muscular skeletal problems

A client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is most supportive of this client? "It is normal to feel depressed at times about your condition. You have my support." "You could exercise more often to build up your strength and endurance." "How do you feel about the pain in your spine? I am here if you want to talk." "What does your family say to you? Try talking to them."

"How do you feel about the pain in your spine? I am here if you want to talk."

When receiving discharge instructions, a patient with osteoporosis makes all of these statements. Which statement indicates to the nurse that the patient needs additional teaching? . "I take my ibuprofen every morning as soon as I get up." 2. "My daughter removed all of the throw rugs in my home." 3. "My husband helps me every afternoon with range-of-motion exercises." 4. "I rest in my reclining chair every day for at least an hour."

"I take my ibuprofen every morning as soon as I get up."

A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? "My spouse will be the only person to change my dressing." "I can't believe that this has happened to me. I can't stand to look at it." "I do not want any visitors while I'm in the hospital." "It will take me some time to get used to this."

"It will take me some time to get used to this."

An older adult client who has osteoporosis is discharged from the hospital. What does the nurse include in client teaching related to the client's home safety? "Use area rugs on tile floors." "Keep walkways free of clutter." "Walk slowly on wet floor areas after mopping." "Keep light low to prevent glare."

"Keep walkways free of clutter."

A 25-year-old female client whose mother and grandmother have osteoporosis asks whether she needs to take steps to prevent this disease in herself. What will the nurse tell this client? "You do not have to worry about symptoms at your age." "You should begin to take steps to prevent disease at age 30." "Now is the time to begin building strong bones." "Your risk isn't present until age 50; we can talk about it then."

"Now is the time to begin building strong bones."

The nurse is instructing a client who has been prescribed calcium citrate (Citracal). Which instruction does the nurse include? "Take Citracal with food." "For best absorption, take Citracal with a carbonated beverage." "One-third of the daily dose is best taken during the day." "Milk of Magnesia (MOM) should be taken with Citracal."

"Take Citracal with food."

The nurse is caring for a patient who had a dual-energy x-ray absorptiometry (DEXA) scan and is now prescribed calcium with vitamin D twice a day. The patient asks the nurse the purpose of this drug. What is the nurse's best response? Select all that apply. "When your calcium and vitamin D levels are low, your risk for osteoporosis and osteomalacia increases." "When your vitamin D level is high, your bones release calcium to keep your blood calcium level in the normal range." "When your blood calcium is low, calcium is released from your bones increasing your risk for fractures." "When blood calcium is normal, long bones are formed increasing a person's height." "The extra calcium and vitamin D will help protect your bones from damage such as fractures." "You can also get extra vitamin D by increasing your intake of beef and pork sources."

"When your calcium and vitamin D levels are low, your risk for osteoporosis and osteomalacia increases." "When your blood calcium is low, calcium is released from your bones increasing your risk for fractures." "The extra calcium and vitamin D will help protect your bones from damage such as fractures."

A client with peripheral vascular disease will undergo a Syme amputation. What will the nurse teach this patient when providing education about this procedure? "You will be able to bear weight without needing a prosthesis." "This type of procedure results in more pain than others." "The surgeon will remove both the foot and ankle." "This is an above-the-knee type of amputation."

"You will be able to bear weight without needing a prosthesis."

The nurse is caring for a client who is diagnosed with osteopenia. Which T-score will the nurse expect to see for this client after a bone mineral density (BMD) test? +1.5 0 to -1 -2 -3

-2

During assessment of a patient with fractures of the medial ulna and radius, the nurse finds all of these data. Which assessment finding should the nurse report to the health care provider immediately? 1. The patient reports pressure and pain. 2. The cast is in place and is dry and intact. 3. The skin is pink and warm to the touch. 4. The patient can move all the fingers and the thumb.

1. The patient reports pressure and pain.

The nurse is preparing to teach a patient with a new diagnosis of osteoporosis about strategies to prevent falls. Which teaching points should the nurse be sure to include? Select all that apply. 1. Wear a hip protector when ambulating. 2. Remove throw rugs and other obstacles at home. 3. Exercise to help build your strength. 4. Expect a few bumps and bruises when you go home. 5. Rest when you are tired. 6. Avoid consuming three or more alcoholic drinks per day.

1. Wear a hip protector when ambulating. 2. Remove throw rugs and other obstacles at home. 3. Exercise to help build your strength. 5. Rest when you are tired.

A patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What would the nurse be sure to teach the patient? 1. Pain and numbness are expected to be experienced for several days to weeks. 2. Immediately after surgery, the patient will no longer need assistance. 3. After surgery, the dressing will be large, and there will be lots of drainage. 4. The patient's pain and paresthesia will no longer be present.

1. Pain and numbness are expected to be experienced for several days to weeks.

The nurse delegates the measurement of vital signs to an experienced unlicensed assistive personnel (UAP). Osteomyelitis has been diagnosed in a patient. Which vital sign value would the nurse instruct the UAP to report immediately for this patient? 1. Temperature of 101°F (38.3°C) 2. Blood pressure of 136/80 mm Hg 3. Heart rate of 96 beats/min 4. Respiratory rate of 24 breaths/min

1. Temperature of 101°F (38.3°C)

A patient with a right above-the-knee amputation asks the nurse why he has phantom limb pain. What is the nurse's best response? 1. "Phantom limb pain is not explained or predicted by any one theory." 2. "Phantom limb pain occurs because your body thinks your leg is still present." 3. "Phantom limb pain will not interfere with your activities of daily living." 4. "Phantom limb pain is not real pain but is remembered pain."

1. "Phantom limb pain is not explained or predicted by any one theory."

The nurse is preparing a discussion of musculoskeletal health maintenance for a group of older adults. Which key points would the nurse be sure to include? Select all that apply. 1. Be aware of and consume foods rich in calcium and vitamin D. 2. Wear hats and long sleeves to avoid sun exposure at all times. 3. Consider exercise with low impact to avoid risk for injury. 4. If you smoke, consider a smoking cessation program. 5. Excessive alcohol intake can interfere with vitamins and nutrients for bone growth. 6. Weight-bearing activities decrease the risk for osteoporosis.

1. Be aware of and consume foods rich in calcium and vitamin D. 3. Consider exercise with low impact to avoid risk for injury. 4. If you smoke, consider a smoking cessation program. 5. Excessive alcohol intake can interfere with vitamins and nutrients for bone growth. 6. Weight-bearing activities decrease the risk for osteoporosis.

The charge nurse assigns the nursing care of a patient who has just returned from open carpal tunnel release surgery to an experienced LPN/LVN, who will perform under the supervision of an RN. Which instructions would the RN provide for the LPN/LVN? Select all that apply. 1. Check the patient's vital signs every 15 minutes in the first hour. 2. Check the dressing for drainage and tightness. 3. Elevate the patient's hand above the heart. 4. The patient will no longer need pain medication. 5. Check the neurovascular status of the fingers every hour. 6. Instruct the patient to perform range of motion on the affected wrist.

1. Check the patient's vital signs every 15 minutes in the first hour. 2. Check the dressing for drainage and tightness. 3. Elevate the patient's hand above the heart. 5. Check the neurovascular status of the fingers every hour.

The nurse is working with unlicensed assistive personnel (UAP) to provide care for six patients. At the beginning of the shift, the nurse carefully tells the UAP what patient interventions and tasks he or she is expected to perform. Which "Four Cs" guide the nurse's communication with the UAP? Select all that apply. 1. Clear 2. Comprehensive 3. Concise 4. Credible 5. Correct 6. Complete

1. Clear 3. Concise 5. Correct 6. Complete

The nurse is supervising a new graduate RN caring for a patient with a fracture of the right ankle who is at risk for complications of immobility. For which action should the supervising nurse intervene? 1. Encouraging the patient to go from a lying to a standing position 2. Administering pain medication before the patient begins exercises 3. Explaining to the patient and family the purpose of the exercise program 4. Reminding the patient about the correct use of crutches

1. Encouraging the patient to go from a lying to a standing position

A patient who underwent a right above-the-knee amputation 4 days ago also has a diagnosis of depression. Which order would the nurse clarify with the health care provider? 1. Give fluoxetine 40 mg once a day. 2. Administer acetaminophen with codeine 1 or 2 tablets every 4 hours as needed. 3. Assist the patient to the bedside chair every shift. 4. Reinforce the dressing to the right residual limb as needed.

1. Give fluoxetine 40 mg once a day.

The emergency department nurse receives a call about a patient with a traumatic finger amputation. What instructions does the nurse provide to the patient's wife? Select all that apply. 1. Wrap the completely severed finger in dry sterile gauze (if available) or a clean cloth. 2. Put the finger in a watertight, sealed plastic bag. 3. Place the bag directly on ice. 4. Elevate the affected extremity above the patient's heart. 5. Examine the amputation site and apply direct pressure with layers of dry gauze. 6. After performing these steps, call 911 and check the patient for breathing.

1. Wrap the completely severed finger in dry sterile gauze (if available) or a clean cloth. 2. Put the finger in a watertight, sealed plastic bag. 4. Elevate the affected extremity above the patient's heart. 5. Examine the amputation site and apply direct pressure with layers of dry gauze.

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.) a. Alcohol b. Caffeine c. Fat d. Carbonated beverages e. Vitamin D

A, B, D, E

The nurse plans to refer a client diagnosed with osteoporosis to which community resource? American Bone Society CanSurmount I Can Cope National Osteoporosis Foundation

National Osteoporosis Foundation

An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg. Which action should the nurse take first?a. Assess the pedal pulses. b. Apply oxygen by nasal cannula. c. Increase the IV flow rate. d. Loosen the traction.

a. Assess the pedal pulses.

The nurse is caring for a patient with osteoporosis who is at increased risk for falls. Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Identifying environmental factors that increase risk for falls 2. Monitoring gait, balance, and fatigue level with ambulation 3. Collaborating with the physical therapist to provide the patient with a walker 4. Assisting the patient with ambulation to the bathroom and in the halls

4. Assisting the patient with ambulation to the bathroom and in the halls

The nurse is preparing a patient for magnetic resonance imaging (MRI). Which action can the nurse delegate to the experienced unlicensed assistive personnel (UAP)? 1. Teach the patient what to expect during the test. 2. Instruct the patient to remove metal objects including zippers. 3. Witness that the patient has signed the consent form. 4. Check and record preprocedure vital signs.

4. Check and record preprocedure vital signs.

A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best? a. Consult with the provider about an x-ray. b. Encourage the client to use ibuprofen (Motrin). c. Have the client perform hip range of motion. d. Place the client in a rigid cervical collar.

a. Consult with the provider about an x-ray.

The nurse is preparing a patient who had carpal tunnel release surgery for discharge. Which information is important to provide for this patient? 1. The surgical procedure is a cure for carpal tunnel syndrome (CTS). 2. Do not lift any heavy objects. 3. Frequent doses of pain medication will no longer be necessary. 4. The health care provider should be notified immediately if there is any pain or discomfort.

2. Do not lift any heavy objects.

The nurse's assessment reveals all of these data when a patient with Paget disease is admitted to the acute care unit. Which finding should the nurse notify the health care provider about first? 1. There is a bowing of both legs, and the knees are asymmetrical. 2. The base of the skull is invaginated (platybasia). 3. The patient is only 5 feet tall and weighs 120 lb. 4. The skull is soft, thick, and larger than normal.

2. The base of the skull is invaginated (platybasia).

A patient has a fractured femur. Which finding would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately? The patient reports pain. 2. The patient appears confused. 3. The patient's blood pressure is 136/88 mm Hg. 4. The patient voided using the bedpan.

2. The patient appears confused.

The charge nurse is assigning the nursing care of a patient who had a left below-the-knee amputation 1 day ago to an experienced LPN/LVN, who will function under an RN's supervision. What will the RN tell the LPN/LVN is the major focus for the patient's care today?

2. To monitor for signs of sufficient tissue perfusion

The nurse is caring for a postoperative patient with a hip replacement. Which patient care actions can be delegated to the experienced unlicensed assistive personnel (UAP)? Select all that apply. 1. Inspect heels and other bony prominences every 8 hours. 2. Turn and reposition the patient every 2 hours. 3. Assure that the patient's heels are elevated off the bed. 4. Assess the patient's calf regions for redness and swelling. 5. Check vital signs and oxygen saturation via pulse oximetry. 6. Assess for pain and administer pain medication.

2. Turn and reposition the patient every 2 hours. 3. Assure that the patient's heels are elevated off the bed. 5. Check vital signs and oxygen saturation via pulse oximetry.

20. A client has an ingrown toenail. About what self-management measure does the nurse teach the client? a. Long-term antibiotic use b. Shoe padding c. Toenail trimming d. Warm moist soaks

d. Warm moist soaks

The client has sustained a traumatic amputation of the left arm after a machine accident. In what order should the following nursing actions be taken? 1. Apply direct pressure to the amputated site. 2. Elevate the extremity above the client's heart. 3. Assess the client for breathing problems. 4. Examine the amputation site. 2, 4, 3, 1 3, 4, 1, 2 1, 4, 3, 2 4, 1, 2, 3

3, 4, 1, 2

After the nurse receives change-of-shift report, which patient should be assessed first? 1. A 42-year-old patient with carpal tunnel syndrome who reports pain 2. A 64-year-old patient with osteoporosis awaiting discharge 3. A 28-year-old patient with a fracture who reports that the cast is tight 4. A 56-year-old patient with a left leg amputation who reports phantom pain

3. A 28-year-old patient with a fracture who reports that the cast is tight

The charge nurse observes an LPN/LVN assigned to provide all of these interventions for a patient with Paget disease. Which action requires that the charge nurse intervene? 1. Administering 600 mg of ibuprofen to the patient 2. Encouraging the patient to perform exercises recommended by a physical therapist 3. Applying ice and gentle massage to the patient's lower extremities 4. Reminding the patient to drink milk and eat cottage cheese

3. Applying ice and gentle massage to the patient's lower extremities

The nurse is caring for a patient with carpal tunnel syndrome (CTS) who has been admitted for surgery. Which intervention should be delegated to the unlicensed assistive personnel (UAP)? 1. Initiating placement of a splint for immobilization during the day 2. Assessing the patient's wrist and hand for discoloration and brittle nails 3. Assisting the patient with daily self-care measures such as bathing and eating 4. Testing the patient for painful tingling in the four digits of the hand

3. Assisting the patient with daily self-care measures such as bathing and eating

The nurse is providing care for a patient with a rotator cuff tear. What treatment does the nurse expect the health care provider will prescribe first for this patient? 1. Arthroscopic repair of the rotator cuff tear 2. Elimination of movements in the affected shoulder 3. Conservative therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy 4. Pendulum exercises that start slow and progress over 2 weeks

3. Conservative therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy

The nurse is teaching an older patient about risks for fractures and osteoporosis. Which diagnostic test should the nurse teach about when the goal is to establish the patient's bone strength and determine if osteoporosis is present? 1. Computed tomography (CT) scan 2. Magnetic resonance imaging (MRI) scan 3. Dual-energy x-ray absorptiometry (DXA or DEXA) scan 4. Joint x-rays

3. Dual-energy x-ray absorptiometry (DXA or DEXA) scan

The nurse observes the unlicensed assistive personnel (UAP) performing all of these interventions for a patient with carpal tunnel syndrome (CTS). Which action requires that the nurse intervene immediately? 1. Arranging the patient's lunch tray and cutting his meat 2. Providing warm water and assisting the patient with his bath 3. Replacing the patient's splint in hyperextension position 4. Reminding the patient not to lift very heavy objects

3. Replacing the patient's splint in hyperextension position

A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately? 1. The patient wants to change position in bed. 2. There is a small amount of clear fluid at the pin sites. 3. The traction weights are resting on the floor. 4. The patient reports pain and muscle spasm.

3. The traction weights are resting on the floor.

During morning care, a patient with a below-the-knee amputation asks the unlicensed assistive personnel (UAP) about prostheses. How will the nurse instruct the UAP to respond? 1. "You should get a prosthesis so that you can walk again." 2. "Wait and ask your doctor that question the next time he comes in." 3. "It's too soon to be worrying about getting a prosthesis." 4. "I'll ask the nurse to come in and discuss this with you."

4. "I'll ask the nurse to come in and discuss this with you."

The RN is mentoring a student nurse who is caring for a patient with carpal tunnel syndrome of the right hand with neurovascular check ordered every 2 hours. For which action by the student nurse must the RN intervene? 1. Student nurse checks the patient's radial pulse every 2 hours. 2. Student nurse checks for sensation in the patient's right hand. 3. Student nurse assesses color, temperature, and pain in right wrist and hand. 4. Student nurse instructs the patient to avoid movement because of the pain.

4. Student nurse instructs the patient to avoid movement because of the pain.

The charge nurse is making assignments for the day shift. Which patient should be assigned to the nurse who was floated from the postanesthesia care unit (PACU) for the day? 1. A 35-year-old patient with osteomyelitis who needs teaching before hyperbaric oxygen therapy 2. A 62-year-old patient with osteomalacia who is being discharged to a long-term care facility 3. A 68-year-old patient with osteoporosis given a new orthotic device whose knowledge of its use must be assessed 4. A 72-year-old patient with Paget disease who has just returned from surgery for total knee replacement

4. A 72-year-old patient with Paget disease who has just returned from surgery for total knee replacement

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, The cast is loose enough to slide off. How should the nurse respond? a. Keep your arm above the level of your heart. b. As your muscles atrophy, the cast is expected to loosen. c. I will wrap a bandage around the cast to prevent it from slipping. d. You need a new cast now that the swelling is decreased.

d. You need a new cast now that the swelling is decreased.

A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply.) a. Assess the daily serum calcium level. b. Consult the provider about a loop diuretic. c. Institute seizure precautions for the client. d. Instruct the client to call for help out of bed. e. Place the client on a 1500-mL fluid restriction.

A, B, D

A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client? (Select all that apply.) a. Electromyography b. Muscle biopsy c. Nerve conduction studies d. Serum aldolase e. Serum creatinine kinase

A, B, D, E

A nurse teaches a client who is at risk for carpal tunnel syndrome. Which health promotion activities should the nurse include in this clients teaching? (Select all that apply.) a. Frequently assess the ergonomics of the equipment being used. b. Take breaks to stretch fingers and wrists during working hours. c. Do not participate in activities that require repetitive actions. d. Take ibuprofen (Motrin) to decrease pain and swelling in wrists. e. Adjust chair height to allow for good posture.

A, B, E

The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.) a. Draining sinus tracts b. High fevers c. Presence of foot ulcers d. Swelling and redness e. Tenderness or pain

A, C

A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.) a. Adherence to the antibiotic regimen b. Correct intramuscular injection technique c. Eating high-protein and high-carbohydrate foods d. Keeping daily follow-up appointments e. Proper use of the intravenous equipment

A, C, E

A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. The device has been custom made specifically for you. b. Your prosthetic is good for work but not for exercising. c. A prosthetist will clean your inserts for you each month. d. Make sure that you wear the correct liners with your prosthetic. e. I have scheduled a follow-up appointment for you.

A, D, E

A client with Pagets disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.) a. Administering ibuprofen (Motrin) b. Applying a heating pad c. Providing a massage d. Referring the client to a support group e. Using a bed cradle to lift sheets off the feet

B, C

The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.) a. Antianxiety agents b. Antibiotics c. Barbiturates d. Corticosteroids e. Loop diuretics

C, D, E

An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the nurse monitor to prevent a complication of this injury? (Select all that apply.) a. Temperature b. Urinary output c. Blood pressure d. Pupil reaction e. Skin color

B, C, E

A nurse is providing education to a community womens group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.) a. Cut down on tobacco product use. b. Limit alcohol to two drinks a day. c. Strengthening exercises are important. d. Take recommended calcium and vitamin D. e. Walk 30 minutes at least 3 times a week.

C, D, E

A 55 year-old female client has a high familial risk for osteoporosis and tells the nurse that her mother and an older sister both developed spine and hip fractures as a result of the disease. Which diagnostic test will be appropriate to help determine this client's risk for spine and hip fractures? CT-based absorptiometry Magnetic resonance spectroscopy (MRS) Vertebral imaging studies Dual x-ray absorptiometry (DXA)

CT-based absorptiometry

Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)? Removing the wound drain for a client who had an open reduction of a hip fracture 3 days ago. Assessing for bruising on a client who is receiving warfarin (Coumadin) to prevent deep vein thrombosis. Teaching a client with a right ankle fracture how to use crutches when transferring and ambulating. Checking the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

Checking the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

Which is a secondary effect when a child experiences decreased muscle strength, tone, and endurance from immobilization? Increased metabolism Increased venous return Increased cardiac output Decreased exercise tolerance

Decreased exercise tolerance

A client has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon? Swelling of the right lower extremity 1+ to 2+ bilateral palpable pedal pulses Pain of right lower extremity on movement Decreased sensation of right lower extremity

Decreased sensation of right lower extremity

n older client who lives at home has been receiving intravenous linezolid to treat methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis for 2 weeks and is ready to be discharged from the hospital to undergo continued treatment. The client does not want to go to a skilled nursing facility (SNF). What will the nurse do? Discuss administering oral linezolid at home with the provider. Explain to the client that intravenous medications require skilled nursing care. Arrange for a home health aide to administer intravenous antibiotics at home. Tell the client that the SNF stay will only need to be for one week.

Discuss administering oral linezolid at home with the provider.

Which risk factors are shared by male clients who have osteoporosis or osteopenemia? Select all that apply. High alcohol intake A history of smoking Inadequate exposure to sunlight Homelessness Low BMI

High alcohol intake A history of smoking

The nurse is assessing a client with osteomalacia. Which findings does the nurse expect to observe? Select all that apply. Hyperparathyroidism Hyperuricemia Hypophosphatemia Looser's lines or zones Unsteady gait

Hypophosphatemia Looser's lines or zones Unsteady gait

Which nursing intervention helps to reduce the incidence of osteomyelitis for a client receiving hemodialysis? Instructing the client to brush teeth after every meal Maintaining clean dressing change technique for long-term IV catheters Using clean technique Using Standard Precautions

Instructing the client to brush teeth after every meal

Which statement BEST describes pseudohypertrophic (Duchenne) muscular dystrophy? It is inherited as an autosomal dominant disorder. It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles. It is characterized by muscle weakness usually beginning about 3 years old. Onset occurs in later childhood and adolescence.

It is characterized by muscle weakness usually beginning about 3 years old.

Good Job!

Keep going!

The nurse is assessing a client with Ewing's sarcoma. Which finding does the nurse expect to observe? Bradycardia High fever Leukocytosis Migraine headaches

Leukocytosis

A client sustains a fracture of one arm and the provider applies a plaster cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department? Monitor neuromuscular status for decreased circulation and sensation in the extremity. Apply a heating pad for 15 to 20 minutes four times daily to help with pain. Check the fit of the cast by inserting a tongue blade between the cast and the skin. Keep the cast covered with a soft towel to help it to dry quickly.

Monitor neuromuscular status for decreased circulation and sensation in the extremity.

The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? Select all that apply. Occupational therapist Physical therapist Psychologist Respiratory therapist Speech therapist

Occupational therapist Physical therapist Psychologist

The nurse is caring for a client with prostate cancer who has bone metastasis. The nurse anticipates that the health care provider will prescribe which medication? Calcitonin (Calcimar) Medroxyprogesterone (Prempro) Pamidronate (Aredia) Tamsulosin hydrochloride (Flomax)

Pamidronate (Aredia)

A client undergoes a surgical amputation of a lower extremity after a motor vehicle crash. The client's vital signs are stable. What is a priority nursing action in the early postoperative period to help prevent complications in this client? Fitting the client with a prosthetic device Inspecting the limb stump daily for signs of skin breakdown Positioning and range-of-motion of the affected extremity Teaching the client and family how to apply shrinker stockings

Positioning and range-of-motion of the affected extremity

Which is a priority problem for the older adult client diagnosed with bone cancer? Potential for injury related to weakness and drug therapy Altered self-esteem related to fear of death and dying Reduced mobility related to weakness and fatigue Pain of a chronic nature related to tumor invasion of other organs

Potential for injury related to weakness and drug therapy

Which measure is important in managing hypercalcemia in a child who is immobilized? Promoting adequate hydration Changing position frequently Encouraging a diet high in calcium Providing a diet high in protein and calories

Promoting adequate hydration

The nurse suspects that a client may have plantar fasciitis if the client has which assessment finding? Lateral deviation of the great toe; first metatarsal head becomes enlarged Dorsiflexion of any metatarsophalangeal (MTP) joint, with plantar flexion of the adjacent proximal interphalangeal (PIP) joint Severe pain in the arch of the foot, especially when getting out of bed A small tumor in a digital nerve of the foot

Severe pain in the arch of the foot, especially when getting out of bed

A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider immediately if which change occurs? Observation of a large amount of serosanguineous or bloody drainage Mild to moderate pain controlled with prescribed analgesics Absence of erythema and tenderness at the surgical site Ability to flex and extend the right knee

Talking with an amputee close to the client's age who has a similar amputation

Which intervention does the nurse suggest to a client who has undergone a leg amputation to help cope with loss of the limb? Talking with an amputee close to the client's age who has a similar amputation Drawing a picture of how the client sees him- or herself Talking with a psychiatrist about the amputation Engaging in diversional activities to avoid focusing on the amputation

Talking with an amputee close to the client's age who has a similar amputation

Which finding does the nurse expect to observe in a client with suspected common chronic osteomyelitis? Erythema of the affected area Fever; temperature usually above 101° F (38° C) Ulceration of the skin Constant, localized, and pulsating bone pain

Ulceration of the skin

The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the health care provider will request which supplement? Vitamin C Vitamin D3 Phosphorus Calcium

Vitamin D3

Which is the best way to decrease the risk for osteoporosis in a client who has just been determined to be at high risk for the disease? Increase nutritional intake of calcium. Engage in high-impact exercise, such as running. Increase nutritional intake of phosphorus. Walk for 30 minutes three times a week.

Walk for 30 minutes three times a week.

The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis? Consuming 12 ounces (355 mL) of carbonated beverages daily Working at a desk and playing the piano for a hobby Having a hysterectomy and taking estrogen replacement therapy Consuming one alcoholic drink per week

Working at a desk and playing the piano for a hobby

A 50-year-old woman has osteoporosis and is at risk for developing vertebral fractures. She asks the nurse about exercises to help minimize this risk. Which exercise will the nurse recommend? Cycling Running Walking Yoga

Yoga

A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best? a. Arrange a home safety evaluation. b. Ensure the client has a walker at home. c. Help the client look into assisted living. d. Refer the client to Meals on Wheels.

a. Arrange a home safety evaluation.

A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best? a. Ask the client about fear of falling. b. Instruct the client to increase calcium. c. Suggest other exercises the client can do. d. Tell the client to try weight lifting.

a. Ask the client about fear of falling.

A client is in the internal medicine clinic reporting bone pain. The clients alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate? a. Assess the client for leg bowing. b. Facilitate an oncology workup. c. Instruct the client on fluid restrictions. d. Teach the client about ibuprofen (Motrin).

a. Assess the client for leg bowing.

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the clients psychosocial needs? a. Assess the clients coping skills and support systems. b. Explain that the surgery leads to a longer life expectancy. c. Refer the client to the social worker or hospital chaplain. d. Reinforce physical therapy to aid with ambulating normally.

a. Assess the clients coping skills and support systems.

A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best? a. Ensure the client gets 15 minutes of sun exposure daily. b. Give the client daily vitamin D injections. c. Hide vitamin D supplements in favorite foods. d. Plan to serve foods naturally high in vitamin D.

a. Ensure the client gets 15 minutes of sun exposure daily.

What information does the nurse teach a womens group about osteoporosis? a. For 5 years after menopause you lose 2% of bone mass yearly. b. Men actually have higher rates of the disease but are underdiagnosed. c. There is no way to prevent or slow osteoporosis after menopause. d. Women and men have an equal chance of getting osteoporosis.

a. For 5 years after menopause you lose 2% of bone mass yearly.

After teaching a client who is recovering from a vertebroplasty, the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. I can drive myself home after the procedure. b. I will monitor the puncture site for signs of infection. c. I can start walking tomorrow and increase my activity slowly. d. I will remove the dressing the day after discharge.

a. I can drive myself home after the procedure.

A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best? a. Your feet have less blood flow, so healing is slower. b. The bones in your feet are hard to operate on. c. The surrounding bones and tissue are damaged. d. Your feet bear weight so they never really heal.

a. Your feet have less blood flow, so healing is slower.

A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority? a. Allow the client to rest in a position of comfort. b. Assess the clients cardiac and respiratory systems. c. Assist the client with ambulating and position changes. d. Position the client on one side propped with pillows.

b. Assess the clients cardiac and respiratory systems.

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention should the nurse include in this clients plan of care? a. Place pillows between the clients knees. b. Encourage range-of-motion exercises. c. Administer prophylactic antibiotics. d. Implement strict bedrest in a supine position.

b. Encourage range-of-motion exercises.

A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate? a. Drink at least 8 ounces of water with it. b. Make appointments to come get your shot. c. Sit upright for 30 to 60 minutes after taking it. d. Take the drug on an empty stomach.

b. Make appointments to come get your shot.

A client has a bone density score of 2.8. What action by the nurse is best? a. Asking the client to complete a food diary b. Planning to teach about bisphosphonates c. Scheduling another scan in 2 years d. Scheduling another scan in 6 months

b. Planning to teach about bisphosphonates

A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first? a. Client taking calcium with vitamin D (Os-Cal) who reports flank pain 2 weeks ago b. Client taking ibandronate (Boniva) who cannot remember when the last dose was c. Client taking raloxifene (Evista) who reports unilateral calf swelling d. Client taking risedronate (Actonel) who reports occasional dyspepsia

c. Client taking raloxifene (Evista) who reports unilateral calf swelling

A client is scheduled for a bone biopsy. What action by the nurse takes priority? a. Administering the preoperative medications b. Answering any questions about the procedure c. Ensuring that informed consent is on the chart d. Showing the clients family where to wait

c. Ensuring that informed consent is on the chart

A client has a metastatic bone tumor. What action by the nurse takes priority? a. Administer pain medication as prescribed. b. Elevate the extremity and apply moist heat. c. Handle the affected extremity with caution. d. Place the client on protective precautions.

c. Handle the affected extremity with caution.

A hospitalized client is being treated for Ewings sarcoma. What action by the nurse is most important? a. Assessing and treating the client for pain as needed b. Educating the client on the disease and its treatment c. Handling and disposing of chemotherapeutic agents per policy d. Providing emotional support for the client and family

c. Handling and disposing of chemotherapeutic agents per policy

A nurse cares for a client recovering from an above-the-knee amputation of the right leg. The client reports pain in the right foot. Which prescribed medication should the nurse administer first? a. Intravenous morphine b. Oral acetaminophen c. Intravenous calcitonin d. Oral ibuprofen

c. Intravenous calcitonin

An older client with diabetes is admitted with a heavily draining leg wound. The clients white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first? a. Administer acetaminophen (Tylenol). b. Educate the client on amputation. c. Place the client on contact isolation. d. Refer the client to the wound care nurse.

c. Place the client on contact isolation.

A nurse is caring for four clients. After the hand-off report, which client does the nurse see first? a. Client with osteoporosis and a white blood cell count of 27,000/mm3 b. Client with osteoporosis and a bone fracture who requests pain medication c. Post-microvascular bone transfer client whose distal leg is cool and paled. d.Client with suspected bone tumor who just returned from having a spinal CT

c. Post-microvascular bone transfer client whose distal leg is cool and paled.

A nurse cares for an older adult client who is recovering from a leg amputation surgery. The client states, I dont want to live with only one leg. I should have died during the surgery. How should the nurse respond? a. Your vital signs are good, and you are doing just fine right now. b. Your children are waiting outside. Do you want them to grow up without a father? c. This is a big change for you. What support system do you have to help you cope? d. You will be able to do some of the same things as before you became disabled.

c. This is a big change for you. What support system do you have to help you cope?

Therapeutic management of the patient with systemic lupus erythematosus includes: cold salts to suppress the inflammatory process. high-protein, low-salt diet. an exercise regimen focusing on weight training. corticosteroids to control inflammation.

corticosteroids to control inflammation.

The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option? a. Client with diabetes who has a serum creatinine of 0.8 mg/dL b. Client who recently fell and has vertebral compression fractures c. Hypertensive client who takes calcium channel blockers d. Client with a spinal cord injury who cannot tolerate sitting up

d. Client with a spinal cord injury who cannot tolerate sitting up

A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury? a. Hypertension b. Constipation c. Infection d. Hematuria

d. Hematuria

A nurse is caring for a client who is recovering from an above-the-knee amputation. The client reports pain in the limb that was removed. How should the nurse respond? a. The pain you are feeling does not actually exist. b. This type of pain is common and will eventually go away. c. Would you like to learn how to use imagery to minimize your pain? d. How would you describe the pain that you are feeling?

d. How would you describe the pain that you are feeling?

A client is admitted with a large draining wound on the leg. What action does the nurse take first? a. Administer ordered antibiotics. b. Insert an intravenous line. c. Give pain medications if needed. d. Obtain cultures of the leg wound.ANS: D

d. Obtain cultures of the leg wound.

A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may impede healing of the fracture? a. Sedentary lifestyle b. A 30pack-year smoking history c. Prescribed oral contraceptives d. Pagets disease

d. Pagets disease

After teaching a client with a fractured humerus, the nurse assesses the clients understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture? a. Baked fish with orange juice and a vitamin D supplement b. Bacon, lettuce, and tomato sandwich with a vitamin B supplement c. Vegetable lasagna with a green salad and a vitamin A supplement d. Roast beef with low-fat milk and a vitamin C supplement

d. Roast beef with low-fat milk and a vitamin C supplement

Break time!

hydrate

An appropriate nursing intervention when caring for the child with chronic osteomyelitis is to: provide active range-of-motion exercises for the affected extremity. administer pain medications with meals. encourage frequent ambulation. move and turn the child carefully and gently to minimize pain.

move and turn the child carefully and gently to minimize pain.

Major goals of the therapeutic management of juvenile idiopathic arthritis are to: prevent joint discomfort and regain proper alignment. prevent loss of joint function and achieve cure. prevent physical deformity and preserve joint function. prevent skin breakdown and relieve symptoms.

prevent physical deformity and preserve joint function.

An adolescent who had a lower leg amputated after a motorcycle accident complains of pain in the missing extremity. The nurse's MOST appropriate action is to: withhold pain medications because of narcotic addiction. refer the patient for psychologic counseling. teach the parents and adolescent child about nerve damage. reassure the child that it is normal and is called phantom limb sensation.

reassure the child that it is normal and is called phantom limb sensation.

The nurse is caring for an immobilized preschool child. During this period of immobilization, the nurse's BEST action is to: encourage wearing pajamas. let the child have few behavioral limitations. keep child away from other immobilized children if possible. take child for a "walk" by wagon outside the room.

take child for a "walk" by wagon outside the room.

Take a small break

you've earned it!