Saunders Ch 57 & 58 Questions

A client is being discharged after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client makes which statement? 1. "I need to avoid getting the cast wet." 2. "I will use my fingertips to lift and move the leg." 3. "I need to cover the casted leg with warm blankets." 4. "I can use a padded coat hanger end to scratch under the cast."

1 Rationale: A plaster cast must remain dry to keep its strength. The cast would be handled using the palms of the hands, not the fingertips, until fully dry. Air would circulate freely around the cast to help it dry; the cast also gives off heat as it dries. The client must never scratch under the cast; a cool hair dryer may be used to eliminate itching.

Cyclobenzaprine is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which disorder would indicate a need to contact the primary health care provider (PHCP) regarding the administration of this medication? 1. Glaucoma 2. Emphysema 3. Hyperthyroidism 4. Diabetes mellitus

1 Rationale: Because this medication has anticholinergic effects, it needs to be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride would be used only for short-term 2- to 3-week therapy. The disorders in options 2, 3, and 4 are not a concern when the client is taking cyclobenzaprine.

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder would alert the nurse to contact the primary health care provider (PHCP)? 1. A seizure disorder 2. Hyperthyroidism 3. Diabetes mellitus 4. Coronary artery disease

1 Rationale: Clients with a seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication. The disorders in options 2, 3, and 4 are not a concern when the client is taking baclofen.

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test(s) would identify an adverse effect associated with the administration of this medication? 1. Creatinine 2. Liver function tests 3. Blood urea nitrogen 4. Hematological function tests

2 Rationale: Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests would be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary. Options 1 and 3 are tests that assess kidney function.

The client has been taking medication for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data? 1. The white blood cell and platelet counts 2. A metallic taste in the mouth, with a loss of appetite 3. Whether the client is experiencing fatigue and joint pain 4. Whether the client is experiencing itching and edema at the injection site

1 Rationale: Infection and suppression can occur as a result of etanercept. Laboratory studies are performed before and during treatment. The appearance of abnormal white blood cell and platelet counts can alert the nurse to a potentially life-threatening infection or potential bleeding. Injection site itching and edema are common occurrences following administration. A metallic taste and loss of appetite are not associated with this medication. Fatigue and joint pain occur with rheumatoid arthritis.

The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions would the nurse include on the list? Select all that apply. 1. Keep the cast and extremity elevated 2. The cast needs to be kept clean and dry 3. Allow the wet cast 24 to 72 hours to dry 4. Expect tingling and numbness in the extremity 5. Use a hair dryer set on a warm to hot setting to dry the cast 6. Use a soft-padded object that will fit under the cast to scratch the skin under the cast

1, 2, 3 Rationale: A plaster cast takes 24 to 72 hours to dry (synthetic casts dry in 20 minutes). The cast and extremity may be elevated to reduce edema. A wet cast is handled with the palms of the hands until it is dry, and the extremity is turned (unless contraindicated) so that all sides of the wet cast will dry. A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used because the cast heats up and burns the skin). The cast needs to be kept clean and dry, and the client is instructed not to stick anything under the cast because of the risk of breaking skin integrity. The client is instructed to monitor the extremity for circulatory impairment such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse. The primary health care provider is notified immediately if circulatory impairment occurs.

During the monitoring of a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses? Select all that apply. 1. Symptom control during periods of emotional stress 2. Normal white blood cell, platelet, and neutrophil counts 3. Radiological findings that show nonprogression of joint degeneration 4. An increased range of motion in the affected joints 3 months into therapy 5. Inflammation and irritation at the injection site 3 days after injection is given 6. A low-grade temperature when rising in the morning that remains throughout the day

1, 2, 3, 4 Rationale: Because emotional stress frequently exacerbates the symptoms of rheumatoid arthritis, the absence of symptoms is a positive finding. DMARDs are given to slow progression of joint degeneration. In addition, the improvement in the range of motion after 3 months of therapy with normal blood work is a positive finding. Temperature elevation and inflammation and irritation at the medication injection site could indicate signs of infection.

The nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action would the nurse take first? 1. Provide pin care 2. Check the client's alignment in bed 3. Medicate the client with an analgesic 4. Call the primary health care provider (PHCP)

2 Rationale: A client who complains of severe pain may need realignment or may have had traction weights prescribed that are too heavy. The nurse realigns the client and, if ineffective, calls the PHCP. Severe leg pain, once traction has been established, indicates a problem. Medicating the client would be done after trying to determine and treat the cause. Providing pin care is unrelated to the problem as described.

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. Pain at a pin site 4. Purulent drainage

2 Rationale: A small amount of serous drainage is expected at pin insertion sites. Signs of infection such as inflammation, purulent drainage, and pain at the pin site are not expected findings and would be reported.

The nurse is reinforcing discharge instructions to a client receiving baclofen. Which would the nurse include in the instructions? 1. Restrict fluid intake. 2. Avoid the use of alcohol. 3. Stop the medication if diarrhea occurs. 4. Notify the primary health care provider (PHCP) if fatigue occurs.

2 Rationale: Baclofen is a CNS depressant. The client needs to be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents. It is not necessary to restrict fluids, but the client would be warned that urinary retention can occur. Constipation rather than diarrhea is an adverse effect of baclofen. Fatigue is related to a CNS effect that is most intense during the early phase of therapy and diminishes with continued medication use. It is not necessary that the client notify the PHCP if fatigue occurs.

The nurse is caring for a client with a fresh application of a plaster leg cast. The nurse would plan to prevent the development of compartment syndrome by which action? 1. Elevating the limb and covering it with bath blankets 2. Elevating the limb and applying ice to the affected leg 3. Keeping the leg horizontal and applying ice to the affected leg 4. Placing the leg in a slightly dependent position and applying ice

2 Rationale: Compartment syndrome is prevented by controlling edema. This is achieved most optimally with elevation and application of ice. Therefore, the other options are incorrect.

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication? 1. Depresses spinal reflexes 2. Acts directly on the skeletal muscle to relieve spasticity 3. Acts within the spinal cord to suppress hyperactive reflexes 4. Acts on the central nervous system (CNS) to suppress spasms

2 Rationale: Dantrolene acts directly on skeletal muscle to relieve muscle spasticity. The primary action is the suppression of calcium release from the sarcoplasmic reticulum. This in turn decreases the ability of the skeletal muscle to contract. Options 1, 3, and 4 are not actions of the medication.

The nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client performed which action? 1. Holds the cane on the right side 2. Moves the cane when the right leg is moved 3. Leans on the cane when the right leg swings through 4. Keeps the cane 6 inches out to the side of the right foot

2 Rationale: The cane is held on the stronger side to minimize stress on the affected extremity and provide a wide base of support. The cane is held 6 inches lateral to the fifth great toe. The cane is moved forward with the affected leg. The client leans on the cane for added support, while the stronger side swings through.

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions, the nurse would plan to tell the client to place the crutches in which position? 1. 3 inches to the front and side of the client's toes 2. 8 inches to the front and side of the client's toes 3. 15 inches to the front and side of the client's toes 4. 20 inches to the front and side of the client's toes

2 Rationale: The classic tripod position is taught to the client before giving instructions on gait. The crutches are placed any where from 6 to 10 inches in front and to the side of the client, depending on the client's body size. This provides a wide enough base of support to the client and improves balance.

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse would plan for which intervention? 1. Massaging the skin at the rim of the cast 2. Petaling the cast edges with adhesive tape 3. Using a rough file to smooth the cast edges 4. Applying lotion to the skin at the rim of the cast

2 Rationale: The edges of the cast can be petaled with tape to minimize skin irritation. If a client has a cast applied and returns home, the client can be taught to do the same. Massaging and applying lotion will not alleviate the skin irritation from the cast edges. Filing the edges will cause cast material to fall into the cast and could lead to skin irritation under the cast.

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which would indicate that the client is experiencing a side effect? 1. Polyuria 2. Diarrhea 3. Drowsiness 4. Muscular excitability

3 Rationale: Baclofen is a CNS depressant and frequently causes drowsiness, dizziness, weakness, and fatigue. It can also cause nausea, constipation, and urinary retention. Clients need to be warned about the possible reactions. Options 1, 2, and 4 are not side effects.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by which condition? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The newness of the fracture

3 Rationale: Most pain associated with fractures can be minimized with rest, elevation, application of a cold compress, and administration of analgesics. Pain that is not relieved from these measures needs to be reported to the nurse and primary health care provider because it may be the result of impaired tissue perfusion, tissue breakdown, or necrosis. Because this is a new closed fracture and cast, infection would not have had time to set in.

The nurse is checking the casted extremity of a client. The nurse needs to check for which sign indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. Coolness and pallor of the extremity

3 Rationale: Signs/symptoms of infection under a casted area include odor or purulent drainage from the cast or the presence of "hot spots," which are areas of the cast that are warmer than others. The primary health care provider needs to be notified if any of these occur. Signs of impaired circulation in the distal limb include coolness and pallor of the skin, diminished arterial pulse, and edema.

The nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority? 1. Take a set of vital signs 2. Call the radiology department 3. Immobilize the leg before moving the client 4. Reassure the client that everything will be fine

3 Rationale: When a fracture is suspected, it is imperative that the area is splinted before the client is moved. Emergency help needs to be called if the client is not hospitalized; a primary health care provider is called for the hospitalized client. The nurse must remain with the client and provide realistic reassurance. The nurse does not prescribe radiology tests.

The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse would plan to perform which action? 1. Try to manually reduce the fracture. 2. Leave the person for a few moments to call an ambulance. 3. Stay with the person and encourage the person to remain still. 4. Assist the person with getting up and walking to the sidewalk.

3 Rationale: With a suspected fracture, the client is not moved unless it is dangerous to remain in that spot. The nurse needs to remain with the client and have someone else call for emergency help. A fracture is not reduced at the scene. Before moving the client, the site of the fracture is immobilized to prevent further injury.

The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse would perform which intervention? 1. Keep the leg in a level position 2. Elevate the leg for 3 hours, and put it flat for 1 hour 3. Keep the leg level for 3 hours, and elevate it for 1 hour 4. Elevate the leg on pillows continuously for 24 to 48 hours

4 Rationale: A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and to promote venous drainage. Therefore, the other options are incorrect.

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction has which primary function? 1. Allows bony healing to begin before surgery 2. Provides rigid immobilization of the fracture site 3. Lengthens the fractured leg to prevent severing of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

4 Rationale: Buck's extension traction is a type of skin traction often applied after hip fracture, before the fracture is reduced in surgery. It reduces muscle spasms and helps immobilize the fracture. It does not lengthen the leg for the purpose of preventing blood vessel severance. It also does not allow for bony healing to begin.

The nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further teaching if the nurse observes the client doing which activity? 1. Pulling up on the trapeze 2. Flexing and extending the feet 3. Doing quadriceps-setting and gluteal-setting exercises 4. Performing active range of motion (ROM) to the right ankle and knee

4 Rationale: Exercise is indicated within therapeutic limits for the client in skeletal traction to maintain muscle strength and ROM. The client may pull up on the trapeze, perform active ROM with uninvolved joints, and do isometric muscle-setting exercises (e.g., quadriceps- and gluteal-setting exercises). The client may also flex and extend his or her feet. Performing active ROM to the affected leg can be harmful.

Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions for the administration of the medication. Which instruction would the nurse reinforce? 1. Take the medication at bedtime. 2. Take the medication in the morning with breakfast. 3. Lie down for 30 minutes after taking the medication. 4. Take the medication with a full glass of water after rising in the morning.

4 Rationale: Precautions need to be taken with the administration of alendronate to prevent gastrointestinal side/adverse effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client would not eat or drink anything for 30 minutes following administration and would not lie down after taking the medication.

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse would make which appropriate response to the client? 1. "You should never stop the medication." 2. "It is best that you taper the dose if you intend to stop the medication." 3. "It is okay to stop the medication if you think that you can tolerate the muscle spasms." 4. "Weakness and fatigue commonly occur and will diminish with continued medication use."

4 Rationale: The client would be instructed that symptoms such as drowsiness, weakness, and fatigue are more intense in the early phase of therapy and diminish with continued medication use. The client needs to be instructed never to withdraw or stop the medication abruptly because abrupt withdrawal can cause visual hallucinations, paranoid ideation, and seizures. It is best for the nurse to inform the client that these symptoms will subside and encourage the client to continue the use of the medication.