Mobility EAQ

What should the nurse tell the mother concerning an exercise program for her child diagnosed with idiopathic scoliosis who has a mild structural curve?

Answer: Exercise is used in conjunction with a brace. Reason: An exercise program and a brace are the treatments of choice for mild structural scoliosis. Although compliance will affect the ultimate outcome of treatment, exercises alone are not helpful in this type of scoliosis. Exercises are to be encouraged, regardless of the type or extent of scoliosis. Exercises alone are used only with postural-related, not structural-related, scoliosis.

Which diagnostic procedure is used to detect muscle weakness?

Answer: Electromyography Reason: Electromyography is performed to detect diffuse or localized muscle weakness by determining the electric potential generated in an individual. Arthroscopy is used for the direct visualization of ligaments, menisci, and articular surfaces of a joint. A radiography is performed to detect bone density, alignment, swelling, and intactness of a joint. A myelography is performed to visualize the vertebral column, intervertebral discs, spinal nerve roots, and blood vessels.

A client newly diagnosed with type 1 diabetes asks why it is necessary to exercise on a regular basis. Which response is accurate?

Answer: "Exercise improves the cellular uptake of glucose." Reason: Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin. Glucagon action raises blood glucose but does not affect cell uptake or use of glucose. Cellular requirements for glucose increase with exercise.

After a below-the-knee amputation, a client is refusing to eat, talk, or perform any rehabilitative activities. Which approach would the nurse take when interacting with this client?

Answer: Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving. Reason: The withdrawal provides time for the client to assimilate what has occurred and to integrate the change in body image. The client is not ready to hear explanations about why there is a need to increase activity until assimilation of the surgery has occurred. Emphasizing a return to the previous lifestyle does not acknowledge that the client must grieve; it also does not allow the client to express any feelings that life will never be the same again. In addition, it may be false reassurance. The client might feel that the nurse has no comprehension of the situation or understanding of feelings if the nurse appears cheerful and noncritical regardless of the client's response to attempts at intervention.

The day after undergoing abdominal appendectomy, a school-aged child is prepared for ambulation. Which nursing action would be most effective before the start of ambulation?

Answer: Administering the prescribed pain medication Reason: Children in pain resist any activity that increases their pain. The child is more likely to cooperate with activities that promote recovery if pain is being addressed. Children will rest spontaneously when tired. A reward may be helpful if the child is uncooperative, but it will not be beneficial if the child is in pain. Although use of the spirometer is an important postoperative activity, use of the device before walking is unnecessary. Walking not only helps aerate the lungs but also hastens peristalsis.

Which complications would the nurse monitor in a client who sustained a transection of the spinal cord, but no other injuries?

Answer: Autonomic hyperreflexia Reason: Autonomic hyperreflexia, an uninhibited and exaggerated response of the autonomic nervous system to stimulation, results in a blood pressure greater than 200 mm Hg systolic; it is a medical emergency. Although hemorrhage and hypovolemic shock could occur from the trauma, the scenario stated that no other injuries occurred. Although gastrointestinal atony can result from immobility, it is not a medical emergency.

Which action would the nurse take for a client with a diagnosis of conversion disorder manifesting as paralysis of the legs?

Answer: Avoid focusing on the client's physical symptoms. Reason: The nurse would avoid focusing on the client's physical symptoms. The physical symptoms are not the client's major problem and therefore would not be the focus of care. This is a psychological problem, and the focus would be in this domain. Encouraging the client to try to walk is focusing on the physical symptom of the conflict; the client is not ready to give up the symptom. The disorder operates on an unconscious level but is very real to the client; saying there is nothing wrong denies feelings. Psychotherapy, not physical therapy, is needed at this time.

A client had surgery on the shoulder, and the nurse is to obtain a brachial pulse. Where on the illustration would the nurse indicate to best obtain the brachial pulse rate?

Answer: B Reason: One of the several pulse points in the body is the brachial artery (option b); it is the main artery of the upper arm and it bifurcates into the radial and ulnar arteries. Option a is not a major artery of the arm; it is not a pulse point. Option c is the radial artery, which is where the radial pulse is palpated. Option d is the ulnar artery, which is where the ulnar pulse is palpated.

Which radiographic test is used to view the entire skeleton?

Answer: Bone scan Reason: A bone scan is a radionuclide test in which radioactive material is injected so that the client's entire skeleton can be viewed. Gallium and thallium scans are similar to bone scans but are more specific and sensitive in detecting bone disorders. A CT scan is used to detect musculoskeletal problems primarily in the vertebral column and joints. An MRI scan is used to diagnose musculoskeletal disorders.

Which condition can be identified in a client using Phalen's test?

Answer: Carpal tunnel syndrome Reason: Phalen's test is used to detect carpal tunnel syndrome. A muscle biopsy is done for the diagnosis of atrophy. A computed tomography scan is done to diagnose a bone tumor. The drop arm test is performed to detect rotator cuff injuries. View Topics

The nurse understands which adverse effect on pediatric clients is associated with nalidixic acid?

Answer: Cartilage erosion Reason: Nalidixic acid can cause cartilage erosion in pediatric clients. Sulfonamides can cause kernicterus. Chloramphenicol can cause Gray syndrome in neonates and infants. Fluoroquinolones can cause tendon rupture in pediatric clients.

A 7-year-old child sustains a fractured femur in a bicycle accident. The admission x-ray films reveal evidence of fractures of other long bones in various stages of healing. Which would the nurse suspect as the cause of the fracture?

Answer: Child abuse Reason: Injuries in various stages of healing are the classic sign of child abuse. Vitamin D deficiency, osteogenesis imperfecta, and inadequate calcium intake may all be investigated after child abuse has been ruled out.

Which type of bone tumor occurs most commonly in elderly clients?

Answer: Chondrosarcoma Reason: Chondrosarcoma occurs most commonly in cartilage in the arm, leg, and pelvic bones of older adults in the age group of 50 to 70 years old. Endochroma occurs in clients in the age group of 10 to 20 years old. Osteosarcoma and osteochondroma occur in the age group of 10 to 25 years old.

While assessing a child who has just had a short arm cast applied to a fractured right wrist, the nurse discovers that the fingers of the right hand are cool. Which would the nurse do first?

Answer: Compare the temperature of the two hands. Reason: Cool fingers are a sign of circulatory impairment caused by the pressure of the cast; however, the finding that both hands feel cool indicates that some factor other than circulatory impairment is responsible. The cast should not be adjusted without prior notification of the HCP. Further assessment to determine the cause of temperature change is indicated before remedial action such as elevating the right arm is taken. Further assessment is needed before the practitioner is informed.

Which complication is associated with Pott disease?

Answer: Destruction of intervertebral discs Reason: Pott disease is tuberculosis (TB) of the spine, which can lead to destruction of intervertebral discs. Abdominal TB can cause peritonitis. Central nervous system TB can cause severe bacterial meningitis. Generalized lymphadenopathy can be caused by miliary tuberculosis.

After assessing the muscle functionality of a client, the nurse assigns a grade of F (fair) on the Lovett scale in the client. Which describes the muscle functionality of the client?

Answer: Full range of motion with gravity Reason: In the Lovett scale, grade F (fair) is given to clients who exhibit a full range of motion with gravity. Full range of motion in passive motion is assigned a P (poor) score. When a client exhibits full range of motion against gravity with full resistance, the client is given an N (normal) score. When a client exhibits full range of motion against gravity with marginal resistance, the client is given a score of G (good).

While assessing the muscle tone of a client, the client demonstrates a full range of muscle motion against gravity with some resistance. Which score on the Lovett scale would be given to this client?

Answer: Good (G) Reason: According to the Lovett score, a full range of motion against gravity with some resistance can be categorized as G (good). F (fair) can be given if the client exhibits a full range of motion with no resistance. T (trace) score is given when the client exhibits slight contractility with no movement. N (normal) on the Lovett scale indicates full range of motion against gravity with full resistance.

Which type of fracture is common in preschool children?

Answer: Greenstick Reason: Ossification of the long bones is incomplete in childhood; children's bones can flex to about a 45-degree angle before breaking. When the bone is angulated beyond 45 degrees, the compressed side bends and the torsion side breaks ( greenstick fracture). A transverse fracture is usually a complete fracture seen in blunt trauma; it occurs in adults because bone ossification is complete. A compound fracture is a fracture with an open wound from which the bone protrudes; it is seldom seen in children. A comminuted fracture is a fracture in which small fragments of bone are broken from the fracture site and lie in the surrounding tissue; it is rarely seen in children.

Which hormonal deficiency would increase the client's risk for fractures?

Answer: Growth hormone Reason: Growth hormone deficiency causes decrease in bone density, thereby increasing the risk of fractures. Follicle-stimulating hormone deficiency causes amenorrhea, decreased libido, and infertility in women and impotence in men. Thyroid-stimulating hormone deficiency causes menstrual abnormalities and hirsutism. Adrenocorticotropic hormone deficiency causes hypoglycemia and hyponatremia. View Topics

After a discectomy and fusion surgery, the client wants to attempt walking with assistance for the first time. Upon rising to a standing position, the client reports feeling faint and light headed. Which action would the assisting nurse have the client do upon hearing the client's concern?

Answer: Have the client sit on the edge of the bed so the nurse can hold the client upright. Reason: Sitting maintains alignment of the back and allows the nurses to support the client until orthostatic hypotension subsides. Sliding to the floor and bending forward will induce flexion of the vertebrae, which can traumatize the spinal cord. Rapid movement can flex the vertebrae, which will traumatize the spinal cord; taking the BP at this time is not necessary.

An infant is found to have developmental dysplasia of the hip 6 weeks after birth. The parents ask the nurse why their infant must be restrained in a harness at such an early age. How would the nurse respond?

Answer: Infants' hip joints are cartilaginous, allowing molding of the acetabulum. Reason: The cartilaginous nature of infants' hip joints is the basis for the use of abduction devices (e.g., Pavlik harness) when the infant is very young. Although an infant is easier to manage in a harness than is a toddler, the main reason for the use of a harness so early in life is the easy moldability of the bones at this age. Traction may be used before surgery to correct contractures; these treatments are more traumatic than the harness, which is applied before the infant can walk. Hip dysplasia is usually not painful and does not limit ambulation for the young child. Abduction, not adduction, devices are used; abduction devices are ineffective by the time the child reaches the toddler age.

A student athlete reports muscle pain after a practice session. Which product of muscle metabolism would the nurse explain as being a cause of pain?

Answer: Lactic acid Reason: The ache in muscles that have been vigorously worked without adequate oxygen supply is caused in part by the buildup of lactic acid. During rest, the lactic acid is oxidized completely to carbon dioxide and water, providing adenosine triphosphate for further muscular contraction. Beta-hydroxybutyric acid and acetoacetic acid are not products of muscle contraction; they are ketone bodies resulting from incomplete oxidation of fatty acids. Hydrochloric acid is not a product of muscle contraction; it is present in the stomach to facilitate the digestive process.

A 13-year-old adolescent is found to have idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport would the nurse suggest as the most therapeutic for this preadolescent?

Answer: Swimming Reason: The hyperextension required in swimming helps strengthen back muscles and necessitates deeper respirations, both of which are necessary before surgery and before wearing a brace or cast. The other options involve twisting the back muscles, which is not therapeutic for a child with this condition.

The nurse finds a victim under the wreckage of a collapsed building. The individual is conscious, supine, breathing satisfactorily, reports experiencing back pain and an inability to move the legs. Which action would the nurse implement first?

Answer: Leave the individual lying on the back with instructions not to move, and seek additional help. Reason:The nurse would not move the individual without use of a backboard, to avoid additional spinal cord damage. Moving a person whose spinal cord has been injured may cause irreversible paralysis. A back injury precludes changing the person's position. The client has a suspected back injury; do not move the person. The client needs a flat board; however, one rescuer should not move the person without help.

A client with Parkinsonism takes an anticholinergic medication for morning stiffness and tremors in the right arm. During a visit to the clinic, the client complained of some numbness in the left hand. Which intervention would the nurse implement for this client?

Answer: Make immediate arrangements for further medical evaluation by the client's primary health care provider. Reason: Numbness, a sensory deficit, is inconsistent with Parkinsonism; further medical evaluation is necessary. Numbness, even in the absence of other problems, may be indicative of an impending "brain attack" (cerebrovascular accident [CVA]). Parkinsonism does not have this symptom. Increasing the dosage of the anticholinergic medication will not be helpful. Stressing the importance of having the client call the primary health care provider as soon as possible can cause a delay in the client receiving immediate medical attention.

Which position would the nurse use for placement of the affected extremity of a client who is recovering from an open reduction and internal fixation (ORIF) of a fractured hip?

Answer: Moderate abduction Reason: Abduction reduces stress on anatomic structures and maintains the head of the femur in the acetabulum. External rotation places stress on the acetabulum and the head of the femur. Hip flexion may dislodge the head of the femur from the acetabulum. Functional alignment places stress on the bone, soft tissue, and nail plate; it can cause damage and dislocation of the head of the femur

Which is the priority assessment for the client who has Guillain-Barré syndrome with rapidly ascending paralysis?

Answer: Monitoring respiratory status Reason: The most serious complication of Guillain-Barré syndrome is respiratory failure caused by respiratory muscle paralysis. Urinary retention is common in Guillain-Barré, but monitoring urinary output is of lower priority than monitoring respiratory status. If ascending paralysis impairs the gag reflex, clients may require tube feedings or parenteral nutrition. Assessing nutritional status, however, is of lower priority than monitoring respiratory status. If ascending paralysis impairs cranial nerve functioning or if the client is intubated, verbal communication abilities are lost.

The nurse has provided discharge instructions to a client who received a prescription for a walker. The nurse determines that the teaching has been effective when the client does which?

Answer: Moves the walker no more than 12 inches (30.5 cm) during use Reason: Safety is always a consideration when teaching a client how to use an assistive device. The correct procedure regarding using a walker is to move the walker no more than 12 inches (30.5 cm) in front to maintain balance and to be effective in forward movement. Carrying the walker when ambulating is incorrect. Once the client is instructed and can demonstrate correct use of a walker, there is no need for someone to be present every time the client uses the walker. If the client is ordered to use a walker as part of the discharge plan, it needs to be provided before the client leaves the hospital.

Which is the first-line treatment for Paget's disease?

Answer: Oral alendronate Reason: Oral alendronate, a bisphosphonate, is the first-line treatment for Paget's disease. Clients with Paget's disease also are given 1500 mg of calcium daily as a supplement to reduce the risk for hypocalcemia. When oral medications are ineffective, pamidronate and zoledronic acid are administered intravenously.

A client is admitted to the hospital after general paresis develops as a complication of syphilis. Which therapy is indicated for treatment of this condition?

Answer: Penicillin therapy Reason: Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs. Tranquilizers are used to modify behavior, not to treat general paresis. Behavior, not paresis, is treated with behavior modification. Electroconvulsive therapy is used to treat certain psychiatric disorders.

Which principles of body mechanics would the nurse use when providing care for an immobilized client?

Answer: Placing the feet apart to increase the stability of the body Reason: Placing the feet apart creates a wider base of support and brings the center of gravity closer to the ground. This improves stability. The nurse should avoid bending at the waist because the movement strains the lower back muscles; the muscles of the thighs and buttocks should provide the power of lifting. Prevent pressure on the abdomen by tightening the abdominal and gluteal muscles to form an internal girdle; keeping the body straight does not reduce strain on the abdominal musculature. Relaxing the abdominal muscles with physical activity increases back strain.

Which information would the nurse include in the discharge teaching plan for a client who sustained a cerebrovascular accident (CVA, also known as a "brain attack") with residual hemiparesis and hemianopsia?

Answer: Significance of a safe environment Reason: Safety becomes a priority when the client has hemiparesis (paralysis on one side) and hemianopsia (abnormal visual field). Although a balance between activity and rest is important, the client does not have to maintain bed rest. O 2 generally is not necessary. All the basic nutrients should be included in the diet; there is no reason to reduce protein intake.

How would the nurse prevent footdrop in a client with a leg cast?

Answer: Support the foot with 90 degrees of flexion. Reason: To prevent footdrop (plantar flexion of the foot because of weakness or paralysis of the anterior muscles of the lower leg) in a client with a cast, the foot should be supported with 90 degrees of flexion. Bed rest can cause footdrop, and 45 degrees is not enough flexion to prevent footdrop. Application of an elastic stocking for support also will not prevent footdrop; a firmer support is required.

Which diagnostic study would the health care provider use to investigate the cause of an inflamed joint and determine a client's response to anti-inflammatory medication therapy?

Answer: Thermography Reason: Thermography uses an infrared detector that measures the degree of heat radiating from the skin's surface. Health care providers use this method to investigate the cause of an inflamed joint and in determining the client's response to anti-inflammatory medication therapy. Use of plethysmography is to record variations in volume and pressure of blood passing through tissues. Duplex venous Doppler records blood flow abnormalities to the lower extremities, which helps detect deep vein thrombosis. Somatosensory evoked potential use identifies subtle dysfunction of lower motor neuron and primary muscle disease.

A client returns from surgery, after a right below-the-knee amputation, with the residual limb straight, but elevated on a pillow to prevent edema. In which position would the nurse place the client after the first postoperative day?

Answer: Turn client to the prone position for 15 to 20 minutes at least three times a day Reason: Positioning the client in the prone position for short periods helps prevent hip flexion contractures. Do not immobilize the client's residual limb, but do not keep the joint bent for prolonged periods. Begin exercises to prevent contractures as soon as possible. Positioning the client in the right side-lying position can cause trauma to the incision site and should be avoided. Do not elevate the client's residual limb for more than 48 hours because hip flexion contractures can result.

The nurse is preparing to initiate antibiotic therapy for a client who developed an incisional infection. Which task would the nurse ensure has been completed before starting the first dose of intravenous antibiotics?

Answer: Wound culture Reason: A wound culture always should be completed before the first dose of antibiotic. A wound culture is obtained to determine the organism that is growing. A broad spectrum antibiotic often is given first; after the organism has been identified an organism-specific antibiotic can be given. There is no indication that a red blood cell count is needed; however, a white blood cell count would be beneficial. A urinalysis is not needed, because data gathered during the assessment indicate an incisional infection. At the early stage of the infection, there is no need to obtain a knee x-ray.