Mobility Practice Questions :)

The nurse is aware that clients who use the swing-to-gait for ambulation on a regular basis are at risk for development of which problem?

Atrophy of the leg muscles Explanation: Prolonged use of the swing-to-gait can cause atrophy of unused muscles, the legs.

The UAP is caring for a 79-year-old client who is immobilized and is preparing to complete range-of-motion (ROM) exercises. The nurse cautions the UAP to avoid which motion in an elderly client?

) Hyperextension Explanation: Hyperextension should be avoided in the elderly because joints become joints become less flexible with age and hypertension may cause pain or nerve damage.

The nurse observes the unlicensed assistive person (UAP) perform range-of-motion (ROM) exercises to a client's leg. The nurse knows that UAP is correctly performing abduction of the hip when which set of motions is completed?

A) The UAP moves the leg to the side away from the body. Explanation: Abduction is the movement of a limb away from the medial plane of the body so abduction of the leg would be movement to the side away from the body.

A couple who is caring for their aging parents are concerned about factors that put them at risk for falls. Which factors are most likely to contribute to an increase in falls in the elderly? (Select all that apply.) A. Inadequate lighting B. Throw rugs C. Multiple medications D. Doorway thresholds E. Cords covered by carpets F. Staircases with handrails

ANS: A, B, C, D, E Falls most often occur while transferring from beds, chairs, and toilets; getting into or out of bathtubs; tripping over items such as cords covered by rugs or carpets, carpet edges, or doorway thresholds; slipping on wet surfaces; and descending stairs. Multiple medications also contribute to fall risk.

Which information will the nurse include when discharging a patient with a sprained wrist from the emergency department? A. Keep the wrist loosely wrapped with gauze. B. Apply a heating pad to reduce muscle spasms. C. Use pillows to elevate the arm above the heart. D. Gently move the wrist through the range of motion.

ANS: C Elevation of the arm will reduce the amount of swelling and pain. Compression bandages are used to decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling. The wrist should be rested and kept immobile to prevent further swelling or injury.

The nurse is caring for a client who was placed in skeletal traction 48 hours ago for treatment of a serious femur fracture. The nurse will check the client's neurovascular status of the client's affected foot how often?

) Every 4 hours Explanation: The client's neurovascular status is checked every 4 hours while the client remains in traction.

The nurse is teaching a group of newly hired UAP's about proper body mechanics and instructs them to use which most important piece of equipment to ensure that proper body mechanics are used?

) No special equipment is required Explanation: No special equipment is required to do proper body mechanics but the healthcare worker must know what equipment is available to assist with safe movement of a client.

The nurse will stand where when preparing to ambulate a client who uses crutches?

) On the client's affected side and slightly behind. Explanation: The nurse stands behind the client and toward the affected side to provide support if the client loses balance.

The nurse is observing an unlicensed assistant person (UAP) make an occupied bed and will provide correction if the UAP uses which technique with body mechanics?

) The UAP pulls the client to move him in the bed. Explanation: Pulling an object (or client) to move it puts a strain on a person's back. The UAP should push to move the object using the legs

The nurse is preparing to place a client with COPD in the orthopneic bed position and will place what item in front of this client that is necessary to maintain this position?

Over the bed table Explanation: An overbed table is necessary when the client is in the orthopneic position because it assists the client with exhalation

The nurse is aware that which client would best be able to handle a three-point gait using crutches?

A 25-year-old client with a broken right ankle. Explanation: The three-point gait requires that the client must bear the entire body weight on the unaffected leg. A young person whose only injury is a broken right ankle would be able to do this.

The nurse is preparing to assist a client with ambulation and knows a gait belt may not be appropriate to use for a client with which condition?

A client who has a large abdominal incision. Explanation: A gait belt may not be appropriate for a client who has an abdominal incision because of the pressure is may put on the incision.

The charge nurse is making assignments for the nursing unit and knows that which healthcare worker is responsible for ensuring that staff use proper body mechanics in caring for assigned clients?

All healthcare personnel Explanation: All healthcare personnel are responsible for using proper body mechanics when caring for clients.

A client has a problem with severe painful osteoarthritis. A regimen of heat, massage, and exercise has been ordered. What is the desired response to this treatment? 1. Help maintain joint flexibility and relieve pain and stiffness. 2. Restore range of motion previously lost. 3. Prevent the inflammatory process. 4. Assist the client to effectively cope with pain.

Answer: 1

A client has a long leg plaster cast applied. What nursing action should be implemented while the cast is still wet? 1. Use only the fingertips when moving the cast. 2. Keep the client and cast covered with blankets. 3. Support the cast on plastic-covered pillows. 4. Place a heat lamp directly over the cast.

Answer: 3 The cast should be supported on a pillow that will not absorb the moisture and will not keep the cast wet (e.g., plastic-covered pillow). Palms of the hand should be used in turning the client. Heat should not be applied to a damp cast. (Lewis 8 ed, p. 1593).

An older client has bilateral osteoarthritis in his hips. What would be important for the nurse to teach this client regarding protection of his joints? 1. Use a cane or walker for ambulation. 2. Sit in straight back chairs that you can get out of easily. 3. Use a wheel chair when you are tired. 4. Exercise regularly and control weight.

Answer: 4 Regular exercise increases and strengthens joint mobility, in addition to muscles supporting the joints. It also increases cartilage formation for continued joint mobility. Weight reduction, if appropriate, is critical to decreasing stress on weight-bearing joints. Sitting in a straight back chair does facilitate movement but does not protect the joints. Using devices assists in ambulation and promotes independence but does not offer joint protection as well as exercise and weight loss. (Ignatavicius, Workman, 7 ed., p. 320.)

The nurse and the UAP are preparing to move a client from the bed to a chair for the first time using a hydraulic lift. What is the first thing the nurse should do prior to beginning this procedure?

Demonstrate the use of the hydraulic lift to the client. Explanation: Prior to using the hydraulic lift with a client for the first time, the nurse should demonstrate the use of the lift to calm any anxieties the client may have about the lift.

The nurse is observing a UAP assist a client with a vascular problem back into bed. The nurse would intervene if the UAP placed this client in what position in the bed?

Elevate knee-gatch position Explanation: The elevate knee-gatch bed position is contraindicated in clients with vascular problems because it will put pressure on the blood vessels at the back of the knee.

The nurse and the UAP are preparing to logroll a client who has a spinal injury. The nurse will ask the UAP to obtain what assistive device prior to beginning the procedure?

Friction-reducing device Explanation: A friction-reducing device is necessary to pull the client to the side of the bed prior to logrolling the client.

The nurse is caring for a client with limited movement who weighs 415 pounds and will plan to use which assistive device when moving this client up in bed?

Mechanical lift Explanation: A mechanical lift is necessary to move an obese client up in the bed because the client's weight and immobility will require the nurse to lift more than 35 pounds of the client's weight.

The nurse is preparing to do pin site care for a client in skeletal traction. It is noted that the site appears red and feels warm to the touch. What actions will the nurse perform in taking care of this situation?

Notify the healthcare provider Expect to obtain a culture and sensitivity specimen from the pin site Check the client's vital signs

The nurse has completed discharge teaching about range-of-motion exercises with an elderly client that are to be completed at home. The nurse explains that these exercises are important to complete for what reason?

ROM exercises will help the client maintain necessary muscle mass. Explanation: ROM exercises will help prevent a loss of muscle mass which could lead to difficulties performing activities requiring strength.

The nurse is caring for a client who uses a hydraulic lift to be moved out of the bed. What is the nurse's first action prior to starting this procedure?

Request help from another staff member Explanation: A minimum of 2 healthcare workers is required to safely move a client with a hydraulic lift. The nurse should first obtain assistance.

The nurse is caring for a client who is complaining of esophageal reflux symptoms. After administering the prescribed medication, the nurse will place the client in what bed position to assist in providing comfort to this client?

Reverse Trendelenburg Explanation: Reverse Trendelenburg places the client in position with the bed tilted down starting at the head of the bed. This allows gravity to assist with keeping gastric contents in the stomach and out of the esophagus

The nurse is preparing to conduct an hourly assessment of a client who was placed in skin traction approximately 6 hours ago and has been stable since that time. The plan is to check the client's vital signs, pain level and complete what other assessments?

Skin integrity of both heels. Ensure traction weight is correctly placed. Ensure client's shoulders and hips are in alignment. Explanation: Check the skin integrity of any area exposed to the surface of the bed like the heels.

The nurse is watching an unlicensed assistive person (UAP) prepare to move an eighteen-month-old toddler from the pediatric unit to the radiology unit. The nurse will stop the UAP if the UAP chooses which form of transport?

Stretcher Explanation: A stretcher is not a safe form of transport because a mobile toddler could possibly fall off of it.

The nurse has asked the unlicensed assistive person (UAP) to provide personal care to the client who is in skin traction and will ensure that UAP knows to place the client in what position?

Supine Explanation: The client in skin traction must be maintained in the supine position to maintain body alignment and proper traction

The nurse attempts to meet the developmental needs of a four-year-old child while doing range of motion (ROM) exercises by doing what with the child?

Turning the ROM exercises into a game Explanation: Turning the ROM exercise experience into a game will meet the child's developmental needs and elicit the most cooperation from the child.

The nurse is preparing to transport a six-month-old infant to the radiology department. What measures will the nurse institute to safely complete this procedure?

Use a high-top crib for transporting. Cover the infant with a blanket Explanation: A high-top crib ensures the infant can't fall during transport. Infant is kept covered to prevent hypothermia from occurring.

The nursing assessment of an 80-year-old patient who demonstrates some confusion but no anxiety reveals that the patient is a fall risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to prevent falls for this patient is to: A. Place a bed alarm device on the bed. B. Place the patient in a belt restraint. C. Provide one-on-one observation of the patient. D. Apply wrist restraints.

ANS: A Consider and implement alternatives as appropriate before the use of a restraint. A bed alarm is an alternative that the nurse implements independently.

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. Which of these prescribed collaborative interventions will the nurse implement first? A. Wrap the ankle and apply an ice pack. B. Administer naproxen (Naprosyn) 500 mg PO. C. Give acetaminophen with codeine (Tylenol #3). D. Take the patient to the radiology department for x-rays.

ANS: A Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.

A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should A. loosen the traction and have the patient turn onto the unaffected side. B. place a pillow between the patient's legs and turn gently to each side. C. turn the patient partially to each side with the assistance of another nurse. D. have the patient lift the buttocks by bending and pushing with the left leg.

ANS: D The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.

The nurse would consider the teaching plan successful when an adolescent states that she understands that the Milwaukee brace should be worn: 1. During school hours only 2. At night when sleeping 3. During gym class 4. 23 hours a day

Answer: 4 The Milwaukee brace should be worn about 23 hours a day. The adolescent can be out of the brace for about an hour when showering or exercising. (Hockenberry, Wilson, 9 ed., p. 1669.)

A school-age child has a diagnosis of juvenile rheumatoid arthritis. What instruction(s) to assist in decreasing the child's joint pain should the nurse provide to the parents? Select all that apply. 1. Have the child use elevators of repeated trips up and down stairs. 2. Perform all range-of-motion exercises daily, even if joints are acutely inflamed. 3. Encourage the child to take naps in the afternoon. 4. As soon as the child is awake in the morning, administer an NSAID. 5. Have the child soak in a warm tub for 15 minutes just after arising in the morning. 6. Encourage swimming and pool activities.

Answers: 1, 5, 6 Rheumatoid arthritis may cause chronic, severe joint pain. Using the elevator would decrease joint stress from repetitive movements. Acutely inflamed joints may need temporary rest and immobilization with lightweight splints sometimes prescribed to prevent deformity from muscle spasms and contractures. Moist heat is beneficial, especially in the mornings when the joints are stiff. NSAIDs should be taken after meals and not on an empty stomach. Exercising in a pool allows freedom of movement without weight on the joint. Naps are not encouraged, because they promote stiffness during the day and may interfere with the child sleeping at night. (Hockenberry, Wilson, 9 ed., pp. 1680-1681.)

In reviewing the physical assessment on a newborn, the nurse notes that a "hip click" was noted by the health care provider on the initial assessment. What other characteristics would the nurse assess for that commonly is associated with this finding? 1. Shortened quadriceps 2. Lateral deviation of patella 3. Limited adduction 4. Shortening of leg on affected side

Answer: 4 The hip click is a classic finding in an infant with a congenital dislocation of the hip. Typical findings include Ortolani's (hip click) sign, limited abduction, shortening of the extremity on the affected side, and asymmetric gluteal folds. (Hockenberry, Wilson, 9 ed., pp. 420-422.)

Which of the following would be appropriate client education before having a bone scan? Select all that apply. 1. Maintain NPO status for 8 before the procedure. 2. The procedure will involve intravenous injection of radioisotopes. 3. The procedure will involve a small incision where bone tissue is removed for biopsy. 4. The client will have to lie very still during the scan. 5. Avoid stimulants such as caffeine for 24 hours before the procedure. 6. Increase intake of fluids after the procedure is completed

Answers: 2, 4, 6 The procedure will include an IV injection of radioisotopes, during the scan, the client will have to be very still or the scan pictures may not be clear, and increasing fluids afterwards will promote excretion of the radioisotopes. Food or fluids are not limited before the scan, and no biopsy of the bone will be taken. (Lewis 8 ed, p. 1579).

A patient has been on bed rest for over 4 days. On assessment, the nurse identifies the following as a sign associated with immobility: A. Decreased peristalsis B. Decreased heart rate C. Increased blood pressure D. Increased urinary output

ANS: A Immobility disrupts normal metabolic functioning: decreasing the metabolic rate; altering the metabolism of carbohydrates, fats, and proteins; causing fluid, electrolyte, and calcium imbalances; and causing gastrointestinal disturbances such as decreased appetite and slowing of peristalsis.

The nurse is caring for a patient whose calcium intake must increase because of high risk factors for osteoporosis. Which of the following menus should the nurse recommend? A. Cream of broccoli soup with whole wheat crackers, cheese, and tapioca for dessert B. Hot dog on whole wheat bun with a side salad and an apple for dessert C. Low-fat turkey chili with sour cream with a side salad and fresh pears for dessert D. Turkey salad on toast with tomato and lettuce and honey bun for dessert

ANS: A Teach patient and/or caregiver the current recommended dietary allowances for calcium and review foods high in calcium (e.g., milk fortified with vitamin D, leafy green vegetables, yogurt, and cheese).

Before assisting a patient with ambulation on the day after a total hip replacement, which action is most important for the nurse to take? A. Administer the ordered oral opioid pain medication. B. Instruct the patient about the benefits of ambulation. C. Ensure that the incisional drain has been discontinued. D. Change the hip dressing and document the wound appearance.

ANS: A The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient's willingness to ambulate, but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not affect ambulation.

What is your role as a nurse during a fire? (Select all that apply.) A. Help to evacuate patients B. Shut off medical gases C. Use a fire extinguisher D. Single carry patients out E. Direct ambulatory patients

ANS: A, B, C, E Direct all ambulatory patients to walk by themselves to a safe area. If you have to carry a patient, do so correctly (e.g., two-man carry). After a fire is reported and patients are out of danger, nurses and other personnel take measures to contain or extinguish it such as closing doors and windows, placing wet towels along the base of doors, turning off sources of oxygen and electrical equipment, and using a fire extinguisher.

During a health screening event which assessment finding would alert the nurse to the possible presence of osteoporosis in a white 61-year-old female? A. The presence of bowed legs B. A measurable loss of height C. Poor appetite and aversion to dairy products D. Development of unstable, wide-gait ambulation

ANS: B A gradual but measurable loss of height and the development of kyphosis or "dowager's hump" are indicative of the presence of osteoporosis in which the rate of bone resorption is greater than bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis but are not indicative it is present. A wide gait is used to support balance and does not indicate osteoporosis.

A patient who has been hospitalized for 3 days with a hip fracture has sudden onset shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? A. Stay with the patient and offer reassurance. B. Administer the prescribed PRN oxygen at 4 L/min. C. Check the patient's legs for swelling or tenderness. D. Notify the health care provider about the symptoms.

ANS: B The patient's clinical manifestations and history are consistent with a pulmonary embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiologic need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for fat embolus or venous thromboembolism (VTE) are obtained.

Which of the following observations made by the nurse who is evaluating the crutch-walking technique of a patient who is to have no weight bearing on the right leg indicates that the patient can safely ambulate independently? A. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating. B. The patient advances the right leg and both crutches together and then advances the left leg. C. The patient moves the left crutch with the left leg and then the right crutch with the right leg. D. The patient uses the bedside chair to assist in balance as needed when ambulating in the room.

ANS: B When using crutches, patients are usually taught to move the assistive device and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.

A patient on prolonged bed rest is at an increased risk to develop this common complication of immobility if preventive measures are not taken: A. Myoclonus B. Pathological fractures C. Pressure ulcers D. Pruritus

ANS: C Immobility is a major risk factor for pressure ulcers. Any break in the integrity of the skin is difficult to heal. Preventing a pressure ulcer is much less expensive than treating one; therefore preventive nursing interventions are imperative.

Which of the following are physiological outcomes of immobility? A. Increased metabolism B. Reduced cardiac workload C. Decreased lung expansion D. Decreased oxygen demand

ANS: C Physiologic outcomes of immobility include decreased metabolism, increased cardiac workload, decreased lung expansion, and increased oxygen demand.

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

ANS: C The highest calcium content is present in the lunch containing milk and milk products (yogurt) and small fish with bones (sardines). Chicken, onions, green peas, rice, ham, whole wheat bread, broccoli, apple, eggs, and grapefruit each have less than 75 mg of calcium per 100 g of food. Swiss cheese and American cheese have more calcium, but not as much as the sardines, yogurt, and milk.

The family of a patient who is confused and ambulatory insists that all four side rails be up when the patient is alone. What is the best action to take in this situation? (Select all that apply.) A. Contact the nursing supervisor. B. Restrict the family's visiting privileges. C. Ask the family to stay with the patient if possible. D. Inform the family of the risks associated with side-rail use. E. Thank the family for being conscientious and put the four rails up. F. Discuss alternatives that are appropriate for this patient with the family.

ANS: C, D, F The family is concerned about ensuring a safe environment for their loved one. The nurse should discuss their concerns, the risk of using restraints related to using four side rails, and safer alternatives such as the presence of a family member. If the family still insists on use of four side rails, you could contact the nursing supervisor to further discuss the situation with them. This is not a reason to restrict visitation; but, although you should appreciate their concern, the use of four side rails should be avoided.

Which action will the nurse take in order to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the left femur? A. Assess for hip contractures. B. Monitor for hip dislocation. C. Check the peripheral pulses. D. Ask about left hip pain level.

ANS: D Buck's traction keeps the leg immobilized and reduces painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck's traction.

When giving home care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include? A. Keep the hand immobile to prevent soft tissue swelling. B. Keep the right shoulder elevated on a pillow or cushion. C. Avoid the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 48 hours after the injury. D. Call the health care provider for increased swelling or numbness.

ANS: D Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat pain after a fracture.

Which information obtained by the emergency department nurse when admitting a patient with a left femur fracture is most important to report to the health care provider? a. Bruising of the left thigh b. Complaints of left thigh pain c. Outward pointing toes on the left foot d. Prolonged capillary refill of the left foot

ANS: D Prolonged capillary refill may indicate complications such as arterial damage or compartment syndrome. The other findings are typical with a left femur fracture.

A patient is admitted to the emergency department with possible left lower leg fractures. The initial action by the nurse should be to A. elevate the left leg. B. splint the lower leg. C. obtain information about the tetanus immunization status. D. check the popliteal, dorsalis pedis, and posterior tibial pulses.

ANS: D The initial nursing action should be assessment of the neurovascular status of the injured leg. After assessment, the nurse may need to splint and elevate the leg, based on the assessment data. Information about tetanus immunizations should be done if there is an open wound.

This morning a 21-year-old male patient had a long leg cast applied and wants to get up and try out his crutches before dinner. The nurse will not allow this. What is the best rationale that the nurse should give the patient for this decision? A The cast is not dry yet, and it may be damaged while using crutches. B The nurse does not have anyone available to accompany the patient. C Rest, ice, compression, and elevation are in process to decrease pain. D Excess edema and other problems are prevented when the leg is elevated for 24 hours

ANS: D For the first 24 hours after a lower extremity cast is applied, the leg will be elevated on pillows above the heart level to avoid excessive edema and compartment syndrome. The cast will also be drying during this 24-hour period. RICE is used for soft tissue injuries, not with long leg casts.

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring? A Paresthesia B Pitting edema C Poor venous return D Compartment syndrome

ANS: D The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome.

The nurse is completing discharge teaching with an 80-year-old male patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to 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.

ANS: D The patient should not force hip into adduction or force hip into internal rotation as these movements could displace the hip replacement. Avoiding crossing the legs, using a toilet elevator on a toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching.

The nurse is reinforcing health teaching about osteoporosis with a 72-year-old patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient? A. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. B. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. C. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

ANS: D The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements and/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

A client is scheduled for an open magnetic resonance imaging (MRI) to evaluate for left tibia osteomyelitis. Which information obtained by the nurse indicates that the nurse should consult with the health care provider before scheduling an MRI? Select all that apply. 1. Client has a pacemaker 2. Client is claustrophobic 3. Client is allergic to shellfish 4. Client is pregnant. 5. Client wears a hearing aid and contact lenses 6. Client has an implanted insulin pump

Answer. 1, 4, 6 The physician should be contacted regarding clients with pacemakers (the magnetic field interferes with the function of the pacemaker and interferes with the test as well), clients with implanted insulin pumps, pregnant clients, obese clients, and any client who requires life support equipment (the equipment will malfunction in a magnetic field). Hearing aids can be removed; contact lenses should not be a problem. This is an open MRI, so claustrophobia should not be an issue. Contrast medium is not used, so shellfish allergy is not a contraindication to MRI. (Ignatavicius, Workman,7 ed., p. 1115-1116.)

What is the priority assessment information to obtain from a client who is being admitted with a tentative diagnosis of fractured hip? 1. Circulation and sensation distal to the fracture 2. Amount of swelling around the fracture site 3. Degree of bone healing that has occurred 4. Amount of pain that the fracture and healing are causing

Answer: 1 Rationale: Circulation and neurosensory status distal to the fracture are always priorities for clients with fractures. The amount of swelling is important; however, the primary concern regarding swelling is circulatory and neurosensory deficits. The amount of bone healing cannot be assessed. There is concern regarding pain, but circulatory and neurologic checks are the priority actions. (Lewis 8 ed, p. 1596).

A client has a herniated nucleus pulposus at L5-S1, causing swelling toward the right spinal nerve root. Where would the nurse anticipate the client will feel pain or discomfort? 1. Radiating down the right hip to the thigh 2. Along the lower left side of the back and down to the left calf 3. Lower back bilaterally 4. From across the pelvis to the center of the lower back

Answer: 1 A herniated nucleus pulposus of L5-S1 will affect primarily the lower back, with radiation down one leg, and depending on which area the swelling impinges on, the spinal nerve root. In this case, it would be radiating down the right leg. The pain is most often not felt bilaterally or across the pelvis. (Ignatavicius, Workman, 7 ed., p. 960.)

The nurse is assisting a client to learn how to use an aluminum pick up walker to help stabilize her gait after repair of a fractured hip. Which nursing observations of the client's activity would indicate the client understands how to use the walker? 1. Places the walker forward and walks into walker with affected leg first, flexing both arms about 30 degrees 2. Puts the walker in front, leaning into the walker, and takes several small steps, keeping the arms straight 3. Standing straight, moves the walker forward with each step 4. Places the walker in front and swings both legs together to move into walker

Answer: 1 After repair of a fractured hip, the client would have partial weight bearing as tolerated on the affected leg. Arms are flexed 30 degrees when standing in the walker. The walker is advanced and the client steps into the walker with the affected leg first, bearing weight on the walker as the client moves forward. Leaning into walker before taking a step could put the client off balance. Taking small steps forward as the walker is advanced does not provide stability to the injured hip. A swing-through gait is not appropriate for a client with partial weight bearing. (Lewis, et al, 8 ed., p. 1602; Potter, Perry, 7 ed., p. 295.)

A client is placed in balanced traction with a Thomas splint and a Pearson attachment. What will the nursing care of a client in this type of traction include? 1. Assessing the groin area for signs of pressure 2. Preventing pressure at the heel of the affected side 3. Changing the compression bandages once a shift 4. Maintaining the bed in flat position to facilitate traction

Answer: 1 Balanced suspension traction with a Thomas splint is a type of skeletal traction that requires checking the groin area where the thigh is supported. The leg of the affected side is suspended off the bed, and the heel is usually not a problem. Because it is skeletal traction, there is no compression bandage. (deWit, 2 ed, p. 788, 798-799).

A client with osteoarthritis in the left knee has had a total knee replacement. What is important to include in the postoperative nursing care plan? 1. Use constant passive motion (CPM) to promote joint flexibility. 2. Wrap the knee in a loose fitting absorbent bandage to promote flexibility. 3. Maintain bed rest for 2 days to maintain extension and immobilization of leg. 4. Insert a urinary retention catheter since client is on total bed rest for 2 days.

Answer: 1 Constant passive motion is utilized early to maintain joint flexibility. A compression dressing is used immediately after surgery. The client is ambulated as early as possible. A urinary retention catheter is not used with bed rest unless it is absolutely necessary and the client cannot void on his own. (Ignatavicius, Workman, 7 ed., pp. 329-330.)

A client has been taking low-dose aspirin and prednisone (Deltasone) for the past several years for treatment of her rheumatoid arthritis. What finding would indicate a problem with the drug therapy? 1. Tarry stools 2. Decreased leukocyte count 3. Thrombocytopenia 4. Postural hypotension

Answer: 1 Development of tarry stools indicates gastrointestinal bleeding. Both the aspirin and the corticosteroids place the client at high risk for the development of a peptic ulcer and subsequent GI bleeding. Postural hypotension, thrombocytopenia, and decreased leukocytes are not directly associated with corticosteroids. (Lehne, 7 ed., pp. 832, 850.)

A woman is beginning to take alendronate (Fosamax) for treatment of her osteoporosis. The nurse is discussing with the woman how she should take the medication. What is very important to include in this discussion? 1. The medication must be taken on an empty stomach, and no food must be eaten for at least 30 minutes after the medication is taken. 2. The medication should be taken with a minimal amount of water, and the client should lie down after taking it. 3. The client should take the medication every night at bedtime, and she should not stop taking it abruptly. 4. Orthostatic hypotension may be a potential side affect; she should stand up slowly and make sure she has her balance.

Answer: 1 For the medication to be adequately absorbed, there must be no food in the stomach. A large glass of water should be used to take the medication to make sure it does not lodge in the esophagus. The client should not lie down for 30 minutes after taking the medication because any gastric reflux of the medication can be very irritating to the esophagus. Orthostatic hypotension is not a side effect, and the medication should not be taken at bedtime. (Lehne, 7 ed., pp. 231, 874-876.)

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

Answer: 1 Heparin is administered prophylactically to prevent thromboembolic complications in clients who are immobilized for prolonged periods. It is not effective in preventing fat emboli or venous stasis or promoting vascular perfusion. (Lilly 6 ed, p. 439).

A client with a below-the-knee amputation is complaining of phantom limb pain that is not responsive to administration of narcotic analgesics. The client is started on gabapentin (Neurontin). The nurse explains to the client that this medication works by: 1. Binding at receptor pain sites to decreases neuropathic pain. 2. Decreasing inflammation and irritation at the site of the nerve ending 3. Decreasing pain by inhibiting the pain impulse at the level of the axion 4. Affecting the central nervous system and altering processes affecting pain perception

Answer: 1 Neurontin is used to treat neuropathic pain, which is often the basis for phantom limb pain in amputees. Drugs to decrease inflammation are corticosteroids. Narcotics affect the CNS and the perception of pain. (Lehne, 7 ed., p. 231.)

A client with rheumatoid arthritis has a history of long-term nonsteroidal antiinflammatory drug (NSAID) use and has developed peptic ulcer disease. Which medication would the nurse anticipate administering? 1. Omeprazole (Prilosec) 2. Ticlopidine (Ticlid) 3. Cyanocobalamin (vitamin b12) 4. Prednisolone (prelone)

Answer: 1 Omeprazole (Prilosec) is a proton-pump inhibitor, which suppresses gastric acid secretion. Cyanocobalamin is used to treat vitamin B12 deficiency. Ticlopidine is an antiplatelet agent used to reduce the risk of stroke. Prednisolone is a glucocorticoid used to treat several inflammatory disorders and contributes to gastric ulcer development. (Lehne, 7 ed., p. 917.) Peptic ulcer: A peptic ulcer is a defect in the lining of the stomach or the first part of the small intestine, an area called the duodenum. A peptic ulcer in the stomach is called a gastric ulcer. An ulcer in the duodenum is called a duodenal ulcer.

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

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

For a client with severe painful osteoarthritis, a regimen of heat, massage, and exercise will: 1. Help relax muscles and relieve pain and stiffness 2. Restore range of motion previously lost 3. Prevent the inflammatory process 4. Help the client cope with pain effectively

Answer: 1 Physical therapy relaxes muscles and relieves the aching and stiffness of the involved joints. It usually does not restore lost range of motion, and it does not prevent inflammation. Physical therapy does make the client more comfortable, but it does not assist in coping with pain. (Lewis 8 ed, p. 1644).

The nurse is caring for a client with a fractured hip who has been placed in Buck's traction. On assessing the client, the nurse determines the client's feet are touching the end of the bed. What would be the best nursing action? 1. Assist the client to move up in the bed. 2. Raise the head of the bed. 3. Turn the client to the unaffected side. 4. Take no action if the client is comfortable.

Answer: 1 Pulling the client up in the bed will restore traction, and raising the foot of the bed will decrease the amount of sliding. Turning the client may cause further damage. Taking no action allows the traction to remain ineffective in this situation. (Lewis, et al, 8 ed., p. 1593; Ignatavicius, Workman, 7 ed., pp. 1153-1154.).)

A client is being discharged after receiving a left total hip replacement. He has been instructed on how to use a cane by physical therapy. The nurse is evaluating the client's use of the cane. What observation would indicate the client understands how to use the cane? 1. The cane is held with the right hand and is advanced forward with the left leg. 2. The cane is advanced with the left foot, and held on the left side. 3. The cane is positioned in front of the client and he walks toward the cane. 4. The cane is to the left side; the client bears weight on it when advancing the left leg.

Answer: 1 The cane should be held in the hand opposite the affected leg and should be advanced with the affected leg. The cane would be placed in the right hand, and then the cane is advanced with the left leg. The cane should not be held in the hand on the same side as the injury. (Potter, Perry, 8 ed., p. 760.)

The nurse is assessing a preadolescent girl for scoliosis. How would the nurse perform this assessment? 1. Have the girl bend forward from the waist and observe for asymmetry in the back and hip area. 2. Examine the girl unclothed from the waist down; examine movement of the hips and legs. 3. Have the girl walk heel to toe and observe the gait and pelvis. 4. Place the girl on her back and flex the knees and observe for misalignment.

Answer: 1 The child should remove her shirt (leave on bra or swimsuit top) and bend at the waist. The nurse should examine for uneven hips and shoulders or a visible curvature of the spine. The waist line may be uneven, and one hip may be more prominent. Movement of the hips, walking, and flexing the knees do not provide information regarding scoliosis. (Hockenberry, Wilson, 9 ed., p. 1669.)

A client has been diagnosed with gouty arthritis and has begun taking allopurinol (Zyloprim). What is important for the nurse to discuss with the client regarding this medication? 1. The medication should be taken with food, and intake of liquids should be increased throughout the day. 2. Diarrhea and nausea may occur soon after therapy begins and will subside with no treatment. 3. The client should call the doctor if severe headaches occur after taking the medication. 4. The client should start to feel some pain relief within the first 24 hours after taking the medication.

Answer: 1 The client must take the medication with food to avoid gastrointestinal upset. The medication is being given because of the hyperuricemia; therefore the client needs to increase fluids to flush out the excess uric acid. It will take the medication several days to achieve maximum effectiveness; pain relief will not be immediate. Diarrhea, nausea, and headache are not common side effects. (Lehne, 7 ed., pp. 231, 865.)

A client's x-ray film shows a fractured right femur. The nurse will assess the client for what potential complication? 1. Fat embolus 2. Septicemia 3. Hypovolemic shock 4. Cardiogenic shock

Answer: 1 The common complications associated with a femoral shaft fracture include fat embolism, nerve and vascular injury, and problems with bone union and soft tissue injury. (Lewis, et al, 8 ed., p. 1604.)

The nurse understands that which of the following is characteristic of fractures in children? 1. The younger the child, the faster a fracture heals. 2. Epiphyseal fractures seldom occur because of the elasticity of the growth plate. 3. A child's bone is more pliable and porous as compared with an adult's bone 4. A child's bone is thinner, weaker, and less osteogenic than that of an adult.

Answer: 1 The healing of fractures is more rapid in children, as compared with adults. The speed of healing is inversely related to the age of the child: the younger the child, the more rapid the healing process. The epiphyseal plate is a frequent site of injury during trauma, because it is the weakest point of long bones. Children's bones are more pliable and porous, which allows them to bend, buckle, and break, and have greater porosity, which increases the flexibility of the bone providing a good shock absorber for any forceful injury. The adult, not the child, has periosteum that is thinner, weaker, and less osteogenic. (Hockenberry, Wilson, 9 ed., p. 1637.)

What evaluation is important in the preoperative nursing assessment of a client with a severely herniated lumbar disk? 1. Movement and sensation in the lower extremities 2. Leg pain that radiates to both lower extremities 3. Reflexes in the upper extremities 4. Pupillary reaction to light

Answer: 1 The movement and sensation should be evaluated before surgery to serve as a baseline for comparison during the postoperative recovery period. Radiating leg pain is diagnostic of the condition, and assessing it before surgery is not as beneficial as determining movement and sensation. (Lewis 8 ed, pp. 339, 342 & 1631).

Besides a hip-spica cast, what other devices are used in the treatment of hip dysplasia in a child? 1. Pavlik harness 2. Daily adduction and abduction exercises 3. Harrington rod 4. A large, rounded pillow

Answer: 1 To help stabilize the hip, a Pavlik harness may be used from birth until around 6 months of age. Then, if continued immobilization is needed, a spica cast may be applied after closed reduction of the hip. The hip needs stabilization, not mobility, thus exercises are not appropriate. Adduction, especially, would contribute to redislocation of the hip. Harrington rods are surgically inserted to treat scoliosis. Although pillows may provide comfort, they do not provide sufficient support. (Hockenberry, Wilson, 9 ed., pp. 422-423.)

A client has been fitted with crutches. The nurse is assessing the crutches to determine if they properly fit the client. What observation would cause the nurse the most concern? 1. When the client is standing, with the hands placed on the hand supports, the arms are straight. 2. There is space of about 1 to 2 in between the axillary fold and the top of the crutch. 3. The client can comfortably place crutches about 6 to 8 in lateral to the heel of his foot when walking. 4. The arms are flexed about 30 degrees and resting on the hand supports when the client is standing.

Answer: 1 When the client is standing at rest, the arms should be flexed about 30 degrees. This allows for weight bearing on the hand supports and not under the client's arm when the client begins to walk. There should be about 1 to 2 in between the axillary fold and the top of the crutch to prevent axillary nerve damage. The client should be able to comfortably place the crutches about 6 to 8 in lateral to the heel of the foot. (Potter, Perry, 8 ed., p. 761.)

Which diagnostic tools would the nurse identify as the most useful in evaluating undiagnosed skeletal and joint conditions? 1. X-Ray 2. MRI 3. CT scan 4. Myelogram

Answer: 1 X-ray films are very useful diagnostic tools and can be used to identify joint disruption, bone deformities, calcifications, bone deterioration, and fractures and are used to measure bone density. MRI uses a strong magnetic field and radio waves to diagnose conditions (three-dimensional view), especially problems in the joints and soft tissue injuries. A CT scan can be used to identify injuries of soft tissue, ligaments, tendons, and muscles. Obtaining a myelogram is an invasive procedure used to evaluate abnormalities of the spinal canal and cord. (Ignatavicius, Workman, 7 ed., p. 1114-1115.)

The nursing care plan for a 2-month-old infant in a left hip spica cast includes what nursing measures? 1. Palpating the left brachial artery and comparing it with the right 2. Checking cast for tightness by inserting fingers between skin and cast 3. Assessing for blanching of the skin in areas proximal to the casted left leg 4. Maintaining constant traction on the affected left leg

Answer: 2 A hip spica cast is used for the treatment of congenital hip dysplasia. Check the cast to make sure it is not too tight and constricting circulation by inserting a finger between the skin and cast. The child is not in traction with a hip spica cast and the arms are not being treated. The circulation is checked distal to the cast not proximal. (Hockenberry, Wilson, 9 ed p. 423).

Which medication is most often used in the initial treatment of the client with rheumatoid arthritis? 1. Corticosteriods 2. Aspirin 3. Disease-modifying antirheumatic drugs 4. Gold salts

Answer: 2 Acetylsalicylic acid (aspirin) is the drug of choice and is the most effective in the early treatment of rheumatoid arthritis (RA) because of its immediate effects on relieving symptoms associated with RA. Corticosteroids and gold salts typically are not used in the early or initial treatment. Disease-modifying antirheumatic drugs (DMARDs) are usually started within 3 months of diagnosis. However, DMARDs take several weeks to months to become effective in preventing further joint deterioration. (Lehne, 7 ed., p. 857.)

Postoperatively, after a lumbar laminectomy, the client continues to complain of the same low back pain that he had before surgery. The nurse knows that this finding may be caused by what problem? 1. Failure of the surgeon to remove the client's herniated disk 2. Swelling in the operative area that compresses adjacent structures 3. Twisting of the client's spine when he turns side to side 4. Limitation of movement resulting from spinal fusion

Answer: 2 After surgery, edema may cause compression of structures in the operative area, resulting in similar pain the client experienced before surgery. Twisting will cause pain, but it is usually a different pain than the pain the client experienced before surgery. Limitation of movement will decrease pain. (Ignatavicius, Workman, 7 ed., p. 963-964.)

Fat embolism is a major complication of a client with a fractured femur. What assessment finding would alert the nurse to the possibility of this complication occurring? 1. Ecchymosis on lower extremities 2. Blood-tinged sputum 3. Complaints of bone pain 4. Complaints of muscle spasms.

Answer: 2 Fat emboli, which are made up of lipase and fatty acids, can cause an inflammatory response in the lungs with blood-stained sputum, condition may progress to pulmonary edema with severe hypoxia. Petechiae on the chest may occur and are a classic sign of fat emboli; however, it is a late sign. Ecchymosis on the lower extremities is not an indication of fat emboli. The client is already experiencing bone pain from the fracture. (Ignatavicius, Workman, 7 ed., pp. 1146-1147.)

A client is taking allopurinol (Zyloprim) 200 mg by mouth every day. Which statement by the client indicates an understanding of the nurse's instruction? 1. "My diet will consist of more meat and fewer sugars." 2. "I need to drink at least ten 8-ounce glasses of water a day." 3. "I should increase my intake of dairy products." 4. "This medication should be taken on an empty stomach."

Answer: 2 Allopurinol (Zyloprim) reduces uric acid concentration in the serum and in the urine. It must be taken with at least 8 or more glasses of water to increase urine flow to reduce the risk of renal calculi formation. Increasing protein, limiting sugar, and increasing dairy products do not affect the action of Zyloprim. The medication may cause gastric irritation, and it may be taken with food to decrease incidence of gastric irritation. (Lehne, 7 ed., p. 865.)

While playing tennis, a client suffers an injury to the knee. Which diagnostic test would the nurse anticipate the health care provider ordering to identify soft tissue injury? 1. X-Ray 2. MRI 3. Arthroscopy and thermography of joint 4. Duplex venous doppler

Answer: 2 An MRI records the signals from the cells in a manner that provides information to evaluate soft tissue structures (tumors, blood vessels). An x-ray would be useful in diagnosing fractures. Arthroscopy is used for visualizing the joints, and thermography uses an infrared detector to measure inflammatory response in a joint. A duplex venous Doppler is an ultrasound of the veins most useful in determining deep vein thrombosis. (Ignatavicius, Workman,76 ed., p. 1115.)

A child has an injured wrist and will not allow the nurse to exam the injured arm. Both parents and child are upset. What is a priority nursing intervention? 1. Tell the parents to hold the child down, so the arm can be examined. 2. In a soothing voice, ask the child to point to the "ouchie" or pain and move fingers. 3. Obtain an order for pain analgesic and then examine the arm. 4. Call radiology and have them come to the emergency room to obtain x-ray films.

Answer: 2 Before any measures (obtaining x-rays and administration of analgesics) are started, an initial assessment is the priority. It will be important to calm the child and gain the child's trust. Inspection and observation are important, so asking the child to point to the painful part and moving the fingers, along with noting any pallor or abnormal position would be part of the initial assessment. Parents are not to be asked to restrain their child. If restraint is necessary, then the parents need to leave the room and the nurse needs to obtain assistance from other personnel. (Hockenberry, Wilson, 9 ed., p. 1639.)

Which client injury would the nurse expect to heal the most rapidly? 1. Fractured nose 2. Fractured tibia 3. Torn medial meniscus in the knee 4. Severely sprained wrist

Answer: 2 Bone tissue heals very quickly because of the process of self-healing also known as union. It is characterized by the following stages: fracture hematoma, granulation tissue, callus formation, ossification, consolidation, and remodeling. Injuries to cartilage, tendons, and ligaments are slower to heal because of decreased vascularity and circulation in these tissues. (Ignatavicius, Workman, 7 ed., p. 1144-1145.)

The postoperative nursing care plan for a client who has had a right leg amputation includes: 1. Applying ice packs to the residual limb for 72 hours 2. Having the client lie on his or her abdomen for 30 minutes 3 to 4 times/day 3. Wrapping the residual limb with elastic bandages from proximal to distal ends 4. Managing client's pain with anti-inflammatory medications

Answer: 2 Client should lie on the abdomen for 30 minutes 3 to 4 times/day and position the hip in extension while prone. Also, to prevent flexion contractures clients should avoid sitting in a chair for more than an hour. The residual limb is wrapped from distal to proximal. Ice packs are not used on the residual limb after surgery because the cold restricts blood flow. Anti-inflammatory medications may be used for pain relief but not to prevent edema. (Lewis 8 ed, p. 1612).

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

Answer: 2 Clients with total hip replacement should not bring their operative leg across midline, which may result in a prosthesis dislocation. Clients should maintain abduction (pillow between legs) and use elevated toilet seats. Crossing the legs is adduction, which is contraindicated for this client.

What is the priority nursing intervention in the care of a client in balanced suspension traction for a complete transverse fracture of the left femur? 1. Assessment of the pin site and movement of extremity distal to injury 2. Frequent checks regarding level of pain and sensation distal to the affected extremity 3. Maintaining abduction device between the legs to prevent external rotation of the affected leg 4. Increasing fluid intake to prevent the development of renal stone caused by urinary stasis

Answer: 2 Compartment syndrome is characterized by consistent pain and loss of sensation distal to the area of injury. The client can have an adequate peripheral pulse and still have a problem with compartmental syndrome. The client in balanced suspension traction has pins or wires exerting traction on the bone; pin site care is important, but evaluating for compartmental syndrome is a priority. Maintaining good fluid intake is also important, but assessing neurocirculatory status is more important. (Lewis 8 ed, p. 1591 & 1603).

The nurse is planning care for a client with a herniated disc. What intervention is considered part of conservative treatment of herniated disc? 1. Left lateral Sims' position with bathroom privileges 2. Bed rest and methocarbamol (Robaxin) to decrease muscle spasms 3. Small incision in the spinal column to remove the disk 4. Daily physical therapy and ambulation with crutches

Answer: 2 Conservative treatment means without surgical intervention. The most common conservative therapy includes bed rest and a muscle relaxant. An incision into the spinal column is not considered conservative treatment. Increased mobility may aggravate the herniated disc condition. (Lewis 8 ed, p. 1629).

Twelve hours after a total hip replacement, a client complains of sudden chest pain and shortness of breath. What is the priority nursing action? 1. Reposition and elevate the head of bed. 2. Medicate with an analgesic. 3. Administer oxygen at 2 L/min via nasal cannula. 4. Notify the doctor regarding the pain status.

Answer: 3 Pain in the leg is expected but chest pain is not. The nurse should start oxygen and then notify the physician. There is possibility of a fat embolism, myocardial ischemia, or pulmonary emboli. The other measures of repositioning and medicating are not appropriate with the onset of sudden chest pain. (Ignatavicius, Workman, 7 ed., pp. 325-326.)

A 7-year-old boy is in the emergency department with a greenstick fracture of the ulna. How will the nurse explain the fracture to the parents? 1. The bone is broken across the growth plate. 2. There is a splintering of the bone on one side. 3. There is a separation of the bone at the fracture site. 4. The bone is broken into several fragments.

Answer: 2 Greenstick fracture refers to splintering of the bone, not a complete fracture. The name comes from the splintering effect in attempts to break a "green stick." It is a common fracture in children. A comminuted fracture (bone is broken into several fragments) has multiple bone fragments and is more common in adults. Greenstick fractures do not affect the growth plate and there is no bone separation. (Lewis 8 ed, p. 1590).

A client begins receiving methotrexate (Rheumatrex) for severe symptoms of rheumatoid arthritis. What is the most important information for the nurse to give this client regarding the medication? 1. Take extra fiber and fluids to counteract the constipating effect. 2. It is very important to have periodic lab work done. 3. Take the drug on an empty stomach. 4. Hirsutism and menstrual changes sometimes develop as side effects.

Answer: 2 Lab work will need to be done periodically during administration to monitor for the development of anemia, leukopenia, thrombocytopenia, and/or hepatic toxicity. Hirsutism and menstrual changes occur with long-term corticosteroid use. Methotrexate should be given 1 hour before or 2 hours after meals to prevent vomiting when given PO. Antiemetics are given concurrently with the medication. (Lilly 6 ed, p. 777).

Which client would be at increased risk for musculoskeletal problems based on a nursing nutritional assessment? 1. Client who takes supplemental calcium and iron 2. Client who is overweight and has elevated cholesterol 3. Client who prefers hard cheeses and whole milk 4. Client who prefers fruits and vegetables rather than meats

Answer: 2 Overweight clients put increased stress on the weight-bearing joints and are at more risk for hip, knee, and ankle problems. The other options are not risk factors, and taking supplemental calcium and eating dairy products would reduce the risk of fractures. (Ignatavicius, Workman, 7 ed., p. 1110.)

A client has cyclobenzaprine (Flexeril) prescribed for muscle spasms. What would be important to teach this client regarding the medication? 1. Call the doctor if you get drowsy or dizzy. 2. Get up slowly and stand in place if you are dizzy. 3. It will be important to come back in 2 weeks to have drug levels drawn. 4. The tablets should be taken only with meals.

Answer: 2 Postural hypotension may be a problem initially. The client should not participate in any activity that requires mental alertness for safety. The dizziness and drowsiness are common occurrences and are not alarming. The nurse should teach the client how to manage orthostatic hypotension. Drug levels do not have to be monitored, and the client may take the medication at any time. (Lehne, 7 ed., p. 241.)

An older adult client is admitted to the hospital following a fall in which they sustained a fractured pelvis. What would be priority nursing care? 1. Determine the activity before the fall 2. Assess urine and stool for presence of blood. 3. Determine hemoglobin and hematocrit 4. Assist the client to turn every 2 hour

Answer: 2 Puncture of the bladder or bowel and vascular bleeding are a priority in the initial period after the fracture. The client also should be assessed for abdominal bruising and increasing abdominal distention and rigidity. Activity before the fall can be determined later; physiologic needs are a priority. The hemoglobin and hematocrit will be evaluated, but it would not be indicative of immediate bleeding. The client should remain in the supine position with the head slightly elevated and no turning until the stability of the fracture has been determined. (Ignatavicius, Workman, 7 ed., p. 1162.)

The nurse understands that which characteristic of rheumatoid arthritis distinguishes it from both osteoarthritis and gouty arthritis? 1. Impact is on weight-bearing joints 2. Symmetric involvement of joints 3. Uric acid serum levels are elevated 4. Range-of-motion crepitus

Answer: 2 Rheumatoid arthritis is bilateral and symmetric. Osteoarthritis and gouty arthritis are unilateral. Crepitus is associated with osteoarthritis. Elevated serum uric acid levels occur in gouty arthritis, and an impact on weight-bearing joints is observed with osteoarthritis. (Lewis, et al, 8 ed., p. 1651.)

Which dietary recommendations would the nurse encourage for a client who has just been diagnosed with gout? 1. Increase protein 2. Increase intake fluids to 3000 ml daily 3. Avoid foods containing chocolate 4. Avoid eating cranberries and prunes

Answer: 2 The client should increase the intake of fluids to promote excretion of uric acid. Some physicians prescribe a low-purine diet to decrease formation of uric acid crystals. Chocolate, cranberries, and prunes do not have any effect on the gout. (Ignatavicius, Workman, 7 ed., p. 350.)

Nursing care for the client in Buck's traction includes what measures? 1. Maintaining client in semi-Fowler's position to promote deep breathing 2. Checking the distal circulation of the affected leg 3. Turning the client every 2 hours to the unaffected side 4. Allowing the client to sit in a chair at the bedside

Answer: 2 The priority of care is to check the status of circulation distal to the area of injury. The client is generally kept in the supine position to promote straight pull on the traction; the client is not out of bed. Deep breathing is encouraged, but semi-Fowler's position does not facilitate the traction. (Lewis 8 ed, p. 1593 & 1599).

A client is admitted with a femoral neck hip fracture. The nurse would assess for what complication before repair of this type of fracture? 1. Fat emboli 2. Septicemia 3. Vascular damage 4. Compartment syndrome

Answer: 3 A femoral fracture because of close proximity to the femoral artery could create a risk of hemorrhage, hypovolemia, and shock, especially in the period before the repair. Sepsis is not a common problem in the initial period. Fat emboli are possible but less frequent with this type of fracture. Compartment syndrome occurs with constriction and interference of circulation distal to the fracture, which is not characteristic of a pelvic fracture. (Ignatavicius, Workman, 7 ed., pp. 1145-1147.)

The nurse is teaching a client how to perform isometric exercises. What is an example of an isometric exercise? 1. Exercising both arms and legs extremities simultaneously 2. Running in place for 5 minutes, then taking a pulse check 3. Press back of the knee down and lift heel from the bed 4. Moving arms and legs through full range of motion

Answer: 3 Isometric exercises involve initiating a muscle contraction by pressing against a stationary object, or resistance (pushups, hip lifts). Exercising both arms and legs simultaneously or running in place are not examples of isometric exercises. Moving extremities through full range of motion is not an example of isometric exercise. (Potter, Perry, 8 ed., pp. 747.)

The nurse is caring for a client who has undergone repair of a fractured hip. What will be an important nursing action? 1. Keeping the client flat in bed until adequate healing has occurred 2. Maintaining the client in Buck's traction with leg adducted 3. Getting the client up in a chair, non-weight bearing the day after surgery 4. Keeping the client's leg slightly bent at the knee to prevent internal rotation

Answer: 3 Providing the client is stable, early mobilization is encouraged. This is frequently the day after surgery. When the hip is pinned (internal fixation), early mobility is possible. The client may be maintained in Buck's traction before the hip repair, not after the repair. Keeping the client flat is unnecessary; she should be turned while in bed. The affected leg should be maintained straight and in an abducted position to prevent adduction and internal rotation. (Ignatavicius, Workman, 7 ed., pp. 1161.)

The nurse is positioning an infant who has an uncorrected congenital hip dislocation. What would be the proper position in which to place this infant with regard to the congenital problem? 1. Prone with the hips slightly elevated 2. On the left side with pillow between legs. 3. Hips abducted and feet in a neutral position. 4. Hips adducted and feet extended.

Answer: 3 The nurse should position the infant with the hips abducted and feet in neutral position. This will maintain proper alignment of the hips and lower extremities. This can be achieved initially with the infant placed on his or her back and a pillow wedged between the legs. Adduction may displace the head of the femur and lead to hip dislocation. (Hockenberry, Wilson, 9 ed., p. 422.)

The parents of a child with an above the knee plaster cast are preparing to take the child home. The nurse would know that the teaching was successful if the parents make which of the following statements? 1. "We can dry the casts faster with a heat lamp." 2. "We will keep a wire hanger nearby in case of an itch." 3. "We will need to frequently check the temperature and color of our child's toes." 4. "We can keep the cast clean with soap and water."

Answer: 3 The parents will need to assess the extremities distal to the cast for neurovascular circulation, which is the priority issue. External heat such as a heat lamp should not be used to dry the cast, because it would promote swelling inside of the cast. However, a hair dryer on low setting can be used until the cast is thoroughly dried. Putting water on a plaster cast can soften it and cause it to become misshapen and lose strength. Nothing should be inserted into the cast. (Hockenberry, Wilson, 9 ed., p. 1645.)

An adolescent is in the postoperative recovery area after surgery for scoliosis repair involving placement of a Harrington rod. What is a priority nursing action? 1. Evaluate for presence of bowel sounds. 2. Provide assistance when getting out of bed to use the bathroom. 3. Use log-rolling procedure when changing positions. 4. Monitor skin for development of pressure ulcers.

Answer: 3 Using log-rolling procedure is the most important nursing action immediately after surgery to prevent damage to the fusion and instrumentation. Typically, the client is kept flat in bed for the first 12 hours and is not ambulatory until the second or third postoperative day. Monitoring the skin for development of pressure ulcers is certainly a nursing action, but not an immediate priority, but more of an issue if the client is immobile for a long period of time. Bowel sounds are normally diminished or absent immediately after general surgery, so assessment for the presence of bowel sounds would not be a priority. (Hockenberry, Wilson, 9 ed., p. 1671.)

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

Answer: 4 Always check the weight amounts and make sure they are not lodged against the bed or another area. There are no pin sites because Buck's traction is skin traction, not skeletal traction. The traction boot does not need to be removed as often as every 6 hours to provide skin care. (Lewis 8 ed, p. 1593).

A client is having difficulty with muscle spasms and is being treated with methocarbamol (Robaxin). What comment by the client would indicate to the nurse that the client did not understand the precautions regarding this medication? 1. "I understand I should not drive when I take this medication." 2. "I know I should not drink any alcohol while I am taking this medication." 3. "I will get up carefully in case I get dizzy." 4. "I will continue to take care of my 3-month-old grandson."

Answer: 4 Caring for a 3-month-old will require mental alertness and physically carrying the infant. The client cannot afford to be drowsy and fall asleep or to stumble and fall with the infant. The client should avoid driving and alcohol intake. There may be significant CNS depression, so the client should be careful when ambulating. (Lehne, 7 ed., pp. 231, 240-241.)

A client has a fractured femur and is scheduled for surgery and stabilization with internal fixation. The nurse is assessing the client for the development of a fat embolism. What early assessment findings would suggest the development of this complication? 1. Swelling and redness in the affected area. 2. Blood and fat in the stool 3. Hypotension 4. Confusion and restlessness

Answer: 4 Confusion and restlessness are early signs of hypoxia. A fat embolus travels through the venous system to the lungs, where it lodges and causes an interstitial pneumonitis; this will precipitate symptoms of acute respiratory distress. Swelling and redness of the affected area would a normal observation. Blood and fat in the stool is not an indication of a fat embolism. The client may experience hypotension, but hypotension is not as specific as changes in orientation and level of consciousness. (Ignatavicius, Workman, 7 ed., p. 1146-1147)

The nurse is caring for a client on the operative day following a herniated lumbar disk. What would be a priority nursing assessment? 1. Monitor the level and location of pain. 2. Determine peripheral pulse rate. 3. Evaluate the client for presence of venous stasis. 4. Check the dressing for presence of clear fluid.

Answer: 4 In a lumbar laminectomy, observing the dressing for presence of clear drainage, which may be spinal fluid, is critical. This must be reported to the surgeon immediately, and the client will be at an increased risk of infection. The pain level and location should be closely monitored, but the observation of the dressing for spinal fluid is more critical. The client will need to be evaluated for presence of and prevention of venous stasis, but spinal fluid leakage is more important the operative day. Presence and quality of peripheral pulses, not rate, should be assessed as part of the total assessment. (Ignatavicius, Workman, 7 ed., pp. 963-964.)

The nurse is concerned about compartmental syndrome in an 8-year-old client with a greenstick fracture. For what will the nurse teach the mother to observe? 1. Swelling and discoloration of the hand distal to the fracture site 2. Hematoma formation and pain in the upper arm and shoulders 3. Severe pain radiating proximal to the cast and fracture area 4. Decreased sensation and decreased ability to move the fingers of the affected hand

Answer: 4 Indications of compartmental syndrome include pain, decreased sensation and decreased mobility in the extremity distal to the fracture/cast, decreased or loss of pulse distal to injury, skin cool to touch and blanched in color in an area distal to the fracture/cast. Swelling and discoloration commonly occur as a result of the bruising of the injury. Usually no symptoms are proximal to the fracture site. (Ignatavicius, Workman, 7 ed., p. 1146.)

The school nurse is called to the school parking lot, where one of the children is hit by a slow moving motor vehicle in the school parking lot. The school nurse finds the child on the ground in the parking lot not moving extremities, looking dazed, but responding to questions. What is a priority nursing action? 1. Ask the child to move the lower extremities. 2. Have another person assist with moving the child to the school clinic. 3. Talk soothingly with the child while completing a focused assessment. 4. Have someone call the EMS system.

Answer: 4 It is important and the main priority for a traumatic injury, such as a pedestrian and motor vehicle accident, that the child not be moved until the EMS team arrives with proper equipment to stabilize the spinal cord to prevent further injury. The child needs immediate attention and further assessment to rule out spinal cord injury at a hospital. Talking soothingly to the child and continuing a focused assessment are nursing actions that would be performed after activation of EMS. (Hockenberry, Wilson, 9 ed., p. 1717.)

An older client is admitted for treatment of a fractured left hip. The fracture is repaired by internal fixation. What would be a priority nursing intervention regarding positioning this client in the immediate postoperative period? 1. Keeping the client in low Fowler's position to facilitate slight hip flexion 2. Elevating the foot of the bed to prevent venous pooling in the lower extremities 3. Placing a trochanter roll at the thigh on the left side to prevent internal rotation 4. Placing a pillow or foam frame between the legs to maintain abduction of the left leg

Answer: 4 Maintaining the leg in an abducted position is critical in the first few days after surgery for a client with a fractured hip. This maintains the intactness of the hip joint. The trochanter roll at the thigh will assist to prevent external rotation, not internal rotation. The foot of the bed may be slightly elevated, but maintaining abduction is more critical. (Ignatavicius, Workman, 7 ed., p. 1161.)

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

Answer: 4 Phantom limb pain is real pain for the client and is common in amputees. Phantom pain can best be controlled by pain medication. It is important to respect a client's interpretation of the experience of pain and offer him or her pain medication. (Lewis 8 ed, p. 1612).

What would the nurse identify as the best preprocedure nursing intervention for a client who is scheduled for dual-energy x-ray absorptiometry (DEXA) testing? 1. Obtain vital signs before administering an oral sedative. 2. Check for allergy to iodine and shellfish. 3. Start a peripheral intravenous line. 4. Explain the procedure to the client.

Answer: 4 The best preprocedure nursing intervention for the noninvasive test of a dual-energy x-ray absorptiometry (DEXA) is client education, because the procedure is painless and noninvasive. The nurse should explain to the client to wear loose, comfortable clothing and avoid garments that have zippers, belts, or buttons that are made of metal. Objects such as keys or wallets that would be in the area being scanned should be removed. No preprocedure medications are administered, and contrast medium is not used. (Ignatavicius, Workman, 7 ed., p. 1123.)

The nurse is screening an older woman for the early signs of osteoporosis. What assessment findings would be strongly suggestive of the presence of osteoporosis? 1. Increased pain in lower back when walking 2. A limp when walking because one leg is shorter 3. Waddling gait, frequently requiring assistive devices 4. Decrease of 3 inches in height

Answer: 4 The classic initial observations that indicate osteoporosis is the loss of height along with the spinal deformity of kyphosis or "dowager's hump." The back pain is generally continuous and does not just occur with walking. Both legs are the same length, and the gait is not particularly affected in the early stages. (Ignatavicius, Workman, 7 ed., p. 1122.)

An older woman is being discharged home after repair of a left hip fracture. Which statement by the client would indicate to the nurse that additional teaching is needed? 1. "I put an extension on the toilet seat to make it higher." 2. "I will ask for help in putting on my shoes and socks." 3. "I will use a walker for a while until I am more stable." 4. "I can sleep in any position that is comfortable."

Answer: 4 The client needs to maintain abduction on the affected left extremity. She should not sleep on her right side with her left leg crossing over the right (Sims position). An extension for the toilet seat to make it higher and using a walker are appropriate for the client. Asking for help with shoes and socks helps prevent extreme flexion of the affected hip. (Lewis, et al, 8 ed., pp. 1606-1607.)

A client with a history of arthritis and gastric ulcers comes to the clinic complaining of severe gastrointestinal distress. Which would be the most important question for the nurse to ask the client? 1. "Are you taking the medications with food?" 2. "Are you taking the medications with water?" 3. "Have you changed your eating habits recently?" 4. "What medication are you using for the arthritis?"

Answer: 4 The most important information for the nurse to determine is what medications the client is taking for treatment of the arthritis. The medications should be evaluated and possibly changed. (Lehne, 7 ed., pp. 231, 916.)

A client with a complete transverse fracture of the left femur has been treated with an external fixator device. The nurse is caring for the client the day after the procedure. What would be an important nursing intervention in caring for this client? 1. Notify the physician for clear fluid oozing from the pin sites. 2. Maintain continuous pull on the weights of the traction. 3. Cleanse each pin site every 4 hours with warm water and rinse thoroughly. 4. Assess pin sites for purulent drainage and inflammation.

Answer: 4 The placement of an external device requires pins to be placed in the bone to stabilize the fracture. Infection is a common complication. Serous drainage from the pin sites is expected for the first 48 hours. Most often no traction is involved with the treatment. Pin sites generally are cleansed once a day. Currently no standards are set for pin care, but hydrogen peroxide, normal saline, and antibiotic ointment commonly are used. (Ignatavicius, Workman, 7 ed., p. 1155.)

A client is placed in Buck's traction after admission for a fractured hip. The client asks the nurse to help reposition him toward the head of the bed. What would be an important nursing consideration when repositioning this client? 1. Place the weights on the corners of the bed to allow the nurse to move the client. 2. Add additional weight to the hanging weight to keep the client's position in balance. 3. Release the traction tension and weight while moving the client. 4. Use a draw sheet with one other person and carefully slide the client up the bed.

Answer: 4 Using a draw sheet to help with moving the client would maintain the counter traction. Traction weights should be free and not touching the floor. The nurse must not increase traction tension, release tension, or lift the traction during repositioning. (Ignatavicius, Workman, 7 ed., pp.1153-1154.)

The nurse is caring for a client with a fractured femur that has not been repaired. Fat emboli and pulmonary emboli are both potential complications of this condition. Which symptoms would be suggestive of fat emboli versus a pulmonary emboli? 1. Difficulty breathing 2. Blood-tinged sputum 3. Restless and confusion 4. Petechiae over the trunk and in axillary folds

Answer: 4 Difficulty with respirations, blood-tinged sputum or frothy sputum, chest pain, and restlessness, irritability, and confusion are all common to pulmonary and fat emboli. A pulmonary embolus does not precipitate the development of petechiae over the trunk, buccal membrane, conjunctival sacs, and in anterior axillary folds. (Lewis, et al, 8 ed., p. 1604; Ignatavicius, Workman, 7 ed., pp. 1146-1147.)

The nurse is preparing health teaching for adult women regarding the prevention of osteoporosis. What would be important to include in the teaching plan? Select all that apply. 1. Daily walking for 15 to minutes 2. Supplemental calcium intake 3. Reduction of caffeine intake 4. Increased intake of water 5. Avoidance of sunlight because of photosensitivity 6. Increase intake of fresh fruit and vegetables

Answers: 1, 2, 3, 6 Daily walking, supplemental calcium, and reduction of caffeine intake are the most common preventive measures in women at increased risk for osteoporosis. Some sunlight is encouraged to facilitate utilization of vitamin D and the absorption of the calcium intake. Increased water intake is healthy, but not specific for osteoporosis. Fruits and vegetables are important to a healthy diet and should be encouraged. (Ignatavicius, Workman, 7 ed., p. 1124.)

The nurse is planning discharge teaching for a client who has just been placed on biologic therapy with etanercept (Enbrel)? What will be important for the nurse to include in teaching this client regarding this medication? Select all that apply. 1. Dizziness or headache may occur side effects. 2. A rubella vaccine is recommended within 2 months of beginning this medication. 3. There may be some pain, itching, or redness at the injection site. 4. Lab work every 6 months will be necessary to check your liver function. 5. Take an iron supplement daily as iron deficiency is a side effect of this medication. 6. A runny nose or cough may occur when taking this medication

Answers: 1, 3, 6 Possible side effects of etanercept (Enbrel) include dizziness, headache, pain, redness or itching at the injection site, and upper respiratory symptoms, including rhinitis and cough. Live virus vaccines (such as rubella) should not be taken during treatment with etanercept, and checking liver functions routinely or taking an iron supplement with this medication is not necessary. (Lewis, et al, 8 ed., p. 1647.)

The nurse is obtaining a health history on a toddler who was recently diagnosed with osteomyelitis of a leg. What would priority assessment questions include? Select all that apply. 1. "When did you notice the had an elevated temperature?" 2. "Does your child have any type of food allergies?" 3. "Is there a family history of cardiac disorders?" 4. "Has your toddler had a recent infection, such as an earache?" 5. "Have there been any recent injuries to the affected leg?" 6. "Has the child recently taken and completed any antibiotics?"

Answers: 1, 4, 5, 6 Osteomyelitis is caused by bacteria and frequently is found after an internal infection, such as an ear infection. The onset of an elevated temperature may indicate the beginning of an infection. Leg injury may have broken the skin and allowed deep tissue penetration that could have progressed to osteomyelitis. Prescription (and compliance) with recent antibiotics is important, because decreased compliance could result in progression of an infection. The other questions would be asked as part of the health history but are not the most relevant given the diagnosis of osteomyelitis of a leg. (Hockenberry, Wilson, 9 ed., p. 1673.)

Which of the following put a woman at increased risk for development of osteoporosis? Select all that apply. 1. Hormone replacement therapy 2. Menopausal age 3. Prolonged steriod intake 4. Fractured hip 5. Hyperthyroid disease 6. Compromised pulmonary function

Answers: 2, 3, 5 Menopausal or post menopausal women, prolonged steroid intake, and hyperthyroid disease have been associated with the development of osteoporosis. Hormone replacement actually decreases the risk factor, but use of it must be considered with other associated risks. Presence of a fracture may indicate that osteoporosis is present but is not considered a risk factor. Compromised pulmonary function may occur as a result of the kyphosis but is not considered a risk factor. (Ignatavicius, Workman, 7 ed., p. 1120.)

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

Answers: 2, 3, 5 Paresthesia, edema, and leg pain unrelieved by analgesics are classic indicators of the development of compartmental syndrome. With a femur fracture, there is some degree of edema postoperatively that may leave the toes on the affected leg cool to touch. The decrease in pulse rate is not an indication of pressure, a decrease in pulse strength is. The pins usually do not cause undue pain, and frequently, the client is angry regarding the immobility and does not use effective coping measures. (Lewis 8 ed, p. 1603).