4 Orthopedic Trauma/Musculoskeletal Disorders

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a. "Use your continuous passive motion machine for 2 hours each day." b. "You need to perform weight-bearing exercises twice a week." c. "You need to limit the amount of protein and calcium in your diet." d. "You will receive IV antibiotics for 3 to 6 weeks."

d. "You will receive IV antibiotics for 3 to 6 weeks."

A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"? a. stretched or pulled beyond its capacity b. injury resulting from a blow or blunt trauma c. injuries to ligaments surrounding a joint d. subluxation of a joint

a. stretched or pulled beyond its capacity

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? a. Degenerative joint disease b. Muscular dystrophy c. Scoliosis d. Paget's disease

a. Degenerative joint disease

Which joint is most commonly affected in gout? a. Metatarsophalangeal b. Tarsal area c. Ankle d. Knee

a. Metatarsophalangeal

A client with carpal tunnel syndrome has had limited improvement with the use of a wrist splint. The nurse knows that which procedure will show the greatest improvement in treatment for this client? a. Laser therapy b. Ultrasound therapy c. Open nerve release Id. njection of lidocaine

c. Open nerve release

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a. "This condition is associated with various sports." b. "Surgery is the only sure way to manage this condition." c. "Using arm splints will prevent hyperflexion of the wrist." d. "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

d. "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

An older adult with rheumatoid arthritis limits going out with others because of the need to use a cane. Which response will the nurse make to this client? a. "It must be hard to get older." b. "Everyone will get older at some time." c. "Invite people over to your home instead." d. "Look at the cane as maintaining your independence."

d. "Look at the cane as maintaining your independence."

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? a. Administer prescribed analgesics around-the-clock. b. Avoid administering too much medication because the client is older. c. Administer prescribed pain medication only when the client requests it. d. Give pain medication to the client after providing care.

a. Administer prescribed analgesics around-the-clock.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD? a. Calcitonin (Miacalcin) b. Raloxifene (Evista) c. Teriparatide (Forteo) d. Vitamin D

a. Calcitonin (Miacalcin) Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis.

Which is not one of the general nursing measures employed when caring for the client with a fracture? a. cranial nerve assessment b. administering analgesics c. providing comfort measures d. assisting with ADLs

a. cranial nerve assessment

A client with a discoid facial rash caused by systemic lupus erythematosus (SLE) asks why a urine sample is needed. Which response will the nurse make to the client? a. "It is a routine test done on everyone." b. "The lupus can affect your kidney function." c. "The medication you take can affect your bladder." d. "The test will determine how long you will have the rash."

b. "The lupus can affect your kidney function."

The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about? a. Ibuprofen b. Celecoxib c. Piroxicam d. Tolmetin sodium

b. Celecoxib

Which group is at the greatest risk for osteoporosis? a. Men b. European American women c. Asian American women d. African American women

b. European American women

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? a. Consult a skin specialist. b. Scrub the area vigorously to remove the crust. c. Apply lotions and take warm baths or soaks. d. Avoid exposure to direct sunlight.

c. Apply lotions and take warm baths or soaks.

A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment? a. Have the client make a fist and open the hand against resistance. b. Have the client stretch the fingers around a ball and squeeze with force. c. Have the client hold the palm of the hand up while the nurse percusses over the median nerve. d. Have the client pronate the hand while the nurse palpates the radial nerve.

c. Have the client hold the palm of the hand up while the nurse percusses over the median nerve.

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout? a. Assess diet and activity at home b. Place client on bed rest c. Increase fluids d. Insert a Foley catheter

a. Assess diet and activity at home

Which statements describe open reduction of a fracture? Select all that apply. a. It is performed in the operating room. b. The bone is surgically exposed and realigned. c. The client usually receives general or spinal anesthetic. d. The bone is restored to its normal position by external manipulation.

a. It is performed in the operating room. b. The bone is surgically exposed and realigned. c. The client usually receives general or spinal anesthetic.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about? a. Methotrexate b. Celecoxib c. Methylprednisolone d. Mercaptopurine azathioprine

a. Methotrexate

What food can the nurse suggest to the client at risk for osteoporosis? a. Carrots b. Broccoli c. Chicken d. Bananas

b. Broccoli

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? a. Increase fiber in the diet b. Walk or perform weight-bearing exercises outdoors c. Reduce stress d. Decrease the intake of vitamin A and D

b. Walk or perform weight-bearing exercises outdoors

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) a. "You may cross your legs at the ankles only." b. "Place pillows between your legs when you lay on your side." c. "Avoid bending forward when sitting in a chair." d. "Use a raised toilet seat and high-seated chair." e. "It is okay to briefly flex the hip to put on your clothes."

b. "Place pillows between your legs when you lay on your side." c. "Avoid bending forward when sitting in a chair." d. "Use a raised toilet seat and high-seated chair."

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? a. Administering large doses of oral antibiotics as ordered b. Instructing the client to ambulate twice daily c. Withholding all oral intake d. Administering large doses of I.V. antibiotics as ordered

d. Administering large doses of I.V. antibiotics as ordered

A client with rheumatoid arthritis is discharging to home following an exacerbation of joint pain. Which type of referral will be the priority for the client? a. Home health nurse b. Social services c. Physical therapy d. Occupational therapy

a. Home health nurse After discharge and depending on the severity of the disease and the client's resources and supports, referral for a home health nurse may be warranted. During home visits, the nurse has the opportunity to assess the home environment and its adequacy for client safety and management of the disorder. Social services would not be a priority at this time as physical problems need to be addressed first. Referrals to physical and occupational therapists may be made as problems are identified and limitations increase.

A client is seen in the office for reports of joint pain, swelling, and a low-grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of rheumatoid arthritis (RA)? Select all that apply. a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) c. Red blood cell (RBC) count of >4.0 million/uL d. Red blood cell (RBC) count of <4.0 million/mcL e. Aspartate aminotransferase (AST) and alanine transaminase (ALT) levels of 7 units/L

a. Positive C-reactive protein (CRP) b. Positive antinuclear antibody (ANA) d. Red blood cell (RBC) count of <4.0 million/mcL

A 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? a. "After age 40, height may show a gradual decrease as a result of spinal compression" b. "After menopause, the body's bone density declines, resulting in a gradual loss of height." c. "There may be some slight discrepancy between the measuring tools used." d. "The posture begins to stoop after middle age."

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

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a. Open reduction b. Needle aspiration c. Arthroplasty d. Arthroscopy

d. Arthroscopy

A client is experiencing painful joints and changes in the lungs, heart, and kidneys. For which condition will the nurse schedule this client for diagnostic tests? a. Heart disease b. Vascular diseases c. Metabolic disorders d. Autoimmune disorders

d. Autoimmune disorders

The nurse is caring for a client with ankylosing spondylitis (AS). Which medication will the nurse expect to be prescribed for this client? a. Antibiotics b. Anticoagulants c. Oral corticosteroids d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? a. Wound packing b. Wound irrigation c. Vitamin supplements d. Surgical debridement

d. Surgical debridement

The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given? a. Alendronate b. Raloxifene c. Teriparatide d. Denosumab

a. Alendronate

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? a. Facial erythema, pericarditis, pleuritis, fever, and weight loss b. Photosensitivity, polyarthralgia, and painful mucous membrane ulcers c. Weight gain, hypervigilance, hypothermia, and edema of the legs d. Hypothermia, weight gain, lethargy, and edema of the arms

a. Facial erythema, pericarditis, pleuritis, fever, and weight loss

(RA). The client tells the nurse that she has not been taking her medication because she usually cannot remove the childproof medication lids. a. Encourage the client to store the bottles with their tops removed. b. Have a trusted family member take over the management of the client's medication regimen. c. Encourage her to have her pharmacy replace the tops with alternatives that are easier to open. d. Have the client approach her primary provider to explore medication alternatives.

c. Encourage her to have her pharmacy replace the tops with alternatives that are easier to open.

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? a. Decrease in estrogen b. Increase in calcitonin c. Decrease in parathyroid hormone d. Increase of vitamin D

a. Decrease in estrogen