HESI Prep: Musculoskeletal system

A hospitalized client newly diagnosed with rheumatoid arthritis complains of bilaterally painful knee and wrist joints. The nurse identifies impaired physical mobility related to painful, swollen joints. Which intervention would the nurse teach the client to do during the acute phase of the disease?

Avoid movement of the involved joints. - During the acute phase, immobilization of the joints reduces pain and inflammation. Clients are to avoid all movement to the involved joints during the acute inflammatory phase; joints need to be immobilized. Isometric exercises involve muscles, not joints. Clients should avoid progressive, resistive exercises during the acute inflammatory phase because joints need immobilized to reduce pain and inflammation.

Which client would the nurse suspect may have Parkinson's disease? Client A: festinating gait Client B: short-leg gait Client C: spastic gait Client D: steppage gait

Client A - Festinating gait, when the neck, trunk, and knees flex when the body is rigid, in client A indicates Parkinson's disease. A leg-length discrepancy of more than 1 inch due to arthritis or fracture may lead to the short-leg gait in client B. Neurogenic disorders such as cerebral palsy and hemiplegia may lead to the spastic gait in client C, which is manifested by jerky, uncoordinated, and cross-knee movement. Neurogenic disorders such as peroneal nerve injury and paralyzed dorsiflexor muscles may lead to the steppage gait in client D; this is manifested by increased hip and knee flexion to clear the foot from the floor and foot-dropping while walking.

The registered nurse is evaluating the plans of a nursing student for providing preoperative care to a client scheduled for a kyphoplasty. Which item listed in the nursing student's plan of care would the nurse need to revise?

Ensure that anticoagulants are administered before surgery. - A kyphoplasty is a procedure of inserting a small balloon into the fracture site and inflating it to contain the cement and to restore height to the vertebra. Anticoagulants should be discontinued before this procedure. Intravenous lines are established and vital signs are assessed to prevent complications. The client's ability to lie prone for at least 1 hour is assessed before the procedure. The client's coagulation laboratory results are assessed to ensure that platelet count is more than 100,000/mm3.

Which task regarding the care of a client with Buck's traction is appropriate to delegate to the unlicensed assistive personnel (UAP)?

Help the client with range-of-motion (ROM) exercises. - The nurse would delegate helping with ROM exercises to the UAP because this is an appropriate action for the UAP to take. It is not within the scope of practice for the UAP to perform any assessments, such as checking body positioning or distal pulses and capillary refill. The UAP also should not perform any client teaching.

The nurse is completing the health history of a client admitted to the hospital with osteoarthritis. Which joints would the nurse expect the client will report as having been involved first? Select all that apply. One, some, or all responses may be correct.

Hips + knees - Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first, because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus there is less degeneration. Shoulder joints are not the most likely to be involved first, because these are not weight-bearing joints. Although the distal interphalangeal joints are commonly affected, the remaining interphalangeal joints and metacarpals are not.

The nurse completes medication reconciliation in preparation for discharge of a client recovering from osteomyelitis and a ruptured Achilles tendon. For which medication would the nurse contact the primary health care provider?

Levofloxacin - Tendon rupture (especially the Achilles tendon) can occur with use of the fluoroquinolones (e.g., ciprofloxacin, levofloxacin). Aminoglycosides such as gentamicin do not cause rupture of the Achilles tendon; instead, gentamicin can cause ototoxicity and nephrotoxicity. Acetaminophen is a nonopioid analgesic used to manage pain; it does not cause rupture of the Achilles tendon. Cyclobenzaprine is a muscle relaxant; it does not cause tendon rupture.

A client with rheumatoid arthritis is in the convalescent stage of an exacerbation. The client states, "The only time I am without pain is when I lie perfectly still." Considering the client's statement, which intervention would the nurse encourage the client to do?

Participate in active joint flexion and extension exercises. - Active exercises (e.g., alternating extension, flexion, abduction, and adduction) mobilize exudate in the joints and relieve stiffness and pain. Flexion exercises alone will result in contractures. Performing ROM exercises once a day is not enough to prevent contractures. Continuing immobility until remission occurs will increase stiffness, joint pain, and the occurrence of contractures.

A client is brought to the emergency department triage by private car with bone protruding from the right lower leg. Which assessment would the triage nurse perform first?

Pedal pulses - Distal pulses in the fractured leg must be quickly assessed to determine perfusion adequacy. Weakened or absent distal pulses could be an indicator of subsequent compression syndrome of the right lower leg. Vital signs and pain should be assessed, but after the pulse check is performed. A neurological check might be required based on the events of the trauma or any additional injuries.

A client with dementia is admitted with a fractured hip after a fall at home. Four hours after admission, the client's blood pressure increases to a moderately severe hypertensive level and the client pulls on the bedclothes continuously. The client's family member asks for pain medication for the client. Which inference would the nurse make as the basis for an intervention?

The client may have pain and be unable to verbalize it. - The client's dementia indicates that the client has problems with thought processes and may not be able to interpret or communicate the presence of pain. An increased blood pressure, caused by central nervous system stimulation, and pulling on the bedclothes suggest that the client is in pain. The client may have a need to go to the bathroom, but it is more likely that the client has pain that he or she is unable to communicate. There is no evidence that the family member wants the client overmedicated or has feelings of guilt.

Which rationale explains why the nurse would advise a client to have a dental examination before beginning prescribed therapy with zoledronic acid?

To prevent maxillary osteonecrosis - Zoledronic acid is a bisphosphonate used to treat osteoporosis that can cause maxillary osteonecrosis. The client should have a dental examination before starting the medication therapy to prevent maxillary osteonecrosis. The client's serum creatinine should be checked before and after administration of the medication to prevent kidney failure. To prevent atrial fibrillation, the medication should not be infused too quickly. The medication should not be given to a client who is sensitive to aspirin as it may cause bronchoconstriction.