Unit 1 Neuromuscular Questions

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? 1. A 55-year-old client who is 6 feet tall and weighs 180 lb. 2. A 90-year-old who lives alone. 3. A 74-year-old who has periodontal disease with periodontitis. 4. A 75-year-old who has asthma and uses an inhaler.

3. Infection is a serious complication of total hip replacement and may necessitate removal of the implant. Clients who are obese, poorly nourished, elderly, have poorly controlled diabetes, rheumatoid arthritis, or concurrent infections (e.g., dental, urinary tract) are at high risk for infection. Clients who are of normal weight and have well-controlled chronic diseases are not at risk for infection. Living alone is not a risk factor for infection.

The nurse is providing discharge teaching to the family of an older adult client who was treated for a fracture after a fall. Which recommendation should the nurse include in the​ teaching? A. Always wear socks when ambulating. B. Use a step stool when possible. C. Start a mild exercise program. D. Remove the rubber mat from tub.

C A mild exercise program may help to improve balance and strength. The client should wear shoes with nonslip soles when ambulating to prevent​ falls; socks may cause the client to slip. Use of a step stool should be avoided. Rubber mats are helpful to prevent slipping in the tub.

The nurse is planning care for a client with osteoarthritis​ (OA). Which nursing diagnosis is a priority for the nurse to​ address? A. Lifestyle, Sedentary B. ​Pain, Chronic C. Skin​ Integrity, Impaired D. Family​ Processes, Interrupted

Answer: B​ Rationale: Chronic pain is the priority problem for the nurse to address when planning care for a client diagnosed with osteoarthritis.

The nurse instructs the client with a right BKA to lie on the stomach for at least 30 minutes a day. The client asks the nurse, "Why do I need to lie on my stomach?" Which statement is the most appropriate statement by the nurse? 1. "This position will help your lungs expand better." 2. "Lying on your stomach will help prevent contractures." 3. "Many times this will help decrease pain in the limb." 4. "The position will take pressure off your backside."

2. The prone position will help stretch the hamstring muscles, which will help prevent flexion contractures leading to problems when fitting the client for a prosthesis.

The nurse is caring for an adult male client who has just undergone spinal fusion for a herniated intervertebral disk. To promote comfort and minimize complications, the nurse tells the client to avoid which of the following? 1. Bending the knees when lying on one side 2. Sitting for longer than 20 minutes at a time 3. Using an extra-firm mattress 4. Sitting in a hardback chair

(2) Sitting for longer than 20 minutes at a time— Prolonged sitting puts strain on the back; it's better to walk around or lie down to rest

The nurse is discharging a baby with clubfoot who has had a cast applied. The nurse should provide additional teaching to the parents if they state: 1."I should call if I see changes in the color of the toes under the cast." 2."I should use a pillow to elevate my child's foot as he sleeps." 3."My baby will need a series of casts to fix her foot." 4."Having a cast should not prevent me from holding my baby.

2. Elevating the extremity at different points during the day is helpful to prevent edema, but pillows should not be used in the crib because they increase the risk of sudden infant death syndrome (SIDS). A change in the color of the toes is a sign of impaired circulation and requires medical evaluation. Children typically need a series of 5 to 10 casts to correct the deformity. Infants with club feet still need frequent holding like any other newborn.

The nurse is caring for a client with a right below-the-knee amputation. There is a large amount of bright red blood on the client's residual limb dressing. Which intervention should the nurse implement first? 1. Notify the client's surgeon immediately. 2. Assess the client's blood pressure and pulse. 3. Reinforce the dressing with additional dressing. 4. Check the client's last hemoglobin and hematocrit level.

2. Determining if the client is hemorrhaging is the first intervention. The nurse should check for signs of hypovolemic shock: decreased BP and increased pulse

Which would the nurse expect to assess on a 3-week-old infant with developmental dysplasia of the hip (DDH)? Select all that apply. 1. Excessive hip abduction. 2. Femoral lengthening of an affected leg. 3. Asymmetry of gluteal and thigh folds. 4. Pain when lying prone. 5. Positive Ortolani test

3, 5 1. In DDH, a newborn can have excessive hip adduction. 2. In DDH, an appearance of femoral shortening is frequently present on the affected side. 3. In DDH, asymmetrical thigh and gluteal folds are frequently present. 4. Infants do not experience pain from this condition. 5. The Ortolani maneuver moves a disclocated hip back into the socket with a distinct clunk.

A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying which of the following? 1. "Don't worry. Your new hip is very strong." 2. "Use of a cushioned toilet seat helps to prevent dislocation." 3. "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them." 4. "Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation."

3. Dislocation precautions include: avoid extremes of internal rotation, adduction, and 90-degree flexion of affected hip for at least 4 to 6 weeks after the procedure.

The nurse has established a goal with a client to improve mobility following hip replacement. Which of the following is a realistic outcome at the time of discharge from the surgical unit? 1. The client can walk throughout the entire hospital with a walker. 2. The client can walk the length of a hospital hallway with minimal pain. 3. The client has increased independence in transfers from bed to chair. 4. The client can raise the affected leg 6 inches with assistance.

3. Expected outcomes at the time of discharge from the surgical unit after a hip replacement include the following: increased independence in transfers, participates in progressive ambulation without pain or assistance, and raises the affected leg without assistance. The client will not be able to walk throughout the hospital, walk for a distance without some postoperative pain, or raise the affected leg more than several inches. The client may be referred to a rehabilitation unit in order to achieve the additional independence, strength, and pain relief.

Following a total hip replacement, the nurse should position the client in which of the following ways? 1. Place weights alongside of the affected extremity to keep the extremity from rotating. 2. Elevate both feet on two pillows. 3. Keep the lower extremities adducted by use of an immobilization binder around both legs. 4. Keep the extremity in slight abduction using an abduction splint or pillows placed between the thighs.

4. After total hip replacement, proper positioning by the nurse prevents dislocation of the prosthesis.

Prior to surgery, the nurse is instructing a client who will have a total hip replacement tomorrow. Which of the following information is most important to include in the teaching plan at this time? 1. Teaching how to prevent hip flexion. 2. Demonstrating coughing and deep-breathing techniques. 3. Showing the client what an actual hip prosthesis looks like. 4. Assessing the client's fears about the procedure.

4. Before implementing a teaching plan, the nurse should determine the client's fears about the procedure. Only then can the client begin to hear what the nurse has to share about the individualized teaching plan designed to meet the client's needs.

The client is to be discharged on a low-fat, low-cholesterol, low-sodium diet. Which of the following should be the nurse's first step in planning the dietary instructions? 1. Determining the client's knowledge level about cholesterol. 2. Asking the client to name foods that are high in fat, cholesterol, and salt. 3. Explaining the importance of complying with the diet. 4. Assessing the client's and family's typical food preferences.

4. Before beginning dietary instructions and interventions, the nurse must first assess the client's and family's food preferences, such as pattern of food intake, life style, food preferences, and ethnic, cultural, and financial influences.

A client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should first? 1. Stabilize the leg with Buck's traction. 2. Apply an ice pack to the affected hip. 3. Position the client toward the opposite side of the hip. 4. Notify the orthopedic surgeon.

4. If a prosthesis becomes dislocated, the nurse should immediately notify the surgeon. This is done so the hip can be reduced and stabilized promptly to prevent nerve damage and to maintain circulation.

A person's right thumb was accidentally severed with an axe. The amputated right thumb was recovered. Which action by the nurse preserves the thumb so it could possibly be reattached in surgery? 1. Place the right thumb directly on some ice. 2. Put the right thumb in a glass of warm water. 3. Wrap the thumb in a clean piece of material. 4. Secure the thumb in a plastic bag and place on ice.

4. Placing the thumb in a plastic bag will protect it and then placing the plastic bag on ice will help preserve the thumb so it may be reconnected in surgery. Do not place the amputated part directly on ice because this will cause necrosis of viable tissue.

A nurse is providing a preventive teaching discussion with a client at risk for osteoarthritis. Which guideline should be included in this discussion related to​ exercise? A)Exercise is not recommended B)If there is pain with​ exercise, keep​ going, this is building muscle C)Participate in regular​ exercise, including walking or swimming D)Perform heavy weightlifting exercises three times per week

Answer: C Participating in regular exercise like​ walking, jogging, swimming and cycling can keep joints strong and functional.

A nurse provides discharge teaching to the parents of a newborn who has a cast in place for talipes equinovarus. Which of the following statements indicate a need for additional teaching? "We will... A. Check the toes frequently for color and temperature changes." B. Bring the baby to the doctor next week for a cast change." C. Perform a range of motion exercises to the affected foot." D. Avoid tub baths while the cast is in place."

5. Answer: C. Perform a range of motion exercises to the affected foot." Range of motion exercises are not performed while the cast is in place. The purpose of the cast is to gradually stretch the skin and structures on the medial side of the foot to correct the clubfoot.

A client fell off a ladder and the healthcare provider suspects a fracture of the right wrist. Which manifestation should the nurse anticipate observing in the​ client? (Select all that​ apply.) A. Crepitus B. Visible deformity C. Pain D. Cyanosis of nail beds E. Absence of radial pulse

A, B, C​ The manifestations of a fracture include visible​ deformity, swelling,​ pain, numbness,​ crepitus, hypovolemic​ shock, muscle​ spasms, or ecchymosis. A complication of a​ fracture, compartment​ syndrome, may occur if pressure from edema builds within the​ fascia, leading to decreased blood flow and potential muscle and nerve damage. Neurovascular changes may be noted when this occurs which can include absence of pulse and cyanosis of the nail beds.

A client who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse's first intervention? a. Assess pedal pulses. b. Apply oxygen by nasal cannula. c. Increase the IV flow rate. d. Document the finding.

A. Assess pedal pulses The symptoms represent early warning of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible.

The nurse is teaching a class about the joints commonly affected by osteoarthritis​ (OA). Which joints should the nurse​ include? A. Ankles, feet, and spine B. Knees, feet, and spine C. Hands, knees, and hips D. Neck, shoulders, and ankles

Answer: C​ Hands,​ knees, and hips are the most commonly affected joints of OA.​ Feet, spine,​ neck, shoulders, and ankles are not the most common locations.

A patient has a new order for magnetic resonance imaging (MRI) to evaluate for left femur osteomyelitis after a hip replacement surgery. Which information indicates that the nurse should consult with the health care provider before scheduling the MRI? a. The patient has a pacemaker. b. The patient is claustrophobic. c. The patient wears a hearing aid. d. The patient is allergic to shellfish.

ANS: A Patients with permanent pacemakers cannot have MRI because of the force exerted by the magnetic field on metal objects. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Because contrast medium will not be used, shellfish allergy is not a contraindication to MRI

After performing a physical​ assessment, the nurse suspects that a client is experiencing manifestations of osteoarthritis​ (OA). Which finding supports the​ nurse's suspicion?​ (Select all that​ apply.) A. Leg tremors B. Joint tenderness C. Reduced joint flexibility D. Crepitation E. Joint stiffness

Answer: B, C, D, E ​Rationale: Manifestations of OA include crackling​ sounds, or​ crepitation, with joint​ movement; joint stiffness and​ tenderness; and reduced joint flexibility. Leg tremors can be associated with multiple sclerosis or Parkinson disease.

An occupational therapist is treating a client with rheumatoid arthritis. Which assessment finding in the client does the nurse share with the occupational therapist? a. Difficulty sleeping because of pain in the knees and elbows b. Difficulty tying shoelaces and doing zippers on clothing c. Swollen knees with crepitus and limited range of motion d. Generalized joint stiffness that is worse in the early morning

ANS: B The functional assessment helps nurses and therapists measure how functional the client is with activities of daily living, including dressing. The occupational therapist can assist the client to explore clothing options that are easier to manage with arthritic fingers. The other findings would not necessarily need to be shared with the occupational therapist for the treatment plan.

The nurse is caring for a client who is to have a computed tomography (CT) scan of the leg. Which assessment question does the nurse ask the client before the procedure? a. "Do you have any metal clips, plates, or pins in your body?" b. "Have you had anything to eat or drink in the last 6 hours?" c. "Do you have someone to drive you home after the procedure?" d. "Do you have any allergies to shrimp, scallops, or other seafood?"

ANS: D IV contrast that contains iodine may be required for CT scans to rule out malignancy. The client should be assessed for allergy to shellfish, which contain high amounts of iodine. The other questions are not relevant when a CT scan is to be obtained.

Which is a common risk factor for​ osteoarthritis? (Select all that​ apply.) A. Overuse of joints from sports or strenuous activities B. Obesity C. Ingestion of large amounts of purine D. Autoimmune disorder E. Activities affecting​ weight-bearing joints

Answer: A, B, E ​Rationale: Common risk factors for osteoarthritis include​ obesity, overuse of joints from sports injuries or strenuous​ activities, and activities affecting​ weight-bearing joints. Rheumatoid arthritis is thought to be an autoimmune disorder. Ingestion of large amounts of purines is a risk factor for gout.

The nurse is providing home care teaching to a client diagnosed with osteoarthritis. Which statement is appropriate for the nurse to include in the teaching session for this​ client? A)"When you begin your strengthening​ exercises, it is appropriate to start with a large weight and work your way​ down." B)​"Balance and agility exercises can help maintain daily living skills and have been recommended by your healthcare​ provider." C)"Stretching all muscle groups for 30 minutes each day has been recommended by the healthcare​ provider." D)"Water exercises should not be tried because water buoyancy increases force on the​ joints

Answer: B Balance and agility exercises are recommended for clients with osteoarthritis because they help to maintain daily living skills. When beginning strengthening​ exercises, clients should start with a low weight and work their way up. Water exercise is beneficial because the buoyancy of the water decreases the force on the joints. The client should stretch all muscle groups for 10 minutes each day. Overstretching is contraindicated

Mrs. Gladek is a​ 70-year-old White woman who has experienced progressive symptoms of osteoarthritis over the past 5 years. In addition to taking prescribed analgesics and​ anti-inflammatory medications, she is discussing interventions that she implemented into her daily lifestyle to manage her disease condition. Which activity would you suggest to Mrs. Gladek to provide additional exercise opportunities for​ her. A)Doubles tennis for older adults B)Meditation C)Interval training to jog a 5K D)Water aerobic activities

Answer: D

Which health promotion activities support a healthy lifestyle for clients with​ osteoarthritis? Select all. A)Increase dietary intake of calcium B)Maintain a normal weight C)Use assistive devices as needed D)Limit participation in ROM exercises E)Use soft chairs and recliners for rest

Answers: B, C Maintaining a normal weight places less strain on the joints than carrying additional weight. Assistive devices such as grab​ bars, a shower​ chair, or​ long-handled grippers help the client to maintain an independent lifestyle in safety.

What symptoms of would be an indication of scoliosis during a screening? Select all that apply. a) Both arms are the same length when child is bending forward b) The arm-to-body spaces may be unequal c) Pain in and around the spine d) A scapula may be prominent

B and D The arm-to-body spaces may be unequal and a scapula may be prominent. One arm may appear longer than the other arm when bending forward. Symptoms develop slowly and are not painful.

The nurse who is caring for a client who has a fractured pelvis has determined that the client is experiencing acute pain. Which intervention should the nurse​ implement? (Select all that​ apply.) A. Maintaining strict bedrest until the bone is fused B. Elevating the affected extremity on a pillow C. Playing the​ client's favorite music D. Applying a hot pack to the site of the injury E. Supporting the extremity above and below the fracture site when moving

B, C, E Effective pain management for this client may involve administration of pain​ medication, distraction,​ relaxation, deep​ breathing, ice to reduce​ swelling, and gentle movement while supporting the extremity above and below the fracture site to prevent displacement of bony fragments and nerve damage.

The nurse is caring for a patient admitted to the nursing unit with osteomyelitis of the tibia. Which symptom will the nurse most likely find on physical examination of the patient? A. Nausea and vomiting B. Localized pain and warmth C. Paresthesia in the affected extremity D. Generalized bone pain throughout the leg

B. Localized pain and warmthOsteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or spread from another part of the body.

Which statement from the client regarding cast care requires additional teaching by the​ nurse? A. ​"I can use plastic shields around the cast while showering or​ bathing." B. "If the edges become rough and​ irritating, I can remove the rough​ edges." C. "I can apply ice to the cast and elevate my arm to prevent​ swelling. "D. "I should never place objects in the cast to relieve​ itching."

B​ The client should be taught to protect the cast with plastic while showering or bathing. No part of the​ cast, including rough​ edges, should be removed at any time. Ice and limb elevation may help reduce​ swelling, and no objects should ever be inserted into the cast for any reason.

2. A patient with osteomyelitis has a nursing diagnosis of risk for injury. What is an appropriate nursing intervention for this patient? a. Use careful and appropriate disposal of soiled dressings. b. Gently handle the involved extremity during movement. c. Measure the circumference of the affected extremity daily. d. Provide range-of-motion (ROM) exercise q4hr to the involved extremity.

b. The patient with osteomyelitis is at risk for pathologic fractures at the site of the infection because of weakened, devitalized bone and careful handling of the extremity is necessary.

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring? a. Paresthesia b. Pitting edema c. Poor venous return d. Compartment syndrome

d. Compartment syndrome The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis.

The client has just had a total knee replacement for severe osteoarthritis. Which of the following assessment findings should lead the nurse to suspect possible nerve damage? 1. Numbness. 2. Bleeding. 3. Dislocation. 4. Pinkness.

1. The nurse should suspect nerve damage if numbness is present. However, whether the damage is short-term and related to edema or long-term and related to permanent nerve damage would not be clear at this point.

The client with a right AKA is being taught how to toughen the residual limb. Which intervention should the nurse implement? 1. Instruct the client to push the residual limb against a pillow. 2. Demonstrate how to apply an elastic bandage around the residual limb. 3. Encourage the client to apply vitamin B12 to the surgical incision. 4. Teach the client to elevate the residual limb at least three (3) times a day.

1. Applying pressure to the end of the residual limb will help toughen the limb. Gradually pushing the residual limb against harder and harder surfaces is done in preparation for prosthesis training.

A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the dressing after 45 minutes in the postanesthesia recovery unit. The nurse should: 1. Elevate the stump. 2. Reinforce the dressing. 3. Call the surgeon. 4. Draw a mark around the site.

4. The priority action is to draw a mark around the site of bleeding to determine the rate of bleeding. Once the area is marked, the nurse can determine whether the bleeding is increasing or decreasing by the size of the area marked.

The nurse is caring for a client who develops compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. The nurse's response is based on the understanding that: a. A bone fragment has injured the nerve supply in the area b. An injured artery causes impaired arterial perfusion through the compartment c. Bleeding and swelling cause increased pressure in an area that cannot expand d. The fascia expands with injury, causing pressure on underlying nerves and muscles

C. Bleeding and swelling cause increased pressure in an area that cannot expand. Compartment syndrome is caused by bleeding and swelling within a compartment, which is lined by fascia that does not expand. The bleeding and swelling place pressure on the nerves, muscles, and blood vessels in the compartment, triggering the symptoms.

A middle-aged patient has a tight cast on the left lower leg. Which assessment finding would prompt the nurse to assess further for compartment syndrome? A. Diminished pulses B. Discoloration of some of the toes C. Tingling sensation of the upper leg D. Pain more intense than expected based on initial injury

D. Pain more intense than expected based on initial injuryThe classic sign of acute compartment syndrome is pain, and the pain is more intense than what would be expected from the injury itself.

The nurse is caring for a client with a fractured fibula. Which assessment prompts immediate action by the nurse? a. Reported pain of 4 on a scale of 0 to 10 b. Numbness and tingling in the extremity c. Swollen extremity where the injury occurred d. Reports of being cold in bed

b. Numbness and tingling in extremity The client with numbness and tingling of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention because of possible decreased circulation. Moderate pain and swelling is an expected assessment after a fracture. These findings can be treated with comfort measures. Being cold can be treated with additional blankets or by increasing the temperature of the room.

Parents brought their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot made at birth. Which statement by the parents indicates a need for further teaching regarding this disorder? A. "I realize my infant will require follow-up care until fully grown." B. "Treatment needs to be started as soon as possible." C. "I need to come to the clinic every week with my infant for the casting." D. "I need to bring my infant back to the clinic in 1 month for a new cast."

1. Answer: D. "I need to bring my infant back to the clinic in 1 month for a new cast." Clubfoot is a complex deformity of the ankle and foot that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus; the defect may be unilateral or bilateral.

A client says, "I hate the idea of being an invalid after they cut off my leg." Which of the following would be the nurse's most therapeutic response? 1. "At least you will still have one good leg to use." 2. "Tell me more about how you're feeling." 3. "Let's finish the preoperative teaching." 4. "You're lucky to have a wife to care for you."

2. Encouraging the client who will be undergoing amputation to verbalize his feelings is the most therapeutic response. Asking the client to tell more about how he is feeling helps to elicit information, providing insight into his view of the situation and also providing the nurse with ideas to help him cope.

The parents of a neonate born with congenital clubfoot express feelings of helplessness and guilt, and are exhibiting anxiety about how the neonate will be treated. Which of the following actions by the nurse would be most appropriate initially? 1.Ask them to share these concerns with the primary care provider. 2.Arrange a meeting with other parents whose infants have had successful clubfoot treatment. 3.Discuss the problem with the parents and the current feelings that they are experiencing. 4.Suggest that they make an appointment to talk things over with a counselor.

3. When an infant is born with an unexpected anomaly, parents are faced with questions, uncertainties, and possible disappointments. They may feel inadequate, helpless, and anxious. The nurse can help the parents initially by assessing their concerns and providing appropriate information to help them clarify or resolve the immediate problems. Referring the parents to the primary health care provider is not necessary at this time. The nurse can assist the parents by listening to their concerns. Having them talk with other parents would be helpful a little bit later, once the nurse assesses their concerns and discusses the problem and the parents' current feelings. If the parents continue to have difficulties expressing and working through their feelings, referral to a counselor would be appropriate.

In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight. Which of the following exercises should the nurse recommend as best if the client has no contraindications? 1. Weight lifting. 2. Walking. 3. Aquatic exercise. 4. Tai chi exercise.

3. When combined with a weight loss program, aquatic exercise would be best because it cushions the joints and allows the client to burn off calories. Aquatic exercise promotes circulation, muscle toning, and lung expansion, which promote healthy preoperative conditioning.

A client in the postanesthesia care unit with a left below-the-knee amputation has pain in her left big toe. Which of the following should the nurse do first? 1. Tell the client it is impossible to feel the pain. 2. Show the client that the toes are not there. 3. Explain to the client that her pain is real. 4. Give the client the prescribed opioid analgesic.

4. The nurse's first action should be to administer the prescribed opioid analgesic to the client, because this phenomenon is phantom sensation and interventions should be provided to relieve it.

Which of the following would be the priority nursing diagnosis related to a severe curvature scoliosis patient? A) Impaired breathing due to inadequate chest expansion B) Disturbed body image C) Deficit knowledge related to surgical procedure D) Promotion of developmental tasks

ANSWER A According to Maslow's hierarchy of needs, the physical needs such as adequate breathing would need to be taken care of first before we progress to other aspects such as psychosocial concerns.

If progressive scoliosis is untreated it can lead to the following complication(s). Select all that apply a) Heart and lung complications b) Nausea/Vomiting c) Back pain and fatigue d) Death e) Disability

ANSWER: A,C,E If progressive scoliosis is not treated it can lead to back pain, fatigue, disability, and heart and lung complications. NV and death are not complications from this.

Which statement would indicate that the patient being taught about scoliosis needs additional education? a) During adolescence, scoliosis is more common in girls. b) Treatment is aimed at correcting the curvature and preventing a more severe scoliosis. c) Idiopathic scoliosis affects children 15 years of age and older. d) Screening is started before middle school and should be accessed yearly for prepubescent children.

ANSWER: C Eighty percent of idiopathic scoliosis affects children 11 years of age and older.

A client has an arm cast and reports that it feels really tight and the fingers are puffy. What is the nurse's best response? a. "Elevate your arm on two pillows and apply ice to the cast." b. "Continue to take ibuprofen (Motrin) until the swelling subsides." c. "It is normal for a new cast to feel a little tight for the first few days." d. "Please come to the clinic today to have your arm checked by the health care provider."

D. "Please come to the clinic today to have your arm checked by the health care provider. Puffy fingers and a feeling of tightness from the cast may indicate the development of compartment syndrome. The client should come to the clinic that day to be evaluated by the provider because delay of treatment can cause permanent damage to the extremity. Ice and Motrin are acceptable actions, but checking the cast is the priority because it ensures client safety. The nurse should not just reassure the client that this is normal.

When preparing a client for discharge from the hospital after a total knee replacement, the nurse should include which of the following information in the discharge plan? Select all that apply. 1. Report signs of infection to health care provider. 2. Keep the affected leg and foot on the floor when sitting in a chair. 3. Remove anti-embolism stockings when sleeping. 4. The physical therapist will encourage progressive ambulation with use of assistive devices. 5. Change the dressing daily.

1, 4. After a total knee replacement, efforts are directed at preventing complications, such as thromboembolism, infection, limited range of motion, and peroneal nerve palsy. The nurse should instruct the client to report signs of infection, such as an increased temperature. To prevent edema, the affected leg must remain elevated when the client sits in a chair. After discharge, the client may undergo physical therapy on an outpatient basis per physician order. The client should leave the dressing in place until the follow-up visit with the surgeon.

After teaching the parents of an infant with clubfoot requiring application of a plaster cast how to care for the cast, which of the following statements would indicate that the parents have understood the teaching? 1."If the cast becomes soiled, we'll clean it with soap and water." 2."We'll elevate the leg with the cast on pillows, so the leg is above heart level." 3."We will check the color and temperature of the toes of the casted leg frequently." 4."The petals on the edge of the cast can be removed after the first 24 hours.

3 A cast that is too tight can cause a tourniquet effect, compromising the neurovascular integrity of the extremity. Manifestations of neurovascular impairment include pain, edema, pulselessness, coolness, altered sensation, and inability to move the distal exposed extremity. The toes of the casted extremity should be assessed frequently to evaluate for changes in neurovascular integrity. Wetting a plaster cast with water and soap softens the plaster, which may alter the cast's effectiveness. There is no reason to elevate the casted extremities when a child with clubfoot is being treated with nonsurgical measures. The legs would be elevated if swelling were present. Petals, which are applied to cover the rough edges of the cast, are to be left in place to minimize the risk for skin irritation from the cast edges.

A 11-year-old girl gets diagnosed with idiopathic scoliosis and must wear a Milwaukee Brace what statement shows the nurse that the parents understands what to look for and how to properly use the brace? Select all that apply a) I will try to keep my daughter's self-esteem up knowing it might go down while wearing this brace b) I will let her take it off when she is at school and hanging out with her friends all day to keep her confidence c) I will make sure she wears it for the time the doctor tells her to even though it might range from 16-23 hours a day d) I will let her wear it under her cloths to protect her dignity

ANSWER: A and C Her self-esteem might go down while wearing the brace, but she should still wear it to prevent her scoliosis from getting worse. Talking it off during school is not a good idea since she has to wear it anywhere from 16-23 hours. Letting her wear, it under her clothes might seem like a really good idea to hide it but it can damage the skin by doing that.

Which finding is of highest priority when the nurse is planning care for a 77-year-old patient seen in the outpatient clinic? a. Symmetric joint swelling of fingers b. Decreased right knee range of motion c. Report of left hip aching when jogging d. History of recent loss of balance and fall

d. History of recent loss of balance and fall You can place the pt. on FALL PRECAUTIONS!!