MUSCULOSKELETAL EAQ

Which element of a discharge program would the nurse focus on when teaching crutch-walking to a client with a distal femoral fracture who has a long leg cast applied? Establishing a schedule for pain medication Maintaining a fixed schedule of daily activities Modifying the home environment to prevent accidents Understanding that a more sedentary lifestyle is necessary

Modifying the home environment to prevent accidents ~Modifications in the home may be needed to permit safe use of crutches. Pain medications should not be required on a regular basis. The client may vary the schedule of activities based on abilities and responses to activities. The client does not have to be sedentary as crutches are used for ambulation.

Which response would be given to a client with rheumatoid arthritis who asks the nurse "What kind of drug is acetylsalicylic acid?"? Sedative Hypnotic Analgesic Antibiotic

Analgesic ~Acetylsalicylic acid acts as an analgesic by protecting peripheral pain receptors from bradykinin, which is a component in the inflammatory process. Acetylsalicylic acid does not act as a sedative to calm individuals. Acetylsalicylic acid does not act as a hypnotic to induce sleep. Acetylsalicylic acid does not destroy or control microorganisms.

An older client is admitted to a nursing home after becoming incontinent of urine. The client's rheumatoid arthritis contributes to severely painful joints. Which goal would the nurse address initially in this client? Control of pain Immobilization of joints Motivation and teaching Bladder training and control

Control of pain ~After the need to survive (air, food, water) the need for comfort and freedom from pain closely follow. Care should be given in order of the client's basic needs. Joints must be exercised to prevent stiffness, contractures, and muscle atrophy. Motivation and learning will not occur unless basic needs such as freedom from pain are met. Although bladder training should be included in care, it is not the priority when the client is in pain.

Which movement of the synovial joint is described as turning the sole outward and away from the midline of the body? Pronation Eversion Adduction Supination

Eversion ~Eversion is a synovial joint movement that describes turning the sole outward and away from the midline of the body. Pronation is a synovial joint movement that describes turning the palm downward. Adduction is a synovial joint movement that describes movement toward the midline of the body. Supination is a synovial joint movement that describes turning the palm upward.

Which mechanism would the nurse conclude is responsible for swollen finger joints in a client experiencing an acute episode of rheumatoid arthritis? Urate crystals in the synovial tissue Inflammation in the joint's synovial lining Formation of bony spurs on the joint surfaces Escaped fluid from the capillaries that increases interstitial fluids

Inflammation in the joint's synovial lining ~ The pathological process involved with rheumatoid arthritis is accompanied by vascular congestion, fibrin exudate, and cellular infiltrate, causing inflammation of the synovium. Urate crystals occur with gouty arthritis. Formation of bony spurs on the joint surfaces is unrelated to rheumatoid arthritis. Increased interstitial fluid is only one aspect of the inflammatory response.

The nurse would assess the client with a compound fracture of the femur for which clinical indicator that is unique to a fat embolus? Anxiety Restlessness Pinpoint red spots on the chest Decreased arterial oxygen level

Pinpoint red spots on the chest ~ Fat emboli cause capillary fragility; rupture of capillary walls results in pinpoint red spots (petechiae). Anxiety occurs in both fat embolism and thromboembolism. There often is a feeling of dread or impending doom. Restlessness and confusion due to cerebral hypoxia occur in both fat embolism and thromboembolism. The PO 2 may be decreased in both fat embolism and thromboembolism.

Which reason would the nurse give when a client with rheumatoid arthritis asks why it is necessary to inject hydrocortisone into the knee joint? Lubricates the joint Reduces inflammation Provides physiotherapy Prevents ankylosis of the joint

Reduces inflammation ~ Steroids have an antiinflammatory effect that can reduce arthritic pannus formation. Injecting a steroid into the joint does not provide lubrication. Injection of a drug into a joint is not physiotherapy. Ankylosis refers to fusion of joints. It is only indirectly influenced by steroids, which exert their major effect on the inflammatory process.

In which position would the nurse place a client with osteoarthritis who recently had a left total hip replacement? Maintain the left leg in an adduction position. Place the client in a right-lying position. Place the left leg in an internal rotation. Use pillows to keep the client's legs abducted.

Use pillows to keep the client's legs abducted. ~ Abduction reduces stress on the joint capsule incision, preventing the prosthesis from becoming dislocated. Adduction strains the posterior joint capsule, fostering dislocation. A right-lying position would not allow the heels to be kept off the bed and would not allow proper abduction. Internal rotation strains the posterior joint capsule.

When would a nurse expect increased pain and limited movement of the joints in a client with rheumatoid arthritis? After assistive exercise When the room is cool In the morning on awakening When the latex fixation test is positive

In the morning on awakening ~ Inactivity over an extended time increases stiffness and pain in joints. Assistive exercises help maintain joint mobility. Whether the room is cool is not a factor. Cold applications may decrease joint discomfort. The latex fixation test is positive when the rheumatoid factor is found in blood serum. This factor is present in many conditions, including rheumatoid arthritis, aging, narcotic addiction, and systemic lupus erythematosus (SLE).

Which statement by the nurse best explains arthroscopic knee surgery? "It is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it." "It is a radiologic procedure in which dye is injected to help diagnose the extent of the knee injury." "The procedure will determine the type of treatments the health care provider will prescribe." "You will be anesthetized so that you do not remember anything about the procedure."

"It is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it." ~ he response "It is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it" describes the procedure in which the health care provider uses a scope to visualize and operate on the knee. Arthroscopic surgery is not a radiologic procedure and does not involve the injection of dye. This is a surgical procedure; the only treatment prescribed is physiotherapy after surgery. Although the client will be anesthetized and he or she will not remember anything about the procedure, this response evades the client's concern and does not describe the procedure.

Which response is appropriate to a client scheduled for a muscle biopsy who states "They better give me a general anesthetic. I don't want to feel anything"? "You seem to be worried about the test." "This test is done under local anesthesia." "Tell them when you have pain so they can take care of it." "You probably will not have pain so try not to think about it."

"You seem to be worried about the test." ~ The response "You seem to be worried about the test" acknowledges the client's apprehension and encourages further communication. The response "This test is done under local anesthesia" does not address the client's feelings and may cause more anxiety. The response "Tell them when you have pain so they can take care of it" is perhaps true, but it does not foster communication because the client may focus on the word "pain." The response "You probably will not have pain so try not to think about it" negates the client's feelings and promotes false reassurance.

Which concern is the focus of a nurse caring for a client after an amputation who begins to experience extreme discomfort in the area where the limb once was? Addressing the pain Reversing feelings of hopelessness Promoting mobility in the residual limb Acknowledging the grieving for the lost limb

Addressing the pain ~ Phantom limb sensation is a real experience with no known cause or cure. The pain must be acknowledged and interventions to relieve the discomfort explored. There are no data indicating that the client is hopeless. Promoting mobility in the residual limb may not be effective for all clients, and all possible interventions should be explored. There are no data indicating that the client is grieving.

Which effect does a below-the-knee amputation (BKA) have on a client's confidence and self-worth? Alters a person's sexuality Implies a lack of wholeness Increases dependency needs Affects an idealized self-image

Affects an idealized self-image ~ The loss of a limb affects the idealized self-image because it is difficult to deny the body has not been altered. Sexuality is included in self-image. It is concerned with a variety of other factors not affected by amputation. Amputation may signify a lack of wholeness, but feelings about it are influenced by self- image. Amputation may increase dependency needs, but these needs are influenced by self-image.

Which type of joint helps in the gliding movement of the wrist? Pivot joint Hinge joint Biaxial joint Ball-and-socket joint

Biaxial joint ~ The biaxial joint helps in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Hinge joints allow for flexion and extension. Ball-and-socket joints permit movement in the shoulders and hips.

Which type of equipment is a Buck extension to immobilize a fracture? Skeletal traction Cutaneous traction Halter transfixation Balanced suspension

Cutaneous traction ~ A Buck extension is an example of traction applied directly to the skin (cutaneous) by tape or by a foam boot. Skeletal traction is applied directly to the bony skeleton. There is no such intervention as a halter transfixation. A halter (strap) may be used with cervical or pelvic traction. Balanced suspension traction keeps the affected extremity elevated off the bed.

Which instruction would the nurse give to prevent further problems with the hands when a carpenter returns to work after surgery for carpal tunnel syndrome of the right hand? Avoid carrying tools with the arms Learn to hammer with the left hand Do stretching exercises during breaks Avoid power tools such as cordless screwdrivers

Do stretching exercises during breaks ~ Stretching exercises will assist in keeping the muscles and tendons supple and pliable and reduce the traumatic consequences of repetitive activity. The problem is not caused by carrying articles in the arms but by repetitive-type trauma. Learning to hammer with the left hand is not a satisfactory alternative for a skilled carpenter. The use of power tools will not be a problem.

Which explanation does the nurse make for swollen finger joints in a client who is having an episode of rheumatoid arthritis? Urate crystals in the synovial tissue Inflammation in the joint's synovial lining Formation of bony spurs on the joint surfaces Erosion of cartilage that lines the inside of joints

Inflammation in the joint's synovial lining ~Inflammation in the joint's synovial lining results in vascular congestion, fibrin exudate, and cellular infiltrate. Urate crystals occur with gouty arthritis, not with rheumatoid arthritis. Formation of bony spurs on the joint surfaces is unrelated to rheumatoid arthritis. Erosion of cartilage that lines the inside of joints is associated with osteoarthritis, not rheumatoid arthritis.

Which muscle of the head and neck facilitates the ability to draw the lips together? Zygomaticus Orbicularis oris Orbicularis oculi Sternocleidomastoid

Orbicularis oris ~ The orbicularis oris is the muscle that encircles the lips and helps draw the lips together. The zygomaticus muscles elevate the corners of the mouth and lips. The orbicularis oculi muscles surround the maxillae and frontal bone and facilitate closure of the eyes. The sternocleidomastoid muscle rotates and extends the head.

Which concern is the priority when health care instructions are discussed with a carpenter having trouble holding tools because of carpal tunnel syndrome who continues to work to meet financial obligations? Anxiety Chronic pain Low self-esteem Potential for injury

Potential for injury ~A weak grasp, pain, and uncoordinated movements could result in dropping of tools and can be dangerous. Although the other available options may be a problem, safety is the priority. Although low self-esteem may be an issue in the future if the client can no longer work, at this time safety is the priority.

Which definition best describes a comminuted fracture? Bone protrudes through a break in the skin. The bone has broken into several fragments, and the skin is intact. The bone is broken into two parts, and the skin may or may not be broken. Splintering has occurred on one side of the bone and bending on the other.

The bone is broken into two parts, and the skin may or may not be broken. ~ In a comminuted fracture, the bone is broken into several fragments or crushed. When the bone protrudes through a break in the skin it is a compound fracture. When the bone is broken into two parts and the skin may or may not be broken, it is a complete fracture. When splintering has occurred on one side of the bone and bending on the other it is a greenstick fracture.

Which intervention would be included in the plan of care for an elderly client who has a right hip fracture? Nutrition supplements Cardiac monitoring Oxygen therapy Venous thromboembolism (VTE) prevention

Venous thromboembolism (VTE) prevention ~ VTE causes the greatest number of fatalities in elderly clients with hip fractures, so prevention of VTE is included in the plan of care. Nutritional supplements, cardiac monitoring, and oxygen therapy may be necessary for some, but not all, clients with hip fractures.