Musculoskeletal Ch. 44 exam

A nurse is assessing a client who has osteoarthritis of the knees and fingers. Which of the following clinical manifestations should the nurse expect to find? (Select all that apply.) A. Heberden's nodes B. Swelling of all joints C. Small body frame D. Enlarged joint size E. Limp when walking

A, D, E A. CORRECT: Heberden's nodes are enlarged nodules on the distal interphalangeal joints of the hand sand feet of a client who has osteoarthritis. D. CORRECT: A client may manifest enlarged joints due to bone hypertrophy. E. CORRECT: A client may manifest a limp when walking due to pain from inflammation in the localized joint. B. INCORRECT: Swelling and pain of all joints is a manifestation of rheumatoid arthritis. A local inflammation of a joint is related to osteoarthritis. C. INCORRECT: A small body frame is a risk factor for rheumatoid arthritis. Obesity is a risk factorfor osteoarthritis.

A nurse is talking to an older adult client who is at risk for osteoporosis about strategies for preventing bone loss. Which of the following instructions should the nurse provide? A. Begin a program of brisk walking. B. Take 800 mg of calcium per day. C. Drink of plenty sparkling water. D. Drink 8 oz of red wine each day

A. Begin a program of brisk walking. Weight-bearing exercises help maintain bone mass and prevent osteoporosis. Walking is generally a safe activity for older clients. Incorrect Answers: B. An adequate daily intake of calcium promotes bone strength and can help reduce the risk of osteoporosis. The recommended calcium intake for women 51 years of age or older is 1,200 mg/day. For men, the recommendation is 1,000 mg/day up to age 70 and 1,200 mg/day aer that. C. Carbonated beverages can interfere with the absorption of calcium. D. Drinking alcohol excessively can cause bone loss. One alcoholic drink per day will unlikely cause significant bone loss but will not aid prevention.

A nurse is caring for client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk. B. Ripe bananas. C. Steamed broccoli. D. Green leafy vegetables

A. Fortified milk. Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the gastrointestinal tract. Adults up to age 70 need 600 international units of vitamin D per day and 800 international units thereafter. Therefore, fortified milk is a good source of vitamin D. Bananas are a good source of potassium and can reduce bone loss. However, bananas do not promote calcium absorption. Broccoli is a good source of vitamin C, which is important for bone matrix formation. However, steamed broccoli does not promote calcium absorption. Green leafy vegetables are a good source of vitamin K. However, green leafy vegetables contain oxalic acid, which decreases calcium absorption.

A nurse is caring for a client who is wearing a halo fixator. Which of the following interventions should the nurse implement? (Select all that apply.) A. Monitor the client's vital signs every 4 hr B. Monitor the client's pin sites for loosening C. Hold the halo device when turning the client D. Check the client's skin to ensure the jacket is not applying pressure E. Adjust the screws holding the client's halo device in place to ensure a proper fit

A. Monitor the client's vital signs every 4 hr B. Monitor the client's pin sites for loosening D. Check the client's skin to ensure the jacket is not applying pressure The nurse should monitor the client's vital signs and neurological status every 1 to 4 hours, depending on the client's overall status. Also, the nurse should monitor the client's pin sites for loosening. Loosening of the pins of the halo device can place the client's cervical or thoracic traction at risk, and the provider should be notified immediately if this occurs. Finally, the nurse should check the client's skin for redness and ensure the vest is not rubbing against the client's skin, which can create a pressure ulcer. The nurse should check the client's skin to ensure that it is dry and clean to prevent skin breakdown. Incorrect Answers: C. The nurse should never hold or pull on the client's halo device to turn or reposition the client. This can cause misalignment and loosen the screws that are secured into the client's skull. E. The nurse should never adjust the screws of the client's halo device. The screws are inserted into the client's skull to ensure proper alignment while the client's spinal cord injury heals. The provider is the only person who should make adjustments to the screws if needed.

A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures results when a client's bone breaks into multiple pieces? A. Responses B. Avulsion C. Comminuted D. Compression E. Spiral

B. Comminuted (most of these fractures happen in car accidents when people are commuting) A comminuted fracture is one in which the bone breaks into multiple pieces or fragments. Incorrect Answers: A. In an avulsion fracture, a tendon and its attachment have pulled away from a fragment of bone C. In a compression fracture, a loading force to the long axis of a bone collapses the bone. This is common with vertebral fractures.D. In a spiral fracture, the break twists around the bone's shaft.

A nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation. Which of the following actions should the nurse take? A. Place the client on a soft mattress B. Rewrap the residual limb with a bandage 3 times per day C. Assist the client into a prone position for 20 min every 8 hr daily D. Turn the client every 4 hr while in bed

B.Rewrap the residual limb with a bandage 3 times per day The nurse should rewrap the client's residual limb with a pressure bandage 3 times daily. This keeps the bandage taught, which ensures the residual limb will shrink. Rewrapping the bandage also allows the nurse to check the skin for redness or skin breakdown. Incorrect Answers: A. The nurse should place the client on a firm mattress to prevent contractures from developing following surgery. C. The nurse should assist the client into a prone position for 20 to 30 minutes every 3 to 4 hours daily. This prevents hip contractures from developing following surgery. D. The nurse should turn the client every 2 hours while in bed to prevent contractures and increase the range of motion of the client's extremities. The nurse should turn the client slowly to prevent muscle spasms.

A nurse is assessing a female client who reports severe joint pain. Multiple The nurse should identify that which of the following factors places the client at risk for gout? A. Perimenopause B. Migraine headaches C. Diuretic use D. Irritable bowel syndrome

C. Diuretic use Client's use of diuretics is a risk factor for gout. Gout is a systemic disorder that affects the joints as a result of high uric acid levels in the blood. A client who is postmenopausal is at risk for gout Migraine headaches are a risk factor for fibromyalgia IBS is a risk factor for fibromyalgia

A nurse is assisting with preparing a client for an electromyogram (EMG). Which of the following statements should the nurse identify as an indication that the client understands the pre-procedure instructions? A. This test will help the doctor know if my nerves are working correctly." B. "The doctor will be able to fix the problem with my arm during this procedure." C "I cannot eat or drink for at least 10 hours before I have this procedure." D "I will get enough sedation to put me to sleep for this procedure."

Correct Answer: A. "This test will help my doctor know if my nerves are working correctly." An EMG shows electrical activity within the muscles during contraction. It is useful for discriminating between muscular dysfunction and nerve dysfunction. Incorrect Answers: B. An EMG is a diagnostic procedure that can help the provider plan future interventions; however, this procedure will not correct the client's disorder. C. Fasting is not required for an EMG. However, the client should avoid caeine for at least 3 hours prior to the procedure because an EMG requires the client to refrain from movement. D. The client will most likely not receive any premedication or sedation because the provider will require cooperation during the procedure.

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the absent right foot. Which of the following statements should the nurse make? A. "This type of pain usually decreases over time as the limb becomes less sensitive." B. "Try to look at the surgical wound as a reminder the limb is gone." C. "Use a cold compress intermittently to decrease these pain sensations." D. "Grief over the lost limb can sometimes cause denial that the limb is really gone."

Correct Answer: A. "This type of pain usually decreases over time as the limb becomes less sensitive." The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following an amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain. Incorrect Answers: B. This statement by the nurse does not address the client's current concerns. C. The nurse should instruct the client to use heat and massage, along with pharmacological interventions, to manage this type of pain. D. The nurse should validate the client's report of pain and treat it accordingly. The client is not exhibiting denial; therefore, this statement by the nurse is not appropriate.

A nurse in an acute care clinic is talking with a client who reports that the osteoarthritis pain in her knees is increasing each day. The client wants to discuss non-pharmacological approaches to help relieve her pain. Which of the following interventions should the nurse suggest? A. Applying warm compresses to sore joints B. Decreasing the daily intake of dietary protein C. Keeping joints in extension during rest periods D. Limiting sleep to 6 to 7 hr per night

Correct Answer: A. Applying warm compresses to sore joints Warm packs or warm soaks (e.g. in a bath or hot tub) are often effective for relieving arthritic pain. The nurse should teach the client to avoid temperatures that are hot enough to cause burns. She should plan for a temperature just a little warmer than body temperature for optimal comfort. Incorrect Answers: B. The client should eat a well-balanced diet, including the recommended daily allowance of protein. This promotes gradual weight loss or maintenance of a healthy weight. C. The client should rest her joints in their functional position. She should avoid using large pillows to support her knee joints because they can result in flexion contractures. D. The client should sleep for 8 to 10 hours per night and rest for another 1 to 2 hours during the day.

A nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. Which of the following findings should the nurse identify as the priority? A. Client report of muscle spasms B. Inability to get dressed without assistance C. Client report of feelings of anger D. Refusal to look at the affected limb

Correct Answer: A. Client report of muscle spasms The nurse should consider Maslow's hierarchy of needs, which includes 5 levels of priority. The levels are as follows: physiological needs, safety and security needs, love and belonging needs, personal achievement and self-esteem needs, and achieving the ability to problem solve and cope with life situations. When applying Maslow's hierarchy of needs in a priority-setting framework, the nurse should review physiological needs first. The nurse should then address the client's needs by following the remaining 4 hierarchal levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the specific client situation. Therefore, the nurse should identify the report of muscle spasms (a physiological need) as the priority client finding. Incorrect Answers: B. Clients who have an amputation will likely need assistance with dressing and hygiene. Promoting the client's ability to perform self-care is important because it fosters client independence; however, there is a different finding that is the priority. C. Clients who have an amputation might report feelings of anger while grieving the loss of a limb. Helping the client express these feelings is important to support the client through the grieving process; however, there is a different finding that is the priority. D. Clients who have an amputation might refuse to acknowledge the site of the lost limb. Encouraging the client to look at and care for the limb is important to help the client develop a positive body image; however, there is a different finding that is the priority

A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following pieces of information should the nurse include? A. Cut the wiring if emesis occurs B. Consume 3 meals daily as part of a low-protein diet C. Swab the mouth with hydrogen peroxide if wiring produces oral irritation D. Resume a soft diet in 3 to 5 days

Correct Answer: A. Cut the wiring if emesis occurs Inner maxillary fixation involves wiring of the teeth to support the fractured jaw by holding the jawbones together. The wires are left in place until the fracture is healed. To preserve the client's airway, the nurse should instruct the client to have wire cutters available to cut the wiring immediately if emesis occurs. The client should return to the provider as soon as possible for re-wiring. Incorrect Answers: B. The nurse should encourage the client to consume adequate protein and calories for wound healing. Small, frequent meals can prevent nausea. C. The nurse should instruct the client to report any irritation in the oral cavity to the provider. D. The nurse should instruct the client to consume a liquid diet for 1 to 4 weeks postoperatively.

A nurse is providing teaching for a client following a below-the-knee amputation. Which of the following pieces of information should the nurse include in the teaching? A. Instruct the client to lie prone while in bed B. Ensure the client sleeps on a soft mattress C. Pull up the residual limb while in bed D. Keep the residual limb exposed to air to heal

Correct Answer: A. Instruct the client to lie prone while in bed The nurse should instruct the client to lie in a prone position for 20 to 30 minutes every 3 to 4 hours. This prevents the client from developing contractures while in bed. Incorrect Answers: B. The nurse should instruct the client to sleep on a firm mattress following the procedure to prevent the development of contractures. C. The nurse should instruct the client to push down the residual limb while in bed. This prepares the limb for the prosthetic and reduces the incidence of phantom pain. D. The nurse should instruct the client to wrap the residual limb in an elastic bandage to assist with shrinking the limb and preparing for the prosthesis. The bandage should be wrapped in a figure-8 pattern from a distal to proximal direction. The bandages should be reapplied every 4 to 6 hours or more often if loose.

A nurse is assessing a client who is 48 hr postoperative following open reduction and internal fixation of a fractured tibia. Which the following findings should the nurse report to the provider? A. Toes that are cold to the touch B. Serous drainage from the pin sites C. Blanching of the toenail beds with pressure D. Pink tissue around the fixator insertion sites

Correct Answer: A. Toes that are cold to the touch The nurse should monitor for and report manifestations of compartment syndrome following internal fixation. Therefore, the nurse should contact the provider immediately if the client's toes are cold to the touch. Incorrect Answers: B. The nurse should identify serous drainage from the pin sites as an expected finding during the first 2 to 3 days following the procedure. C. As part of measuring capillary refill, the nurse should press the nail bed long enough to produce a blanching appearance. Therefore, the nurse does not need to report this finding. D. The nurse should identify pink to red tissue at the fixator insertion sites as an expected finding for the first 2 to 3 days following the procedure.

A nurse is teaching a group of clients at a senior center about the risk factors for osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Extended periods of immobility increase your risk of osteoporosis." B. "Prolonged periods of sun exposure increase your risk of osteoporosis." C. "Eating a diet high in protein can reduce your risk of osteoporosis." D. "Corticosteroid therapy will reduce your risk of osteoporosis."

Correct Answer: A."Extended periods of immobility increase your risk of osteoporosis." Osteoporosis is a disorder of weakened bones due to a loss of bone mass and a change in bone structure. Immobility can result in osteoporosis; therefore, weight-bearing exercise, such as walking, can help prevent osteoporosis. Incorrect Answers: B. Prolonged exposure to sunlight does not increase the risk of developing osteoporosis. Appropriate amounts of sun exposure increase vitamin D levels, which increases the absorption of calcium. C. Eating large amounts of protein can result in more calcium loss through the kidneys. D. The chronic use of steroid medications increases the risk of osteoporosis.

A nurse is providing discharge teaching to a client who has osteoarthritis. Which of the following instructions should the nurse include? A. "Rest frequently after periods of activity." B. "Perform your exercises only on days that you feel good." C. "Perform your exercises after applying cold packs to your joints." D. "Place a large pillow under your knees when lying down."

Correct Answer: A."Rest frequently after periods of activity." The joint pain in osteoarthritis is caused by deterioration of the synovial membranes and often worsens after activity. Rest usually helps relieve the pain, so performing activities at a comfortable pace with periods of rest is appropriate. Incorrect Answers: B. The client should perform exercise consistently on both good and bad days. C. The client should perform exercise immediately after applying heat to painful joints. D. The client should not use a large pillow under the knees or head because this can lead to contractures. A small pillow should be placed under the head or neck when lying down.

A nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. Which of the following actions should the nurse plan to take? A. Use a hair dryer on a cool setting to blow air into the cast B. Ask the provider to bivalve the cast C. Provide the client with a sterile cotton swab to rub the affected skin D. Wrap the extremity with a dry heating pad

Correct Answer: A.Use a hair dryer on a cool setting to blow air into the cast The nurse should provide relief for this client's itching by blowing air into the cast using a hair dryer on a cool setting or an empty 60 mL plunger syringe. Incorrect Answers: B. Cast bivalving is used relieve pressure when a cast becomes too tight on the affected extremity. C. The nurse should instruct the client not to place any foreign object under the cast to prevent injury to the skin. D. The nurse should avoid using heat on a casted extremity because this can increase edema.

A nurse is caring for a client who is 72 hr postoperative following an above-the-knee amputation. Which of the following actions should the nurse take? A. Elevate the residual limb on a soft pillow B. Assist the client into a prone position every 4 hr C. Re-apply a bandage to the residual limb every 12 hr D. Apply dressings to the site in a proximal-to-distal direction

Correct Answer: B. Assist the client into a prone position every 4 hr The nurse should assist the client into a prone position for 20 to 30 minutes every 3 to 4 hours following an amputation to reduce the risk of flexion contractures. Incorrect Answers: A. The nurse should avoid elevation of the residual limb for 72 hours following an amputation because this position increases the client's risk of flexion contractures. C. The nurse should reapply a bandage to the residual limb every 4 to 6 hours to assist in preparation for a prosthetic limb. D. The nurse should apply bandages to the residual limb in a distal-to-proximal direction to prevent restriction of blood flow.

A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures results when a client's bone breaks into multiple pieces? A. Avulsion B. Comminuted C. Compression D. Spiral

Correct Answer: B. Comminuted (most of these fractures happen in car accidents when people are commuting) A comminuted fracture is one in which the bone breaks into multiple pieces or fragments. Incorrect Answers: A. In an avulsion fracture, a tendon and its attachment have pulled away a fragment of bone. C. In a compression fracture, a loading force to the long axis of a bone collapses the bone. This is common with vertebral fractures. D. In a spiral fracture, the break twists around the bone's shaft.

A nurse is caring for a client who has a fractured hip and was placed in Buck's traction 4 hr ago. Which of the following actions should the nurse take? A. Inspect the client's skin underneath the boot every 12 hr B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr C. Remove the weights from the traction while repositioning the client in bed D. Loosen the ropes if the client reports muscle spasms in the affected extremity

Correct Answer: B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr The nurse should encourage the client to perform dorsiflexion of the affected extremity every 2 hours to assess if the client is experiencing nerve damage. Weakness of dorsiflexion can indicate peroneal nerve damage. If this occurs, the nurse should notify the provider immediately. Incorrect Answers: A. The nurse should inspect the client's skin underneath the boot for irritation, increased swelling, and skin breakdown every 8 hours. C. The weights should never be removed without a prescription from the provider. The purpose of the weights is to decrease muscle spasms as a result of the hip fracture. D. The ropes of the traction should never be loosened. This can affect the traction and increase the client's muscle spasms.

A nurse in the emergency department is assessing a client who was in a motor-vehicle crash 2 days ago and sustained fractures of his tibia, ulna, and several ribs. The client is now disoriented to time and place and has a SaO2 of 87%. The nurse notes generalized petechiae on the client's skin. Which of the following complications should the nurse suspect? A. Hypovolemic shock B. Fat embolism syndrome C. Thrombophlebitis D. Avascular bone necrosis

Correct Answer: B. Fat embolism syndrome The nurse should identify the triad of neurological changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and a fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels. Incorrect Answers: A. The nurse should suspect hypovolemic shock in a client who experiences hypotension following extreme fluid loss, as with uncontrolled bleeding, dehydration, or severe edema. C. The nurse should suspect thrombophlebitis for a client who reports redness and warmth over the involved vein, along with extremity pain. D. The nurse should suspect avascular bone necrosis as a long-term complication for a client who reports pain and limited movement. Radiographs of the extremity will reveal loss of bone structure.

A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor for and report which of the following findings as an indication of compartment syndrome? A. Sensation of heat on the surface of the cast B. Paresthesias of the extremity C. Pruritus of the extremity D. Musty odor noted from cast materials

Correct Answer: B. Paresthesias of the extremity The nurse should identify paresthesias as a finding of compartment syndrome. Compartment syndrome involves the compression of nerves and blood vessels in an enclosed space, leading to impaired blood flow and nerve damage. Other findings include numbness, tingling, weakness, and pain that does not respond to medication. Incorrect Answers: A. The nurse should expect the cast to feel hot immediately following application due to a chemical reaction in the casting materials. C. The nurse should identify pruritus as an indication of possible cast irritation and implement measures to provide relief. D. The nurse should expect a new plaster cast to feel damp and have a musty odor for 24 to 72 hours until drying is complete.

A nurse is caring for a client who has a pelvic fracture. The client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. This client is experiencing which of the following complications? A. Pneumonia B. Pulmonary embolus C. Tension pneumothorax D. Tuberculosis

Correct Answer: B. Pulmonary embolus Immobility following musculoskeletal trauma places the client at an increased risk of pulmonary embolus. The client might also exhibit tachycardia and chest petechiae and have a decreased SaO2. The nurse should notify the rapid response team immediately. Incorrect Answers: A. The nurse should expect a productive cough and pleural pain as findings of pneumonia, which is a complication of immobility following pelvic fracture. C. The nurse should expect tracheal deviation and absent breath sounds on the affected side for a client experiencing tension pneumothorax, which is a complication of chest trauma or mechanical ventilation. D. The nurse should expect anorexia, fatigue, and night sweats in a client who has active tuberculosis. Pulmonary tuberculosis causes hemoptysis and chest tightness.

A nurse is providing discharge teaching for a client who had a left total hip arthroplasty. Which of the following client statements indicates the teaching was effective? A. "I should expect swelling of the affected leg for several weeks." B. "I should not cross my legs at the ankles or knees." C. "I will inspect my hip incision every other day for redness." D. "I can bend over at the hip to pick up objects."

Correct Answer: B."I should not cross my legs at the ankles or knees." The nurse should instruct the client to avoid crossing the legs at the knees or ankles because this can result in the dislocation of the femoral head. Incorrect Answers: A. The client should be instructed to notify the provider of potential complications such as leg swelling, pain or redness. This can be an indication of deep vein thrombosis. C. The client should inspect the surgical incision site daily for redness and warmth. This can be an indication of infection following surgery. D. The client should avoid bending at the hip to pick up objects on the floor and should not flex the hip more than 90°. This can cause dislocation of the hip following surgery.

A nurse is teaching a client who had an amputation of the left lower leg 3 days ago. Which of the following statements indicates that the client understands how to care for the incision and his left upper leg? A. "I should use powder inside my limb sock to keep it cool." B. "I will lie on my stomach for 30 min a few times a day." C. "I should expect some drainage with a strong odor because I had gangrene." D. "I will keep elevating my leg on 2 pillows to keep the swelling down."

Correct Answer: B."I will lie on my stomach for 30 min a few times a day." The client should lie prone 3 or 4 times per day for 20 to 30 minutes. This position will help reduce the risk of developing hip flexion contractures. Incorrect Answers: A. The client should not use any lotions or powder on the residual limb. C. The amputation will have removed any gangrenous tissue. Foul-smelling drainage indicates infection. The client should report this finding to the provider immediately. D. The client should not elevate the residual limb on pillows in the first 24 to 48 hours after the procedure because this can lead to hip or knee flexion contractures.

A nurse is providing post-procedural teaching to a client who had a diagnostic knee arthroscopy. Which of the following statements indicates that the client understands the nurse's instructions? A. "I'll take aspirin to relieve my pain." B. "I'll keep my leg elevated for the first day." C. "I'll put a heating pad on my knee for the first day." D. "I'll resume my usual activities as soon as I leave."

Correct Answer: B."I'll keep my leg elevated for the first day." Following a diagnostic arthroscopy, the client should keep the leg elevated for 12 to 24 hours to help reduce pain and swelling. Incorrect Answers: A. Following a diagnostic arthroscopy, the client should take a mild analgesic prescribed by the provider to relieve pain. Aspirin can increase the risk of bleeding. C. Following a diagnostic arthroscopy, the client should apply ice intermittently for the first 24 hours. D. Following a diagnostic arthroscopy, the client should adhere to short-term activity restrictions.

A nurse is preparing a client who is scheduled to have an arthroscopy the following day. Which of the following statements indicates that the client understands the pre-procedure teaching? A. "I have to keep my leg straight throughout the whole procedure." B. "The doctor will be able to see if I have signs of rheumatoid arthritis." C. "I should expect to stay overnight until I can walk around." D. "I'll have a scar that will be about an inch long."

Correct Answer: B."The doctor will be able to see if I have signs of rheumatoid arthritis." An arthroscopy helps with diagnosing musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, and internal joint injuries. Incorrect Answers: A. The client has to be able to flex the knee at least 40° so the surgeon can insert the arthroscope into the joint space. C. An arthroscopy typically requires ambulatory or same-day surgery. Activity restrictions are likely; however, the client is allowed to ambulate after anesthesia recovery, most likely with crutches. D. The client might have several incisions that are typically about 0.6 cm (0.24 in) long.

A nurse is caring for a client who is postoperative following shoulder surgery. The client has a prescription to keep the affected arm adducted. Which of the following instructions should the nurse share with the client? A. "Keep your arm bent at the elbow." B. "Use a pillow to prop your shoulder up close to your ear." C. "Hold your arm against the side of your body." D. "Position your arm with the shoulder at a 90° angle."

Correct Answer: C. "Hold your arm against the side of your body." Adduction means to position toward the midline of the body. Therefore, the nurse should provide these instructions to explain the provider's prescription. Incorrect Answers: A. The nurse should provide these instructions for a client who is prescribed elbow flexion. B. The nurse should provide these instructions for a client who is prescribed shoulder elevation. D. The nurse should provide these instructions for a client who is prescribed shoulder abduction, moving the arm away from the midline of the body.

A nurse is reinforcing preoperative teaching with a client who is scheduled for total knee arthroplasty. Which of the following statements by the client indicates an understanding of the teaching? A. I will begin using a continuous movement machine on my knee a day after surgery. B. I should avoid taking NSAIDs medications for pain. C. I should wear elastic stockings on both of my legs. D. I will have the small weight attached to my leg to hold the joint in place after the surgery

Correct Answer: C. "I should wear elastic stockings on both of my legs." The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as an understanding of the teaching. Incorrect Answers: A. A continuous passive motion (CPM) machine is usually prescribed for a few hours at a time, several times a day. Not all clients are prescribed CPM therapy following total knee arthroplasty. B. The client's pain will be initially addressed with epidural or patient-controlled analgesia and supplemented by other analgesic medications, including NSAIDs. D. The nurse should instruct the client to begin leg exercises while in bed during the immediate postoperative period, including heel pumps and quadriceps-setting exercises.

A nurse is preparing a client who is postoperative following total hip arthroplasty for discharge. Which of the following statements indicates that the client understands the instructions? A. "I'll use alcohol pads to clean my incision each day." B. "When I'm doing my exercises, I'll include bent-leg raises." C. "I'll use a reacher to help me pick up anything I drop on the floor." D. "When I can walk without my walker, I can stop attending physical therapy."

Correct Answer: C. "I'll use a reacher to help me pick up anything I drop on the floor." To prevent dislocation, the client must avoid flexing to 90° at the waist. Using a device that allows the client pick up objects from the floor without bending will help avoid this type of flexion. Incorrect Answers: A. The client should cleanse the hip incision with soap and water every day. B. The client should perform straight-leg raises, ankle pumps, and other exercises as recommended by the physical therapist. D. The goal of physical therapy is to help the client resume usual activities. Typically, clients use a walker first and then a cane before the final transition to ambulation without an assistive device.

A nurse is caring for a client who is postoperative following a total knee arthroplasty and has been prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, "I am in so much pain." Which of the following actions should the nurse take first? A. Remind the client to push the button for the PCA device B. Discuss activities the client may use to distract from the pain C. Ask the client to describe the characteristics of the pain D. Pause the CPM machine briefly to apply a cold pack to the client's knee

Correct Answer: C. Ask the client to describe the characteristics of the pain The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to acquire further data by asking the client to describe the characteristics of the pain. Incorrect Answers: A. The nurse should remind the client to push the button for the PCA device to promote the client's understanding of the PCA and to facilitate consistent pain control, but there is a different action the nurse should take first. B. The nurse should discuss activities the client may use to distract from the pain to provide nonpharmacological pain relief measures, but there is a different action the nurse should take first. D. The nurse should stop the CPM machine briefly to apply a cold pack to the client's knee to help reduce edema of the joint as a nonpharmacological pain relief measure, but there is a different action the nurse should take first

A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid? A. Colchicine B. Naproxen C. Aspirin D. Prednisone

Correct Answer: C. Aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications. Incorrect Answers: A. Colchicine is an anti-inflammatory gout medication used in conjunction with probenecid in acute gout attacks. It is not known to interact with probenecid. B. Naproxen is an NSAID used to decrease inflammation for clients who have gout; it is not known to interact with probenecid. D. Prednisone is a glucocorticoid medication used to treat gout; it is not known to interact with probenecid.

A nurse in the emergency department is caring for a client who reports pain in her left leg following a motor-vehicle crash. The client's left leg has bruising, swelling, and displacement of the bones. Which of the following actions should the nurse take first? A. Obtain an X-ray of the injured leg B. Apply ice packs to the affected area C. Check neurovascular status distal to the injury D. Elevate the affected leg on 2 pillows

Correct Answer: C. Check neurovascular status distal to the injury The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. The greatest risk to this client is impaired circulation to the limb from trauma and the resulting edema; therefore, the first action is to check the circulation, sensation, and movement distal to the level of the injury. If the nurse notes a weak or absent pulse distal to the injury, the limb's circulation is compromised, and immediate action is critical. Incorrect Answers: A. The client needs an X-ray to confirm the nature and extent of the injury; however, there is another action that is the priority. B. The client needs cold application to reduce swelling and pain from the injury; however, there is another action that is the priority. D. The client needs elevation of the leg to reduce swelling and pain from the injury; however, there is another action that is the priority.

A nurse is caring for a client who has a depressed skull fracture of the bone that makes up the larger part of the upper and side wall of the cranium. This fracture is located on which of the following bones? A. Sphenoid B. Occipital C. Parietal D. Frontal

Correct Answer: C. Parietal The parietal bones form the larger part of the upper and side wall of the cranium. Incorrect Answers: A. The sphenoid bone forms part of the face. B. The occipital bone is in the back of the skull. D. The frontal bone is in the front of the skull.

A nurse is planning care for a client following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan? A. Position the client with her legs adducted B. Internally rotate the client's affected hip C. Place a pillow between the client's legs D. Instruct the client to avoid flexing her hip more than 95º

Correct Answer: C. Place a pillow between the client's legs The nurse should plan to place a pillow or a wedge between the client's legs to reduce the risk of hip dislocation. Incorrect Answers: A. The nurse should position the client with her legs abducted to reduce the risk of hip dislocation. B. The nurse should avoid internal rotation of the client's affected hip to reduce the risk of hip dislocation. D. The nurse should instruct the client to avoid flexing her hip more than 90º to reduce the risk of hip dislocation.

A nurse is assessing a client's skeletal system. The nurse should be in which of the following positions to screen the client for scoliosis? A. Standing beside the client, who is lying on the examination table B. Facing the client, who is sitting in a chair C. Standing behind the client, who is bent over at the waist D. Standing at the client's side, while the client leans back

Correct Answer: C. Standing behind the client, who is bent over at the waist The nurse should stand behind the client, who is bent over at the waist, to inspect the symmetry of the scapula and curvature of the spine from the posterior view. These are essential components of a scoliosis screening. Incorrect Answers: A. The client should lie supine on the table for various other procedures, such as an abdominal evaluation, but not for a scoliosis screening. B. The client should sit in a chair for other types of examinations, such as blood pressure measurement, but not for a scoliosis screening. D. The examiner may ask a client to lean backward to test posture or flexibility, but the examiner needs to support the client to prevent falling.

A nurse is providing nutrition education to a client who has osteomalacia. The nurse should identify that this condition is caused by a deficiency in which of the following nutrients? A. Fluoride B. Vitamin A C. Vitamin D D. Phosphorus

Correct Answer: C. Vitamin D Osteomalacia, a softening of the bones due to defective bone mineralization, results from a deficiency of vitamin D. Incorrect Answers: A. Dental caries can result from a deficiency in fluoride. Fluoride does not contribute to bone health. B. Deficiency of vitamin A can cause problems with vision, tooth decay, impaired digestion, and decreased immune function. Vitamin A does not contribute to bone health. D. Phosphorus deficiency is rare. This mineral regulates acid-base balance in the body and is a component of RNA and DNA. It does not contribute to bone health.

A nurse is preparing a community education program about reducing the risk of osteoporosis. Which of the following pieces of information should the nurse include? A. Avoid sun exposure. B. Take a calcium supplement once each day if at risk for osteoporosis. C. Walking is the preferred mode of exercise to maintain strong bones. D. Caffeine intake minimizes the risk of developing osteoporosis.

Correct Answer: C. Walking is the preferred mode of exercise to maintain strong bones. The nurse should emphasize that regular walks are the preferred weight-bearing exercise to build and maintain strong bones. Incorrect Answers: A. The nurse should include in the education program that sunlight exposure is important to ensure an adequate supply of vitamin D. B. Supplementation of 1 to 1.5 g of calcium in divided doses daily will help promote strong bones. D. Excessive caffeine intake increases the risk of developing osteoporosis.

A nurse is caring for a client who is scheduled to undergo surgery to repair an open hip fracture. In which of the following positions should the nurse plan to place the client postoperatively? A. With the leg on the affected side adducted B. With the hip externally rotated on the affected side C. With the leg on the affected side abducted D. With the hip flexed to 90° on the affected side

Correct Answer: C. With the leg on the affected side abducted The nurse should plan to place the client with the leg abducted on the affected side postoperatively. Adduction or external rotation of the leg will cause the hip to dislocate. Incorrect Answers: A. Adduction of the client's leg will cause the hip to dislocate, requiring further surgery. B. External rotation of the client's leg will cause the hip to dislocate, requiring further surgery. D. Flexion of the client's hip at 90° or greater will cause the hip to dislocate, requiring further surgery.

A home health nurse is performing an assessment on a client who is 1 week postoperative following a total knee replacement. Which of the following statements by the client indicates an understanding of the teaching? A. "I will discontinue the blood thinner my doctor prescribed once I am at home." B. "I will keep a pillow under my knee when I am in bed." C. "I plan to use a walker to help me get around." D. "I will discontinue using the CPM machine when I get home."

Correct Answer: C."I plan to use a walker to help me get around." The nurse should identify that the client will receive a prescription for a walker, cane, or crutches to promote ambulation following a total knee replacement. Incorrect Answers: A. A blood thinner such as warfarin is typically prescribed to a client following joint surgery to prevent the development of a deep-vein thrombosis (DVT). The client should continue to take the medication until able to ambulate again and the provider decides the medication is no longer needed. B. A pillow should not be placed under the client's knee, as this can promote a contracture of the knee joint, making full extension difficult. D. A CPM machine will be continued for a client who is going home following a total knee replacement. A CPM machine is used to increase the range of motion of the knee following surgery, and the client should continue to use the machine until physical therapy has been discontinued by the provider.

A nurse is providing teaching about disease management to a client who has rheumatoid arthritis. Which of the following responses by the client indicates an understanding of the teaching? A. "I will take a hot bath every morning to decrease my stiffness." B. "When my arthritis acts up, I will rest all day and avoid exercising." C. "I will have handrails installed in my bathroom and hall." D. "I will avoid taking naps so I sleep better at night."

Correct Answer: C."I will have handrails installed in my bathroom and hall." The nurse should instruct the client to have handrails installed in the bathroom and hall to promote safety as the disease progresses. Incorrect Answers: A. The nurse should instruct the client to take a hot shower to decrease morning stiffness. Getting in and out of a bathtub is a safety risk for a client who has rheumatoid arthritis. B. Immobility will further hinder joint movement and should be avoided. Gentle exercise of the affected extremities should be performed, even when joints are painful and inflamed. A physical therapy regimen might be required. D. The client should balance activity with rest by taking 1 or 2 naps during the day.

A nurse is preparing a client for discharge who is postoperative following a conventional lumbar disk excision. Which of the following statements indicates that the client understands the nurse's instructions? A. "I should have no problem climbing stairs when I get home." B. "I'll wait about 3 weeks before I return to my usual activities." C. "I'll use my heating pad if I feel any muscle spasms in my back." D. "I can go back to driving in about 2 weeks or so."

Correct Answer: C."I'll use my heating pad if I feel any muscle spasms in my back." The client should apply heat to the back to relax the paraspinal muscles and reduce spasms. Incorrect Answers: A. The client will have to limit daily stair climbing but should start daily walking right away. B. A client may take up to 6 weeks to heal following a laminectomy. The client should resume activities gradually over that time to prevent spasms of the muscles near the spine. D. Driving adds flexion strain to the back. The client should avoid driving until the spine has healed, which typically takes up to 6 weeks.

A nurse is teaching a client who has a new prescription for alendronate for the treatment of osteoporosis. Which of the following statements by the client indicates an understanding of the teaching? A. "I will take the medication in the evening." B. "I will drink a full glass of milk with the medication." C. "I will take the medication at mealtime." D. "I will sit upright after taking the medication."

Correct Answer: D. "I will sit upright after taking the medication." A client taking alendronate should sit upright for 30 minutes after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching. Incorrect Answers: A. The nurse should instruct the client to take alendronate in the morning. B. High-calcium foods can reduce the absorption of alendronate. Alendronate can cause hypocalcemia; therefore, the client might require a calcium supplement to be taken at a different time of day. C. The nurse should instruct the client to take alendronate at least 30 minutes before food.

A nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client? A. Perform passive range-of-motion exercises of the ankle hourly B. Keep the affected extremity in a dependent position C. Wrap a loose dressing around the affected ankle D. Apply cold compresses to the extremity intermittently

Correct Answer: D. Apply cold compresses to the extremity intermittently Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 minutes at a time. Incorrect Answers: A. Perform passive range-of-motion exercises of the ankle hourly. B. The nurse should instruct the client to elevate the extremity to decrease swelling. C. The nurse should instruct the client to apply a compression dressing to decrease swelling of the affected area.

A nurse is caring for a client who has a fractured right hip. Which of the following types of traction should the nurse expect the client to have prior to hip arthroplasty surgery? A. Balanced skeletal traction B. Pelvic belt C. Pelvic sling D. Buck's traction

Correct Answer: D. Buck's traction Buck's traction is used prior to hip arthroplasty to maintain alignment and prevent muscle spasms prior to surgery. Incorrect Answers: A. Balanced skeletal traction is used to stabilize fractures of the femur or pelvis, not the hip. Skeletal traction involves the surgical insertion of pins, tongs, wires, or screws; this is sometimes used to stabilize long bone and vertebral fractures. B. A pelvic belt is used to treat back pain and does not provide traction prior to hip arthroplasty. C. A pelvic sling is used to stabilize pelvic fractures, not hip fractures.

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate-containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa

Correct Answer: D. History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to decreased bone density, increasing the risk of fractures. Incorrect Answers: A. An increased intake of phosphate-containing foods, such as carbonated beverages, is a risk factor for osteoporosis. B. A lack of time outdoors in sunlight is a risk factor for osteoporosis. C. Decreased estrogen or testosterone is a risk factor for osteoporosis.

A nurse is teaching a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Reduce dietary protein intake B. Apply ice to painful areas C. Increase calcium intake to 900 mg per day D. Perform weight-bearing exercises

Correct Answer: D. Perform weight-bearing exercises The nurse should instruct the client to perform weight-bearing exercises to promote bone formation and increase strength and mobility. Incorrect Answers: A. The nurse should instruct the client to increase the dietary intake of calcium, vitamin D, protein, magnesium, and vitamin K to promote bone formation. B. The nurse should instruct the client to apply heat to relieve discomfort. C. The nurse should instruct the client to increase the calcium intake to 1,200 to 1,500 mg per day.

A nurse is caring for a client following a hip arthroplasty. The nurse places an abduction pillow on the client for which of the following purposes? A. To raise the bed linens off the client's feet to prevent plantar flexion B. To keep the client's heels off the bed to prevent pressure ulcers C. To position the client off the operative site while in bed D. To prevent dislocation of the hip during position changes or movement

Correct Answer: D. To prevent dislocation of the hip during position changes or movement Following surgery, the nurse should use an abduction pillow to prevent dislocation of the new hip joint. The nurse should place the wedge-shaped pillow between the client's legs to prevent adduction beyond the midline of the body during position changes or client movement, which can lead to subluxation or total dislocation of the hip joint. Incorrect Answers: A. If the client is at risk for plantar flexion resulting in foot drop, the nurse should place a foot cradle at the foot of the bed to raise the bed linens off the feet. B. The nurse should use regular bed pillows to keep the client's heels off the bed to prevent shearing and skin breakdown. C. The nurse should use regular pillows and rolled blankets to position the client off the operative site while in bed.

A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following information should nurse include? A. "You will need to apply a cold pack to the site 3 times a day." B. "Your provider might ask you to walk frequently to increase circulation to the area." C. "You will need to limit your consumption of high-protein foods." D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy."

Correct Answer: D."Your provider might prescribe a central catheter line for long-term antibiotic therapy." Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV antibiotic therapy for treatment. Therefore, the nurse should discuss the need for long-term IV access for antibiotic therapy. Incorrect Answers: A. Cold therapy is contraindicated for a client who has an open wound. Cold causes decreased blood flow, which can further damage the impaired tissue. B. The client is at increased risk of a fracture of the weakened bone. Therefore, the nurse should instruct the client to limit weight-bearing as prescribed by the provider. C. The client should consume a diet high in protein to support wound healing.

A nurse is reinforcing teaching with a client who has a cast on his left arm to treat a forearm fracture. Which of the following statements indicates that the client understands the instructions? A. I'll call the doctor's office if my fingers get colder on the arm with the cast. B. If I have any itching under the cast. I'll try to reach it with a cotton swab. C. If my fingers swell, I should just put a heating pad on them and rest. D. If I have any tingling under my cast, I'll know I need to move my fingers more

Correct Answer: A. "I'll call the doctor's office if my fingers get colder on the arm with the cast." The nurse should emphasize the importance of doing neurovascular checks and notifying the provider of any unexpected findings, such as temperature variances. Incorrect Answers: B. The client should not insert any objects under the cast to relieve itching. Instead, the client can try blowing cool air from a blow dryer under the cast to relieve itching. C. The client should elevate his arm to reduce swelling. Some providers prescribe ice packs for the first 24 to 48 hours, which might also help reduce swelling. D. Tingling can indicate compartment syndrome, a complication that involves increased pressure within the fascia leading to reduced circulation to the area. It can also mean the cast is too tight. The client should report this finding to the provider immediately.

A nurse is preparing a client for magnetic resonance imaging (MRI) of the spine. Which of the following pieces of information should the nurse give the client prior to the procedure? A. "You can have a mild sedative before the procedure." B. "You'll have to lie still on your back for 15 to 20 minutes." C. "You can't have this test if you've had cataract surgery." D. "Your exposure to radiation will be minimal."

Correct Answer: A. "You can have a mild sedative before the procedure." Some clients need mild sedation, especially when using an older closed MRI machine. Clients can feel claustrophobic and anxious as they slowly pass through what seems like a tunnel. Incorrect Answers: B. The client will have to lie supine and still for 45 to 60 min. C. Cataract surgery is not a contraindication to receiving an MRI, but an MRI can be unsafe for clients who have pacemakers or stents. D. There is no exposure to radiation during an MRI

A nurse is caring for a client who has chronic phantom limb pain following an above-knee amputation. Which of the following prescriptions should the nurse verify with the provider? A. Meperidine B. Amitriptyline C. Gabapentin D. Propranolol

Correct Answer: A. Meperidine Opioids are more effective for residual limb pain rather than phantom limb pain. Additionally, meperidine is not recommended for chronic pain because long-term use can cause accumulation of a toxic metabolite. Incorrect Answers: B. Amitriptyline is a tricyclic antidepressant that can help manage chronic phantom limb pain. C. Gabapentin is an antiepileptic that can help manage chronic phantom limb pain. D. Beta blockers, such as propranolol, can reduce the persistent, dull, burning sensations of chronic phantom limb pain.

A nurse is preparing to care for a client who is in balanced skeletal traction to stabilize a femur fracture. Which of the following actions should the nurse recommend for the client's plan of care? A. Offering the client a diet high in fluid and fiber B. Encouraging active range of motion of the affected leg C. Removing the weights prior to repositioning the client D. Assisting the client to a lateral position every 4 hours

Correct Answer: A. Oering the client a diet high in fluid and fiber A client who is immobile is at risk of constipation. The nurse should encourage a diet high in fluid and fiber to promote gastrointestinal function. Incorrect Answers: B. Active range of motion of the unaffected limbs is encouraged to prevent muscle wasting; however, active range of motion of a limb in traction is not feasible, as the traction apparatus limits mobility. C. Once the weights are in place, the nurse should not remove them. D. The nurse should plan to inspect the client's pin sites at least every 8 to 12 hours due to the risk of infection.

A nurse is teaching a client who is on bed rest about preventing complications. Which of the following client statements indicates an understanding of the teaching? A. "I should perform range-of-motion exercises once per day." B. "I should cough and deep-breathe every hour." C. "I should change my position every 4 hours." D. "I should perform foot and ankle pumps every 3 hours."

Correct Answer: B. "I should cough and deep-breathe every hour." The nurse should instruct the client to cough and deep-breathe every hour to promote lung expansion, maintain adequate gas exchange, and mobilize secretions. Incorrect Answers: A. The nurse should instruct the client to perform range-of-motion exercises 3 to 4 times per day to reduce the risk of muscle wasting and promote mobility. C. The nurse should instruct the client to change positions every 1 to 2 hours to reduce the risk of skin breakdown. D. The nurse should instruct the client to perform foot and ankle pump exercises every 1 to 2 hours to reduce the risk for thrombus formation.

A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition? A. Misoprostol B. Dantrolene C. Celecoxib D. Colchicine

Correct Answer: C. Celecoxib Celecoxib is a type of NSAID known as cyclooxygenase-2 (COX-2) inhibitors that are used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation. Incorrect Answers: A. Misoprostol is a histamine-blocking agent. A client who has RA may be prescribed misoprostol to prevent the adverse gastrointestinal effects of taking an NSAID, but this medication does not treat manifestations of RA. B. Dantrolene is an antispasmodic medication prescribed to relieve muscle spasms for clients who have multiple sclerosis. D. Colchicine is an anti-inflammatory medication prescribed to relieve pain for clients who have gout.

A nurse is collecting data from a client who has a fractured left femur and is skeletal traction. Which of the following findings should the nurse report to the provider as an indication of fat emboli? A. Ecchymosis of the thigh. B. Serous drainage at the pin site. C. Chest petechiae. D. Muscle spasms in the left leg

Correct Answer: C. Chest petechiae The nurse should identify chest petechiae as an indication of fat embolism syndrome. Clients who have fractures of the long bones such as the femur are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets from the marrow enter into the systemic circulation and are deposited in the lungs. The nurse should immediately notify the provider because the client could progress to acute respiratory failure. Incorrect Answers: A. Ecchymosis of the thigh as an expected finding for a client who has a fractured le femur. B. Serous drainage is expected at the pin site for a client who is in skeletal traction. The nurse should monitor for purulent drainage that can indicate an infection at the site. D. Muscle spasms in the le leg are an expected finding for a client who has a fractured le femur.

A nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis? A. Bulging in the area over the surgical incision. B. Shortening of the right leg. C. Sensation of warmth over the surgical incision. D. Pallor following elevation of right leg

Correct Answer: B. Shortening of the right leg The nurse should monitor the client for shortening of the affected leg as an indication of dislocation of the prosthesis. Other findings include increased hip pain, an inability to move the extremity, and rotation of the hip internally or externally. Incorrect Answers: A. The nurse should not expect visible bulging following dislocation of the prosthesis. C. The nurse should not expect a sensation of warmth over the surgical incision following dislocation of the prosthesis. A sensation of warmth or heat can indicate infection of the joint. D. The nurse should not expect pallor following elevation of the right leg aer dislocation of the prosthesis. This finding is expected for a client who has impaired arterial circulation.

A nurse is caring for a client with a hip fracture who has Buck's extension traction in place. Which of the following pieces of the information should the nurse give the client about this type of traction? (Select all that apply)? A. You'll have considerably less pain with the traction in place. B. You'll have the traction in place for a week or so. C. The traction will help decrease muscle spasms. D. The weight as a pulling force to keep your leg and hip still. E. We have to make sure the weight are just barely touching the floor.

Correct Answers: A. "You'll have considerably less pain with the traction in place." C. "The traction will help decrease muscle spasms." D. "The weights act as a pulling force to keep your leg and hip still." Pain is usually more severe without the traction. Buck's extension traction uses weights to help decrease muscle spasms. Typically, 2.3 to 5.5 kg (5 to 10 lb) of force helps stabilize the hip and leg preoperatively. Incorrect Answers: B. Buck's extension traction is for short-term stabilization of a hip fracture prior to surgery. E. The weights must stay suspended at all times and should not touch the floor.

A nurse is determining a client's risk of developing osteoporosis. The nurse should identify which of the following as risk factors for bone loss? (Select all that apply.) A. Small body frame B. Hypertension C. African-American ethnicity D. Low vitamin D intake E. Smoking

Correct Answers: A. Small body frame D. Low vitamin D intake E. Smoking Females have a higher risk of developing osteoporosis than males. Other risk factors include family history, low body mass index, and a small body frame. Consuming inadequate levels of calcium and vitamin D, smoking, and ingesting high amounts of alcohol or caffeine also increase the risk of developing osteoporosis. Incorrect Answers: B. Hypertension does not specifically contribute to osteoporosis risk. Common osteoporosis comorbidities include hyperthyroidism and diabetes mellitus. C. Caucasian and Asian ethnicities are associated with a higher risk of developing osteoporosis.

A nurse is preparing a client for a bone scan. Which of the following statements indicates that the client understands the pre-procedure teaching? (Select all that apply.) A. "I will have to drink a radioactive solution before the test begins." B. "A special camera will scan the bones in my entire body." C. "There will be better absorption of the radiation by healthy bone." D. "I'll have to drink a lot of water to help get the radiation out of my body." E. "I understand the radiation is harmless, and I don't have to worry about it."

Correct Answers: B. "A special camera will scan the bones in my entire body." D. "I'll have to drink a lot of water to help get the radiation out of my body." E. "I understand the radiation is harmless, and I don't have to worry about it." A bone scan is a radionuclide procedure that allows viewing of the entire skeleton. It is less common than other diagnostic tests but is still useful for identifying hairline fractures and some malignancies. The client should drink plenty of fluids to promote urinary excretion of the radioactive material. Also, the nurse should reassure the client that the radioactive material is not dangerous because it deteriorates quickly in the body and exits via urine and stool. Incorrect Answers: A. For a bone scan, the client will receive the radioactive material via IV injection. C. Increased absorption of contrast material indicates bone disease and disorders

A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following pieces of information should the nurse include about osteoarthritis? A. "Osteoarthritis is caused by autoimmune processes." B. "Osteoarthritis leads to a decreased erythrocyte sedimentation rate." C. "Osteoarthritis affects other organ systems." D. "Osteoarthritis can impair a joint on a single side of the body."

D. "Osteoarthritis can impair a joint on a single side of the body." The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment. Incorrect Answers: A. The nurse should identify aging as a risk factor that causes degenerative changes in osteoarthritis. RA is an autoimmune disease in which the body's immune system attacks itself. B. The nurse should expect an increased erythrocyte sedimentation rate for a client who has osteoarthritis. C. Osteoarthritis is limited to the joints. RA is a systemic autoimmune disease, involving other body organs.

A nurse is reinforcing teaching with a client who has arthritis and is experiencing joint pain that impairs mobility. Which of the following instructions should the nurse include? A. Engage you joints in resistance exercise. B. Avoid using assistive devices when walking. C. Perform passive exercise. D. Apply heat to your joints prior to exercise

D. Apply heat to your joints prior to exercise Nurse should instruct the client to apply heat to joints prior to exercise to increase mobility and reduce pain. Nurse should instruct the client to avoid resistance exercise because it can cause joint injury when joints are soft and inflamed. Nurse should instruct the client to use assistive devices when walking to promote independence and increase mobility. Nurse should instruct client to perform active exercises when possible to increase mobility.

A nurse is assessing a client who has osteoarthritis. The client's medical record indicates the presence of Heberden's nodes. Which of the following findings should the nurse expect? A. Inflamed, fluid-filled sacs over the joints B. Clubbing of the fingernails C. Flexion contracture of the fingers D. Hard lumps over the joints of the fingers

D. Hard lumps over the joints of the fingers Heberden's nodes are hard, bony lumps or nodules in the joints of the fingers. Inflamed, fluid-filled sacs over the joints are manifestations of bursitis or inflammation of the bursa of the joints. Clubbing of the fingernails reflects prolonged hypoxia. A progressive flexion contracture of the palmar fascia affecting the middle, fourth, or fifth fingers describes Dupuytren's disease.

A nurse is collecting data from a client who has several risk factors for osteoporosis. Which of the following findings should the nurse identify as an indication that the client requires further evaluation for this disorder? A. Leg cramps with exercise B. Stress incontinence. C. Abd distention. D. Lower back pain

D. Lower back pain Lower back pain is common among clients who have osteoporosis, especially when they li, stoop, or bend. Back pain and tenderness that cause movement restriction might indicate vertebral compression fractures, which are the most common type of fracture resulting from osteoporosis. Incorrect Answers: A. Leg cramps are not a symptom of osteoporosis. A variety of imbalances such as deficiencies of calcium and magnesium can cause muscle cramps. B. Stress incontinence is not a symptom of osteoporosis. Weakening of the bladder neck supports as a result of childbirth or anatomical damage to the urethral sphincter cause this disorder. C. Abdominal distention is not a symptom of osteoporosis. It can be a sign of gastrointestinal disorders such as irritable bowel syndrome and intestinal obstruction.