mobility- Nclex

Major goals of the therapeutic management of juvenile idiopathic arthritis are to: prevent joint discomfort and regain proper alignment. prevent loss of joint function and achieve cure prevent physical deformity and preserve joint function prevent skin breakdown and relieve symptoms.

prevent physical deformity and preserve joint function. Once the joint is damaged, it may not be possible to regain proper alignment. It may not be possible to achieve a cure. These are the goals of treatment. A third goal is to control pain. Skin breakdown is usually not an issue in juvenile rheumatoid arthritis.

The nurse provides instructions to a 30-yr-old office worker who has low back pain. Which statement indicate additional patient teaching is required? "Switching between hot and cold packs may relieve pain and stiffness." "Acupuncture to the lower back would cause irreparable nerve damage." "Smoking may aggravate back pain by decreasing blood flow to the spine." "Sleeping on my side with knees and hips bent reduces stress on my back."

"Acupuncture to the lower back would cause irreparable nerve damage." Acupuncture is a safe therapy when the practitioner has been appropriately trained. Very fine needles are inserted into the skin to stimulate specific anatomic points in the body for therapeutic purposes.

A patient with acute osteomyelitis asks the nurse how this problem will be treated initially. Which response by the nurse is most appropriate? "IV antibiotics are usually required for several weeks." "Oral antibiotics are often required for several months." "Surgery is almost always necessary to remove the dead tissue that present." "Drainage of the foot and instilling antibiotics into the affected area are the usual therapy."

"IV antibiotics are usually required for several weeks." The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. However, as many as 3 to 6 months may be required. Bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all microorganisms. Surgery may be used for chronic osteomyelitis, to include debridement of the devitalized, infected tissue and irrigation of the affected bone with antibiotics.

The nurse is caring for patients in a primary care clinic. Which patient is most at risk to develop osteomyelitis caused by Staphylococcus aureus? A 22-yr-old female patient with gonorrhea who is an IV drug user A 48-yr-old male patient with muscular dystrophy and acute bronchitis A 32-yr-old male patient with type 1 diabetes and stage 4 pressure injury A 68-yr-old female patient with hypertension who had a knee arthroplasty 3 years ago

A 32-yr-old male patient with type 1 diabetes and stage 4 pressure injury Osteomyelitis caused by S. aureus is usually associated with a pressure ulcer or vascular insufficiency related to diabetes. Osteomyelitis caused by Staphylococcus epidermidis is usually associated with indwelling prosthetic devices from joint arthroplasty. Osteomyelitis caused by Neisseria gonorrhoeae is usually associated with gonorrhea. Osteomyelitis caused by Pseudomonas is usually associated with IV drug use. Muscular dystrophy is not associated with osteomyelitis.

The patient with frostbite on the distal toes of both feet is scheduled for amputation of the damaged tissue. Which assessment finding or diagnostic study is most objective in determining tissue viability? Arteriogram showing blood vessels Peripheral pulse palpation bilaterally Patches of black, indurated, cold tissue Bilateral pale, cool skin below the ankles

Arteriogram showing blood vessels Arteriography determines viable tissue for salvage based on blood flow observed in real time and is considered the gold standard for evaluating arterial perfusion. Only arteriography determines where tissue perfusion stops, and amputation needs to occur. Bilateral peripheral pulse assessment and areas of black, indurated, cold, and pale skin indicate ischemia.

The nurse admits a 55-year-old woman with multiple sclerosis to a long-term care facility. Which finding represents a safety concern? Ataxic gait Severe fatigue Radicular pain Urinary retention

Ataxic gait An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in those with gait instability and visual or cognitive impairments. The other signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also occur in the patient with multiple sclerosis.

The nurse is admitting a patient with a history of a herniated lumbar disc and low back pain. Which action would likely aggravate the pain? Bending or lifting Application of warm moist heat Sleeping in a side-lying position Sitting in a fully extended recliner

Bending or lifting Back pain related to a herniated lumbar disc is aggravated by events and activities that increase stress and strain on the spine, such as bending or lifting, coughing, sneezing, and lifting the leg with the knee straight (straight leg-raising test). Moist heat, sleeping position, and ability to sit in a fully extended recliner do not aggravate the pain of a herniated lumbar disc.

Which structures protect a client's internal organs, support blood cell production, and store minerals? 1 Joints 2 Bones 3 Muscles 4 Cartilages

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

Which finding in older adult clients is associated with aging? 1 Decrease in height 2 Decreased neck rigidity 3 Increased fine-motor dexterity 4 Increased range of motion (ROM)

Decrease in height Loss of height and deformity and shortening of the trunk are common in older adults because of vertebral compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age because of loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult because of slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult because of cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.

The public health nurse is providing community education to increase the number of people who seek care after a tick bite. What priority information should the nurse provide to people at risk for tick bites? The best therapy for the acute illness is IV antibiotics. Check for an enlarging reddened area with a clear center. Surveillance is necessary during the summer months only. Antibiotics will prevent Lyme disease if taken for 10 days

Check for an enlarging reddened area with a clear center. After a tick bite, the expanding "bull's eye rash" is the most characteristic symptom that usually occurs in 3 to 30 days. Flu-like symptoms and migrating joint and muscle pain also may be present. Active lesions are treated with oral antibiotics for 2 to 3 weeks; doxycycline is effective in preventing Lyme disease when given within 3 days after the bite of a deer tick. IV therapy is used with neurologic or cardiac complications. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors. No vaccine is available.

A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. Which would the nurse suspect as the cause of the fracture? 1 Child abuse 2 Vitamin D deficiency 3 Osteogenesis imperfecta 4 Inadequate calcium intake

Child abuse Injuries in various stages of healing are the classic sign of child abuse. Vitamin D deficiency, osteogenesis imperfecta, and inadequate calcium intake may all be investigated after child abuse has been ruled out.

Which type of joint is present in between the client's tarsal bones? Pivot Hinge Saddle Gliding

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

To prevent thrombophlebitis in the immediate postoperative period, which action is important for the nurse to include in the client's plan of care? 1 Increase fluid intake. 2 Restrict fluids. 3 Encourage early mobility. 4 Elevate the knee gatch of the bed

Encourage early mobility. In the immediate postoperative period, mobility is encouraged because veins require the assistance of the surrounding muscle beds to help pump blood toward the heart. This reduces venous stasis and the risk of thrombophlebitis. Increased fluid intake, if not contraindicated, will prevent dehydration and venous stasis. Restriction of fluids may promote venous stasis and increase risk. Elevating the knee gatch of the bed will impede venous blood flow and increase the risk for thrombophlebitis.

The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis. Which finding should the nurse expect when examining the patient's knees? Ulnar drift Pain with joint movement Reddened, swollen affected joints Stiffness that increases with movement

Pain with joint movement Osteoarthritis is characterized predominantly by joint pain upon movement and is a classic feature of the disease. Ulnar drift occurs with rheumatoid arthritis, not osteoarthritis. Local inflammation (red, swollen joints) is unlikely with osteoarthritis. Stiffness decreases with movement.

The parents of a child with juvenile idiopathic arthritis are investigating other therapies to use with medications. Which therapy would the nurse recommend? 1 Physical therapy 2 Speech therapy 3 Nutritional therapy 4 Behavioral therapy

Physical therapy A physical therapist can prescribe an exercise protocol to keep the joints as mobile as possible; a routine can be developed to help the child alleviate morning stiffness. There is no evidence that speech therapy is needed at this time. Although nutrition is an appropriate part of therapy, it is the physical therapy program that can most directly influence movement. Behavioral therapy is referent only to special circumstances when the behavior needs warrant.

Which treatment is beneficial for a client with muscle spasm? Thermotherapy Muscle massage 3 Frequent position changes 4 Muscle-strengthening exercise regimen

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

A youngster has just returned from surgery in a hip spica cast. The PRIORITY nursing intervention is to: elevate the head of the bed. check circulation. turn the child to the right side. offer sips of water.

check circulation. The nurse must be observant to the risk of increased swelling in the extremities. The chief concern is that the extremity may continue to swell. This must be assessed to ensure that the cast does not become a tourniquet. Elevating the head of the bed might help with comfort. The child's position should be changed every 2 hours. Sips of water are acceptable, but only after the assessment of the extremities is completed.

An appropriate nursing intervention when caring for the child with chronic osteomyelitis is to: provide active range-of-motion exercises for the affected extremity. administer pain medications with meals. encourage frequent ambulation. move and turn the child carefully and gently to minimize pain.

move and turn the child carefully and gently to minimize pain. Active range of motion is contraindicated until pain has subsided. Pain medication should be administered as needed. Ambulation is contraindicated until pain has subsided. Osteomyelitis is extremely painful. Movement is carried out only as needed and then carefully and gently.

A nurse performs discharge teaching for a patient after a left hip arthroplasty using the posterior approach. Which statement indicates teaching is successful? "Leg-raising exercises are necessary for several months." "I should not try to drive a motor vehicle for 2 to 3 weeks." "I will not have any restrictions now on hip and leg movements." "Blood tests will be done weekly while taking enoxaparin (Lovenox)."

"Leg-raising exercises are necessary for several months." Exercises designed to restore strength and muscle tone will be done for months after surgery. The exercises include leg raises in supine and prone positions. Driving a car is not allowed for 4 to 6 weeks. In the posterior approach hip arthroplasties, extremes of internal rotation and 90-degree flexion of the hip must be avoided for 4 to 6 weeks postoperatively. The knees must be kept apart. The patient should never cross the legs or twist to reach behind. To prevent thromboembolism, enoxaparin is administered subcutaneously and can be given at home. Enoxaparin does not require monitoring of the patient's coagulation status.

A teenager is being discharged with a cast. Which would the nurse recommend if the client experiences pruritus around the cast edges? 1 "Scratch the itchy area gently." 2 "Put an ice pack on the affected area." 3 "Sprinkle a layer of powder around the itchy spots." 4 "Ask your doctor for a prescription for an antihistamine."

"Put an ice pack on the affected area." An ice pack numbs the area and may temporarily diminish the discomfort. Scratching stimulates the release of histamine, which worsens the pruritus; also, scratching may break the skin and open an avenue for infection. Powder may become caked and slip under the cast, causing additional discomfort. Also, powder should be avoided because it is toxic if inhaled. Antihistamines are not prescribed unless all other measures have failed.

Which is the priority nursing care in the immediate postoperative period for a toddler with a newly applied hip spica cast? 1 Offering oral fluids 2 Checking the toddler's peripheral circulation 3 Encouraging independent incentive spirometer use 4 Teaching how to use the overhead trapeze

Checking the toddler's peripheral circulation Priority nursing care for any cast application includes checking the color and temperature of the area surrounding the cast to ensure that the cast is not too tight. A tight cast compresses arteries and veins, thereby impairing circulation. Offering oral fluids is not the priority nursing care. The child has probably had a general anesthetic; if so, fluids will be offered later to avoid vomiting and aspiration. A toddler is not likely able to use an incentive spirometer independently. If a trapeze is to be used, this teaching should have been done before surgery or should be delayed until the child's condition has stabilized and the cast is dry.

When administered long-term, which medication requires ongoing musculoskeletal assessment? Corticosteroids β-Adrenergic blockers Antiplatelet aggregators Calcium-channel blockers

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

Which estrogen antagonist would the health care provider prescribe a client for the prevention and treatment of osteoporosis in postmenopausal women? 1 Raloxifene 2 Denosumab 3 Alendronate 4 Zoledronic acid

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

When the patient is diagnosed with muscular dystrophy, what information should the nurse include in the teaching plan? Use prolonged bed rest to decrease fatigue. Continuous positive airway pressure will facilitate sleeping. An orthotic jacket will limit mobility and may contribute to deformity. Remain active to prevent skin breakdown and respiratory complications.

Remain active to prevent skin breakdown and respiratory complications. With muscular dystrophy, the patient must remain active for as long as possible. Prolonged bed rest should be avoided because immobility leads to further muscle wasting. An orthotic jacket may be used to provide stability and prevent further deformity. Continuous positive airway pressure (CPAP) may be used as respiratory function decreases before mechanical ventilation is needed to sustain respiratory function.

An adolescent who had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. The nurse's MOST appropriate action is to: 1. withhold pain medications because of narcotic addiction. 2. refer the patient for psychologic counseling. 3. teach the parents and adolescent child about nerve damage. 4. reassure the child that it is normal and is called phantom limb sensation.

reassure the child that it is normal and is called phantom limb sensation. Phantom limb sensation is an expected phenomena following amputation of an extremity. The other choices are not relevant. Phantom limb sensation is an expected experience because the nerve-brain connections are still present. They gradually fade. This should be discussed before surgery with the child.

A 24-yr-old male patient has come to the clinic with a gradual onset of pain and swelling in the left knee. The patient is diagnosed with osteosarcoma without metastasis. Chemotherapy is ordered before surgery. How would the nurse explain the reason for preoperative chemotherapy? "The chemotherapy is being used to save your left leg." "Chemotherapy will increase your 5-year survival rate." "Chemotherapy is being used to decrease the tumor size." "Chemotherapy will help decrease the pain before and after surgery."

"Chemotherapy is being used to decrease the tumor size." Preoperative chemotherapy is used to decrease the tumor size before surgery. The chemotherapy will not save his leg if the lesion is too big or there is neurovascular or muscle involvement. Adjunct chemotherapy after amputation or limb salvage has increased 5-year survival rates in people without metastasis. Chemotherapy is not used to decrease pain before or after surgery.

An 82-yr-old patient is frustrated by loose abdominal tissue and rigid hips. How should the nurse respond? "You should go on a diet and exercise more to feel better about yourself." "Something must be wrong with you because you should not have these problems." "You have arthritis and need to take nonsteroidal antiinflammatory drugs (NSAIDs)." "Decreased muscle mass and strength and increased hip rigidity are expected with aging."

"Decreased muscle mass and strength and increased hip rigidity are expected with aging." The musculoskeletal system's normal changes of aging include decreased muscle mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees; decreased fine motor dexterity; and slowed reaction times. Going on a diet and exercising will help but not stop these changes. Telling the patient "Something must be wrong with you..." is untrue and will not be helpful to the patient's frustrations.

The nurse is admitting a patient who reports the new onset of lower back pain. To distinguish between the pain of a lumbar herniated disc from other causes, what is the best question for the nurse to ask the patient? "Is the pain worse in the morning or in the evening?" "Is the pain sharp and stabbing or burning and aching?" "Does the pain radiate down the buttock or into the leg?" "Is the pain totally relieved by acetaminophen (Tylenol)?"

"Does the pain radiate down the buttock or into the leg?" Lower back pain associated with a herniated lumbar disc is accompanied by radiation along the sciatic nerve. It is often described as traveling through the buttock to the posterior thigh or down the leg. This is because the herniated disc causes compression on spinal nerves as they exit the spinal column. Time of occurrence, type of pain, and pain relief questions do not elicit differentiating data.

A client newly diagnosed with type 1 diabetes asks why it is necessary to exercise on a regular basis. Which response is accurate? "Exercise decreases insulin sensitivity." 2 "It stimulates glucagon production." 3 "Exercise improves the cellular uptake of glucose." 4 "It reduces metabolic requirements for glucose."

"Exercise improves the cellular uptake of glucose." Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin. Glucagon action raises blood glucose but does not affect cell uptake or use of glucose. Cellular requirements for glucose increase with exercise.

A 21-yr-old soccer player has injured the anterior crucial ligament (ACL) and is having reconstructive surgery. Which patient statement indicates more teaching is required? "I probably won't be able to play soccer for 6 to 8 months." "They will have me do range of motion with my knee soon after surgery." "I will need to wear an immobilizer and progressively bear weight on my knee." "I can't wait to get this done now so I can play in the soccer tournament next month."

"I can't wait to get this done now so I can play in the soccer tournament next month." The patient does not understand the severity of ACL reconstructive surgery if planning to resume playing soccer soon; safe return will not occur for 6 to 8 months. A physical therapist will oversee initial range of motion, immobilization, and progressive weight bearing.

The nurse obtains a history from a 46-yr-old woman with rheumatoid arthritis. The nurse should follow up on which patient statement? "I perform range of motion exercises at least twice a day." "I use a heating pad for 20 minutes to reduce morning stiffness." "I take a 20-minute nap in the afternoon even if I sleep 9 hours at night." "I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)."

"I restrict fluids to prevent edema when taking methotrexate (Rheumatrex)." Methotrexate can affect renal function. Patients should be well hydrated to prevent nephropathy. Heat application, range of motion, and rest are appropriate interventions to manage rheumatoid arthritis.

When reinforcing health teaching on managing osteoarthritis, which patient statement indicates additional instruction is needed? "I can use a cane to relieve the pressure on my back and hip." "I should take the Naprosyn as prescribed to help control the pain." "I should try to stay standing all day to keep my joints from becoming stiff." "A warm shower in the morning will help relieve the stiffness I have when I get up."

"I should try to stay standing all day to keep my joints from becoming stiff." Maintaining a balance between rest and activity is important to prevent overstressing joints affected by OA. Naproxen may be used for moderate to severe OA pain. Using a cane and warm shower to help relieve pain and morning stiffness are helpful.

The registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for additional instruction? "I should walk on soft scatter rugs at home." 2 "I should drink 3000 mL of water every day." 3 "I should eat fruits and vegetables six times a day." 4 "I should exercise the joints above and below the cast daily."

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

The nurse has provided instructions about back safety to a client. Which statement by the client indicates understanding of these instructions? 1 "I will carry objects about 18 inches from my body." 2 "I will sleep on my stomach with a firm mattress." 3 "I will carry objects close to my body." 4 "I will pull rather than push when moving heavy objects."

"I will carry objects close to my body." By carrying objects close to the center of the body, the client can lessen back strain. Sleeping on the stomach, pulling objects, and carrying objects too far away from the body add pressure and strain to the back muscles.

A patient is scheduled for arthrocentesis arrives at the outpatient surgery unit and states, "I do not want this procedure done today." Which response by the nurse is most appropriate? "When would you like to reschedule the procedure?" "Tell me what your concerns are about this procedure." "The procedure is safe, so why should you be worried?" "The procedure is not painful because an anesthetic is used."

"Tell me what your concerns are about this procedure." The nurse should use therapeutic communication to determine the patient's concern about the procedure. The nurse should not provide false reassurance. It is not appropriate for the nurse to conclude the patient is concerned about pain or assume the patient is asking to reschedule the procedure.

The nurse receives report from the licensed practical nurse (LPN/VN) about care provided to patients on the orthopedic surgical unit. It is most important for the nurse to follow up on which statement? "The patient who had a spinal fusion 12 hours ago has hypoactive bowel sounds and is not passing flatus." "The patient who had cervical spine surgery 2 days ago wants to wear her soft cervical collar when out of bed." "The patient who had spinal surgery 3 hours ago is reporting a headache and has clear drainage on the dressing." "The patient who had a laminectomy 24 hours ago is using patient-controlled analgesia with morphine for pain management."

"The patient who had spinal surgery 3 hours ago is reporting a headache and has clear drainage on the dressing." After spinal surgery, there is potential for cerebrospinal fluid (CSF) leakage. Severe headache or leakage of CSF (clear or slightly yellow) on the dressing should be reported immediately. The drainage is CSF if a dipstick test is positive for glucose. Patients after spinal surgery may experience interference with bowel function for several days. Postoperatively most patients require opioids such as morphine IV for 24 to 48 hours. Patient-controlled analgesia is the preferred method for pain management during this time. After cervical spine surgery, patients often wear a soft or hard cervical collar to immobilize the neck.

A patient is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement by the patient indicates understanding of the procedure? "The bone density in my heel will be measured." "This procedure will not cause any pain or discomfort." "I will not be exposed to any radiation during the procedure." "I will need to remove my hearing aids before the procedure."

"This procedure will not cause any pain or discomfort." DXA is painless and measures the bone mass of spine, femur, forearm, and total body with minimal radiation exposure. A quantitative ultrasound evaluates bone density using ultrasound of the calcaneus (heel). MRI would require removal of objects such as hearing aids that have metal parts.

A patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information? "Mild pain is associated with the procedure." "Two additional follow-up scans will be required." "The procedure takes approximately 15 to 30 minutes." "You will need to drink increased fluids after the procedure."

"You will need to drink increased fluids after the procedure." Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans are required. Only mild pain may be associated with bone scans related to 1 hour of lying supine.

Which term describes synovial joint movement away from the midline of the body? Inversion Extension Pronation Abduction

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

After a below-the-knee amputation, a client is refusing to eat, talk, or perform any rehabilitative activities. Which approach would the nurse take when interacting with this client? 1 Explain why there is a need to increase activity. 2 Emphasize that with a prosthesis, there will be a return to the previous lifestyle. 3 Appear cheerful and noncritical regardless of the client's response to attempts at intervention. 4 Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving

Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving. The withdrawal provides time for the client to assimilate what has occurred and to integrate the change in body image. The client is not ready to hear explanations about why there is a need to increase activity until assimilation of the surgery has occurred. Emphasizing a return to the previous lifestyle does not acknowledge that the client must grieve; it also does not allow the client to express any feelings that life will never be the same again. In addition, it may be false reassurance. The client might feel that the nurse has no comprehension of the situation or understanding of feelings if the nurse appears cheerful and noncritical regardless of the client's response to attempts at intervention.

A 90-year-old resident fell and fractured the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. Which general fact about the older adult would the nurse consider when caring for this client? 1 Aging causes a lower pain threshold. 2 Aging reduces the physiological coping defenses. 3 Most confused states result from dementia. 4 Older adults psychologically tolerate changes well.

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

Which finding during a home health visit would prompt the nurse to provide a client with home safety instructions? Select all that apply. One, some, or all responses may be correct. 1 Area rugs on the floor 2 Clogged, dirty fireplace 3 Multiple electrical cords 4 Multiple prescribed medications 5 Wheeled walker with uneven leg

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

The nurse completes an admission history for a 73-yr-old man with osteoarthritis scheduled for total knee arthroplasty. Which response is expected when asking the patient the reason for admission? Recent knee trauma Debilitating joint pain Repeated knee infections Onset of frozen knee joint

Debilitating joint pain The most common reason for knee arthroplasty is debilitating joint pain despite exercise, weight management, and drug therapy. Recent knee trauma, repeated knee infections, and onset of frozen knee joint are not primary indicators for a knee arthroplasty.

Which is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? Increased metabolism Increased venous return Increased cardiac output Decreased exercise tolerance

Decreased exercise tolerance Metabolism decreases during periods of immobility. There is decreased venous return because of decreased muscle activity. There is decreased cardiac output. Muscle disuse leads to tissue breakdown and loss of muscle mass. It may take weeks or months to recover.

A nurse is working with a 73-yr-old patient with osteoarthritis. Which description of the disorder should be included in the teaching plan? Joint destruction caused by an autoimmune process Degeneration of articular cartilage in synovial joints Overproduction of synovial fluid resulting in joint destruction Breakdown of tissue in non-weight-bearing joints by enzymes

Degeneration of articular cartilage in synovial joints OA is a degeneration of the articular cartilage in diarthrodial (synovial) joints from damage to the cartilage. The condition has also been referred to as degenerative joint disease. OA is not an autoimmune disease. There is no overproduction of synovial fluid causing destruction or breakdown of tissue by enzymes.

The patient brought to the emergency department after a car accident is diagnosed with a femur fracture. What nursing intervention should the nurse implement at this time to decrease risk of a fat embolus? Administer enoxaparin (Lovenox). Provide range-of-motion exercises. Apply sequential compression boots. Immobilize the fracture preoperatively.

Immobilize the fracture preoperatively. The nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus development before surgical reduction. Enoxaparin is used to prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient.

The nurse is caring for a patient with bilateral knee osteoarthritis. Which measure should the nurse recommend to slow progression of the disease? Use a wheelchair to avoid walking as much as possible. Sit in chairs that cause the hips to be lower than the knees. Eat a well-balanced diet to maintain a healthy body weight. Use a walker for ambulation to relieve the pressure on the hips.

Eat a well-balanced diet to maintain a healthy body weight. Because maintaining an appropriate load on the joints is essential to the preservation of articular cartilage integrity, the patient should maintain an optimal overall body weight or lose weight if overweight. Walking is encouraged. The best chairs for this patient have a higher seat and armrests to facilitate sitting and rising from the chair. Relieving pressure on the hips is not important for knee disease.

Which diagnostic procedure is used to detect muscle weakness? 1 Arthroscopy 2 Radiography 3 Myelography 4 Electromyography

Electromyography Electromyography is performed to detect diffuse or localized muscle weakness by determining the electric potential generated in an individual. Arthroscopy is used for the direct visualization of ligaments, menisci, and articular surfaces of a joint. A radiography is performed to detect bone density, alignment, swelling, and intactness of a joint. A myelography is performed to visualize the vertebral column, intervertebral discs, spinal nerve roots, and blood vessels.

A patient has a plaster cast applied to the right arm for a Colles' fracture. Which nursing action is most appropriate? Elevate the right arm on 2 pillows for 24 hours. Apply heating pad to reduce muscle spasms and pain. Limit movement of the thumb and fingers on the right hand. Place arm in a sling to prevent movement of the right shoulder.

Elevate the right arm on 2 pillows for 24 hours. The casted extremity should be elevated at or above heart level for 24 hours to reduce swelling or inflammation. The cast should be supported on pillows during the drying period to prevent denting and flattening of the cast. Ice (not heat) should be applied for the first 24 to 36 hours to reduce swelling or inflammation. Active movement of the thumb and fingers should be encouraged to reduce edema and increase venous return. A sling may be used to support and protect the extremity after the cast is completely dry, but the patient should perform active movements of the shoulder to prevent stiffness or contracture.

The nurse is reinforcing health teaching about osteoporosis with a 72-yr-old patient admitted to the hospital. What should the nurse explain to the patient? With a family history of osteoporosis, you cannot prevent or slow bone resorption. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise

Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements or foods high in calcium and engages in regular weight-bearing exercise. Corticosteroids interfere with bone metabolism. Estrogen therapy is no longer used to prevent osteoporosis because of the associated increased risk of heart disease and breast and uterine cancer.

Which hormonal deficiency would increase the client's risk for fractures? 1 Growth hormone 2 Follicle-stimulating hormone 3 Thyroid-stimulating hormone 4 Adrenocorticotropic hormone

Growth hormone Growth hormone deficiency causes decrease in bone density, thereby increasing the risk of fractures. Follicle-stimulating hormone deficiency causes amenorrhea, decreased libido, and infertility in women and impotence in men. Thyroid-stimulating hormone deficiency causes menstrual abnormalities and hirsutism. Adrenocorticotropic hormone deficiency causes hypoglycemia and hyponatremia.

Which statement is true concerning osteogenesis imperfecta? It is easily treated It is an inherited disorder Later-onset disease usually runs a more difficult course Braces and exercises are of no therapeutic value.

It is an inherited disorder. It is a lifelong problem caused by defective bone mineralization, abnormal bone architecture, and increased susceptibility to fracture. Osteogenesis imperfecta is an inherited disorder. The type of disease determines the course it will take. Lightweight braces and splints can help support limbs and fractures.

The nurse is caring for a patient with osteoarthritis scheduled for total left knee arthroplasty. Preoperatively, the nurse assesses for which contraindication to surgery? Pain Left knee stiffness Left knee infection Left knee instability

Left knee infection The patient must be free of infection before total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring more extensive surgery. The nurse must assess the patient for signs of infection, such as redness, swelling, fever, and elevated white blood cell count. Pain, knee stiffness, or instability are typical of osteoarthritis.

The home care nurse visits a 74-yr-old man diagnosed with Parkinson's disease who fell while walking this morning. What observation is of most concern to the nurse?2 × 6 cm right calf abrasion with sanguineous drainage Left leg externally rotated and shorter than the right leg Stooped posture with a shuffling gait and slow movements Mild pain and minimal swelling of the right ankle and foot

Left leg externally rotated and shorter than the right leg Manifestations of hip fracture include external rotation, muscle spasm, shortening of the affected extremity, and severe pain and tenderness in the region of the fracture site. Expected clinical manifestations of Parkinson's disease include a stooped posture, shuffling gait, and slow movements. An abrasion is a soft tissue injury. Mild pain and minimal swelling may occur with a sprain or strain.

Which tissue connects the client's tibia to the femur at the knee joint? 1 Fascia 2 Bursae Tendons Ligaments

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

The nurse is caring for a patient admitted to the nursing unit with osteomyelitis of the tibia. When completing a focused assessment, which symptom should the nurse expect? Nausea and vomiting Localized pain and warmth Paresthesia in the affected extremity Generalized bone pain throughout the leg

Localized pain and warmth Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or spread from another part of the body. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and warmth. Nausea and vomiting and paresthesia of the extremity are not expected to occur. Pain occurs, but it is localized rather than generalized throughout the leg.

Which nursing action would be implemented after a client has a lumbar puncture? 1 Maintaining the client in the supine position for several hours 2 Encouraging the client to ambulate every hour for at least 6 hours 3 Keeping the client in the Trendelenburg position for at least 2 hours 4 Placing the client in the high-Fowler position immediately after the procedure

Maintaining the client in the supine position for several hours Staying flat may help prevent spinal fluid leakage and postprocedure headache; this is recommended, even though some people develop a headache despite this precaution. Encouraging the client to ambulate every hour for at least 6 hours may predispose to spinal fluid leakage; the client should be kept flat for 6 to 12 hours. The Trendelenburg position may increase intracranial pressure and is not appropriate. Placing the client in the high-Fowler position immediately after the procedure may predispose to spinal fluid leakage; the client should be kept flat.

The nurse is completing discharge teaching with a patient who is recovering from a right total hip arthroplasty by posterior approach. Which patient action indicates further instruction is needed? Uses an elevated toilet seat. Sits with feet flat on the floor. Maintains hip in adduction and internal rotation. Verifies need to notify future caregivers about the prosthesis

Maintains hip in adduction and internal rotation. The patient should not force hip into adduction or internal rotation because these movements could dislocate the hip prosthesis. Sitting with feet flat on the floor (avoiding crossing the legs), using an elevated toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching.

During a health screening event, which assessment finding in a 61-yr-old patient would alert the nurse to the possible presence of osteoporosis? Presence of bowed legs Measurable loss of height Poor appetite and aversion to dairy products Development of unstable, wide-gait ambulation

Measurable loss of height A gradual but measurable loss of height and the development of kyphosis ("dowager's hump") are indicative of the presence of osteoporosis. Bowed legs may be caused by abnormal bone development or rickets but are not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis but are not indicative of its presence. A wide gait is used to support balance and does not indicate osteoporosis.

Which element would the nurse focus on when teaching crutch-walking to a client who has a casted leg fracture? 1 Establishing a schedule for pain medication 2 Maintaining a fixed schedule of daily activities 3 Modifying the home environment to prevent accidents 4 Understanding that a more sedentary lifestyle is necessary

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

The nurse is caring for a patient placed in Buck's traction before open reduction and internal fixation of a left hip fracture. Which care can be delegated to the LPN/VN? Assess skin integrity around the traction boot. Determine correct body alignment to enhance traction. Remove weights from traction when turning the patient. Monitor pain intensity and administer prescribed analgesics.

Monitor pain intensity and administer prescribed analgesics. The LPN/VN can monitor pain intensity and administer analgesics. Assessment of skin integrity and determining correct alignment to enhance traction are within the RN scope of practice. Removing weights from the traction should not be delegated or done. Removal of weights can cause muscle spasms and bone misalignment and should not be delegated or done.

The home care nurse visits an 84-yr-old woman with pneumonia after her discharge from the hospital. Which age-related change in the musculoskeletal system should the nurse expect? Positive straight-leg-raising test Muscle strength is scale grade 3/5 Lateral S-shaped curvature of the spine Fingers drift to the ulnar side of the forearm

Muscle strength is scale grade 3/5 Decreased muscle strength is an age-related change of the musculoskeletal system caused by decreased number and size of the muscle cells. The other assessment findings indicate musculoskeletal abnormalities. A positive straight-leg-raising test indicates nerve root irritation from intervertebral disk prolapse and herniation. An ulnar deviation or drift indicates rheumatoid arthritis due to tendon contracture. Scoliosis is a lateral curvature of the spine.

A patient with a fracture of the proximal left tibia in a long leg cast reports of severe pain and a prickling sensation in the left foot. The toes on the left foot are pale and cool. Which nursing action is a priority? Notify the health care provider immediately. Elevate the left leg above the level of the heart. Administer prescribed morphine sulfate intravenously. Apply ice packs to the left proximal tibia over the cast.

Notify the health care provider immediately. Notify the health care provider immediately of this change in patient's condition, which suggests development of compartment syndrome. Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications of impending compartment syndrome. Changes in sensation (tingling) also suggest compartment syndrome. Because elevation of the extremity may lower venous pressure and slow arterial perfusion, the extremity should not be elevated above heart level. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. Administration of morphine may be warranted, but it is not the first priority.

The nurse is performing a musculoskeletal assessment on an 81-yr-old patient whose mobility has been progressively declining. How should the nurse safely assess range of motion (ROM) in the affected leg? Observe the patient's unassisted ROM in the affected leg. Perform passive ROM, asking the patient to report any pain. Ask the patient to lift progressive weights with the affected leg. Move both the patient's legs from a supine position to full flexion.

Observe the patient's unassisted ROM in the affected leg. Observing the patient's active ROM is more accurate and safer than lifting weights. Passive ROM should be performed with extreme caution; it may cause harm when performed on older patients.

Which hormone promotes bone resorption in a client and potentially leads to decreased bone densities? 1 Estrogen 2 Calcitonin 3 Growth hormone 4 Parathyroid hormone (PTH)

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

A 67-yr-old patient hospitalized with osteomyelitis has an order for bed rest with bathroom privileges and elevation of the affected foot on 2 pillows. The nurse would place the highest priority on which intervention? Ambulate the patient to the bathroom every 2 hours. Ask the patient about preferred activities to relieve boredom. Allow the patient to dangle legs at the bedside every 2 to 4 hours. Perform frequent position changes and range-of-motion exercises.

Perform frequent position changes and range-of-motion exercises. The patient is at risk for atelectasis of the lungs and contractures because of prescribed bed rest. For this reason, the nurse should place the priority on changing the patient's position frequently to promote lung expansion and performing range-of-motion exercises to prevent contractures. Assisting the patient to the bathroom will keep the patient safe as the patient is in pain, but it may not be needed every 2 hours. Providing activities to relieve boredom will assist the patient to cope with the bed rest. Dangling the legs every 2 to 4 hours may be too painful.

Which nursing intervention is most appropriate when turning a patient after spinal surgery? Having the patient turn to the side by grasping the side rails to help turn Placing a pillow between the patient's legs and turning the body as a unit Elevating the head of bed 30 degrees and having the patient extend the legs while turning Turning the patient's head and shoulders and then the hips, keeping the patient's body centered in the bed

Placing a pillow between the patient's legs and turning the body as a unit Placing a pillow between the legs and turning the patient as a unit (logrolling) helps to keep the spine in good alignment and reduces pain and discomfort after spinal surgery. The other interventions will not maintain proper spine alignment and may cause spinal damage.

Which principles of body mechanics would the nurse use when providing care for an immobilized client? 1 Bending at the waist to provide the power for lifting 2 Placing the feet apart to increase the stability of the body 3 Keeping the body straight when lifting to reduce pressure on the abdomen 4 Relaxing the abdominal muscles while using the extremities to prevent strain

Placing the feet apart to increase the stability of the body Placing the feet apart creates a wider base of support and brings the center of gravity closer to the ground. This improves stability. The nurse should avoid bending at the waist because the movement strains the lower back muscles; the muscles of the thighs and buttocks should provide the power of lifting. Prevent pressure on the abdomen by tightening the abdominal and gluteal muscles to form an internal girdle; keeping the body straight does not reduce strain on the abdominal musculature. Relaxing the abdominal muscles with physical activity increases back strain.

The nurse is caring for a patient who had a left total knee arthroplasty to relieve the pain of severe osteoarthritis. What care would be expected postoperatively? Progressive leg exercises to obtain 90-degree flexion Early ambulation with full weight bearing on the left leg Bed rest for 3 days with the left leg immobilized in extension Immobilization of the left knee in 30-degree flexion to prevent dislocation

Progressive leg exercises to obtain 90-degree flexion The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible; continuous passive motion also may be used based on surgeon preference. Early ambulation is implemented, sometimes the day of surgery, but orders are likely to indicate weight bearing as tolerated rather than full weight bearing. Immobilization and bed rest are not indicated. The patient's knee is unlikely to dislocate.

Which is characteristic of fractures in children? Fractures rarely occur at the growth plate site, because it absorbs shock well. Rapidity of healing is inversely related to the age of the child. Pliable bones of growing children are less porous than those of the adult. Periosteum of a child's bone is thinner, weaker, and has less osteogenic potential compared with that of the adult.

Rapidity of healing is inversely related to the age of the child. The cartilage epiphyseal plate is the weakest point of the long bone. Therefore, it is a frequent site of damage. Fractures heal in children in less time than they do in adults. As the child ages, the healing time increases. The periosteum is thickened, and there is a great production of osteoclasts when a bone injury occurs. Bone healing in children is rapid because of the thickened periosteum and generous blood supply.

What is the rationale for elevating an extremity after a soft tissue injury such as a sprained ankle? Increases the pain threshold. Increases metabolism in the tissues. Produces a deep tissue vasodilation. Reduces edema formation.

Reduces edema formation. This should have no effect on the pain threshold. This should not affect metabolism. Venous return to the heart, not vasodilation, is facilitated. Elevating the extremity uses gravity to facilitate venous return to reduce edema.

A nurse is assessing the recent health history of a 63-yr-old patient with osteoarthritis. Which activity pattern should the nurse recommend? Bed rest with bathroom privileges Daily high-impact aerobic exercise Regular exercise program of walking Frequent rest periods with minimal exercise

Regular exercise program of walking A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in patients with osteoarthritis. A balance of rest and activity is needed. High-impact aerobic exercises would cause stress to affected joints and further damage.

A patient presents to the clinical after tripping on a curb and spraining the right ankle. Which initial care measures are appropriate? (Select all that apply.) Apply ice directly to the skin. Apply heat to the ankle every 2 hours. Administer antiinflammatory medication. Compress ankle using an elastic bandage. Rest and elevate the ankle above the heart. Perform passive and active range of motion

Remember RICE which stands for Rest, Ice, compress, and elevate. You would give anti-imflammatories to decrease pain and reduce the inflammatory process that is causing the pain. Administer antiinflammatory medication. Compress ankle using an elastic bandage. Rest and elevate the ankle above the heart. You wouldn't add heat You wouldn't perform active range of motion because the sprain would cause too much pain and could result in increasing the damage. You would NEVER apply Ice Directly to the skin, this can cause damage to the skin and surrounding blood vessels. This was a trick, the rest of the answers in RICE you would do. Read carefully.

A client sustains a crushing injury of the spinal cord above the level of origin of the phrenic nerve. As a result of this injury, the nurse expects to react to which clinical manifestation? 1 Ventricular fibrillation and decreased perfusion 2 Dysfunction of the vagus nerve with hiccups 3 Retention of sensation but paralysis of the lower extremities 4 Respiratory paralysis and cessation of diaphragmatic contractions

Respiratory paralysis and cessation of diaphragmatic contractions The phrenic nerve innervates the diaphragm. A crushing spinal cord injury above the cervical plexuses, the level of phrenic nerve origin, results in respiratory paralysis. Cardiac activity will not be affected; the heart is regulated by the autonomic nervous system fibers originating in the medulla. Activities regulated by the vagus nerve will be unaffected; the vagus nerve originates in the medulla, which is superior to the cervical region; the phrenic nerves originate from the cervical plexuses. In a crushing spinal cord injury, both motor and sensory conduction are affected.

Which activities would be encouraged of a child with juvenile idiopathic arthritis to prevent loss of joint function? Select all that apply. One, some, or all responses may be correct. Riding a bicycle Walking to school Watching videos after school Swimming in the community pool Playing computer games after school

Riding a bicycle Walking to school Swimming in the community pool Riding a bicycle and walking are low-impact activities that help maintain joint mobility while not requiring too much weight bearing by the joints. Swimming helps maintain muscle tone while providing freedom of movement without the need to bear weight on the joints. Prolonged sitting, while watching videos or playing computer games, can lead to stiffness and flexion contractures.

The nurse determines dietary teaching for a 75-yr-old patient with osteoporosis has been successful when the patient selects which meal as highest in calcium? Chicken stir fry with 1 cup each onions and green peas, and 1 cup of steamed rice Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple Sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk A 2-egg omelet with 2 oz of American cheese, 1 slice of whole wheat toast, and a half grapefruit

Sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk

How would the nurse prevent footdrop in a client with a leg cast? 1 Encourage complete bed rest to promote healing of the foot. 2 Place the foot in traction. 3 Support the foot with 90 degrees of flexion. 4 Place an elastic stocking on the foot to provide support.

Support the foot with 90 degrees of flexion. To prevent footdrop (plantar flexion of the foot because of weakness or paralysis of the anterior muscles of the lower leg) in a client with a cast, the foot should be supported with 90 degrees of flexion. Bed rest can cause footdrop, and 45 degrees is not enough flexion to prevent footdrop. Application of an elastic stocking for support also will not prevent footdrop; a firmer support is required.

A 13-year-old adolescent is found to have idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport would the nurse suggest as the most therapeutic for this preadolescent? 1 Golf 2 Bowling 3 Swimming 4 Badminton

Swimming The hyperextension required in swimming helps strengthen back muscles and necessitates deeper respirations, both of which are necessary before surgery and before wearing a brace or cast. The other options involve twisting the back muscles, which is not therapeutic for a child with this condition.

Which statement is true about the skeletal system of toddlers? 1 The bones of toddlers are less pliable than those of older persons. 2 The bones of toddlers have less cartilage than those of young adults. 3 The bones of toddlers can better withstand falls than those of older adults. 4 The bones of toddlers are more susceptible to osteoporosis than those of women.

The bones of toddlers can better withstand falls than those of older adults. The bones of toddlers can withstand falls better than those of older adults. Toddlers' bones are more pliable than those of older persons. Toddlers have greater amounts of cartilage and are highly flexible as compared with the cartilage of young adults. Older adults, especially women, are more susceptible to bone-density loss and are more prone to developing osteoporosis, which increases the risk of fractures.

The nurse is planning health promotion teaching for a 45-yr-old patient with asthma who has low back pain from herniated lumbar disc. What activity would the nurse include in an individualized exercise plan for the patient? Yoga Walking Calisthenics Weightlifting

Walking The patient would benefit from an aerobic exercise that considers the patient's health status and fits the patient's lifestyle. The best exercise is walking, which builds strength in the back and leg muscles without putting undue pressure or strain on the spine. If the patient has exercise-induced asthma, the nurse would recommend use of a rescue inhaler prior to exercise. Yoga, calisthenics, and weightlifting would all put pressure on or strain the spine.

An infant is born with one lower limb deficiency. When is the optimum time for the child to be fitted with a prosthetic device? As soon as possible after birth When the infant begins sitting up and can maintain balance. At about age 12 to 15 months, when most children are walking. At about 4 years, when the healthy limb is not growing so rapidly.

When the infant begins sitting up and can maintain balance. The device will not be useful until the child is developmentally ready to use the leg. This is the most optimum time for the child to be fitted with a prosthetic device. The child is ready to stand, and the prosthetic device will be integrated into his or her capabilities. This may be too late. The device should be provided when the child is showing readiness to stand. This is too late.

The nurse is caring for an immobilized preschool child. During this period of immobilization, the nurse's BEST action is to: encourage wearing pajamas. let the child have few behavioral limitations. keep child away from other immobilized children if possible take child for a "walk" by wagon outside the room.

take child for a "walk" by wagon outside the room. The child should be encouraged to wear street clothes during the daytime. Limit setting is necessary with all children. There is no reason to segregate children who are immobilized unless there are other medical issues that need to be addressed. It is important for children to have activities outside of the room if possible. This increases environmental stimuli and provides social contact with others.