Med-Surg: Musculoskeletal

A nurse is caring for a client who is postoperative following a total knee arthroplasty and has been prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, "I am in so much pain." Which of the following actions should the nurse take first? A. Remind the client to push the button for the PCA device B. Discuss activities the client may use to distract from the pain C. Ask the client to describe the characteristics of the pain D. Pause the CPM machine briefly to apply a cold pack to the client's knee

C. Ask the client to describe the characteristics of the pain The first step of the nursing process is assessment. The first action the nurse should take is to acquire further data by asking the client to describe the characteristics of the pain.

A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition? A. Misoprostol B. Dantrolene C. Celecoxib D. Colchicine

C. Celecoxib Celecoxib is a type of NSAID known as cyclooxygenase-2 (COX-2) inhibitors that are used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation. - A: Misoprostol is a histamine-blocking agent. A client who has RA may be prescribed misoprostol to prevent the adverse GI effects of taking an NSAID, but this medication does not treat manifestations of RA. - B: Dantrolene is an antispasmodic medication prescribed to relieve muscle spasms for clients who have multiple sclerosis. - D: Colchicine is an anti-inflammatory medication prescribed to relieve pain for clients who have gout.

A nurse is determining a client's risk of developing osteoporosis. The nurse should identify which of the following risk factors for bone loss? (Select all that apply.) A. Small body frame B. Hypertension C. African-American ethnicity D. Low vitamin D intake E. Smoking

A, D, E A. Small body frame D. Low vitamin D intake E. Smoking Females have a higher risk of developing osteoporosis than males. - Other risk factors include family history, low body mass index, and a small body frame. - Consuming inadequate levels of calcium and vitamin D, smoking, and ingesting high amounts of alcohol or caffeine also increase the risk of developing osteoporosis. - B: Hypertension does not specifically contribute to osteoporosis risk. Common osteoporosis comorbidities include hyperthyroidism and diabetes mellitus. - C: Caucasian and Asian ethnicities are associated with a higher risk of developing osteoporosis.

A nurse is providing teaching for a client following a below-the-knee amputation. Which of the following pieces of information should the nurse include in the teaching? A. Instruct the client to lie prone while in bed B. Ensure the client sleeps on a soft mattress C. Pull up the residual limb while in bed D. Keep the residual limb exposed to air to heal

A. Instruct the client to lie prone while in bed The nurse should instruct the client to lie in a prone position for 20 to 30 minutes every 3 to 4 hours. This prevents the client from developing contractures while in bed. - B: The nurse should instruct the client to sleep on a firm mattress following the procedure to prevent the development of contractures. - C: The nurse should instruct the client to push down the residual limb while in bed. This prepares the limb for the prosthetic and reduces the incidence of phantom pain. - D: The nurse should instruct the client to wrap the residual limb in an elastic bandage to assist with shrinking the limb and preparing for the prosthesis. The bandage should be wrapped in a figure-8 pattern from a distal to proximal direction. The bandages should be reapplied every 4 to 6 hours or more often if loose.

A nurse is caring for a client who has a pelvic fracture. The client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. The client is experiencing which of the following complications? A. Pneumonia B. Pulmonary embolus C. Tension pneumothorax D. Tuberculosis

B. Pulmonary embolus Immobility following musculoskeletal trauma places the client at an increased risk of pulmonary embolus. The client might also exhibit tachycardia and chest petechiae and have a decreased SaO2. The nurse should notify the rapid response team immediately.

A nurse in the emergency department is caring for a client who reports pain in her left leg following a motor-vehicle crash. The client's left leg has bruising, swelling, and displacement of the bones. Which of the following actions should the nurse take first? A. Obtain an X-ray of the injured leg B. Apply ice packs to the affected area C. Check neuromuscular status distal to the injury D. Elevate the affected leg on 2 pillows

C. Check neuromuscular status distal to the injury The greatest risk to this client is impaired circulation to the limb from trauma and the resulting edema; therefore, the first action is to check the circulation, sensation, and movement distal to the level of the injury. If the nurse notes a weak or absent pulse distal to the injury, the limb's circulation is compromised, and immediate action is critical.

A nurse is caring for a client who is postoperative following a lumbar disk excision. Which of the following interventions should the nurse include in the client's plan of care? A. Keep the client's legs flat with the knees extended B. Encourage the client to sit up in a chair for as long as possible C. Logroll the client in bed for care procedures D. Expect urinary retention for the first postoperative day

C. Logroll the client in bed for care procedures The client should receive instructions about logrolling preoperatively. The nurse may need to engage other staff members in assisting with logrolling to maintain proper alignment of the client's spine at all times postoperatively. - A: The client's knees should be in a position of slight flexion to help relax the back muscles. - B: Except while defecating, the client should avoid sitting in the immediate postoperative period. - D: Urinary retention is an indication of neurological deterioration following a laminectomy. The nurse should report this finding to the surgeon immediately.

A nurse is caring for a client who has a depressed skull fracture of the bone that makes up the larger part of the upper and side wall of the cranium. This fracture is located on which of the following bones? A. Sphenoid B. Occipital C. Parietal D. Frontal

C. Parietal The parietal bones from the larger part of the upper and side wall of the cranium. - A: The sphenoid bone forms part of the face - B: The occipital bone is in the back of the skull - D: The frontal bone is in the front of the skull

A nurse is providing nutrition education to a client who has osteomalacia. The nurse should identify that this condition is caused by a deficiency in which of the following nutrients? A. Fluoride B. Vitamin A C. Vitamin D D. Phosphorus

C. Vitamin D Osteomalacia, a softening of the bones due to defective bone mineralization, results from a deficiency of vitamin D.

A nurse is caring for a client following a hip arthroplasty. The nurse places an abduction pillow on the client for which of the following purposes? A. To raise the bed linens off the client's feet to prevent plantar flexion B. To keep the client's heels off the bed to prevent pressure ulcers C. To position the client off the operative site while in bed D. To prevent dislocation of the hip during position changes or movement

D. To prevent dislocation of the hip during position changes or movement Following surgery, the nurse should use an abduction pillow to prevent dislocation of the new hip joint. The nurse should place the wedge-shaped pillow between the client's legs to prevent adduction beyond the midline of the body during position changes or client movement, which can lead to subluxation or total dislocation of the hip joint.

A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following information should the nurse include? A. You will need to apply a cold pack to the site 3 times a day B. Your provider might ask you to walk frequently to increase circulation to the area C. You will need to limit your consumption of high-protein foods D. Your provider might prescribe a central catheter line for long-term antibiotic therapy

D. Your provider might prescribe a central catheter line for long-term antibiotic therapy Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV antibiotic therapy for treatment. Therefore, the nurse should discuss the need for long-term IV access for antibiotic therapy. - A: Cold therapy is contraindicated for a client who has an open wound. Cold causes decreased blood flow, which can further damage the impaired tissue. - B: The client is at an increased risk of a fracture of the weakened bone. Therefore, the nurse should instruct the client to limit weight-bearing as prescribed by the provider. - C: The client should consume a diet high in protein to support wound healing.

A nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. Which of the following findings should the nurse identify as the priority? A. Client reports of muscle spasms B. Inability to get dressed without assistance C. Client report of feelings of anger D. Refusal to look at the affected limb

A. Client reports of muscle spasms - According to Maslow's hierarchy of needs physical/physiological needs come before mental/emotional needs. - Therefore, the nurse should identify the report of muscle spasms (a physiological need) as the priority client finding

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the absent right foot. Which of the following statements should the nurse make? A. This type of pain usually decreases over time as the limb becomes less sensitive B. Try to look at the surgical wound as a reminder the limb is gone C. Use a cold compress intermittently to decrease these pain sensations D. Grief over the lost limb can sometimes cause denial that the limb is really gone

A. This type of pain usually decreases over time as the limb becomes less sensitive The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following an amputation. The nurse should instruct the client that the sensation should decrease over time. - The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain. - B: This statement by the nurse does not address the client's current concerns. - C: The nurse should instruct the client to use heat and massage, along with pharmacological interventions, to manage this type of pain. - D: The nurse should validate the client's report of pain and treat it accordingly. The client is not exhibiting denial; therefore, this statement by the nurse is not appropriate.

A nurse is caring for a client who is wearing a halo fixator. Which of the following interventions should the nurse implement? (Select all that apply.) A. Monitor the client's vital signs every 4 hr B. Monitor the client's pin sites for loosening C. Hold the halo device when turning the client D. Check the client's skin to ensure the jacket is not applying pressure E. Adjust the screws holding the client's halo device in place to ensure a proper fit

A, B, D A. Monitor the client's vital signs every 4 hr B. Monitor the client's pin sites for loosening D. Check the client's skin to ensure the jacket is not applying pressure - The nurse should monitor the client's vital signs and neurological status every 1 to 4 hours, depending on the client's overall status. - The nurse should monitor the client's pin sites for loosening. Loosening of the pins of the halo device can place the client's cervical or thoracic traction at risk, and the provider should be notified immediately if this occurs. - The nurse should check the client's skin for redness and ensure the vest is not rubbing against the client's skin, which can create a pressure ulcer. The nurse should check the client's skin to ensure that it is dry and clean to prevent skin breakdown. - C: The nurse should never hold or pull on the client's halo device to turn or reposition the client. This can cause misalignment and loosen the screws that are secured into the client's skull. - E: The nurse should never adjust the screws of the client's halo device. The screws are inserted into the client's skull to ensure proper alignment while the client's spinal cord injury heals. The provider is the only person who should make adjustments to the screws if needed.

A nurse is caring for a client with a hip fracture who has Buck's extension traction in place. Which of the following pieces of information should the nurse give the client about this type of traction? (Select all that apply.) A. You'll have considerably less pain with the traction in place B. You'll have the traction in place for a week or so C. The traction will help decrease muscle spasms D. The weights act as a pulling force to keep your leg and hip still E. We have to make sure the weights are just barely touching the floor

A, C, D A. You'll have considerably less pain with the traction in place C. The traction will help decrease muscle spasms D. The weights act as a pulling force to keep your leg and hip still Pain is usually more severe without the traction. - Buck's extension traction uses weights to help decrease muscle spasms. - Typically, 2.3-5.5 kg (5-10 lb) of force helps stabilize the hip and leg preoperatively. - B: Buck's extension traction is for short-term stabilization of a hip fracture prior to surgery. - E: The weights must stay suspended at all times and should not touch the floor.

A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following pieces of information should the nurse include? A. Cut the wiring if emesis occurs B. Consume 3 meals daily as part of a low-protein diet C. Swab the mouth with hydrogen peroxide if wiring produces oral irritation D. Resume a soft diet in 3 to 5 days

A. Cut the wiring if emesis occurs Inner maxillary fixation involves wiring of the teeth to support the fractured jaw by holding the jawbones together. The wires are left in place until the fracture is healed. - To preserve the client's airway, the nurse should instruct the client to have wire cutters available to cut the wiring immediately if emesis occurs. The client should return to the provider as soon as possible for re-wiring. - B: The nurse should encourage the client to consume adequate protein and calories for wound healing. Small, frequent meals can prevent nausea. - C: The nurse should instruct the client to report any irritation in the oral cavity to the provider. - D: The nurse should instruct the client to consume a liquid diet for 1 to 4 weeks postoperatively.

A nurse is teaching a client who has a cast on his left arm to treat a forearm fracture. Which of the following statements indicates that the client understands the teaching? A. I'll call the doctor's office if my fingers get colder on the arm with the cast B. If I have any itching under the cast, I'll try to reach the area with a cotton swab C. If my fingers swell, I should put a heating pad on them and rest D. If I have any tingling under my cast, I'll know I need to move my fingers more

A. I'll call the doctor's office if my fingers get colder on the arm with the cast The nurse should emphasize the importance of doing neuromuscular checks and notifying the provider of any unexpected findings, such as temperature variances. - B: The client should not insert any objects under the cast to relieve itching. Instead, the client can try blowing cool air from a blow dryer under the cast to relieve itching. - C: The client should elevate his arm to reduce swelling. Some providers prescribe ice packs for the first 24-48 hours, which might also help reduce swelling. - D: Tingling can indicate compartment syndrome, a complication that involves increased pressure within the fascia leading to reduced circulation to the area. It can also mean the cast is too tight. The client should report this finding to the provider immediately.

A nurse is caring for a client who has chronic phantom limb pain following an above-the-knee amputation. Which of the following medication prescriptions should the nurse verify with the provider? A. Meperidine B. Amitriptyline C. Gabapentin D. Propranolol

A. Meperidine Opioids are more effective for residual limb pain rather than phantom pain. Additionally, meperidine is not recommended for chronic pain because long-term use can cause accumulation of a toxic metabolite. - B: Amitriptyline is a tricyclic antidepressant that can help manage chronic phantom limb pain. - C: Gabapentin is an anti epileptic that can help manage chronic phantom limb pain. - D: Beta blockers, such as propranolol, can reduce the persistent, dull, burning sensations of chronic phantom limb pain.

A nurse is preparing to care for a client who is in balanced skeletal traction to stabilize a femur fracture. Which of the following actions should the nurse include int he client's plan of care? A. Offering the client a diet high in fluid and fiber B. Encouraging active range of motion of the affected leg C. Removing the weights prior to repositioning the client D. Inspecting pin sites every 24 hr for drainage

A. Offering the client a diet high in fluid and fiber A client who is immobile is at risk of constipation. The nurse should encourage a diet high in fluid and fiber to promote gastrointestinal function. - B: Active range of motion of the unaffected limbs is encouraged to prevent muscle wasting; however, active range of motion of a limb in traction is not feasible, as the traction apparatus limits mobility. - C: Once the weights are in place, the nurse should not remove them. - D: The nurse should plan to inspect the client's pin sites at least every 8 to 12 hours due to the risk of infection.

A nurse is providing discharge teaching to a client who has osteoarthritis. Which of the following instructions should the nurse include? A. Rest frequently after periods of activity B. Perform your exercises only on days that you feel good C. Perform your exercises after applying cold packs to your joints D. Place a large pillow under your knees when lying down

A. Rest frequently after periods of activity The joint pain in osteoarthritis is caused by deterioration of the synovial membranes and often worsens after activity. Rest usually helps relieve the pain, so performing activities at a comfortable pace with periods of rest is appropriate. - B: The client should perform exercise consistently on both good and bad days - C: The client should perform exercise immediately after applying heat to painful joints - D: The client should not use a large pillow under the knees or head because this can lead to contractors. A small pillow should be placed under the head or neck when lying down.

A nurse is preparing a client for an electromyogram (EMG). Which of the following statements indicates that the client understands the pre-procedure teaching? A. This test will help my doctor know if my nerves are working correctly B. The doctor will be able to fix the problem with my arm during this procedure C. I cannot eat or drink for at least 10 hr before I have this procedure D. I will get enough sedation to put me to sleep for this procedure

A. This test will help my doctor know if my nerves are working correctly An EMG shows electrical activity within the muscles during contraction. It is useful for discriminating between muscular dysfunction and nerve dysfunction.

A nurse is caring for a client who has a fractured right hip. Which of the following types of traction should the nurse expect the client to have prior to hip arthroplasty surgery? A. Balanced skeletal traction B. Pelvic belt C. Pelvic sling D. Buck's traction

D. Buck's traction Buck's traction is used prior to hip arthroplasty to maintain alignment and prevent muscle spasms prior to surgery. - A: Balanced skeletal traction is used to stabilize fractures of the femur or pelvis, not the hip. Skeletal traction involves the surgical insertion of pins, tongs, wires, or screws; this is sometimes used to stabilize long bone and vertebral fractures. - B: A pelvic belt is used to treat back pain and does not provide traction prior to hip arthroplasty. - C: A pelvic sling is used to stabilize pelvic fractures, not hip fractures.

A nurse is preparing a client for a bone scan. Which of the following statements indicates that the client understands the pre-procedure teaching? (Select all that apply.) A. I will have to drink a radioactive solution before the test begins B. A special camera will scan the bones in my entire body C. There will be better absorption of the radiation by healthy bone D. I'll have to drink a lot of water to help get the radiation out of my body E. I understand the radiation is harmless, and I don't have to worry about it

B, D, E B. A special camera will scan the bones in my entire body D. I'll have to drink a lot of water to help get the radiation out of my body E. I understand the radiation is harmless, and I don't have to worry about it A bone scan is a radionuclide procedure that allows viewing of the entire skeleton. It is less common than other diagnostic tests but is still useful for identifying hairline fractures and some malignancies. - The client should drink plenty of fluids to promote urinary excretion of the radioactive material. - The nurse should reassure the client that the radioactive material is not dangerous because it deteriorates quickly in the body and exits via urine and stool. - A: For a bone scan, the client will receive the radioactive material via IV injection. - C: Increased absorption of contrast material indicates bone disease and disorders.

A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures results when a client's bone breaks into multiple pieces? A. Avulsion B. Comminuted C. Compression D. Spiral

B. Comminuted A comminuted fracture is one in which the bone breaks into multiple pieces or fragments. - A: In an avulsion fracture, a tendon and its attachment have pulled away a fragment of bone. - C: In a compression fracture, a loading force to the long axis of a bone collapses the bone. This is common with vertebral fractures. - D: In a spiral fracture, the break twists around the bone's shaft.

A nurse is caring for a client who has a fractured hip and was placed in Buck's traction 4 hr ago. Which of the following actions should the nurse take? A. Inspect the client's skin underneath the boot every 12 hr B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr C. Remove the weights from the traction while repositioning the client in bed D. Loosen the ropes if the client reports muscle spasms in the affected extremity

B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr The nurse should encourage the client to perform dorsiflexion of the affected extremity every 2 hours to assess if the client is experiencing nerve damage. - Weakness of dorsiflexion can indicate peroneal nerve damage. If this occurs, the nurse should notify the provider immediately. - A: The nurse should inspect the client's skin underneath the boot for irritation, increased swelling, and skin breakdown every 8 hours. - C: The weights should never be removed without a prescription from the provider. The purpose of the weights is to decrease muscle spasms as a result of the hip fracture. - D: The ropes of the traction should never be loosened. This can affect the traction and increase the client's muscle spasms.

A nurse is caring for a client who is in skeletal traction following a femur fracture. On entering, the nurse finds that the client has slid toward the foot of the bed, and the traction weight is resting on the floor. Which of the following actions should the nurse take? A. Remove the weight temporarily to reposition the client to the correct alignment in bed B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely C. Lift the rope off the pulley while the client rocks back and forth to reposition himself D. Lift the weight manually while another staff member moves the client up in bed

B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely The nurse should ensure that traction weight is hanging freely. The client can use an overhead trapeze bar to move up in bed, or the nurse can assist the client while making sure to maintain proper alignment of the extremity. - A: The nurse should not remove the weight without a prescription, as this could interfere with the correct alignment of the extremity. - C: The nurse should ensure the traction ropes are on the pulley. Lifting the rope displaces the weight and can interfere with the correct alignment of the extremity. - D: The nurse should not lift the weight without a prescription because this could interfere with the correct alignment of the extremity.

A nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation. Which of the following actions should the nurse take? A. Place the client on a soft mattress B. Rewrap the residual limb with a bandage 3 times per day C. Assist the client into a prone position for 20 min every 8 hr daily D. Turn the client every 4 hr while in bed

B. Rewrap the residual limb with a bandage 3 times per day The nurse should rewrap the client's residual limb with a pressure bandage 3 times daily. This keeps the bandage taught, which ensures the residual limb will shrink. Rewrapping the bandage also allows the nurse to check on the skin for redness or skin breakdown. - A: The nurse should place the client on a firm mattress to prevent contractures from developing following surgery. - C: The nurse should assist the client into a prone position for 20 to 30 minutes every 3 to 4 hours daily. This prevents hip contractures from developing following surgery. - D: The nurse should turn the client every 2 hours while in bed to prevent contractures and increase the range of motion of the client's extremities. The nurse should turn the client slowly to prevent muscle spasms.

A nurse is preparing a client who is scheduled to have an arthroscopy the following day. Which of the following statements indicates that the client understands the pre-procedure teaching? A. I have to keep my leg straight throughout the whole procedure B. The doctor will be able to see if I have signs of rheumatoid arthritis C. I should expect to stay overnight until I can walk around D. I'll have a scar that will be about an inch long

B. The doctor will be able to see if I have signs of rheumatoid arthritis An arthroscopy helps with diagnosing musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, and internal joint injuries. - A: The client has to be able to flex the knee at least 40 degrees so the surgeon can insert the arthroscope into the joint space. - C: An arthroscopy typically requires ambulatory or same-day surgery. Activity restrictions are likely; however, the client is allowed to ambulate after anesthesia recovery, most likely with crutches. - D: The client might have several incisions that are typically about 0.6 cm (0.24 in) long.

A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid? A. Colchicine B. Naproxen C. Aspirin D. Prednisone

C. Aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications. - A: Colchcine is an anti-inflammatory gout medication used in conjunction with probenecid in acute host attacks. It is not known to interact with probenecid. - B: Naproxen is an NSAID used to decrease inflammation for clients who have gout; it is not known to interact with probenecid. - D: Prednisone is a glucocorticoid medication used to treat gout; it is not known to interact with probenecid.

A nurse is assessing a female client who reports severe joint pain. The nurse should identify that which of the following factors places the client at risk for gout? A. Perimenopause B. Migraine headaches C. Diuretic use D. Irritable bowel syndrome

C. Diuretic use The client's use of diuretics is a risk factor for gout. - Gout is a systemic disorder that affects the joints as a result of high uric acid levels in the blood. - A: A client who is postmenopausal is at risk for gout. - B: Migraine headaches are a risk factor for fibromyalgia, not gout. - D: Irritable bowel syndrome is a risk factor for fibromyalgia, not gout.

A nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client indicates an understanding of the teaching? A. I will wear a continuous movement machine on my knee for 24 hr a day B. I should avoid taking NSAID medications for pain after surgery C. I should wear elastic stockings on both of my legs D. I will begin exercising my legs the day after surgery

C. I should wear elastic stockings on both of my legs The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as an understanding of the teaching. - A: A continuous passive motion (CPM) machine is usually prescribed for a few hours at a time, several times a day. Not all clients are prescribed CPM therapy following a total knee arthroplasty. - B: The client's pain will be initially addressed with epidural or patient-controlled analgesia and supplemented by other analgesic medications, including NSAIDs. - D: The nurse should instruct the client to begin leg exercises while in bed during the immediate postoperative period, including heel pumps and quadriceps-setting exercises.

A nurse is planning care for a client following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan? A. Position the client with her legs adducted B. Internally rotate the client's affected hip C. Place a pillow between the client's legs D. Instruct the client to avoid flexing her hip more than 95 degrees

C. Place a pillow between the client's legs The nurse should plan to place a pillow or a wedge between the client's legs to reduce the risk of hip dislocation. - A: The nurse should position the client with her legs abducted to reduce the risk of hip dislocation - B: The nurse should avoid internal rotation of the client's affected hip to reduce the risk of hip dislocation - D: The nurse should instruct the client to avoid flexing her hip more than 90 degrees to reduce the risk of hip dislocation

A nurse is caring for a client who is scheduled to undergo surgery to repair an open hip fracture. In which of the following positions should the nurse plan to place the client postoperatively? A. With the leg on the affected side adducted B. With the hip externally rotated on the affected side C. With the leg on the affected side abducted D. With the hip flexed to 90 degrees on the affected side

C. With the leg on the affected side abducted The nurse should plan to place the client with the leg abducted on the affected side postoperatively. Adduction or external rotation of the leg will cause the hip to dislocate. - A: Adduction of the client's leg will cause the hip to dislocate, requiring further surgery. - B: External rotation of the client's leg will cause the hip to dislocate, requiring further surgery. - D: Flexion of the client's hip at 90 degrees or greater will cause the hip to dislocate, requiring further surgery.

A nurse in the emergency department is preparing to discharge a client following a Grade 2 (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client? A. Perform passive range-of-motion exercises of the ankle hourly B. Keep the affected extremity in a dependent position C. Wrap a loose dressing around the affected ankle D. Apply cold compresses to the extremity intermittently

D. Apply cold compresses to the extremity intermittently Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 minutes at a time. - A: Perform passive range-of-motion exercises of the ankle hourly. - B: The nurse should instruct the client to elevate the extremity to decrease swelling. - C: The nurse should instruct the client to apply a compression dressing to decrease swelling of the affected area.

A nurse is teaching a client with arthritis who is experiencing joint pain that impairs mobility. Which of the following instructions should the nurse include? A. Engage your joints in resistance exercises B. Avoid using assistive devices when walking C. Perform passive exercises D. Apply heat to your joints prior to exercising

D. Apply heat to your joints prior to exercising The nurse should instruct the client to apply heat to the joints prior to exercising to increase mobility and reduce pain. - A: The nurse should instruct the client to avoid resistance exercise because it can cause joint injury when joints are soft and inflamed. - B: The nurse should instruct the client to use assistive devices when walking to promote independence and increase mobility. - C: The nurse should instruct the client to perform active exercises when possible to increase mobility.

A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures is especially common in children? A. Impacted B. Depressed C. Compound D. Greenstick

D. Greenstick With a greenstick fracture, there is an incomplete break in the bone. One side of the bone usually splinters, while the other side is bent but intact. This type of fracture is common in children because their bones are more flexible than those of an adult. - A: In an impacted fracture, the force of the injury drives one fragment of bone into another fragment of bone. - B: In a depressed fracture, the force of the injury drives the bone fragments inward. This is common with skull and facial fractures. - C: In a compound fracture, the sharp edge of the bone breaks through the skin.

A nurse is assessing a client who has osteoarthritis. The client's medical record indicates the presence of Heberden's nodes. Which of the following findings should the nurse expect? A. Inflamed, fluid-filled sacs over the joints B. Clubbing of the fingernails C. Flexion contracture of the fingers D. Hard lumps over the joints of the fingers

D. Hard lumps over the joints of the fingers Herberden's nodes are hard, bony lumps or nodules in the joints of the fingers. - A: Inflamed, fluid-filled sacs over the joints are manifestations of bursitis or inflammation of the bursa of the joints. - B: Clubbing of the fingernails reflects prolonged hypoxia. - C: A progressive flexion contracture of the palmar fascia affecting the middle, fourth, or fifth fingers describes Dupuytren's disease.

A nurse is teaching a client who has a new prescription for alendronate for the treatment of osteoporosis. Which of the following statements by the client indicates an understanding of the teaching? A. I will take the medication in the evening B. I will drink a full glass of milk with the medication C. I will take the medication at mealtime D. I will sit upright after taking the medication

D. I will sit upright after taking the medication A client taking alendronate should sit upright for 30 minutes after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching. - A: The nurse should instruct the client to take alendronate in the morning. - B: High-calcium foods can reduce the absorption of alendronate. Alendronate can cause hypocalcemia; therefore, the client might require a calcium supplement to be taken at a different time of day. - C: The nurse should instruct the client to take alendronate at least 30 minutes before food.