Ortho question collection
A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? Potassium level of 6.3 mEq/L Calcium level of 11.6 mg/dl Sodium level of 110 mEq/L Magnesium level of 0.9 mg/dl
Calcium level of 11.6 mg/dl In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 1.3 mg/dl) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.
Identify the area on the figure where the nurse would assess for lordosis
Lordosis, also known as swayback, is an exaggeration of the lumbar curve of the spine.
A client is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan? Removing the weights once every shift Maintaining the bed in the knee-Gatch position Keeping the client in semi-Fowler's position Maintaining correct body alignment
Maintaining correct body alignment Buck's traction produces realignment by exerting a pulling force on the fractured hip. Therefore, the nurse must maintain correct body alignment. Traction should be continuous; if the weights must be removed, the nurse should apply manual traction until the weights are replaced. The nurse shouldn't use the knee-Gatch position because it disrupts the constant pulling force needed for alignment. Using the semi-Fowler's position would cause the client to slide in the direction of the traction, defeating the purpose of traction.
Identify descriptors of the pathophysiologic process seen in osteomalacia. Select all that apply. There is a deficiency of activated vitamin D (calcitriol). Calcium and phosphate are not moved to the bones. The bone mass is structurally weaker, and bone deformities occur. Excessive osteoclastic activity causes the bones to become soft and bowed initially; later, the bones thicken but are not well formed, making the bones weak and prone to fracture.
There is a deficiency of activated vitamin D (calcitriol). Calcium and phosphate are not moved to the bones. The bone mass is structurally weaker, and bone deformities occur. In the pathophysiologic process seen in osteomalacia, there is a deficiency of activated vitamin D (calcitriol), calcium and phosphate are not moved to the bones, the bone mass is structurally weaker, and bone deformities occur.
Which nerve is assessed when the nurse asks the client to spread all fingers? Ulnar Peroneal Radial Median
Ulnar Asking the client to spread all fingers allows the nurse to assess motor function affected by ulnar innervation, while pricking the fat pad at the top of the small finger allows assessment of the sensory function affected by the ulnar nerve. The peroneal nerve is assessed by asking the client to dorsiflex the ankle and to extend the toes. The radial nerve is assessed by asking the client to stretch out the thumb, then the wrist, and then the fingers at the metacarpal joints. The median nerve is assessed by asking the client to touch the thumb to the little finger.
A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply. Sit in a straight-backed chair with arm rests. Use a firm pillow placed behind the thoracic vertebrae to straighten the small of the back. Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under."
Sit in a straight-backed chair with arm rests. Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under." All choices are correct, except that a soft pillow support is recommended to eradicate the hollow of the back.
A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? Apply the traction straps snugly. Assess the client's level of consciousness. Remove the traction at least every 8 hours. Teach the client how to prevent problems caused by immobility.
Teach the client how to prevent problems caused by immobility. By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.
A nurse is providing care for a client whose pattern of laboratory testing reveals long-standing hypocalcemia. What other laboratory result is most consistent with this finding? An elevated parathyroid hormone level An increased calcitonin level An elevated potassium level A decreased vitamin D level
An elevated parathyroid hormone level In the response to low calcium levels in the blood, increased levels of parathyroid hormone prompt the mobilization of calcium and the demineralization of bone. Increased calcitonin levels would exacerbate hypocalcemia. Vitamin D levels do not increase in response to low calcium levels. Potassium levels would likely be unaffected.
The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery? Antidysrhythmia therapy Antianginal therapy Antineoplastic therapy Anticoagulation therapy
Anticoagulation therapy Anticoagulation therapy and early ambulation are very important for clients who have knee or hip replacement to prevent thrombus formation. The other therapy is not indicated solely for the knee or hip arthroplasty.
Which would be an inappropriate initial pain relief measure for the client with a cast? Application of cold packs Application of a new cast Administration of analgesics Elevation of the involved part
Application of a new cast Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary.
A nurse is assessing a client who is receiving traction. The nurse's assessment confirms that the client is able to perform plantar flexion. What conclusion can the nurse draw from this finding? The leg that was assessed is free from DVT. The client's tibial nerve is functional. Circulation to the distal extremity is adequate. The client does not have peripheral neurovascular dysfunction.
The client's tibial nerve is functional. Plantar flexion demonstrates function of the tibial nerve. It does not demonstrate the absence of DVT and does not allow the nurse to ascertain adequate circulation. The nurse must perform more assessments on more sites in order to determine an absence of peripheral neurovascular dysfunction.
Hypercalcemia is a dangerous complication of bone cancer. Therefore, nursing assessment includes evaluation of symptoms that require immediate treatment. Which of the following are signs/symptoms that are indictors of an elevated serum calcium? Select all that apply. a. Muscle weakness b. Tachycardia c. Anorexia and constipation d. Prolonged ST segment e. Shortened QT interval f. Lack of muscle coordination
a. Muscle weakness c. Anorexia and constipation e. Shortened QT interval f. Lack of muscle coordination Hypercalcemia is a dangerous complication of bone cancer. The symptoms must be recognized and treatment initiated promptly. Symptoms include muscular weakness, incoordination, anorexia, nausea and vomiting, constipation, electrocardiographic changes (eg, shortened QT interval and ST segment, bradycardia, heart blocks), and altered mental states (eg, confusion, lethargy, psychotic behavior).
A client reports being consistently tired, with no energy. The client's CBC indicates low hemoglobin. Where is hemoglobin manufactured? ribs ulna femur All options are correct.
ribs Red bone marrow, found primarily in the sternum, ileum, vertebrae, and ribs, manufactures blood cells and hemoglobin.
A client reports swelling and severe pain in the right wrist. After examination and radiographs negate a fracture, what would the physician likely prescribe as treatment? splint brace cast All options are correct.
splint The client would use a splint when a musculoskeletal condition does not require rigid immobilization, causes a large degree of swelling, or requires special skin treatment.
Which is a circulatory indicator of peripheral neurovascular dysfunction? Weakness Paresthesia Cool skin Paralysis
Cool skin Indicators of peripheral neurovascular dysfunction related to circulation include pale, cyanotic, or mottled skin with a cool temperature. The capillary refill is more than 3 seconds. Weakness and paralysis are related to motion. Paresthesia is related to sensation.
The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble? Elastic compression bandages Gauze bandages and tape Sterile saline and basin Stockinette and cotton padding
Elastic compression bandages Bivalving of a cast involves splitting the cast longitutdinally and spreading the cast apart to relieve pressure. The fractured extremity is immobilized by securing the two parts of the cast together with an elastic compression bandage.
A client has had an electromyography. What is an appropriate nursing intervention following this diagnostic procedure? Apply warm compresses. Apply a compression dressing. Monitor the client for infection. Monitor the client for anaphylaxis.
Apply warm compresses. Electromyography involves the insertion of needles into select muscles. The nurse applies warm compresses to the insertion sites to relieve discomfort following the procedure.
A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? Keeping the casted arm warm by covering it with a light blanket Avoiding handling the cast for 24 hours or until it is dry Evaluating pedal and posterior tibial pulses every 2 hours Assessing movement and sensation in the fingers of the right hand
Assessing movement and sensation in the fingers of the right hand The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? Assessing the extremity for neurovascular integrity Keeping the client from sliding to the foot of the bed Keeping the ropes over the center of the pulley Ensuring that the weights hang free at all times
Assessing the extremity for neurovascular integrity Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.
Which assessment findings would the nurse expect in the client with osteomalacia? A - Ca (7.2) Ph (5.3) Alkaline Ph (125) B - Ca (6.8) Ph (1.9) Alkaline Ph (135) C - Ca (11.2) Ph (3.0) Alkaline Ph (96) D - Ca (5.3) Ph (4.8) Alkaline Ph (45)
B - Ca (6.8) Ph (1.9) Alkaline Ph (135) Osteomalacia is characterized by decreased serum calcium and phosphorus and elevated alkaline phosphatase levels.
Which assessment findings would the nurse expect to find in the client with osteomyelitis? A - WBC (6,000) ESR (12) Ca (7.2) Ph (5.3) Alkaline Ph (125) B - WBC (12,000) ESR (32) Ca (9.2) Ph (3.1) Alkaline Ph (88) C - WBC (15,000) ESR (9) Ca (11.2) Ph (3.0) Alkaline Ph (96) D - WBC (9,000) ESR (45) Ca (5.3) Ph (4.8) Alkaline Ph (45)
B - WBC (12,000) ESR (32) Ca (9.2) Ph (3.1) Alkaline Ph (88) Osteomyelitis is characterized by elevated white blood cell count and erythrocyte sedimentation rate.
The nurse teaching the client with a cast about home care includes which instruction? Cover the cast with plastic or rubber Keep the cast below heart level Fix a broken cast by applying tape Dry a wet fiberglass cast thoroughly to avoid skin problems
Dry a wet fiberglass cast thoroughly to avoid skin problems Instruct the client to keep the cast dry, to dry a wet fiberglass cast thoroughly to avoid skin problems, and not to cover it with plastic or rubber. A cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. A casted extremity should be elevated frequently to heart level to prevent swelling. A broken cast should be reported to the physician and the client should not attempt to fix it.
A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? Advising the client to avoid red meat Urging her to keep the affected limb in an elevated position Educating the client about the effects of menopause Exploring factors related to the client's home environment
Exploring factors related to the client's home environment Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Because the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Because the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.
An older female client who had a total hip replacement is to be discharged because her healing is almost complete. What would be most important for this client? Advising the client to avoid red meat. Urging her to keep the affected limb in an elevated position. Educating the client about the effects of menopause. Exploring factors related to the client's home environment.
Exploring factors related to the client's home environment. Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Since the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Since the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.
The nurse's musculoskeletal assessment of a client reveals involuntary twitching of muscle groups. How would the nurse document this observation in the client's chart? Tetany Atony Clonus Fasciculations
Fasciculations Fasciculation is involuntary twitching of muscle fiber groups. Clonus is a series of involuntary, rhythmic, muscular contractions and tetany is involuntary muscle contraction, but neither is characterized as "twitching." Atony is a loss of muscle strength.
The nurse is caring for a patient with bone metastasis from a primary breast cancer. The patient complains of muscle weakness and nausea and is voiding large amounts frequently. Cardiac dysrhythmias are observed on the telemetry monitor. What should the nurse suspect based on these clinical manifestations? Hypercalcemia Hypocalcemia Hypokalemia Hyperkalemia
Hypercalcemia Hypercalcemia is present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.
A nurse notices a client lying on the floor at the bottom of the stairs. The client is alert and oriented and denies pain other than in the arm, which is swollen and appears deformed. After calling for help, what should the nurse do? Place the client in a sitting position. Immobilize the client's arm. Help the client walk to the nearest nurses' station. Raise the client's arm above the heart.
Immobilize the client's arm. Signs of a fracture in an extremity include pain, deformity, swelling, discoloration, and loss of function. When a nurse suspects a fracture, the extremity should be immobilized before moving the body part. It isn't appropriate for the nurse to move the client into a sitting position without further assessment. The client shouldn't walk to the nurses' station; the client should wait for help to arrive.
A nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, interventions should address what nursing diagnoses? Select all that apply. Impaired Physical Mobility Acute Pain Disturbed Auditory Sensory Perception Risk for Injury Risk for Unstable Blood Glucose
Impaired Physical Mobility Acute Pain Disturbed Auditory Sensory Perception Risk for Injury Clients with Paget disease are at risk of decreased mobility, pain, hearing loss, and injuries resulting from decreased bone density. Paget disease does not affect blood glucose levels.
A nurse provides health teaching to the family of an older adult client who has trouble walking independently. The nurse reviews age-related changes to the musculoskeletal system with the family. Which of the following statements would the nurse include in the teaching? Select all that apply. Tendons become more elastic. Intervertebral discs become thin. Muscles atrophy. Muscle fibrosis increases. Collagen increases
Intervertebral discs become thin. Muscles atrophy. Muscle fibrosis increases. Collagen increases
Which of the following are clinical manifestations of impingement syndrome? Select all that apply. Pain Shoulder tenderness Limited movement Muscle spasms Atrophy
Pain Shoulder tenderness Limited movement Muscle spasms Atrophy The patient experiences pain, shoulder tenderness, limited movement, muscle spasms, and atrophy. The process may progress to a rotator cuff tear.
A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply. Elevate the arm above the heart. Prepare to remove the cast. Provide support to the injured extremity. Assess neurovascular status every 8 hours. Apply ice to extremity.
Prepare to remove the cast. Provide support to the injured extremity. The nurse should anticipate immediate removal of the cast and provide support to the injured extremity. Neurovascular status should be assessed more frequently than every 8 hours. If the client's neurovascular status is not improving, then a fasciotomy may be needed. Waiting 8 hours to assess neurovascular status may cause permanent damage to the extremity. To promote arterial blood flow, the arm should be elevated to the heart level, not above. Ice should not be used, as it could further decrease blood flow to the extremity.
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. The client will remain free from injury. The client will maintain effective airway clearance.
The client will experience a tolerable level of pain. The client will demonstrate wound care. The client will maintain adequate nutritional intake. Pain is a priority problem for the client with osteomyelitis, and it can interfere with mobility of joint. In this situation, the client's jaw is the site of infection. Pain in this location can interfere with nutritional intake of the individual. Chronic osteomyelitis presents with a nonhealing ulcer over the infected bone with a connecting sinus that will intermittently and spontaneously drain pus. The client will need to be able to provide wound care in the home setting. Remaining free from injury and maintaining an effective airway clearance are not priority goals for the client.
What areas of the body may be examined when bone densitometry is done? Select all that apply. hip spine wrist knee
hip spine wrist The hip, spine, wrist, finger, or heel bone may be examined during bone densitometry testing. The knee is not used for bone densitometry testing.
A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? Renal calculi Urinary tract infection (UTI) Benign prostatic hyperplasia Dehydration
Renal calculi Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.
The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed? "Under no circumstances should I get my cast wet." "The cast should not come in contact with other plastics." "I should avoid touching the cast while it is wet." "The cast will be hot while it is drying."
"Under no circumstances should I get my cast wet." Some fiberglass casts are waterproof, allowing the client to shower or swim. A wet fiberglass cast is susceptible to denting while it is wet. Fiberglass casting involves an exothermic reaction as the cast hardens. The cast should not come in contact with other plastics as the reaction occurs.
To confirm a diagnosis of low back pain, which of the following diagnostic procedures would be ordered to rule out the presence of a tumor? Bone scan Computed tomography Magnetic resonance imaging Electromyogram
Bone scan A bone scan is the preferred diagnostic procedure to disclose tumors in a patient with low back pain.
A nurse is caring for a client who is being assessed following complaints of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply. Computed tomography (CT) Angiography Magnetic resonance imaging (MRI) Ultrasound X-ray
Computed tomography (CT) Magnetic resonance imaging (MRI) Ultrasound X-ray A variety of diagnostic tests can be used to address lower back pain, including CT, MRI, ultrasound, and x-rays. Angiography is not related to the etiology of back pain.
Which would be contraindicated as a component of self-care activities for the client with a cast? Cover the cast with plastic to insulate it Cushioning rough edges of the cast with tape Elevate the casted extremity to heart level frequently Do not attempt to scratch the skin under a cast
Cover the cast with plastic to insulate it The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.
Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder? Osteomalacia Osteoporosis Osteomyelitis Osteitis deformans
Osteitis deformans Osteitis deformans (Paget disease) results in bone that is highly vascularized and structurally weak, predisposing to pathologic fractures. Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. Osteoporosis is characterized by reduction of total bone mass and a change in bone structure that increases susceptibility to fracture. Osteomyelitis is an infection of bone that comes from the extension of a soft-tissue infection, direct bone contamination, or hematogenous spread.
Which cells are involved in bone resorption? Chondrocytes Osteoblasts Osteoclasts Osteocytes
Osteoclasts Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from osteoblasts, are the chief cells in bone tissue.
During which stage or phase of bone healing after fracture does callus formation occur? Remodeling Inflammation Reparative Revascularization
Reparative Callus formation occurs during the reparative stage, but it is disrupted by excessive motion at the fracture site. Remodeling is the final stage of fracture repair during which the new bone is reorganized into the bone's former structural arrangement. During inflammation, macrophages invade and debride the fracture area. Revascularization occurs within about 5 days after the fracture.
A health care provider diagnoses primary osteoporosis in a client who has lost bone mass. For which client is primary osteoporosis most common? elderly man young child young menstruating woman elderly postmenopausal woman
elderly postmenopausal woman Although the cause of primary osteoporosis is unknown, an important contributing factor may be faulty protein metabolism resulting from estrogen deficiency and a sedentary lifestyle. Typically, these conditions occur in elderly postmenopausal women.
A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure: the client that he or she won't be cut. that the cast cutter blade is sharp. that pedal pulses are present. All options are correct.
the client that he or she won't be cut. Casts are removed with a mechanical cast cutter. Cast cutters are noisy and frightening, and the client needs reassurance that the machine will not cut into the skin.
Which classic symptom will the nurse assess for to detect the development of plantar fasciitis? Shortened height Morning heel pain Elevated temperature Shortening of affected leg
Morning heel pain Plantar fasciitis is characterized by heel pain.
A patient has a long leg cast applied. Where does the nurse understand a common pressure problem may occur? Dorsalis pedis Peroneal nerve Popliteal artery Posterior tibialis
Peroneal nerve The nurse assesses circulation by observing the color, temperature, and capillary refill of the exposed toes. Nerve function is assessed by observing the patient's ability to move the toes and by asking about the sensations in the foot. Numbness, tingling, and burning may indicate peroneal nerve injury resulting from pressure at the head of the fibula.
Which cleansing solution is the most effective for use in completing pin site care? Betadine Chlorhexidine Hydrogen peroxide Alcohol
Chlorhexidine Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.
A client is reporting pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the client states the pain is unrelieved. The nurse should identify the warning signs of what complication? Subcutaneous emphysema Skin breakdown Compartment syndrome Disuse syndrome
Compartment syndrome Compartment syndrome may manifest as unrelenting, uncontrollable pain. This presentation of pain is not suggestive of disuse syndrome or skin breakdown. Subcutaneous emphysema is not a complication of casting.
The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? Keep the knees together at all times Never cross the affected leg when seated Avoid placing a pillow between the legs when sleeping Bend forward only when seated in a chair
Never cross the affected leg when seated Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The client should be taught to keep the knees apart at all times, to put a pillow between the legs when sleeping, and to avoid bending forward when seated in a chair.
Which statement is accurate regarding care of a plaster cast? The cast must be covered with a blanket to keep it moist during the first 24 hours. The cast will dry in about 12 hours. The cast can be dented while it is damp. A dry plaster cast is dull and gray.
The cast can be dented while it is damp. The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.
Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? Instruct about using client-controlled analgesia, if prescribed Instruct about exercise, as prescribed Apply antiembolism stockings Apply cold packs
Apply antiembolism stockings Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a client who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain, while ROM exercises help maintain muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling; cold does not prevent deep vein thrombosis.
To help prevent osteoporosis, what should a nurse advise a young woman to do? Avoid trauma to the affected bone. Encourage the use of a firm mattress. Consume at least 1,000 mg of calcium daily. Keep the serum uric acid level within the normal range.
Consume at least 1,000 mg of calcium daily. To help prevent osteoporosis, the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Before menopause, the RDA is 1,000 mg; after menopause, it's 1,500 mg. Because osteoporosis affects all bones, avoiding trauma to the affected bone only is inappropriate. Using a firm mattress and keeping the uric acid level within the normal range don't relate to osteoporosis. The nurse should encourage a client with ankylosing spondylitis to sleep on a firm mattress. The nurse should advise a client with gouty arthritis to keep the serum uric acid level in the normal range.
Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? It provides active range of motion. It promotes healing by increasing circulation and movement of the knee joint. It promotes healing by immobilizing the knee joint. It prevents infection and controls edema and bleeding.
It promotes healing by increasing circulation and movement of the knee joint. A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.
A deoxypyridinoline (Dpd) level has been ordered. How will the nurse prepare for this measurement? Obtain a clean-catch urine. Obtain a blood specimen. Assist the health care provider in obtaining a synovial fluid specimen. Assist the health care provider in obtaining a bone marrow specimen.
Obtain a clean-catch urine. A deoxypyridinoline level is determined from a urine sample. It is a biochemical marker used to assess bone formation.
Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? High fever Persistent draining sinus Rapid pulse Tenderness over the affected area
Persistent draining sinus Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection.
The nurse is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis? Engaging in non-weight-bearing exercises daily Ensuring adequate calcium and vitamin D intake Undergoing assessment of serum calcium levels every year Having a DXA beginning at age 35 years
Ensuring adequate calcium and vitamin D intake Nutritional intake of calcium and vitamin D are essential for the prevention of osteoporosis.
Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Arthrodesis Joint arthroplasty Total joint arthroplasty Open reduction
Open reduction An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching? "Elevating my leg will reduce swelling after the procedure." "My physician may prescribe pain pills after the procedure." "I should use my heating pad this evening to reduce some of the pain in my knee." "I may notice some bruising or swelling in my knee."
"I should use my heating pad this evening to reduce some of the pain in my knee." The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.
Which client would the nurse identify as having the greatest risk for osteoporosis? A 40-year-old overweight African American woman A 16-year-old male with a history of asthma A small-framed, thin 45-year-old white woman A 20-year-old male athlete with repeated injuries
A small-framed, thin 45-year-old white woman Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.
A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Select all that apply. Advise the client to use a trochanter roll. Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach. Advise the client to use antiembolism stockings on both legs. Advise the client to place pillows between the legs.
Advise the client to use a trochanter roll. Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach. Use a trochanter roll to prevent external rotation of the hip and knee. Avoid placing pillows between the legs. If the client is lying on the stomach, the nurse should advise the client to adduct the stump so it presses against the other leg. Adduction stretches flexor muscles and prevents abduction deformity. The client should only use an antiembolism stocking on the unaffected leg.
A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about? Kirschner wires Thomas splint Steinmann pins Crutchfield tongs
Crutchfield tongs Crutchfield tongs are cranial tongs that are used to maintain alignment for a cervical fracture. Kirschner wires and Steinmann pins are used for the skeletal traction to attach to. A Thomas splint is used to suspend a leg in traction.
Which are true about Lyme disease? Select all that apply. If untreated, the disease moves through three stages. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Cardiac and neurologic symptoms occur midstage, followed by arthritis and joint problems. Nephrotic syndromes occur in the later stages.
If untreated, the disease moves through three stages. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Cardiac and neurologic symptoms occur midstage, followed by arthritis and joint problems. If untreated, the disease moves through three stages. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Cardiac and neurologic symptoms occur midstage, followed by arthritis and joint problems. There is no kidney involvement with Lyme disease.
Which of the following are common primary sites of tumors that metastasize to the bone? Select all that apply. Kidney Prostate Lung Breast Ovary
Kidney Prostate Lung Breast Ovary The most common primary sites of tumors that metastasize to bone are the kidney, prostate, lung, breast, ovary, and thyroid.
Which of the following are the major hormonal regulators of calcium homeostasis? Select all that apply. Parathormone Calcitonin Thyroid Cortisol Growth hormone
Parathormone Calcitonin Parathormone and calcitonin are the major hormonal regulators of calcium homeostasis. Excessive thyroid hormone production in adults can result in increased bone resorption and decreased bone formation. Increased levels of cortisol have the same effects. Growth hormone has direct and indirect effects on skeletal growth and remodeling.
Which is an inaccurate principle of traction? The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely. The client must be in good alignment in the center of the bed. Skeletal traction is interrupted to turn and reposition the client.
Skeletal traction is interrupted to turn and reposition the client. Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.
Which is a strategy for lowering risk for osteoporosis? Low initial bone mass Diet low in calcium and vitamin D Smoking cessation Increased age
Smoking cessation Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.
A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include? "Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical." "Most accidental injuries among the elderly are automobile-related. Elderly clients should have vision testing every 6 months while they're still driving." "Because of the increase in home burglaries involving the elderly, these clients should have burglar bars on every window in the home." "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars."
"Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.
A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. What procedure will the nurse prepare the client for? Arthroscopy Arthrocentesis Arthrogram Bone densitometry
Arthrogram An arthrogram is a radiographic examination of a joint, usually the knee or shoulder. The health care provider first injects a local anesthetic and then inserts a needle into the joint space. Fluoroscopy may be used to verify correct placement of the needle. The synovial fluid in the joint is aspirated and sent to the laboratory for analysis. A contrast medium is then injected, and x-ray films are taken. Arthroscopy is the internal inspection of a joint using an instrument called an arthroscope. Arthrocentesis is the aspiration of synovial fluid. The client receives local anesthesia just before this procedure. The health care provider inserts a large needle into the joint and removes the fluid. This can be done during an arthrogram or arthroscopy. Bone densitometry estimates bone density using radiography or advanced radiographic techniques.
After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? Monitoring the client for skin breakdown Maintaining traction continuously to ensure its effectiveness Supporting the traction weights with a chair or table to prevent accidental slippage Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use
Maintaining traction continuously to ensure its effectiveness The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest.
A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. Assess the fingers for color and temperature. Administer a prescribed analgesic to promote comfort and allay anxiety. Assess for a pressure sore Determine the exact site of the pain. Cut the cast with a cast saw
Assess the fingers for color and temperature. Assess for a pressure sore Determine the exact site of the pain. Neurovascular assessment includes the assessment of peripheral circulation, motion, and sensation of the affected extremity, assessing the fingers or toes of the affected extremity, and comparing them with those of the opposite extremity. When assessing peripheral circulation, the nurse must check peripheral pulses as well as capillary refill response (within 3 seconds), edema, and the color and temperature of the skin. The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer.
To help minimize calcium loss from a hospitalized client's bones, the nurse should: reposition the client every 2 hours. encourage the client to walk in the hall. provide the client dairy products at frequent intervals. provide supplemental feedings between meals.
encourage the client to walk in the hall. Calcium absorption diminishes with reduced physical activity because of decreased bone stimulation. Therefore, encouraging the client to increase physical activity, such as by walking in the hall, helps minimize calcium loss. Turning or repositioning the client every 2 hours wouldn't increase activity sufficiently to minimize bone loss. Providing dairy products and supplemental feedings wouldn't lessen calcium loss — even if the dairy products and feedings contained extra calcium — because the additional calcium doesn't increase bone stimulation or osteoblast activity.
A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) Apply an emollient lotion to soften the skin. Control swelling with elastic bandages, as directed. Gradually resume activities and exercise. Use friction to remove dead surface skin by rubbing the area with a towel. Use a razor to shave the dead skin off.
Apply an emollient lotion to soften the skin. Control swelling with elastic bandages, as directed. Gradually resume activities and exercise. The skin needs to be washed gently and lubricated with an emollient lotion. The patient should be instructed to avoid rubbing and scratching the skin, because doing so can cause damage to newly exposed skin. The nurse and physical therapist educate the patient to resume activities gradually within the prescribed therapeutic regimen. Exercises prescribed to help the patient regain joint motion are explained and demonstrated. Because the muscles are weak from disuse, the body part that has been immobilized cannot withstand normal stresses immediately. In addition, the patient should be instructed to control swelling by elevating the formerly immobilized body part, no higher than the heart, until normal muscle tone and use are reestablished.
A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client? Fingers on the left hand are swollen and cool Presence of a normal popliteal pulse Cast edges are rough, with skin irritation present Minimal pain in the left arm
Fingers on the left hand are swollen and cool Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.
A continuous passive motion (CPM) machine is used to promote healing and flexibility in the knee and hip joint and increase circulation to the operative area. What is true about the use of CPM? Select all that apply. The physician orders the amount of extension and flexion produced by the machine. The physician orders the frequency of use of the machine. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine. The amount of flexion for clients with hip replacements should never exceed 60 degrees in the CPM machine.
The physician orders the amount of extension and flexion produced by the machine. The physician orders the frequency of use of the machine. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine. The physician orders the amount of extension and flexion produced by the machine. The physician orders the frequency of use of the machine. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine.
During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? "After age 40, height may show a gradual decrease as a result of spinal compression" "After menopause, the body's bone density declines, resulting in a gradual loss of height." "There may be some slight discrepancy between the measuring tools used." "The posture begins to stoop after middle age."
"After menopause, the body's bone density declines, resulting in a gradual loss of height." The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.
Upon reporting to work and receiving report, a nurse has been assigned to provide care for three clients. Each of the clients has called out to the nurses' station requesting assistance. Which client should the nurse see first? A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter A 56-year-old male, who had an arthroscopy of his left knee 3 hours ago, who is asking to be discharged A 60-year-old female, who is in traction to manage chronic muscle spasms, who is requesting assistance to order her evening meal The order doesn't matter; all clients are of equal priority
A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter The male who reports his cast feels tighter requires a complete assessment that focuses on his neurovascular status. The nurse should respond to him first. The older male and female are stable and aren't priorities at this time.
Lifestyle risk factors for osteoporosis include lack of aerobic exercise. a low-protein, high-fat diet. an estrogen deficiency or menopause. lack of exposure to sunshine.
lack of exposure to sunshine. Lifestyle risk factors for osteoporosis include lack of exposure to sunshine, a diet low in calcium and vitamin D, cigarette smoking, consumption of alcohol and/or caffeine, and lack of weight-bearing exercise. Lack of weight-bearing exercise, not aerobic exercise, is a lifestyle risk factor for osteoporosis. A diet low in calcium and vitamin D, not a low-protein, high-fat diet, is a lifestyle risk factor for osteoporosis. An estrogen deficiency or menopause is an individual risk factor for osteoporosis. Other individual risk factors include female gender, non-Hispanic white or Asian race, increased age, low weight and body mass index, family history of osteoporosis, low initial bone mass, and contributing coexisting medical conditions and medications.
