Chapter 39: Assessment of Musculoskeletal Function. Chapter 40: Musculoskeletal Care Modalities - ML7

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? * "Limit hip flexion to 90 degrees." * "Perform rotation exercises each day." * "Intermittently cross and uncross your legs several times each day." * "Avoid weight bearing until the hip is completely healed."

* "Limit hip flexion to 90 degrees." The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight-bearing ambulation may not be restricted, depending on the type of prosthesis.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? * Crutchfield tongs * Thomas splint * Buck's * Balanced suspension

* Buck's An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? * Assisting with range-of-motion and isometric exercises. * Changing the client's position within prescribed limits. * Administering prescribed analgesics. * Applying warm compresses.

* Changing the client's position within prescribed limits. Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? * Have the patient extend both hands while the nurse compares the volume of both radial pulses. * Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. * Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. * Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

* Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? * Neuroma * Hematoma * Chronic osteomyelitis * Unexplainable burning pain (causalgia)

* Hematoma Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course.

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding? * Lordosis * Scoliosis * Kyphosis * Dowager's hump

* Lordosis Lordosis is an exaggeration of the lumbar spine curve.

The client with a newly applied cast reports severe unrelenting pain. What is the nurse's best response? * Make the client NPO and notify the health care provider. * Loosen the edges of the cast and elevate the leg. * Reposition the extremity for comfort and apply ice. * Administer a dose of morphine sulfate.

* Make the client NPO and notify the health care provider. The client is exhibiting symptoms of compartment syndrome. The health care provider needs to be contacted as treatment options include bivalving of the cast or a possible fasciotomy, a surgical procedure.

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. * Surgery will not be required. * Muscle spasms will be relieved. * The bones of the left leg will be aligned. * Immobilization of the left leg will be maintained. * Less pain medication will be required.

* Muscle spasms will be relieved. * The bones of the left leg will be aligned. * Immobilization of the left leg will be maintained. Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction.

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes? * Radial * Peroneal * Median * Ulnar

* Peroneal The motor function of the peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes, while pricking the skin between the great toe and center toe assesses sensory function. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger. Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation.

Red bone marrow produces which of the following? Select all that apply. * Platelets * White blood cells (WBCs) * Red blood cells (RBCs) * Estrogen * Corticosteroids

* Platelets * White blood cells (WBCs) * Red blood cells (RBCs) The red bone marrow located within the bone cavities produces RBC, WBCs, and platelets through the process of hematopoiesis. The red bone marrow does not produce estrogen or corticosteroids.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis? * Risk for infection * Chronic pain * Deficient knowledge: procedure * Activity intolerance

* Risk for infection The priority nursing diagnosis following an arthrocentesis is risk for infection. The client may experience acute pain. The client needs adequate information before experiencing the procedure. Activity intolerance would not be an expected nursing diagnosis.

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for? * Lack of sleep and appetite * Serous drainage * Signs of depression * Signs of shock

* Serous drainage When the client undergoes an invasive knee joint examination, the nurse should inspect the knee area for swelling, bleeding, and serous drainage. An invasive joint examination does not cause lack of sleep or appetite, depression, or shock. The client may be in shock due to the injury itself.

What is the term for a rhythmic contraction of a muscle? * Atrophy * Clonus * Hypertrophy * Crepitus

* Clonus Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkage-like decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do? * Cut a cast window. * Remove the cast. * Apply a fiberglass cast. * Initiate physical therapy.

* Cut a cast window. After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing.

Which of the following is the most common site of joint effusion? * Knee * Elbow * Hip * Shoulder

* Knee The most common site for joint effusion is the knee. If inflammation or fluid is suspected in a joint, consultation with a provider is indicated. The elbow, hip, and shoulder are not the most common site of joint effusion.

A patient comes to the clinic and informs the nurse of numbness, tingling, and a burning sensation in the arm from the elbow down to the fingers. What type of symptom would this be documented as? * Paresthesia * Flaccidity * Atonia * Effusion

* Paresthesia Sensory disturbances are frequently associated with musculoskeletal problems. The patient may describe paresthesias, which are sensations of burning, tingling, or numbness. These sensations may be caused by pressure on nerves or by circulatory impairment.

Which principle applies to the client in traction? * Weights should rest on the bed. * Skeletal traction is never interrupted. * Knots in the ropes should touch the pulley. * Weights are removed routinely.

* Skeletal traction is never interrupted. Skeletal traction is applied directly to the bone and is never interrupted. To be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? * "Metal pins will go through my skin to the bone." * "I will wear a boot with weights attached." * "A belt will go around my pelvis and weights will be attached." * "The traction can be removed once a day so I can shower."

* "Metal pins will go through my skin to the bone." In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? * "This allows for the strength in the arm to remain consistent." * "The joint above the fracture and below the fracture must be immobilized." * "When a spica cast is ordered, the arm must be immobilized." * "The method allows for the fastest healing time and the greatest mobility."

* "The joint above the fracture and below the fracture must be immobilized." Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent; most clients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may shorten healing time, it does not allow for increased mobility.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? * Providing crutches to the client. * Assisting in early ambulation. * Using a continuous passive motion (CPM) machine. * Encouraging expressions of anxiety.

* Assisting in early ambulation. An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? * Replacement of one of the articular surfaces of a joint * Incision and diversion of the muscle fascia * Excision of damaged joint fibrocartilage * Replacement of knee with artificial joint

* Excision of damaged joint fibrocartilage The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells? * Remodeling * Resorption * Ossification and calcification * Epiphyses and diaphysis formation

* Ossification and calcification Ossification and calcifications the body's process to transform osteoblasts into mature bone cells called osteocytes. Osteocytes are involved in maintaining bone tissue. Resorption and remodeling are involved in bone destruction. Epiphyses and diaphyses are bone tissues that provide strength and support to the human skeleton.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? * aspirin * furosemide * digoxin * NPH insulin

* aspirin Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

Which data is most important for the nurse to record while assessing a client with an open wound? * when the client last received a tetanus immunization? * vital signs * time and place of the injury * degree of movement and range of motion

* when the client last received a tetanus immunization? If the client has an open wound, the nurse ascertains when the client last received a tetanus immunization. This vital information helps in assessing the risk of infection in a client with an open wound.

A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Select all that apply. * Advise the client to use a trochanter roll. * Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach. * Advise the client to use antiembolism stockings on both legs. * Advise the client to place pillows between the legs.

* Advise the client to use a trochanter roll. * Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach. Use a trochanter roll to prevent external rotation of the hip and knee. Avoid placing pillows between the legs. If the client is lying on the stomach, the nurse should advise the client to adduct the stump so it presses against the other leg. Adduction stretches flexor muscles and prevents abduction deformity. The client should only use an antiembolism stocking on the unaffected leg.

The nurse is performing a neurological assessment. What will this assessment include? * Ask the client to plantar flex the toes. * Observe for capillary refill of the great toe. * Palpate the dorsalis pedis pulse. * Inspect the foot for edema.

* Ask the client to plantar flex the toes. A neurological assessment evaluates sensation and motion. Assessing plantar flexion of the toes would be included in a neurological assessment. Capillary refill, palpation of pulses, and inspecting for edema would be included in a vascular assessment.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? * Better molding to the client * Quicker drying * Longer lasting * More breathable

* Better molding to the client Plaster casts require a longer time for drying but mold better to the client and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longer lasting, and breathable.

The nurse is teaching a client about osteoporosis. What diagnostic test will the nurse include with the client teaching? * dual-energy x-ray * absorptiometry * bone biopsy * arthrocentesis * arthroscopy

* dual-energy x-ray (DEXA) Osteoporosis is characterized by decreased bone density. Dual-energy x-ray absorptiometry can determine the extent of bone loss. A bone biopsy is used to detect abnormal cells such as a malignancy. An arthrocentesis is used for joint swelling or arthritis. An arthroscopy is used to detect joint problems.

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate? * Muscle weakness * Muscle composition * Bone density * Metastatic bone lesions

* Muscle weakness Electromyography tests the electric potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, disability, and to differentiate muscle and nerve problems. A bone biopsy is done to identify bone composition. Bone densitometry is done to evaluate bone density. A bone scan would be appropriate to detect metastatic bone lesions.

Which of the following is the final stage of fracture repair? * Remodeling * Cartilage calcification * Cartilage removal * Angiogenesis

* Remodeling The final stage of fracture repair consists of remodeling the new bone into its former structural arrangement. During cartilage calcification, enzymes within the matrix vesicles prepare the cartilage for calcium release and deposit. Cartilage removal occurs when the calcified cartilage is invaded by blood vessels and becomes reabsorbed by chondroblasts and osteoclasts. Angiogenesis occurs when new capillaries infiltrate the hematoma, and fibroblasts from the periosteum, endosteum, and bone marrow produce a bridge between the fractured bones.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? * Body aligned opposite to line of traction pull * Weights hanging and touching the floor * Pulleys without evidence of the obstruction * Ropes freely moving over pulleys

* Weights hanging and touching the floor When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.

A client has an exaggerated convex curvature of the thoracic spine. What is this condition called? * kyphosis * lordosis * scoliosis * diaphysis

* kyphosis Kyphosis is an exaggerated convex curvature of the thoracic spine. Lordosis is an excessive concave curvature of the lumbar spine. Scoliosis is a lateral curvature of the spine. Diaphyses are the long shafts of bones in the arms and legs.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? * physical therapy * discontinue use of crutches * cold compresses to leg for swelling * No options are correct.

* physical therapy For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.

A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first? * "My toes are numb. * "My knee aches." * "My feet are cold." * "My foot is swollen."

* "My toes are numb. Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage. An aching knee is expected after the procedure. Cold or swollen feet are not priority assessments.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? * An open reduction * A fasciotomy * A total hip replacement * A total knee replacement

* A fasciotomy A treatment option for compartment syndrome is fasciotomy.

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? * Abduction * Adduction * Flexion * Internal rotation

* Abduction The nurse educates the patient about protective positioning, which includes maintaining abduction and avoiding internal and external rotation, hyperextension, and acute flexion.

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? * Arthrodesis * Joint arthroplasty * Total joint arthroplasty * Open reduction

* Open reduction An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.

Which laboratory study indicates the rate of bone turnover? * Urine calcium * Serum calcium * Serum phosphorous * Serum osteocalcin

* Serum osteocalcin Serum osteocalcin (bone GLA protein) indicates the rate of bone turnover. Urine calcium concentration increases with bone destruction. Serum calcium concentration is altered in clients with osteomalacia and parathyroid dysfunction. Serum phosphorous concentration is inversely related to calcium concentration and is diminished in osteomalacia associated with malabsorption syndrome.

A hip spica cast: * encircles the trunk. * is a short or long leg cast reinforced for strength. * encloses the trunk and a lower extremity. * extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

* encloses the trunk and a lower extremity. A hip spica cast encloses the trunk and a lower extremity. A double hip spica cast includes both legs. A body cast encircles the trunk. A walking cast is a short or long leg cast reinforced for strength. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration? * A serum calcium test * An electromyography * An arthroscopy * A magnetic resonance imaging (MRI)

* An electromyography An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. A serum calcium test evaluates the calcium in the blood. An arthroscopy assesses changes in the joint. An MRI identifies abnormalities in the targeted area.

A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding? * Rigidity * Flaccidity * Atonic * Tetanic

* Flaccidity A muscle that is limp and without tone is described as flaccid; a muscle with greater-than-normal tone is described as spastic. Conditions characterized by lower motor neuron destruction (e.g., muscular dystrophy), denervated muscle becomes atonic (soft and flabby) and atrophies.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? * Keep the cast clean and dry. * Position the client on the affected side. * Promote elimination with a regular bedpan. * Keep the legs in abduction.

* Keep the cast clean and dry. Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse? * The patient has osteoarthritis. * The patient has lupus erythematosus. * The patient has rheumatoid arthritis. * The patient has neurofibromatosis.

* The patient has rheumatoid arthritis. The subcutaneous nodules of rheumatoid arthritis are soft and occur within and along tendons that provide extensor function to the joints. Osteoarthritic nodules are hard and painless and represent bony overgrowth that has resulted from destruction of the cartilaginous surface of bone within the joint capsule. Lupus and neurofibromatosis are not associated with the production of nodules.

Meniscectomy refers to the: * replacement of one of the articular surfaces of a joint. * incision and diversion of the muscle fascia. * excision of damaged joint fibrocartilage. * removal of a body part.

* excision of damaged joint fibrocartilage. The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Amputation refers to the removal of a body part.

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? * Blood pressure of 140/90 mm Hg * Crackles in the lung bases * Client complains of pain in the affected rib area when taking a deep breath * Heart rate of 94 beats/minute

* Crackles in the lung bases Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minute is within normal range.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? * Assessing the extremity for neurovascular integrity * Keeping the client from sliding to the foot of the bed * Keeping the ropes over the center of the pulley * Ensuring that the weights hang free at all times

* Assessing the extremity for neurovascular integrity Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following? * Joint * Muscle * Ligament * Cartilage

* Muscle Tendons attach muscles to the periosteum of bone. Joints are a junction between two or more bones. Ligaments connect two freely movable bones. Cartilage is a dense connective tissue used to reduce friction between two structures.

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification? * Osteoblasts * Cortical bone * Osteoclasts * Cancellous bone

* Osteoblasts Osteoblasts secrete bone matrix (mostly collagen), in which inorganic minerals, such as calcium salts, are deposited. This process of ossification and calcification transforms the blast cells into mature bone cells, called osteocytes, which are involved in maintaining bone tissue. Cortical bone is dense hard bone found in the long shafts; cancellous bone is spongy bone found in the irregular rounded edges of bone.

Which device is designed specifically to support and immobilize a body part in a desired position? * Brace * Continuous passive motion (CPM) device * Splint * Trapeze

* Splint A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.

A client's cast is removed. The client is worried because the s* kin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? * Consult a skin specialist. * Scrub the area vigorously to remove the crust. * Apply lotions and take warm baths or soaks. * Avoid exposure to direct sunlight.

* Apply lotions and take warm baths or soaks. The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.

Which would be contraindicated as a component of self-care activities for the client with a cast? * Cover the cast with plastic to insulate it * Cushioning rough edges of the cast with tape * Elevate the casted extremity to heart level frequently * Do not attempt to scratch the skin under a cast

* Cover the cast with plastic to insulate it The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? * "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." * "The continuous passive motion device can decrease the development of adhesions." * "Bleeding is a complication associated with the continuous passive motion device." * "Monitoring skin integrity is important while the continuous passive motion device is in place."

* "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.

The nurse is discussing an older adult's risk for skeletal fractures with a group of students assigned to the clinical area. Which of the following would the nurse most likely explain as the underlying reason for the increased risk? * Collagen formation decreases. * Aging leads to a deficiency of calcium. * No bone reformation occurs in the older adult. * Bone resorption is more rapid than bone formation.

* Bone resorption is more rapid than bone formation. Older adults are more prone to skeletal fractures because bone resorption is more rapid than bone formation. Collagen formation increases resulting in fibrosis and loss of strength and flexibility. Increased risk for skeletal fractures is not always due to a calcium deficiency. The process of bone reformation does not stop with age. Age-related declines of estrogen and testosterone production cause bone loss. After age 35 years, people generally experience a loss of bone mass.

A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse? * "While you are lifting weights, endorphins are released, creating increase in muscle mass, but if the muscles are not used they will atrophy." * "The muscle mass has decreased from the lack of calcium in the cells." * "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." * "Once you stop exercising, the contraction of the muscle does not regain its strength."

* "Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued." Muscles need to exercise to maintain function and strength. When a muscle repeatedly develops maximum or close to maximum tension over a long time, as in regular exercise with weights, the cross-sectional area of the muscle increases. This enlargement, known as hypertrophy, results from an increase in the size of individual muscle fibers without an increase in their number. Hypertrophy persists only if the exercise is continued.

A nurse performs a neurovascular assessment on a client 2 weeks after a wrist cast had been removed. The nurse documents in the client's chart that there is normal sensation in the ulnar nerve. What finger assessment test will the nurse perform on this client? * Prick the skin midway between the thumb and second finger. * Prick the distal fat pad on the small finger. * Prick the top or distal surface of the index finger. * Prick the top of the middle finger.

* Prick the distal fat pad on the small finger. See Table 40-2 in the text. The ulnar nerve runs near the ulnar bone and enters the palm of the hand. It branches to the fifth finger (small finger) and the ulnar side of the fourth finger.

The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care? * Keeping the affected knee flexed. * Applying warm packs to the insertion site. * Maintaining the client's NPO status. * Administering the prescribed analgesic.

* Administering the prescribed analgesic. After an arthroscopy, the client's entire leg is elevated without flexing the knee. A cold pack is placed over the bulky dressing covering the site where the arthroscope was inserted. A prescribed analgesic is administered as necessary. The client is allowed to resume his or her usual diet as tolerated.

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? * Keeping the casted arm warm by covering it with a light blanket * Avoiding handling the cast for 24 hours or until it is dry * Evaluating pedal and posterior tibial pulses every 2 hours * Assessing movement and sensation in the fingers of the right hand

* Assessing movement and sensation in the fingers of the right hand The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn? * From the prone to the supine position only, and the patient must keep the affected hip extended and abducted * 45 degrees onto the unoperated side if the affected hip is kept abducted * To any comfortable position as long as the affected leg is extended * To the operative side if the affected hip remains extended

* 45 degrees onto the unoperated side if the affected hip is kept abducted When the nurse turns the patient in bed to the unaffected side, it is important to keep the operative hip in abduction (movement away from the center or median line of the body). The patient should not be turned to the operative side, which could cause dislocation, unless specified by the surgeon. The patient's hip is never flexed more than 90 degrees

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint? * Between the vertebrae * In the fingers * At the hip * Skull at the temporal and occipital bones

* Skull at the temporal and occipital bones A synarthrodial joint is immovable and can be found at the suture line of the skull between the temporal and occipital bones. Amphiarthrodial joints are slightly moveable and are found between the vertebrae. The finger and hip joints are examples of diarthrodial joints that are freely moveable.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? * Apply the traction straps snugly. * Assess the client's level of consciousness. * Remove the traction at least every 8 hours. * Teach the client how to prevent problems caused by immobility.

* Teach the client how to prevent problems caused by immobility. By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding? * Tear in the joint capsule * Fracture of the clavicle * Decreased bone density * Injury to the radial nerve

* Tear in the joint capsule Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. X-rays are used to diagnose bone fractures. Bone densitometry is used to estimate bone mineral density. An electromyogram (EMG) provides information about the electrical potential of the muscles and nerves leading to them.

Which is not a guideline for avoiding hip dislocation after replacement surgery. * The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. * Keep the knees apart at all times. * Put a pillow between the legs when sleeping. * Never cross the legs when seated.

* The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. * Placing a trapeze on the bed * Ensuring that the weights are hanging freely * Assessing the client's alignment in the bed * Removing skeletal traction to turn and reposition the client * Frequently assessing pain level

* Placing a trapeze on the bed * Ensuring that the weights are hanging freely * Assessing the client's alignment in the bed * Frequently assessing pain level The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do? * Tell the client that this noncompliance will be reported to the health care provider. * Discuss the complications that the client may experience if there is lack of cooperation with the care plan. * Do nothing because the client has the ultimate right to determine the degree of participation. * Document the client's refusal to ambulate.

* Discuss the complications that the client may experience if there is lack of cooperation with the care plan. The nurse should discuss the care plan and its rationale with the client. Calling the health care provider to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, the nurse should first discuss the care plan with the client.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? * Explain that the sensation being felt is normal and will not burn the client. * Remove the cast immediately, notifying the physician. * Administer antianxiety and pain medication. * Call for assistance to hold the client in the required position until the cast has dried.

* Explain that the sensation being felt is normal and will not burn the client. A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? * It provides active range of motion. * It promotes healing by increasing circulation and movement of the knee joint. * It promotes healing by immobilizing the knee joint. * It prevents infection and controls edema and bleeding.

* It promotes healing by increasing circulation and movement of the knee joint. A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.

A nurse is caring for a client who recently underwent a total hip replacement. What is the best action by the nurse for client care? * Ease the client onto a low toilet seat. * Allow the client's legs to be crossed at the knees when out of bed. * Use soft chairs when the client is sitting out of bed. * Limit hip flexion of the client's hip when the client sits up.

* Limit hip flexion of the client's hip when the client sits up. The nurse should instruct the client to limit hip flexion to 90 degrees when sitting. The nurse should supply an elevated toilet seat so that the client can sit without having to flex the hip more than 90 degrees. The nurse should instruct the client not to cross legs to avoid dislodging or dislocating the prosthesis. The nurse should caution the client against sitting in chairs that are too low or too soft; these chairs increase flexion, which is undesirable.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? * Monitoring the client for skin breakdown * Maintaining traction continuously to ensure its effectiveness * Supporting the traction weights with a chair or table to prevent accidental slippage * Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use

* Maintaining traction continuously to ensure its effectiveness The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest.

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? * Apply Buck's traction. * Notify the health care provider. * Externally rotate the extremity. * Bend the knee and rotate the knee internally.

* Notify the health care provider. If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest.

A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant? * Osteoblast formation will stop during the time needed for fracture healing. * Red blood cell production will be temporarily reduced because of the damage to the medullar cavity. * Potential growth problems may result from damage to the epiphyseal plate. * Periosteal blood vessels will be damaged, thus compromising blood flow to the compact bone.

* Potential growth problems may result from damage to the epiphyseal plate. The distal and proximal ends of a long bone are called epiphyses, which are composed of cancellous bone. The epiphyseal plate, which separates the epiphyses from the diaphysis, is the center for longitudinal growth in children. Its damage can be a critical indictor of potential growth problems if fractured. All other choices are wrong.

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? * A dull, deep, boring ache * Sharp and piercing * Similar to "muscle cramps" * Sore and aching

* Sharp and piercing The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the patient to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place.

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone? * Growth hormone * Vitamin D * Sex hormones * Calcitonin

* Calcitonin Calcitonin, secreted by the thyroid gland in response to elevated blood calcium concentration, inhibits bone reabsorption and increases the deposit of calcium in the bone. The other answers do not apply.

Which statement is accurate regarding care of a plaster cast? * The cast must be covered with a blanket to keep it moist during the first 24 hours. * The cast will dry in about 12 hours. * The cast can be dented while it is damp. * A dry plaster cast is dull and gray.

* The cast can be dented while it is damp. The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.