Neuromuscular NCLEX Qs

56 Following a total joint replacement, which of the following complications has the greatest likelihood of occurring?. 1. Deep vein thrombosis (DVT). 2. Polyuria. 3. Intussusception of the bowel. 4. Wound evisceration.

1. DVT is a complication of total joint replacement and may occur during hospitalization or develop later when the client is home. Clients who are obese or have previous history of a DVT or PE are at high risk. Immobility produces venous stasis, increasing the client's chance to develop a venous thromboembolism. Signs of a DVT include unilateral calf tenderness, warmth, redness, and edema (increased calf circumference). Findings should be reported promptly to the physician for definitive evaluation and therapy. Polyuria may be indicative of diabetes mellitus. Intussusception of the bowel and wound evisceration tend to occur after abdominal surgeries.

46 The laboratory notifies the nurse that a client who had a total knee replacement 3 days ago and is receiving heparin has an activated partial thromboplastin time (aPTT) of 75 seconds. After verifying the values, the nurse calls the physician. The nurse should anticipate receiving a prescription for:. 1. Protamine sulfate. 2. Vitamin K. 3. Warfarin (Coumadin). 4. Packed red blood cells.

1. The aPTT is at a critical value, and the client should receive protamine sulfate as the antidote for heparin. Vitamin K is the antidote for warfarin. Packed red blood cells are administered to increase the hematocrit.

106 The client asks the nurse what the activity limitations are while in Buck's traction. The nurse should tell the client:. 1. "You can sit up whenever you want." 2. "You must lie flat on your back most of the time." 3. "You can turn your body." 4. "You must lie on your stomach."

1. The client can sit up in bed, remaining in the supine position so that an even, sustained amount of traction is maintained under the bandage used in Buck's traction. Maintenance of even, sustained traction decreases the chance that the bandage or traction strap might slip and cause compression or stress on the nerves or vascular tracts, resulting in permanent damage. The client does not have to remain flat but may adjust the head of the bed to varying degrees of elevation while remaining in the supine position. The client should not turn his body to another position because the bandage may slip.

34. The nurse is assessing a client for neurologic impairment after a total hip replacement. Which of the following would indicate impairment in the affected extremity?. 1. Decreased distal pulse. 2. Inability to move. 3. Diminished capillary refill. 4. Coolness to the touch.

2. Being unable to move the affected leg suggests neurologic impairment. A decrease in the distal pulse, diminished capillary refill, and coolness to touch of the affected extremity suggest vascular compromise.

53 The nurse is assessing a client's left leg for neurovascular changes following a total left knee replacement. Which of the following are expected normal findings? Select all that apply. 1. Reduced edema of the left knee. 2. Skin warm to touch. 3. Capillary refill response. 4. Moves toes. 5. Pain absent. 6. Pulse on left leg weaker than right leg.

1, 2, 3, 4. Postoperatively, the knee in a total knee replacement is dressed with a compression bandage and ice may be applied to control edema and bleeding. Recurrent assessment by the nurse for neurovascular changes can prevent loss of limb. Normal neurovascular findings include color normal, extremity warm, capillary refill less than 3 seconds, moderate edema, tissue not palpably tense, pain controllable, normal sensations, no paresthesia, normal motor abilities, no paresis or paralysis, and pulses strong and equal.

Which of the following should be included in the teaching plan for a client with osteoporosis? Select all that apply. 1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2. Choose good calcium sources, such as figs, broccoli, and almonds. 3. Use alcohol in moderation because a moderate intake has no known negative effects. 4. Try swimming as a good exercise to maintain bone mass. 5. Avoid the use of high-fat foods, such as avocados, salad dressings, and fried foods.

1, 2, 3. A diet with adequate amounts of vitamin D aids in the regulation, absorption, and subsequent utilization of calcium and phosphorus, which are necessary for the normal calcification of bone. Figs, broccoli, and almonds are very good sources of calcium. Moderate intake of alcohol has no known negative effects on bone density but excessive alcohol intake does reduce bone density. Swimming, biking, and other non-weight-bearing exercises do not maintain bone mass. Walking and running, which are weight-bearing exercises, do maintain bone mass. The client should eat a balanced diet but does not need to avoid the use of high-fat foods.

89 When developing a teaching plan for a client who is prescribed acetaminophen (Tylenol) for muscle pain, which information should the nurse expect to include? Select all that apply. 1. The drug can be used if the person is allergic to aspirin. 2. Acetaminophen does not affect platelet aggregation. 3. This drug causes little or no gastric distress. 4. Acetaminophen exerts a strong anti-inflammatory effect. 5. The client should have the international normalized ratio (INR) checked regularly.

1, 2, 3. Acetaminophen is an alternative for a client who is allergic to aspirin. It does not affect platelet aggregation and the client does not need to have coagulation studies (such as INR). Acetaminophen causes little or no gastric distress. Acetaminophen exerts no anti-inflammatory effects.

49 The nurse is assessing a client who had a left hip replacement 36 hours ago. Which of the following indicates the prosthesis is dislocated? Select all that apply. 1. The client reported a "popping" sensation in the hip. 2. The left leg is shorter than the right leg. 3. The client has sharp pain in the groin. 4. The client cannot move the right leg. 5. The client cannot wiggle the toes on the left leg.

1, 2, 3. Dislocation of a hip prosthesis may occur with positioning that exceeds the limits of the prosthesis. The nurse must recognize dislocation of the prosthesis. Signs of prosthesis dislocation include: acute groin pain in the affected hip, shortening of the affected leg, restricted ability or inability to move the affected leg, and reported "popping" sensation in the hip. Toe wiggling is not a test for potential hip dislocation.

42 The nurse is preparing a client who has had a knee replacement with a metal joint to go home. The nurse should instruct the client about which of the following? Select all that apply. 1. Notify health care providers about the joint prior to invasive procedures. 2. Avoid use of magnetic resonance imaging (MRI) scans. 3. Notify airport security that the joint may set off alarms on metal detectors. 4. Refrain from carrying items weighing more than 5 lb (2.3 kg). 5. Limit fluid intake to 1,000 mL/day.

1, 2, 3. The nurse should instruct the client to notify the dentist and other health care providers of the need to take prophylactic antibiotics if undergoing any procedure (eg, tooth extraction) due to the potential of bacteremia. The nurse should also advise the client that the metal components of the joint may set off the metal-detector alarms in airports. The client should also avoid MRI studies because the implanted metal components will be pulled toward the large magnet core of the MRI. Any weight bearing that is permitted is prescribed by the orthopedic surgeon and is usually not limited to 5 lb (2.3 kg). Post-surgery, the client can resume a normal diet with regular fluid intake.

33. Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? Select all that apply. 1. Avoid turning the toes or knee outward. 2. Use an abduction pillow between the legs when in bed. 3. Use an elevated toilet seat and shower chair. 4. Do not extend the operative leg backwards. 5. Restrict motion for 2 weeks after surgery.

1, 3, 4. A client who has had a total hip replacement via an anterolateral approach has almost the opposite precautions as those for a client who has had a total hip replacement through the posterolateral approach. The hip joint should not be actively abducted. The client should avoid turning the toes or knee outward. The client should keep the legs side by side without a pillow or wedge. The client should use an elevated toilet seat and shower chair and should not extend the operative leg backward. The client should perform rangeof- motion exercises as directed by the physical therapist.

45 A client is to have a total hip replacement. The preoperative plan should include which of the following? Select all that apply. 1. Administer antibiotics as prescribed to ensure therapeutic blood levels. 2. Apply leg compression device. 3. Request a trapeze be added to the bed. 4. Teach isometric exercises of quadriceps and gluteal muscles. 5. Demonstrate crutch walking with a 3-point gait. 6. Place Buck's traction on the bed.

1, 3, 4. Administration of antibiotics as prescribed will aid in the acquisition of therapeutic blood levels during and immediately after surgery to prevent osteomyelitis. The nurse can request that a trapeze be added to the bed so the client can assist with lifting and turning. The nurse should also demonstrate and have the client practice isometric exercises (muscle setting) of quadriceps and gluteal muscles. The client will not use crutches after surgery; a physical therapy assistant will initially assist the client with walking by using a walker. The client will not use Buck's traction. The client will require antiembolism stockings and use of a leg compression device to minimize the risk of thrombus formation and potential emboli; the leg compression device is applied during surgery and maintained per physician prescription.

A client is in the acute phase of rheumatoid arthritis. In which order of priority should the nurse establish the following goals? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

1, 4, 2, 3. Pain relief is the highest priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function is the next goal to set, followed by preventing joint deformity during the acute phase to promote an optimal level of functioning and reduce the risk of contractures. Maintaining usual ways of accomplishing tasks is the goal with the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks.3. Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold.

55 When preparing a client for discharge from the hospital after a total knee replacement, the nurse should include which of the following information in the discharge plan? Select all that apply. 1. Report signs of infection to health care provider. 2. Keep the affected leg and foot on the floor when sitting in a chair. 3. Remove antiembolism stockings when sleeping. 4. The physical therapist will encourage progressive ambulation with use of assistive devices. 5. Change the dressing daily.

1, 4. After a total knee replacement, efforts are directed at preventing complications, such as thromboembolism, infection, limited range of motion, and peroneal nerve palsy. The nurse should instruct the client to report signs of infection, such as an increased temperature. To prevent edema, the affected leg must remain elevated when the client sits in a chair. After discharge, the client may undergo physical therapy on an outpatient basis per physician prescription. The client should leave the dressing in place until the follow-up visit with the surgeon.

39 A client who had a total hip replacement 2 days ago has developed an infection with a fever and profuse diaphoresis. The nurse establishes a goal to reduce the fluid deficit. Which of the following is the most appropriate outcome?. 1. The client drinks 2,000 mL of fluid per day. 2. The client understands how to manage the incision. 3. The client's bed linens are changed as needed. 4. The client's skin remains cool throughout hospitalization.

1. An average adult requires approximately 1,100 to 1,400 mL of fluids per day. In some instances, such as when a person has an increase in body temperature or has increased perspiration, additional water may be necessary. With an increase in body temperature, there is also an increase in insensible fluid loss. The increased loss of fluid causes an increased need for fluid replacement. If the loss is significant and/or goes untreated, an individual's intake will not be balanced with output. Managing the incision, changing the bed linens, or keeping the client's skin cool are not outcomes indicative of resolution of a fluid volume deficit.

A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which of the following activities should the nurse instruct the client to avoid?. 1. Crossing the legs while sitting down. 2. Sitting on a raised commode seat. 3. Using an abductor splint while lying on the side. 4. Rising straight from a chair to a standing position.

1. Any activity or position that causes flexion, adduction, or internal rotation of greater than 90 degrees should be avoided until the soft tissue surrounding the prosthesis has stabilized, at approximately 6 weeks. Crossing the legs while sitting down can lead to dislocation of the femoral head from the hip socket. Sitting on a raised commode seat prevents hip flexion and adduction. Using an abductor splint while side-lying keeps the hip joint in abduction, thus preventing adduction and possible dislocation. Rising straight from a chair to a standing position is acceptable for this client because this action avoids hip flexion, adduction, and internal rotation of greater than 90 degrees.

A client with rheumatoid arthritis states, "I can't do my household chores without becoming tired. My knees hurt whenever I walk." Which goal for this client should take priority?. 1. Conserve energy. 2. Adapt self-care skills. 3. Develop coping skills. 4. Adapt body image.

1. Based on the information from the client, the nurse should develop a plan with the client that will conserve energy and decrease episodes of fatigue. Although the client may dterm-0evelop a self-care deficit related to the increasing joint pain, the client is voicing concerns about household chores and difficulty around the house and yard, not self-care issues. Over time, the client may have difficulty coping or experience changes in body image as the disorder becomes chronic with increasing pain and fatigue, but the current priority is to conserve energy.

After teaching the client with severe rheumatoid arthritis about prescribed methotrexate, which of the following statements indicates the need for further teaching?. 1. "I will take my vitamins while I'm on this drug." 2. "I must not drink any alcohol while I'm taking this drug." 3. "I should brush my teeth after every meal." 4. "I will continue taking my birth control pills."

1. Because some over-the-counter vitamin supplements contain folic acid, the client should avoid self-medication with vitamins while taking methotrexate, a folic acid antagonist. Because methotrexate is hepatotoxic, the client should avoid the intake of alcohol, which could increase the risk for hepatotoxicity. Methotrexate can cause bone marrow depression, placing the client at risk for infection. Therefore, meticulous mouth care is essential to minimize the risk of infection. Contraception should be used during methotrexate t

Which of the following statements indicates that the client with osteoarthritis understands the effects of capsaicin (Zostrix) cream?. 1. "I always wash my hands right after I apply the cream." 2. "After I apply the cream, I wrap my knee with an elastic bandage." 3. "I keep the cream in the cabinet above the stove in the kitchen." 4. "I also use the same cream when I get a cut or a burn."

1. Capsaicin cream, which produces analgesia by preventing the reaccumulation of substance P in the peripheral sensory neurons, is made from the active ingredients of hot peppers. Therefore, clients should wash their hands immediately after applying capsaicin cream if they do not wear gloves, to avoid possible contact between the cream and mucous membranes. Clients are instructed to avoid wearing tight bandages over areas where capsaicin cream has been applied because swelling may occur from inflammation of the arthritis in the joint and lead to constriction on the peripheral neurovascular system. Capsaicin cream should be stored in areas between 59°F and 86°F (15°C and 30°C). The cabinet over the stove in the kitchen would be too warm. Capsaicin cream should not come in contact with irritated and broken skin, mucous membranes, or eyes. Therefore, it should not be used on cuts or burns.

The client diagnosed with osteoarthritis states, "My friend takes steroid pills for her rheumatoid arthritis. Why don't I take steroids for my osteoarthritis?" Which of the following is the best explanation?. 1. Intra-articular corticosteroid injections are used to treat osteoarthritis. 2. Oral corticosteroids can be used in osteoarthritis. 3. A systemic effect is needed in osteoarthritis. 4. Rheumatoid arthritis and osteoarthritis are two similar diseases.

1. Corticosteroids are used for clients with osteoarthritis to obtain a local effect. Therefore, they are given only via intra-articular injection. Oral corticosteroids are avoided because they can cause an acceleration of osteoarthritis. Rheumatoid arthritis and osteoarthritis are two different diseases.

96 A client has a tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the left tibial fracture despite the morphine injection administered 30 minutes previously. Which of the following should be the nurse's next assessment?. 1. Presence of a distal pulse. 2. Pain with a pain rating scale. 3. Vital sign changes. 4. Potential for drug tolerance.

1. The nurse should assess the client's ability to move the toes and for the presence of distal pulses, including a neurovascular assessment of the area below the cast. Increasing pain unrelieved by usual analgesics and occurring 4 to 12 hours after the onset of casting or trauma may be the first sign of compartment syndrome, which can lead to permanent damage to nerves and muscles. Although the nurse can use a pain rating scale or assess for changes in vital signs to objectively assess the client's pain, the client's comments suggest early and important signs of compartment syndrome requiring immediate intervention. The nurse should not confuse these signs with the potential for drug tolerance. This assessment might be appropriate once the suspicion of compartment syndrome has been ruled out.

A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of the left eye. Correct interpretation of this assessment finding indicates which of the following?. 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.

2. Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine (Plaquenil) in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals. Although cataracts may develop in young adults, they are less likely, and damage from the hydroxychloroquine is the most obvious at-risk factor. Eyesight is not affected by the disease process of rheumatoid arthritis.

109 The client with an open femoral fracture was discharged to the home and developed fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. Which of the following reflects the best interpretation of these findings?. 1. Pulmonary emboli. 2. Osteomyelitis. 3. Fat emboli. 4. Urinary tract infection.

2. Fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg are clinical manifestations of osteomyelitis, which is a pyogenic bone infection caused by bacteria (usually staphylococci), a virus, or a fungus. The bone is inaccessible to macrophages and antibodies for protection against infections, so an infection in this site can become serious quickly. The client with a pulmonary or fat embolus would develop symptoms of pulmonary compromise, such as shortness of breath, chest pain, angina, and mental confusion. Signs and symptoms of urinary tract infection would include pain over the suprapubic, groin, or back region with fever and chills, with no restrictive movement of the leg.

110 The nurse is planning care for a client with osteomyelitis. The client is taking an antibiotic, but the infection has not resolved. The nurse should advise the client to do which of the following?. 1. Use herbal supplements. 2. Eat a diet high in protein and vitamins C and D. 3. Ask the health care provider for a change of antibiotics. 4. Encourage frequent passive range of motion to the affected extremity.

2. The goal of care for this client is healing and tissue growth while the client continues on long-term antibiotic therapy to clear the infection. A diet high in protein and vitamins C and D promotes healing. Herbal supplements may potentiate bleeding (eg, ginkgo, ginger, tumeric, chamomile, kelp, horse chestnut, garlic, and dong quai) and have not been proven through research to promote healing. Frequent passive motion will increase circulation but may also aggravate localized bone pain. It is not appropriate to advise the client to change antibiotics as treatment may take time.

48 A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying which of the following?. 1. "Don't worry. Your new hip is very strong." 2. "Use of a cushioned toilet seat helps to prevent dislocation." 3. "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them." 4. "Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation."

3. Dislocation precautions include: avoid extremes of internal rotation, adduction, and 90-degree flexion of affected hip for at least 4 to 6 weeks after the procedure. Use of an abduction pillow prevents adduction. Decreasing use of the abductor pillow does not strengthen the muscles to prevent dislocation. Informing a client to "not worry" is not therapeutic. A cushioned toilet seat does not prevent hip dislocation.

At which of the following times should the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?. 1. At bedtime. 2. On arising. 3. Immediately after a meal. 4. On an empty stomach.

3. Drugs that cause gastric irritation, such as ibuprofen, are best taken after or with a meal, when stomach contents help minimize the local irritation. Taking the medication on an empty stomach at any time during the day will lead to gastric irritation. Taking the drug at bedtime with food may cause the client to gain weight, possibly aggravating the osteoarthritis. When the client arises, he is stiff from immobility and should use warmth and stretching until he gets food in his stomach.

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit?. 1. "I can use heat and cold as often as I want." 2. "With heat, I should apply it for no longer than 20 minutes at a time." 3. "Heat-producing liniments can be used with other heat devices." 4. "Ten to fifteen minutes per application is the maximum time for cold applications."

3. Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes. Application for longer periods results in the opposite of the intended effect: vasoconstriction instead of vasodilation with heat, and vasodilation instead of vasoconstriction with cold.

90 A client who has been taking hydrocodone with acetaminophen at home for 6 weeks following a fractured tibia is admitted with a blood pressure of 80/50 mm Hg, a pulse rate of 115 bpm, and respirations of 8 breaths per minute and shallow. The nurse interprets these findings as indicating which of the following?. 1. Expected common adverse effects of the hydrocodone. 2. Hypersensitivity reaction to the acetaminophen. 3. Possible habituating effect of the long-term drug use. 4. Hemorrhage from gastrointestinal irritation associated with the pain medication.

3. Hypotension and depressed respirations are signs of high levels of ingestion of hydrocodone, and the client may be developing a habit of taking this drug for a prolonged period. Expected common adverse effects of hydrocodone and acetaminophen would include drowsiness, confusion, blurred vision, and constipation. Hemorrhage from gastrointestinal irritation is not associated with this drug. Hypersensitivity reactions would be manifested by pruritus and rashes.

51 The nurse is planning care for a group of clients who have had total hip replacement. Of the clients listed below, which is at highest risk for infection and should be assessed first?. 1. A 55-year-old client who is 6 feet (180 cm) tall and weighs 180 lb (81.7 kg). 2. A 90-year-old who lives alone. 3. A 74-year-old who has periodontal disease with periodontitis. 4. A 75-year-old who has asthma and uses an inhaler.

3. Infection is a serious complication of total hip replacement and may necessitate removal of the implant. Clients who are obese, poorly nourished or elderly who have poorly controlled diabetes, rheumatoid arthritis, or concurrent infections (eg, dental, urinary tract) are at high risk for infection. Clients who are of normal weight and have well-controlled chronic diseases are not at risk for infection. Living alone is not a risk factor for infection.

87 A client has a leg immobilized in traction. Which of the following activities demonstrated by the client indicate that the client understands actions to take to prevent muscle atrophy?. 1. The client adducts the affected leg every 2 hours. 2. The client rolls the affected leg away from the body's midline twice per day. 3. The client performs isometric exercises to the affected extremity three times per day. 4. The client asks the nurse to add a 5-lb (2.3-kg) weight to the traction for 30 min/day.

3. Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger. Adduction of the leg puts work onto the hip joint as well as altering the pull of traction. Rolling the leg, or external rotation, alters the pull of traction. Additional weight should not be added to traction unless prescribed by the physician; it will not prevent muscle atrophy.

36. Prior to surgery, the nurse is instructing a client who will have a total hip replacement tomorrow. Which of the following information is most important to include in the teaching plan at this time?. 1. Teaching how to prevent hip flexion. 2. Demonstrating coughing and deep-breathing techniques. 3. Showing the client what an actual hip prosthesis looks like. 4. Assessing the client's fears about the procedure.

4. Before implementing a teaching plan, the nurse should determine the client's fears about the procedure. Only then can the client begin to hear what the nurse has to share about the individualized teaching plan designed to meet the client's needs. In the preoperative period, the client needs to learn how to correctly prevent hip flexion and to demonstrate coughing and deep breathing. However, this teaching can be effective only after the client's fears have been assessed and addressed. Although the client may appreciate seeing what a hip prosthesis looks like, so as to understand the new body part, this is not a necessity.

After teaching the client with rheumatoid arthritis about measures to conserve energy in activities of daily living involving the small joints, which of the following, if stated by the client, would indicate the need for additional teaching?. 1. Pushing with palms when rising from a chair. 2. Holding packages close to the body. 3. Sliding objects. 4. Carrying a laundry basket with clinched fingers and fists.

4. Carrying a laundry basket with clinched fingers and fists is not an example of conserving energy of small joints. The laundry basket should be held with both hands opened as wide as possible and with outstretched arms so that pressure is not placed on the small joints of the fingers. When rising from a chair, the palms should be used instead of the fingers so as to distribute weight over the larger area of the palms. Holding packages close to the body provides greater support to the shoulder, elbow, and wrist joints because muscles of the arms and hands are used to stabilize the weight against the body. This decreases the stress and weight or pull on small joints such as the fingers. Objects can be slid with the palm of the hand, which distributes weight over the larger area of the palms instead of stressing the small joints of the fingers to pick up the weight of the object to move it to another place.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods?. 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

99 After teaching the client with a femoral fracture about the purpose of treatment with skeletal traction, which of the following, if stated by the client, would indicate the need for additional teaching?. 1. To align injured bones. 2. To provide long-term pull. 3. To apply 25 lb (11.3 kg) of traction. 4. To pull weight with a boot.

4. Skeletal traction is not used to pull weight with a boot. Skeletal traction involves the insertion of a wire or a pin into the bone to maintain a pull of 5 to 45 lb (2.3 to 20.4 kg) on the area, promoting proper alignment of the fractured bones over a long term.

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate?. 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

100 The nurse is planning care for the client with a femoral fracture who is in balanced suspension traction. Which of the following would the nurse be least likely to include in the plan of care?. 1. Use of a fracture bedpan. 2. Checks for redness over the ischial tuberosity. 3. Elevation of the head of bed no more than 25 degrees. 4. Personal hygiene with a complete bed bath.

4. The client with a femoral fracture in balanced suspension traction should not be given a complete bed bath. Rather, the client is encouraged to participate in self-care and movement in bed, such as with a trapeze triangle. Use of a fracture bedpan is appropriate. A fracture bedpan is lower, and it is easier for the client to move on and off the bedpan without altering the line of traction. Checking for areas of redness or pressure over all areas in contact with the traction or bed, including the ischial tuberosity, is important to prevent possible skin breakdown. The client should be positioned so that the feet do not press against the footboard. Therefore, elevating the head of the bed no more than 25 degrees is recommended to keep the client from moving down in the bed.

54 On the evening of surgery for total knee replacement, a client wants to get out of bed. To safely assist the client, the nurse should do which of the following?. 1. Encourage the client to apply full weight bearing. 2. Prescribe a walker for the client. 3. Place a straight-backed chair at the foot of the bed. 4. Apply a knee immobilizer.

4. The knee is usually protected with a knee immobilizer (splint, cast, or brace) and is elevated when the client sits in a chair. Pre- and postsurgery, the physician prescribes weight-bearing limits and use of assistive devices for progressive ambulation. Positioning a straight-backed chair at the foot of the bed is not an action conducive to getting the client out of bed on the evening of surgery for a total knee replacement.

83 A client in the postanesthesia care unit with a left below-the-knee amputation has pain in the left big toe. Which of the following should the nurse do first?. 1. Tell the client it is impossible to feel the pain. 2. Show the client that the toes are not there. 3. Explain to the client that the pain is real. 4. Give the client the prescribed opioid analgesic.

4. The nurse's first action should be to administer the prescribed opioid analgesic to the client, because this phenomenon is phantom sensation and interventions should be provided to relieve it. Pain relief is the priority. Phantom sensation is a real sensation. It is incorrect and inappropriate to tell a client that it is impossible to feel the pain. Although it does relieve the client's apprehensions to be told that phantom sensations are a real phenomenon, the client needs prompt treatment to relieve the pain sensation. Usually phantom sensation will go away. However, showing the client that the toes are not there does nothing to provide the client with relief.

A retired 66yo female client is being evaluated for osetoporosis as part of the yearly physical exam. The client states that she is a smoker, watches television most of the day, and has been hospitalized twice for fractures within the last year. Based on this info, which condition does the nurse suspect? 1. low bone mass leading to increased bone fragility 2. degeneration of the articular cartilage 3. recurrent attacks of acute arthritis 4. personality changes caused by chronic illness

1. low bone mass leading to increased bone fragility

The nurse is conducting a class on health promotion. Which risk factors identified by the nurse would put a client at risk for osteoporosis? SATA 1. menopause 2. sedentary lifestyle 3. decreased intake of calcium 4. use of glucocorticoids 5. increased fluid intake

1. menopause 2. sedentary lifestyle 3. decreased intake of calcium 4. use of glucocorticoids

The nurse is caring for a client with skeletal traction. Which priority intervention should the nurse carry out? 1. evaluate pin site for unusual redness, swelling, drainage, odor 2. measure distance b/t clients hips and traction 3. record the number of times client exercises limb 4. report how client is coping with immobilization

1. evaluate pin site for unusual redness, swelling, drainage, odor

84 The client with an above-the-knee amputation is to use crutches while the prosthesis is being adjusted. Which of the following exercises will best prepare the client for using crutches?. 1. Abdominal exercises. 2. Isometric shoulder exercises. 3. Quadriceps setting exercises. 4. Triceps stretching exercises.

4. Use of crutches requires significant strength from the triceps muscles. Therefore, efforts are focused on strengthening these muscles in anticipation of crutch walking. Bed and wheelchair push-ups are excellent exercises targeted at the triceps muscles. Abdominal exercises, range-of-motion and isometric exercises of the shoulders, and quadriceps and gluteal setting exercises are not helpful in preparing for crutch walking.

85 The nurse teaches a client about using crutches, instructing the client to support the weight primarily on which of the following body areas?. 1. Axillae. 2. Elbows. 3. Upper arms. 4. Hands.

4. When using crutches, the client is taught to support weight primarily on the hands. Supporting body weight on the axillae, elbows, or upper arms must be avoided to prevent nerve damage from excessive pressure.

The nurse is preparing to receive a client from the ED with an acute fractured femus caused by a fall. Which potential complication should the nurse monitor for? 1. crush injury 2. chronic pain 3. reduced mobility 4. fat emboli syndrome

4. fat emboli syndrome

A client with a recently applied plaster leg cast reports unrelieved pain and paresthesia in the affected extremity. The assessment by the nurse reveals diminished pulse, pallor, and increased pain on passive motion. What should the nurse do first? 1. monitor client for the next hour. 2. administer analgesic for pain 3. administer anxiolytic 4. notify PCP immediately.

4. notify PCP immediately. signs of compartment syndrome. medical emergency

37 The client has just had a total knee replacement for severe osteoarthritis. Which of the following assessment findings should lead the nurse to suspect possible nerve damage?. 1. Numbness. 2. Bleeding. 3. Dislocation. 4. Pinkness.

1. The nurse should suspect nerve damage if numbness is present. However, whether the damage is short term and related to edema or long term and related to permanent nerve damage would not be clear at this point. The nurse needs to continue to assess the client's neurovascular status, including pain, pallor, pulselessness, paresthesia, and paralysis (the five P's). Bleeding would suggest vascular damage or hemorrhage. Dislocation would suggest malalignment. Pink color would suggest adequate circulation to the area. Numbness would suggest neurologic damage.

A client with a total hip replacement is concerned about dislocation of the prosthesis. The nurse should include which information in a response? 1. activities involving hip adduction may cause dislocation 2. using elevated toilet seats may cause hip dislocation 3. exercises involving bending are useful in preventing dislocation 4. removing the foam abduction pillow will prevent hip location

1. activities involving hip adduction may cause dislocation

38 After surgery and insertion of a total hip prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?. 1. A developing infection. 2. Bleeding in the operative site. 3. Joint dislocation. 4. Glue seepage into soft tissue.

3. The joint has dislocated when the client with a total joint prosthesis develops severe sudden pain and an inability to move the extremity. Clinical manifestations of an infection would include inflammation, redness, erythema, and possibly drainage and separation of the wound. Bleeding could be external (eg, blood visible from the wound or on the dressing) or internal and manifested by signs of shock (eg, pallor, coolness, hypotension, tachycardia). The seepage of glue into soft tissue would have occurred in the operating room, when the glue is still in the liquid form. The glue dries into the hard, fixed form before the wound is closed.

105 Which of the following is the priority for a client with a fractured femur who is in traction at this time?. 1. Prevent effects of immobility while in traction. 2. Develop skills to cope with prolonged immobility. 3. Choose appropriate diversional activities during the prolonged recovery. 4. Adapt to inactivity from the impaired mobility.

1 The priority for this client is to prevent the effects of prolonged immobility, such as preventing skin breakdown and encouraging the client to take deep breaths, and use active range-of-motion exercises for the joints that are not immobilized. Although not the priority, the nurse also should seek ways to help the client adjust to and cope with the present state of immobility. Emphasis should be placed on what the client can do, such as participating in daily care and exercises to maintain muscle strength. Finding diversional activities is not a priority at this moment. Although the client must adapt to the inactivity, helping the client develop coping skills is the priority at this time.

108 The client in traction for a fractured femur is having difficulty managing self-care activities. Which of the following would indicate a successful outcome of a goal of promoting independence for this client?. 1. The client assists as much as possible in care, demonstrating increased participation over time. 2. The client allows the nurse to complete care in an efficient manner without interfering. 3. The client allows the spouse to assume total responsibility for care. 4. The client accepts that self-care is not possible while in traction.

1. The client's assisting as much as possible in self-care and increasing participation over time indicate that the client has accomplished self-care by gaining a sense of control. If the client lets the nurse complete the care without interfering, the behavior would indicate passivity, possibly from denial or depression. If the client allows the spouse to assume total responsibility, a successful outcome has not been reached. The client is able to accomplish self-care activities within the limits of immobilization from the traction.

The nurse is preparing a teaching plan for a client who is being discharged following a total hip replacement. The nurse should include which instructions in the teaching plan? SATA 1. avoid low, cushioned chairs 2. use a device that raises the toilet seat 3. avoid bending greater than 90 degrees 4. turn at the waist to reach objects 5. do not cross the legs

1. avoid low, cushioned chairs 2. use a device that raises the toilet seat 3. avoid bending greater than 90 degrees 5. do not cross the legs

The nurse is providing discharge instructions to a client who had hip replacement. The nurse should teach the client to avoid what activity to prevent dislocation? 1. crossing legs at the knee 2. taking leisurely walks 3. sitting in a chair that has arms 4. using a raised toilet seat

1. crossing legs at the knee

32. A client had a posterolateral total hip replacement 2 days ago. What should the nurse include in the client's plan of care? Select all that apply. 1. When using a walker, encourage the client to keep the toes pointing inward. 2. Position a pillow between the legs to maintain abduction. 3. Allow the client to be in the supine position or in the lateral position on the unoperated side. 4. Do not allow the client to bend down to tie or slip on shoes. 5. Place ice on the incision after physical therapy.

2, 3, 4, 5. A client who has had a posterolateral total hip replacement should not adduct the hip joint, which would lead to dislocation of the ball out of the socket; therefore, the client should be encouraged to keep the toes pointed slightly outward when using a walker. An abduction pillow should be kept between the legs to keep the hip joint in an abducted position. The client should rotate between lying supine and lateral on the unoperated side, but not on the operated side. Ice is used to reduce swelling on the operative side. The client should not flex the operated hip beyond a 90-degree angle, such as when bending down to tie or slip on shoes. Doing so could lead to joint dislocation.

41 A client returns from the first session of scheduled physical therapy sessions following total knee replacement surgery. The nurse assesses that the client's knee is swollen, slightly erythematous, and painful. The client rates the pain as 7 out of 10 and has not had any scheduled or PRN pain medication today. Which of the following are appropriate nursing interventions? Select all that apply. 1. Gently massage the area to increase circulation to reduce pain. 2. Administer pain medication as prescribed. 3. Elevate the leg and apply a cold pack. 4. Notify the physician. 5. Call physical therapy to cancel the next treatment.

2, 3. It is anticipated that there might be some swelling, redness, and discomfort immediately after activity, including physical therapy. Ideally, pain medication could be offered or given prior to therapy to reduce posttreatment pain, but should be administered now. Elevation and cold packs can also reduce swelling and decrease pain. It is not appropriate to notify the physician as pain and swelling are normal after therapy. It is also not appropriate to massage the area. This will increase circulation and therefore increase swelling and pain.

The nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which would be the correct type to recommend?. 1. A desk-type swivel chair. 2. A padded upholstered chair. 3. A high-backed chair with armrests. 4. A recliner with an attached footrest.

3. A high-backed straight chair with armrests is recommended to help keep the client in the best possible alignment after surgery for a femoral head prosthesis placement. Use of this type of chair helps to prevent dislocation of the prosthesis from the socket. A desktype swivel chair, padded upholstered chair, or recliner should be avoided because it does not provide for good body alignment and can cause the overly flexed femoral head to dislocate.

91 When admitting a client with a fractured extremity, the nurse should first focus the assessment on which of the following?. 1. The area proximal to the fracture. 2. The actual fracture site. 3. The area distal to the fracture. 4. The opposite extremity for baseline comparison.

3. The nursing assessment is first focused on the region distal to the fracture for neurovascular injury or compromise. When a nerve or blood vessel is severed or obstructed at the actual fracture site, innervation to the nerve or blood flow to the vessel is disrupted below the site; therefore, the area distal to the fracture site is the area of compromised neurologic input or vascular flow and return, not the area above the fracture site or the fracture site itself. The nurse may assess the opposite extremity at the area proximal to the fracture site for a baseline comparison of pulse quality, color, temperature, size, and so on, but the comparison would be made after the initial neurovascular assessment.

35. In preparation for total knee surgery, a 200-lb (90.7-kg) client with osteoarthritis must lose weight. Which of the following exercises should the nurse recommend as best if the client has no contraindications?. 1. Weight lifting. 2. Walking. 3. Aquatic exercise. 4. Tai chi exercise.

3. When combined with a weight loss program, aquatic exercise would be best because it cushions the joints and allows the client to burn off calories. Aquatic exercise promotes circulation, muscle toning, and lung expansion, which promote healthy preoperative conditioning. Weight lifting and walking are too stressful to the joints, possibly exacerbating the client's osteoarthritis. Although tai chi exercise is designed for stretching and coordination, it would not be the best exercise for this client to help with weight loss.

The primary care provider determines that a 55yo female is experiencing menopause and is at risk for osteoporosis. What foods other than milk can the nurse suggest? 1. seafood, wheat, corn, green veggies 2. chicken, green veggies, pasta, broccoli, 3. green veggies, sardines, salmon with bone, molassas 4. fresh fruit, english muffin, black beans, asparagus

3. green veggies, sardines, salmon with bone, molassas

A client in skeletal traction slides down the bed and the feet are now touching the foot of the bed. What should the nurse do to ensure that the pull of traction remains uninterrupted? 1. release weights, pull client up in bed, the reapply weights. 2. ask provider to change the prescribed weight 3. move client up the bed without releasing the pull of traction 4. elevate clients feet on a pillow

3. move client up the bed without releasing the pull of traction

Which of the following should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis?. 1. Anemia. 2. Osteoporosis. 3. Weight loss. 4. Local joint pain.

4. Osteoarthritis is a degenerative joint disease with local manifestations such as local joint pain, unlike rheumatoid arthritis, which has systemic manifestation such as anemia and osteoporosis. Weight loss occurs in rheumatoid arthritis, whereas most clients with osteoarthritis are overweight.

97 A client with a fracture develops compartment syndrome. Which of the following signs should alert the nurse to impending organ failure?. 1. Crackles. 2. Jaundice. 3. Generalized edema. 4. Dark, scanty urine.

4. The client with compartment syndrome may release myoglobin from damaged muscle cells into the circulation. This becomes trapped in the renal tubules, resulting in dark, scanty urine, possibly leading to acute renal failure. Crackles may suggest respiratory complications; jaundice suggests liver failure; and generalized edema may suggest heart failure. However, these are not associated with compartment syndrome.

82 A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the dressing after 45 minutes in the postanesthesia recovery unit. The nurse should:. 1. Elevate the stump. 2. Reinforce the dressing. 3. Call the surgeon. 4. Draw a mark around the site.

4. The priority action is to draw a mark around the site of bleeding to determine the rate of bleeding. Once the area is marked, the nurse can determine whether the bleeding is increasing or decreasing by the size of the area marked. Because the spot is bright red, the bleeding is most likely arterial in origin. Once the rate and source of bleeding are identified, the surgeon should be notified. The stump is not elevated because adhesions may occur, interfering with the ability to fit a prosthesis. The dressing would be reinforced if the bleeding is determined to be of venous origin, characterized by slow oozing of darker blood that ceases with the application of a pressure dressing. Typically, operative dressings are not changed for 24 hours. Therefore, the dressing is reinforced to prevent organisms from penetrating through the blood-soaked areas of the initial postoperative dressing.

47 The nurse is teaching the client to administer enoxaparin (Lovenox) following a total hip replacement. The nurse should instruct the client about which of the following? Select all that apply. 1. Report promptly any difficulty breathing, rash, or itching. 2. Notify the health care provider of unusual bruising. 3. Avoid all aspirin-containing medications. 4. Wear or carry medical identification. 5. Expel the air bubble from the syringe before the injection. 6. Remove needle immediately after medication is injected.

1, 2, 3, 4. Client/family teaching should include advising the client to report any symptoms of unusual bleeding or bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing to health care provider immediately. Instruct the client not to take aspirin or nonsteroidal anti-inflammatory drugs without consulting the health care provider while on therapy. A low-molecular-weight heparin is considered to be a high-risk medication and the client should wear or carry medical identification. The air bubble should not be expelled from the syringe because the bubble ensures the client receives the full dose of the medication. The client should allow 5 seconds to pass before withdrawing the needle to prevent seepage of the medication out of the site.

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults who are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1, 2, 4. RA affects women three times more often than men between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA.

Which of the following statements should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to withdraw fluid from your joint." 3. "The procedure, although not painful, will provide immediate relief." 4. "We'll want you to keep your joint active after the procedure to increase blood flow." 5. "You will need to wear a compression bandage for several days after the procedure."

1, 2, 5. An arthrocentesis is performed to aspirate excess synovial fluid, pus, or blood from a joint cavity to relieve pain or to diagnosis inflammatory diseases such as rheumatoid arthritis. A local agent may be used to decrease the pain of the needle insertion through the skin and into the joint cavity. Aspiration of the fluid into the syringe can be very painful because of the size and inflammation of the joint. Usually a steroid medication is injected locally to alleviate the inflammation; a compression bandage is applied to help decrease swelling; and the client is asked to rest the joint for up to 24 hours afterward to help relieve the pain and promote rest to the inflamed joint. The client may experience pain during this time until the inflammation begins to resolve and swelling decreases.

A client with osteoarthritis will undergo an arthrocentesis on a painful, edematous knee. What should be included in the nursing plan of care? Select all that apply. 1. Explain the procedure. 2. Administer preoperative medication 1 hour before surgery. 3. Instruct the client to immobilize the knee for 2 days after the surgery. 4. Assess the site for bleeding. 5. Offer pain medication.

1, 4, 5. To prepare a client for an arthrocentesis, the nurse should tell the client that a local anesthetic administered by the physician will decrease discomfort. There may be bleeding after the procedure, so the nurse should check the dressing. The client may experience pain. The nurse should offer pain medication and evaluate outcomes for pain relief. Because a local anesthetic is used, the client will not require preoperative medication. The client will rest the knee for 24 hours and then should begin range-of-motion and muscle-strengthening exercises.

104 Which of the following indicates that a client with a fracture of the right femur may be developing a fat embolus?. 1. Acute respiratory distress syndrome. 2. Migraine-like headaches. 3. Numbness in the right leg. 4. Muscle spasms in the right thigh.

1. Fat emboli usually result in symptoms of acute respiratory distress syndrome, such as apprehension, chest pain, cyanosis, dyspnea, tachypnea, tachycardia, and decreased partial pressure of arterial oxygen resulting from poor oxygen exchange. Migraine-like headaches are not a symptom of a fat embolism, but mental confusion, memory loss, and a headache from poor oxygen exchange may be seen with central nervous system involvement. Numbness in the right leg is a peripheral neurovascular response that most likely is related to the femoral fracture. Muscle spasms in the right thigh are a symptom of a neuromuscular response affecting the local muscle around the femoral fracture site.

A postmenopausal client is scheduled for a bone-density scan. The nurse should instruct the client to:. 1. Remove all metal objects on the day of the scan. 2. Consume foods and beverages with a high content of calcium for 2 days before the test. 3. Ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4. Report any significant pain to the physician at least 2 days before the test.

1. Metal will interfere with the test. Metallic objects within the examination field, such as jewelry, earrings, and dental amalgams, may inhibit organ visualization and can produce unclear images. Ingesting foods and beverages days before the test will not affect bone mineral status. Short-term calcium gluconate intake will also not influence bone mineral status. The client may already have had chronic pain as a result of a bone fracture or from osteoporosis.

A physician prescribes a lengthy x-ray examination for a client with osteoarthritis. Which of the following actions by the nurse would demonstrate client advocacy?. 1. Contact the x-ray department and ask the technician if the lengthy session can be divided into shorter sessions. 2. Contact the physician to determine if an alternative examination could be scheduled. 3. Provide a dose of acetaminophen (Tylenol). 4. Cancel the examination because of the hard x-ray table.

1. Shorter sessions will allow the client to rest between the sessions. Changing the physician's prescription to a different examination will not provide the information needed for this client's treatment. Acetaminophen is a nonopioid analgesic and an antipyretic, not an anti-inflammatory agent. Thus, it would not help this client avoid the adverse effects of a lengthy x-ray examination. Although the x-ray table is hard, there are other options for making the client comfortable, rather than canceling the examination.

44 Following a total hip replacement, the nurse should do which of the following? Select all that apply. 1. With the aid of a coworker, turn the client from the supine to the prone position every 2 hours. 2. Encourage the client to use the overhead trapeze to assist with position changes. 3. For meals, elevate the head of the bed to 90 degrees. 4. Use a fracture bedpan when needed by the client. 5. When the client is in bed, prevent thromboembolism by encouraging the client to do toe-pointing exercises.

2, 4, 5. Following total hip replacement, the client should use the overhead trapeze to assist with position changes. The head of the bed should not be elevated more than 45 degrees; any height greater than 45 degrees puts a strain on the hip joint and may cause dislocation. To use a fracture bedpan, instruct the client to flex the unoperated hip and knee to lift buttocks onto pan. Toe-pointing exercises stimulate circulation in the lower extremities to prevent the formation of thrombi and potential emboli. The prone position is avoided shortly after a total hip replacement.

The nurse is assessing the home environment of an elderly client who is using crutches during the postoperative recovery phase after hip pinning. Which of the following would pose the greatest hazard to the client as a risk for falling at home?. 1. A 4-year-old cocker spaniel. 2. Scatter rugs. 3. Snack tables. 4. Rocking chairs.

2. Although pets and furniture, such as snack tables and rocking chairs, may pose a problem, scatter rugs are the single greatest hazard in the home, especially for elderly people who are unsure and unsteady with walking. Falls have been found to account for almost half the accidental deaths that occur in the home. The risk of falls is further compounded by the client's need for crutches.

After teaching a group of clients with osteoarthritis about using regular exercise, which of the following client statements indicates effective teaching?. 1. "Performing range-of-motion exercises will increase my joint mobility." 2. "Exercise helps to drive synovial fluid through the cartilage." 3. "Joint swelling should determine when to stop exercising." 4. "Exercising in the outdoors year-round promotes joint relaxation."

2. Weight-bearing exercise plays a very important role in stimulating regeneration of cartilage, which lacks blood vessels, by driving synovial fluid through the joint cartilage. Joint mobility is increased by weight-bearing exercises, not range-of-motion exercises, because surrounding muscles, ligaments, and tendons are strengthened. Pain is an early sign of degenerative joint bone problems. Swelling may not occur for some time after pain, if at all. Osteoarthritic pain is worsened in cold, damp weather; therefore, exercising outdoors is not recommended year round in all settings.

The nurse is caring for a client with Buck's traction following a hip fracture. Which nursing interventions are appropriate for this client? SATA 1. remove weights prior to lifting the client up in bed 2. maintain traction by having weights hang freely 3. administer analgesics as prescribed 4. monitor neurovascular integrity of the affected leg 5. increased fluid intake

2. maintain traction by having weights hang freely 3. administer analgesics as prescribed 4. monitor neurovascular integrity of the affected leg 5. increased fluid intake

The nurse is preparing a client for a bone scan. What is the priority assessment to perform for this client? 1. history of claustrophobia 2. presence of IV access 3. current VS and pain level 4. presence of metallic implants such as pacemaker or aneurysm clips

2. presence of IV access bone scan involves administration of radioisotope to visualize bone for diagnosis.

92 Which of the following client statements identifies a knowledge deficit about cast care?. 1. "I'll elevate the cast above my heart initially." 2. "I'll exercise my joints above and below the cast." 3. "I can pull out cast padding to scratch inside the cast." 4. "I'll apply ice for 10 minutes to control edema for the first 24 hours."

3. Clients should not pull out cast padding to scratch inside the cast because of the hazard of skin breakdown and subsequent potential for infection. Clients are encouraged to elevate the casted extremity above the level of the heart to reduce edema and to exercise or move the joints above and below the cast to promote and maintain flexibility and muscle strength. Applying ice for 10 minutes during the first 24 hours helps to reduce edema.

52 The nurse has established a goal with a client to improve mobility following hip replacement. Which of the following is a realistic outcome at the time of discharge from the surgical unit?. 1. The client can walk throughout the entire hospital with a walker. 2. The client can walk the length of a hospital hallway with minimal pain. 3. The client has increased independence in transfers from bed to chair. 4. The client can raise the affected leg 6 inches (15.2 cm) with assistance.

3. Expected outcomes at the time of discharge from the surgical unit after a hip replacement include the following: increased independence in transfers, participates in progressive ambulation without pain or assistance, and raises the affected leg without assistance. The client will not be able to walk throughout the hospital, walk for a distance without some postoperative pain, or raise the affected leg more than several inches. The client may be referred to a rehabilitation unit in order to achieve the additional independence, strength, and pain relief.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for:. 1. Limited motion of joints. 2. Deformed joints of the hands. 3. Early morning stiffness. 4. Rheumatoid nodules.

3. Initially, most clients with early symptoms of rheumatoid arthritis report early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.

40 After knee arthroplasty, the client has a sequential compression device (SCD). The nurse should do which of the following?. 1. Elevate the SCD on two pillows. 2. Change the settings on the SCD to make the client more comfortable. 3. Stop the SCD to remove dressings and bathe the leg. 4. Discontinue the SCD when the client is ambulatory.

4. After knee arthroplasty, the knee will be extended and immobilized with a firm compression dressing and an adjustable soft extension splint in place. An SCD will be applied. The SCD can be discontinued when the client is ambulatory, but while the client is in bed the SCD needs to be maintained to prevent thromboembolism. The SCD should be positioned on the bed, but not on two pillows. Settings for the SCD are prescribed by the orthopedic surgeon. Initial dressing changes are completed by the orthopedic surgeon and changed as needed per physician prescription.

43 Following a total hip replacement, the nurse should position the client in which of the following ways?. 1. Place weights alongside the affected extremity to keep the extremity from rotating. 2. Elevate both feet on two pillows. 3. Keep the lower extremities adducted by use of an immobilization binder around both legs. 4. Keep the extremity in slight abduction using an abduction splint or pillows placed between the thighs.

4. After total hip replacement, proper positioning by the nurse prevents dislocation of the prosthesis. The nurse should place the client in a supine position and keep the affected extremity in slight abduction using an abduction splint or pillows or Buck's extension traction. The client must not abduct or flex the operated hip because this may produce dislocation.

50 A client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should first: 1. Stabilize the leg with Buck's traction. 2. Apply an ice pack to the affected hip. 3. Position the client toward the opposite side of the hip. 4. Notify the orthopedic surgeon.

4. If a prosthesis becomes dislocated, the nurse should immediately notify the surgeon. This is done so the hip can be reduced and stabilized promptly to prevent nerve damage and to maintain circulation. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. If prescribed by the surgeon, an ice pack may be applied post-reduction to limit edema, although caution must be utilized due to potential muscle spasms. Some orthopedic surgeons may prescribe the client be turned toward the side of the reduced hip, but that is not the nurse's first response.

The client with rheumatoid arthritis tells the nurse, "I have a friend who took gold shots and had a wonderful response. Why didn't my physician let me try that?" Which of the following responses by the nurse would be most appropriate?. 1. "It's the physician's prerogative to decide how to treat you. The physician has chosen what is best for your situation." 2. "Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3. "That drug is used for cases that are worse than yours. It wouldn't help you, so don't worry about it." 4. "Every person is different. What works for one client may not always be effective for another."

4. The nurse's most appropriate response is one that is therapeutic. The basic principle of therapeutic communication and a therapeutic relationship is honesty. Therefore, the nurse needs to explain truthfully that each client is different and that there are various forms of arthritis and arthritis treatment. To state that it is the physician's prerogative to decide how to treat the client implies that the client is not a member of his or her own health care team and is not a participant in his or her care. The statement also is defensive, which serves to block any further communication or questions from the client about the physician. Asking the client to tell more about the friend presumes that the client knows correct and complete information, which is not a valid assumption to make. The nurse does not know about the client's friend and should not make statements about another client's condition. Stating that the drug is for cases that are worse than the client's demonstrates that the nurse is making assumptions that are not necessarily valid or appropriate. Also, telling the client not to worry ignores the underlying emotions associated with the question, totally discounting the client's feelings.