 C).

B. - The client with an airway/breathing problem is the priority. Recall that dyspnea and petechial rash are signs of fat embolism. Other signs include elevated HR, RR, and decreased BP. The nurse should (1) Notify the HCP, (2) Administer oxygen and IV fluids, (3) Prepare for intubation if necessary; and avoid repositioning. Client A: Pulselessness is a sign of compartment syndrome and should be seen second. Client C: Some post-op pain is expected, but 8/10 is poorly managed; this client should be seen next. Client D: Fever after a fracture may indicate osteomyelitis. However, this client's temperature is not above 100.4 F (38 C). This client can be seen last.

The nurse is caring for a client in balanced suspension traction. Which of the following nursing actions using traction is the least appropriate? A. Assess the client's body position. B. Verify that the weights are resting on the floor. C. Check the circulation of the affected extremity. D. Ensure that the overhead trapeze is within reach.

B. - The nurse should ensure that there are no weights on the bed or floor.

What should the nurse teach a client recovering from a total hip replacement to avoid? A. Sleeping on the abdomen. B. Sitting with the legs crossed. C. Abduction exercises of the affected leg. D. Bearing weight on the affected leg for 6 weeks.

B. - The patient and the caregiver must be fully aware of positions and activities that predispose the patient to dislocation (more than 90 degrees of flexion, adduction across the midline [crossing of legs and ankles], internal rotation).

A client is discharged home after a total knee arthroplasty surgery. What should the nurse teach the client regarding their home environment during recovery? Select all that apply. A. Climb the stairs at home daily to increase knee strength. B. Arrange to live on one floor until knee strength returns. C. Install a raised toilet seat. D. Get a stable bench for the shower. E. Prepare to have baths only to protect the surgical incision.

B., C., & D. - Clients should limit climbing stairs during recovery, they will need to build up their mobility and strength first. It may help to arrange their living area on one floor until their strength returns. A raised toilet seat will also help to make their home safer for the client during recovery. The client should also get a stable bench for the shower. The client will have difficulty getting in and out of the bathtub during the early stages of recovery.

The nurse is caring for a client who had an open reduction with internal fixation of a fractured femur. A neurovascular assessment is ordered q4h. Which of the following actions are part of this assessment? Select all that apply. A. Pulse oximetry. B. Colour and temperature of the extremities. C. Capillary refill. D. Dorsiflexion and plantar flexion. E. Palpating the dorsal surface.

B., C., D., & E. - Neurovascular assessment is important for clients with musculoskeletal injuries. It includes peripheral vascular (colour, temperature, capillary refill, pulses, edema) and peripheral neurological assessments (sensation, motor function, pain). Pulse oximetry is not part of a neurovascular assessment.

A nurse is performing a musculoskeletal assessment on an older client. Which of the following physiological changes should the nurse expect? Select all that apply. A. Rheumatoid arthritis. B. Decreased range of motion. C. Scoliosis. D. Changes in gait. E. Muscle atrophy.

B., D., & E. - Decreased range of motion, muscle atrophy, and gait changes are associated with the normal process of aging due to the older population having decreased bone density and elasticity of joints. RA is a chronic and autoimmune disease characterized by inflammation of the synovial joints. This condition is not expected with aging. Scoliosis is a lateral S-shaped curvature of the spine. With aging, older adults tend to have a more kyphotic structure.

The nurse is caring for a client with a halo fixation device. Which of the following nursing actions would warrant immediate intervention? A. The nurse lays the client supine when unfastening the halo jacket. B. The nurse can slip one finger easily beneath the jacket. C. The nurse holds the halo device to turn the client. D. The nurse removes the front plate of the halo device to perform CPR.

C. - A halo-vest is a brace that is used to immobilize and protect the cervical spine and neck after surgery or accident. The nurse should never use the halo fixation device to turn the client.

The nurse is admitting a client who has cellulitis, probable osteomyelitis, and has just received an injection of radioisotope at 0900 hours before a bone scan. Which of the following times should the nurse take the client for the bone scan? A. 0930 hours. B. 1000 hours. C. 1100 hours. D. 1300 hours.

C. - A technologist usually administers a calculated dose of a radioisotope two hours before a bone scan. If the client was injected at 0900 hours, the procedure should be done at 1100 hours.

A nurse is caring for a client who just underwent bilateral total knee arthroplasties to treat the joint damage caused by rheumatoid arthritis. Which of the following actions should the nurse perform first? A. Turn and reposition the client. B. Perform a neurovascular assessment. C. Assess the client's vital signs. D. Hang the client's scheduled ceftriaxone IV.

C. - Based on the steps of the nursing process, the nurse should perform assessments first. Vital signs should be assessed before neurovascular status because life-threatening conditions may be revealed based on the client's vital signs.

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for an older-adult client following a left total knee replacement. Which of the following actions would be an appropriate nursing intervention for this client? A. Promote vitamin D and calcium intake in the diet. B. Provide passive range of motion to all of the joints q4h. C. Encourage isometric quadriceps-setting exercises at least qid. D. Keep the left leg in extension and abduction to prevent contractures.

C. - Great emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the first day after surgery.

The nurse is caring for a client with osteoarthritis who is about to undergo left total knee arthroplasty (TKA). The nurse assesses the client carefully to be sure that there is no evidence of which of the following symptoms in the preoperative period? A. Pain. B. Left knee stiffness. C. Left knee infection. D. Left knee instability.

C. - It is critical that the client be free of infection before a total knee arthroplasty (TKA). An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the client for signs of infection, such as redness, swelling, fever, and elevated white blood cell count.

A nurse is providing discharge instructions to a client recently diagnosed with rheumatoid arthritis. Which of the following statements by the client is most concerning? A. "I will sit on a high stool during meal preparation." B. "I will use my palms when getting up from a chair." C. "I will sit in a chair when I am knitting for long periods." D. "I will place a small and flat pillow under my head and shoulders during sleep."

C. - Knitting and performing other repetitive tasks is a concern for a client with arthritis. The nurse should caution the client to take frequent rests and inform the client about the effect of repetitive movements on the joints. Avoiding stress on the joints, not performing repetitive movements, and keeping joints in a neutral position are key interventions used to protect joints from further injury and pain.

Which of the following indicates a neurovascular problem during the nurse's assessment of a client with a fracture? A. Exaggeration of extremity movement. B. Increased redness and heat below the injury. C. Decreased sensation distal to the fracture site. D. Purulent drainage at the site of an open fracture.

C. - Musculoskeletal injuries have the potential for causing changes in the neurovascular condition of an injured extremity. Application of a cast or constrictive dressing, poor positioning, and physiologic responses to the injury can cause nerve or vascular damage, usually distal to the injury. The neurovascular assessment consists of peripheral vascular evaluation (i.e. color, temperature, capillary refill, peripheral pulses, and edema) and peripheral neurologic evaluation (i.e. sensation and motor function).

The nurse is performing a musculo-skeletal assessment of an older-adult client whose mobility has been progressively decreasing in recent months. How should the nurse best assess the client's range of motion (ROM) in the affected leg? A. Perform passive ROM, asking the client to report any pain. B. Ask the client to lift progressive weights with the affected leg. C. Observe the client's unassisted ROM in the affected leg. D. Move both of the client's legs from a supine position to full flexion.

C. - Passive range of motion (ROM) should be performed with extreme caution, and may be best avoided when assessing clients of advanced age. Observing the client's active ROM is more accurate and safe than asking the client to lift weights with her legs.

A nurse instructor is teaching a pathophysiology class about common MSK conditions affecting the adult population. Which of the following statements correctly reflects the difference between rheumatoid arthritis and osteoarthritis? A. The onset of RA is older than 60y while OA is between 35-45y. B. OA affects more females while RA affects more males. C. RA produces systemic effects while OA is nonsystemic and unilateral. D. OA is an autoimmune disease while RA is a degenerative disease.

C. - RA typically produces systemic manifestations including fatigue, weakness, weight loss, fever, and anemia. OA may be unilateral and affect a single joint only. The onset of RA is generally between 35-45y while OA is diagnosed in individuals over 60y. Both OA and RA are more commonly found in females. RA is an autoimmune disease while OA has a degenerative disease process.

Which statement by the client regarding lifestyle changes to prevent osteoporosis indicates a need for further teaching by the nurse? A. "I will incorporate more dairy products into my diet." B. "I will cut down the amount of wine I drink each night." C. "I will practice for the upcoming running marathon." D. "I will attend smoking cessation classes at the hospital."

C. - Running is a high-impact exercise that may cause vertebral compression fractures. Patients who are at high risk for osteoporosis should opt for activities that improve joint mobility and increase muscle tone, such as swimming, ROM exercises, and muscle-tightening exercises for extremity muscles. Increasing intake of vitamin D, reducing consumption of alcohol, and smoking cessation are effective prevention activities for osteoporosis.

The nurse is caring for a client who has recently undergone open reduction with internal fixation of a hip fracture. Which of the following client data is the most concerning? A. WBC count of 9000 cells/mm3 B. Edema and pain in the hip. C. A lump in the buttock. D. A temperature of 97.5 F (36.4 C).

C. - Sudden severe pain, a lump in the buttock or a shortened limb indicates prosthesis dislocation. This will require closed or open reduction to realign the femoral head in the acetabulum.

A nurse is admitting an elderly client with osteoporosis into a nursing home. The client's daughter reports that the client moves during his sleep and suggests using limb restraints at night to prevent falls. Which of the following responses by the nurse is best? A. "We will require your consent to use limb restraints." B. "Putting all the side rails up is safer and less restrictive for the client." C. "Restraints may increase the risk of injury." D. "Was your father in limb restraints in his previous home?"

C. - The client's daughter should be made aware of the increased risk of injury when using restraints. It is best to implement less restrictive methods to prevent falls, such as providing adequate lighting, maintaining a clutter-free environment, and placing the bed in the lowest position. Restraints should be considered only when all other interventions have been attempted.

The nurse is completing an admission history for an older-adult client who has osteoarthritis admitted for knee arthroplasty and the nurse asks about the client's perception of the reason for admission. Which of the following client responses should the nurse anticipate related to this question? A. Recent knee trauma. B. Debilitating joint pain. C. Repeated knee infections. D. Onset of "frozen" knee joint.

C. - The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy.

A post-operative client who had an above-the-knee amputation (AKA) has orders from the health care provider, which includes wrapping the stump with an elastic bandage. The nurse understands that this order is to help with which of the following? A. Decrease bleeding. B. Prevent phantom pain. C. Shrink the stump. D. Prevent the client from seeing the area.

C. - Wrapping the stump in an elastic bandage allows the stump to shrink and prepare it to be fit for a prosthetic.

A nurse is working with an unlicensed assistive personnel (UAP) on an orthopedic unit. They are caring for a female client 3 days post internal fixation of a femoral fracture. Which of the following tasks are appropriate to delegate to the UAP? Select all that apply. A. Monitor the client's skin integrity. B. Check circulation in the client's lower extremities. C. Assist the client in repositioning herself. D. Help the client with range of motion exercises. E. Take the client's morning vital signs.

C., D., & E. - A UAP cannot perform any tasks that involve medication administration, assessment, evaluation, or teaching. Assisting the client with repositioning, helping the client with ROM exercises, and taking the client's routine, stable vital signs do not require any assessment, evaluation, or teaching.

The nurse has provided instructions to a client who has just had a plaster cast applied following a fibula fracture. She recognizes the need for further instruction when she observes the client doing which of the following? Select all that apply. A. Using a hair dryer on cool setting to relieve an itch. B. Keeping the extremity elevated. C. Handling the cast gently with palms. D. Using a pencil to scratch inside the cast. E. Covering the cast with a plastic bag.

D. & E. - The client should be instructed not to insert any objects into the cast, apply heat, or cover the wet cast. Covering a plaster cast while it's drying generates heat and can burn the skin. A hair dryer on a cool setting is recommended for relieving an itch. The extremity should be elevated above the level of the heart for the first 48h. The fresh cast should be handled gently with the palms to prevent denting or deforming the cast.

A client with a comminuted fracture of the femur is to have an open reduction with internal fixation (ORIF) of the fracture. In which of the following situations is an ORIF indicated? A. The client is able to tolerate prolonged immobilization. B. The client cannot tolerate the surgery for a closed reduction. C. A temporary cast would be too unstable to provide normal mobility. D. Adequate alignment cannot be obtained by other nonsurgical methods.

D. - A comminuted fracture consists of more than two bone fragments. ORIF is indicated for a comminuted fracture and is used to realign and maintain bony fragments. Other nonsurgical methods can result in a failure to obtain satisfactory reduction. Internal fixation reduces the hospital stay and complications associated with prolonged bed rest.

A nurse is assessing a client who suffered a compound fracture two days ago while playing basketball. The client appears lethargic and is disoriented to person, place, and time. A petechial rash on the upper chest is noted. The client's HR is 134 bpm, RR of 31 breaths/min, and O2 saturation of 87% on room air. Which of the following actions should the nurse perform first? A. Administer IV fluids. B. Continue to monitor vital signs. C. Administer oxygen. D. Call for help and contact the HCP.

D. - A fat embolism occurs when a fat globule is released into the bloodstream after a fracture, which can occur in the first 48-72h. Clinical manifestations include hypotension, tachycardia, tachypnea, hypoxia, dyspnea, mental status change, and restlessness. When a fat embolism is suspected, it is a medical emergency, and action must be taken immediately. The actions that are taken by the nurse are: (1) Notify the HCP, (2) Administer oxygen, (3) Administer IV fluids, (4) Monitor vital signs, (5) Prepare for intubation if necessary, and (6) Document the event.

When would the nurse suspect an ankle sprain for the client being seen at the urgent care centre? A. Client was hit by another soccer player on the field. B. Client has ankle pain after sprinting around the track. C. Client dropped a 4.5 kg weight on his lower leg at the health club. D. Client had a twisting injury while running bases during a baseball game.

D. - A sprain is an injury to the ligaments surrounding a joint and is usually caused by a wrenching or twisting motion. Most sprains occur in the ankle and knee joints.

A client with a C6 spinal cord injury just had his NG tube removed as his paralytic ileus has resolved. The speech and language pathologist performed a swallowing assessment and confirmed that he should be able to resume oral intake of fluids and solid foods. However, the client reports not having any appetite and refuses to eat. Which of the following actions is the most appropriate? A. Inform the client that a high-protein, high-calorie diet is necessary to prevent muscle wasting. B. Request that the physician place the client on TPN. C. Ask for assistance from the client's family during meals. D. Ask the client about his food preferences.

D. - By asking the client about his food preferences and incorporating some preferred items into his diet, the client can gain some control over his environment. Although a high-protein, high-calorie diet is important to prevent muscle wasting, the priority is to get the client to eat. The nurse should first assess why the client refuses to eat. Additionally, she should not request TPN without the client's consent. Gaining family assistance during meals may be helpful, but it's not the most appropriate action.

The nurse is preparing a client for a bone scan. Which of the following information should the nurse include in the teaching plan? A.Two additional follow-up scans will be required. B. There will be only mild pain associated with the procedure. C. The procedure takes approximately 15-30 minutes to complete. D. The client will be asked to drink increased fluids after the procedure.

D. - Clients are asked to drink increased fluids after the procedure to aid in excretion of the radioisotope, if not contraindicated by another condition.

A nurse working in the orthopedic surgery unit receives four client assignments. Which of the following clients with joint replacements should the nurse attend to first? A. The client who requires teaching about an abduction splint. B. The client who was last repositioned 2 hours ago. C. The client who has dried sanguineous drainage on the dressing. D. The client with an increased pain rating despite administered pain medication.

D. - Clients with increased pain unrelieved by analgesic medication may indicate a potential sign of infection. Other indications may include compartment syndrome or surgical complications. The nurse should visit this client first to perform a vital sign check and an assessment of the incision site to observe for redness, drainage, warmth, or swelling.

A client with an above-the-knee amputation (AKA) should be placed in which position to prevent contractures? A. Supine with the HOB raised. B. Supine with the foot of the bed raised. C. Right side-lying position. D. Prone.

D. - Contractures refer to abnormal flexion and position of a joint. This is a common complication of amputations which can be prevented by proper positioning. Patients with AKA should lie prone.

The nurse is caring for a client who sustained fractures to his tibia and fibula. She suspects that he has compartment syndrome. Which of the following interventions should be completed first? A. Bivalve the cast. B. Elevate the affected limb. C. Prepare the client for fasciotomy. D. Notify the healthcare provider.

D. - If the nurse suspects compartment syndrome, the HCP must be notified immediately as this represents a medical emergency. The affected limb should not be elevated as this decreases the perfusion of the limb. Nurses should frequently assess for the 5 P's of compartment syndrome: pain, pulses, pallor, paresthesia, and paralysis/paresis.

Isometric exercises are recommended for clients who have sustained a fracture to prevent muscle atrophy. Which of the following exercises describes an isometric activity that would be most appropriate for a client post-hip fracture repair? A. Forward flexion. B. Leg raises. C. Supine leg abduction. D. Tightening the kneecap.

D. - In tightening the kneecap, the quadricep muscles contract with little or no movement of the knee joint. This isometric exercise helps strengthen the quadriceps, preventing atrophy. Forward flexion, leg raises, and supine leg abduction are not an isometric exercises and are not recommended for post-operative hip fracture.

A nurse is caring for a postoperative client after a total joint arthroplasty. Which of the following interventions would be inappropriate to include in this client's care plan? A. Have the client wear elastic stockings during ambulation. B. Teach active range of motion exercises of the leg. C. Observe client for changes in mental status. D. Massage affected leg q4h.

D. - Massages are contraindicated for clients who have or are at risk for venous thromboembolism (VTE) because stimulation can dislodge a clot from the vein and allow it to travel upwards toward the lungs and heart. VTE is a major complication following joint arthroplasty; encouraging the use of stockings, ambulation, and exercise are important interventions to prevent this complication. Observing for changes in mental status would also indicate whether a clot has been dislodged and travelled to another area of the body.

A nurse is providing health teaching for a client with moderate rheumatoid arthritis. Which statement by the client indicates to the nurse that he has understood the health teaching? A. "Exercise could cause additional damage to my joints and should be avoided." B. "The nodules that have appeared on my elbows will go away on their own." C. "Corticosteroid therapy increases my metabolism so I should eat high-calorie meals." D. "I have been prescribed methotrexate, so I need to avoid people with colds."

D. - Methotrexate is an immunosuppressant and can cause bone marrow suppression. Patients taking this medication should be taught to avoid people with colds, perform appropriate hand hygiene, and notify the HCP if signs of infection occur (fever, chills, etc.).

A nurse is providing a health teaching session to the community about the prevalence of osteoporosis in older women. Which of the following statements best explains the relationship between estrogen levels and osteoporosis? A. Increased estrogen levels result in bone density loss. B. Increased estrogen levels suppress calcium absorption in the bones. C. Decreased estrogen levels enhance the activity of osteoblasts. D. Decreased estrogen levels lead to reduced bone formation.

D. - Older women are at a higher risk for osteoporosis due to decreased estrogen levels after menopause. This is because decreased estrogen levels reduce the activity of osteoblasts, which lowers the rate of bone formation.

A client with a stable, closed fracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. For which of the following symptoms would the nurse suspect compartment syndrome and notify the physician? A. Increasing edema of the limb. B. Muscle spasms of the lower arm. C. Rebounding pulse at the fracture site. D. Pain when passively extending the fingers.

D. - One or more of the following are characteristic of early compartment syndrome: (1) paresthesia (numbness and tingling sensation); (2) pain distal to the injury that is not relieved by opioid analgesics and is increased on passive stretch of muscle; (3) increased pressure in the compartment; and (4) pallor, coolness, and loss of normal color of the extremity. Paralysis and pulselessness are late sign of compartment syndrome. The examination also includes assessment of peripheral edema, especially pitting edema, which may occur with severe injury.

A client admitted yesterday underwent surgery for the repair of a fractured femur and cast application. When conducting routine morning assessments, upon which finding would the nurse report to the health care provider? A. Pain rated at 4/10. B. Warm toes. C. Rapid pedal pulses. D. Paresthesia of the toes.

D. - Paresthesia is an abnormal finding that requires further follow up as this could indicate compartment syndrome. This occurs when blood flow is reduced to areas in the body due to increased tissue pressure and swelling within that confined area. It must be reported to the HCP immediately as further interventions are required.

The nurse is completing discharge teaching with an older-adult client who underwent right total hip arthroplasty (THA). Which of the following client statements indicates a need for further instruction? A. Avoid crossing his legs. B. Use a toilet elevator on toilet seat. C. Notify future caregivers about the prosthesis. D. Maintain hip in adduction and internal rotation.

D. - The client should not cross legs, force hip into adduction, or force hip into internal rotation.

The nurse is caring for an older-adult client who underwent left total knee arthroplasty and has a new health care provider order to be "up in chair today before noon." Which of the following actions would the nurse implement to protect the knee joint while carrying out the order? A. Administer a dose of prescribed analgesic before completing the order. B. Ask the physiotherapist for a walker to limit weight bearing while getting out of bed. C. Keep the continuous passive motion machine in place while lifting the client from bed to chair. D. Put on a knee immobilizer before moving the client out of bed and keep the surgical leg elevated while sitting.

D. - The nurse should apply a knee immobilizer for stability before assisting the client to get out of bed. This is a standard measure to protect the knee during movement following surgery.

The nurse is caring for a 65-year-old Japanese client after a total hip replacement. After offering the client's scheduled analgesic, the client states that she is fine and declines any pain medication. How should the nurse proceed? A. Accept that the client is not experiencing any pain. B. Assume that the refusal reflects a cultural value. C. Remind the client that pain hinders the healing process. D. Ask the client to rate her pain on a scale of 0-10.

D. - The nurse should complete the pain assessment despite the client's statement that she is "fine." Although pain expression and medication use may be impacted by culture, the nurse should still perform thorough assessments.

A client with rheumatoid arthritis who lives alone presents to the clinic looking disheveled and unwashed. Which priority question should the nurse ask the client? A. "Are you sexually active?" B. "Why haven't you been taking care of yourself?" C. "Are you feeling depressed?" D. "Tell me about your support system."

D. - This is an open-ended question that allows the client to tell the nurse about the support that he is receiving. Support systems are very important for individuals with RA as they may have challenges with mobility, ADLs, fatigue, and loss of self-esteem. The nurse should assess the client's support systems and suggest community resources if the client is interested.