NU272 HESI Prep: Med-surg Musculoskeletal

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?

" 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.

A client reports mild tenderness and swelling near the ankle while running. Which nursing instruction would help the client prevent future injury?

"Do warm-up muscle exercises before performing an activity." - A client with mild tenderness and swelling at the ankle area has a first-degree (mild) sprain. Warming up muscles then doing stretching exercises before performing any vigorous activity may reduce the risk of sprains and strains. The sprain may be reduced when endurance exercises start at a low level of effort and progress gradually to a moderate level. Balancing exercises, which may overlap with some strengthening exercises, help prevent falling but are not as important in a strain as is proper warm-up. Strengthening exercises must be done before undertaking an activity to build muscle strength and bone density.

A client who is in skin traction while awaiting surgery for repair of a fractured femur asks the nurse to release the traction because of leg pain. Which response would the nurse make?

"I can't do that because the weights are needed to keep the bone aligned." - The response "I can't do that because the weights are needed to keep the bone aligned" explains why the traction may not be released; a continuous pull must be maintained. Reducing the weight requires a primary health care provider's prescription; removing half the weights will not maintain the bone in alignment. The response "I'll get your prescribed pain medication increased to help relieve your discomfort" ignores the client's request to release the traction; further assessment is needed. Although the response "I have to follow the primary health care provider's directions, and releasing weights is not prescribed" is a true statement, it does not provide the rationale as to why the weights should not be released.

The registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for additional instruction?

"I should walk on soft scatter rugs at home." - A client with injuries due to a fall must avoid having throw or scattered rugs at home to reduce the incidence of falls. The registered nurse (RN) would encourage the client to drink 3000 mL of water per day to promote optimal bladder and bowel function. The client would eat six small meals with foods rich in fiber, such as fruits and vegetables, to prevent constipation. The RN has to encourage the client to perform exercise above and below the cast daily for a speedy recovery.

After signing a legal consent for hip replacement surgery and within hours before the surgery, the client states, "I decided not to go through with the surgery." Which response would the nurse use initially?

"Let's talk about your concerns regarding the procedure." - The response, "Let's talk about your concerns regarding the procedure," attempts to explore why the client is refusing the procedure and promotes communication. The response, "Then you shouldn't have signed the consent," is accusatory; the client has the right to withdraw consent at any time. The response, "I can understand why you changed your mind," draws a conclusion without adequate data; also, the statement may increase the client's anxiety level. The response, "Tell me why you decided to refuse the operation," may be too direct and authoritative; also the statement may put the client on the defensive.

Which joint helps in the gliding movement of the wrist?

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

Which foot disorder is caused by continual pressure over bony prominences?

Corn - A corn is a foot disorder caused by continual pressure over bony prominences. A plantar wart is a foot disorder caused by a virus. Hammertoe is a foot disorder caused by flexion and deformity in the joints. Hallux rigidus is caused by osteoarthritis.

Which change in the joint may result in joint pain for older adults?

Increased cartilage erosion - Joint pain in an older adult is due to increased cartilage erosion. A loss in height and shortening of the trunk is due to a loss of water from the discs. A decrease in muscle cells causes a decrease in muscle strength. An increased rigidity in the neck, shoulders, back, hips, and knees is due to a loss of elasticity in the ligaments.

Which nursing interventions would the nurse implement when providing postoperative care for a client who had a below-the-knee amputation?

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.

Which synovial joint movement is described as turning the sole away from the midline of the body?

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

Which daily diet recommendation would the nurse reinforce with a client who has arthritis?

Foods from a variety of food groups - There is no special diet for arthritis. A balanced diet, consisting of foods from all groups of the MyPlate dietary guidelines, is essential in maintaining nutrition. Limiting the diet to particular foods does not provide all the essential nutrients. If nutritional intake is adequate, large doses of multivitamins are unnecessary and are dangerous.

Which tissue connects the client's tibia to the femur at the knee joint?

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 clinical manifestation would the nurse associate with Landouzy-Déjérine muscular dystrophy (MD)?

Loss of hearing - Loss of hearing is the clinical manifestation of Landouzy-Déjérine MD. Cardiomyopathy and respiratory failure are the clinical manifestations of both Duchenne and Becker MD. Duchenne MD is clinically manifested by mental impairment.

Which element would the nurse focus on when teaching crutch-walking to a client who has a casted leg fracture?

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 reason for a decrease in height is common in older women?

Older adults may have osteoporosis-related height changes. - Because of the decreasing amounts of estrogen in older women, there is a loss of calcium as well, which can lead to osteoporotic bone loss and a loss in height. Older adults have decreased levels of growth hormone but that does not cause a loss of height. Sweeping statements about older adults not being active enough or having poor posture are not accurate.

Which action would the nurse take in caring for a client after surgical placement of an external fixator on the client's leg?

Perform a neurovascular assessment of the lower extremities. - A neurovascular assessment identifies early signs and symptoms of compartment syndrome. Compartment syndrome is increased pressure within a closed fascial space caused by a fracture or soft-tissue damage that compresses circulatory vessels, nerves, and tissues, compromising viability of the limb. The nurse would monitor for the six Ps: unrelenting pain, pallor, paresthesia, pressure, pulselessness, and paralysis. In addition, the circumference of the extremity will increase, and the leg will feel hard and firm on palpation. Both legs are assessed for symmetry. There is no established standard of care associated with pin care; some primary health care providers believe that pin care is contraindicated because it disrupts the skin's natural barrier to infection. Initially the client should use a wheelchair or walk without bearing weight on the affected extremity. As healing occurs, the primary health care provider will prescribe progressive weight bearing exercises. Maintaining abduction of the leg is not necessary with an external fixation of the tibia.

Which condition would the nurse suspect in the client who reports a burning sensation and sharp pain on the sole of a foot?

Plantar fasciitis - Plantar fasciitis is a burning sensation and sharp pain on the sole of the foot. It is caused by chronic degeneration and inflammation. Torticollis is the twisting of the neck to one side to an unusual position. Pes planus is the abnormal flatness of the sole and arch of the foot. Crepitation is a frequent, audible crackling sound with a palpable grating that accompanies movement.

Which type of diet would the nurse expect the primary health care provider to prescribe for a client diagnosed with rheumatoid arthritis?

Regular diet with vitamins and minerals - There are no dietary restrictions for clients with rheumatoid arthritis, but iron and vitamins should be encouraged to treat any underlying nutritional deficiencies. A salt-free, low-fiber diet is not indicated. A high-calorie diet will increase the client's weight; this is contraindicated because it will increase the strain on weight-bearing joints. A balanced diet should fulfill nutritional needs; there is no need to increase protein or restrict calcium.

Which estrogen antagonist would the health care provider prescribe a client for the prevention and treatment of osteoporosis in postmenopausal women?

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.

The nurse anticipates the provider will apply which type of immobilization device for a client with an acute wrist fracture and considerable swelling after 12 hours?

Sugar-tong splint - A sugar-tong splint is used in acute wrist injuries that can cause considerable swelling or inflammation. A short arm cast is used in a stable wrist or metacarpal fracture. A long arm cast is used for a stable forearm or elbow fracture. A posterior splint is used early after the injury occurred.

Which action by a 70-year-old female client would best limit further progression of osteoporosis?

Taking supplemental calcium and vitamin D - Research demonstrates that women past menopause need at least 1500 mg of calcium a day, which is almost impossible to obtain through dietary sources because the average daily consumption of calcium is 300 to 500 mg. Vitamin D promotes the deposition of calcium into the bone. Consumption of eggs and cheese does not contain adequate calcium to meet requirements to prevent osteoporosis; these foods do not contain vitamin D unless fortified. If large amounts of magnesium are present, calcium absorption is impeded because magnesium and calcium absorption are competitive; vitamin E is unrelated to osteoporosis. Milk and milk products may not be consumed in quantities adequate to meet requirements to prevent osteoporosis.

Goniometer

The goniometer, a device used to measure the angle of a joint (as shown in the image), is used to assess range of motion. An arthroscope is a small fiberoptic tube that can be inserted into a joint for visualization. Splints and orthoses (braces) are used to immobilize joints after fracture. External fixators are used to stabilize bone injuries.

Which age-related finding would the nurse discover when assessing the health of a 69-year-old client?

Walking with neck bent forward - Aging is associated with changes in gait. Walking with neck bent forward suggests a gait change, supporting the nurse's conclusion. Wide opening of eyes is not an age-related change. The release of sex hormones in both men and women causes growth of facial hair, which is normal. A bruise could be a result of an injury and not limited to aging.

Which assessment findings are systemic manifestations of acute osteomyelitis? Select all that apply. One, some, or all responses may be correct.

malaise restlessness night sweats - Malaise, restlessness, and night sweats are systemic manifestations of acute osteomyelitis. Warmth and swelling at the infection site are local manifestations of acute osteomyelitis.