Med-Surg: Musculoskeletal

a nurse is assessing a client who is 24 hr post-op following an above-the-elbow amputation. which of the following findings should the nurse identify as the priority?

- Report of muscle spasms The nurse should consider Maslow's hierarchy of needs, which includes five levels of priority. The first level consists of physiological needs; the second level consists of safety and security needs; the third level consists of love and belonging needs; the fourth level consists of personal achievement and self-esteem needs; and the fifth level consists of achieving full potential and the ability to problem solve and cope with life situations. When applying Maslow's hierarchy of needs priority-setting framework, the nurse should review physiological needs first. The nurse should then address the client's needs by following the remaining four hierarchal levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the specific client situation. The fourth level of Maslow's hierarchy of needs includes usefulness, self-worth, and self-confidenc

a nurse is caring for a client who is 3 days post-op following a right total hip arthroplasty. while transferring to a chair, the client cries out in pain. the nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis?

- Shortening of the right leg The nurse should monitor the client for shortening of the affected leg as an indication of dislocation of the prosthesis. Other findings include increased hip pain, inability to move the extremity, and rotation of the hip internally or externally.

a nurse is assessing a client who is 48 hr. post-op following open reduction and internal fixation of a fractured tibia. which of the following findings should the nurse report to the provider?

- Toes cold to the touch The nurse should monitor for and report manifestations of compartment syndrome following internal fixation. Therefore, the nurse should contact the provider immediately if the client's toes are cold to the touch.

a nurse is caring for a client who had a fiberglass cast placed on her left arm several hrs. ago and now reports itching under the cast. which of the following actions should the nurse plan to take?

- Use a hair dryer on a cool setting to blow air into the cast. The nurse should provide relief for the report of itching by blowing cool air into the cast using a hair dryer on a cool setting or an empty 60-mL plunger syringe.

a nurse is caring for a client who is post-op following shoulder surgery. the client has a prescription to keep the affected arm adducted. which of the following instructions should the nurse provide the client?

"Hold your arm against the side of your body." Adduction means to position toward the midline of the body. Therefore, the nurse should provide these instructions to explain the provider's prescription.

a nurse is providing pre-op teaching for a client who is scheduled for total knee arthroplasty. which of the following statements by the client should the nurse identify as understanding of the teaching?

- "I should wear elastic stockings on both of my legs." The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as understanding of the teaching.

a nurse is teaching a client who has a new prescription for alendronate for treatment of osteoporosis. which of the following statements by the client indicates understanding of the teaching?

- "I will sit upright after taking the medication." A client taking alendronate should sit upright for 30 min after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.

a nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. which of the following information should the nurse include about osteoarthritis?

- "Osteoarthritis can impair a joint on a single side of the body." The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment.

a nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. the client reports sensations of burning and crushing pain in the toes of the right foot. which of the following statements should the nurse make?

- "This type of pain usually decreases over time as the limb becomes less sensitive." The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain.

a nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. which of the following informaiton should nurse include?

- "Your provider might prescribe a central catheter line for long-term antibiotic therapy." Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV antibiotic therapy for treatment. Therefore, the nurse should discuss the need for long-term IV access for antibiotic therapy.

a nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client?

- Apply cold compresses to the extremity intermittently. Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 min at a time.

a nurse is caring for a client who is postoperative following a total knee arthroplasty and is prescribed a continuous passive motion (CPM) machine and PCA. the client tells the nurse, "I am in so much pain." which of the following actions should the nurse take first?

- Ask the client to describe the characteristics of the pain. Answering this item requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, she must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to acquire further data by asking the client to describe the characteristics of the pain.

a nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. the nurse should identify that which of the following medications can interact with probenecid?

- Aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications.

a nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). which of the following medications should the nurse identify as the treatment for this condition

- Celecoxib Celecoxib is a type of NSAID, called cyclooxygenase-2 (COX-2) inhibitors, used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation.

a nurse is providing discharge instructions for a client who is post-op following inner maxillary fixation with wiring. which of the following information should the nurse include?

- Cut the wiring if emesis occurs. Inner maxillary fixation involves wiring of the teeth to support the fractured jaw by holding the jawbones together. The wires are left in place until the fracture is healed. To preserve the client's airway, the nurse should instruct the client to have wire cutters available to immediately cut wiring if emesis occurs. The client should return to the provider as soon as possible for re-wiring.

a nurse in the emergency department is assessing a client who was in a motor-vehicle crash 2 days ago and sustained fractures to his tibia, ulna, and several ribs. the client is now disoriented to time and place, has a SaO2 of 87%, and the nurse notes generalized petechiae on the client's skin. which of the following complications should the nurse suspect?

- Fat embolism syndrome The nurse should identify the triad of neurologic changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels.

a nurse is caring for a client who is in skeletal traction following a femur fracture. the nurse finds the client has slid down toward the foot of the bed and the traction weight is resting on the floor. which of the following actions should the nurse take?

- Have the client use a trapeze to pull himself up while ensuring the weight hangs freely. The nurse should ensure that traction weight is hanging freely. The client can use an overhead trapeze bar to move up in bed, or the nurse can assist the client up, making sure to maintain proper alignment of the extremity.

a nurse is reviewing the medical record of a female client. which of the following findings should the nurse identify as a risk factor for osteoporosis?

- History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to a decreased bone density, increasing the risk for fractures.

a nurse is caring for a client immediately following application of a plaster cast. the nurse should monitor for and report which of the following findings as an indication of compartment syndrome?

- Paresthesias of the extremity The nurse should identify paresthesias as a finding of compartment syndrome. Compartment syndrome involves the compression of nerves and blood vessels in an enclosed space, leading to impaired blood flow and nerve damage. Other findings include numbness, tingling, weakness, and pain that does not respond to medication.

a nurse is caring for a client who has pelvic fracture. the client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. the nurse should identify that the client is experiencing which of the following complications?

- Pulmonary embolus Immobility following musculoskeletal trauma places the client at an increased risk for pulmonary embolus. The client might also exhibit tachycardia, chest petechiae, and have a decreased SaO2. The nurse should notify the rapid response team immediately.