Musculoskeletal IGGY Evolve Ch 44, 45, 46, 47
Which risk factors are shared by male clients who have osteoporosis or osteomalcia? (Select all that apply.) High alcohol intake Homelessness Low BMI A history of smoking Inadequate exposure to sunlight
High alcohol intake A history of smoking
Which aspect of postoperative management will the nurse plan to discuss with a client about to undergo an arthroscopic repair of the knee? Pharmacy for client medications Physical therapy for exercises Social work for care coordination Registered dietitian for nutrition
Physical therapy for exercises
An older adult client who has osteoporosis is discharged from the hospital. What does the nurse include in health teaching related to the client's home safety? "Keep walkways free of clutter." "Keep light low to prevent glare." "Walk slowly on wet floor areas after mopping." "Use area rugs on tile floors."
"Keep walkways free of clutter."
The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the primary health care provider will request which supplement? Vitamin D3 Vitamin C Calcium Phosphorus
Vitamin D3
A client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test? "Do not eat or drink for 8 hours before the test." "It will be important to lie still in a reclined position for 20 minutes." "You can have the MRI if you have an internal pacemaker." "All jewelry and clothing with zippers or metal fasteners must be removed."
"All jewelry and clothing with zippers or metal fasteners must be removed."
The client asks what tool the physical therapist (PT) used to measure joint range of motion (ROM)? How would the nurse respond? "Goniometer" "Reflex hammer" "Tonometer" "Doppler device"
"Goniometer"
The nurse is using a common scale to grade a client's muscle strength. The client is able to complete range of motion (ROM) only with gravity eliminated. Which grade does the nurse document in this client's record? 0 3 1 2
2
The nurse is preparing a client for a total hip arthroplasty today. What IV antibiotic would the nurse likely administer if the client has no drug allergies? Penicillin Clindamycin Vancomycin Cefazolin
Cefazolin
A middle-age female client has osteoporosis and is at risk for developing vertebral fractures. She asks the nurse about exercises to help minimize this risk. Which exercise will the nurse recommend? Cycling Running Walking Yoga
Yoga
The nurse is assessing an older client who has bony nodules on finger joints (Heberden and Bouchard nodes). What priority question would the nurse want to ask as part of the client interview? "When did your bony nodules develop?" "How do you feel about having these bony nodules?" "Are you able to independently perform ADLs?" "Are your bony nodules painful or tender?"
"Are you able to independently perform ADLs?"
Buck's (skin) traction for a fractured hip is applied to a client while a urinary tract infection is treated before surgery. What instruction will the nurse give assistive personnel (AP) for providing client care related to the traction? "Inspect the pins in the traction for signs of infection." "Remove the boot every shift to inspect the skin." "Do not allow the traction weights to rest on the ground." "Remove traction weights when turning the client."
"Do not allow the traction weights to rest on the ground."
A client who uses a computer for hours each day asks the nurse how to help prevent carpal tunnel syndrome (CTS). Which statement by the client indicates a need for further teaching? "I need to make sure I have an ergonomically sound computer station." "I need to exercise repetitively to strengthen my wrists." "I should stretch my fingers and wrists frequently during the day." "I may need to wear a wrist splint when my wrist gets inflamed."
"I need to exercise repetitively to strengthen my wrists."
The nurse is caring for a client who is diagnosed with osteopenia. Which T-score will the nurse expect to see for this client after a bone mineral density (BMD) test? −2 −3 0 to −1 +1.5
−2
The nurse is planning health teaching for a client starting hydroxychloroquine for rheumatoid arthritis. What instruction would the nurse include in the teaching? "Be aware that the drug may cause secondary types of cancer." "Expect nausea and vomiting for the first week after starting the drug." "Have eye examinations every 6 months while on the drug." "Keep this medication in the refrigerator at all times."
"Have eye examinations every 6 months while on the drug."
The nurse has provided health teaching for a female client starting on methotrexate (MTX) for early rheumatoid arthritis. What statement by the client indicates a need for further teaching? "I will try to avoid crowds because I could easily get an infection." "I will start folic acid supplements which can help decrease side effects." "I can drink alcohol in small amounts at night to help me relax." "I will use strict birth control while I am taking this drug."
"I can drink alcohol in small amounts at night to help me relax."
A client is scheduled for magnetic resonance arthrography of the right knee to determine ligament damage. Which statement by the client indicates a need for further teaching? "I can take ibuprofen to help with any discomfort after the procedure." "I will need to use ice for a day or two after the procedure to prevent swelling." "My knee will be numbed before the needle is inserted into my joint." "I'll only be in the hospital overnight to get the procedure done."
"I'll only be in the hospital overnight to get the procedure done."
A client is scheduled to have a bone scan for a suspected bone tumor. What statement by the nurse is correct about the procedure for this test? "It sees sound waves to produce an image of the skeleton." "It requires an injected radioactive material to view the entire skeleton." 'It requires an injected iodine-based contrast medium to view the bone." "It relies on magnetic waves to help produce the image of the bone."
"It requires an injected radioactive material to view the entire skeleton." A bone scan produces images of the entire skeleton through the use of a radioactive material that is used prior to imaging.
A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? "I can't believe that this has happened to me. I can't stand to look at it." "I do not want any visitors while I'm in the hospital." "My spouse will be the only person to change my dressing." "It will take me some time to get used to this."
"It will take me some time to get used to this."
A young female client whose mother and grandmother have osteoporosis asks whether she needs to take steps to prevent this disease in herself. What will the nurse tell this client? "Now is the time to begin building strong bones." "Your risk isn't present until age 50; we can talk about it then." "You do not have to worry about symptoms at your age." "You should begin to take steps to prevent disease at age 30."
"Now is the time to begin building strong bones."
A client who has osteopenia is prescribed to begin risedonate. What health teaching would the nurse include about this drug? "Take the drug with dinner or other meal or snack every day." "Remain in an upright position for 30 minutes after taking the drug." "Be sure to follow up with lab work to monitor your liver function." "Be sure to report any new bone pain or infection."
"Remain in an upright position for 30 minutes after taking the drug."
The nurse is caring for a client who has been treated for osteoporosis for 15 years and is starting on denosumab. What health teaching is appropriate for the nurse to include about this drug? "You will receive an IV infusion once a year by your provider." "Take the drug every morning with a glass of water." "Have a dental examination prior to beginning the drug." "See your primary health care provider for twice yearly injections."
"See your primary health care provider for twice yearly injections."
The nurse is caring for an older, alert adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies? "I do not know how long my wife will be able to take care of me at home." "I am helping with the dishes and laundry, but I hurt so badly when I am doing it." "I do not know how much longer my neighbor can continue to help clean my house." "The bus is coming to pick me up from the senior center three times a week so I can play cards."
"The bus is coming to pick me up from the senior center three times a week so I can play cards."
The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan? "Avoid rigorous exercise." "Avoid contact sports." "Wear helmets when riding a motorcycle." "Avoid driving in inclement weather."
"Wear helmets when riding a motorcycle."
A client was recently diagnosed with osteoarthritis and asks the nurse which over-the-counter drug would be the best to take? What would the nurse's recommendation be? Ibuprofen Acetaminophen Tramadol Gabapentin
Acetaminophen
A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? Surgical repair of the rotator cuff Patient-controlled analgesia with morphine Activity limitations for the affected arm Prescribed exercises of the affected arm
Activity limitations for the affected arm
A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 m) fall 2 days ago. The nurse plans to assess the client for which potential complications? (Select all that apply.) Urinary tract infection (UTI) Acute compartment syndrome (ACS) Fat embolism syndrome (FES) Osteomyelitis Heart failure
Acute compartment syndrome (ACS) Fat embolism syndrome (FES) Osteomyelitis
The nurse is reviewing the laboratory test results for a client who was diagnosed with muscular dystrophy (MD) as a child. Which lab results will the nurse expect to be elevated? (Select all that apply.) Alkaline phosphatase Aldolase Calcium Lactic dehydrogenase (LDH) Creatine kinase (CK-MM)
Alkaline phosphatase Aldolase Lactic dehydrogenase (LDH) Creatine kinase (CK-MM)
The nurse is caring for a postoperative client with total hip arthroplasty. What actions would the nurse take to prevent venous thromboembolism (VTE) postoperatively? (Select all that apply.) Apply pneumatic or sequential compression devices. Administer anticoagulant therapy. Ambulate the client on the day of surgery. Elevate the client's legs Keep the legs slightly abducted.
Apply pneumatic or sequential compression devices. Administer anticoagulant therapy. Ambulate the client on the day of surgery.
What will the nurse recommend as the most appropriate way to decrease the risk for osteoporosis in a client who has just been determined to be at high risk for the disease? Increase nutritional intake of phosphorus. Walk for 30 minutes three times a week. Increase nutritional intake of calcium. Engage in high-impact exercise, such as running.
Walk for 30 minutes three times a week.
A client who had a right elective above-the-knee amputation reports severe pain in the right lower leg and foot. What is the nurse's best action at this time? Assess the level of the client's pain. Change the subject and talk about the client's hobbies. Distract the client with stories about the nurse's family. Remind the client that the lower leg was removed.
Assess the level of the client's pain.
The nurse is caring for a client who is at risk for osteoporosis. What lifestyle changes might the client be able to implement to decrease this risk? (Select all that apply.) Avoiding excessive alcohol consumption Increasing foods high in phosphorus Decreasing consumption of carbonated beverages Preventing a sedentary daily lifestyle Seeking a smoking cessation program, if needed Including more calcium-rich foods into the diet
Avoiding excessive alcohol consumption Decreasing consumption of carbonated beverages Preventing a sedentary daily lifestyle Seeking a smoking cessation program, if needed Including more calcium-rich foods into the diet
The nurse is teaching a client about the use of crutches following a foot fracture. When adjusting the crutches to ensure a correct fit, what action will the nurse take? Ensure that each crutch fits firmly into the client's armpit. Be sure that the top of each crutch is well padded. Use the crutch on the affected side only. Check to see how many steps the client can take with the crutches.
Be sure that the top of each crutch is well padded.
The nurse is caring for a client who has a continuous femoral nerve blockade following a total knee arthroplasty. What nursing assessment does the nurse need to perform to ensure client safety? Monitor vital signs frequently to detect early complications. Perform focused cardiovascular and respiratory assessments. Check that the client can dorsiflex and plantar flex the foot on the operative leg. Monitor for excessive blooding and bruising during the infusion.
Check that the client can dorsiflex and plantar flex the foot on the operative leg.
A client with an open fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is essential for the nurse to take first? Check the dorsalis pedis pulses. Administer the prescribed analgesic. Place a dressing on the affected area. Immobilize the left leg with a splint.
Check the dorsalis pedis pulses.
A client had a fractured tibia repair several weeks ago and tells the nurse that she has persistent burning pain, ongoing edema, and muscle spasms in her affected leg. For which chronic complication is the client at risk? Chronic osteomyelitis Complex regional pain syndrome Severe osteoporosis Compartment syndrome
Complex regional pain syndrome
Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast? Arthroscopy Electromyography (EMG) Computed tomography (CT) Tomography
Computed tomography (CT) A CT scan creates three-dimensional images and may be done with iodine-based contrast. Arthroscopy, EMG, and tomography do not use iodine-based contrast.
The nurse is assessing an older adult client who has severe kyphosis. What psychosocial client problem would the nurse anticipate? Dementia Bipolar disorder Psychosis Depression
Depression
The nurse assesses a client diagnosed with Sjögren syndrome. The nurse anticipates that the client will also have which symptom? Excessive production of saliva in the mouth Intermittent episodes of diarrhea Abdominal bloating after eating Dry eyes
Dry eyes
The nurse is teaching a postmenopausal client about the need for bone health and screening. What diagnostic test would the nurse recommend? Serum Vitamin D Dual x-ray absorptiometry (DXA) Serum calcium and phosphorus Vertebral x-rays
Dual x-ray absorptiometry (DXA)
A client is admitted to the emergency department following a left severe ankle sprain caused by playing football with friends. What nursing actions will the nurse implement at this time? (Select all that apply.) Elevate the left leg above the level of the heart. Tell the client to keep his left leg still. Apply an elastic wrap or ankle or compression brace. Administer morphine via IV push. Apply heat to promote blood flow and healing.
Elevate the left leg above the level of the heart. Tell the client to keep his left leg still. Apply an elastic wrap or ankle or compression brace.
The nurse is reviewing the laboratory test results of a client with a recently diagnosed osteosarcoma. What abnormal laboratory finding would the nurse expect for this client? Elevated alkaline phosphatase Decreased hematocrit Increased calcium Increased white blood cell count
Elevated alkaline phosphatase
The nurse recognizes that a client who has persistent pain may have difficulty with pain management after a total joint arthroplasty. What collaborative interventions are needed to help the client manage postoperative pain? (Select all that apply.) Establish trust and explain the postoperative pain management plan. Consult the pain management team if needed and available. Plan continuing pain management after discharge. Use multimodal and alternative pain management modalities. Identify at-risk clients preoperatively using a comprehensive assessment.
Establish trust and explain the postoperative pain management plan. Consult the pain management team if needed and available. Plan continuing pain management after discharge. Use multimodal and alternative pain management modalities. Identify at-risk clients preoperatively using a comprehensive assessment.
The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider? Allergy to shellfish and iodine Knee pain at a level of 9 (0-10 scale) Previous surgery on the other knee Warm, red, and swollen knee
Warm, red, and swollen knee
The nurse is caring for a client immediately after a vertebroplasty. In what position would the nurse most likely place the client? Prone for the first 1 to 2 hours High-Fowler for the first hour Side-lying for the first 2 hours Flat supine for the first 1 to 2 hours
Flat supine for the first 1 to 2 hours
The nurse is caring for a client with an inflamed, reddened, and severely painful first metatarsal joint. With what type of arthritis are these signs and symptoms associated? Rheumatoid arthritis Infectious arthritis Gouty arthritis Osteoarthritis
Gouty arthritis
The nurse is caring for a client with osteoarthritis who reports severe pain in both knees. What nonpharmacologic intervention is the most appropriate for the nurse to recommend for this client? Massage and hypnosis. Hot compresses or moist heating pad. Glucosamine and chondroitin combination. Ice packs used every 3 to 4 hours during the day.
Hot compresses or moist heating pad.
The nurse is caring for a client who has an external fixator for an open fracture of the tibia and fibula. What is the nurse's priority for care related to the fixator? Inspect the pins to monitor for infection and do not remove crusts. Make sure that the wound is managed using a moist wound healing method. Keep the leg covered to keep the extremity warm to promote circulation.
Inspect the pins to monitor for infection and do not remove crusts.
A client is in skeletal traction for a complex femoral fracture. Which nursing intervention ensures proper care of this client? Ensure that weights are placed on the floor. Remove the traction weights only for bathing. Ensure that pins are not loose and tighten as needed. Inspect the skin at least every 8 hours.
Inspect the skin at least every 8 hours.
An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? Keep the client's heels off the bed at all times. Reposition the client every 3 to 4 hours. Avoid the use of antiembolism stockings. Administer pain medication before deep-breathing exercises.
Keep the client's heels off the bed at all times.
The nurse is performing a focused musculoskeletal assessment on an older female client. What assessment findings associated with aging would the nurse expect? (Select all that apply.) Scoliosis Kyphosis Decreased range of motion Muscle atrophy Osteoarthritis Widened gait
Kyphosis Decreased range of motion Muscle atrophy Osteoarthritis Widened gait
A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse would instruct the client to notify the primary health care provider immediately if which change occurs? Absence of erythema and tenderness at the surgical site Ability to flex and extend the right knee Large amount of serosanguineous or bloody drainage Mild to moderate pain controlled with prescribed analgesics
Large amount of serosanguineous or bloody drainage
When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor would be the priority for client teaching? Low calcium intake Postmenopausal status Positive family history Previous use of steroids
Low calcium intake The client's calcium and vitamin D intake is the priority risk factor that the client can change. The nurse will discuss the other risk factors as contributing to osteoporosis, but the teaching will focus on ways to increase calcium intake.Postmenopausal status, positive family history, and previous use of steroids are not risk factors that the client can change. These risk factors should be discussed but are not the priority for this client.
A client sustains a fracture of one arm and the primary health care provider applies a synthetic cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department? Monitor neuromuscular status for decreased circulation and sensation in the extremity. Check the fit of the cast by inserting a tongue blade between the cast and the skin. Apply a heating pad for 15 to 20 minutes four times daily to help with pain. Keep the cast covered with a soft towel to help it to dry quickly.
Monitor neuromuscular status for decreased circulation and sensation in the extremity.
A client in the emergency department receives moderate sedation while having a closed reduction of a fractured ankle. What is the nurse's priority assessment during this procedure? Check the client's blood pressure frequently. Monitor the client's pain level. Monitor the client's respiratory rate. Perform circulation checks before and after the procedure.
Monitor the client's respiratory rate.
A client is admitted to the same-day surgical center PACU after a bunionectomy. After assessing the client's ABCs, what is the priority assessment for the client? Muscle strength assessment Joint assessment Neurovascular assessment Neurologic assessment
Neurovascular assessment
The nurse is caring for a female client who has a right wrist ganglion which is interfering with her ability to do her job as an administrative assistant. What collaborative treatment would the nurse anticipate for this client? Physical therapy Occupational therapy Removal of the ganglion Intravenous antibiotic therapy
Removal of the ganglion
The nurse is caring for an older client who has a large bulky lower leg dressing with posterior splint to maintain alignment after closed reduction for an ankle fracture. Which client assessment finding would the nurse report to the primary health care provider or Rapid Response Team immediately? Affected foot slightly cooler than the other foot. Reports pain level is 4 on a 0-10 pain intensity scale. Pedal pulse on affected foot is 1+ and regular. Reports tingling and numbness in affected foot.
Reports tingling and numbness in affected foot.
The nurse suspects that a client may have plantar fasciitis if the client has which assessment finding? Dorsiflexion of any metatarsophalangeal (MTP) joint, with plantar flexion of the adjacent proximal interphalangeal (PIP) joint A small tumor in a digital nerve of the foot Severe pain in the arch of the foot, especially when getting out of bed Lateral deviation of the great toe; first metatarsal head becomes enlarged
Severe pain in the arch of the foot, especially when getting out of bed
The nurse is teaching a client preparing to have a total knee replacement about interventions to help prevent surgical infection. What interventions would the nurse include in this teaching? (Select all that apply.) Using nasal mupirocin for at least a week before surgery Avoiding sleeping with pets in the client's bed Showering the night before and the morning of surgery with chlorhexidine Giving antibiotics before and after surgery for at least 3 days Sleeping on clean linen wearing clean nightwear
Sleeping on clean linen wearing clean nightwear Using nasal mupirocin for at least a week before surgery Avoiding sleeping with pets in the client's bed Showering the night before and the morning of surgery with chlorhexidine
Which intervention would the nurse suggest to a client who has undergone a leg amputation to help cope with loss of the limb? Talking with a psychiatrist about the amputation Engaging in diversional activities to avoid focusing on the amputation Talking with an amputee close to the client's age who has a similar amputation Drawing a picture of how the client sees him- or herself
Talking with an amputee close to the client's age who has a similar amputation
The nurse is preparing to give apixaban for a client who recently had a total knee arthroplasty. What does the nurse recognize as the advantage of this drug over other anticoagulants? The client does not need to have labs drawn for PT or INR. The client only needs to take the drug while in the hospital. The client is not at risk for bleeding or bruising. The client does not need to wear sequential compression devices.
The client does not need to have labs drawn for PT or INR.
The nurse is caring for a client with osteoarthritis (OA) in the left knee. What factor does the nurse suspect is the most likely cause of this client's OA? Trauma to the joint Aging Osteoporosis Familial history
Trauma to the joint
Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury? Lungs for bilateral normal breath sounds Urine specimen to assess for the red blood cells Pain score and level of alertness Skin to evaluate lacerations and abrasions
Urine specimen to assess for the red blood cells
The nurse is developing a health teaching plan for a client diagnosed with osteoarthritis (OA). The nurse includes which instruction in the teaching plan? Take up knitting to slow down joint degeneration. Eat at least 2 yogurts every day. Wear supportive shoes at all times. Begin a jogging or running program.
Wear supportive shoes at all times.
