Quiz 3 PU

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 menopause, the body's bone density declines, resulting in a gradual loss of height."

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

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?

"I should use my heating pad this evening to reduce some of the pain in my knee."

On a visit to the family health care provider, 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 patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

24 - 48 hours

The community health nurse is assessing the risk factors for osteoporosis in a female client at a health fair.

66 years old Post-menopausal Asian heritage Takes fluticasone inhaler for asthma

Which term refers to moving away from midline?

Abduction

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?

Administer prescribed analgesics around-the-clock

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?

An electromyography

The nurse is taking an initial history of a new client with a musculoskeletal problem. Which factor is most important for the nurse to keep in mind for this assessment?

Any chronic disorder or recent injury

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?

Apply a cold pack at the insertion site

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist?

Arthrography

A nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what action should be included in the plan of care?

Assess the pin insertion site every 8 hours

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

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Avascular necrosis

What food can the nurse suggest to the client at risk for osteoporosis?

Broccoli

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?

Calcitonin

Which cleansing solution is the most effective for use in completing pin site care?

Chlorehexidine

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?

Chlorpheniramine

Which assessment findings would the nurse expect in the client with osteomalacia?

Column B

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

Contusion

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician?

Crackles in the lung bases

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia?

DIC

The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response?

Decrease in estrogen

The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found?

Decreased right-sided muscle strength

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose?

Dislocation

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?

Dislocation of the hip

Colles fracture occurs in which area?

Distal radius

Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness?

Electromyograph (EMG)

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?

Elevate the affected extremity and apply cold

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

Encouraging the client to care for the residual limb Allowing the client to express grief Introducing the client to local amputee groups

The nurse uses the Fracture Risk Assessment Tool during an assessment of an older adult. Which information indicates to the nurse that the client is at risk for a fracture? Select all that apply.

Female gender Smokes cigarettes

The nurse is performing a musculoskeletal assessment for a client whose right leg muscles exhibit no tone and are limp. Which descriptor should the nurse use to document this condition?

Flaccid

During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding?

Hammer toe

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care?

Has a weight gain of 5 pounds

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

Hemorrage and shock

Which type of cast encloses the trunk and a lower extremity?

Hip spica

Which type of fracture involves a break through only part of the cross-section of the bone?

Incomplete

Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy?

Increased diameter of the calf

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention?

Keep the cast dry and clean

Which of the following is an example of a hinge joint?

Knee

A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks?

L4, L5, and S1

Which term refers to mature compact bone structures that form concentric rings of bone matrix?

Lamellae

The human body has 206 bones, which are classified into four categories. Which types of bones are the femur and ulna?

Long bones

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

Long bones bowing

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

Lower lumbar

A client has undergone an external fixation. Which actions would be the priority for this client?

Maintaining pin care

The nurse is preparing a plan of care for a client who sustained a femur fracture. Which action(s) will the nurse include in the care plan? Select all that apply.

Monitor temperature and pulses of the affected extremity Monitor and treat pain as prescribed

A client scheduled to undergo an electromyography asks the nurse what this test will evaluate. What is the correct response from the nurse?

Muscle weakness

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?

Ossification and calcification

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?

Osteoblasts

Which serum level indicates the rate of bone turnover?

Osteocalcin

A client is informed of having a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor?

Osteoclastoma

A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings?

Osteomyelitis

Which is a hallmark sign of compartment syndrome?

Pain

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall?

Pathologic fracture

The nurse is collaborating with the health care provider on a plan of care for a 54-year-old male client with osteomyelitis of the left femur secondary to uncontrolled type 1 diabetes.

Perform neurovascular checks of lower extremities every 8 hours. Administer IV antibiotic based on culture and sensitivity report Administer ibuprofen 400 mg orally three times daily, as needed for pain. Make referral to dietitian to discuss nutrition for healing and blood glucose control. Provide education on self-blood glucose monitoring and insulin administration.

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?

Performing hourly neurological assessments in the first 24 hrs

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg

The emergency department nurse teaches clients with sports injuries to remember the acronym PRICE. This acronym stands for which combination of treatments?

Protection, rest, ice, compression, elevation

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?

Pulselessness

Which term refers to a disease of a nerve root?

Radiculopathy

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient?

Reactive phases, reparative phase, remodeling phase

Which of the following is the final stage of fracture repair?

Remodeling

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

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?

Report joint crackling or clicking noises occurring after the second day.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?

Right shoulder slopes downward and droops inward

Which laboratory study indicates the rate of bone turnover?

Serum osetocalcin

A nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb:

Should begin the day after surgery (Post-Op Day 1)

Which is an inaccurate principle of traction?

Skeletal traction is interrupted to turn and reposition the client.

The clinic nurse is caring for a client with an injured body part that does not require rigid immobilization. What method of immobilization would the nurse expect the health care provider to use on a short-term basis?

Splint

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

Sprain

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

Morton neuroma is exhibited by which clinical manifestation?

Swelling of the third (lateral) branch of the median plantar nerve

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.

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? Select all that apply.

The client will experience a tolerable level of pain The client will demonstrate wound care The client will maintain adequate nutritional intake

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?

The fracture is on the diaphysis

Which is not a guideline for avoiding hip dislocation after replacement surgery.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

After a bone density test, an older adult female client tells the nurse, "I don't understand why I have osteoporosis because I eat well and take my calcium." What does the nurse explain as the reason that the client may have osteoporosis?

The loss is from withdrawal of estrogen and a decrease in activity levels

Which statement describes external fixation?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for?

Total arthroplasty

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?

Traction

A nurse is caring for a client in skin traction. In order to prevent bony fragments from moving against one another, the nurse should caution the client against performing what action?

Turning from side to side

A nurse is preparing to discharge an emergency department client who has been fitted with a sling to support her arm after a clavicle fracture. What should the nurse instruct the client to do?

Use the arm for light activities within the range of motion

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg?

Within 30 minutes, then every 1 - 2 hours

The nurse is preparing the client for computed tomography. Which information should be given by the nurse?

You must remain very still during the procedure

The nurse is reviewing the client's admission assessment and notes that crepitus of the right knee joint was documented. What assessment will the nurse find as described by crepitus?

a grating sound when a joint is put through range of motion