NU272 EAQ Evolve Elsevier NU272 HESI Prep: Med-Surg Musculoskeletal

1Which bones are examples of a client's flat bones? Select all that apply. One, some, or all responses may be correct. o Sacrum o Scapula o Sternum o Humerus o Mandible

o Scapula o Sternum · Flat bones such as the scapula and sternum are compact bones separated by a layer of cancellous bone that contains bone marrow. Bones such as the sacrum and mandible are irregular bones; they appear in a variety of shapes and sizes. The humerus is a long bone with a central shaft and two widened ends.

The nurse advises a client recovering from a musculoskeletal injury to increase intake of which nutrient? o Fat o Protein o Sodium o Vitamin A

o Protein · People suffering from a musculoskeletal injury should be advised to increase their intake of protein to promote tissue healing and recovery. Also important are adequate intake of fluids, fiber, and minerals such as calcium, phosphorus, and magnesium. Fat, sodium, and vitamin A are not specifically beneficial for musculoskeletal injuries.

The nurse is providing discharge teaching to a client who was hospitalized for exacerbation of rheumatoid arthritis. Which statement by the client indicates correct understanding of the treatment plan? o "I will plan to rest in bed for the next 2 weeks." o "I will only take my medications when I am having joint pain." o " I will reduce the number of exercise repetitions when I have pain." o "I will push off with my fingers rather than my palms to get out of bed."

o " I will reduce the number of exercise repetitions when I have pain." · The amount of exercise and number of repetitions should be reduced to prevent further joint damage if the client is experiencing increased pain. Activity should be balanced with rest. Medications should not be discontinued without consulting the primary health care provider. Pushing off with fingers may cause further damage to the phalangeal joints.

Which client statement indicates effective learning of their osteomyelitis treatment with ciprofloxacin therapy? o "I should go to my primary health care provider's clinic for a weekly dressing change." o "I should stop taking the medication as soon as my symptoms begin to decrease." o "I should not remove the soiled dressing without someone's assistance." o "I should contact my primary health care provider if white patches appear in my mouth."

o "I should contact my primary health care provider if white patches appear in my mouth." · Ciprofloxacin causes adverse effects like formation of whitish-yellow or curd-like lesions in the mouth and itching in the perianal area. The client's statement regarding the primary health care provider should be contacted in case of white patches in the mouth indicates effective learning. Clients should change their dressings once soiled, not weekly. The client must take the antibiotic even after the symptoms have subsided and feels better. If the client abruptly discontinues this medication, medication resistance may develop. There are no restrictions as to who should change the dressing; the client can also change the dressing as needed.

Which key factor assists the nurse in assessing how a client will cope with the body image change after an above-the-knee amputation? o Extent of the change o Suddenness of the change o Obviousness of the change o Personal perception of the change

o Personal perception of the change · The reality of a situation is not the important issue at this time, but the client's feelings or perceptions about the change are the most important determinant of the client's ability to cope. The extent of change is not relevant; what is relevant is whether the client perceives the change as enormous or less important. Although suddenness of the change may influence a person's coping ability, this is not the primary factor influencing a client's coping mechanisms with body image changes. Although obviousness of the change may influence a person's coping ability, this is not the primary factor influencing coping mechanisms with body image changes.

Which type of joint is present in between the client's tarsal bones? o Pivot o Hinge o Saddle o Gliding

o Gliding · The gliding joint is present in between the tarsal bones. The pivot joint is present in the proximal radioulnar joint. The hinge joint is present in the elbows and knees. The saddle joint is present in between the carpometacarpal joints of the thumb.

A client who had an above-the-knee amputation (AKA) has a pressure dressing on the end of the residual limb. The client asks, "Why do I have to have this tight dressing on my leg?" Which response would the nurse provide? o "It decreases the swelling of the area." o "It decreases the formation of scar tissue." o "It prevents the formation of blood clots." o "It reduces phantom limb pain."

o "It decreases the swelling of the area." · The pressure dressing prevents fluid from shifting into the interstitial compartment; this promotes shrinkage of the residual limb to facilitate use of a prosthesis. Bandaging will not affect the formation of a scar, prevent blood clots, or reduce phantom limb pain.

A client admitted to the hospital with an acute episode of rheumatoid arthritis (RA) asks why physical therapy has not been prescribed. Which response would the nurse make? o "Your primary health care provider must have forgotten to prescribe it." o "Your condition is not severe enough to have physical therapy approved." o "Your joints are still inflamed, and physical therapy can be harmful." o "Physical therapy is not helpful for persons who have RA."

o "Your joints are still inflamed, and physical therapy can be harmful." · Rest is required during active inflammation of the joints to prevent injury; once active inflammation has receded, an activity and exercise regimen can begin. Physical therapy is not prescribed during a period of exacerbation because it can traumatize already inflamed joints. The extent of the arthritis is not the determinant; whether the process is in exacerbation or remission is the deciding factor. Physical therapy is helpful, but it is not performed during an acute exacerbation of the arthritis.

Which term describes synovial joint movement away from the midline of the body? o Inversion o Extension o Pronation o Abduction

o Abduction · Abduction is a synovial joint movement that involves movement of a part away from the midline of the body. Inversion is turning of the sole inward toward the midline of the body. Pronation is a synovial joint movement that involves the turning of the palm downward. Extension is a synovial joint movement that involves a straightening of joint that increases the angle between two bones.

In the postanesthesia care unit after a below-the-knee amputation, a client reaches for the lower leg and begins crying. Which intervention would the nurse choose? o Administer medication to induce sleep. o Allow the client to ventilate feelings of loss. o Provide privacy by leaving the room. o Wait to address the behavior until the client is more alert

o Allow the client to ventilate feelings of loss. · Allowing the client to grieve for the lost limb often aids acceptance of the loss. Sedation will prevent the client from facing the problem. Leaving the client alone may be interpreted by the client as rejection. Client expressions of emotions should not be ignored.

Which finding during a home health visit would prompt the nurse to provide a client with home safety instructions? Select all that apply. One, some, or all responses may be correct. o Area rugs on the floor o Clogged, dirty fireplace o Multiple electrical cords o Multiple prescribed medications o Wheeled walker with uneven legs

o Area rugs on the floor o Clogged, dirty fireplace o Multiple electrical cords o Multiple prescribed medications o Wheeled walker with uneven legs · There are multiple potential hazards in the home clients should be educated about to avoid injury. Area rugs and multiple electrical cords on the floor pose a fall risk. A clogged, dirty fireplace could lead to carbon monoxide poisoning. Polypharmacy can cause mental status changes, confusion, and orthostatic blood pressure changes; these can increase the client's fall risk. If the nurse observes a wheeled walker with uneven legs, the physical therapist would be notified as they can follow-up to evaluate the mobility aid's safety.

The nurse is providing discharge planning for a college student who has undergone a knee arthroscopy for a tendon repair. The client plans to return to the college dormitory and spend the weekend there before returning to class in 2 days. Which action is most important for the nurse to include in planning process? o Arrange for transportation to return the client to the dormitory. o Instruct the client to restrict activities for at least several days. o Suggest the client ask college instructors for additional time to complete assignments. o Ask the client who is available in the dormitory to provide assistance.

o Ask the client who is available in the dormitory to provide assistance. · Before discharge, the nurse would ensure that a responsible person is available to assist the client if needed. Arranging transportation without a plan for follow-up care is unsafe nursing care. Instruction to restrict activities is inadequate, incomplete nursing care. Suggesting the client ask for additional time to complete assignments is helpful, but not a safety priority.

Which ethnic group has a greater incidence of osteoporosis due to musculoskeletal differences? o Irish Americans o African Americans o Chinese Americans o Egyptian Americans

o Chinese Americans · Chinese Americans have an increased incidence of osteoporosis because they have shorter and smaller bones with lower bone density. Irish Americans have taller and broader bones than other Euro-Americans. African Americans have a decreased incidence of osteoporosis. Egyptian Americans are shorter in stature than Euro-Americans and African Americans.

When describing the self-sustained major automobile collision to a friend, the hospitalized client becomes very restless and experiences sudden tachycardia with tachypnea. Which factor most likely initiated the physiological responses? o Client's method of seeking sympathy o Bleeding from an undiscovered injury o Delayed psychological response to trauma o Parasympathetic nervous system response to anxiety

o Delayed psychological response to trauma · Reliving the experience brings back the feelings, such as anxiety and fear, associated with the experience; the alterations described reflect sympathetic nervous system activity. There are not enough data present to determine the client's usual method of seeking sympathy. The increased pulse and restlessness may indicate bleeding; however, the other data presented support anxiety. Additional assessment is necessary to confirm bleeding. These changes are indicative of a sympathetic, not a parasympathetic, response.

At which joint would the nurse be able to palpate spongy swelling caused by excess synovial fluid? o Biaxial joint o Pivotal joint o Synovial joint o Temporomandibular joint

o Temporomandibular joint · The temporomandibular joint is palpated by asking the client to open his or her mouth; the nurse checks for any pain or weakness in the face. Common abnormal findings include tenderness, crepitus (a grating sound), and a spongy swelling caused by excess synovial fluid. Biaxial joints help in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Synovial joints provide movement at the point of contact of articulating bones such as the hip, shoulders, and knees.

Which nursing interventions would the nurse implement when providing postoperative care for a client who had a below-the-knee amputation? o Maintain strict bed rest for 2 days post procedure to reduce dependent edema. o Elevate residual leg slightly while keeping the knee joint straight for first 24 hours. o Hemorrhage rarely occurs during the early postoperative period. o The surgeon will change the dressing within 48 hours after the procedure.

o Elevate residual leg slightly while keeping the knee joint straight for first 24 hours. · Elevation of the residual limb helps prevent edema; however, slight elevation during the first 24 hours as continued elevation may lead to hip contractures. The knee joint is kept extended, not flexed during this time. The client usually is out of bed on the second postoperative day. Hemorrhage and infection are the two most common complications. The dressing usually is a pressure dressing, and the surgeon does not change the pressure dressing this soon postoperatively. Sometimes the pressure dressing has a cast in place to shape the residual leg for a prosthesis.

After an amputation of a limb, a client reports extreme discomfort in the area where the limb once was. On which goal would the nurse plan to focus interventions? o Identifying actions to decrease pain in the lost limb o Reversing feelings of hopelessness about the future o Promoting mobility in the residual limb o Facilitating the grieving process for the lost limb

o Identifying actions to decrease pain in the lost limb · Phantom limb sensation is a real experience with no known cause or cure. The pain must be acknowledged and interventions to relieve the discomfort explored. There are no data indicating that the client is hopeless. Although promoting mobility in the residual limb may be effective for some people, it may not be effective for others; all possible interventions should be explored. There are no data indicating that the client is grieving.

A student athlete reports muscle pain after a practice session. Which product of muscle metabolism would the nurse explain as being a cause of pain? o Lactic acid o Acetoacetic acid o Hydrochloric acid o Beta-hydroxybutyric acid

o Lactic acid · The ache in muscles that have been vigorously worked without adequate oxygen supply is caused in part by the buildup of lactic acid. During rest, the lactic acid is oxidized completely to carbon dioxide and water, providing adenosine triphosphate for further muscular contraction. Beta-hydroxybutyric acid and acetoacetic acid are not products of muscle contraction; they are ketone bodies resulting from incomplete oxidation of fatty acids. Hydrochloric acid is not a product of muscle contraction; it is present in the stomach to facilitate the digestive process.

Which activity will prepare the client who has a new above-the-knee amputation for crutch walking? o Lifting weights o Turning in bed o Caring for the residual limb o Performing phantom limb exercises

o Lifting weights · Preparation for crutch walking includes exercises to strengthen arm and shoulder muscles. Position changes help prevent hip flexion contractures but do not prepare the client for crutch walking. Caring for the residual limb promotes healing and helps prepare the limb for the prosthesis, but it does not prepare the client for crutch walking. The phantom limb sensation includes a feeling that the absent limb is present; there are no specific exercises for this phenomenon.

Which tissue connects the client's tibia to the femur at the knee joint? o Fascia o Bursae o Tendons o Ligaments

o Ligaments · A ligament is a dense, fibrous connective tissue that connects bone to bone, such as the tibia to the femur at the knee joint. Ligaments provide stability while permitting controlled movement at the joint. Fascia is a connective tissue that can withstand limited stretching; it provides strength to muscle tissues. Bursae are small sacs of connective tissue lined with synovial membrane and synovial fluid that are located at bony prominences and joints to relieve pressure. A tendon is a dense, fibrous connective tissue that attaches muscle to bone.

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

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

Which estrogen antagonist would the health care provider prescribe a client for the prevention and treatment of osteoporosis in postmenopausal women? o Raloxifene o Denosumab o Alendronate o Zoledronic acid

o Raloxifene · Raloxifene prevents and treats osteoporosis in postmenopausal women by increasing bone mineral density, reducing bone desorption, and reducing incidences of osteoporotic vertebral fractures. Denosumab is a monoclonal antibody used to treat osteoporosis when other medications are not effective. Alendronate and zoledronic acid are commonly used for the prevention and treatment of osteoporosis.

Which action would the nurse teach a client to avoid after a total hip replacement? o Climbing stairs o Stretching exercises o Sitting in a low chair o Lying prone more than 15 minutes

o Sitting in a low chair · Excessive flexion of the hip, such as that caused by sitting in a low chair, can cause dislocation of the femoral head. Climbing stairs should not cause undue strain on the operative site. Stretching exercises should be encouraged as long as no extremes of position are implemented. The client is permitted to lie prone for more than 15 minutes; lying prone should be encouraged because it prevents hip flexion contractures.

A client who has bone cancer is being prepared for the first radiation treatment. The client starts crying, stating, "I'm so discouraged." Which response would the nurse make? o Tell the client, "It's difficult to deal with your diagnosis and treatment." o Complete the preparation and tell the client, "We can talk about this later." o Explain the therapy and reinforce that it will only cause a little discomfort. o Allow the client to be alone for a few minutes so the client can regain composure

o Tell the client, "It's difficult to deal with your diagnosis and treatment." · The correct response focuses on the client's feelings of despair and provides the opportunity to talk about them. Leaving the client alone abandons the client and leaves the client with no support. Avoiding a pressing problem misses an opportunity for discussion of feelings. Explaining the therapy and saying it will only cause a little discomfort focuses on the nurse's interpretation of the problem, not the client's.