Final Exam Semester 2 Neuromuscular

The client with osteomalacia is depressed and anxious about the outcome of the illness. The most beneficial nursing response would be "Cortisone and active weight-bearing exercises will reduce the symptoms." "Don't worry; some adjustments in lifestyle can offer a normal life expectancy." "I can see you are upset. Did the doctor tell you this is easy to treat and control?" "Treatment with high-dose calcium supplements will correct the disorder."

"I can see you are upset. Did the doctor tell you this is easy to treat and control?" Interventions for clients with osteomalacia include daily vitamin D until signs of healing occur, at which time a daily low maintenance dose of vitamin D and adequate intake of calcium, phosphorus, and protein should be ensured. This answer not only gives the client correct information but shows the nurse communicating in a therapeutic manner.

A client who has undergone repair of the anterior cruciate ligament complains that the use of the continuous passive motion (CPM) machine causes pain and asks how long he is expected to use the machine. The nurse's most appropriate response would be "I will give you pain medication to make you comfortable, since you should use the machine at least 8 hours out of 24." "Try using the machine for 1 hour of every 4 hours, and see if that schedule re-duces your discomfort." "You do not have to use the machine for the next few days. You can resume after the pain subsides." "You should use the machine continuously. I will ask the physician to increase your dose of analgesics."

"I will give you pain medication to make you comfortable, since you should use the machine at least 8 hours out of 24." The CPM machine should be used at least 8 hours a day or until full range of motion is achieved.

The nurse is caring for an older adult client who has had leg amputation surgery the previous day. During the admission assessment, the client tells the nurse, "I don't want to live with only one leg, so I should have died during the surgery." Which is the nurse's best response? "Your vital signs are good, and you are doing just fine right now." "Your children are waiting outside and do not want to lose their parent." "Remember that you are still the same person inside, with a missing body part." "You will be able to do some of the same things as before you became disabled."

"Remember that you are still the same person inside, with a missing body part." The client feels like less of a person following the amputation, so the nurse should remind the client that he is still the same person inside. The nurse should not try to make the client feel guilty by saying that his children do not want to lose their parent. The nurse should not ignore the client's feelings by focusing on vital signs. The nurse should not refer to the client as being "disabled."

An elderly client is in the emergency department after suffering a fracture. The daughter is distraught and says "This will never heal in my mother; she's so old!" The most appropriate re-sponse by the nurse is "Actually fractures in infants take the longest to heal." "Do you think your mother has a bone disease, like osteoporosis?" "Unless there are other problems, elderly bones heal as quickly as in adults." "You're right; fractures take longer to heal in the elderly."

"Unless there are other problems, elderly bones heal as quickly as in adults." A fracture in an infant may heal in only 4-6 weeks, but the time increases somewhat with age. However, fractures in the elderly heal at the same speed as in other adults, unless a disease like osteoporosis is present. Other favorable and unfavorable factors that affect bone healing are summarized in Box 27-1.

An adult client who has been diagnosed with osteomyelitis is beginning antibiotic therapy. Which information will the nurse include in the client's teaching plan? "Surgical intervention will be needed." "You will need to be on isolation." "You will need to remain in the hospital for the duration of the treatment." "You can receive antibiotic treatment at home."

"You can receive antibiotic treatment at home." Typically, osteomyelitis requires treatment with IV antibiotics for several weeks. The client will leave the hospital with a central IV catheter for home infusion of the medication. Oral antibiotics for several more weeks usually follow the IV regimen. Surgical intervention is reserved for clients with chronic osteomyelitis. Contact isolation is only needed if the infection can be transmitted to another client.

After application of a synthetic cast, the client asks the nurse how long he must wait until the cast is completely dry and he can tolerate weight-bearing. The nurse's most appropriate response is 10 minutes. 20 minutes. 30 minutes. 60 minutes.

30 minutes Synthetic casts are dry to the touch in a few minutes but require about 30 minutes to set and allow weight-bearing.

Which client with a fracture will the nurse prioritize to intervene for first? A client who is complaining of pain of 6 on a scale of 1 to 10 A client who complains of numbness in their extremity A client whose affected extremity is red A client who complains of being cold

A client who complains of numbness in their extremity The client with numbness of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention. *WAS ON TEST

For which client will the nurse provide interventions to prevent infection? A client with a fractured clavicle A client with an open fracture of the tibia A client with a simple fracture of the wrist A client with a compression fracture of a vertebra

A client with an open fracture of the tibia Bone infection or osteomyelitis is most common in clients with an open fracture, because skin integrity is lost and organisms gain access easily. The nurse will remind all those who come into contact with the client to use good handwashing and will observe the wound daily for signs of infection. *WAS ON TEST

An emergency department nurse triages a client with diabetes mellitus who has fractured her arm. Which action should the nurse take first? a. Remove the medical alert bracelet from the fractured arm. b. Immobilize the arm by splinting the fractured site. c. Place the client in a supine position with a warm blanket. d. Cover any open areas with a sterile dressing.

A ~ A clients medical alert bracelet should be removed from the fractured arm before the affected extremity swells. Immobilization, positioning, and dressing should occur after the bracelet is removed.

A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left humerus. Which action should the nurse take next? a. Immobilize the left arm. b. Assess the clients distal pulse. c. Monitor for signs of infection. d. Administer prescribed steroids.

A ~ A grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone fragments. Because bone fragments may be present, the nurse should immobilize the clients arm and tell the client not to move the arm. The grating sound does not indicate circulation impairment or infection. Steroids would not be indicated.

A home health nurse assesses a client with diabetes who has a new cast on the arm. The nurse notes the clients fingers are pale, cool, and slightly swollen. Which action should the nurse take first? a. Raise the arm above the level of the heart. b. Encourage range of motion. c. Apply heat to the affected hand. d. Bivalve the cast to decrease pressure.

A ~ Arm casts can impair circulation when the arm is in the dependent position. The nurse should immediately elevate the arm above the level of the heart, ensuring that the hand is above the elbow, and should re-assess the extremity in 15 minutes. If the fingers are warmer and less swollen, the cast is not too tight and adjustments do not need to be made, but a sling should be worn when the client is upright. Encouraging range of motion would not assist the client as much as elevating the arm. Heat would cause increased edema and should not be used. If the cast is confirmed to be too tight, it could be bivalved.

After teaching a client who is recovering from a vertebroplasty, the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. I can drive myself home after the procedure. b. I will monitor the puncture site for signs of infection. c. I can start walking tomorrow and increase my activity slowly. d. I will remove the dressing the day after discharge.

A ~ Before discharge, a client who has a vertebroplasty should be taught to avoid driving or operating machinery for the first 24 hours. The client should monitor the puncture site for signs of infection. Usual activities can resume slowly, including walking and slowly increasing activity over the next few days. The client should keep the dressing dry and remove it the next day.

A nurse reviews prescriptions for an 82-year-old client with a fractured left hip. Which prescription should alert the nurse to contact the provider and express concerns for client safety? a. Meperidine (Demerol) 50 mg IV every 4 hours b. Patient-controlled analgesia (PCA) with morphine sulfate c. Percocet 2 tablets orally every 6 hours PRN for pain d. Ibuprofen elixir every 8 hours for first 2 days

A ~ Meperidine (Demerol) should not be used for older adults because it has toxic metabolites that can cause seizures. The nurse should question this prescription. The other prescriptions are appropriate for this clients pain management.

A nurse cares for a client placed in skeletal traction. The client asks, What is the primary purpose of this type of traction? How should the nurse respond? a. Skeletal traction will assist in realigning your fractured bone. b. This treatment will prevent future complications and back pain. c. Traction decreases muscle spasms that occur with a fracture. d. This type of traction minimizes damage as a result of fracture treatment.

A ~ Skeletal traction pins or screws are surgically inserted into the bone to aid in bone alignment. As a last resort, traction can be used to relieve pain, decrease muscle spasm, and prevent or correct deformity and tissue damage. These are not primary purposes of skeletal traction. *WAS ON TEST

A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The clients vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first? a. Administer oxygen via nasal cannula. b. Re-position to a high-Fowlers position. c. Increase the intravenous flow rate. d. Assess response to pain medications.

A ~ The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Sitting the client in a high-Fowlers position will not decrease hypoxia related to a fat embolism. The IV rate is not related. Pain medication most likely would not cause the client to be restless.

An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg. Which action should the nurse take first? a. Assess the pedal pulses. b. Apply oxygen by nasal cannula. c. Increase the IV flow rate. d. Loosen the traction.

A ~ These symptoms represent early warning signs of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible. Vital signs need to be obtained to determine if oxygen and intravenous fluids are necessary. Traction, if implemented, should never be loosened without a providers prescription.

A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is administered, the client reports pain in the site of the fracture. Which actions should the nurse take? (Select all that apply.) a. Administer additional opioids as prescribed. b. Elevate the extremity on pillows. c. Apply ice to the fracture site. d. Place a heating pad at the site of the injury. e. Keep the extremity in a dependent position.

A, B, C ~ The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in decreasing pain. Administration of an additional opioid within the dosage guidelines may be ordered. Heat will increase edema and may increase pain. Dependent positioning will also increase edema.

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery for a right hip fracture. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Elevate heels off the bed with a pillow. b. Ambulate the client on the first postoperative day. c. Push the clients patient-controlled analgesia button. d. Re-position the client every 2 hours. e. Use pillows to encourage subluxation of the hip.

A, B, D ~ Postoperative care for a client who has ORIF of the hip includes elevating the clients heels off the bed and re-positioning every 2 hours to prevent pressure and skin breakdown. It also includes ambulating the client on the first postoperative day, and using pillows or an abduction pillow to prevent subluxation of the hip. The nurse should teach the client to use the patient-controlled analgesia pump, but the nurse should never push the button for the client.

A nurse teaches a client with a fractured tibia about external fixation. Which advantages of external fixation for the immobilization of fractures should the nurse share with the client? (Select all that apply.) a. It leads to minimal blood loss. b. It allows for early ambulation. c. It decreases the risk of infection. d. It increases blood supply to tissues. e. It promotes healing.

A, B, E ~ External fixation is a system in which pins or wires are inserted through the skin and bone and then connected to a ridged external frame. With external fixation, blood loss is less than with internal fixation, but the risk for infection is much higher. The device allows early ambulation and exercise, maintains alignment, stabilizes the fracture site, and promotes healing. The device does not increase blood supply to the tissues. The nurse should assess for distal circulation, movement, and sensation, which can be disturbed by fracture injuries and treatments. *WAS ON TEST

A nurse assesses a client with a cast for potential compartment syndrome. Which clinical manifestations are correctly paired with the physiologic changes of compartment syndrome? (Select all that apply.) a. Edema ~ Increased capillary permeability b. Pallor ~ Increased blood blow to the area c. Unequal pulses ~ Increased production of lactic acid d. Cyanosis ~ Anaerobic metabolism e. Tingling ~ A release of histamine

A, C, D ~ Clinical manifestations of compartment syndrome are caused by several physiologic changes. Edema is caused by increased capillary permeability, release of histamine, decreased tissue perfusion, and vasodilation. Unequal pulses are caused by an increased production of lactic acid. Cyanosis is caused by anaerobic metabolism. Pallor is caused by decreased oxygen to tissues, and tingling is caused by increased tissue pressure.

A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. The device has been custom made specifically for you. b. Your prosthetic is good for work but not for exercising. c. A prosthetist will clean your inserts for you each month. d. Make sure that you wear the correct liners with your prosthetic. e. I have scheduled a follow-up appointment for you.

A, D, E ~ A client with a new prosthetic should be taught that the prosthetic device is custom made for the client, taking into account the clients level of amputation, lifestyle (including exercise preferences), and occupation. In collaboration with a prosthetist, the client should be taught proper techniques for cleansing the sockets and inserts, wearing the correct liners, and assessing shoe wear. Follow-up care and appointments are important for ongoing assessment.

The client who has had an above-knee amputation of the right leg complains of pain in the right foot. Which is the nurse's priority intervention? Administering IV morphine Administering 650 mg of acetaminophen Administering IV calcitonin Administering 600 mg of ibuprofen

Administering IV calcitonin The client is experiencing phantom limb pain. IV infusions of calcitonin during the week after amputation can reduce phantom limb pain. The elastic bandage must be worn night and day and taken off only for bathing. The other medications will not assist in decreasing the client's com-plaints of pain.

When providing care for a client who has had a débridement for osteomyelitis, which intervention is most important for the nurse to implement? Assessing the white blood cell count Assessing circulation in the distal extremities Administering pain medication Monitoring temperature

Assessing circulation in the distal extremities All the interventions would be done during the care of this client. However, after resection of infected bone, neurovascular assessments must be done frequently because the client experiences increased swelling, which could cause neurovascular compromise

The nurse is caring for a client with an external fixator in place on their leg. Which is the nurse's priority intervention?a. b. c. d. Assessing for alteration in skin integrity Assessing for impaired motor action Assessing for acute pain Assessing for signs of infection

Assessing for signs of infection As long as the external fixator is in place, there is a direct connection between the external envi-ronment and the bone. The risk for infection is high. There is an expected alteration in skin in-tegrity and decrease in movement. Acute pain would not be expected, but the client should be medicated for pain if necessary.

The nurse is rounding on assigned orthopedic clients. The client with which type of fracture requires immediate interventions to prevent infection? a. Fractured clavicle b. Open fracture of the tibia c. Simple fracture of the wrist d. Compression fracture of a vertebra

B ~ Bone infection or osteomyelitis is most common in clients with an open fracture because skin integrity is lost and organisms gain access easily. The nurse will remind all those who come into contact with the client to use good handwashing and will observe the wound daily for signs of infection. The other clients do not have extra risk factors for infection.

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention should the nurse include in this clients plan of care? a. Place pillows between the clients knees. b. Encourage range-of-motion exercises. c. Administer prophylactic antibiotics. d. Implement strict bedrest in a supine position.

B ~ Clients with a below-the-knee amputation should complete range-of-motion exercises to prevent flexion contractions and prepare for a prosthesis. A pillow may be used under the limb as support. Clients recovering from this type of amputation are at low risk for infection and should not be prescribed prophylactic antibiotics. The client should be encouraged to re-position, move, and exercise frequently, and therefore should not be restricted to bedrest. *WAS ON TEST

A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action? a. Pain of 4 on a scale of 0 to 10 b. Numbness in the extremity c. Swollen extremity at the injury site d. Feeling cold while lying in bed

B ~ The client with numbness and/or tingling of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention because of possible decreased circulation. Moderate pain and swelling is an expected assessment after a fracture. These findings can be treated with comfort measures. Being cold can be treated with additional blankets or by increasing the temperature of the room.

A nurse cares for a client who had a long-leg cast applied last week. The client states, "I cannot seem to catch my breath and I feel a bit light-headed." Which action should the nurse take next? a. Auscultate the clients lung fields anteriorly and posteriorly. b. Administer oxygen to keep saturations greater than 92%. c. Check the clients blood glucose level. d. Ask the client to take deep breaths.

B ~ The clients symptoms are consistent with the development of pulmonary embolism caused by leg immobility in the long cast. The nurse should check the clients pulse oximetry reading and provide oxygen to keep saturations greater than 92%. Auscultating lung fields, checking blood glucose level, or deep breathing will not assist this client.

A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to manage this clients pain? a. Meperidine (Demerol) injections every 4 hours around the clock b. Patient-controlled analgesia (PCA) pump with morphine c. Ibuprofen (Motrin) 600 mg orally every 4 hours PRN for pain d. Morphine 4 mg intravenous push every 2 hours PRN for pain

B ~ The older adult client should never be treated with meperidine because toxic metabolites can cause seizures. The client should be managed with a PCA pump to control pain best. Motrin most likely would not provide complete pain relief with multiple fractures. IV morphine PRN would not control pain as well as a pump that the client can control.

An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the nurse monitor to prevent a complication of this injury? (Select all that apply.) a. Temperature b. Urinary output c. Blood pressure d. Pupil reaction e. Skin color

B, C, E ~ With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse monitors the clients heart rate, blood pressure, urine output, skin color, and level of consciousness frequently to determine whether shock is manifesting. It is important to monitor the urine for blood to assess whether the urinary system has been damaged with the pelvic fracture. Changes in temperature and pupil reactions are not directly associated with hypovolemic shock. Temperature changes are usually associated with hypo- or hyperthermia or infectious processes. Pupillary changes occur with brain injuries, bleeds, or neurovascular accidents.

An older woman is admitted after falling down the stairs. She was immobile for 3 days before being found by a neighbor. Which assessment findings require immediate intervention? (Select all that apply.) Blood pressure 80/50 mm Hg Potassium 6.0 mEq/L Dark brown urine Heart rate 90 beats/min Urine output 50 mL/hr

Blood pressure 80/50 mm Hg Potassium 6.0 mEq/L Dark brown urine A low blood pressure could indicate hypovolemia, which occurs with crush syndrome. Hyper-kalemia and dark brown urine also may indicate crush syndrome. A heart rate of 90 beats/min is within normal limits, and a urine output of 50 mL/hr also is within normal.

A nurse assesses a client with a rotator cuff injury. Which finding should the nurse expect to assess? a. Inability to maintain adduction of the affected arm for more than 30 seconds b. Shoulder pain that is relieved with overhead stretches and at night c. Inability to initiate or maintain abduction of the affected arm at the shoulder d. Referred pain to the shoulder and arm opposite the affected shoulder

C ~ Clients with a rotator cuff tear are unable to initiate or maintain abduction of the affected arm at the shoulder. This is known as the drop arm test. The client should not have difficulty with adduction of the arm, nor experience referred pain to the opposite shoulder. Pain is usually more intense at night and with overhead activities.

A nurse cares for an older adult client who is recovering from a leg amputation surgery. The client states, "I don't want to live with only one leg. I should have died during the surgery." How should the nurse respond? a. Your vital signs are good, and you are doing just fine right now. b. Your children are waiting outside. Do you want them to grow up without a father? c. This is a big change for you. What support system do you have to help you cope? d. You will be able to do some of the same things as before you became disabled.

C ~ The client feels like less of a person following the amputation. The nurse should help the client to identify coping mechanisms that have worked in the past and current support systems to assist the client with coping. The nurse should not ignore the clients feelings by focusing on vital signs. The nurse should not try to make the client feel guilty by alluding to family members. The nurse should not refer to the client as being disabled as this labels the client and may fuel the clients poor body image.

A nurse cares for a client recovering from an above-the-knee amputation of the right leg. The client reports pain in the right foot. Which prescribed medication should the nurse administer first? a. Intravenous morphine b. Oral acetaminophen c. Intravenous calcitonin d. Oral ibuprofen

C ~ The client is experiencing phantom limb pain, which usually manifests as intense burning, crushing, or cramping. IV infusions of calcitonin during the week after amputation can reduce phantom limb pain. Opioid analgesics such as morphine are not as effective for phantom limb pain as they are for residual limb pain. Oral acetaminophen and ibuprofen are not used in treating phantom limb pain.

A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include when delegating care for this client to an unlicensed assistive personnel (UAP)? a. Assess distal pulses for potential compartment syndrome. b. Turn the client every 3 to 4 hours to promote cast drying. c. Use a cloth-covered pillow to elevate the clients leg. d. Handle the cast with your fingertips to prevent indentations.

C ~ When delegating care to a UAP for a client with a wet plaster cast, the UAP should be directed to ensure that the extremity is elevated on a cloth pillow instead of a plastic pillow to promote drying. The client should be assessed for impaired arterial circulation, a complication of compartment syndrome; however, the nurse should not delegate assessments to a UAP. The client should be turned every 1 to 2 hours to allow air to circulate and dry all parts of the cast. Providers should handle the cast with the palms of the hands to prevent indentations.

The nurse is caring for a client with a pelvic fracture. Which is the nurses priority action to prevent complications? a. Monitor temperature daily. b. Insert a urethral catheter. c. Monitor blood pressure frequently. d. Turn the client every 2 hours.

C ~ With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse monitors the clients vital signs, skin color, and level of consciousness frequently to determine whether shock is occurring. The client may need a urethral catheter inserted at some point in time if voiding is a problem. It is important to monitor the urine for blood to assess whether the urinary system has been damaged with the pelvic fracture. The client should not be turned on his or her side unless the fracture is stabilized.

Which nursing intervention is most effective in preventing the transfer of an organism from the wound of a client with osteomyelitis to other clients? Contact precautions Restriction of visitors Irrigating the wound as needed Leaving the wound open to air

Contact precautions In the presence of wound drainage, contact precautions may be used to prevent the spread of the offending organism to other clients and health care personnel. Restricting visitors does not pre-vent transfer. One visitor could possibly transfer the bacteria to another surface. Irrigating the wound would not destroy the organism. The wound should be covered to prevent transfer of the organism.

While caring for a client who has chronic osteomyelitis and wound drainage, which intervention is most important for the nurse to implement? Covering the wound with a dressing Teaching about the cause of the infection Monitoring the erythrocyte sedimentation rate (ESR) Preparing the client for hyperbaric oxygenation

Covering the wound with a dressing If an open wound is present in the hospital or long-term care setting, the client's treatment usu-ally includes standard precautions for limiting infection by covering the wound. Teaching about the cause of the infection could prevent further episodes of the infection, but does not take care of the current problem. The ESR rate just tells the health care provider that an inflammatory process is going on. Hyperbaric oxygenation is only used for clients with chronic, unremitting osteomyelitis. Covering the wound would be the most important step for the nurse to take first.

The nurse notes that the skin around the client's skeletal traction pin site is swollen, red, and crusty, with dried drainage. Which is the nurse's priority intervention? Decreasing the traction weight Applying a new dressing Cleansing the area, scrubbing off the crusty areas Culturing the drainage

Culturing the drainage These clinical manifestations indicate inflammation and possible infection. Infected pin sites can lead to osteomyelitis and should be treated immediately. The nurse should obtain a culture and assess vital signs. The health care provider should also be notified. *WAS ON TEST

A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at highest risk for developing deep vein thrombosis? a. An 18-year-old male athlete with a fractured clavicle b. A 36-year old female with type 2 diabetes and fractured ribs c. A 55-year-old woman prescribed aspirin for rheumatoid arthritis d. A 74-year-old man who smokes and has a fractured pelvis

D ~ Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis, and heart disease. The other clients do not have risk factors for DVT.

The nurse is caring for several clients with fractures. Which client does the nurse consider at highest risk for developing deep vein thrombosis? a. Middle-aged woman with a fractured ankle taking aspirin for rheumatoid arthritis b. Young adult male athlete with a fractured clavicle c. Female with type 2 diabetes with fractured ribs d. Older man who smokes and has a fractured pelvis

D ~ Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis, and heart disease. The other clients do not have risk factors for DVT.

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, The cast is loose enough to slide off. How should the nurse respond? a. Keep your arm above the level of your heart. b. As your muscles atrophy, the cast is expected to loosen. c. I will wrap a bandage around the cast to prevent it from slipping. d. You need a new cast now that the swelling is decreased.

D ~ Often the surrounding soft tissues may be swollen considerably when the cast is initially applied. After the swelling has resolved, if the cast is loose enough to permit two or more fingers between the cast and the clients skin, the cast needs to be replaced. Elevating the arm will not solve the problem, and the clients muscles should not atrophy while in a cast for 6 weeks or less. An elastic bandage will not prevent slippage of the cast. *WAS ON TEST

A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may impede healing of the fracture? a. Sedentary lifestyle b. A 30 pack-year smoking history c. Prescribed oral contraceptives d. Paget's disease

D ~ Paget's disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing. The other factors do not impede healing but may cause other health risks.

A phone triage nurse speaks with a client who has an arm cast. The client states, "My arm feels really tight and puffy." How should the nurse respond? a. Elevate your arm on two pillows and get ice to apply to the cast. b. Continue to take ibuprofen (Motrin) until the swelling subsides. c. This is normal. A new cast will often feel a little tight for the first few days. d. Please come to the clinic today to have your arm checked by the provider.

D ~ Puffy fingers and a feeling of tightness from the cast may indicate the development of compartment syndrome. The client should come to the clinic that day to be evaluated by the provider because delay of treatment can cause permanent damage to the extremity. Ice and ibuprofen are acceptable actions, but checking the cast is the priority because it ensures client safety. The nurse should not reassure the client that this is normal.

After teaching a client with a fractured humerus, the nurse assesses the clients understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture? a. Baked fish with orange juice and a vitamin D supplement b. Bacon, lettuce, and tomato sandwich with a vitamin B supplement c. Vegetable lasagna with a green salad and a vitamin A supplement d. Roast beef with low-fat milk and a vitamin C supplement

D ~ The client with a healing fracture needs supplements of vitamins B and C and a high-protein, high-calorie diet. Milk for calcium supplementation and vitamin C supplementation are appropriate. Meat would increase protein in the diet that is necessary for bone healing. Fish, a sandwich, and vegetable lasagna would provide less protein.

A nurse is caring for a client who is recovering from an above-the-knee amputation. The client reports pain in the limb that was removed. How should the nurse respond? a. The pain you are feeling does not actually exist. b. This type of pain is common and will eventually go away. c. Would you like to learn how to use imagery to minimize your pain?d. How would you describe the pain that you are feeling?

D ~ The nurse should ask the client to rate the pain on a scale of 0 to 10 and describe how the pain feels. Although phantom limb pain is common, the nurse should not minimize the pain that the client is experiencing by stating that it does not exist or will eventually go away. Antiepileptic drugs and antispasmodics are used to treat neurologic pain and muscle spasms after amputation. Although imagery may assist the client, the nurse must assess the clients pain before determining the best action.

A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury? a. Hypertension b. Constipation c. Infection d. Hematuria

D ~ The pelvis is very vascular and close to major organs. Injury to the pelvis can cause integral damage that may manifest as blood in the urine (hematuria) or stool. The nurse should also assess for signs of hemorrhage and hypovolemic shock, which include hypotension and tachycardia. Constipation and infection are not complications of a pelvic fracture.

A nurse cares for a client in skeletal traction. The nurse notes that the skin around the clients pin sites is swollen, red, and crusty with dried drainage. Which action should the nurse take next? a. Request a prescription to decrease the traction weight. b. Apply an antibiotic ointment and a clean dressing. c. Cleanse the area, scrubbing off the crusty areas. d. Obtain a prescription to culture the drainage.

D ~ These clinical manifestations indicate inflammation and possible infection. Infected pin sites can lead to osteomyelitis and should be treated immediately. The nurse should obtain a culture and assess vital signs. The provider should be notified. By decreasing the traction weight, applying a new dressing, or cleansing the area, the infection cannot be significantly treated. *WAS ON TEST

A nurse plans care for a client who is prescribed skeletal traction. Which intervention should the nurse include in this plan of care to decrease the clients risk for infection? a. Wash the traction lines and sockets once a day. b. Release traction tension for 30 minutes twice a day. c. Do not place the traction weights on the floor. d. Schedule for pin care to be provided every shift.

D ~ To decrease the risk for infection in a client with skeletal traction of external fixation, the nurse should provide routine pin care and assess manifestations of infection at the pin sites every shift. The traction lines and sockets are external and do not come in contact with the clients skin; these do not need to be washed. Although traction weights should not be removed or released for any period of time without a prescription, or placed on the floor, this does not decrease the risk for infection.

A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating hygiene care for this client? a. Remove the traction when re-positioning the client. b. Inspect the clients skin when performing a bed bath. c. Provide pin care by using alcohol wipes to clean the sites. d. Ensure that the weights remain freely hanging at all times.

D ~ Traction weights should be freely hanging at all times. They should not be lifted manually or allowed to rest on the floor. The client should remain in traction during hygiene activities. The nurse should assess the clients skin and provide pin and wound care for a client who is in traction; this should not be delegated to the UAP.

A home care nurse is visiting a diabetic client with a new cast on the arm. On assessment, the nurse finds the client's fingers to be pale, cool, and slightly swollen. Which is the nurse's first intervention? Elevating the arm above the level of the heart Encouraging active and passive range of motion Applying heat to the affected hand Applying a bivalve the cast

Elevating the arm above the level of the heart Arm casts can impinge on circulation when the arm is in the dependent position. The nurse should elevate the arm above the level of the heart, ensuring that the hand is above the elbow, and reassess the extremity in 15 minutes. If the fingers are warmer and less swollen, the cast is not too tight and adjustments do not need to be made. Heat would cause more edema. Encourag-ing range of motion would not assist the client as much as elevating the arm. *WAS ON TEST

A client with a new fracture is complaining of pain. An opioid pain medication was administered 20 minutes ago. Which is the nurse's best intervention? (Select all that apply.) Administration of additional opioids Elevation of the extremity Application of ice Application of heat Keep the extremity in a dependent position

Elevation of the extremity Application of ice Administration of additional opioids The client with a new fracture likely has edema and elevating the extremity and applying ice will probably help in decreasing pain. Heat will increase edema and may increase pain. Dependent positioning will also increase edema. Administration of additional opioid within the dosage guidelines may be ordered.

A nurse is teaching a community group about bone health. Which of the following does the nurse recommend? (Select all that apply.) Engage in regular weight-bearing exercise. Get plenty of calcium and vitamin D in the diet If diagnosed with osteoporosis, take medications as prescribed Stop, or do not start, smoking. Swim or cycle to get aerobic activity without stressing joints.

Engage in regular weight-bearing exercise. Get plenty of calcium and vitamin D in the diet If diagnosed with osteoporosis, take medications as prescribed Stop, or do not start, smoking. All four options are good for bone health. Swimming/cycling provides muscle-strengthening exercises that may help prevent falls, but does not improve actual bone health.

The nurse admits a client diagnosed with Paget's disease. The nurse anticipates that the client will have which condition? Progressive muscle weakness Low body weight, thin build Enlarged, thick skull Bone infection

Enlarged, thick skull ~ An enlarged thick skull is a feature of Paget's disease. Progressive muscle weakness is a feature of muscular dystrophy. Low body weight with a thin build is a feature of osteoporosis. Bone infection is a feature of osteomyelitis.

A client who had a plaster cast applied to the right arm 3 weeks ago presents to the clinic with an erythrocyte sedimentation rate (ESR) that has increased from 15 to 25 mm/hr. Which is the nurse's best action? Repeating this laboratory assessment in 4 hours Having the cast reapplied Evaluating temperature and vital signs Obtaining blood for a platelet count

Evaluating temperature and vital signs A rise in the ESR during fracture healing suggests a bone infection. The nurse should collect all other assessment data that can assist in confirming this diagnosis and then notify the health care provider. *WAS ON TEST

A client who will not regain mobility has a case manager. What important topics does the nurse need to address in the client's long-term plan of care? (Select all that apply.) Informal caregivers Sexuality Recreation Vocational adjustments

Informal caregivers Sexuality Recreation Vocational adjustments The client who will not regain mobility must make many choices regarding a lifestyle that has been changed dramatically. All topics are important, but sexuality is often overlooked. Sexuality, recreation, and vocation are important components of quality of life. Informal caregivers can fill the gap between formal, provided services and client need.

Which nursing intervention helps to reduce the incidence of osteomyelitis for a client receiving hemodialysis? Instructing the client to brush teeth after every meal Maintaining clean dressing change technique for long-term IV catheters Using clean technique Using Standard Precautions

Instructing the client to brush teeth after every meal ~ Proper dental hygiene helps prevent periodontal infection, which can be a causative factor in osteomyelitis of the facial bone. Long-term IV catheters can be a primary source of infection, so dressing changes are done using sterile technique. All clients undergoing hemodialysis require careful sterile technique before needle cannulation. Standard Precautions should be used for all clients.

Which statement regarding a pathologic fracture is true? It results from minimal trauma to a bone weakened by disease. It occurs when a bone is broken and pierces the skin. It is a painless fracture of the hand digits. It is produced by a loading force on bones in the vertebral column.

It results from minimal trauma to a bone weakened by disease. A pathologic or spontaneous fracture results from minimal trauma to a bone weakened by dis-ease. Although it is true that abuse can contribute to such fractures, pathologic fractures occur even with careful handling of the client. *WAS ON TEST

A client has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon? Swelling of the right lower extremity 1+ to 2+ bilateral palpable pedal pulses Pain of right lower extremity on movement Paresis of right lower extremity

Paresis of right lower extremity ~ Paresis indicates a neurovascular compromise that must be reported immediately to the surgeon. The client undergoing a sequestrectomy experiences increased swelling after the procedure; the affected extremity should be elevated to increase venous return and thus control swelling. Palpable pulses of 1+ to 2+ bilaterally are a sign of adequate blood flow. Pain on movement of the right lower extremity is an expected finding.

Which gait-training technique is correct when teaching the client who has left leg weakness to walk with a cane? Placing the cane in the client's left hand and moving the cane forward, followed by moving the left leg one step forward Placing the cane in the client's left hand and moving the cane forward, followed by moving the right leg one step forward Placing the cane in the client's right hand and moving the cane forward, followed by moving the left leg one step forward Placing the cane in the client's right hand and moving the cane forward, followed by moving the right leg one step forward

Placing the cane in the client's right hand and moving the cane forward, followed by moving the left leg one step forward Placing the cane in the client's left hand does not provide sufficient stability. After the cane in the right hand (stronger side) is moved ahead, the cane and the stronger leg provide a stable base for movement of the weaker leg.

The nurse reviews the health history of a client with acute osteomyelitis. Which findings might have contributed to the diagnosis? (Select all that apply.) Recent dental work Urinary tract infection Pregnancy Hemodialysis Age Gastrointestinal parasites

Poor dental hygiene and gum infections, urinary tract infection, hemodialysis, and penetrating or nonpenetrating trauma can be the source of bacterial infection and, consequently, osteomyelitis.

The nurse is caring for a client 3 days after a below-knee amputation. Which is a priority intervention? Range-of-motion exercises Use of a very soft bed mattress Placement of a pillow between the client's knees Placing the client in a high Fowler's position

Range-of-motion exercises To prevent flexion contractures, the nurse instructs the client in range-of-motion exercises, pro-vides the client with a firm mattress, and places the client in a prone position every 4 hours for 20 to 30 minutes.

Which client with an above-knee amputation will the nurse treat first? The client who complains of phantom limb pain The client with a complaint of cramping The client who does not want to move the leg The client with regional pain syndrome

The client with regional pain syndrome The first priority in the management of clients with complex regional pain syndrome is pain relief. Pain can be of prolonged duration and will require pharmacologic and nonpharmacologic modalities for control. If this client is not treated immediately, it can trigger prolonged pain. The client with phantom limb pain would be the next priority. The client who does not want to move and the client with cramping would be treated last.

The nurse assesses a client with a below-knee amputation. Which finding requires immediate action? The skin flap is pink and warm to touch The skin flap is pale and cool to touch. The skin flap is dark pink and dry to the touch. The skin flap is pink and slightly moist.

The skin flap is pale and cool to touch. The skin flap should appear pink in a light-skinned person and not discolored in a darker skinned person. The area should feel warm, but not hot. Pale and cool skin could indicate inadequate blood flow to the area. The nurse would notify the health care provider. *WAS ON TEST

Which assessment finding relates most directly to a diagnosis of chronic osteomyelitis? Erythema of the affected area Swelling around the affected area Temperature higher than 101° F (38° C) Ulceration of the skin

Ulceration of the skin Fever, swelling, and erythema are far less common in chronic osteomyelitis, whereas ulceration, sinus tract formation, and localized pain are more characteristic.

Which finding does the nurse expect to observe in a client with suspected common chronic osteomyelitis? Erythema of the affected area Fever; temperature usually above 101° F (38° C) Ulceration of the skin Constant, localized, and pulsating bone pain

Ulceration of the skin ~ Ulceration of the skin is a feature of chronic osteomyelitis. Erythema of the affected area; fever; and constant, localized, pulsating bone pain are features of acute osteomyelitis.

The nurse is assessing a client with a body cast. Which assessment finding indicates a complication that needs to be reported to the health care provider? Blood pressure 130/85 mm Hg, temperature 99° F (37.2° C) Urinary output 40 mL/hr Redness around the edges of the cast Vomiting after meals

Vomiting after meals The client in a body cast is monitored for cast syndrome, which results in intestinal obstruction. Vomiting after meals may indicate this is occurring. Bowel sounds might be "normal" with this condition. *WAS ON TEST

The nurse assesses an 85-year-old client who has fallen and finds crepitus and swelling below the right elbow. The nurse interprets these findings as a closed fracture. a dislocation. manifestations of degenerative joint disease. normal variations related to age.

a closed fracture Crepitus and swelling are caused by motion in the middle of a bone or by bone fragments rub-bing together.

Two days after an accident in which a client sustained multiple injuries, including fractures, the client becomes confused and dyspneic and has a fever of 103.4° F. The nurse assesses that the client has developed a fat embolism. a pulmonary embolism. compartment syndrome. wound infection

a fat embolism Manifestations of confusion, hypoxia, and fever may indicate a fat embolism in a client with multiple fractures.

The assessment that would alert the nurse to the possibility of cast syndrome in a client with a spica cast is abdominal distention. diminished pulses in the foot "hot spot" felt on cast. musty, unpleasant odor to cast.

abdominal distention Abdominal distention and persistent vomiting result when the duodenum is compressed between major vessels and vertebral bodies because of constriction on the spica cast.

The nurse discussing treatment options with a client with Paget's disease will focus on the most frequent treatment, which is with bisphosphonates. calcium supplements. heat and cold application. splinting.

bisphosphonates The current therapies of choice for Paget's disease are potent bisphosphonates, such as pamidro-nate (Aredia), alendronate (Fosamax), and risedronate (Actone). NSAIDs are used to control pain. Heat therapy and splinting or bracing can also be tried.

When a 68-year-old client with a new full-leg cast exhibits bilateral pedal edema, the nurse would assess for compartment syndrome. cardiovascular disease. local leg trauma. thrombophlebitis.

cardiovascular disease Swelling after traumatic injury and reduction should peak within 24-48 hours, but mild swelling afterwards is expected. Moderate or severe swelling and discoloration are abnormal. With ab-normal unilateral pedal edema, the nurse should consider whether it is caused by further trauma, by compartment syndrome, or by thrombophlebitis. With bilateral pedal edema, the nurse should consider a cardiovascular origin.

A client with a new cast for his fractured ulna tells the nurse that he cannot feel his fingers. The nurse should initially check for capillary refill in the client's fingers. notify the physician immediately. reassure the client that this is normal remove the padding around the fingers to increase space.

check for capillary refill in the client's fingers. When casts prevent full neurovascular assessment, the nurse should observe for edema, capillary refill, and joint movement.

When implementing and delegating the application of heat or cold therapies to an unlicensed assistive personnel (UAP), the NURSE SHOULD (Select all that apply) allow the UAP to document the treatment and the client's response. clarify the order to ensure the task can be delegated. inspect the client's skin before the treatment instruct the UAP to wrap the heat or cold in a protective cover. reassess the client's skin after the treatment is done.

clarify the order to ensure the task can be delegated. inspect the client's skin before the treatment instruct the UAP to wrap the heat or cold in a protective cover. reassess the client's skin after the treatment is done. The nurse is responsible for assessments before and after the treatment and for documenting the client's response to a treatment. The nurse should also ensure that the task is appropriate for del-egation. For further information, see the Management and Delegation feature.

To evaluate a client's swollen right knee further, the nurse should first compare the right knee to the left knee. palpate for crepitus. put the knee through range of motion. test muscle strength.

compare the right knee to the left knee The initial approach to assessing the joints is to inspect them and compare findings bilaterally.

On admission assessment of a client with Paget's disease, the nurse would anticipate the client to complain of continuous bone pain. fever in the afternoon. pain on ambulation. swelling at site of deformity.

continuous bone pain Paget's disease is defined as a disorder of bone architecture characterized by an initial phase of increased bone tissue breakdown by osteoclasts, followed by excessive abnormal bone formation by osteoblasts. In clients with symptomatic Paget's disease, the most common presenting com-plaints include bone pain, skeletal deformity, changes in skin temperature, pathologic fractures through diseased bone, and manifestations related to nerve compression.

The nurse explains that the rationale for LMW (low-molecular-weight) heparin therapy after open reduction of a fractured femur is to decrease hematoma at the fracture site. decreases the threat of thrombus. increase blood supply at the fracture site. increase platelet formation.

decreases the threat of thrombus. Prevention of DVT is a primary goal for the client after ORIF. Pharmacologic agents such as LMW heparin or warfarin are used to prevent DVT.

The nurse teaching a class on osteoarthritis (OA) stresses that this disorder is best described as degeneration of articular cartilage in synovial joints. enzymatic breakdown of tissue in non-weight-bearing joints. joint destruction caused by an autoimmune process. overproduction of synovial fluid, resulting in joint destruction.

degeneration of articular cartilage in synovial joints. OA is a chronic joint disease characterized by degeneration and loss of articular cartilage cover-ing joint surfaces.

The nurse preparing a client for a dual-energy x-ray absorptiometry (DEXA) test explains that the purpose of this test is to measure presence of bone infection. degree of fracture healing. degree of bone loss. amount of joint deformity.

degree of bone loss A DEXA scan is considered the gold standard test for osteoporosis and measures bone loss.

A client with a left lower leg fracture in a cast for 3 days complains to the nurse that the pain medication does not relieve the pain any more. The priority action by the nurse would be to administer more analgesics. do a neurovascular assessment. elevate the cast on pillows. notify the physician.

do a neurovascular assessment. Unrelieved pain is a manifestation of compartment syndrome, which is a serious complication of fractures. Other manifestations include pain out of proportion to the injury and escalating pain. If unrecognized or untreated, the client can lose nerve and muscle function. Amputation may be necessary. The nurse should perform a complete neurovascular assessment and notify the physician.

The nurse notices a stain on a newly dried plaster cast over a client's fracture site. The most appropriate method to assess this finding is to assess for a "hot spot" over the stain. bivalve the cast and inspect the site. draw around the circumference with a pen and record. dry the stained area of the cast with a hair dryer.

draw around the circumference with a pen and record. A stain indicates wound drainage and should be carefully measured and documented. Drawing on the cast around the stain gives a baseline against which to compare extension of the stain.

The nursing intervention that would be most appropriate for a client who has entered the emergency department with a severe strain to the knee is apply a heat pack to reduce swelling. elevate the leg and apply ice. manipulate the knee in the full range of motion. teach the client exercises to speed healing.

elevate the leg and apply ice. Acute sprains require RICE: rest, ice, compression, and elevation for the first 24-48 hours to re-duce swelling. Heat may be used after that if desired. During healing, which takes 4-6 weeks, movement of the injured part should be minimized.

The nurse explains to a client with delayed union of a fractured femur that treatment for this complication is based on finding and correcting the cause. physical therapy using deep-heat modalities. realigning the fracture with traction. stabilizing the fracture with a metal plate

finding and correcting the cause. If the cause of the delayed union can be identified and corrected, the fracture usually heals.

The initial process of bone healing occurring at the fracture site in the first 72 hours is formation of a hematoma. formation of a provisional callus. proliferation of osteoblasts. reabsorption of the clot.

formation of a hematoma. Immediate formation of a hematoma at a fracture site occurs in 1 to 3 days.

A client is admitted to the emergency department with a complete fracture of the left radius. The nurse understands that with this type of fracture, the bone is displaced with fragments out of normal position. fractured only through one cortex of bone. fractured through the entire bone. fragmented with multiple pieces of bone.

fractured through the entire bone. In a complete fracture, the fracture line extends across the entire bone. the other options: displaced fracture; is an incomplete fracture (only through cortex of bone); and multiple fragments is a burst fracture.

In the application of a cast, the most appropriate nursing intervention is to allow excess casting material to dry on the skin before removal. carefully cut the stockinette to the exact length of the cast. gently support the extremity from underneath. flush plaster-laden water down the toilet rather than the sink.

gently support the extremity from underneath. The nurse assisting during a cast application should support the extremity from underneath using only the palms of the hands to avoid applying pressure to any one area. The nurse should ensure he/she does not press fingertips into the cast or allow it to rest on a hard surface because this can lead to indentations in the cast that can ultimately cause pressure and injury to the client. The stockinette is cut several inches longer than the anticipated cast. As soon as the cast is applied, excess plaster needs to be removed from the client's skin. The water used to wet the plaster should be dumped down a sink with a plaster trap. If no such sink is available, the water should be allowed to sit until the plaster settles at the bottom of the bucket; then the water can be drained off the top and the plaster scooped out into a trash bag.

The client who has osteoarthritis describes a grating sound in the hip. The nurse explains that this bothersome manifestation is related to bursa enlargement. joint irregularities. normal findings with age the presence of fluid.

joint irregularities Muscles should feel firm and smooth. A slight increase in mass, or hypertrophy, on the dominant side is normal.

Important self-care measures the nurse should teach to the client who is expected to be immobile in a wheelchair for a lengthy period of time include learning how to inspect all skin surfaces for friction or pressure. massaging bony prominences four times a day. sitting upright in a chair or wheelchair on the sacrum. using a gel wheelchair cushion to prevent pressure ulcers.

learning how to inspect all skin surfaces for friction or pressure. Clients, especially those with paraplegia and decreased sensation, need to learn to inspect all body surfaces for pressure or friction injuries, using a long-handled mirror if necessary. Clients should not massage bony prominences because this leaves them soft and vulnerable to pressure or shear. Clients should sit upright on their buttocks. Gel cushions should be avoided because they are expensive and heavy, they tend to break down, and they make moving the wheelchair more difficult.

A client complains of deep aching in his lower leg. The nurse completes an assessment focusing on other indicators of bone cancer. infection. muscle strain. neuromuscular impairment.

muscle strain Aches generally indicate a muscle strain, sharp pain may indicate a fracture or infection, and throbbing pain is often bone-related.

When counseling a client who is a strict vegan, the nurse would caution that this diet puts the client at risk for gout. osteoarthritis. osteomalacia. Paget's disease.

osteomalacia Osteomalacia mainly affects women, and it is endemic in Asia. The most common cause is mal-absorption or inadequate intake of vitamin D. Occasionally the disease can be found in strict vegetarians or post-gastrectomy clients.

In caring for a client in skeletal traction with a nursing diagnosis of Risk for Injury related to traction, the nurse should take special care to carefully inspect pin sites every other day to assess for pin site infection. encourage the client to assume a position of comfort to reduce the risk of pressure ulcers. knot ropes between the client and pulley to prevent weights from touching the floor. position weight ropes to ensure that the weights hang freely from pulleys.

position weight ropes to ensure that the weights hang freely from pulleys. The weights must hang freely to ensure traction. Knotting the ropes between the client and the pulley causes distraction. The client must be kept in anatomic alignment to prevent poor union. Pin sites should be checked more often than every other day.

A client with long-standing dementia is sent to the emergency department from the nursing home in which the client resides. The report from the nursing staff states that the client is complaining of vague pain in the buttocks but seems to be ambulating without problems. The family requested the transfer. The emergency department nurse would suspect an overprotective family. arthritis pain the client cannot articulate. possible hip fracture. worsening dementia.

possible hip fracture. Some clients with hip fractures have normal ambulation and complain only of vague pain in their buttocks, knees, thighs, groin, or back, especially if they also have dementia. Since hip fractures are one of the leading causes of morbidity and mortality in the elderly, the nurse must maintain a high index of suspicion for fractures, especially in a client who has dementia

The nurse counseling a client with osteoporosis identifies one of the medications that may have contributed to the condition as aspirin. colchicine. ibuprofen. prednisone.

prednisone Osteoporosis can also result from underlying medical conditions, such as hyperparathyroidism, thyrotoxicosis, anorexia nervosa, and Cushing's syndrome, and from long-term use of medications such as thyroid hormone, anticonvulsants, furosemide, and corticosteroids (e.g., prednisone).

After the cast on a client's fractured ulna has been changed to a bivalve cast, the nurse will alter the approach to care by omitting vascular checks to the extremity. preventing pinching the extremity between the two halves. taking off both halves of the cast when x-ray films are ordered. taping the halves together with paper tape

preventing pinching the extremity between the two halves. The bivalve cast allows for removal of the top half for wound care or x-ray films and for ease in assessing tissue perfusion or pressure areas. When the top half is reapplied, the nurse must take precaution not to pinch the client's extremity between the two halves as they are secured together with an Ace wrap.

The nurse explains to the client that in addition to approximating the bone fragments, traction also increases blood supply to the fracture site. increases speed of bone healing. reduces muscle spasm. reduces neuromuscular dysfunction.

reduces muscle spasm. The purpose of traction is to realign the fracture and decrease muscle spasm. It does not increase blood supply, speed healing, or reduce neuromuscular dysfunction.

As a beneficial exercise program, the nurse teaching a group of clients with osteoarthritis would suggest daily vigorous aerobic exercise followed by a warm shower or bath. minimal exercise several times daily, followed by rest periods. regular daily, low-impact exercise program. strength-building exercises with weights or resistance.

regular daily, low-impact exercise program. All clients benefit from a careful balance of rest and activity. Low-impact aerobic exercise, such as walking, does not cause further harm to damaged joints.

The principal concept that a nurse would include in a teaching plan regarding partial weight-bearing is that the client should bear as much weight as can be tolerated 30% to 50% of the time. prevent the affected limb from touching the floor; bear weight on the unaffected limb. rest the affected foot on the floor and place weight on it 30% to 50% of the time. use a walker or crutches and bear 30% to 50% of weight on the affected limb

rest the affected foot on the floor and place weight on it 30% to 50% of the time. Partial weight-bearing allows the client to bear 30% to 50% of weight on the affected limb.

The complaint of proximal thigh pain in an older client who has fallen leads the nurse to suspect a hip fracture and that the location of the fracture is intracapsular. intratrochanteric. subtrochanteric. the femoral neck.

subtrochanteric Subtrochanteric fractures typically produce pain over the proximal thigh. Groin pain is associated with a femoral neck fracture and pain over the trochanter with an intratrochanteric fracture.

The nurse assesses the client for common musculoskeletal clinical manifestations, which include (Select all that apply) swelling. stiffness. pain. limited range of motion. infection.

swelling stiffness pain limited range of motion infection Other common manifestations include deformity and sensory changes

The nurse assesses that the individual most susceptible to osteoporosis is the muscular 50-year-old man with diabetes. obese 50-year-old woman who is allergic to milk. thin 70-year-old man with gout. very slender 75-year-old woman.

very slender 75-year-old woman. Women have accelerated bone loss after menopause because of the loss of exogenous estrogen. Low body weight (<127 pounds) is an additional risk factor.