Musculoskeletal

A client has a metastatic bone tumor in the left leg. What action by the nurse is appropriate?

Administer pain medication as prescribed.

A nurse is caring for four clients. After the hand-off report, which client would the nurse see first?

Post-microvascular bone transfer client whose distal leg is cool and pale

The nurse interviews an older client with moderate osteoarthritis and her husband. What psychosocial assessment question would the nurse include?

"Do you experience discomfort during sex?"

The nurse assesses a client with diabetes and osteoarthritis (OA) during a checkup. The nurse notes the client's blood glucose readings have been elevated. What question by the nurse is most appropriate?

"Have you been taking glucosamine supplements?"

The nurse is teaching a client who is planning to have a total hip arthroplasty. What statement by the client indicates a need for further teaching?

"I will receive IV heparin before surgery to decrease the risk of clots."

The nurse is teaching a client who is prescribed acetaminophen for control of osteoarthritic joint pain. What statement by the client indicates a need for further teaching?

"I won't take more than 5000 mg of this drug each day."

A client is prescribed celecoxib for joint pain. What statement by the client indicates a need for further teaching?

"I'll be sure to take this drug three times a day only on an empty stomach."

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.)

-Alcohol -Caffeine -Carbonated beverages -Vitamin D

A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.)

-Adherence to the antibiotic regimen -Eating high-protein and high-carbohydrate foods -Proper use of the intravenous equipment

A client has been prescribed denosumab. What health teaching about this drug is most appropriate for the nurse to include?

"Make appointments to come get your injection."

A client has a left knee arthrocentesis to remove excess joint fluid. What post procedure health teaching will the nurse include?

"Monitor the site for bleeding or clear fluid leakage when you are home."

The nurse teaches assistive personnel (AP) about care of an older adult diagnosed with osteoporosis. What teaching would the nurse include?

"Osteoporosis places the client is at risk for fractures."

What information does the nurse teach a women's group about osteoporosis?

"Primary osteoporosis occurs in postmenopausal women due to lack of estrogen."

The primary health care provider prescribes methotrexate (MTX) for a client with a new diagnosis of rheumatoid arthritis. The nurse provides health teaching about the drug. What statement by the nurse is appropriate to include about methotrexate?

"The drug can increase your risk for infection, so you should avoid crowds."

A client has long-term rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is appropriate?

"Try a paraffin wax dip 20 minutes before you quilt."

A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?

"Your feet have less blood flow, so healing is slower."

A nurse is planning postoperative care for a client following a total hip arthroplasty. What nursing interventions would help prevent venous thromboembolism for this client? (Select all that apply.)

- Early ambulation -Quadriceps-setting exercises -Compression stockings/devices -Anticoagulant drug therapy

A client who had a recent total knee arthroplasty will be using a continuous passive motion (CPM) machine after discharge at home. What health teaching about the CPM machine will the nurse include? (Select all that apply.)

-"Keep the machine padded well to prevent skin breakdown." -"Ensure that your leg is placed properly on the machine." - "Use the machine as prescribed but not at mealtime." -"When the machine is not being used, do not store it on the floor." - "Check that the cycle and range of motion is kept at the level prescribed."

The nurse is teaching assistive personnel about postoperative care for an older adult who had a posterolateral total hip arthroplasty. What teaching will the nurse include? (Select all that apply.)

-"Move the client slowly to prevent dizziness and a possible fall." -"Encourage the client to deep breathe and cough at least every 2 hours." -"Help the client use the incentive spirometer at least every 2 hours." -"Keep the abduction pillow in place at all times while the client is in bed." -"Let me know if the client has an elevated temperature or pulse." -"Keep in mind that the client may be a little confused after surgery."

The nurse is teaching a client with mild rheumatoid arthritis (RA) about how to protect synovial joints. Which health teaching will the nurse include? (Select all that apply.)

-"Use both hands instead of one with holding objects." -"When getting out of bed or a chair, use the palms of your hands." -"Bend your knees instead of your waist and keep your back straight." -"Do not use multiple pillows under your head to prevent neck flexion." -"Use a device or rubber grip to open jars or bottle tops." -"Use long-handled devices such as a hairbrush with an extended handle."

A nurse is visiting a client discharged home after a total hip arthroplasty. What safety precautions would the nurse recommend to the client and family? (Select all that apply.)

-Buy and install an elevated toilet seat. -Install grab bars in the shower and by the toilet. -Remove all throw rugs throughout the house. -Use a shower chair while taking a shower.

The nurse is caring for an older client who had a total knee arthroplasty. Prior to surgery, the client lived alone independently. With which interprofessional health care team members will the nurse collaborate to ensure positive client outcomes? (Select all that apply.)

-Case manager -Physical therapist

The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.)

-Draining sinus tracts -Presence of foot ulcers

A client asks the nurse about what medications may be included for nonopioid multimodal analgesia following a total knee arthroplasty. What medications may be given to the client? (Select all that apply.)

-Gabapentin -Ketorolac -Ketamine -Bupivacaine

A client has rheumatoid arthritis (RA) and the nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.)

-Grab bars to reach high items -Long-handled bath scrub brush -Toothbrush with built-up handle

A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.)

-Strengthening exercises are important. -Take recommended calcium and vitamin D. -Walk for 30 minutes at least three times a week.

A nurse is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which drug does the nurse plan health teaching?

Acetaminophen

A client with osteoporosis is going home where the client lives alone. What action by the nurse is best?

Arrange a home safety evaluation.

A client has been advised to perform weight-bearing exercises to help slow bone loss, but has not followed this advice. What response by the nurse is appropriate at this time?

Ask the client about fear of falling.

The nurse assesses a client after a total hip arthroplasty. The client's surgical leg is visibly shorter than the other one and the client reports extreme pain. While a co-worker calls the surgeon, what action by the nurse is appropriate?

Assess neurovascular status in both legs.

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs?

Assess the client's coping skills and support systems.

The nurse reviews a list of drugs that can cause secondary osteoporosis. Which drugs are most commonly associated with this health problem? (Select all that apply.)

Barbiturates Corticosteroids Loop diuretics

A nurse assesses clients in an osteoporosis clinic. Which client would the nurse assess first?

Client taking raloxifene who reports unilateral calf swelling.

A nurse assesses a group of clients who have rheumatoid arthritis (RA). Which client would the nurse see first?

Client with a red, hot, swollen right wrist

The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option?

Client with a spinal cord injury who cannot tolerate sitting up.

The nurse assesses a client with long-term rheumatoid arthritis (RA) for late signs and symptoms. Which assessment findings will the nurse document as late signs and symptoms of RA? (Select all that apply.)

Felty syndrome Joint deformity Weight loss

A client who has rheumatoid arthritis is prescribed etanercept. What health teaching by the nurse about this drug is appropriate?

Giving subcutaneous injections

A client is getting out of bed into the chair for the first time after an uncemented total hip arthroplasty. What action by the nurse is appropriate?

Have adequate help to transfer the patient.

A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic intervention does the nurse recommend?

Ice packs

After a total knee arthroplasty, a client is on the postoperative nursing unit with a continuous femoral nerve blockade. On assessment, the nurse notes the skin of both legs is pale pink, warm, and dry, but the client is unable to dorsiflex or plantarflex the surgical foot. What action would the nurse take next?

Notify the surgeon or anesthesia provider immediately.

A client asks the nurse about having a total knee arthroplasty to relieve joint pain. Which factor would place the client at the highest risk for impaired postoperative healing?

Obesity

The nurse is assessing a client with long-term rheumatoid arthritis (RA) who has been taking prednisone for 10 years. For which complications of chronic drug therapy would the nurse assess? (Select all that apply.)

Osteoporosis Diabetes mellitus Glaucoma Hypertension Hypokalemia Decreased immunity

The nurse is caring for a client who has severe osteoarthritis. What primary joint problems will the nurse expect the client to report?

Pain

An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 (38 x 10^9/L) but the client is afebrile.

Place the client on Contact Precautions.

A client has a bone density score of -2.8. What intervention would the nurse anticipate based on this assessment?

Planning to teach about bisphosphonates

A client is scheduled to have a total hip arthroplasty. What preoperative teaching by the nurse is most important?

Remind the client to have all dental procedures completed at least 2 weeks prior to surgery.

The nurse is caring for a young client who has been diagnosed with osteopenia. Which risk factor in the client's history most likely contributed to the bone loss?

Rheumatoid arthritis

The nurse is performing an assessment of a client with possible plantar fasciitis in the right foot. What assessment finding would the nurse expect in the right foot?

Severe pain in the arch of the foot

The nurse assesses a client with rheumatoid arthritis (RA) and Sjögren syndrome. What assessment would be most important for this client?

Visual acuity