UNIT 4

12. The blood pressure of a patient recovering from total hip replacement surgery is dropping. What should the nurse suspect is occurring with this patient? 1) Blood loss 2) Pain medication overdose 3) Development of a deep vein thrombosis 4) Development of a postoperative infection

1

17. A patient is seeking medical treatment for chronic low back pain. Which approach will help speed this patient's recovery? 1) Regular exercise 2) Spinal injections 3) Nonsteroidal anti-inflammatory agents (NSAIDs) 4) Transcutaneous electrical nerve stimulation (TENS)

1

A patient recovering from surgery to repair a fractured femur is experiencing pain and pulselessness. The nurse recognizes which treatment is indicated for this patient? 1)Fasciotomy 2)Limb CT scan 3)Intravenous fluids 4)Anticoagulant therapy

1) Fasciotomy

24. A patient with low back pain asks what nonmedical treatments can be used to help with the discomfort. Which complementary and alternative therapies should the nurse recommend to this patient? Select all that apply. 1) Yoga 2) Qi gong 3) Acupuncture 4) Massage therapy 5) Chiropractic treatments

1,2,3,4

24. The nurse suspects that a home care patient recovering from hip replacement surgery is developing osteomyelitis. What findings caused the nurse to come to this conclusion? Select all that apply. 1) Fever 2) Bone deformity 3) Pain unrelieved by rest 4) Progressive muscle weakness 5) Tenderness and warmth at the surgical site

1,3,5

A patient recovering from surgery to repair a fractures hip is placed in skin traction. The nurse correlates which data to the effectiveness of the traction? 1)Strong peripheral pulses 2)Reduction in muscle spasms 3)Improved mobility of the foot 4)Reduction of lower extremity edema

2)Reduction in muscle spasms

1. A patient asks what smoking cigarettes has to do with low back pain. How should the nurse respond to this patient? 1) "Smoking is a sedentary activity." 2) "Smoking is linked to nutritional disorders." 3) "Nicotine in cigarettes interferes with nutrients that supply the disk spaces." 4) "Nicotine hinders the mobility of the vertebral spaces and interferes with nerve function."

3

11. A patient with severe hip pain is diagnosed with osteoarthritis (OA). What information should the nurse provide to the patient about this disease process? 1) "OA causes an overgrowth of cartilage in the joints." 2) "OA causes joint fluid to become bluish-white in color." 3) "OA causes a decrease in joint fluid that affects the cartilage." 4) "OA causes a build of fluid in the joints, hindering movement."

3

5. A patient with low back pain asks what aspirin is supposed to do help with the pain. How should the nurse respond to this patient? 1) "It depresses the central nervous system." 2) "It blocks sodium channels and stops the formation of nerve impulses." 3) "It blocks enzymes and chemicals in the body to decrease pain and inflammation." 4) "It blocks the production of substances that trigger allergic and inflammatory reactions."

3

9. The nurse is evaluating dietary teaching provided to a patient recovering from osteomyelitis. Which meal choice indicates that additional teaching is required? 1) Green salad, meat loaf, brown rice, and broccoli 2) Caesar's salad, pork loin slices, sauerkraut, baked potato, and sautéed carrots 3) Tossed salad, spaghetti with marinara sauce, Italian bread, and creamed spinach 4) Iceberg lettuce wedge, baked chicken breast, parsley red potatoes, and green beans

3

A patient with severe hip pain is diagnosed with osteoarthritis (OA). What information should the nurse provide to the patient about this disease process? 1)"OA causes an overgrowth of cartilage in the joints." 2)"OA causes joint fluid to become bluish-white in color." 3)"OA causes a decrease in joint fluid that affects the cartilage." 4)"OA causes a build of fluid in the joints, hindering movement."

3)"OA causes a decrease in joint fluid that affects the cartilage."

The nurse is evaluating dietary teaching provided to a patient recovering from osteomyelitis. Which meal choice indicated that additional teaching is required? 1)Green salad, meat loaf, brown rice, and broccoli 2)Caesar's salad, pork loin slices, sauerkraut, baked potato, and sautéed carrots 3)Tossed salad, spaghetti with marinara sauce, Italian bread, and creamed spinach 4)Iceberg lettuce wedge, baked chicken breast, parsley red potatoes, and green beans

3)Tossed salad, spaghetti with marinara sauce, Italian bread, and creamed spinach

16. A patient is experiencing severe lower back pain that radiates down the leg causing weakness. Which diagnostic test should be considered after an MRI? 1) CT scan 2) Bone scan 3) Spinal x-ray 4) Electromyography

4

6. The nurse is caring for a patient with unrelenting low back pain caused by a herniated disk. What instruction should the nurse provide to this patient to help with the pain? 1) Sit with the legs elevated 2) Reduce the intake of fluids 3) Limit activity until the pain subsides 4) Bend at the knees with a straight back

4

8. A patient recovering from total knee replacement surgery develops osteomyelitis. What teaching should the nurse prepare as a priority for this patient? 1) Antibiotic therapy 2) Pain management 3) Debridement of the wound 4) Removal of the knee prosthesis

4

A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? select all that apply A. Crepitus with joint movement B. Decreased range of motion of the affected joint C. low-grade fever D. Spongy tissue over the joints E. Joint pain that resolves with rest

A, B, E Crepitus with joint movement is correct. Osteoarthritis is a degenerative joint disease. Crepitus, a grating sound, is an expected finding with clients who have osteoarthritis as loosened bone and cartilage move around in the fluid inside the joint. Decreased range of motion is an expected finding with clients who have osteoarthritis because the client's pain limits movement. Rheumatoid arthritis causes many systemic manifestations, including low-grade fever, weakness, anorexia, and paresthesia. Spongy joint tissue is an expected finding with rheumatoid arthritis, which is an inflammatory disease, not a degenerative disease. Joint pain that resolves with rest is an expected finding with clients who have osteoarthritis. A client who has osteoarthritis experiences increased pain with activity and decreased pain with rest.

Which patient statement indicates the need for additional teaching for the patient being discharged after a Total Knee Replacement? A) "I will increase intake of vitamins and minerals." B) "I should expect that my knee may change shape." C) "I should continue physical therapy as prescribed." D) "I will report pain or swelling to the health care provider."

B) "I should expect that my knee may change shape." Rationale:An arthroplasty is a procedure that relieves pain and promotes mobility by reconstructing or replacing a joint; a THA removes the ball-and-socket joint and the upper shaft of the femur. A hip resurfacing arthroplasty is an alternative to THA that allows the ball of the joint to be preserved and reshaped. An osteotomy removes a wedge or slice of bone to restore alignment and shift weight-bearing, thus relieving pain. A debridement procedure removes degenerative debris from the join to relieve pain and promote mobility.

The nurse is providing teaching about crutches to a client who has a fracture of the right foot. Which of the following instructions should the nurse include? A) When you go up a flight of stairs, place your right foot on the first step B) Keep the rubber crutch tips securely in place C) When standing, keep the crutches 12 inches in front of you and 12 inches to the side D) Place your weight on the crutch pads at your armpits

B) Keep the rubber crutch tips securely in place

A nurse is caring for a client who is in balanced suspension skeletal traction and reports intermittent muscle spasms. Which of the following actions should the nurse take first? A. Reposition the client B. Check the position of the weights and ropes C. Administer a muscle relaxant D. Provide distraction

B. Check the position of the weights and ropes The first action the nurse should take when using the nursing process is to assess the client. The nurse should first check the position of the weights and ropes to investigate the cause of the muscle spasms. The weights might be too heavy, or the nurse might need to realign the client.

a nurse is teaching a client who has osteoporosis and has a new prescription for alendronate. Which of the following information should the nurse include in the teaching? A. Take this medication with 8 oz of milk B. Remain upright for 30 minutes after taking this medication C. Wait 1 hour after taking other medication to take alendronate D. Take vitamin C to promote absorption of this medication

B. Remain upright for 30 minutes after taking this medication. To prevent esophagitis or esophageal ulcers, which can result from alendronate therapy, the client should sit upright for 30 min after taking this medication. The nurse should instruct the client to take alendronate with 240 mL (8 oz) of water, The nurse should instruct the client to take alendronate with 240 mL (8 oz) of water.

A nurse is planning care for a client following a lumbar puncture. Which of the following actions should the nurse plan to take? A. apply a pressure dressing to the site for 8hr B. Restrict the client's fluid intake for 24hr C. Ensure that the client lies flat for up to 12hr D. Inform the client that neck stiffness is an expected outcome of the procedure

C. Ensure that the client lies flat for up to 12hr The client should lie flat for up to 12 hr to prevent cerebrospinal fluid leakage from the puncture site, which can cause a headache.

nurse is caring for a client who is 72 hr postoperative following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? A. remind the client that the surgery removed the limb B. change the dressing on the client's residual limb C. request a prescription for gabapentin for the client D. Elevate the client's residual limb above heart level

C. request a prescription for gabapentin for the client The nurse should request a prescription for a nonopioid medication to help minimize phantom limb pain. Gabapentin is an oral antiepileptic medication that is effective for treating sharp, burning, phantom limb pain.

A nurse is evaluating a clients use of crutches, The nurse should identify that which of the following actions by the client indicates safe usage of this equipment? A) The client places a crutch on each side when assuming a sitting position B) The client moves the unaffected leg onto a step first when descending stairs C) The client places weight on the axillae when walking D) The client has slightly flexed elbows when ambulating with the crutches

D) The client has slightly flexed elbows when ambulating with the crutches

A nurse is teaching an assistive personnel about providing care to a client following a total hip arthroplasty. Which of the following instructions should the nurse include? A. Avoid applying antiembolism stockings to the affected let B. Have the client lean forward when moving from a sitting to a standing position C. Discourage the client from sitting in a wheelchair with the back reclined. D. Place an abductor pillow between the client's legs when turning the client

D. Place an abductor pillow between the client's legs when turning the client The nurse should inform the AP that a client who had a total hip arthroplasty should maintain the hip in abduction following surgery to reduce the risk of dislocating the affected hip. The AP should place an abductor pillow between the client's legs when turning the client to keep the hips in abduction.

The nurse provides discharge instructions for a patient who experienced a traumatic amputation of the leg below the knee. Which patient statement indicated the need for further teaching?

I will place a pillow under my stump

A nurse is teaching a client who is postoperative following a right hip arthroplasty. Which of the following images indicates the position the nurse should teach the client to take when sitting in a chair?

The nurse should instruct the client to sit with the hips at a 90° angle with the knees slightly lower than the hips to avoid hip dislocation.

A nurse in an emergency department is caring for a client who has sustained a fracture of the femur following a motor-vehicle crash. Which of the following images should the nurse recognize as a comminuted fracture?

This is an image of a comminuted fracture, in which the injury causes the bone to fragment into several pieces.

A patient states, "I can hear a crunching or grating sound when I kneel." She also states that "it is very difficult to get out of bed in the morning because of stiffness and pain in my joints." The nurse should assess for signs of what problem? a. Crepitation b. Bone spur c. Loose tendon d. Fluid in the knee joint

a. Crepitation

The functional units of the musculoskeletal system are the: a. Joints. b. Bones. c. Muscles. d. Tendons.

a. Joints.

A nurse is planning care for a client who has a new prescription for methotrexate. The nurse should plan to monitor the client for which of the following adverse effects? a. bone marrow depression b. thrombocythemia c. double vision d. constipation

a. bone marrow depression

A nurse is caring for a client who is taking alendronate to treat postmenopausal osteoporosis. the nurse should explain to the client that alendronate increases bone mass by which of the following actions? a. decreases activity of osteoclasts b. increases calcium excretion c. promotes intestinal absorption of calcium and phosphorus d. reduces action osteoblasts

a. decreases activity of osteoclasts

A nurse should instruct a client who is taking alendronate to monitor for which of the following adverse effects? (select all that apply) a. jaw pain b. drowsiness c. blurred vision d. tinnitus e. muscle pain

a. jaw pain c. blurred vision e. muscle pain

A nurse is teaching a client about calcitonin-salmon intra nasal spray to treat osteoporosis. Which of the following information should the nurse include? (select all that apply) a. report rash or itching b. deliver two sprays to each nostril c. prime the pump before the first dose d. report nasal irritation e. hold the pump horizontally

a. report rash or itching c. prime the pump before the first dose d. report nasal irritation

The nurse is assessing the joints of a woman who has stated, "I have a long family history of arthritis, and my joints hurt." The nurse suspects that she has osteoarthritis. Which of these are symptoms of osteoarthritis? Select all that apply. a. Symmetric joint involvement b. Asymmetric joint involvement c. Pain with motion of affected joints d. Affected joints are swollen with hard, bony protuberances. Affected joints may have heat, redness, and swelling

b. Asymmetric joint involvement c. Pain with motion of affected joints d. Affected joints are swollen with hard, bony protuberances

A patient has been diagnosed with osteoporosis and asks the nurse, "What is osteoporosis?" The nurse explains that osteoporosis is defined as: a. Increased bone matrix. b. Loss of bone density. c. New, weaker bone growth. d. Increased phagocytic activity.

b. Loss of bone density.

A nurse is teaching a client who has a prescription for prednisone and takes 1,500 mg/day of calcium carbonate to reduce the risk of osteoporosis. Which of the following info should the nurse include? (select all that apply) a. take the calcium tablets with food b. drink 240 ml (8oz) of water with the calcium tablets c. chew calcium tablets before swallowing them d. take the drugs 1 hr aparte. divide the daily dosage of allium into three 500-mg doses

b. drink 240 ml (8oz) of water with the calcium tablets c. chew calcium tablets before swallowing them d. take the drugs 1 hr aparte. divide the daily dosage of allium into three 500-mg doses

A nurse should identify that a client who has diabetes mellitus and is taking etanercept is at an increased risk for which of the following adverse effects? a. kidney toxicity b. infection c. gout d. DVT

b. infection

Which of the following is a therapeutic action of raloxifene? a. blocks the effects of estrogen on endometrial tissue b. mimics the effects of estrogen on bone tissue c. stimulates secretion of parathyroid hormone d. stimulates menstruation

b. mimics the effects of estrogen on bone tissue

The nurse suspects that a patient has carpal tunnel syndrome and wants to perform the Phalen test. To perform this test, the nurse should instruct the patient to: a. Dorsiflex the foot. b. Plantarflex the foot. c. Hold both hands back to back while flexing the wrists 90 degrees for 60 seconds. d. Hyperextend the wrists with the palmar surface of both hands touching, and wait for 60 seconds.

c. Hold both hands back to back while flexing the wrists 90 degrees for 60 seconds.

The nurse is teaching a class on preventing osteoporosis to a group of perimenopausal women. Which of these actions is the best way to prevent or delay bone loss in this group? a. Taking calcium and vitamin D supplements b. Taking medications to prevent osteoporosis c. Performing physical activity, such as fast walking d. Assessing bone density annually

c. Performing physical activity, such as fast walking

A teenage girl has arrived complaining of pain in her left wrist. She was playing basketball when she fell and landed on her left hand. The nurse examines her hand and would expect a fracture if the girl complains of a: a. Dull ache. b. Deep pain in her wrist. c. Sharp pain that increases with movement. d. Dull throbbing pain that increases with rest.

c. Sharp pain that increases with movement.

A nurse is teaching a client about methotrexate. The nurse should inform the client to monitor for which of the following as an adverse effect of this drug? a. muscle pain b. peripheral edema c. black, tarry stools d. redness in the calf

c. black, tarry stools

A nurse is teaching a client about raloxifene therapy to prevent osteoporosis. Th nurse should instruct the client to monitor for which of the following indications of an adverse reaction to this drug? a. loss of hair b. numbness of the fingertips c. calf pain d. blisters on mucous membranes

c. calf pain

A nurse is caring for a client who was diagnosed with postmenopausal osteoporosis. Which of the following actions should the nurse take prior to administering calcitonin-salmon to the client for the first time? a. check the client's urine for sedimentation b. assess the client's liver function c. use skin testing to check the client for allergies d. evaluate the client's breath sounds

c. use skin testing to check the client for allergies

a nurse is preparing to administer alendronate to a client who has osteoporosis. the nurse should recognize which of the following as an adverse effect of alendronate? a. venous thromboemboli b. ventricular dysrhythmias c. breast cancer d. joint pain

d. joint pain

A nurse is teaching a client who has prescription for calcitonin-salmon about manifestations of hypercalcemia. which of the following manifestations should the nurse include in the teaching? a. muscle twitching b. laryngospasm c. paresthesia d. vomiting

d. vomiting