chronic mod 9 chap 45, 46, 47

Which assessment finding best indicates to the nurse that perfusion in the affected limb of a close-fractured lower femur with extensive swelling and bruising is adequate? 1. Pulse oximetry on the right forefinger is 98% 2. Pedal pulse of the affected limb is easily palpated and strong 3. Femoral pulse of the affected limb is easily palpated and strong 4. Capillary refill on the great toe of the affected limb is about 4 seconds

2

Which assessment finding in a client who has a fracture of the right wrist alerts the nurse to a possible early indication of a complication? 1. Wiggling finders causes pain 2. Client reports numbness and tingling 3. Fingers are cold and pale; pulses are impalpable 4. Pain is severe and seems out of proportion to injury

2

Which client will the nurse determine requires the most assistance with performance of ADLs? 1. 28-year-old with bilateral below-the-knee amputations 2. 40-year-old with amputation of the dominant hand 3. 50-year-old with an above-the-knee amputation of the dominant leg 4. 70-year-old with amputations of all toes on the left foot

2

What advantages will the nurse tell the client that external fixation has over internal fixation of fractures? SATA 1. The risk of infection is reduced 2. You lost less blood than you would have with an internal fixation 3. This device allows you to move and walk earlier than an internal device 4. You will not need surgery to remove these devices after healing is complete 5. Most people have less pain with the external devices than with internal devices 6. This device replaces the need for the use of any other device, such as a cast or a boot later.

2,3,5

Which action will the nurse perform first when a client in a body cast reports a painful "hot spot" underneath the cast and an unpleasant odor? 1. Requesting a cast change 2. Offering the client a PRN pain medication 3. Assessing the client's temperature and other vital signs 4. Elevating the extremity and applying an ice pack over the spot

3

Which assessment is the priority for the nurse to perform on a client admitted to the emergency department with multiple rib fractures? 1. Pulses in all four extremities 2. Pulse rate and rhythm 3. Oxygen saturation 4. Pain intensity

3

The nurse is caring for a client with severe osteoarthritis. What will the nurse anticipate as the client's priority problem? A. Joint pain B. ADL dependence C. Risk for falls D. Muscle stiffness

A Osteoarthritis indicates a joint disease in which bone cartilage degenerates causing joint pain and secondary inflammation (Choice A). The client often experiences muscle stiffness which is not as uncomfortable as joint pain (Choice D). Clients who have severe osteoarthritis are not necessarily dependent in ADLs or at risk for falling (Choice B and C).

1. The nurse is teaching a client who has osteopenia about alendronate. Which statement by the client indicates a need for further teaching? A. "I will take this drug at night to prevent nausea." B. "I need a dental checkup before taking the drug." C. "I need to sitting up for 30 minutes after taking the drug." D. "I will drink plenty of water after I take the drug."

A This drug is a bisphosphonate and can cause esophageal irritation or damage. Therefore, it is taken on an empty stomach in the morning followed by plenty of water while sitting or standing upright for at least 30 minutes.

Which assessment data are factors increase the risk for osteoporosis for an older Euro-American female? Select all that apply. A. Drinks 3-4 glasses of wine each day B. Sits at a desk all day in her job C. Smokes a pack of cigarettes a day D. Takes a mile-long walk 5 days a week E. Takes 1000 mg acetaminophen for arthritis daily F. Weighs 110 pounds (50 kg)

A, B, C, F Rationales: Regular exercise helps to prevent or slow osteoporosis; Choice D suggests that the client includes exercise in her life style. Acetaminophen is not a drug that causes bone loss, so Choice E is not a risk factor. However, excessive alcohol (Choice A), sedentary job (Choice B), smoking (Choice C), and being a petite, thin woman (Choice F) increases the client's risk for osteoporosis.

1. The nurse is caring for a client who was admitted with a draining diabetic ulcer on the lower extremity. What personal protective equipment will the nurse teach the staff to use? Select all that apply. A. Gown B. Gloves C. Mask D. Foot covers E. Goggles

A,B The client with an open draining wound likely has a local or possibly a systemic infection. Therefore, Contact Precaution are needed to prevent contact with the drainage. Gloves and gowns are the most appropriate personal protective equipment to prevent infection transmission.

A client has a new synthetic leg cast for a right fractured tibia. What health teaching will the nurse include before discharge to home? Select all that apply. A. "Elevate your right leg as often as possible to reduce swelling." B. "Report increased pain or burning sensation under your cast." C. "Use ice on the affected leg for the first 24-36 hours." D. "Do not bear weight on the affected leg until instructed to do so." E. "Do not cover the cast when you are in bed; keep it open to air to dry."

A,B,C,D Ice and elevation of the affected leg can decrease swelling which is needed to prevent pressure from the cast (Choices A and C). The purpose of the cast is to immobilize the foot such that the tibia can heal. Therefore, no weight-bearing is allowed (Choice D). Increased pain and burning are indicators that the cast may be too tight and the skin under the cast may break down. These changes need to be reported promptly to the primary health care provider (Choice B). A synthetic cast dries immediately (unlike a plaster cast) and therefore Choice E is an incorrect response.

A client had a left noncemented posterolateral total hip arthroplasty 2 days ago. Which statements will the nurse include in health teaching for the client? Select all that apply. A. "Practice leg exercises each day as instructed." B. "Take deep breaths and use incentive spirometry every 2 hours." C. "Be sure to cross your legs to be more comfortable in a chair." D. "Report sudden increased hip pain or rotation immediately to the nurse." E. "Stand on your right leg and pivot into the chair when getting out of bed."

A,B,D,E The client who had a posterolateral surgical approach is at risk for hip dislocation and should be taught NOT cross his or her legs which cause adduction. Therefore, Choice C is an incorrect response. All clients having a total hip arthroplasty are at risk for clotting and leg exercises can help reduce that risk (Choice A). Taking deep breaths and using incentive spirometry are important for all surgical clients to prevent pneumonia or ateletasis (Choice B). Choice D is important for client teaching because these signs and symptoms may indicate hip dislocation. Clients with noncemented implants should not initially bear weight on the affected leg (Choice E).

Which assessment findings will the nurse expect for the client with early-stage rheumatoid arthritis? Select all that apply. A. Joint inflammation B. Subcutaneous nodules C. Severe weight loss D. Fatigue E. Thrombocytosis F. Anorexia

A,D,F Subcutaneous nodules (Choice B), severe weight loss (Choice C) and thrombocytosis (Choice E) are all commonly seen in clients with late-stage, advanced RA. Joint inflammation (Choice A) is common in early disease and often occurs with client reports of fatigue and anorexia (Choices D and F).

1. The nurse is assigned to care for a postoperative client who had an open reduction, internal fixation of the right tibia yesterday. The client reports increased right leg pain, numbness, and tingling. What would be the nurse's first action at this time? A. Elevate the surgical leg on a pillow. B. Perform a neurovascular assessment. C. Administer pain medication. D. Call the primary health care provider.

B The nurse would suspect neurovascular compromise which is causing the client's reported signs and symptoms. Therefore, the first nursing action is to perform a complete neurovascular assessment, also called a "circ" or "CMS check" to validate the client's condition (Choice B). Neurovascular compromise results in decreased arterial perfusion and elevating the leg would decrease it further (Choice A). Although the nurse would report the client's complication to the primary health care provider and give the client an analgesic, these actions would not be performed first (Choices C and D).

1. The nurse is caring for a client who was admitted to the Emergency Department (ED) with report of left knee pain and swelling after playing baseball with friends. Which nursing actions are appropriate when caring for the client? Select all that apply. A. Apply heat to the affected area. B. Assess the severity and quality of pain. C. Perform a neurovascular assessment. D. Elevate the affected extremity. E. Immobilize the injured knee joint.

B, C, D, E Rationales: The nurse always performs an assessment as part of nursing care, including pain and neurovascular assessments (Choice B and C). Musculoskeletal injuries are usually treated using RICE (rest/immobilization, ice, compression, and elevation) Choice D and E). Therefore, Choice A using heat for the new injury is contraindicated.

The primary health care provider prescribes daily celecoxib for a client experiencing persistent joint pain in both knees. Which health teaching will the nurse provide for the client regarding this drug for long term pain control? Select all that apply. A. "Take the prescribed drug before breakfast each day." B. "Report any sign of bleeding, including bloody or dark, tarry stool." C. "Do not take other NSAIDs while on celecoxib." D. "Report any major changes in the amount of urine you excrete each day." E. "Follow up with lab tests to assess liver function."

B,C,D Celecoxib is a COX-2 inhibiting NSAID and therefore can cause many adverse effects including GI symptoms, such as bleeding (Choice B), and acute kidney injury which is manifested by decreased urinary output (Choice D). Other NSAIDs should be avoided to reduce potential adverse effects (Choice C). All NSAIDs should be taken with meals or food to decrease GI effects, making Choice A the wrong response. Lab tests to measure liver function are more likely requested for patients taking acetaminophen, so Choice E is not appropriate for celecoxib therapy.

A client had an open reduction internal fixation (ORIF) of the right wrist. What health teaching is appropriate for the nurse to provide for this client before returning home? Select all that apply. A. "Keep your right arm below the level of your heart as often as possible." B. "Use an ice pack for the first 24 hours to decrease tissue swelling." C. "Report coolness or discoloration of your right hand to your doctor." D. "Don't place any device under the cast to scratch the skin if it itches." E. "Move the fingers of the right hand frequently to promote blood flow."

B,C,E An ORIF requires an open surgical procedure to reduce and immobilize the fracture. As a result, the client is at risk for swelling and neurovascular compromise. Therefore, keeping the affected arm above the heart is preferred rather than below the heart. Choice A is an incorrect response. Ice and moving the fingers can help to decrease swelling (Choice B and Choice E). The client should report any sign of decreased circulation, such as discoloration or coolness (Choice C). Choice E is incorrect because the client has a surgical incision and would not have a cast.

The nurse is assessing a client who has late-stage rheumatoid arthritis. Which assessment findings would the nurse expect for this client? Select all that apply. A. Joint inflammation B. Severe weight loss C. Bony nodules D. Joint deformities E. Sjogren's syndrome

B,D,E Although rheumatoid arthritis (RA) is an inflammatory disease, clients with late-stage disease have joint deformity rather than inflammation (Choice A and D). Bony nodules occur in clients who have osteoarthritis; subcutaneous nodules are more common in clients with RA (Choice C). Severe weight loss and possibly Sjogren's syndrome are common in clients with late-stage RA (Choice B and E).

An unlicensed assistive personnel (UAP) is assigned to care for a client who had a cemented total knee arthroplasty yesterday. Which observation by the UAP indicates a need for follow-up by the nurse? A. "The client's surgical knee is very swollen and discolored." B. "The client states that the surgical knee is very painful when moving it." C. "The client's lower leg on the surgical side is painful and red." D. "The client needs assistance with walking to the bathroom."

C A client who had a TKA one-day ago is expected to have a swollen and discolored surgical knee that is very painful when moving. The client is also expected to need assistance with a walker and possibly a staff member when ambulating. Therefore, Choices A, B, and D do not require follow-up by the nurse. However, redness, pain, and possibly swelling of the lower leg may indicate deep vein thrombosis which requires follow-up and assessment by the nurse (Choice C).

What is the nurse's priority when doing an admission for a client who returned directly from the operating suite after a carpal tunnel repair? A. Monitor vital signs, including pulse oximetry. B. Check the surgical dressing to ensure that it is intact. C. Assess neurovascular assessment in the affected arm. D. Monitor intake and output.

C Choices A, B, and C all apply for postoperative care for carpal tunnel syndrome (CTS). However, the most important priority action is to check for adequate circulation, movement, and sensation (neurovascular assessment). Therefore, Choice C is the best answer. Monitoring intake and output are not relevant for CTS surgery.

The nurse assesses a client recently diagnosed with metastatic vertebral bone cancer. Which intervention is the priority when caring for this client? A. Consult with rehabilitative therapy B. Referral to hospice care C. Drug therapy to manage persistent pain D. Oxygen therapy to prevent dyspnea

C Metastatic vertebral bone pain is very painful, which is the priority in this client situation. Therefore, Choice C is the best answer because the client is expected to have persistent pain that needs to be well managed. Physical or occupational therapy (Choice A) may also be needed to help the client with ADL function, but it is not as important as pain control. Severe pain can cause shallow breathing and dyspnea, and therefore, the client may require oxygen therapy (Choice D). However, the situation does not provide information that suggests the need for oxygen. Choice B may be needed later, but this client has recently been diagnosed and very likely may not meet hospice care criteria at this time.

The nurse is caring for a client immediately after a bunionectomy. What is the nurse's priority action? A. Relieve or reduce the client's pain. B. Maintain the client's airway. C. Assess neurovascular status in the surgical foot. D. Apply a hot compress to the surgical area.

C The client's situation does not suggest any problem with breathing and, therefore, Choice B is not correct. Assessing circulation in the surgical foot is more important than managing pain (Choice A). Choice D is incorrect because cold would reduce local pain and swelling. Heat would increase circulation but increase pain and swelling to the surgical site.

The nurse is caring for a client who had a posterolateral total his arthroplasty yesterday. For which commonly occurring postoperative complication will the nurse monitor for this client? A. Pneumonia B. Paralytic ileus C. Wound dehiscence D. Surgical hip dislocation

D Even with aggressive preventive interventions, the client who has a total hip arthroplasty (THA) is at most risk for the common complication of venous thromboembolism. The other choices are much less common for clients having a THA, and would be seen in clients having other types of surgery.

A client who had an elective below-the-knee amputation (BKA) reports pain in the foot that was amputated last week. What is the nurse's most appropriate response to the client's pain? A. "The pain will go away after the swelling decreases." B. "That's phantom limb pain, and every amputee has that." C. "Your foot has been amputated, so it's in your head." D. "On a scale of 0 to 10, how would you rate your pain?"

D Nurses should treat any pain as real to the patient, even if the pain is perceived in a part of the body that is no longer there. Choice D demonstrates that the nurse acknowledges that the pain is real and further assesses is intensity. Choices A, B, and C dismisses the client's report of pain.

The nurse teaches assistive personnel (AP) how to position a client who had an above-the-knee amputation (AKA) last week. Which statement by the AP indicates understanding of the teaching? A. "We should keep the surgical leg elevated on two pillows at all times." B. "We should keep the client in a sitting position as long as possible." C. "We should keep the surgical leg as flat on the bed as possible." D. "We should keep the client in a prone position most of the day.

c One of the complications of an AKA is flexion hip contracture of the affected leg. The flexor muscles become spastic which causes hip flexion; therefore, the surgical leg ("stump") should be positioned as flat as possible in an extended position to prevent that complication (Choice C). Elevation would promote flexion (Choice A). Placing the client occasionally in a prone position can help promote hip extension but the client cannot remain in that position for a prolonged period of time (Choice D). Prolonged sitting can lead to sacral or buttock pressure injuries and would not be the best client position (Choice B).