NCLEX_Musculoskeletal Disorders 222Q no exp

The nurse is giving medication instructions to a client who is receiving baclofen as maintenance therapy. Which client statement about the maintenance dose of baclofen indicates that education was effective?

"I will take 15 mg four times daily."

A client is to receive a prescription for methocarbamol. The nurse provides instructions to the client about the medication. Which client statement would indicate a need for further education?

"If my vision becomes blurred, I don't need to be concerned about it."

A client is being discharged to home after spinal fusion with insertion of instrumentation (rod). The unit nurse should consult with the continuing care nurse regarding the need for modification of the home environment if the client makes which statement?

"My bedroom and bathroom are on the second floor of my home."

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply.

1. Control of symptoms during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show no progression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy

A client who sustained a severe sprain of the ankle is told by the health care provider that the pain experienced is caused by muscle spasm and swelling in the area of the injury. Which interventions should the nurse anticipate will be included in the client's initial plan of care? Select all that apply.

1. Ice bags 2.Elevation 4. Compression bandage

The nurse is creating a plan of care for a client scheduled for a left total hip arthroplasty. Which interventions should the nurse include in the plan to prevent complications of the surgery? Select all that apply.

1. Keep the leg slightly abducted. 2. Teach leg exercises to the client. 3. Use aseptic technique for wound care. 4. Prevent hip flexion beyond 90 degrees.

A client with gout has begun to take allopurinol. The nurse informs the client that which medication may also be necessary during the beginning phase of medication therapy with allopurinol? Select all that apply.

1. Naproxen 2. Colchicine 4. Indomethacin

The nurse is caring for a client diagnosed with osteomyelitis. Which data noted in the client's record are supportive of this diagnosis? Select all that apply.

1. Pyrexia 3. Elevated white blood cell count 4. Elevated erythrocyte sedimentation rate 5. Bone scan impression indicative of infection

The nurse is collecting data related to a client's risk factors associated with osteoporosis. Which data should the nurse include? Select all that apply.

1. Thin body build 2. Smoking history 3. Postmenopausal age 4. Chronic corticosteroid use 6. Family history of osteoporosis

The nurse is caring for a client with acute back pain. Which are the most likely causes of this problem? Select all that apply.

1. Twisting of the spine 3. Hyperflexion of the spine 6. Herniation of an intervertebral disk

Which tests can be used to diagnose gout? Select all that apply.

2. Serum uric acid level 5. Synovial fluid aspiration 6. 24-hour urine uric acid level

The nurse has given activity guidelines to a client with chronic low back pain. The nurse determines that the client understands the instructions if the client states to do which activities? Select all that apply.

2. Sitting using a lumbar roll or pillow 3. Standing with one foot on a step or stool

The nurse is evaluating the serum acetylsalicylic acid results for a client receiving acetylsalicylic acid for rheumatoid arthritis. Which noted result is indicative that the client is within the range for the medication's antiarthritic effect?

26 mg/dL (1.88 mmol/L)

The nurse in the hospital emergency department is caring for a client with a fractured arm and is preparing the client for a reduction of the fracture that will be done in the casting room in the emergency department. The nurse should take which actions? Select all that apply.

Administer a prescribed analgesic. Explain the procedure to the client. Obtain informed consent for the procedure.

The nurse is performing an assessment on a client after a closed reduction of a fractured right humerus and application of a plaster cast. To assess for signs of compartment syndrome, the nurse should perform which action?

Assess capillary refill, temperature, color, and amount of pain in the right hand.

A client has several fractures of the lower leg, which has been placed in an external fixation device. The client is upset about the appearance of the leg, which is edematous. The nurse documents which client problem in the plan of care?

Body image alteration

A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which finding, if noted during the nursing assessment, would indicate that the client is experiencing a side/adverse effect of this medication?

Drowsiness

A client with muscle spasms in the lumbar area of the spine has been started on cyclobenzaprine. The nurse should monitor for which most frequent side effect of the medication?

Drowsiness

A clinic nurse is performing an assessment on a client with rheumatoid arthritis who has been taking acetylsalicylic acid for the disorder. The nurse assesses the client for signs of aspirin toxicity. Which finding should alert the nurse to the possibility of toxicity?

Fever and signs of hyperventilation

The nurse provides instructions to a client diagnosed with osteoporosis. Education about prevention of which complication is the most important?

Fractures

The nurse is caring for an older adult who has been placed in Buck's extension traction after a hip fracture. On assessment of the client, the nurse notes that the client is disoriented. What is the best nursing action based on this information?

Place a clock and calendar in the client's room.

The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take?

Rewrap the residual limb with an elastic compression bandage.

The nurse is creating a plan of care for a client in skin traction. Which frequent assessment should the nurse include in the plan as a priority intervention?

Signs of skin breakdown

The nurse is preparing to teach a client how to safely use crutches. Before initiating the teaching, the nurse performs an assessment on the client. The priority nursing assessment should include which information?

The client's vital signs, muscle strength, and previous activity level

A client has been on treatment for rheumatoid arthritis for 3 weeks. During the administration of etanercept, which is most important for the nurse to assess?

The white blood cell counts and platelet counts

A client with a diagnosis of rheumatoid arthritis is taking sulindac. The health care provider prescribes misoprostol for the client. The nurse explains that this medication has been prescribed for which purpose?

To prevent gastric complications such as ulcer disease

The nurse is providing dietary instructions to a client with osteoporosis and is discussing appropriate food items to include in the diet. Which food items should the nurse recommend as being high in calcium? Select all that apply.

Tofu 2. Salmon Spinach 5. Sardines

Diclofenac is prescribed for a client with osteoarthritis. Which medication, if noted on the client's record, would alert the nurse to consult with the health care provider?

Warfarin sodium

The nurse is providing medication instructions to a client with multiple sclerosis receiving baclofen. Which information should the nurse include in the instructions?

Watch for urinary retention as a side effect.

The nurse is lecturing to a group of women who are at high risk for osteoporosis. The nurse should inform the women about which most important measure?

Limit caffeine intake.

The nurse has completed giving discharge instructions to a client who has had a total joint replacement (TJR) of the knee with a metal prosthetic system. The nurse determines that the client understands the instructions if the client makes which statement?

"All caregivers should be told about the metal implant."

A nursing student is providing health maintenance education to a client with osteitis deformans (Paget's disease). Which statement by the client indicates a need for further education?

"Because I have no symptoms, my disease is not progressing."

The nurse is giving medication instructions to a client who has been prescribed acetylsalicylic acid. Which client statement indicates that education was effective?

"I may develop heartburn."

The nurse is planning discharge teaching for a client diagnosed and treated for compartment syndrome. Which information should the nurse include in the teaching?

"Bleeding and swelling caused increased pressure in an area that couldn't expand."

The nurse is preparing instructions for a client who is diagnosed with osteomalacia. Which information should the nurse include in the teaching?

"Ensure adequate intake of vitamin D fortified foods."

The nurse teaches a client who is going to have a plaster cast applied about the procedure. Which statement by the client indicates a need for further teaching?

"I can bear weight on the cast in one-half hour."

A client with a short-leg plaster cast complains of an intense itching under the cast. The nurse provides instructions to the client regarding relief measures for the itching. Which client statement indicates an understanding of appropriate measures to relieve the itching?

"I can use a hair dryer on the low setting and allow the cool air to blow into the cast."

A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast?

"I need to avoid getting the cast wet."

A client has had a bone scan done. The nurse determines that the client demonstrates understanding of postprocedure care when the client makes which statement?

"I need to drink plenty of water for 1 to 2 days after the procedure."

The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood?

"I need to report a fever or swelling to my health care provider."

A client has just had a cast removed, and the underlying skin is yellow-brown and crusted. The nurse gives the client instructions for skin care. The nurse determines that the client needs further teaching of the directions if he or she makes which statement?

"I need to scrub the skin vigorously with soap and water."

Acetylsalicylic acid has been prescribed for a client with rheumatoid arthritis, and the nurse provides instructions to the client about the medication. Which statement by the client indicates the need for further teaching?

"I need to take this medication on an empty stomach for it to work."

A male client arrives in the hospital emergency department and tells the nurse that he twisted his ankle while jogging. The client is seen by the health care provider and is diagnosed with a sprained ankle. The nurse provides instructions to the client regarding home care for the injury. Which statement, if made by the client, would indicate an understanding of appropriate care measures for the next 24 hours?

"I should elevate my foot above the level of the heart."

The nurse has provided discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further instruction?

"I should sit in my recliner when I get home."

Probenecid has been prescribed for a client with a diagnosis of gout, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction?

"I should take acetylsalicylic acid for relief of headache."

The nurse teaches the client with hypocalcemia how to take calcium carbonate. Which statement by the client indicates an understanding of the instructions?

"I should take the tablet an hour after lunch."

A client has been experiencing muscle weakness over a period of several months. The health care provider suspects polymyositis. Which client statement correctly identifies a confirmation of test results and this diagnosis?

"I will know I have polymyositis if the muscle fibers are inflamed."

The client is given medication instructions for maintenance therapy for oral dantrolene sodium for the treatment of spasticity. Which client statement indicates understanding of the instructions?

"I will take 100 mg twice a day."

The nurse has provided instructions to a client with a diagnosis of rheumatoid arthritis about measures to protect the joints. Which statement by the client indicates a need for further instruction?

"Pain or fatigue is expected, and I should try to continue with the activity if this occurs."

A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. The nurse provides the client with the most reassurance by making which statement?

"The cane has a flared tip with concentric rings to give stability."

A client with a history of spinal cord injury is beginning medication therapy with baclofen. The nurse determines that the client understands the side/adverse effects of the medication if the client makes which statement?

"The medication may make me drowsy."

A client is receiving a new prescription for colchicine. Which information about this medication should the nurse include in an educational session?

"This is an antiinflammatory agent specific for gout."

The nurse is giving medication instructions to a client who is receiving dantrolene sodium. Which statement by the client indicates that the educational session was effective?

"This medication acts directly on the skeletal muscle to relieve spasticity."

Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply.

1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated.

The nurse has completed giving discharge instructions to a client after total knee arthroplasty and replacement with a prosthetic system. The nurse teaches the client about weight-bearing status. What information should the nurse include?

"You will use full weight bearing by discharge."

The nurse is assigned to care for a client with multiple sclerosis who is receiving an intravenous dose of methocarbamol. The nurse monitors the client knowing that which is an expected side effect?

Dark green-colored urine

Calcium carbonate is prescribed for a client with hypocalcemia. How should the nurse instruct the client to take the medication?

1 hour after meals

A client with multiple sclerosis is receiving baclofen. The nurse assessing the client monitors for which finding as an indication of a primary therapeutic response to the medication?

Decreased muscle spasms

The nurse has given the client instructions about crutch safety. Which statement indicates that the client understands the instructions? Select all that apply.

1. "I should not use someone else's crutches." 2. "I need to remove any scatter rugs at home." 4. "I need to have spare crutches and tips available."

A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse determines that the client needs additional teaching if the client states that it is acceptable to eat which food?

Chicken liver

The nurse is caring for a client with osteoarthritis. The nurse performs an assessment knowing that which clinical manifestations are associated with the disorder? Select all that apply

3. Joint pain that diminishes after rest 5. Joint pain that intensifies with activity

A client who has had a total knee arthroplasty tells the nurse that there is pain with extension of the knee. The nurse should perform which action?

Administer an analgesic.

The nurse is planning to teach a client how to stand on crutches. The nurse will incorporate into written instructions that the client should be told to place the crutches in what manner?

6 inches (15 cm) to the front and side of the toes

The community health nurse is providing a teaching session on osteoporosis to women living in the community. The nurse informs these community residents that which is a risk factor for this disorder?

A diet low in vitamin D

A client is admitted to the nursing unit after a left below-the-knee amputation after a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How should the nurse interpret this client statement?

A normal response that indicates the presence of phantom limb sensation

The nurse is repositioning a client who has been returned to the nursing unit after internal fixation of a fractured right hip with a femoral head replacement. The nurse should use which method to reposition the client?

A pillow to keep the right leg abducted during turning

The nurse is conducting health screen for osteoporosis. Which client is at greatest risk of developing this disorder?

A sedentary 65-year-old woman who smokes cigarettes

The nurse provides instructions to a client with bilateral deformities of the joints of the fingers due to rheumatoid arthritis. When providing teaching about the disease process, the nurse should inform the client that the changes are most likely due to what type of response?

Autoimmune

A client who has had spinal fusion and insertion of hardware is extremely concerned with the perceived lengthy rehabilitation period. The client expresses concerns about finances and the ability to return to prior employment. The nurse understands that the client's needs could best be addressed by referral to which member of the health care team?

A social worker

A client has slight weakness in the right leg. On the basis of this assessment finding, the nurse determines that the client would benefit most from the use of which item?

A straight leg cane

A client is being transferred to the nursing unit from the postanesthesia care unit after spinal fusion with rod insertion. The nurse should prepare to transfer the client from the stretcher to the bed by using which best method?

A transfer (slider) board and the assistance of three people

A client has had surgery to repair a fractured left hip. When repositioning the client from side to side in the bed, what should the nurse plan to use as the most important item for this maneuver?

Abductor splint

Dantrolene sodium is prescribed for the client experiencing flexor spasms. The client asks the nurse how the medication is going to help. The nurse replies that this medication acts in which way?

Acts directly on the skeletal muscle to relieve the spasms

The nurse is reviewing the postprocedure plan of care formulated by a nursing student for a client scheduled for a bone biopsy. The nurse determines that the student needs additional information about postprocedure care if which inaccurate intervention is documented?

Administering opioid analgesics intramuscularly

The nurse is giving a client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed touch-down of the affected leg. The nurse should tell the client to perform which action?

Advance the crutches along with the left leg, and then advance the right leg.

A client is complaining of low back pain that radiates down the left posterior thigh. The nurse should ask the client if the pain is worsened or aggravated by which factor?

Bending or lifting

The nurse is reviewing laboratory results for a client taking dantrolene sodium. The nurse should notify the health care provider if which finding is noted on the laboratory report sheet?

Alanine aminotransferase (ALT) 96 U/L (96 U/L)

Diagnostic studies are prescribed for a client with suspected Paget's disease. In reviewing the client's record, the nurse would expect to note that the health care provider has prescribed which laboratory study?

Alkaline phosphatase

A client with a new medication prescription for allopurinol asks the nurse, "I know this is for gout, but how does it work?" The nurse plans to reply based on which medication action?

Allopurinol decreases uric acid production.

The nurse is talking to a client who had a below-the-knee amputation 2 days earlier. The client states, "I hate looking at this; I feel that I'm not even myself anymore." What client problem should the nurse incorporate in the plan of care based on the statement by this client?

Altered body image

The nurse is reviewing the medical record of a newly assigned client and notes that the client is receiving cyclobenzaprine hydrochloride for the treatment of muscle spasms. The nurse questions the prescription if which disorder is noted in the admission history?

Angle-closure glaucoma

A client is treated in a health care provider's office for a sprained ankle after a fall. Radiographic examination has ruled out a fracture. Before sending the client home, the nurse plans to teach the client to avoid which activity in the next 24 hours?

Applying a heating pad

The nurse overhears the health care provider (HCP) tell a client with rheumatoid arthritis that the condition needs to be treated with gold therapy. The nurse interprets that the HCP is referring to which medication?

Auranofin

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan?

Avoid the use of alcohol.

The health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication will be administered intrathecally. Which medication should the nurse expect to be prescribed and administered by this route?

Baclofen

The nurse is teaching a client who had a lumbar laminectomy how to perform activities of daily living without causing strain on the back. Which action performed by the client indicates a need for further instruction?

Bends over to tie shoes

The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease). Which does the nurse identify as the cause of the client's stooped posture and bowing of lower extremities?

Bone resorption and regeneration

The nurse is evaluating goal achievement for a client in traction with impaired physical mobility. The nurse determines that the plan of care needs to be revised if which outcome is noted?

Bowel movement every 4 days

The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect should the nurse monitor?

Bradycardia

The nurse is performing a musculoskeletal assessment of an immobile client for disuse osteoporosis. Which should the nurse assess to obtain the best information about the bone remodeling process?

Calcitonin

The nurse is caring for the client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which is the priority nursing action?

Call the health care provider.

The nurse is preparing a plan of care for a client who is scheduled to return from the recovery room after a left total knee arthroplasty. The nurse includes in the plan of care to assess the client's neurovascular status the monitoring of which parameter?

Capillary refill, sensation, color, and pulse of the left foot

A client is admitted to the emergency department with an open fracture of the right tibia. What intervention is most appropriate for this client?

Check the neurovascular status of the area distal to the extremity.

The nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast is applied, the client reports a significant increase in pain level even after administration of the prescribed dose of opioid analgesic. What is the initial nursing action?

Check the neurovascular status of the toes on the casted leg.

The nurse is assigned to care for a client in traction. The nurse creates a plan of care for the client and should include which action in the plan?

Check the weights to ensure that they are off of the floor.

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus?

Clear mentation

The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse should suspect impairment with the neurovascular status of the client's casted extremity if which findings are noted? Select all that apply.

Client report of severe, deep, unrelenting pain Client report of pain as nurse assesses finger movement Client report of numbness and tingling sensation in the fingers

The nurse is caring for a client with a radius fractured across the shaft and bone splintered into fragments. Information about which type of fracture should be included by the nurse in the client's education?

Comminuted fracture

The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a posterior approach. In implementing hip precautions, which action should the nurse teach the client to avoid?

Crossing legs at the ankle

The home care nurse is providing instructions to a client regarding the use of crutches. The client asks the nurse to demonstrate the method for going down the stairs with the crutches. How should the nurse accurately demonstrate this technique?

Crutches and the affected leg down, followed by the unaffected leg

A client has been diagnosed with osteomalacia, or adult rickets. The nurse should anticipate that the health care provider will include a new prescription for which vitamin supplement?

D

Baclofen is prescribed for the client with multiple sclerosis. The nurse determines that the medication is having the intended effect if which finding is noted in the client?

Decreased muscle spasms

The nurse is caring for a client diagnosed with osteomyelitis. Which mechanism of the disease process can result in necrosis of the bone?

Devascularization

The nurse is preparing to perform pin site care for a client in skeletal traction. On assessment of the pin site, the nurse notes the presence of serous drainage. Which nursing action would be appropriate?

Document the findings.

Allopurinol is prescribed for a client and the nurse provides medication instructions to the client. Which instruction should the nurse provide?

Drink 3000 mL of fluid a day.

Etanercept is prescribed for a client with rheumatoid arthritis. The nurse should monitor the client for which side/adverse effect of the medication following administration?

Dyspnea

The nurse is caring for a client who was just admitted to the hospital with a diagnosis of a fractured right hip sustained from a fall 5 hours earlier. The nurse creates a plan of care for the client and includes interventions related to monitoring for signs of fat embolism. Which findings should be listed in the care plan as a sign/symptom of fat embolism?

Dyspnea and chest pain

The nurse is receiving a client from the postanesthesia care unit following left above-knee amputation. Which is the priority nursing action at this time?

Elevate the foot of the bed.

The nurse is caring for a client who has just had a plaster leg cast applied. The nurse should plan to prevent the development of compartment syndrome by performing which action?

Elevate the limb slightly.

The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg?

Elevated on pillows continuously for 24 to 48 hours

Dantrolene is prescribed for a client with spinal cord injury for discomfort caused by spasticity. Which finding would alert the nurse to a potential adverse effect associated with this medication?

Elevated temperature

Dantrolene is prescribed for a client experiencing discomfort caused by spasticity. In providing instructions to the client regarding the medication, what should the nurse emphasize?

Expect that periodic liver function studies will be required.

The nurse is gathering subjective and objective data from a client with a diagnosis of suspected rheumatoid arthritis (RA). The nurse would expect to note which early signs and symptoms of RA? Select all that apply.

Fatigue Morning stiffness

What should the nurse anticipate when evaluating for the effects of raloxifene in an older client?

Increased bone density

A client seeks treatment in the hospital emergency department for a lower leg injury. Deformity of the lower portion of the leg is evident, and the injured leg appears shorter than the other. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced which injury?

Fracture

The nurse is assessing a client with a shortened, adducted, and externally rotated left leg. On the basis of this finding, which condition should the nurse anticipate?

Fracture of the femoral neck

An older client is diagnosed with osteoporosis. The nurse teaches the client about self-care measures, knowing that the client is most at risk for which problem as a result of this disorder of the bones?

Fractures

Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, would indicate a need to contact the health care provider about the administration of this medication?

Glaucoma

A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which are interventions to aid the client in relieving the spasm? Select all that apply.

Heat Analgesics Muscle relaxers Intermittent traction

Which teaching point is the priority when the nurse is teaching the client about caring for a plaster cast?

Immediately report any increase in drainage or interruption in cast integrity.

The nurse witnesses a client sustain a fall and suspects that the right leg may be broken. The nurse should take which priority action?

Immobilize the right leg before moving the client.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain?

Impaired tissue perfusion

The nurse is performing a neurovascular assessment on a client with a cast on the left lower leg. The nurse notes the presence of edema in the foot below the cast. The nurse should make which interpretation about this finding?

Impaired venous return

The nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bed rest in Williams' position to minimize the pain. The nurse should put the bed in what position?

In semi Fowler's position, with the knees slightly flexed

A client immobilized in skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse identifies which client problem as the priority?

Inability to entertain self

The nurse is planning discharge teaching for a client admitted with a fracture of the leg that does not extend all the way through the bone. The nurse should include information about which types of fractures?

Incomplete

Allopurinol has been prescribed for a client with a diagnosis of gout. The nurse develops a list of instructions for the client regarding the use of this medication. Which measures should be included on the list? Select all that apply.

Increase fluid intake. Take the medication with food. Consume items to maintain an alkaline urine. Return to the health care clinic for liver and renal function tests.

The nurse is caring for a client at risk for fat embolism because of a fracture of the left femur and pelvis sustained in a fall. The client also sustained a head injury, is comatose, and is unable to communicate verbally. Which assessment findings should the nurse identify as early signs of possible fat embolism?

Increased heart rate and adventitious breath sounds

A client is complaining of knee pain. The knee is swollen, reddened, and warm to the touch. The nurse interprets that the client's signs and symptoms are compatible with which conditions? Select all that apply.

Infection Recent injury Inflammation

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement?

Injury to the brachial plexus nerves

The nurse is caring for a client with a hip fracture who has just been placed in Buck's traction. What intervention is most important for the nurse to perform?

Inspect the skin at least every 8 hours for signs of irritation or inflammation.

A client has Buck's extension traction applied to the right leg. Which intervention should the nurse plan to prevent complications of the device?

Inspect the skin on the right leg.

The nurse is assigned to care for a client who is in Buck's traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan?

Inspect the skin under the boot at least every 8 hours.

The nurse gives a dose of diazepam to an assigned client. What is the most important action to be taken by the nurse before leaving the room?

Instituting safety measures

A client has been diagnosed with subluxation of the shoulder. The nurse explains to the client that which injury has occurred to the joint?

It has incompletely dislocated.

A client who suffered a contusion after being hit on the thigh with a racquetball has been told that it is acceptable to apply heat to the area 72 hours after the injury. The nurse explains the rationale for this treatment to the client, stating that which is the physiological benefit of heat in this case?

It promotes reabsorption of blood from the injured tissue.

The nurse is preparing a client for an arthroscopy of the knee. When providing teaching, which information is essential for the nurse to include

It will identify if there is joint injury and provide a route for surgical repair if indicated.

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder?

Kidney disease

The home health nurse is reviewing medications with a client receiving colchicine for the treatment of gout. The nurse evaluates that the medication is effective if the client reports a decrease in which measure?

Joint inflammation

The nurse notes that a client has been taking colchicine. The nurse assesses the client for which finding that is an indication for the use of this medication?

Joint inflammation and pain

A client has just undergone spinal fusion after experiencing herniation of a lumbar disk. The nurse should include which interventions to maintain client safety after this procedure? Select all that apply.

Keep the head of the bed flat. Place pillows under the length of the legs. Use logrolling technique for repositioning. Assist the client with eating meals and drinking fluids.

A client has skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should assess which area as high risk for pressure and breakdown?

Left heel

The nurse is teaching a client with a right arm cast how to prevent stiff or frozen shoulder. What should the nurse instruct the client to do?

Lift the shoulder of the casted arm over the head periodically throughout the day.

The nurse is analyzing the laboratory studies on a client receiving dantrolene. Which laboratory test would identify an adverse effect associated with the administration of this medication?

Liver function tests

The nurse asks a nursing student about the uses of the medication dantrolene. The nursing student correctly states that dantrolene is used to manage hypermetabolism of skeletal muscle that occurs in which condition?

Malignant hyperthermia

A client is seen in the health care provider's office for complaints of wrist pain. A diagnosis of carpal tunnel syndrome is made. In explaining this disorder to the client, the nurse states that it is caused by compression of which nerve?

Median

Auranofin has been prescribed for a client with rheumatoid arthritis. The nurse provides instructions to the client about the medication and tells the client to notify the health care provider if which occurs?

Metallic taste in the mouth

A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse should anticipate that which type of wound care to the fasciotomy site will be prescribed?

Moist sterile saline dressings

The nurse is evaluating a client's use of a cane for left-sided weakness. The nurse should intervene and correct the client if the nurse observed that the client performs which action?

Moves the cane when the right leg is moved

The nurse is caring for a client admitted for a herniated intervertebral lumbar disk who is complaining about stabbing pain radiating to the lower back and the right buttock. The nurse determines that the client's signs/symptoms are most likely due to which condition?

Muscle spasm in the area of the herniated disk

A client who had a body cast applied 2 days earlier begins to complain of anorexia, nausea, and abdominal discomfort. The nurse should take which immediate action?

Notify the health care provider.

The nurse is caring for a client in skeletal traction. On assessing the pin sites, the nurse notes the presence of purulent drainage. Which nursing action is most appropriate?

Notify the health care provider.

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome?

Numbness and tingling in the fingers

A hospitalized client has been diagnosed with osteomyelitis of the left tibia. The nurse determines that this condition is most likely a result of which event in the client's recent history?

Open trauma to the left leg

The nurse is planning measures to increase bed mobility for a client in skeletal leg traction. Which item should the nurse consider to be most helpful for this client?

Overhead trapeze

A client with a fractured femur experiences sudden dyspnea, tachypnea, and tachycardia. A set of arterial blood gas tests reveals the following: pH, 7.35 (7.35); Paco2, 43 mm Hg (43 mm Hg); Pao2, 58 mm Hg (58 mm Hg); HCO3, 23 mEq/L (23 mmol/L). The nurse interprets that the client probably has experienced fat embolus because of the result of which parameter?

Pao2

A client with osteoarthritis is receiving diclofenac sodium. The nurse would be concerned about the administration of this medication if the client's history and physical included a diagnosis of which condition?

Peptic ulcer disease

The nurse is caring for a client who sustained an open fracture and is diagnosed with acute osteomyelitis of the right lower extremity. Which intervention should the nurse plan to perform?

Perform sterile dressing changes.

The nurse has suggested specific leg exercises for a client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client performing which action?

Performing active range of motion to the right ankle and knee

The client is complaining of skin irritation from the edges of a cast applied the previous day. Which action should the nurse take?

Petal the cast edges with adhesive tape.

The home care nurse visits a client who has a cast applied to the left lower leg. On assessment of the client, the nurse notes the presence of skin irritation from the edges of the cast. Which nursing intervention is most appropriate?

Petal the cast edges with appropriate material.

The nurse is caring for a client who is an athlete and has sustained an injury to the anterior cruciate ligament. The nurse is providing education to the client regarding the potential treatment measures for this injury. What should the nurse include in the teaching? Select all that apply.

Physical therapy Knee immobilizer Aspiration of joint fluid antiinflammatory medications

A client who has experienced a stroke has partial hemiplegia of the left leg. The nurse interprets that the client could benefit from the support and stability provided by which item?

Quad cane

The nurse is caring for a client in skeletal leg traction with an overbed frame. Which nursing intervention will best assist the client with self-positioning in bed?

Place a trapeze on the bed frame to provide a means for the client to lift the hips off the bed.

A client who has experienced nonunion of a fracture is scheduled for bone grafting using cadaver bone. The client appears restless and anxious about the procedure. After determining that the client understands the surgical procedure, the nurse should explore which item next?

Potential worry about contracting hepatitis or possibly human immunodeficiency virus infection

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?

Presence of a "hot spot" on the cast

The nurse is assisting in performing a physical assessment of a right-handed client's musculoskeletal system. Which would be an abnormal finding?

Presence of fasciculations

A client with a hip fracture asks the nurse about Buck's (extension) traction that is being applied before surgery and what is involved. The nurse should provide which information to the client?

Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

The nurse has delegated the ambulation of a client to the unlicensed assistive personnel (UAP). Which actions by the UAP support a clear understanding of the appropriate steps to carry out this task safely? Select all that apply.

Remove clutter that may interfere with ambulation. Assist client in applying nonskid shoes before ambulation. Instruct client to sit up on the bedside and dangle before ambulation. Observe the client for dizziness during ambulation and report immediately.

A client has been administered cyclobenzaprine for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. How should the nurse interpret these findings?

Represent an allergic reaction to the medication

The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states to take which action?

Restricting fluids

The nurse is collecting data from a client and notes that the client is taking acetylsalicylic acid 5 g daily in divided doses. The nurse determines that this medication has been prescribed to treat which condition?

Rheumatoid arthritis

A client is admitted to the hospital, and the nurse notes that the client is taking acetylsalicylic acid to treat a chronic rheumatoid disorder. The nurse should monitor the client for which sign or symptom that indicates a toxic effect of the medication?

Ringing in the ears

A client who has been taking high doses of acetylsalicylic acid to relieve pain from osteoarthritis now has more generalized joint pain and an elevated temperature. The nurse should assess for which complication to determine whether the client has other signs of aspirin toxicity?

Ringing in the ears

A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which complication is the client at most risk for after surgery?

Separation of the wound edges

The nurse is caring for a client admitted for a fractured hip status post fall at home. On assessment of the client's affected lower extremity, which signs/symptoms would most likely be noted?

Shortening and external rotation

A client is fearful about having an arm cast removed. Which action by the nurse would be the most helpful?

Showing the client the cast cutter and explaining how it works

The nurse is creating a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client?

Signs of skin breakdown

A client has been placed in Buck's extension traction. The nurse can provide for countertraction to reduce shear and friction by performing which action?

Slightly elevating the foot of the bed

A client is receiving baclofen for muscle spasms because of a spinal cord injury. Which side/adverse effect related to this medication should the nurse monitor the client for?

Slurred speech

The home health nurse is providing dietary instructions to a client who is taking probenecid for the treatment of gout. Which food should the nurse instruct the client to continue to eat?

Spinach

The nurse is caring for a client with a swollen left ankle who has difficulty bearing weight on this leg and states that he twisted his ankle. Based on these findings, which condition does the nurse determine the client has most likely experienced?

Sprain

The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention should the nurse take?

Stay with the victim and encourage him or her to remain still.

A film-coated form of diflunisal, a nonsteroidal antiinflammatory medication, has been prescribed for a client to treat chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which instruction should the nurse provide to the client?

Swallow the tablets with large amounts of water or milk.

The clinic nurse is performing an assessment on a client with a diagnosis of rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA?

Systemic symptoms such as fatigue, anorexia, and weight loss

A client has just been admitted to the hospital with a fractured femur and pelvic fractures. The nurse should plan to carefully monitor the client for which signs/symptoms?

Tachycardia and hypotension

A client was admitted to the hospital 2 hours ago following multiple fractures to the pelvis and soft tissue injury to the abdomen. Diagnostic studies have ruled out perforation of abdominal organs. The nurse places highest priority on monitoring this client for which changes in vital signs?

Tachycardia, hypotension

The nurse is teaching a client who will be discharged on alendronate about the medication. Which should be included in the teaching plan? Select all that apply.

Take the medication at the same time daily. Take the medication on an empty stomach. Remain upright for 30 minutes following ingestion.

Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions on administration of the medication. Which instruction should the nurse provide?

Take the medication with a full glass of water after rising in the morning.

The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding?

Temperature of 101.6°F (38.7°C) orally

The nurse is caring for a client diagnosed with the rotator cuff lesion. The nurse assesses the client knowing that the client most likely has which structure affected?

Tendon

The nurse in the hospital emergency department is assessing a client with an open leg fracture. The nurse should inquire about the last time the client had which done?

Tetanus vaccine

A client is seen in the hospital emergency department after injury to the right ankle. The client tells the nurse that she twisted her ankle while playing volleyball. The health care provider (HCP) has prescribed a topical analgesic cream for the injury. The nurse providing instruction about the medication should provide the client with which information?

That the medication contains a combination of medications, one of which is an analgesic

The nurse has developed a plan of care for a client in traction and documents a problem of inability to perform self-care independently. The nurse evaluates the plan of care and determines that which observation indicates a successful outcome?

The client assists in self-care as much as possible.

The home care nurse has instructed a client how to perform the three-point gait with the use of crutches. The nurse observes the client using this gait to ensure correct performance of the maneuvers. Which observation, if made by the nurse, would indicate that the client understands how to perform this type of gait?

The client moves both crutches forward, along with the affected leg, and then moves the unaffected leg forward.

The nurse is obtaining a health history from a client and is assessing for risk factors associated with osteoporosis. The nurse would be most concerned if which data were obtained? Select all that apply.

The client reports that she doesn't exercise much at all. 2. The client reports that she smokes a few cigarettes a day. 3. The client reports that she is taking phenytoin to treat a seizure disorder. The client reports that she takes a daily low dose of prednisone to treat a chronic respiratory condition.

The nurse is planning to teach proper use of a thoracolumbosacral orthosis to a client who has had spinal fusion with instrumentation. The nurse should include which teaching point in the discussion with the client?

The device is applied before getting out of bed in the morning.

An older client with rheumatoid arthritis has been instructed by the health care provider to take ibuprofen 400 mg orally (PO) three times daily. The home care nurse reading the medication prescription knows that the instruction has been effective when the client states the instructed dose is which?

The normal adult dose

The nurse is caring for a client admitted for a torn meniscus. What is the focus of the nurse's immediate assessment?

The knee

The health care provider has prescribed a lidocaine 5% patch for a client with a diagnosis of neck pain due to osteoarthritis. Which should the nurse tell the client regarding this medication?

The medication patch will act as a local anesthetic.

The home care nurse is visiting a client who is in a body cast. While performing an assessment, the nurse plans to evaluate the psychosocial adjustment of the client to the cast. What is the most appropriate assessment for this client?

The need for sensory stimulation

A client is having a plaster cast placed on the lower extremity that will extend from mid-thigh to the center of the foot. Which instruction should be given to the client before hospital discharge?

The need to notify the health care provider immediately if the client notices numbness or swelling or if the foot becomes cold and pale

The nurse is caring for a client with a long bone fracture at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by performing an assessment of which item(s)?

The neurological and respiratory systems

The nurse is reviewing the health care provider's prescriptions for an adult client who has been admitted to the hospital after a back injury. Carisoprodol is prescribed for the client to relieve the muscle spasms. The health care provider has prescribed 350 mg to be administered four times a day. What should the nurse conclude?

The prescription is the normal adult dosage.

The nurse is planning to teach the client with below-the-knee amputation about care to prevent skin breakdown. Which point should the nurse include in developing the teaching plan?

The socket of the prosthesis must be dried carefully before it is used.

The nurse is providing care for a client admitted 3 days ago with a severe left ankle contusion. The nurse determines that heat application to the area has been effective if which has occurred?

There is reabsorption of blood noted at the injured site.

The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding?

Thick, yellow drainage from the pin sites

A client is taking large doses of acetylsalicylic acid for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication?

Tinnitus, hearing loss, dizziness, and ataxia

The home care nurse is visiting a client who sustained a severe muscle sprain to the back. Carisoprodol is prescribed for the client. The nurse provides instructions to the client regarding the medication and should teach the client to take which measure?

To avoid driving until the reaction to the medication is known

A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need which intervention?

To have a window cut in the cast

The nurse determines that a client's skeletal traction needs correction if which observation is made?

Traction ropes rest against the footboard.

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?

Uric acid level of 9.0 mg/dL (0.54 mmol/L)

The nurse develops a plan of care for a client with a spica cast that covers a lower extremity and documents that the client is at risk for constipation. When planning for bowel elimination needs, the nurse should include which in the plan of care?

Use a fracture pan for bowel elimination.

The nurse has taught a client with a below-the-knee amputation about prosthesis and residual limb care. The nurse determines that the client has understood the instructions if the client makes which statement?

Use a mirror to inspect all areas of the residual limb each day.

The nurse has reviewed activity restrictions with a client who is being discharged after insertion of a femoral head prosthetic system. What statement by the client will help the nurse determine that the client understands the material presented?

Use a raised toilet seat.

The home health nurse is planning to teach a client with osteoporosis about home modifications to reduce the risk of falls. Which recommendations would be necessary to include in the teaching plan? Select all that apply.

Use night lights. Remove scatter rugs. Use staircase railings. place hand rails in the bathroom

The nurse is developing a plan of care for a client in Buck's traction. The plan of care should include assessing the client for which finding indicating a complication associated with the use of this type of traction?

Weak pedal pulses

A client newly diagnosed with gout has been prescribed allopurinol. The nurse would be concerned if the client was also currently taking which medication?

Warfarin

A client who has rheumatoid arthritis has begun treatment with anakinra and has received the first injection. What finding would indicate that the health care provider should be notified and that the medication should be discontinued?

White blood cell count of 12,000 mm3 (12 × 109/L) and a temperature of 99.9°F (37.7°C)

The nurse is providing instructions to a client regarding ambulation after the application of a fiberglass cast to the lower leg. The nurse determines that the client understands the instructions if the client states that weight bearing on the casted leg can begin at which time period?

Within 20 to 30 minutes of application

The community health nurse is providing an educational session for community members regarding dietary measures that will assist in reducing the risk of osteoporosis. The nurse should instruct the community members to increase dietary intake of which food known to be helpful in minimizing this risk?

Yogurt

The nurse is performing an assessment on a client with suspected Paget's disease. On assessment the nurse would expect the client to report which as the most common symptom of this disease?

bone pain