Musculoskeletal Disorders

The nurse has instructed the client about the correct positioning of the leg and hip following hip replacement surgery. Which of the following statements indicates that the client has understood these instructions?

"I should avoid bending over to tie my shoes." R:Acute flexion and adduction of the hip should be avoided after hip replacement surgery. The client may not cross (adduct) the legs as this puts the client at risk for dislocating the prosthesis. The client should not sit in low chairs that will require excessive hip flexion to get in or out of. Hip flexion also increases the risk of dislocation. Frequent walks are encouraged to increase muscle strength and provide hip exercises

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching

"I should use my heating pad this evening to reduce some of the pain in my knee." Explanation: The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?

"Keep your right leg elevated above heart level." R: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection

The nurse is caring for a client on a second course of antibiotics to eliminate osteomyelitis. It is most essential for the nurse to instruct on which aspect of daily care?

A diet high in protein and nutrients R:It is essential for the nurse to instruct on a diet that is high in protein and nutrients to increase healing and strengthen the immune system. This, in addition to the second course of antibiotics, may be sufficient to eliminate the osteomyelitis. Opioids may be needed for pain management but this is not most essential. Bedrest is not common in care and assistive devices are used only in the acute period.

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

"Pace yourself and rest frequently, especially after activities." A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. Telling the client to do her chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace herself and take frequent rests rather than doing all chores at once.

A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury?

"Stand close to the object you're lifting." R: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 a larger number of muscle groups distributes the workload

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include which of the following?

A:Heavy smoking, sedentary lifestyle, and high intake of carbonated drinks r:Osteoporosis has been linked to heavy smoking. A sedentary lifestyle results in more osteoclastic or breakdown activity rather than bone building or osteoblastic activity. Because carbonated drinks tend to have high phosphate levels, the inverse relationship of phosphorus to calcium results in a depletion of calcium. Sunlight exposure for vitamin D and calcium intake all promote bone density. Regular exercise and weight-bearing activities also preserve bone mass. A deficient diet has not been proven to contribute to osteoporosis.

A public health nurse is providing an information session focusing on injury prevention for young children diagnosed with juvenile arthritis. Of the information offered below, what should be included in this session?

Daily range of motion exercises are required to support joint mobility. R:Daily range of motion exercises are required to help children with juvenile arthritis strengthen their muscles and use their joints to their full range of motion. Children should be encouraged to participate in as much of their own care as possible to keep their joints fluid. Excessive exercise, as evidenced by running, jumping, and so on, should be discouraged because it puts an excessive amount of pressure on the joints. The children should also remain active and independent, but should not overexert themselves. Home schooling is not required in this situation

After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do?

Discuss the complications that the client's may experience if he doesn't cooperate with the care plan. Explanation: The nurse should discuss the care plan and its rationale with the client. Calling the physician to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, she should first discuss the care plan with the client

When assessing an older adult as a candidate for crutch walking, the nurse should take into account that for some elderly people, crutch walking is an impractical goal primarily because of decreased:

Motor coordination. R: Some elderly people are not good candidates for crutch walking because they are not strong enough to use crutches or are not coordinated enough to walk safely with crutches. Visual acuity may influence the ability to learn crutch walking but is not as important as motor coordination. Reaction time may influence the ability to learn crutch walking but is not as important as motor coordination. Level of comprehension may influence the ability to learn crutch walking but is not as important as motor coordination

What would be the most important nursing intervention in caring for the client's residual limb during the first 24 hours after amputation of the left leg?

Elevating the residual limb on a pillow. Explanation: Elevating the residual limb on a pillow for the first 24 hours after surgery helps prevent edema and promotes comfort by increasing venous return. Elevating the residual limb for longer than the first 24 hours is contraindicated because of the potential for developing a hip flexion contracture. Keeping the limb flat will be an important intervention after the first 24 hours. Preventing excessive swelling, however, is a priority in the first 24 hours. Adducting the residual limb on a scheduled basis prevents abduction contracture. Traction may be used to prevent or treat a hip flexion contracture; however, not in the first 24 hours

The nurse is planning an educational program about the prevention of osteoporosis for a group of women at the local community center. Which of the following preventive measures would be appropriate for the nurse to include in the teaching plan?

Encouraging weight-bearing exercise on a regular basis. R:Exercise, especially weight-bearing exercise such as walking or jogging, is recommended on a regular basis to maintain high-density bone mass. Diet should be high in calcium and vitamin D; increasing the daily intake of protein is not appropriate. It is recommended that premenopausal women consume about 1,000 to 1,200 mg of calcium daily. Sunbathing is not recommended

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. R:A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise should be scheduled at least 1 hour after awakening. Exercising in the evening interferes with the client's ability to rest at bedtime.

The client with rheumatoid arthritis has been taking large doses of aspirin to relieve joint pain. The nurse should assess the client for?

Tinnitus. Explanation: Tinnitus (ringing in the ears) is a common symptom of aspirin toxicity. Dysuria is not associated with aspirin toxicity. Chest pain is not associated with aspirin toxicity. Drowsiness is not associated with aspirin toxicity.

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period

logroll client from side to side Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. The nurse should encourage ROM exercises to maintain muscle strength. Because of pressure on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations.

A client is admitted to the trauma center with a spinal cord transection at T4. Which of the physical limitations does the nurse anticipate when planning care? Select all that apply.

• The client will be unable to independently ambulate. • The client will have no control of the bladder. Explanation: The client with a spinal cord transection (complete tear) at the thoracic 4 location will be a paraplegic with no control of the body below mid chest. The client will need assistance to ambulate (wheelchair) and assistance with urination. The client will be able to breathe independently, speak, feed themselves and have normal cognitive function.

A client in the surgical intensive care unit has skeletal tongs in place to stabilize a cervical fracture. Protocol dictates that pin care should be performed each shift. When providing pin care for the client, which finding should the nurse report to the physician?

A small amount of yellow drainage at the left pin insertion site R:The nurse should report the presence of yellow drainage, which indicates the presence of infection, at the left pin insertion site. Crust formation around the pin site is a natural response to the trauma caused by the pin insertion. Redness at the insertion site may be an early sign of infection; the nurse should continue to monitor the area, but this finding doesn't need to be reported to the physician. The client may experience pain at the pin insertion sites; therefore, the nurse should administer pain medications as ordered. It's necessary to notify the physician only if the pain medication is ineffective

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

Administering large doses of I.V. antibiotics as prescribed Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Administering ordered analgesics and monitoring their effects An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management the priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management.

To prevent external rotation of the client's hips while lying on the back, it would be best for the nurse to place

Trochanter rolls alongside the legs from ilium to midthigh. R: Trochanter rolls placed alongside the client's legs from the ilium to midthigh are recommended to prevent external rotation of the hips. Pillows can be used only as a temporary measure because they cannot hold the legs and hips in proper alignment over a prolonged period. Placing sandbags from the knees to the ankle will not effectively support the hips in proper alignment. A footboard does not help to keep the legs and hips in proper alignment