Prep U-Musculoskeletal
A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying:
"Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them."
A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?
Turning the client from side to side, using the logroll technique
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
The nurse has instructed the client about the correct positioning of the leg and hip following hip replacement surgery. Which of the following statements indicates that the client has understood these instructions?
"I should avoid bending over to tie my shoes."
When a client is placed in balanced skeletal traction, which of the following nursing actions would be appropriate?
Ensuring that the traction weights hang freely from the bed at all times.
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?
Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
Passive range-of-motion (ROM) exercises for the legs and assisted ROM exercises for the arms are part of the care regimen for a client with a spinal cord injury. Which observation by the nurse would indicate a successful outcome of this treatment?
Free, easy movement of the joints.
To protect a client's skin under a back brace, the nurse should:
Have the client wear a thin cotton shirt under the back brace.
A nurse notices a client lying on the floor at the bottom of the stairs. He's alert and oriented and states that he fell down several stairs. He denies pain other than in his arm, which is swollen and appears deformed. After calling for help, what should the nurse do?
Immobilize the client's arm.
Which goal is the priority for a client with a fractured femur who is in traction at this time?
Prevent effects of immobility while in traction Rationale: 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
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?
a 74-year-old who has periodontal disease with periodontitis
A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and she observes petechiae on the client's chest. Which nursing action is indicated first?
Administer oxygen Rationale: The client is demonstrating clinical manifestations consistent with a fatty embolus. Administering oxygen is the top priority. Elevating the extremity won't alter the client's condition.
After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do?
Discuss the complications that the client's may experience if he doesn't cooperate with the care plan.
What would be the most important nursing intervention in caring for the client's residual limb during the first 24 hours after amputation of the left leg?
Elevating the residual limb on a pillow.
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?
Logroll the client from side to side. Rationale: Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area.
A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?
One side of the bone is broken and the other side is bent.
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?
Severe lower back pain
Which of the following activities should the nurse plan to teach the client to strengthen the hand muscles in preparation for using crutches?
Squeezing a rubber ball
A client has a leg immobilized in traction. Which observation by the nurse indicates that the client understands actions to take to prevent muscle atrophy?
The client performs isometric exercises to the affected extremity three times per day.
The nurse is evaluating the outcome of therapy for a client with osteoarthritis. Which indicates goals of therapy have been met?
The client's joint range of motion has improved.
The client sustained an open fracture of the femur from an automobile accident. The nurse should assess the client for which type of shock?
hypovolemic
When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?
impaired skin integrity
Following a total hip replacement, the nurse should position the client by:
keeping the extremity in slight abduction using an abduction splint or pillows placed between the thighs.
The client returns from surgery for a below-the-knee amputation with the residual limb covered with dressings and a woven elastic bandage. At first, the bandage was dry. Now, 30 minutes later, the nurse notices a small amount of bloody drainage. The nurse should first?
mark the area of drainage
A client has been diagnosed with degenerative joint disease (osteoarthritis) of the left hip. Which of the following factors in the client's history would most likely increase the joint symptoms of osteoarthritis?
obesity
A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?
"Keep your right leg elevated above heart level."
The nurse teaches the parent of a young child with Duchenne muscular dystrophy about the disease and its management. Which statement by the parent indicates successful teaching?
"My son will probably be unable to walk independently by the time he is 9 to 11 years old."
When the client who has had a hip replacement is lying on the side, the nurse should place pillows or an abductor splint between the legs to prevent:
Adduction of the hip joint.
Elderly clients who fall are most at risk for which injuries?
Pelvic fractures
A 30-year-old client hospitalized with a fractured femur, which is being treated with skeletal traction, has not had a bowel movement for 2 days. The nurse should:
increase the client's fluid intake to 3,000 mL/day. Rationale: Increasing the client's fluid intake to 3,000 mL/day, unless contraindicated, is the most appropriate action. Typically, clients who are immobilized by skeletal traction are given stool softeners. Treating constipation with diet, increased fluids, and stool softeners is preferred to the administration of an enema
A client is to have a below-the-knee amputation. Prior to surgery, the circulating nurse in the operating room should:
initiate a time out Rationale: universal protocol
On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?
"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?
Administering large doses of I.V. antibiotics as ordered
What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?
Assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation Rationale: Assessing the neurovascular status, including circulation and innervation, is very important postoperatively. Control of pain is also a priority. Maintaining the integrity of the skin through frequent turns and ambulation will prevent pressure ulcers. Correct postoperative positioning involves maintaining the leg in a neutral position and preventing adduction
The initial postoperative assessment is completed on a client who had an arthroscopy of the knee. Which information is not necessary to obtain every 15 minutes during the first postoperative hour?
Urine output Rationale: Assessments every 15 minutes during the first hour would include vital signs, pulse oximeter values, and pain to monitor the client's comfort level and check for compartment syndrome
A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:
administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program
A male client underwent a lumbar spinal fusion yesterday. Which nursing assessment should alert the nurse to the development of a possible complication?
clear, yellowish drainage on the dressing
The nurse is caring for an older adult male who had open reduction internal fixation (ORIF) of the right hip 24 hours ago. The client is now experiencing shortness of breath and reports having "tightness in my chest." The nurse reviews the recent lab results. The nurse should report which lab results to the health care provider (HCP)?
troponin: 1.4 mcg/L (1.4 ?g/L) Rationale: 1.4 is indicative of some damage to heart muscle
After a total hip replacement, the client tells the nurse that the pain in the operative hip has increased. Assessing the hip and leg, the nurse notes that the leg is internally rotated and shorter than the other leg and that the client has difficulty moving the leg. Based on this information, the nurse determines that the client:
Has experienced a dislocation of the hip prosthesis.
A hospitalized client with a fracture of the tibia and fibula of the left leg is reporting increased pain at the site. What signs must the nurse be alert to that would indicate compromised circulation to the leg?
Increased swelling of the toes and decreased distal pulses
A client in the surgical intensive care unit has skeletal tongs in place to stabilize a cervical fracture. Protocol dictates that pin care should be performed each shift. When providing pin care for the client, which finding should the nurse report to the physician?
A small amount of yellow drainage at the left pin insertion site
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?
"Apply ice packs for the first 24 to 48 hours, then apply heat packs."
A nurse monitors a client receiving enoxaparin 30 mg subcutaneously b.i.d after hip replacement surgery. Which adverse reaction is the client most likely to experience?
Bleeding Rationale: low-molecular weight heparin is a blood thinner
The nurse assigns a nursing assistant to the care of a client who has just returned from surgery for repair of a fractured right wrist and application of an arm cast. The nurse should stress to the assistant the importance of reporting which of the following assessments immediately?
Client cannot move the fingers on the right hand.
Which goal is the priority for a client with a fractured femur who is in traction at this time?
Prevent effects of immobility while in traction.
When the client has a cord transection at T4, the nurse should focus the assessment on:
vascular status Rationale: client's vascular status is the primary focus of the nursing assessment because the sympathetic feedback system is lost and the client is at risk for hypotension and bradycardia
