Musculoskeletal CP

The nurse is reinforcing education for a client diagnosed with gout. What statement made by the client demonstrates an understanding by the client? "Increasing fluid intake will increase the calcium my body absorbs." "Increasing fluid intake will cause my body to excrete more uric acid." "I'll increase my fluids so that the inflammation will be reduced." "Increasing fluids will help provide a cushion for my bones."

"Increasing fluid intake will cause my body to excrete more uric acid." Fluids promote the excretion of uric acid. Fluids don't decrease inflammation, increase calcium absorption, or provide a cushion for bones.

A client asks for information about osteoarthritis. Which statement should the nurse include when reinforcing education for the client on this condition? "Osteoarthritis afflicts people older than age 60." "Osteoarthritis is a rare form of arthritis." "Osteoarthritis is rarely debilitating." "Osteoarthritis is the most common form of arthritis."

"Osteoarthritis is the most common form of arthritis."

The nurse is caring for a client who reports of lower back pain. Which instructions should the nurse give the client to prevent back injury? "Bend over the object you are lifting." "Narrow the stance when lifting." "Stand close to the object you are lifting." "Push or pull an object using your arms."

"Stand close to the object you are lifting." Standing close to an object when lifting moves the body's center of gravity closer to the object, allowing the legs, rather than the back, to bear the weight. No one should bend over an object when lifting; instead, the back should be straight, and bending should be at the hips and knees. When lifting, spreading the legs apart widens the base of support and lowers the center of gravity, providing better balance. Pushing or pulling an object using the weight of the body, rather than the arms or back, prevents back strain. Using multiple muscle groups distributes the workload.

The health care provider has ordered for a child with an open femur fracture morphine sulfate 10 mg PO times one dose. The elixir on hand is 100 mg/5 mL. How many milliliters will the nurse administer? Record your answer using one decimal place.

0.5

Which of the following would the nurse identify as a neurotransmitter? Adenosine triphosphate (ATP) Cholinesterase Creatine phosphate Acetylcholine

Acetylcholine Acetylcholine is a neurotransmitter contained in the axon terminal vesicles. ATP is the substance that, when broken down, provides energy for muscle contraction. Cholinesterase is an enzyme that breaks down acetylcholine and prevents continuous stimulation of skeletal muscle. Creatine phosphate is a substance found in muscle that, when broken down, releases energy.

A nurse is providing care to a client with an acute attack of gout. Which action should the nurse provide first? Administer analgesics. Force fluids. Encourage bed rest. Instruct the client on relaxation techniques.

Administer analgesics. Administering analgesics to relieve the pain of gout should be the priority. The other actions are appropriate measures to institute but aren't the priority.

The nurse monitors a client receiving enoxaparin, 30 mg subQ b.i.d after hip replacement surgery. Which adverse reaction is the client most likely to experience? Hypersensitivity Bronchospasm Anaphylactic shock Bleeding

Bleeding

The nurse is caring for an elderly female with osteoporosis. When teaching the client, the nurse should include information about which major complication of this condition? Loss of estrogen Negative calcium balance Bone fracture Dowager's hump

Bone fracture

A client is brought to the emergency department with a painful swollen ankle. Which is the nurse's most appropriate action? Elevate the ankle. Administer 500 mg acetaminophen. Apply a warm compress. Encourage active range of motion.

Elevate the ankle

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative plan of care? Removing the pressure dressing after the first 8 hours Applying heat to the stump as the client desires Elevating the stump for the first 24 hours Maintaining the client on complete bed rest

Elevating the stump for the first 24 hours Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.

A 22-year-old client with an external fixation device attached to his left thigh is unable to bear weight on his left leg. He asks a nurse if he can take a shower on his third postoperative day. After a review of the physician's orders, the nurse notes an order stating, "Client may shower ten (10) days after surgery." In order to meet the client needs, what appropriate action will the nurse take? Assist the client into the shower while he supports himself with one crutch. Explain that he is not permitted to shower, but the nursing assistant can help him with a sponge bath. Wrap the device with plastic and then assist the client into the shower using a wheelchair. Suggest that the client wait until he's able to bear weight on his left leg.

Explain that he is not permitted to shower, but the nursing assistant can help him with a sponge bath.

A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men older than age 30?

Gouty arthritis

The infection control team has identified a 25% infection rate on the orthopedic floor. The nursing staff members are asked to record their care activities by recording them in a log to help identify the cause of the high infection rate. Which of the following care activities should be recorded in the activity log? Sterile gown use when changing clients' linens Wearing a mask when changing sterile dressings Hand washing between client contacts Clean glove use when applying sterile dressings

Hand washing between client contacts

A client sustained a fracture of the right tibia and has just had a cast applied. Which instruction should the nurse reinforce regarding cast care? Cover the cast with a blanket until it dries. Keep the extremity elevated above heart level. A foul smell from the cast is normal. Use a metal object to scratch itching inside the cast.

Keep the extremity elevated above heart level.

A client recovering from back surgery tells a nurse that she's concerned about going home. She explains that she has many stairs to navigate and household responsibilities she must perform. How can the nurse help ease this client's concerns? Notify the physician of the client's concerns, and request that he postpone her discharge. Ask the client's husband to hire an assistant to help the client while she recovers. Encourage the client to express her feelings, and offer suggestions to help her cope. Notify the charge nurse of the client's concerns, and request a team meeting to discuss the client's discharge planning.

Notify the charge nurse of the client's concerns, and request a team meeting to discuss the client's discharge planning The nurse should notify the charge nurse of the client's concerns and request a team meeting to discuss the client's discharge planning. Planning should include the client's need for home health care as well as assistance with household chores. The nurse shouldn't independently contact the client's husband. The nurse should encourage the client to express her feelings, but she must also devise a discharge plan that will effectively meet the client's needs after discharge. The nurse shouldn't request that the physician delay discharge unnecessarily.

A nurse is caring for a client who sustained a gunshot wound to the leg during a jewelry store robbery. The client is in police custody and receiving treatment in the emergency department. A member of the media asks the nurse about the client's condition. How should the nurse respond? Contact the physician to receive an update on the client's condition and then inform the media. Meet with the media in the lobby and inform them of the client's condition. Notify the nursing supervisor so she can obtain a formal statement from the physician about the client's condition for the media. Ask security to escort the media to the client care area to interview the client.

Notify the nursing supervisor so she can obtain a formal statement from the physician about the client's condition for the media.

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent

A nurse is caring for a confused client with a fractured hip who is trying to get out of bed. Which action should the nurse take first? Reorient the client to the surroundings. Move the client closer to the nurse's station. Review the facility's restraint policy. Obtain a prescription for wrist restraints.

Reorient the client to the surroundings.

A nurse is reinforcing homecare instructions to a client who is being discharged with a lower leg cast. Which critical information should the nurse reinforce? Report excessive swelling below the cast immediately. Avoid walking on the leg cast until instructed to do so. Use the crutches as instructed to prevent injury. Exercise joints above and below the cast, as prescribed.

Report excessive swelling below the cast immediately. Although all of these interventions are important, reporting signs of impaired circulation is the most critical for the client being discharged with a cast on the leg. The nurse must instruct the client to report signs of impaired circulation or neurovascular compromise to prevent permanent tissue damage (Increased pain and the feeling numbness and tingling, excessive swelling, and loss of movement below the cast). The other options reflect more long-term concerns. The client should learn to use the crutches properly to avoid nerve damage. The client may exercise above and below the cast, per primary care provider prescription. The client should be told not to walk on the cast without the primary care provider's permission.

A child is brought to the school nurse with the index finger of the left hand partially amputated and hanging by a shred of skin. What is the appropriate action by the nurse? Securely wrap the hand and finger and place them in a cold water-filled baggie. Place the finger under warm running water and wrap in a towel. Tightly squeeze the finger 1 inch above the cut to stop bleeding. Cut the skin holding the finger and wrap the detached finger in a clean wet towel.

Securely wrap the hand and finger and place them in a cold water-filled baggie. Leave the skin intact, wrap the entire hand and finger with a towel, and place it in a cool solution to preserve cell life and increase the chance of successful reattachment. The finger should not be detached, warm water should not be used and the circulation to the finger should not be decreased by tightly squeezing about the cut.

The nurse is caring for a client with a long leg cast. Which nursing intervention can best prevent foot drop? Support the foot with 45 degrees of flexion. Support the foot with 90 degrees of flexion. Place a stocking on the foot to provide warmth. Encourage bed rest.

Support the foot with 90 degrees of flexion. To prevent foot drop in a casted leg, the foot should be supported with 90 degrees of flexion. Bed rest can cause foot drop. Keeping the extremity warm won't prevent foot drop.

The nurse is instructing unlicensed assistive personnel (UAP) on the proper care of a client in Buck's extension traction following a fracture of his left fibula. Which observation indicates that the education was effective? The UAP instructs the client to perform ankle rotation exercises. The weights are allowed to hang freely over the end of the bed. The UAP lifts the weights when assisting the client to move up in bed. The leg in traction is kept externally rotated.

The weights are allowed to hang freely over the end of the bed In Buck's extension traction, the weights should hang freely without touching the bed or floor. Lifting the weights would break the traction. The client should be moved up in bed, allowing the weights to move freely along with the client. The leg should be kept in straight alignment. Performing ankle rotation exercises could cause the leg to go out of alignment.

The nurse is reinforcing education on cast care for a client with a cast on the arm. How should the nurse instruct the client to place the casted limb, if there is swelling? below the level of the heart close to the body at the level of the heart above the level of the heart

above the level of the heart To reduce swelling, place the limb with the cast above the level of the heart. Placing it below or at the level of the heart won't reduce swelling. To elevate a cast, the limb may need to be extended from the body.

In a child with developmental dysplasia of the hip (DDH), which position of the femur is accurate in relation to the acetabulum?

anterior

Which intervention would a nurse expect to use to prevent venous stasis after skeletal traction application? convoluted foam mattress antiembolism stockings or an intermittent compression device bed rest only vigorous pulmonary care

antiembolism stockings or an intermittent compression device

A client with long-standing rheumatoid arthritis has frequent reports of joint pain. The plan of care should be based on the understanding that chronic pain is most effectively relieved when analgesics are administered in which way? conservatively intramuscular at regularly scheduled intervals on an as-needed basis

at regularly scheduled intervals To control chronic pain and prevent cycled pain, regularly scheduled intervals of analgesia administration are most effective. As-needed and conservative administration aren't effective means to manage chronic pain because the pain isn't relieved regularly. IM administration isn't practical on a long-term basis.

A child in skeletal traction for a fracture of the right femur reports new and constant left calf pain. Also, the nurse notes that the child's left calf is 1 inch larger than the right and that he has nonpitting edema below the left knee. The nurse knows these signs are most consistent with which condition? infection fat emboli pulmonary embolism deep vein thrombosis (DVT)

deep vein thrombosis (DVT) Constant unilateral leg pain and significant edema should lead the nurse to suspect DVT. Symptoms of fat emboli include restlessness, tachypnea, and tachycardia and are more common in long-bone injuries. It's unlikely that an infection would occur on the side opposite the fracture without cause. Tachycardia, chest pain, and shortness of breath may be symptoms of a pulmonary embolism.

A client is taking salicylates for osteoarthritis. What should the nurse carefully monitor the client for? increased pain in joints hearing loss decreased calcium absorption increased bone demineralization

hearing loss Many older adults already have diminished hearing, and salicylate use can lead to further or total hearing loss. Salicylates don't increase bone demineralization, decrease calcium absorption, or increase pain in joints.

A client with a recent fracture is suspected of having compartment syndrome. Which findings does the nurse recognize correlate with this diagnosis? inability to perform active movement; pain with passive movement a growth in and around the bone tissue inability to perform passive movement; pain with active movement bodywide decrease in bone mass

inability to perform active movement; pain with passive movement

The parents of a neonate diagnosed with clubfoot ask the nurse to explain talipes varus. The nurse would describe this as which condition? inversion of the foot dorsiflexion eversion of the foot plantar flexion

inversion of the foot Talipes varus is an inversion of the foot. Talipes valgus is an eversion of the foot. Talipes equinus is plantar flexion of the foot and talipes calcaneus is dorsiflexion of the foot.

A nurse is providing nutritional information to a client with a diagnosis of gout. Which of the client's favorite foods should be limited?

liver

After a traumatic spinal cord injury, a client requires skeletal traction. When caring for this client, the nurse must: change the client's position only if ordered by the physician. support the traction weights with a chair or table to prevent accidental slippage. maintain traction continuously to ensure its effectiveness. restrict the client's fluid and fiber intake to reduce the movement required for bedpan use.

maintain traction continuously to ensure its effectiveness.

After treatment of compartment syndrome, a client reports experiencing paresthesia. Which symptoms should the nurse monitor? change in range of motion (ROM) fever and chills pain and blanching numbness and tingling

numbness and tingling Paresthesia is described as numbness and tingling. It doesn't include pain or blanching and isn't associated with fever and chills or change in ROM.

A client in skeletal traction reports pain even though receiving an analgesic 1 hour ago. The nurse offers an alternative pain management measure. Which measure can be implemented within the nursing scope of practice? Swedish massage and the Feldenkrais method relaxation and imagery hypnosis and therapeutic touch acupressure and shiatsu

relaxation and imagery

The nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb: begins at a rehabilitation center. isn't necessary. should begin the day after surgery. should begin immediately postoperatively.

should begin the day after surgery.