Geri and Musculoskeletal Nursing

Which assessment finding is suggestive of a torn meniscus in the client with a knee injury? a. A positive McMurray test b. A positive Blumberg's sign c. A positive Murphy's sign d. A positive Cullen's test

A A client with a torn meniscus may have a positive McMurray test. A clicking sound is heard or palpated when the examiner flexes and rotates the client's knee while pressing on the medial aspect and slowly extending the leg.

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

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

What is a priority nursing intervention to prevent falls for an older adult client with multiple chronic diseases? a. Providing assistance to the client in getting out of the bed or chair b. Placing the client in restraints to prevent movement without assistance c. Keeping all four side rails up while the client is in bed d. Requesting that a family member remain with the client to assist in ambulation

A Advanced age, multiple illnesses, particularly those that result in alterations in sensation, such as diabetes, predispose this client to falls. The nurse should provide assistance to the client with transfer and ambulation to prevent falls. The client should not be restrained or maintained on bedrest without adequate indication. Although family members are encouraged to visit, their presence around the clock is not necessary at this point.

The nurse performs an admission history on a client who has been transferred to a rehabilitation floor of the hospital. The client asks, "Why are you doing this again? They took my history on the other floor." How will the nurse respond? a. "I need to formulate an individualized plan of care." b. "This will assist in building your self-esteem." c. "I need to establish a baseline assessment." d. "We have to determine who can best care for you."

A Although all the responses can be correct to some extent, the need to formulate an individualized plan of care is most correct. The other activities will add to or be an outcome of the plan of care. The assessment establishes the client's normal routine, abilities, and activity tolerance to establish interventions developed specifically for this client.

The client asks why a plaster cast is not applied to the fractured clavicle. Which is the nurse's best response? a. "Plaster will make the area too heavy for movement." b. "A splint or bandage is sufficient to keep the bones in alignment." c. "Cloth braces are less likely to disrupt circulation." d. "Fractures to the upper body always heal more quickly."

B Because upper extremities do not bear weight, cloth splints are usually sufficient to immobilize the fracture. The other rationales are not accurate.

Which exercise will the nurse recommend to a client at risk for osteoporosis? a. High-impact aerobics 45 minutes once weekly b. Walking 30 minutes three times weekly c. Jogging 30 minutes four times weekly d. Bowling for 1 hour twice weekly

B Weight-bearing, nonjarring exercises have been proven to reduce or slow bone loss without causing vertebral compression. High-impact aerobics, jogging, and bowling are activities that actually could cause fractures in a client with osteoporosis.

A female client who is a carrier of the gene for Duchenne's muscular dystrophy asks if any of her daughters will have this disease. Which is the nurse's best response? a. "Both parents must have the defective gene." b. "Your daughter cannot get the disease." c. "Your daughters have a 50% chance of developing the disease." d. "Your daughters will become carriers of the gene."

B Women who are carriers have a 50% chance of passing the gene to their daughter, who are then carriers and their sons, who then have the disease. This type of muscular dystrophy affects only males.

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

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

Which instruction will the nurse give to the client before he or she has electromyography (EMG)? a. "Make sure that you have someone to drive you home after the test." b. "Do not eat or drink anything for at least 6 hours before the test." c. "You will have to avoid heavy lifting for 24 hours following the test." d. "Do not take your cyclobenzaprine (Flexeril) for the 2 days before the test."

D Electromyography (EMG) testing measures nerve signal transmission to and through muscles. Skeletal muscle relaxants such as Flexeril can affect test results and should be avoided for at least 2 days prior to the test. The other instructions are not relevant prior to EMG testing.

When preparing to care for a client with a family history of Paget's disease, it is most important for the nurse to include education in which area? a. Avoidance of infections b. Exercise program c. Nutrition high in vitamin C d. Need for genetic testing

D Paget's disease has been noted in up to 30% of people with a positive family history. Clients who have a history of this disease in their family should be taught the importance of genetic counseling. An exercise program may be started with the help of a physical therapist. Exercise may be difficult because of pain and danger of fracture. The diet should be rich in calcium and vitamin C.

The RN assigned a client who has severe osteoporosis to an LPN. Which information about the care of the client is most important for the RN to provide the LPN? a. Provide passive ROM to all weight-bearing joints. b. Position the client upright to promote lung expansion. c. Place a pillow between the client's knees when he or she is in the side-lying position. d. Use a lift sheet to reposition the client.

D Severe osteoporosis causes such bone density loss that pathologic fractures can easily occur when lifting or pulling a client. Use of a lift sheet when positioning reduces this risk. Passive range of motion prevents contractures. Weight-bearing exercise reduces bone resorption. Positioning the client to promote lung expansion and positioning with a pillow are important for any client. The most important intervention for this client is to prevent bone fractures.

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? a. Blood pressure 130/85 mm Hg, temperature 99° F (37.2° C) b. Urinary output 40 mL/hr c. Redness around the edges of the cast d. Vomiting after meals

D 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.

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

D 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.

After the administration of each dose of zoledronic acid (Zometa), it is most important for the nurse to determine which finding? a. Heart rate b. Pain relief c. Tumor size d. Urine output

D Zoledronic acid is a bisphosphonate that helps protect bones and prevent fractures. Urine output should be monitored because this drug can be toxic to the kidneys. Zometa does not relieve pain or affect heart rate. Tumor size cannot be measured in a nursing assessment. Zoledronic acid does not affect tumor size.

Primary prevention interventions for older adults should include prevention of which condition? a. Accidents b. Morbid obesity c. Coronary artery disease d. Diabetes mellitus type 2

A Although stroke is the leading cause of disability in the United States, many younger adults are disabled from accidents rather than from disease. Morbid obesity, coronary artery disease, and diabetes mellitus type 2 are diseases/common chronic conditions that may result in varying degrees of disability. Most occur in people older than 65 years.

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? a. Elevating the arm above the level of the heart b. Encouraging active and passive range of motion c. Applying heat to the affected hand d. Applying a bivalve the cast

A 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. Encouraging range of motion would not assist the client as much as elevating the arm.

Which action will the nurse implement to prevent pressure ulcer formation in a bedridden client? a. Adjusting nutritional intake based on serum albumin and transferrin levels b. Measuring the ulcer diameter and depth every shift c. Changing the gauze dressing whenever drainage is observed d. Applying antibiotic ointment to all excoriated skin areas

A Assessing serum and transferrin levels helps determine the client's nutritional status and allows the care providers to alter the diet, as needed, to prevent pressure ulcers. All other options are treatment-oriented rather than prevention-oriented.

During the admission history intake, a client with hip problems asks, "Why are you asking about my bowels and bladder?" What is the nurse's best response? a. "To plan your care based on your normal elimination routine." b. "To help prevent side effects of your medications." c. "We need to evaluate your ability to function independently." d. "It is best to schedule your activities around your elimination pattern."

A Bowel elimination varies from client to client and needs to be evaluated based on the client's normal routine. Oral analgesics may cause constipation, but don't interfere with bladder control. Elimination is usually scheduled around the activities. The client is in rehabilitation to assist her or his ability to function independently.

Which behavior exhibited by an older adult client should alert the nurse to the possibility that the client is experiencing delirium? a. The client becomes confused within 24 hours after hospital admission. b. The client displays a cheerful attitude despite a poor prognosis. c. The client becomes depressed and sleeps most of the day. d. The client begins to use slurred speech.

A Delirium is characterized by acute confusion that is usually short term. Delirium can result from placement in unfamiliar surroundings, such as being hospitalized.

Which statement indicates that the client understands teaching about alendronate (Fosamax)? a. "I should take this drug with a full glass of water." b. "I need to lie down for 30 minutes after taking it." c. "This drug should be taken after a meal." d. "This drug needs to be taken at the same time with calcium."

A Fosamax needs to be taken on an empty stomach with a full glass of water. After taking the drug, the client needs to stay upright for 30 minutes. Fosamax should be taken on an empty stomach for best absorption. Calcium can be taken, but not at the same time as the Fosamax.

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

A If an open wound is present in the hospital or long-term care setting, the client's treatment usually 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.

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

A 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 prevent 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.

Which client is at highest risk for the development of plantar fasciitis? a. Young adult runner b. Teenager c. Older adult client who walks with a cane d. Adult client confined to a wheelchair

A Plantar fasciitis accounts for 10% of running-related injuries. Obesity is also thought to be a factor in the development of plantar fasciitis. It is often seen in middle-aged and older adults who are ambulatory. Even though distractor C might be a candidate for plantar fasciitis, it is most often seen in athletes, especially runners.

Which nursing intervention will the nurse implement to prevent venous stasis and thrombus formation in a client undergoing rehabilitation? a. Range-of-motion exercises b. Foot support while in bed c. Increased dietary calcium intake d. Avoidance of sudden position changes

A Range-of-motion exercises involve skeletal muscle contraction of the upper and lower extremities. Muscle contraction promotes venous return, preventing stasis and thrombus formation.

The client for whom skeletal traction is planned asks for an explanation regarding the purpose of this type of traction. Which is the nurse's best response? a. "This type of traction will aid in realigning the bone." b. "This type of traction will prevent you from having low back pain." c. "This type of traction will decrease muscle spasms that occur with a fracture." d. "This type of traction will prevent injury to the skin as a result of the fracture."

A Skeletal traction pins or screws are surgically inserted into the bone to aid in bone alignment.

An older adult client is being discharged from the hospital on several medications. What is the best way to reinforce medication teaching for this client? a. Have the client actively participate in drug administration during hospitalization. b. Include the client's children in discussions regarding proper medication administration. c. Give the client a pamphlet outlining the actions, side effects, and doses of all prescribed drugs. d. Make a chart for the client, showing exactly which drugs are to be taken at different times during the day.

A Supervised self-administration of medications allows accurate assessment of the client's capabilities and hands-on learning opportunities for instruction or reinforcement.

While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. Which is the nurse's first action? a. Administering oxygen via nasal cannula b. Applying restraints c. Slowing the IV flow rate d. Discontinuing the pain medication

A The client is at high risk for a fat embolism and has some of the clinical manifestations. 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. Pain medication would most likely not cause the client to be restless.

A client diagnosed with primary bone sarcoma of the leg is scheduled for tumor removal. He expresses fear of the loss of function. Which is the nurse's best response? a. "It is normal to feel this way." b. "Physical therapy will assist you to regain function." c. "This surgery is better than an amputation." d. "This surgery was necessary to save your life."

A The client with bone cancer is expected to adjust to actual or impending loss. An expected outcome of nursing care includes the ability of the client to verbalize the reality of the loss and seek social support.

A client is being discharged from the hospital with the diagnosis of osteoporosis and hip fracture. When planning this client's discharge, it is most important for the nurse to coordinate with which member of the health care team? a. Case manager b. Osteoporosis Foundation representative c. Occupational therapist d. Wound care nurse

A The client with osteoporosis with a fracture may need to be transferred to a long-term care facility for rehabilitation or permanent residence. Case managers assist in preparing the client and family for placement. An Osteoporosis Foundation representative can provide information regarding the disease, but is not the most important member of the health care team at this time. An occupational therapist and wound care nurse are important members of the health care team, but are not vital in the situation described in this question.

A client who has sustained a crush injury to the right lower leg complains of numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse's first intervention? a. Assessing pedal pulses b. Applying oxygen by nasal cannula c. Increasing the IV flow rate d. Documenting the finding as the only action

A The symptoms represent early warning 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.

The nurse is caring for a client who presents with achy jaw pain. Which assessment technique will the nurse use to determine if the client has inflammation of the temporomandibular joint (TMJ)? a. The nurse checks for decayed, fractured, loose, or missing teeth. b. The nurse observes the jaw joint as the client chews a piece of food. c. The nurse palpates the joint during movement for tenderness or crepitus. d. The nurse observes for asymmetrical joint protrusion when the client's mouth is closed.

A The temporomandibular joints are best assessed by palpation while the client opens his or her mouth. The other assessment techniques are not effective for assessing possible TMJ inflammation.

An older old client is agitated and confused on admission to the long-term care unit. How will the nurse minimize relocation stress syndrome for this client? a. Reorient the client frequently to his or her location. b. Obtain a certified sitter to remain with the client. c. Speak to the client as little as possible to avoid overstimulation. d. Provide adequate sedation for all procedures to avoid fear-provoking situations.

A There are many nursing interventions that can be helpful to older adults who experience relocation stress syndrome. If the client becomes confused, agitated, or combative, the nurse should reorient the client to his or her surroundings. The nurse also can encourage family members to visit often, keep familiar objects at the client's bedside, and work to establish a trusting relationship with the client

Which instruction will the nurse include in the discharge teaching plan of a client who has osteoporosis? a. "Avoid using scatter rugs." b. "Avoid weight-bearing exercises." c. "Use a cane when walking outside." d. "Reduce the amount of protein in your diet."

A To avoid falls, the client should keep a hazard-free environment, including avoiding scatter rugs, cluttered rooms, and wet floor areas. Weight-bearing exercises help prevent bone resorption. A cane is not needed unless the client has a physical disability. A protein deficiency should be avoided because it might cause a reduction in bone density.

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

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

The client who has long-standing chronic obstructive pulmonary disease (COPD) is recovering from a stroke. Which intervention is a priority when caring for the client to assess activity tolerance during rehabilitation? a. Assessing vital signs before, during, and after activity b. Performing cognitive assessment c. Measuring arterial blood gases frequently d. Keeping client on bedrest

A To see whether a client is tolerating activity, vital signs are measured before, during, and after the activity. If the client is not tolerating activity, heart rate may increase more than 20 beats/min, blood pressure may increase over 20 mm Hg, and vital signs will not return to baseline within 5 minutes after the activity. A cognitive assessment is not necessary prior to basic activities. Arterial blood gases are not measured frequently because of the invasive nature of the test. A client should not be kept on bedrest unless she or he is unable to tolerate standing, sitting, or ambulating.

The nurse is assessing the client's ability to transfer from the bed to the wheelchair. What might impair the client's ability to perform this task? a. Recent weight gain b. Expressive aphasia c. Bowel and bladder incontinence d. Strong upper arm strength

A With impaired mobility and use of a wheelchair, the client tends to gain weight. The increased weight requires greater upper body strength for movement and hinders the client's ability to become independent in transfer. Expressive aphasia deals with communication on the client's part. This has little to do with transfer. Incontinence puts the client at risk for skin breakdown. Strong upper arm strength would decrease a chance of problems with transfer.

Which nursing diagnosis has the highest priority for a client with a lesion in the area of the tibia that is swollen and tender? a. Imbalanced Nutrition related to increased metabolism b. Pain related to physical injury c. Self-Care Deficit related to weakness d. Risk for Fall related to skeletal impairment

B A palpable mass and swelling in the area of the tibia are symptoms of osteochondroma, which is a common, benign, bone tumor. Pain is the most common manifestation of a benign bone tumor. The other distractors are important, but relief of pain is the highest priority.

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

B 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.

Which clinical manifestations will the nurse expect to observe in a client with a grade III open fracture? a. An open fracture with minimal skin damage b. A 6- to 8-cm wound with damage to skin, muscle, and nerve tissue c. An open fracture accompanied by skin and muscle contusions d. Internal damage to skin, muscle, and nerve tissue, but no open wound noted

B An open or compound grade III fracture is the most severe. The client may have a 6- to 8-cm wound with damage to skin, muscle, nerve tissue, and blood vessels.

Two hours after limb salvage surgery for a client with left leg bone sarcoma, the nurse notes that the toes of the left foot are more edematous, cooler to the touch, and have a slower capillary refill. Which action will the nurse take first? a. Applying ice to the distal extremity b. Checking the splint for proper placement c. Elevating the left foot d. Loosening the pressure dressing

B Assessment of the neurovascular status of the affected extremity should be performed every 1 to 2 hours after surgery. Splinting or casting of the limb may cause neurovascular compromise and needs to be checked for proper placement. Applying ice will cause vasoconstriction and further impair blood flow. Elevation of the foot will similarly decrease circulation to the area.

For which client will the nurse provide interventions to prevent infection? a. A client with a fractured clavicle b. A client with an open fracture of the tibia c. A client with a simple fracture of the wrist d. A client with a 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 mother of a 16-year-old client diagnosed with Ewing's sarcoma expresses concern that her son seems to be angry at everyone in the family. How will the nurse respond? a. "You need to set limits with your son." b. "This is a normal stage in the grieving process." c. "He will be back to normal when he leaves the hospital." d. "This is typical behavior for a teenager."

B Clients often experience a loss of control over their lives when a diagnosis of cancer (e.g., Ewing's sarcoma) is made. Clients may progress through the grieving process, which includes denial, followed by anger. Setting limits without understanding the grieving process can make the client feel that he has no control. The behavior is not typical of a teenager without the disease. It is part of the grieving process. The mother should not expect the son to go back to "normal" when he goes home.

An older adult client presents with signs and symptoms related to digoxin toxicity. Which age-related change may have contributed to this problem? a. Increased total body water b. Decreased renal blood flow c. Increased gastrointestinal motility d. Decreased ratio of adipose tissue to lean body mass

B Decreased renal blood flow and reduced glomerular filtration can result in slower medication excretion time, potentially resulting in toxic drug accumulation. Aging results in decreased total body water and gastrointestinal motility, and an increase in the ratio of adipose tissue to lean body mass.

Which condition will the nurse anticipate in the client who has rheumatoid arthritis? a. Dupuytren's contracture b. Hallux valgus c. Morton's neuroma d. Plantar fasciitis

B Hallux valgus deformity is a common foot problem in which the great toe deviates laterally at the first metatarsophalangeal joint. This condition often occurs as a result of poorly fitted shoes, family history, osteoarthritis, and rheumatoid arthritis.

A client with Alzheimer's disease has been hospitalized for dehydration. In making an assessment, the nurse notes the presence of a cluster of bruises on the client's buttocks and suspects that the client may be the victim of elder neglect and abuse. What is the nurse's priority action? a. Calling the local police b. Notifying the client's physician and social worker c. Confronting the client's family caregiver with the suspicions d. Alerting hospital security to prevent visits by the client's caregiver

B If a nurse suspects elder abuse or neglect, the nurse notifies the physician and social worker to begin an investigation of the situation.

How will the nurse support a client who relates a feeling of "loss of control" after having a mild stroke? a. Explain to the client that such feelings are normal, but that expectations for rehabilitation must be realistic. b. Encourage the client to perform as many tasks as possible and to participate in decision making. c. Further assess the client's mental status for other signs of denial. d. Obtain an order for physical and occupational therapy.

B Older adults can experience a number of losses that affect their sense of control over their lives, including a decrease in physical mobility. The nurse should support the client's self-esteem and increase feelings of competency by encouraging activities that assist in maintaining some degree of control, such as participation in decision making and performing tasks that he or she can manage.

A client with a past history of angina has had a total knee replacement. What will the nurse teach the client prior to rehabilitation activities? a. "Use analgesics even if you are not in pain." b. "Take nitroglycerine prophylactically prior to activity." c. "Take anti-inflammatory medications before you get out of bed." d. "Do not exercise if you have knee pain."

B Participation in exercise may increase myocardial oxygen demand beyond the ability of the coronary circulation to deliver enough oxygen to meet the increased need. Nitroglycerin dilates coronary arteries within 5 minutes of use, ensuring that they will be ready to meet the demand during exercise.

What is a priority nursing intervention for an older adult client in physical restraints? a. Assessing the client hourly, while keeping the restraints in place b. Assessing the client every 30 to 60 minutes, releasing the restraints every 2 hours c. Assessing the client once each shift, releasing the restraints for feeding d. Assessing the client twice each shift, keeping the restraints in place

B The application of restraints can have serious consequences. Thus, the nurse should check the client every 30 to 60 minutes, releasing the restraints every 2 hours for positioning and toileting. The other answers would not be appropriate because the client would not be assessed frequently enough, and circulation to the limbs could be compromised. Assessing every hour and releasing the restraints every 2 hours is in compliance with federal policy for monitoring clients in restraints.

Which action by the client with left-sided weakness indicates that additional teaching is needed about proper cane use? a. The client holds the cane in his right hand. b. The client advances the cane while his right leg moves forward. c. The client steps forward first with his right leg when ambulating. d. The client's elbow is flexed 15 to 20 degrees when holding the cane.

B The cane should be held on the strong right side so that it provides support for the weaker left side. The cane should be advanced with the opposite affected lower limb (the left leg for this client). The client should step forward with the strong right leg when ambulating. The elbow should be flexed 15 to 20 degrees when holding the cane.

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? a. "Your vital signs are good, and you are doing just fine right now." b. "Your children are waiting outside and do not want to lose their parent." c. "Remember that you are still the same person inside, with a missing body part." d. "You will be able to do some of the same things as before you became disabled."

B 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."

What is the priority nursing diagnosis for a client in a rehabilitation program after a stroke that has caused extensive right-sided weakness? a. Self-Care Deficit: hygiene, feeding, toileting b. Risk for Impaired Skin Integrity c. Constipation d. Impaired Physical Mobility

B The client has a self-care deficit and impaired physical mobility. These problems greatly increase the risk for the client to experience skin breakdown, complicating or interfering with the recovery and rehabilitation efforts. Impaired mobility can lead to constipation, which is uncomfortable and can lead to intestinal problems. Risk for impaired skin integrity is the highest priority. First, it can lead to infection, local or systemic. It causes discomfort, prolongs hospitalization, and delays rehabilitation. It also will result in decreased financial and insurance reimbursement.

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

B 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.

An older adult client has become agitated and combative toward the health care personnel on the unit. What is the first action that the nurse will take? a. Obtain an order for a sedative-hypnotic medication to reduce combative behavior. b.Attempt to soothe the client's fears and reorient the client to surroundings. c. Obtain an order to place the client's arms in restraints to protect personnel. d. Arrange for the client to be transferred to a mental health facility.

B The nurse should establish a trusting relationship with the client, soothe the client's fears, and reorient the client to the facility before resorting to physical or chemical restraints. Restraints, both physical and chemical, may be overused in certain situations. Sedative-hypnotic drugs may have adverse effects in older adults and should be used sparingly. Physical restraints also can have serious repercussions. Transfer to a mental health facility requires evaluation by psychiatric staff and may not be appropriate here.

A paraplegic client is being evaluated for transfer to a rehabilitation unit. The nurse refers the client to which interdisciplinary team member for evaluation of activities of daily living? a. Physical therapist b. Occupational therapist c. Recreational therapist d. Vocational therapist

B The occupational therapist is responsible for ADL training, the physical therapist for muscle strength, the vocational therapist for job training, and the recreational therapist for hobbies or pastime activities.

The nurse is caring for an older adult client with multiple fractures. How will the nurse manage pain in this client? a. Meperidine injections every 4 hours rather than PRN b. Patient-controlled analgesia (PCA) pump with morphine c. Motrin (ibuprofen) 600 mg every 4 hours d. IV morphine PRN

B The older adult client should never be treated with meperidine because there are toxic metabolites that can cause seizures. The client should be managed with a PCA pump to control pain best. Motrin would most likely 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.

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

B 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.

A female client is seen at the clinic with the medical diagnosis of osteomalacia. When taking the client's history, what information is the most significant? a. Arm and leg strength b. Dietary intake of vitamin D c. Dietary intake of calcium d. Exercise habits

B Vitamin D deficiency is the most important factor in the development of osteomalacia. Weak arm and leg strength may be seen, calcium deficiency plays a part in the disease process, and discomfort while exercising may be seen. However, the most significant risk factor in this disease process is vitamin D deficiency.

What intervention will best help a client with decreased mobility decrease the risk of fractures? a. Applying a foot support b. Performing weight-bearing activities c. Increasing calcium-rich foods in the diet d. Using pressure-relieving devices

B Weight-bearing activity reduces bone mineral loss and promotes bone uptake of calcium, contributing to maintenance of bone density and reducing the risk for bone fractures. Although increasing the calcium in the diet is a good intervention, this alone will not reduce the client's susceptibility to bone fractures. A foot support and pressure relieving devices will not help prevent fractures, but may help with mobility and skin integrity.

A client with a flaccid bladder is undergoing bladder training. The nurse begins the client's bladder training by teaching which technique? a. Stroking the medial aspect of the thigh b. Valsalva maneuver and Credé's maneuver c. Self-catheterization d. Frequent toileting

B With a flaccid bladder, the voiding reflex arc is not intact and additional stimulation may be needed to initiate voiding, the Valsalva and Credé maneuvers. Intermittent catheterization may be used after attempting the previous maneuvers. In reflex bladder, the voiding arc is intact and voiding can be initiated by any stimulus, such as stroking the medial aspect of the thigh. Consistent toileting routine is used to re-establish voiding continence with an uninhibited bladder.

A client newly diagnosed with fibrosarcoma is most likely to exhibit which behavior? a. Acceptance b. Bargaining c. Denial d. Resolution

C A client with bone cancer is expected to adjust to actual or impending loss. Indicators include that the client will have the ability to progress through the stages of grief. The first stage of this process is denial that he has the disease.

How is a handicap different from an impairment, as defined by the World Health Organization? a. An impairment may be temporary and a handicap is usually permanent. b. Handicaps only involve mobility and an impairment may involve any organ structure or function. c. Impairments are physical abnormalities and handicaps are societal values placed on individuals with impairments. d. Handicaps are societal attempts to improve the functional ability of a person with an impairment, allowing more mainstream integration.

C A handicap is a preventable and reversible disturbance at the societal level that is experienced by a person with a disability or impairment. It is a negative value that is ascribed to the person, the disability, or the impairment. A handicap is often described by what a person is perceived to be unable to perform.

A client's susceptibility to osteomalacia is related to which risk factor? a. Calcium level of 11 mg/dL (normal = 8.2 ? 10.2 mg/dL) b. Diet high in milk and soy c. Phosphate level of 1.0 mg/dL (normal = 2.5 ? 4.5 mg/dL) d. Taking vitamin D supplements

C A low serum phosphate level predisposes a client to osteomalacia. Vitamin D, diets high in vitamin D (e.g., milk and soy), and high calcium levels are not risk factors for osteomalacia.

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? a. Repeating this laboratory assessment in 4 hours b. Having the cast reapplied c. Evaluate temperature and vital signs d. Obtaining blood for a platelet count

C 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.

Which statement indicates that the client does not understand medication therapy? a. "My husband is on the same medication, so we always take our medications together in the morning." b. "I prepare all my medication for the week and place the pills in a container labeled for each day." c. "When I don't sleep well at night, I take two thyroid pills the next day instead of just one." d. "I take my Coumadin every day when the noon news comes on the television."

C Changing the dose of medication without correct understanding of the drug's use and appropriate schedule can cause serious problems.

Which assessment finding would prevent a client from being a candidate for self-catheterization? a. Arthritis b. Blindness c. Confusion d. Paraplegia

C Clients of any age with a variety of impairments and disabilities can participate in intermittent self- catheterization. The two main requirements are that the client be cognitively intact and can reach the area.

The family of an older adult client expresses concern regarding the gradual decline in cognitive functioning of their family member. The nurse focuses teaching on what clinical condition? a. Depression b. Psychosis c. Dementia d. Delirium

C Dementia is characterized by a gradual decline in intellectual functioning that is chronic and progressive

The nurse is caring for a client with a spinal cord injury at level T3. How will the nurse assist the client with bladder dysfunction? a. Inserts an indwelling urinary catheter b. Monitors the amount of fluid intake c. Uses Credé's maneuver for the bladder every 3 hours d. Applies a Texas catheter with leg bag

C If the spinal cord injury is above T12, the client is unaware of a full bladder and therefore does not void or is incontinent. Therefore, the client would not benefit from a Texas catheter with a leg bag. The client needs to be straight-catheterized when the bladder is full, which is determined by palpating the bladder (Credé's maneuver). Indwelling urinary catheters are not generally used because of the increased incidence of urinary tract infections. Fluid intake need to be monitored, ensuring that adequate amount of fluids are taken in. Fluids should not be restricted unless for another medical problem.

Which physical assessment finding is consistent with injury to the rotator cuff? a. The client is unable to maintain adduction of the affected arm at the shoulder for more than 30 seconds. b. The client is able to raise the affected arm to shoulder height but feels pain on doing this maneuver. c. The client is unable to initiate or maintain abduction of the affected arm at the shoulder. d. The client has referred pain to the shoulder and arm opposite the affected shoulder.

C In clients with a rotator cuff tear, the client is unable to initiate or maintain abduction of the affected arm at the shoulder. This is known as the drop arm test.

Which best represents the four subgroups of late adulthood that the nurse may encounter when caring for older clients? a. Young old, middle old, older old, oldest old b. Youthful old, mid-old, older old, oldest old c. Young old, middle old, older old, elite old d. Youthful old, mid-old, elite old, eldest old

C Late adulthood can be divided into four subgroups: the young old (65 to 74 years), the middle old (75 to 84 years), the older old (85 to 99 years), and the elite old (100 years or older).

What government resource is available to assist older adults to meet the cost of healthcare? a. Preferred provider organizations b. Health maintenance organizations c. Medicare d. Medicaid

C Medicare is a federal insurance program designed to assist older adults to meet the cost of health care. Medicare provides health insurance to those aged 65 years or older and to qualified disabled people.

An older adult client is suspected of being neglected by their caregiver. What assessments will the nurse make that assist in confirming a suspicion of neglect in an older adult client? a. Injuries noted in the "bathing suit" zone of the body b. Disorientation to time, place, and person c. Excessive weight loss d. Rapid heart rate

C Neglect is often manifested by dehydration, under nutrition, pressure ulcers, or contractures. Injuries raise the suspicion for abuse, whereas disorientation and rapid heart rate can be the result of disease processes.

A nurse is caring for an older adult client who lives alone. Which economic situation presents the most serious problem for this client? a. Stock market fluctuations b. Increased provider benefits c. Social Security as the basis of income d. Costs associated with setting up a living will

C Older adults on fixed incomes are unable to adjust their income to meet rising costs.

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

C 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 client has left-sided weakness. Which gait-training technique will the physical therapist and nurse use when assisting the client to walk with a cane? a. Placing the cane in the client's weaker hand and moving the cane forward, followed by moving the weaker leg one step forward b. Placing the cane in the client's weaker hand and moving the cane forward, followed by moving the stronger leg one step forward c. Placing the cane in the client's stronger hand and moving the cane forward, followed by moving the weaker leg one step forward d. Placing the cane in the client's stronger hand and moving the cane forward, followed by moving the stronger leg one step forward

C Placing the cane in the client's weaker hand does not provide sufficient stability. After the cane in the stronger hand is moved ahead, the cane and the stronger leg provide a stable base for movement of the weaker leg.

The nurse assesses a client admitted for rehabilitation. The client has full range of motion, but presents with a weak grasp. What exercise does the nurse perform? a. Passive range of motion (ROM) b. Active range of motion c. Resistive range of motion d. Aerobic exercise

C Resistive ROM involves gradually and progressively adding gentle resistance to a range-of-motion exercise, promoting an increase in strength of the muscles required to move the joint. The client needs to strengthen the muscle groups related to grasp. Because the client already has full range of motion, active and passive ROM exercises are not needed. Aerobic exercises are not used for weak grasp.

Which activity plan would best conserve a client's energy without compromising the client's physical or mental health? a. Reducing hygiene activities and restricting visitors b. Ensuring that the client toilets before and after any other planned activity c. Scheduling energy-intensive activities in the morning when energy levels are high d. Scheduling as many activities as possible in a small block of time

C Some of the best techniques for energy conservation include spacing activities with a rest period in between and individualizing the scheduling of more energy-intensive activities to the time of day when the client knows or feels that his or her energy levels are higher.

Which intervention is a priority for a client after arthroscopy surgery? a. Passive range of motion on the involved knee b. Active range of motion on the involved knee c. Straight leg raises with the involved leg d. Immobilization of the leg

C Straight leg raises are started immediately after the client awakens from the anesthesia. Bending the affected knee should not be done for several days. Immobilization will lead to more complications.

The client who had a long leg cast applied last week tells the nurse that he just can't seem to catch his breath and feels a bit lightheaded. Which is the priority action of the nurse? a. Listening to the client's lungs and checking the client's blood glucose level b. Giving the client 2 L of oxygen via nasal cannula and checking vital signs c. Check the client's pulse oximetry and arranging emergency transfer to the hospital d. Reassuring the client that it takes much more effort to move with a long leg cast

C The client's symptoms are consistent with the development of pulmonary embolism (PE) caused by leg immobility in the long cast. The nurse should check the client's pulse oximetry reading and arrange for transfer to the hospital for further testing and treatment. The client should not be reassured that the symptoms are caused by exertion. The nurse can check vital signs, administer oxygen, and check the client's blood glucose level while waiting for transport to the emergency department.

What test will best assist the nurse in determining the severity of a client's disability? a. Instrumental activities of daily living (IADLs) b. Minimum data set (MDS) c. Functional independence measure (FIM) d. Independent living skills test (ILST)

C The functional independence measure is a uniform data set used for outcome data collection in the United States. The FIM attempts to quantify what the person actually does, whatever the diagnosis or impairment. Categories for assessment are self-care, sphincter control, mobility, locomotion, communication, and cognition. IADLs is a functional assessment tool carried out by numerous members of the interdisciplinary team in the health care setting. The MDS is used to assess nursing home residents in areas of motor ability, sensations, and cognitions as well as overall health status.

The client is receiving the following medications: levothyroxine (Synthroid) at 7 AM and digoxin (Lanoxin) at 9 AM. What would be the best time to administer the psyllium (Metamucil)? a. 0700 b. 0900 c. 1100 d. 1300

D Synthroid needs to be given before meals. There should be at least 4 hours between the administration of Metamucil and digoxin because of the interference in absorption of the digoxin by the Metamucil.

An older adult client is getting out of bed for the first time. The nurse is alert for the development of which potential problem? a. Deep vein thrombosis (DVT) b. Incontinence c. Orthostatic hypotension d. Pulmonary embolism

C The older client with cardiac disease or on antihypertensive medications is particularly at risk for orthostatic hypotension. The client would be a risk for DVT or pulmonary embolism the longer he or she remained on bed rest. Incontinence has nothing to do with getting out of bed.

The nurse is planning discharge teaching about rehabilitation for the client who is paraplegic. The client verbalizes that he doesn't know why he should go. What is the nurse's best response? a. "Your doctor ordered rehabilitation, and he does know what is best for you." b. "When new discoveries are made, people in rehabilitation programs will benefit first." c. "Rehabilitation will teach you how to maintain the functional ability you have." d. "You are right. I will cancel the orders for rehabilitation."

C There are many purposes for participating in rehabilitation programs, including disability prevention, maintenance of functional ability, and restoration of function. Without the special knowledge learned through rehabilitation, the client with a newly acquired disability may never learn the skills needed to prevent long-term problems or conserve energy.

A nurse catheterizes a client immediately after voiding. The residual volume is 50 mL. What will the nurse do next? a. Notify the physician. b. Insert an indwelling catheter. c. Document the finding as the only action. d. Modify or extend the bladder-training program.

C This finding is normal. Therefore, the nurse should document the finding and continue with the present bladder-training program. The goals of a bladder-training program are to avoid the use of an indwelling catheter and keep the residual volume at less than 100 mL.

The nurse is assessing a client who complains of severe knee pain after a fall. Which question will the nurse ask to determine the radiation of the pain? a. "What makes the pain better or worse?" b. "Are you able to bear any weight on the knee at all?" c. "Does the pain move to another area from your knee?" d. "How would you rate the pain on a scale of 1 to 10?"

C To determine radiation of the pain, the nurse asks the client if the pain moves to another area from the knee. The other questions address the amount, functional impact, and alleviating or aggravating factors of the pain.

The nurse is caring for a client with a pelvic fracture. Which is the nurse's priority action to prevent complications? a. Monitoring temperature daily b. Inserting a Foley c. Monitoring blood pressure frequently d. Turning client every 2 hours

C With a pelvic fracture, there can be internal organ damage, resulting in bleeding and hypovolemic shock. The nurse monitors the client's vital signs, skin color, and level of consciousness frequently to determine if shock is occurring. The client does not necessarily need a Foley inserted, and should not be turned on her or his side unless the fracture is stabilized.

The client who is performing intermittent self-catheterization at home is concerned about the cost of the catheters. What is the nurse's best response? a. "I will try to find out whether or not you qualify for money to purchase these necessary supplies." b. "Even though it is expensive, the cost of taking care of urinary tract infections would be even higher." c. "You can boil the catheters and reuse them up to 10 times each." d. "You can reuse the catheters at home. Clean technique, rather than sterile technique, is acceptable."

D At home, clean technique for intermittent self-catheterization is sufficient to prevent cystitis and other urinary tract infections. The nurse would refer the client to the social worker to explore financial concerns. The nurse should not threaten the client, nor should the client be instructed to boil the catheters.

Which client will the nurse consider highest risk for deep vein thrombosis? a. A middle-aged woman with a fractured ankle who takes aspirin for rheumatoid arthritis b. A young adult male athlete with a fractured clavicle c. A female with type 2 diabetes with fractured ribs d. An older man who smokes and has a fractured pelvis

D Deep vein thrombosis as a complication with bone fractures occurs more often when the 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.

Which of the postoperative orders will the nurse clarify with the surgeon before discharging the client who just had arthroscopic surgery on the right knee? a. Keep right leg elevated on a soft pillow b. Non-weight-bearing by right leg for 48 hours c. Bathroom privileges with assistance and crutches d. Two tablets of propoxyphene-acetaminophen (Darvocet N-100) every 4 hours for pain

D Each tablet of Darvocet N-100 contains 650 mg of acetaminophen, so each dose = 1300 mg of acetaminophen. 1300 mg every 4 hours = 7800 mg of acetaminophen, well over the 4000-mg safe maximal dose for 24 hours. The rest of the orders are appropriate.

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

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

The nurse is caring for a client who is to have a computed tomography (CT) scan of the leg. Which assessment question will the nurse ask the client prior to the procedure? a. "Do you have any metal clips, plates, or pins in your body?" b. "Have you had anything to eat or drink in the last 6 hours?" c. "Do you have someone to drive you home after the procedure?" d. "Do you have any allergies to shrimp, scallops, or other seafood?"

D IV contrast that contains iodine may be required for CT scans to rule out malignancy. The client should be assessed for allergy to shellfish, which contain high amounts of iodine. The other questions are not relevant when a CT scan is to be obtained.

The nurse is performing passive range-of-joint motion exercises on a semiconscious client and meets resistance while attempting to extend the right elbow more than 45 degrees. What will the nurse do? a. Splint the joint and continue the passive range of motion to the shoulder only. b. Progressively increase the joint motion 5 degrees beyond the resistance each day. c. Apply weights to the right distal extremity before initiating any joint exercise. d. Move the joint only to the point at which resistance is met.

D Moving a joint beyond the point at which the client feels pain or resistance can damage the joint. The nurse should move the joint only to the point of resistance. Splinting the joint will not assist the client's range of motion. The client's joint should not be forced. Applying weights to the extremity will not increase the range of motion of the joint, but will most likely cause damage.

A client who had a wrist cast applied 3 days ago calls from home, reporting that the cast is loose enough to slide off. How will 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. "Wrap an elastic 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 client's skin, the cast needs to be replaced. Elevating the arm will not solve the problem, and the client's muscles should not atrophy while in a cast for 6 weeks or less.

The nurse is caring for a client with a fractured femur. Which factor in the client's history may impede healing of the fracture? a. A sedentary lifestyle b. A history of smoking c. Oral contraceptive use d. Peripheral vascular disease

D Peripheral vascular disease reduces arterial circulation to bone. The bone receives less oxygen and nutrients than needed for healing. The other factors do not impede healing, but may cause other health risks.

What will the nurse teach the client with hypertension who complains that "food does not taste good without salt?" a. Salt can be used as long as the blood pressure remains controlled. b. All salt should be removed from the diet to preserve kidney function. c. Table salt in small amounts in conjunction with diuretics can be used. d. Herbs and spices can be substituted to season food.

D Physical changes associated with aging can affect the intake of nutrients. Diminished senses of taste and smell, particularly a decline in the ability to taste sweet and salty, may lead the older adult to overuse sugar and salt. In such cases, the nurse should recommend that the client use herbs and spices to season food.

The client tells the nurse that his arm cast feels really tight and his fingers are puffy. What is the nurse's best response? a. "Elevate your arm on two pillows and apply ice to the cast." b. "Continue to take ibuprofen (Motrin) until the swelling subsides." c. "It is normal for a new cast to feel a little tight for the first few days." d. "Please come to clinic today to have your arm checked by the physician."

D Puffy fingers and 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 physician, because delay of treatment can cause permanent damage to the extremity.

Which dietary choice indicates that the client understands nutritional needs to assist in healing a fracture? a. Skim milk, vitamin D supplements, fish b. Soy milk, vitamin B supplements, bacon, lettuce and tomato sandwich c. Whole milk, vitamin A supplements, vegetable lasagna d. Low-fat milk, vitamin C supplements, roast pork.

D The client with a healing fracture needs supplements of vitamins B and C, high-protein and 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 client is starting on a structured cardiac rehabilitation program. Before starting the activity, what will the nurse do? a. Administer nitroglycerin to increase the blood flow to the heart. b. Refer the client for psychological testing related to fear of death. c. Start oxygen at 2 L/min via nasal cannula. d.Determine the level of activity before shortness of breath occurs.

D The level of activity that can be accomplished without experiencing shortness of breath needs to be established prior to activity. This will alleviate fear and anxiety and prevent the occurrence of cardiac symptoms. Oxygen should only be started if the pulse oximetry reading is below 90% or if there are electrocardiographic changes or cardiac symptoms, none of which are indicated in this question. The client does not require psychological testing at this time because the fear that he or she feels is related to something real. If the fear continues, a referral can be made.

Which of the following has the highest priority when the nurse intervenes in the care of the client with severe Paget's disease? a. Dietary education b. Exercise program c. Genetic testing d. Relief of pain

D The primary intervention for Paget's disease is drug therapy. Pain management is a priority and can be accomplished with various drugs and complementary measures. All the other distractors are treatments for Paget's disease. Pain management is the priority.

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? a. Decreasing the traction weight b. Applying a new dressing c. Cleansing the area, scrubbing off the crusty areas d. Culturing 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 health care provider should also be notified.

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

D 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.